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Rustand D, van Niekerk J, Krainski ET, Rue H, Proust-Lima C. Fast and flexible inference for joint models of multivariate longitudinal and survival data using integrated nested Laplace approximations. Biostatistics 2024; 25:429-448. [PMID: 37531620 PMCID: PMC11017128 DOI: 10.1093/biostatistics/kxad019] [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: 10/17/2022] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023] Open
Abstract
Modeling longitudinal and survival data jointly offers many advantages such as addressing measurement error and missing data in the longitudinal processes, understanding and quantifying the association between the longitudinal markers and the survival events, and predicting the risk of events based on the longitudinal markers. A joint model involves multiple submodels (one for each longitudinal/survival outcome) usually linked together through correlated or shared random effects. Their estimation is computationally expensive (particularly due to a multidimensional integration of the likelihood over the random effects distribution) so that inference methods become rapidly intractable, and restricts applications of joint models to a small number of longitudinal markers and/or random effects. We introduce a Bayesian approximation based on the integrated nested Laplace approximation algorithm implemented in the R package R-INLA to alleviate the computational burden and allow the estimation of multivariate joint models with fewer restrictions. Our simulation studies show that R-INLA substantially reduces the computation time and the variability of the parameter estimates compared with alternative estimation strategies. We further apply the methodology to analyze five longitudinal markers (3 continuous, 1 count, 1 binary, and 16 random effects) and competing risks of death and transplantation in a clinical trial on primary biliary cholangitis. R-INLA provides a fast and reliable inference technique for applying joint models to the complex multivariate data encountered in health research.
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Affiliation(s)
- Denis Rustand
- Statistics Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Janet van Niekerk
- Statistics Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Elias Teixeira Krainski
- Statistics Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Håvard Rue
- Statistics Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Cécile Proust-Lima
- Bordeaux Population Health Center, Inserm, UMR1219, Univ. Bordeaux, F-33000 Bordeaux, France
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Bendetowicz D, Fabbri M, Sirna F, Fernagut PO, Foubert-Samier A, Saulnier T, Le Traon AP, Proust-Lima C, Rascol O, Meissner WG. Recent Advances in Clinical Trials in Multiple System Atrophy. Curr Neurol Neurosci Rep 2024; 24:95-112. [PMID: 38416311 DOI: 10.1007/s11910-024-01335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW This review summarizes previous and ongoing neuroprotection trials in multiple system atrophy (MSA), a rare and fatal neurodegenerative disease characterized by parkinsonism, cerebellar, and autonomic dysfunction. It also describes the preclinical therapeutic pipeline and provides some considerations relevant to successfully conducting clinical trials in MSA, i.e., diagnosis, endpoints, and trial design. RECENT FINDINGS Over 30 compounds have been tested in clinical trials in MSA. While this illustrates a strong treatment pipeline, only two have reached their primary endpoint. Ongoing clinical trials primarily focus on targeting α-synuclein, the neuropathological hallmark of MSA being α-synuclein-bearing glial cytoplasmic inclusions. The mostly negative trial outcomes highlight the importance of better understanding underlying disease mechanisms and improving preclinical models. Together with efforts to refine clinical measurement tools, innovative statistical methods, and developments in biomarker research, this will enhance the design of future neuroprotection trials in MSA and the likelihood of positive outcomes.
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Affiliation(s)
- David Bendetowicz
- Univ. Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France.
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, NS-Park/FCRIN Network, Bordeaux, France.
| | - Margherita Fabbri
- MSA French Reference Center, Univ. Hospital Toulouse, Toulouse, France
- Univ. Toulouse, CIC-1436, Departments of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital, Inserm, U1048/1214, Toulouse, France
| | - Federico Sirna
- Univ. Bordeaux, INSERM, BPH, U1219, IPSED, Bordeaux, France
| | - Pierre-Olivier Fernagut
- Université de Poitiers, Laboratoire de Neurosciences Expérimentales et Cliniques, INSERM UMR-S 1084, Poitiers, France
| | - Alexandra Foubert-Samier
- Univ. Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, NS-Park/FCRIN Network, Bordeaux, France
- Univ. Bordeaux, INSERM, BPH, U1219, IPSED, Bordeaux, France
| | | | - Anne Pavy Le Traon
- MSA French Reference Center, Univ. Hospital Toulouse, Toulouse, France
- Univ. Toulouse, CIC-1436, Departments of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital, Inserm, U1048/1214, Toulouse, France
| | | | - Olivier Rascol
- MSA French Reference Center, Univ. Hospital Toulouse, Toulouse, France
- Univ. Toulouse, CIC-1436, Departments of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital, Inserm, U1048/1214, Toulouse, France
| | - Wassilios G Meissner
- Univ. Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, NS-Park/FCRIN Network, Bordeaux, France
- Department of Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
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Le Gall L, Harambat J, Combe C, Philipps V, Proust-Lima C, Dussartre M, Drüeke T, Choukroun G, Fouque D, Frimat L, Jacquelinet C, Laville M, Liabeuf S, Pecoits-Filho R, Massy ZA, Stengel B, Alencar de Pinho N, Leffondré K, Prezelin-Reydit M. Haemoglobin trajectories in chronic kidney disease and risk of major adverse cardiovascular events. Nephrol Dial Transplant 2024; 39:669-682. [PMID: 37935529 DOI: 10.1093/ndt/gfad235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/13/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The trajectories of haemoglobin in patients with chronic kidney disease (CKD) have been poorly described. In such patients, we aimed to identify typical haemoglobin trajectory profiles and estimate their risks of major adverse cardiovascular events (MACE). METHODS We used 5-year longitudinal data from the CKD-REIN cohort patients with moderate to severe CKD enrolled from 40 nationally representative nephrology clinics in France. A joint latent class model was used to estimate, in different classes of haemoglobin trajectory, the competing risks of (i) MACE + defined as the first event among cardiovascular death, non-fatal myocardial infarction, stroke or hospitalization for acute heart failure, (ii) initiation of kidney replacement therapy (KRT) and (iii) non-cardiovascular death. RESULTS During the follow-up, we gathered 33 874 haemoglobin measurements from 3011 subjects (median, 10 per patient). We identified five distinct haemoglobin trajectory profiles. The predominant profile (n = 1885, 62.6%) showed an overall stable trajectory and low risks of events. The four other profiles had nonlinear declining trajectories: early strong decline (n = 257, 8.5%), late strong decline (n = 75, 2.5%), early moderate decline (n = 356, 11.8%) and late moderate decline (n = 438, 14.6%). The four profiles had different risks of MACE, while the risks of KRT and non-cardiovascular death consistently increased from the haemoglobin decline. CONCLUSION In this study, we observed that two-thirds of patients had a stable haemoglobin trajectory and low risks of adverse events. The other third had a nonlinear trajectory declining at different rates, with increased risks of events. Better attention should be paid to dynamic changes of haemoglobin in CKD.
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Affiliation(s)
- Lisa Le Gall
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
| | - Jérôme Harambat
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
- Bordeaux University Hospital, Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Sorare, Pellegrin-Enfants Hospital, Bordeaux, France
| | - Christian Combe
- Bordeaux University Hospital, Department of Nephrology, transplantation, dialysis, Bordeaux, France
- University Bordeaux, INSERM U1026, Bordeaux, France
| | - Viviane Philipps
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Cécile Proust-Lima
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Maris Dussartre
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Tilman Drüeke
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Gabriel Choukroun
- Amiens Picardie University Hospital, Department of Nephrology Dialysis Transplantation, Amiens, France
- University of Picardie Jules Verne, MP3CV Research Unit, Amiens, France
| | - Denis Fouque
- Hopital Lyon Sud, Département de néphrologie, Lyon, France
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Luc Frimat
- CHRU de Nancy, Department of Nephrology, Vandoeuvre-lès-Nancy, France
- Lorraine University, APEMAC, Nancy, France
| | - Christian Jacquelinet
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
- Agence de la biomedecine, La Plaine-Saint-Denis, France
| | - Maurice Laville
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Sophie Liabeuf
- University of Picardie Jules Verne, MP3CV Research Unit, Amiens, France
- Amiens-Picardie University Medical Center, Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens, France
| | - Roberto Pecoits-Filho
- DOPPS Program Area, Arbor Research Collaborative for Health, Ann Arbor, MI, USA
- School of Medicine, Pontificia Universidade Catolica do Parana, Cutitiba, PR, Brazil
| | - Ziad A Massy
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
- Ambroise Paré University Hospital, APHP, Department of Nephrology, Boulogne-Billancourt/Paris, France
| | - Bénédicte Stengel
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Natalia Alencar de Pinho
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Karen Leffondré
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
| | - Mathilde Prezelin-Reydit
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
- Maison du REIN AURAD Aquitaine, Néphrologie, Gradignan, Nouvelle-Aquitaine, FR
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Savel H, Meyer-Losic F, Proust-Lima C, Richert L. Statistical classification of treatment responses in mouse clinical trials for stratified medicine in oncology drug discovery. Sci Rep 2024; 14:934. [PMID: 38195626 PMCID: PMC10776864 DOI: 10.1038/s41598-023-51055-7] [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: 08/08/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024] Open
Abstract
Translational oncology research strives to explore a new aspect: identifying subgroups that exhibit treatment response even during pre-clinical phases. In this study, we focus on PDX models and their implementation in mouse clinical trials (MCT). Our primary objective was to identify subgroups with different treatment responses using Latent Class Mixed Model (LCMM).We used a public dataset and focused on one treatment, encorafenib, and two indications, melanoma and colorectal cancer, for which efficacy depends on a specific mutation BRAF V600E. One LCMM per indication was implemented to classify treatment responses at the PDX level, analyzing the growth kinetics of treated tumors and matched controls within the PDX models. A simulation study was carried out to explore the performance of LCMM in this context. For both applications, LCMM identified classes for which the higher the proportion of mutated BRAF V600E PDX models the greater the treatment effect, which is aligned with encorafenib use recommendations. The simulation study showed that LCMM could identify classes with large differences in treatment effects. LCMM is a suitable tool for MCT to explore treatment response subgroups of PDX. Once these subgroups are defined, characterization of their phenotypes/genotypes could be performed to explore treatment response predictors.
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Affiliation(s)
- Hélène Savel
- U1219, Inserm Bordeaux Population Health Research Centre, Department of Public Health, Université de Bordeaux, 33000, Bordeaux, France
- Ipsen Innovation, 5 Avenue du Canada, 91940, Les Ulis, France
- Inria, SISTM, 33400, Talence, France
| | | | - Cécile Proust-Lima
- U1219, Inserm Bordeaux Population Health Research Centre, Department of Public Health, Université de Bordeaux, 33000, Bordeaux, France
- Institut Bergonié, CHU de Bordeaux, INSERM, Université de Bordeaux, CIC-EC 1401, 33000, Bordeaux, France
| | - Laura Richert
- U1219, Inserm Bordeaux Population Health Research Centre, Department of Public Health, Université de Bordeaux, 33000, Bordeaux, France.
- Institut Bergonié, CHU de Bordeaux, INSERM, Université de Bordeaux, CIC-EC 1401, 33000, Bordeaux, France.
- Inria, SISTM, 33400, Talence, France.
- Université de Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux Cedex, France.
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Le Bourdonnec K, Samieri C, Tzourio C, Mura T, Mishra A, Trégouët DA, Proust-Lima C. Addressing unmeasured confounders in cohort studies: Instrumental variable method for a time-fixed exposure on an outcome trajectory. Biom J 2024; 66:e2200358. [PMID: 38098309 DOI: 10.1002/bimj.202200358] [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: 12/19/2022] [Revised: 06/12/2023] [Accepted: 08/11/2023] [Indexed: 01/30/2024]
Abstract
Instrumental variable methods, which handle unmeasured confounding by targeting the part of the exposure explained by an exogenous variable not subject to confounding, have gained much interest in observational studies. We consider the very frequent setting of estimating the unconfounded effect of an exposure measured at baseline on the subsequent trajectory of an outcome repeatedly measured over time. We didactically explain how to apply the instrumental variable method in such setting by adapting the two-stage classical methodology with (1) the prediction of the exposure according to the instrumental variable, (2) its inclusion into a mixed model to quantify the exposure association with the subsequent outcome trajectory, and (3) the computation of the estimated total variance. A simulation study illustrates the consequences of unmeasured confounding in classical analyses and the usefulness of the instrumental variable approach. The methodology is then applied to 6224 participants of the 3C cohort to estimate the association of type-2 diabetes with subsequent cognitive trajectory, using 42 genetic polymorphisms as instrumental variables. This contribution shows how to handle endogeneity when interested in repeated outcomes, along with a R implementation. However, it should still be used with caution as it relies on instrumental variable assumptions hardly testable in practice.
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Affiliation(s)
| | - Cécilia Samieri
- Inserm, BPH, U1219, University of Bordeaux, Bordeaux, France
| | | | - Thibault Mura
- Institute for Neurosciences of Montpellier INM, University of Montpellier, INSERM, Montpellier, France
| | - Aniket Mishra
- Inserm, BPH, U1219, University of Bordeaux, Bordeaux, France
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Devaux A, Helmer C, Genuer R, Proust-Lima C. Random survival forests with multivariate longitudinal endogenous covariates. Stat Methods Med Res 2023; 32:2331-2346. [PMID: 37886845 DOI: 10.1177/09622802231206477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Predicting the individual risk of clinical events using the complete patient history is a major challenge in personalized medicine. Analytical methods have to account for a possibly large number of time-dependent predictors, which are often characterized by irregular and error-prone measurements, and are truncated early by the event. In this work, we extended the competing-risk random survival forests to handle such endogenous longitudinal predictors when predicting event probabilities. The method, implemented in the R package DynForest, internally transforms the time-dependent predictors at each node of each tree into time-fixed features (using mixed models) that can then be used as splitting candidates. The final individual event probability is computed as the average of leaf-specific Aalen-Johansen estimators over the trees. Using simulations, we compared the performances of DynForest to accurately predict an event with (i) a joint modeling alternative when considering two longitudinal predictors only, and with (ii) a regression calibration method that ignores the informative truncation by the event when dealing with a large number of longitudinal predictors. Through an application in dementia research, we also illustrated how DynForest can be used to develop a dynamic prediction tool for dementia from multimodal repeated markers, and quantify the importance of each marker.
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Affiliation(s)
- Anthony Devaux
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France
- The George Institute for Global Health, UNSW Sydney, Australia
- School of Population Health, UNSW Sydney, Australia
| | | | - Robin Genuer
- Univ. Bordeaux, INSERM, INRIA, BPH, U1219, Bordeaux, France
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Proust-Lima C, Saulnier T, Philipps V, Traon APL, Péran P, Rascol O, Meissner WG, Foubert-Samier A. Describing complex disease progression using joint latent class models for multivariate longitudinal markers and clinical endpoints. Stat Med 2023; 42:3996-4014. [PMID: 37461227 DOI: 10.1002/sim.9844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 01/31/2023] [Accepted: 06/26/2023] [Indexed: 09/05/2023]
Abstract
Neurodegenerative diseases are characterized by numerous markers of progression and clinical endpoints. For instance, multiple system atrophy (MSA), a rare neurodegenerative synucleinopathy, is characterized by various combinations of progressive autonomic failure and motor dysfunction, and a very poor prognosis. Describing the progression of such complex and multi-dimensional diseases is particularly difficult. One has to simultaneously account for the assessment of multivariate markers over time, the occurrence of clinical endpoints, and a highly suspected heterogeneity between patients. Yet, such description is crucial for understanding the natural history of the disease, staging patients diagnosed with the disease, unravelling subphenotypes, and predicting the prognosis. Through the example of MSA progression, we show how a latent class approach modeling multiple repeated markers and clinical endpoints can help describe complex disease progression and identify subphenotypes for exploring new pathological hypotheses. The proposed joint latent class model includes class-specific multivariate mixed models to handle multivariate repeated biomarkers possibly summarized into latent dimensions and class-and-cause-specific proportional hazard models to handle time-to-event data. Maximum likelihood estimation procedure, validated through simulations is available in the lcmm R package. In the French MSA cohort comprising data of 598 patients during up to 13 years, five subphenotypes of MSA were identified that differ by the sequence and shape of biomarkers degradation, and the associated risk of death. In posterior analyses, the five subphenotypes were used to explore the association between clinical progression and external imaging and fluid biomarkers, while properly accounting for the uncertainty in the subphenotypes membership.
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Affiliation(s)
- Cécile Proust-Lima
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France
- Inserm, CIC1401-EC, Bordeaux, France
| | - Tiphaine Saulnier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France
| | - Viviane Philipps
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France
| | - Anne Pavy-Le Traon
- MSA Reference Center and CIC-1436, Department of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Univ Toulouse, Inserm, UPS, Toulouse, France
| | - Olivier Rascol
- MSA Reference Center and CIC-1436, Department of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France
| | - Wassilios G Meissner
- Univ. Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
- Dept. Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Alexandra Foubert-Samier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France
- Inserm, CIC1401-EC, Bordeaux, France
- Univ. Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
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Lespinasse J, Dufouil C, Proust-Lima C. Disease progression model anchored around clinical diagnosis in longitudinal cohorts: example of Alzheimer's disease and related dementia. BMC Med Res Methodol 2023; 23:199. [PMID: 37670234 PMCID: PMC10478286 DOI: 10.1186/s12874-023-02009-0] [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: 01/27/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Alzheimer's disease and related dementia (ADRD) are characterized by multiple and progressive anatomo-clinical changes including accumulation of abnormal proteins in the brain, brain atrophy and severe cognitive impairment. Understanding the sequence and timing of these changes is of primary importance to gain insight into the disease natural history and ultimately allow earlier diagnosis. Yet, modeling changes over disease course from cohort data is challenging as the usual timescales (time since inclusion, chronological age) are inappropriate and time-to-clinical diagnosis is available on small subsamples of participants with short follow-up durations prior to diagnosis. One solution to circumvent this challenge is to define the disease time as a latent variable. METHODS We developed a multivariate mixed model approach that realigns individual trajectories into the latent disease time to describe disease progression. In contrast with the existing literature, our methodology exploits the clinical diagnosis information as a partially observed and approximate reference to guide the estimation of the latent disease time. The model estimation was carried out in the Bayesian Framework using Stan. We applied the methodology to the MEMENTO study, a French multicentric clinic-based cohort of 2186 participants with 5-year intensive follow-up. Repeated measures of 12 ADRD markers stemmed from cerebrospinal fluid (CSF), brain imaging and cognitive tests were analyzed. RESULTS The estimated latent disease time spanned over twenty years before the clinical diagnosis. Considering the profile of a woman aged 70 with a high level of education and APOE4 carrier (the main genetic risk factor for ADRD), CSF markers of tau proteins accumulation preceded markers of brain atrophy by 5 years and cognitive decline by 10 years. However we observed that individual characteristics could substantially modify the sequence and timing of these changes, in particular for CSF level of A[Formula: see text]. CONCLUSION By leveraging the available clinical diagnosis timing information, our disease progression model does not only realign trajectories into the most homogeneous way. It accounts for the inherent residual inter-individual variability in dementia progression to describe the long-term anatomo-clinical degradations according to the years preceding clinical diagnosis, and to provide clinically meaningful information on the sequence of events. TRIAL REGISTRATION clinicaltrials.gov, NCT01926249. Registered on 16 August 2013.
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Affiliation(s)
- Jérémie Lespinasse
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, BPH, U1219, 33000, Bordeaux, France
- Inserm, CIC1401-EC, 33000, Bordeaux, France
- Pôle de santé publique, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000, Bordeaux, France
| | - Carole Dufouil
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, BPH, U1219, 33000, Bordeaux, France
- Inserm, CIC1401-EC, 33000, Bordeaux, France
- Pôle de santé publique, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000, Bordeaux, France
| | - Cécile Proust-Lima
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, BPH, U1219, 33000, Bordeaux, France.
- Inserm, CIC1401-EC, 33000, Bordeaux, France.
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9
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Saulnier T, Fabbri M, Pavy-Le Traon A, Le Goff M, Helmer C, Péran P, Meissner WG, Rascol O, Foubert-Samier A, Proust-Lima C. Disease Progression in Multiple System Atrophy: The Value of Clinical Cohorts with Long Follow-Up. Mov Disord 2023; 38:1567-1569. [PMID: 37565400 DOI: 10.1002/mds.29534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- Tiphaine Saulnier
- Univ. Bordeaux, Bordeaux Population Health Research Center,Inserm U1219, Bordeaux, France
| | - Margherita Fabbri
- MSA French Reference Center, Univ. Hospital Toulouse, Toulouse, France
- Univ. Toulouse, CIC-1436, Departments of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital,InsermU1048/1214, Toulouse, France
| | - Anne Pavy-Le Traon
- MSA French Reference Center, Univ. Hospital Toulouse, Toulouse, France
- Univ. Toulouse, CIC-1436, Departments of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital,InsermU1048/1214, Toulouse, France
| | - Mélanie Le Goff
- Univ. Bordeaux, Bordeaux Population Health Research Center,Inserm U1219, Bordeaux, France
| | - Catherine Helmer
- Univ. Bordeaux, Bordeaux Population Health Research Center,Inserm U1219, Bordeaux, France
- Inserm,CIC1401-EC, Bordeaux, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Univ Toulouse, Inserm, UPS, Toulouse, France
| | - Wassilios G Meissner
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc,CRMRAMS, NS-Park/FCRIN Network, Bordeaux, France
- Univ. Bordeaux, CNRS, IMN, Bordeaux, France
- Department Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Olivier Rascol
- MSA French Reference Center, Univ. Hospital Toulouse, Toulouse, France
- Univ. Toulouse, CIC-1436, Departments of Clinical Pharmacology and Neurosciences, NeuroToul COEN Center, NS-Park/FCRIN Network, Toulouse University Hospital,InsermU1048/1214, Toulouse, France
| | - Alexandra Foubert-Samier
- Univ. Bordeaux, Bordeaux Population Health Research Center,Inserm U1219, Bordeaux, France
- Inserm,CIC1401-EC, Bordeaux, France
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc,CRMRAMS, NS-Park/FCRIN Network, Bordeaux, France
- Univ. Bordeaux, CNRS, IMN, Bordeaux, France
| | - Cécile Proust-Lima
- Univ. Bordeaux, Bordeaux Population Health Research Center,Inserm U1219, Bordeaux, France
- Inserm,CIC1401-EC, Bordeaux, France
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10
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Portugal B, Artaud F, Degaey I, Roze E, Fournier A, Severi G, Canonico M, Proust-Lima C, Elbaz A. Association of Physical Activity and Parkinson Disease in Women: Long-term Follow-up of the E3N Cohort Study. Neurology 2023; 101:e386-e398. [PMID: 37197993 PMCID: PMC10435054 DOI: 10.1212/wnl.0000000000207424] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/03/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previous cohort studies reported that a single measure of physical activity (PA) assessed at baseline was associated with lower Parkinson disease (PD) incidence, but a meta-analysis suggested that this association was restricted to men. Because of the long prodromal phase of the disease, reverse causation could not be excluded as a potential explanation. Our objective was to study the association between time-varying PA and PD in women using lagged analyses to address the potential for reverse causation and to compare PA trajectories in patients before diagnosis and matched controls. METHODS We used data from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale (1990-2018), a cohort study of women affiliated with a national health insurance plan for persons working in education. PA was self-reported in 6 questionnaires over the follow-up. As questions changed across questionnaires, we created a time-varying latent PA (LPA) variable using latent process mixed models. PD was ascertained using a multistep validation process based on medical records or a validated algorithm based on drug claims. We set up a nested case-control study to examine differences in LPA trajectories using multivariable linear mixed models with a retrospective timescale. Cox proportional hazards models with age as the timescale and adjusted for confounders were used to estimate the association between time-varying LPA and PD incidence. Our main analysis used a 10-year lag to account for reverse causation; sensitivity analyses used 5-, 15-, and 20-year lags. RESULTS Analyses of trajectories (1,196 cases and 23,879 controls) showed that LPA was significantly lower in cases than in controls throughout the follow-up, including 29 years before diagnosis; the difference between cases and controls started to increase ∼10 years before diagnosis (p interaction = 0.003). In our main survival analysis, of 95,354 women free of PD in 2000, 1,074 women developed PD over a mean follow-up of 17.2 years. PD incidence decreased with increasing LPA (p trend = 0.001), with 25% lower incidence in those in the highest quartile compared with the lowest (adjusted hazard ratio 0.75, 95% CI 0.63-0.89). Using longer lags yielded similar conclusions. DISCUSSION Higher PA level is associated with lower PD incidence in women, not explained by reverse causation. These results are important for planning interventions for PD prevention.
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Affiliation(s)
- Berta Portugal
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Fanny Artaud
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Isabelle Degaey
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Emmanuel Roze
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Agnès Fournier
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Gianluca Severi
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Marianne Canonico
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Cécile Proust-Lima
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Alexis Elbaz
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France.
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11
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Wu Y, Rosenberg DE, Greenwood-Hickman MA, McCurry SM, Proust-Lima C, Nelson JC, Crane PK, LaCroix AZ, Larson EB, Shaw PA. Analysis of the 24-h activity cycle: An illustration examining the association with cognitive function in the Adult Changes in Thought study. Front Psychol 2023; 14:1083344. [PMID: 37057157 PMCID: PMC10087899 DOI: 10.3389/fpsyg.2023.1083344] [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: 11/08/2022] [Accepted: 02/07/2023] [Indexed: 03/30/2023] Open
Abstract
The 24-h activity cycle (24HAC) is a new paradigm for studying activity behaviors in relation to health outcomes. This approach inherently captures the interrelatedness of the daily time spent in physical activity (PA), sedentary behavior (SB), and sleep. We describe three popular approaches for modeling outcome associations with the 24HAC exposure. We apply these approaches to assess an association with a cognitive outcome in a cohort of older adults, discuss statistical challenges, and provide guidance on interpretation and selecting an appropriate approach. We compare the use of the isotemporal substitution model (ISM), compositional data analysis (CoDA), and latent profile analysis (LPA) to analyze 24HAC. We illustrate each method by exploring cross-sectional associations with cognition in 1,034 older adults (Mean age = 77; Age range = 65-100; 55.8% female; 90% White) who were part of the Adult Changes in Thought (ACT) Activity Monitoring (ACT-AM) sub-study. PA and SB were assessed with thigh-worn activPAL accelerometers for 7-days. For each method, we fit a multivariable regression model to examine the cross-sectional association between the 24HAC and Cognitive Abilities Screening Instrument item response theory (CASI-IRT) score, adjusting for baseline characteristics. We highlight differences in assumptions and the scientific questions addressable by each approach. ISM is easiest to apply and interpret; however, the typical ISM assumes a linear association. CoDA uses an isometric log-ratio transformation to directly model the compositional exposure but can be more challenging to apply and interpret. LPA can serve as an exploratory analysis tool to classify individuals into groups with similar time-use patterns. Inference on associations of latent profiles with health outcomes need to account for the uncertainty of the LPA classifications, which is often ignored. Analyses using the three methods did not suggest that less time spent on SB and more in PA was associated with better cognitive function. The three standard analytical approaches for 24HAC each have advantages and limitations, and selection of the most appropriate method should be guided by the scientific questions of interest and applicability of each model's assumptions. Further research is needed into the health implications of the distinct 24HAC patterns identified in this cohort.
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Affiliation(s)
- Yinxiang Wu
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Dori E. Rosenberg
- Investigative Sciences Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | | | - Susan M. McCurry
- School of Nursing, University of Washington, Seattle, WA, United States
| | | | - Jennifer C. Nelson
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Paul K. Crane
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Andrea Z. LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | - Eric B. Larson
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Pamela A. Shaw
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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12
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Karamouza E, Glasspool RM, Kelly C, Lewsley LA, Carty K, Kristensen GB, Ethier JL, Kagimura T, Yanaihara N, Cecere SC, You B, Boere IA, Pujade-Lauraine E, Ray-Coquard I, Proust-Lima C, Paoletti X. CA-125 Early Dynamics to Predict Overall Survival in Women with Newly Diagnosed Advanced Ovarian Cancer Based on Meta-Analysis Data. Cancers (Basel) 2023; 15:1823. [PMID: 36980708 PMCID: PMC10047009 DOI: 10.3390/cancers15061823] [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: 02/04/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
(1) Background: Cancer antigen 125 (CA-125) is a protein produced by ovarian cancer cells that is used for patients' monitoring. However, the best ways to analyze its decline and prognostic role are poorly quantified. (2) Methods: We leveraged individual patient data from the Gynecologic Cancer Intergroup (GCIG) meta-analysis (N = 5573) to compare different approaches summarizing the early trajectory of CA-125 before the prediction time (called the landmark time) at 3 or 6 months after treatment initiation in order to predict overall survival. These summaries included observed and estimated measures obtained by a linear mixed model (LMM). Their performances were evaluated by 10-fold cross-validation with the Brier score and the area under the ROC (AUC). (3) Results: The estimated value and the last observed value at 3 months were the best measures used to predict overall survival, with an AUC of 0.75 CI 95% [0.70; 0.80] at 24 and 36 months and 0.74 [0.69; 0.80] and 0.75 [0.69; 0.80] at 48 months, respectively, considering that CA-125 over 6 months did not improve the AUC, with 0.74 [0.68; 0.78] at 24 months and 0.71 [0.65; 0.76] at 36 and 48 months. (4) Conclusions: A 3-month surveillance provided reliable individual information on overall survival until 48 months for patients receiving first-line chemotherapy.
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Affiliation(s)
- Eleni Karamouza
- Gustave Roussy, Office of Biostatistics and Epidemiology, Université Paris-Saclay, 94805 Villejuif, France
- Oncostat, Labeled Ligue Contre le Cancer, CESP U1018, Inserm, Université Paris-Saclay, 94805 Villejuif, France
| | - Rosalind M. Glasspool
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow G12 0XH, UK
| | - Caroline Kelly
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow G12 0YN, UK
| | - Liz-Anne Lewsley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow G12 0YN, UK
| | - Karen Carty
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow G12 0YN, UK
| | - Gunnar B. Kristensen
- Department of Gynecologic Oncology, Institute for Cancer Genetics and Informatics, Oslo University Hospital, 0424 Oslo, Norway
| | - Josee-Lyne Ethier
- Department of Medical Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Tatsuo Kagimura
- Foundation for Biomedical Research and Innocation, Translational Research Center for Medical Innovation, Kobe 650-0047, Japan
| | | | - Sabrina Chiara Cecere
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy
| | - Benoit You
- EMR UCBL/HCL 3738, Faculté de Médecine Lyon-Sud, Université Lyon, Université Claude Bernard Lyon 1, 69100 Lyon, France
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, 69495 Lyon, France
| | - Ingrid A. Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | | | | | - Cécile Proust-Lima
- UMR1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, 33000 Bordeaux, France
| | - Xavier Paoletti
- Faculty of Medicine, University of Versailles Saint-Quentin, Université Paris Saclay, 78000 Versailles, France
- INSERM U900, Statistics for Personalized Medicine, Institut Curie, 92210 Saint-Cloud, France
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13
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Grasset L, Proust-Lima C, Mangin JF, Habert MO, Dubois B, Paquet C, Hanon O, Gabelle A, Ceccaldi M, Annweiler C, David R, Jonveaux T, Belin C, Julian A, Rouch-Leroyer I, Pariente J, Locatelli M, Chupin M, Chêne G, Dufouil C. Explaining the association between social and lifestyle factors and cognitive functions: a pathway analysis in the Memento cohort. Alzheimers Res Ther 2022; 14:68. [PMID: 35585559 PMCID: PMC9115948 DOI: 10.1186/s13195-022-01013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/27/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
This work aimed to investigate the potential pathways involved in the association between social and lifestyle factors, biomarkers of Alzheimer’s disease and related dementia (ADRD), and cognition.
Methods
The authors studied 2323 participants from the Memento study, a French nationwide clinical cohort. Social and lifestyle factors were education level, current household incomes, physical activity, leisure activities, and social network from which two continuous latent variables were computed: an early to midlife (EML) and a latelife (LL) indicator. Brain magnetic resonance imaging (MRI), lumbar puncture, and amyloid-positron emission tomography (PET) were used to define three latent variables: neurodegeneration, small vessel disease (SVD), and AD pathology. Cognitive function was defined as the underlying factor of a latent variable with four cognitive tests. Structural equation models were used to evaluate cross-sectional pathways between social and lifestyle factors and cognition.
Results
Participants’ mean age was 70.9 years old, 62% were women, 28% were apolipoprotein-ε4 carriers, and 59% had a Clinical Dementia Rating (CDR) score of 0.5. Higher early to midlife social indicator was only directly associated with better cognitive function (direct β = 0.364 (0.322; 0.405), with no indirect pathway through ADRD biomarkers (total β = 0.392 (0.351; 0.429)). In addition to a direct effect on cognition (direct β = 0.076 (0.033; 0.118)), the association between latelife lifestyle indicator and cognition was also mostly mediated by an indirect effect through lower neurodegeneration (indirect β = 0.066 (0.042; 0.090) and direct β = − 0.116 (− 0.153; − 0.079)), but not through AD pathology nor SVD.
Conclusions
Early to midlife social factors are directly associated with higher cognitive functions. Latelife lifestyle factors may help preserve cognitive functions through lower neurodegeneration.
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14
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Proust-Lima C, Sébille V. Recent developments for the analysis of latent constructs using measurement scales in health research. Methods 2022; 205:232-233. [PMID: 35907604 DOI: 10.1016/j.ymeth.2022.07.015] [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] Open
Affiliation(s)
- Cécile Proust-Lima
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, F-33000 Bordeaux, France.
| | - Véronique Sébille
- Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France; Methodology and Biostatistics Unit, CHU Nantes, Nantes, France.
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15
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de Courson H, Proust-Lima C, Tuaz E, Georges D, Verchère E, Biais M. Relationship Between Brain Tissue Oxygen and Near-Infrared Spectroscopy in Patients with Nontraumatic Subarachnoid Hemorrhage. Neurocrit Care 2022; 37:620-628. [PMID: 35876962 DOI: 10.1007/s12028-022-01563-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Continuous monitoring of cerebral oxygenation is one of the diagnostic tools used in patients with brain injury. Direct and invasive measurement of cerebral oxygenation with a partial brain oxygen pressure (PbtO2) probe is promising but invasive. Noninvasive assessment of regional transcranial oxygen saturation using near-infrared spectroscopy (NIRS) may be feasible. The aim of this study was to evaluate the interchangeability between PbtO2 and NIRS over time in patients with nontraumatic subarachnoid hemorrhage. METHODS This retrospective study was performed in a neurocritical care unit. Study participants underwent hourly PbtO2 and NIRS measurements over 72 h. Temporal agreement between markers was described by their pointwise correlation. A secondary analysis assessed the structure of covariation between marker trajectories using a bivariate linear mixed model. RESULTS Fifty-one patients with subarachnoid hemorrhage were included. A total of 3362 simultaneous NIRS and PbtO2 measurements were obtained. The correlation at each measurement time ranged from - 0.25 to 0.25. The global correlation over time was - 0.026 (p = 0.130). The bivariate linear mixed model confirmed the lack of significant correlation between the PbtO2 and NIRS measurements at follow-up. NIRS was unable to detect PbtO2 values below 20 mm Hg (area under the receiver operating characteristic curve 0.539 [95% confidence interval 0.536-0.542]; p = 0.928), and percentage changes in NIRS were unable to detect a decrease in PbtO2 ≥ 10% (area under the receiver operating characteristic curve 0.615 [95% confidence interval 0.614-0.616]; p < 0.001). CONCLUSIONS PbtO2 and NIRS measurements were not correlated. There is no evidence that NIRS could be a substitute for PbtO2 monitoring in patients with nontraumatic subarachnoid hemorrhage.
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Affiliation(s)
- Hugues de Courson
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France.,U1219, Bordeaux Population Health, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France
| | - C Proust-Lima
- U1219, Bordeaux Population Health, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France
| | - Estelle Tuaz
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Delphine Georges
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Eric Verchère
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Matthieu Biais
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France. .,U1034, Biology of Cardiovascular Diseases, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France.
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16
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Devaux A, Genuer R, Peres K, Proust-Lima C. Individual dynamic prediction of clinical endpoint from large dimensional longitudinal biomarker history: a landmark approach. BMC Med Res Methodol 2022; 22:188. [PMID: 35818025 PMCID: PMC9275051 DOI: 10.1186/s12874-022-01660-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/09/2021] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background The individual data collected throughout patient follow-up constitute crucial information for assessing the risk of a clinical event, and eventually for adapting a therapeutic strategy. Joint models and landmark models have been proposed to compute individual dynamic predictions from repeated measures to one or two markers. However, they hardly extend to the case where the patient history includes much more repeated markers. Our objective was thus to propose a solution for the dynamic prediction of a health event that may exploit repeated measures of a possibly large number of markers. Methods We combined a landmark approach extended to endogenous markers history with machine learning methods adapted to survival data. Each marker trajectory is modeled using the information collected up to the landmark time, and summary variables that best capture the individual trajectories are derived. These summaries and additional covariates are then included in different prediction methods adapted to survival data, namely regularized regressions and random survival forests, to predict the event from the landmark time. We also show how predictive tools can be combined into a superlearner. The performances are evaluated by cross-validation using estimators of Brier Score and the area under the Receiver Operating Characteristic curve adapted to censored data. Results We demonstrate in a simulation study the benefits of machine learning survival methods over standard survival models, especially in the case of numerous and/or nonlinear relationships between the predictors and the event. We then applied the methodology in two prediction contexts: a clinical context with the prediction of death in primary biliary cholangitis, and a public health context with age-specific prediction of death in the general elderly population. Conclusions Our methodology, implemented in R, enables the prediction of an event using the entire longitudinal patient history, even when the number of repeated markers is large. Although introduced with mixed models for the repeated markers and methods for a single right censored time-to-event, the technique can be used with any other appropriate modeling technique for the markers and can be easily extended to competing risks setting. Supplementary Information The online version contains supplementary material available at (10.1186/s12874-022-01660-3).
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Affiliation(s)
| | - Robin Genuer
- INSERM, BPH, U1219, Univ. Bordeaux, Bordeaux, France.,INRIA Bordeaux Sud-Ouest, Talence, France
| | - Karine Peres
- INSERM, BPH, U1219, Univ. Bordeaux, Bordeaux, France
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Sakarovitch C, Schlosser O, Courtois S, Proust-Lima C, Couallier J, Pétrau A, Litrico X, Loret JF. Monitoring of SARS-CoV-2 in wastewater: what normalisation for improved understanding of epidemic trends? J Water Health 2022; 20:712-726. [PMID: 35482387 DOI: 10.2166/wh.2022.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
SARS-CoV-2 RNA quantification in wastewater has emerged as a relevant additional means to monitor the COVID-19 pandemic. However, the concentration can be affected by black water dilution factors or movements of the sewer shed population, leading to misinterpretation of measurement results. The aim of this study was to evaluate the performance of different indicators to accurately interpret SARS-CoV-2 in wastewater. Weekly/bi-weekly measurements from three cities in France were analysed from February to September 2021. The concentrations of SARS-CoV-2 gene copies were normalised to the faecal-contributing population using simple sewage component indicators. To reduce the measurement error, a composite index was created to combine simultaneously the information carried by the simple indicators. The results showed that the regularity (mean absolute difference between observation and the smoothed curve) of the simple indicators substantially varied across sampling points. The composite index consistently showed better regularity compared to the other indicators and was associated to the lowest variation in correlation coefficient across sampling points. These findings suggest the recommendation for the use of a composite index in wastewater-based epidemiology to compensate for variability in measurement results.
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Affiliation(s)
| | | | - Sophie Courtois
- SUEZ, CIRSEE, 38 rue du Président Wilson, 78230 Le Pecq, France
| | - Cécile Proust-Lima
- Université de Bordeaux, INSERM, Bordeaux Population Health Center, UMR1219, F-33000 Bordeaux, France
| | - Joanne Couallier
- SUEZ, LYRE, 15 av Léonard de Vinci, 33600 Pessac, France E-mail:
| | - Agnès Pétrau
- SUEZ Rivages Pro Tech, Technopôle Izarbel, 2 Allée Théodore Monod, 64210 Bidart, France
| | - Xavier Litrico
- SUEZ, CB21, 16 Place de l'Iris, 92040 Paris La Défense, France
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18
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Saulnier T, Philipps V, Meissner WG, Rascol O, Traon APL, Foubert-Samier A, Proust-Lima C. Joint models for the longitudinal analysis of measurement scales in the presence of informative dropout. Methods 2022; 203:142-151. [DOI: 10.1016/j.ymeth.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 11/29/2022] Open
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Rouanet A, Avila-Rieger J, Dugravot A, Lespinasse J, Stuckwisch R, Merrick R, Anderson E, Long L, Helmer C, Jacqmin-Gadda H, Dufouil C, Judd S, Manly J, Sabia S, Gross A, Proust-Lima C. How Selection Over Time Contributes to the Inconsistency of the Association Between Sex/Gender and Cognitive Decline Across Cognitive Aging Cohorts. Am J Epidemiol 2022; 191:441-452. [PMID: 34521111 DOI: 10.1093/aje/kwab227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/26/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
The association between sex/gender and aging-related cognitive decline remains poorly understood because of inconsistencies in findings. Such heterogeneity could be attributable to the cognitive functions studied and study population characteristics, but also to differential selection by dropout and death between men and women. We aimed to evaluate the impact of selection by dropout and death on the association between sex/gender and cognitive decline. We first compared the statistical methods most frequently used for longitudinal data, targeting either population estimands (marginal models fitted by generalized estimating equations) or subject-specific estimands (mixed/joint models fitted by likelihood maximization) in 8 studies of aging: 6 population-based studies (the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study (1996-2009), Personnes Âgées QUID (PAQUID; 1988-2014), the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study (2003-2016), the Three-City Study (Bordeaux only; 1999-2016), the Washington Heights-Inwood Community Aging Project (WHICAP; 1992-2017), and the Whitehall II Study (2007-2016)) and 2 clinic-based studies (the Alzheimer's Disease Neuroimaging Initiative (ADNI; 2004-2017) and a nationwide French cohort study, MEMENTO (2011-2016)). We illustrate differences in the estimands of the association between sex/gender and cognitive decline in selected examples and highlight the critical role of differential selection by dropout and death. Using the same estimand, we then contrast the sex/gender-cognitive decline associations across cohorts and cognitive measures suggesting a residual differential sex/gender association depending on the targeted cognitive measure (memory or animal fluency) and the initial cohort selection. We recommend focusing on subject-specific estimands in the living population for assessing sex/gender differences while handling differential selection over time.
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Proust-Lima C, Philipps V, Perrot B, Blanchin M, Sébille V. Modeling repeated self-reported outcome data: a continuous-time longitudinal Item Response Theory model. Methods 2022; 204:386-395. [PMID: 35041926 DOI: 10.1016/j.ymeth.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/17/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 12/28/2022] Open
Abstract
Item Response Theory (IRT) models have received growing interest in health science for analyzing latent constructs such as depression, anxiety, quality of life or cognitive functioning from the information provided by each individual's items responses. However, in the presence of repeated item measures, IRT methods usually assume that the measurement occasions are made at the exact same time for all patients. In this paper, we show how the IRT methodology can be combined with the mixed model theory to provide a longitudinal IRT model which exploits the information of a measurement scale provided at the item level while simultaneously handling observation times that may vary across individuals and items. The latent construct is a latent process defined in continuous time that is linked to the observed item responses through a measurement model at each individual- and occasion-specific observation time; we focus here on a Graded Response Model for binary and ordinal items. The Maximum Likelihood Estimation procedure of the model is available in the R package lcmm. The proposed approach is contextualized in a clinical example in end-stage renal disease, the PREDIALA study. The objective is to study the trajectories of depressive symptomatology (as measured by 7 items of the Hospital Anxiety and Depression scale) according to the time from registration on the renal transplant waiting list and the renal replacement therapy. We also illustrate how the method can be used to assess Differential Item Functioning and lack of measurement invariance over time.
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Affiliation(s)
- Cécile Proust-Lima
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, F-33000 Bordeaux, France.
| | - Viviane Philipps
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, F-33000 Bordeaux, France
| | - Bastien Perrot
- Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France; Methodology and Biostatistics Unit, CHU Nantes, Nantes, France
| | - Myriam Blanchin
- Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France
| | - Véronique Sébille
- Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France; Methodology and Biostatistics Unit, CHU Nantes, Nantes, France
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21
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Baussard L, Proust-Lima C, Philipps V, Portales F, Ychou M, Mazard T, Cousson-Gélie F. Determinants of Distinct Trajectories of Fatigue in Patients Undergoing Chemotherapy for a Metastatic Colorectal Cancer: 6-Month Follow-up Using Growth Mixture Modeling. J Pain Symptom Manage 2022; 63:140-150. [PMID: 34161813 DOI: 10.1016/j.jpainsymman.2021.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/11/2021] [Accepted: 06/14/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This longitudinal prospective and observational study was designed to identify fatigue trajectories during a 6-month period of chemotherapy in patients with metastatic colorectal cancer, and examine the psychosocial factors predicting these trajectories. Associations between fatigue and survival were also investigated. METHODS A total of 169 patients (Mage = 64.36 years, SD = 10.5) reported their fatigue levels every 2 weeks for 6 months. Psychological variables (anxiety, depression, internal control, and coping) were assessed at baseline. A Growth Mixture Model was used to identify latent trajectories of fatigue, and a multinomial logistic regression tested covariate predictors of patients' trajectories. RESULTS Four clinically distinct fatigue trajectories were identified: intense fatigue (6.51%), moderate fatigue (48.52%), no fatigue (33%), and increasing fatigue (11.83%). Fatigue severity was directly associated with overall survival. High depression levels were associated with fatigue severity over time for intense (OR = 1.80 [1.32-2.47]) and for moderate (OR = 1.58 [1.25-2.00]) fatigue, compared to patients reporting no fatigue. Patients who did not report fatigue were better adjusted, and had more resources, such as better internal control over the disease and less emotion-focused coping (guilt and avoidance), than those who reported intense (ORcontrol = 0.77 [0.65-0.92]) or moderate (ORcontrol = 0.89 [0.79-0.99] and ORcoping = 1.13 [1.02-1.24]) fatigue. CONCLUSION Fatigue trajectories differed considerably across patients with metastatic colorectal cancer. This first longitudinal study on colorectal cancer patients involving transactional variables suggests that psychosocial interventions should target these specific outcomes, in order to help patients manage their fatigue.
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Affiliation(s)
- Louise Baussard
- University of Nîmes (L.B.), APSY-V Research Laboratory, Nîmes, France.
| | | | | | - Fabienne Portales
- Digestive Oncology Department (F.P., M.Y., T.M.), Montpellier Cancer Institute, Montpellier, France
| | - Marc Ychou
- Digestive Oncology Department (F.P., M.Y., T.M.), Montpellier Cancer Institute, Montpellier, France
| | - Thibault Mazard
- Digestive Oncology Department (F.P., M.Y., T.M.), Montpellier Cancer Institute, Montpellier, France
| | - Florence Cousson-Gélie
- University Paul Valéry Montpellier 3 (F.C.G.), University Montpellier, Montpellier, France; Epidaure Prevention Department (F.C.G.), Montpellier Cancer Institute, Montpellier, France
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22
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Dartigues JF, Le Bourdonnec K, Tabue-Teguo M, Le Goff M, Helmer C, Avila-Funes JA, Coureau G, Feart C, Pérès K, Genuer R, Letenneur L, Amieva H, Proust-Lima C. Co-Occurrence of Geriatric Syndromes and Diseases in the General Population: Assessment of the Dimensions of Aging. J Nutr Health Aging 2022; 26:37-45. [PMID: 35067701 PMCID: PMC8720645 DOI: 10.1007/s12603-021-1722-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/22/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVES The co-occurrence of multiple medical or psycho-social conditions (geriatric syndromes (GS) and age-related diseases) is a growing concern in older people. Given the diversity of these conditions and their complex interactions, our aim was to determine whether they could be structured into synthetic dimensions in order to facilitate the management of multimorbidity. DESIGN The underlying structure of 10 GSs and 8 age-related diseases was identified using a multiple correspondence analysis (MCA), and confronted to subjective and objective health outcomes. SETTING community residents from Bordeaux City (France) older than 75 years in 2010. PARTICIPANTS 630 adults aged 75+ years who lived in Bordeaux and participated in the 10-year follow-up of the Three-City study. MEASUREMENTS GSs included physical frailty, cognitive impairment and dementia, dependency, depressive symptoms, polymedication, thinness, falls, sensory deficit, social isolation, incontinence. Age-related diseases were cancer, cardiac diseases, peripheral vascular diseases, diabetes, hypertension, pulmonary diseases, osteoporosis, other chronic diseases. Association of the MCA-derived independent dimensions was assessed with 10-year visit subjective health and well-being, and with incident death and entry into institution during the remaining cohort follow-up. RESULTS Most of the participants (82%) had at least two age-related syndromes or diseases. The MCA structured the 18 conditions into three major dimensions: Degradation (D) driven by GS, Vascular (V), and Psychosocial (P) representing 68.7%, 7.4%, and 5.7% of the total variance, respectively. Dimension D was a strong predictor of future death and institutionalization. Dimensions D and P were strongly associated with current well-being. CONCLUSIONS This work confirmed that multimorbidity is very common among older adults, and demonstrated the essential role of GS as manifestations of aging, even more than age-related diseases.
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Affiliation(s)
- J-F Dartigues
- Cécile Proust-Lima, Univ. Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France,
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23
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Du Preez A, Lefèvre-Arbogast S, González-Domínguez R, Houghton V, de Lucia C, Low DY, Helmer C, Féart C, Delcourt C, Proust-Lima C, Pallàs M, Sánchez-Pla A, Urpi-Sardà M, Ruigrok SR, Altendorfer B, Aigner L, Lucassen PJ, Korosi A, Manach C, Andres-Lacueva C, Samieri C, Thuret S. Impaired hippocampal neurogenesis in vitro is modulated by dietary-related endogenous factors and associated with depression in a longitudinal ageing cohort study. Mol Psychiatry 2022; 27:3425-3440. [PMID: 35794184 PMCID: PMC7613865 DOI: 10.1038/s41380-022-01644-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 12/20/2022]
Abstract
Environmental factors like diet have been linked to depression and/or relapse risk in later life. This could be partially driven by the food metabolome, which communicates with the brain via the circulatory system and interacts with hippocampal neurogenesis (HN), a form of brain plasticity implicated in depression aetiology. Despite the associations between HN, diet and depression, human data further substantiating this hypothesis are largely missing. Here, we used an in vitro model of HN to test the effects of serum samples from a longitudinal ageing cohort of 373 participants, with or without depressive symptomology. 1% participant serum was applied to human fetal hippocampal progenitor cells, and changes in HN markers were related to the occurrence of depressive symptoms across a 12-year period. Key nutritional, metabolomic and lipidomic biomarkers (extracted from participant plasma and serum) were subsequently tested for their ability to modulate HN. In our assay, we found that reduced cell death and increased neuronal differentiation were associated with later life depressive symptomatology. Additionally, we found impairments in neuronal cell morphology in cells treated with serum from participants experiencing recurrent depressive symptoms across the 12-year period. Interestingly, we found that increased neuronal differentiation was modulated by increased serum levels of metabolite butyrylcarnitine and decreased glycerophospholipid, PC35:1(16:0/19:1), levels - both of which are closely linked to diet - all in the context of depressive symptomology. These findings potentially suggest that diet and altered HN could subsequently shape the trajectory of late-life depressive symptomology.
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Affiliation(s)
- Andrea Du Preez
- grid.13097.3c0000 0001 2322 6764Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 9NU UK
| | - Sophie Lefèvre-Arbogast
- grid.508062.90000 0004 8511 8605University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
| | - Raúl González-Domínguez
- grid.5841.80000 0004 1937 0247Nutrition, Food Science and Gastronomy Department, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 0828 Barcelona, Spain
| | - Vikki Houghton
- grid.13097.3c0000 0001 2322 6764Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 9NU UK
| | - Chiara de Lucia
- grid.13097.3c0000 0001 2322 6764Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 9NU UK
| | - Dorrain Y. Low
- Université Clermont Auvergne, INRA, UMR1019, Human Nutrition Unit, F-63000 Clermont Ferrand, France
| | - Catherine Helmer
- grid.508062.90000 0004 8511 8605University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
| | - Catherine Féart
- grid.508062.90000 0004 8511 8605University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
| | - Cécile Delcourt
- grid.508062.90000 0004 8511 8605University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
| | - Cécile Proust-Lima
- grid.508062.90000 0004 8511 8605University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
| | - Mercè Pallàs
- grid.5841.80000 0004 1937 0247Pharmacology Section, Department of Pharmacology, Toxicology and Medicinal Chemistry, Faculty of Pharmacy and Food Sciences, and Institute of Neurosciences, University of Barcelona, Av. Joan XXIII, 27-31, E-08028 Barcelona, Spain
| | - Alex Sánchez-Pla
- grid.5841.80000 0004 1937 0247Nutrition, Food Science and Gastronomy Department, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 0828 Barcelona, Spain
| | - Mireia Urpi-Sardà
- grid.5841.80000 0004 1937 0247Nutrition, Food Science and Gastronomy Department, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 0828 Barcelona, Spain
| | - Silvie R. Ruigrok
- grid.7177.60000000084992262Brain Plasticity Group, Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, 1098 XH Amsterdam, The Netherlands
| | - Barbara Altendorfer
- grid.21604.310000 0004 0523 5263Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, 5020 Austria
| | - Ludwig Aigner
- grid.21604.310000 0004 0523 5263Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, 5020 Austria
| | - Paul J. Lucassen
- grid.7177.60000000084992262Brain Plasticity Group, Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, 1098 XH Amsterdam, The Netherlands
| | - Aniko Korosi
- grid.7177.60000000084992262Brain Plasticity Group, Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, 1098 XH Amsterdam, The Netherlands
| | - Claudine Manach
- Université Clermont Auvergne, INRA, UMR1019, Human Nutrition Unit, F-63000 Clermont Ferrand, France
| | - Cristina Andres-Lacueva
- grid.5841.80000 0004 1937 0247Nutrition, Food Science and Gastronomy Department, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 0828 Barcelona, Spain
| | - Cécilia Samieri
- grid.508062.90000 0004 8511 8605University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
| | - Sandrine Thuret
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9NU, UK. .,Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany.
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Foubert-Samier A, Pavy-Le Traon A, Saulnier T, Le-Goff M, Fabbri M, Helmer C, Rascol O, Proust-Lima C, Meissner WG. An Item Response Theory analysis of the Unified Multiple System Atrophy Rating Scale. Parkinsonism Relat Disord 2021; 94:40-44. [PMID: 34875563 DOI: 10.1016/j.parkreldis.2021.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/11/2021] [Revised: 11/03/2021] [Accepted: 11/21/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The Unified Multiple System Atrophy Rating Scale (UMSARS) has four subscales that have been specifically designed for the clinical assessment of MSA patients. UMSARS I (activities of daily living) and II (motor examination) subscales are regularly used as primary endpoints in treatment trials. The main objective of this study was to identify UMSARS I and II subscale items that best describe progression over time. METHODS All MSA patients seen at the French Reference Centre for MSA from 2007 to 2020 were included in a prospective cohort with an annual follow-up assessment including UMSARS. The repeated measures of the 26 UMSARS I and II items were analyzed using a longitudinal Item Response Theory model to identify the most informative items for each of the five UMSARS IV disease stages. Sample size estimates were further calculated for the most informative items as a group. RESULTS A total of 557 MSA patients were included with a mean follow-up of 2.3 years. The majority of items progressed with disease duration or across the different UMSARS IV disability stages, with the exception of those related to dysautonomia. Roughly 70% of the scale information was carried by only 11/26 items, many reflecting the patient perspective. These yielded similar sample size estimates than UMSARS I + II items. CONCLUSION This study provides important information about the progression of UMSARS I and II subscale items. Improvements seem particularly necessary regarding those assessing dysautonomia. A shortened scale may be useful as outcome for future clinical trials.
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Affiliation(s)
- Alexandra Foubert-Samier
- French Reference Centre for MSA, University Hospital Bordeaux, Bordeaux, France; Univ. Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France; Inserm, CIC 1401 Bordeaux, Clinical Epidemiology Unit, F-33000 Bordeaux, France; Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux University, Bordeaux, France.
| | - Anne Pavy-Le Traon
- French Reference Centre for MSA, University Hospital Toulouse, Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, Inserm U 1297, Toulouse University, Toulouse, France
| | - Tiphaine Saulnier
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France; Inserm, CIC 1401 Bordeaux, Clinical Epidemiology Unit, F-33000 Bordeaux, France
| | - Mélanie Le-Goff
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France
| | - Margherita Fabbri
- French Reference Centre for MSA, University Hospital Toulouse, Toulouse, France; Inserm, Toulouse University and CHU Toulouse, Clinical Investigation Center, CIC 1436, NS-Park/F-CRIN Network, NeuroToul COEN Center, and Departments of Neurosciences and Clinical Pharmacology, Toulouse, France
| | - Catherine Helmer
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France; Inserm, CIC 1401 Bordeaux, Clinical Epidemiology Unit, F-33000 Bordeaux, France
| | - Olivier Rascol
- French Reference Centre for MSA, University Hospital Toulouse, Toulouse, France; Inserm, Toulouse University and CHU Toulouse, Clinical Investigation Center, CIC 1436, NS-Park/F-CRIN Network, NeuroToul COEN Center, and Departments of Neurosciences and Clinical Pharmacology, Toulouse, France
| | - Cécile Proust-Lima
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France; Inserm, CIC 1401 Bordeaux, Clinical Epidemiology Unit, F-33000 Bordeaux, France
| | - Wassilios G Meissner
- French Reference Centre for MSA, University Hospital Bordeaux, Bordeaux, France; Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux University, Bordeaux, France; Dept. Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
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25
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Wagner M, Grodstein F, Leffondre K, Samieri C, Proust-Lima C. Time-varying associations between an exposure history and a subsequent health outcome: a landmark approach to identify critical windows. BMC Med Res Methodol 2021; 21:266. [PMID: 34837966 PMCID: PMC8627635 DOI: 10.1186/s12874-021-01403-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022] Open
Abstract
Background Long-term behavioral and health risk factors constitute a primary focus of research on the etiology of chronic diseases. Yet, identifying critical time-windows during which risk factors have the strongest impact on disease risk is challenging. To assess the trajectory of association of an exposure history with an outcome, the weighted cumulative exposure index (WCIE) has been proposed, with weights reflecting the relative importance of exposures at different times. However, WCIE is restricted to a complete observed error-free exposure whereas exposures are often measured with intermittent missingness and error. Moreover, it rarely explores exposure history that is very distant from the outcome as usually sought in life-course epidemiology. Methods We extend the WCIE methodology to (i) exposures that are intermittently measured with error, and (ii) contexts where the exposure time-window precedes the outcome time-window using a landmark approach. First, the individual exposure history up to the landmark time is estimated using a mixed model that handles missing data and error in exposure measurement, and the predicted complete error-free exposure history is derived. Then the WCIE methodology is applied to assess the trajectory of association between the predicted exposure history and the health outcome collected after the landmark time. In our context, the health outcome is a longitudinal marker analyzed using a mixed model. Results A simulation study first demonstrates the correct inference obtained with this approach. Then, applied to the Nurses’ Health Study (19,415 women) to investigate the association between body mass index history (collected from midlife) and subsequent cognitive decline (evaluated after age 70), the method identified two major critical windows of association: long before the first cognitive evaluation (roughly 24 to 12 years), higher levels of BMI were associated with poorer cognition. In contrast, adjusted for the whole history, higher levels of BMI became associated with better cognition in the last years prior to the first cognitive interview, thus reflecting reverse causation (changes in exposure due to underlying disease). Conclusions This approach, easy to implement, provides a flexible tool for studying complex dynamic relationships and identifying critical time windows while accounting for exposure measurement errors. Supplementary Information The online version contains supplementary material available at (10.1186/s12874-021-01403-w).
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Affiliation(s)
- Maude Wagner
- BPH Research Center, Inserm U1219, Bordeaux University, 146 rue Léo-Saignat, Bordeaux, France.
| | - Francine Grodstein
- RUSH Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Karen Leffondre
- BPH Research Center, Inserm U1219, Bordeaux University, 146 rue Léo-Saignat, Bordeaux, France
| | - Cécilia Samieri
- BPH Research Center, Inserm U1219, Bordeaux University, 146 rue Léo-Saignat, Bordeaux, France
| | - Cécile Proust-Lima
- BPH Research Center, Inserm U1219, Bordeaux University, 146 rue Léo-Saignat, Bordeaux, France
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Carles S, Taddé BO, Berr C, Helmer C, Jacqmin-Gadda H, Carrière I, Proust-Lima C. Dynamic reciprocal relationships between cognitive and functional declines along the Alzheimer's disease continuum in the prospective COGICARE study. Alzheimers Res Ther 2021; 13:148. [PMID: 34479648 PMCID: PMC8418020 DOI: 10.1186/s13195-021-00887-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 08/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Thoroughly understanding the temporal associations between cognitive and functional dimensions along the dementia process is fundamental to define preventive measures likely to delay the disease's onset. This work aimed to finely describe the trajectories of cognitive and functional declines, and assess their dynamic bidirectional relationships among subjects at different stages of the dementia process. METHODS We leveraged extensive repeated data of cognition and functional dependency from the French prospective COGICARE study, designed to better characterize the natural history of cognitive and functional declines around dementia diagnosis. Cognition was measured by the Mini-Mental State Examination, the Isaacs Set Test for verbal fluency, the Benton Visual Retention Test for visuo-spatial memory, and Trail Making Test Part B for executive functioning. Functional dependency was measured by basic and instrumental activities of daily living. The study included 102 cognitively normal, 123 mildly cognitively impaired, and 72 dementia cases with a median of 5 repeated visits over up to 57 months. We used a dynamic causal model which addresses the two essential issues in temporal associations assessment: focusing on intra-individual change and accounting for time. RESULTS Better cognitive abilities were associated with lower subsequent decline of the functional level among the three clinical stages with an intensification over time but no reciprocity of the association whatever the clinical status. CONCLUSION This work confirms that the progressive functional dependency could be induced by cognitive impairment. Subjects identified as early as possible with clinically significant cognitive impairments could benefit from preventive measures before the deterioration of activities of daily living and the appearance of dementia clinical signs.
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Affiliation(s)
- Sophie Carles
- Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, F-34091, Montpellier, France
| | | | - Claudine Berr
- Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, F-34091, Montpellier, France
| | | | | | - Isabelle Carrière
- Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, F-34091, Montpellier, France
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Du Preez A, Lefèvre-Arbogast S, Houghton V, de Lucia C, Low DY, Helmer C, Féart C, Delcourt C, Proust-Lima C, Pallàs M, Ruigrok SR, Altendorfer B, González-Domínguez R, Sánchez-Pla A, Urpi-Sardà M, Andres-Lacueva C, Aigner L, Lucassen PJ, Korosi A, Manach C, Samieri C, Thuret S. The serum metabolome mediates the concert of diet, exercise, and neurogenesis, determining the risk for cognitive decline and dementia. Alzheimers Dement 2021; 18:654-675. [PMID: 34402599 DOI: 10.1002/alz.12428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Diet and exercise influence the risk of cognitive decline (CD) and dementia through the food metabolome and exercise-triggered endogenous factors, which use the blood as a vehicle to communicate with the brain. These factors might act in concert with hippocampal neurogenesis (HN) to shape CD and dementia. METHODS Using an in vitro neurogenesis assay, we examined the effects of serum samples from a longitudinal cohort (n = 418) on proxy HN readouts and their association with future CD and dementia across a 12-year period. RESULTS Altered apoptosis and reduced hippocampal progenitor cell integrity were associated with exercise and diet and predicted subsequent CD and dementia. The effects of exercise and diet on CD specifically were mediated by apoptosis. DISCUSSION Diet and exercise might influence neurogenesis long before the onset of CD and dementia. Alterations in HN could signify the start of the pathological process and potentially represent biomarkers for CD and dementia.
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Affiliation(s)
- Andrea Du Preez
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sophie Lefèvre-Arbogast
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Vikki Houghton
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chiara de Lucia
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dorrain Y Low
- Pharmacology Section, Department of Pharmacology, Toxicology and Medicinal Chemistry, Pharmacy and Food Sciences, and Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Catherine Helmer
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Catherine Féart
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Cécile Delcourt
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Cécile Proust-Lima
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Mercè Pallàs
- Pharmacology Section, Department of Pharmacology, Toxicology and Medicinal Chemistry, Pharmacy and Food Sciences, and Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Silvie R Ruigrok
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, The Netherlands
| | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria
| | - Raúl González-Domínguez
- Nutrition, Food Science and Gastronomy Department, Pharmacy and Food Science, University of Barcelona, Spain.,CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Barcelona, Spain
| | - Alex Sánchez-Pla
- Nutrition, Food Science and Gastronomy Department, Pharmacy and Food Science, University of Barcelona, Spain.,CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Barcelona, Spain
| | - Mireia Urpi-Sardà
- Nutrition, Food Science and Gastronomy Department, Pharmacy and Food Science, University of Barcelona, Spain.,CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Barcelona, Spain
| | - Cristina Andres-Lacueva
- Nutrition, Food Science and Gastronomy Department, Pharmacy and Food Science, University of Barcelona, Spain.,CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Barcelona, Spain
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria
| | - Paul J Lucassen
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, The Netherlands
| | - Aniko Korosi
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, The Netherlands
| | - Claudine Manach
- Université Clermont Auvergne, INRA, UMR1019, Human Nutrition Unit, France
| | - Cécilia Samieri
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Sandrine Thuret
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Edjolo A, Dartigues JF, Pérès K, Proust-Lima C. Heterogeneous Long-Term Trajectories of Dependency in Older Adults: The PAQUID Cohort, a Population-Based Study over 22 years. J Gerontol A Biol Sci Med Sci 2021; 75:2396-2403. [PMID: 32115657 DOI: 10.1093/gerona/glaa057] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A critical step toward successful aging is to identify opportunities for prevention of functional decline. Our aim was to describe the heterogeneity in trajectories of dependency preceding death in elders and to identify factors associated with this heterogeneity. METHODS The study relied on 3,238 participants of the prospective population-based PAQUID cohort aged 65+ at baseline in 1988. Dependency was defined from an 11-item scale of basic and instrumental activities of daily living (ADL: bathing, dressing, toileting, continence, eating, and transferring; instrumental activities of daily living (IADL): telephoning, shopping, using transport, handling medication, and managing finances) collected over 22 years. Heterogeneous trajectories were estimated using a longitudinal item response theory model including latent classes. RESULTS Five distinct profiles of functional dependency were identified over the two last decades of life: persistently high (12%), moderate (26%), persistently low (40%), and accelerated high dependency (15%), and no dependency (8%). Main factors associated with heterogeneity included age at death, sex, education, initial cognition (Mini-Mental State Examination [MMSE] score and dementia), initial disability, and poly-medication. CONCLUSIONS In the two last decades of life, more than 9 elders in 10 were characterized as functional decliners. On average, around half of the elders died with no or mild dependency, while 27% live several years with a high level of limitations and would need assistance in activities of daily living, at least for 2-4 years preceding death. The identified factors associated with these trajectories are important to understand functional heterogeneity in elders and to propose interventions to postpone or prevent "chronic" disability.
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Affiliation(s)
- Arlette Edjolo
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR, France
| | | | - Karine Pérès
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR, France
| | - Cécile Proust-Lima
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR, France
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29
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Thomas A, Proust-Lima C, Baillet M, Helmer C, Delcourt C, Foubert-Samier A, Catheline G, Féart C, Samieri C. Plasma carotenoids and medial temporal lobe atrophy in older adults. Clin Nutr 2021; 40:2460-2463. [PMID: 33558180 DOI: 10.1016/j.clnu.2020.09.056] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND & AIMS Carotenoids are vegetable pigments with neuroprotective properties. Clinical studies found efficacy of specific carotenoids on improving brain perfusion and functioning with aging. However, evidence of an effect on neurodegeneration, which may require longer follow-up period to observe, is more limited. Leveraging biomarkers from a large population-based cohort study of older adults, we investigated whether blood carotenoids were associated with atrophy of the medial temporal lobe (a biomarker of neurodegeneration in aging) over 10 years. METHODS This study included 461 dementia-free participants from the Three-City Bordeaux study (aged ≥65) who had plasma carotenoids measured at baseline and up to three repeated brain imaging exams in the subsequent 10 years. RESULTS In adjusted linear mixed models, each increase of 1 SD in plasma level of total carotenoids and of β-carotene was associated with 0.02 cm3 (95% CI, 0.001-0.04; P = 0.04) and 0.02 cm3 (95% CI, 0.01-0.04; P = 0.008) smaller medial temporal lobe volume loss per year, respectively. CONCLUSIONS Our results based on a unique long-term prospective evaluation of a neuroimaging biomarker suggest a beneficial role of carotenoids for the prevention of age-related neurodegeneration.
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Affiliation(s)
- Aline Thomas
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France.
| | | | - Marion Baillet
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France
| | | | - Cécile Delcourt
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France
| | - Alexandra Foubert-Samier
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France; Institut des Maladies Neurodégénératives, Bordeaux Univ. Hospital, F-33000, Bordeaux, France
| | - Gwénaëlle Catheline
- Univ. Bordeaux, CNRS, Institut de Neurosciences cognitives et intégratives d'Aquitaine, UMR 5287, EPHE-PSL, F-33000, Bordeaux, France
| | - Catherine Féart
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France
| | - Cécilia Samieri
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France
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Lefèvre-Arbogast S, Hejblum BP, Helmer C, Klose C, Manach C, Low DY, Urpi-Sarda M, Andres-Lacueva C, González-Domínguez R, Aigner L, Altendorfer B, Lucassen PJ, Ruigrok SR, De Lucia C, Du Preez A, Proust-Lima C, Thuret S, Korosi A, Samieri C. Early signature in the blood lipidome associated with subsequent cognitive decline in the elderly: A case-control analysis nested within the Three-City cohort study. EBioMedicine 2021; 64:103216. [PMID: 33508744 PMCID: PMC7841305 DOI: 10.1016/j.ebiom.2021.103216] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Brain lipid metabolism appears critical for cognitive aging, but whether alterations in the lipidome relate to cognitive decline remains unclear at the system level. METHODS We studied participants from the Three-City study, a multicentric cohort of older persons, free of dementia at time of blood sampling, and who provided repeated measures of cognition over 12 subsequent years. We measured 189 serum lipids from 13 lipid classes using shotgun lipidomics in a case-control sample on cognitive decline (matched on age, sex and level of education) nested within the Bordeaux study center (discovery, n = 418). Associations with cognitive decline were investigated using bootstrapped penalized regression, and tested for validation in the Dijon study center (validation, n = 314). FINDINGS Among 17 lipids identified in the discovery stage, lower levels of the triglyceride TAG50:5, and of four membrane lipids (sphingomyelin SM40:2,2, phosphatidylethanolamine PE38:5(18:1/20:4), ether-phosphatidylethanolamine PEO34:3(16:1/18:2), and ether-phosphatidylcholine PCO34:1(16:1/18:0)), and higher levels of PCO32:0(16:0/16:0), were associated with greater odds of cognitive decline, and replicated in our validation sample. INTERPRETATION These findings indicate that in the blood lipidome of non-demented older persons, a specific profile of lipids involved in membrane fluidity, myelination, and lipid rafts, is associated with subsequent cognitive decline. FUNDING The complete list of funders is available at the end of the manuscript, in the Acknowledgement section.
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Affiliation(s)
- Sophie Lefèvre-Arbogast
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, 146 rue Léo-Saignat, Bordeaux 33076, France
| | - Boris P Hejblum
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, 146 rue Léo-Saignat, Bordeaux 33076, France; Inria SISTM, Bordeaux Sud-Ouest, Bordeaux 33000, France
| | - Catherine Helmer
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, 146 rue Léo-Saignat, Bordeaux 33076, France
| | | | - Claudine Manach
- University of Clermont Auvergne, INRA, UMR1019, Human Nutrition Unit, Clermont Ferrand 63000, France
| | - Dorrain Y Low
- University of Clermont Auvergne, INRA, UMR1019, Human Nutrition Unit, Clermont Ferrand 63000, France
| | - Mireia Urpi-Sarda
- Nutrition, Food Science and Gastronomy Department, Faculty of Pharmacy and Food Science, CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, University of Barcelona, Barcelona 08028, Spain
| | - Cristina Andres-Lacueva
- Nutrition, Food Science and Gastronomy Department, Faculty of Pharmacy and Food Science, CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, University of Barcelona, Barcelona 08028, Spain
| | - Raúl González-Domínguez
- Nutrition, Food Science and Gastronomy Department, Faculty of Pharmacy and Food Science, CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, University of Barcelona, Barcelona 08028, Spain
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg 5020, Austria
| | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg 5020, Austria
| | - Paul J Lucassen
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam 1098 XH, Netherlands
| | - Silvie R Ruigrok
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam 1098 XH, Netherlands
| | - Chiara De Lucia
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 9NU, United Kingdom
| | - Andrea Du Preez
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 9NU, United Kingdom
| | - Cécile Proust-Lima
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, 146 rue Léo-Saignat, Bordeaux 33076, France
| | - Sandrine Thuret
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 9NU, United Kingdom; Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Aniko Korosi
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam 1098 XH, Netherlands
| | - Cécilia Samieri
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, 146 rue Léo-Saignat, Bordeaux 33076, France.
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Faucon AL, Leffondré K, Flamant M, Metzger M, Boffa JJ, Haymann JP, Houillier P, Thervet E, Vrtovsnik F, Proust-Lima C, Stengel B, Vidal-Petiot E, Geri G. Trajectory of extracellular fluid volume over time and subsequent risks of end-stage kidney disease and mortality in chronic kidney disease: a prospective cohort study. J Intern Med 2021; 289:193-205. [PMID: 32654192 DOI: 10.1111/joim.13151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/23/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extracellular fluid volume (ECF) is independently associated with chronic kidney disease (CKD) progression and mortality in patients with CKD, but the prognostic value of the trajectory of ECF over time beyond that of baseline value is unknown. OBJECTIVES To characterize ECF trajectory and evaluate its association with the risks of end-stage kidney disease (ESKD) and mortality. METHODS From the prospective tricentric NephroTest cohort, we included 1588 patients with baseline measured glomerular filtration rate (mGFR) ≥15 mL min-1 /1.73 m2 and ECF measurement. ECF and GFR were measured repeatedly using the distribution volume and clearance of 51 Cr-EDTA, respectively. ESKD and mortality were traced through record linkage with the national registries. Adjusted shared random-effect joint models were used to analyse the association between the trajectory of ECF over time and the two competing outcomes. RESULTS Patients were mean age 58.7 years, 66.7% men, mean mGFR of 43.6 ± 18.6 mL min-1 /1.73 m2 and mean ECF of 16.1 ± 3.6 L. Over a median follow-up of 5.3 [IQR: 3.0;7.4] years, ECF increased by 136 [95%CI 106;167] mL per year on average, whilst diuretic prescription and 24-hour urinary sodium excretion remained stable. ESKD occurred in 324 (20.4%) patients, and 185 (11.6%) patients died before ESKD. A higher current value of ECF was associated with increased hazards of ESKD (adjusted hazard ratio [aHR]: 1.12 [95%CI 1.06;1.18]; P < 0.001 per 1 L increase in ECF), and death before ESKD (aHR: 1.10 [95%CI 1.04;1.17]; P = 0.002). CONCLUSIONS The current value of ECF was associated with the risks of ESKD and mortality, independent of multiple potential confounders, including kidney function decline. This highlights the need for a close monitoring and adjustment of treatment to avoid fluid overload in CKD patients.
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Affiliation(s)
- A-L Faucon
- From the, Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR 1018, Renal and Cardiovascular Epidemiology, Université Paris-Saclay, Paris, France
| | - K Leffondré
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, ISPED, Bordeaux, France
| | - M Flamant
- Department of Physiology, AP-HP, Hôpital Bichat and INSERM U1149, Paris, France.,Université de Paris, Paris, France
| | - M Metzger
- From the, Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR 1018, Renal and Cardiovascular Epidemiology, Université Paris-Saclay, Paris, France
| | - J-J Boffa
- Department of Nephrology, AP-HP, Hôpital Tenon, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - J-P Haymann
- Université Pierre et Marie Curie, Paris, France.,Department of Physiology, AP-HP, Hôpital Tenon, Paris, France
| | - P Houillier
- Université de Paris, Paris, France.,Department of Physiology, AP-HP, INSERM U1138, Centre de Recherche des Cordeliers, Hôpital Européen Georges Pompidou and Centre de Recherche des Cordeliers, Paris, France
| | - E Thervet
- Université de Paris, Paris, France.,Department of Nephrology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - F Vrtovsnik
- Université de Paris, Paris, France.,Department of Nephrology, AP-HP, Hôpital Bichat, Paris, France
| | - C Proust-Lima
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, ISPED, Bordeaux, France
| | - B Stengel
- From the, Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR 1018, Renal and Cardiovascular Epidemiology, Université Paris-Saclay, Paris, France
| | - E Vidal-Petiot
- Department of Physiology, AP-HP, Hôpital Bichat and INSERM U1149, Paris, France.,Université de Paris, Paris, France
| | - G Geri
- From the, Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR 1018, Renal and Cardiovascular Epidemiology, Université Paris-Saclay, Paris, France.,Medical Intensive Care Unit, AP-HP, Hôpital Ambroise Paré, Boulogne-Billancourt, France.,Université Paris-Saclay, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France
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Thomas A, Baillet M, Proust-Lima C, Féart C, Foubert-Samier A, Helmer C, Catheline G, Samieri C. Blood polyunsaturated omega-3 fatty acids, brain atrophy, cognitive decline, and dementia risk. Alzheimers Dement 2020; 17:407-416. [PMID: 33090665 DOI: 10.1002/alz.12195] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION We searched for consistent associations of an omega-3 index in plasma (sum of eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) with several dementia-related outcomes in a large cohort of older adults. METHODS We included 1279 participants from the Three-City study, non-demented at the time of blood measurements at baseline, with face-to-face neuropsychological assessment and systematic detection of incident dementia over a 17-year follow-up. An ancillary study included 467 participants with up to three repeated brain imaging exams over 10 years. RESULTS In multivariable models, higher levels of plasma EPA+DHA were consistently associated with a lower risk of dementia (hazard ratio for 1 standard deviation = 0.87 [95% confidence interval, 0.76-0.98]), and a lower decline in global cognition (P = .04 for change over time), memory (P = .06), and medial temporal lobe volume (P = .02). DISCUSSION This prospective study provides compelling evidence for a relationship between long-chain omega-3 fatty acids levels and lower risks for dementia and related outcomes.
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Affiliation(s)
- Aline Thomas
- INSERM, BPH, U1219, Univ. Bordeaux, Bordeaux, F-33000, France
| | - Marion Baillet
- INSERM, BPH, U1219, Univ. Bordeaux, Bordeaux, F-33000, France
| | | | - Catherine Féart
- INSERM, BPH, U1219, Univ. Bordeaux, Bordeaux, F-33000, France
| | - Alexandra Foubert-Samier
- INSERM, BPH, U1219, Univ. Bordeaux, Bordeaux, F-33000, France
- Institut des Maladies Neurodégénératives, Bordeaux Univ. Hospital, Bordeaux, F-33000, France
| | | | - Gwénaëlle Catheline
- CNRS, INCIA, UMR5287, Univ. Bordeaux, Bordeaux, F-33000, France
- Laboratoire Neuroimagerie et vie quotidienne, EPHE-PSL, Bordeaux, F-33000, France
| | - Cécilia Samieri
- INSERM, BPH, U1219, Univ. Bordeaux, Bordeaux, F-33000, France
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Kwint M, Stam B, Proust-Lima C, Philipps V, Hoekstra T, Aalbersberg E, Rossi M, Sonke JJ, Belderbos J, Walraven I. The prognostic value of volumetric changes of the primary tumor measured on Cone Beam-CT during radiotherapy for concurrent chemoradiation in NSCLC patients. Radiother Oncol 2020; 146:44-51. [DOI: 10.1016/j.radonc.2020.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/05/2019] [Accepted: 02/05/2020] [Indexed: 02/09/2023]
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Wagner M, Grodstein F, Proust-Lima C, Samieri C. Long-Term Trajectories of Body Weight, Diet, and Physical Activity From Midlife Through Late Life and Subsequent Cognitive Decline in Women. Am J Epidemiol 2020; 189:305-313. [PMID: 31781745 DOI: 10.1093/aje/kwz262] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 12/21/2022] Open
Abstract
Healthy lifestyles are promising targets for prevention of cognitive aging, yet the optimal time windows for interventions remain unclear. We selected a case-control sample nested within the Nurses' Health Study (starting year 1976, mean age = 51 years), including 14,956 women aged ≥70 years who were free of both stroke and cognitive impairment at enrollment in a cognitive substudy (1995-2001). Cases (n = 1,496) were women with the 10% worst slopes of cognitive decline, and controls (n = 7,478) were those with slopes better than the median. We compared the trajectories of body mass index (weight (kg)/height (m)2), alternate Mediterranean diet (A-MeDi) score, and physical activity between groups, from midlife through 1 year preceding the cognitive substudy. In midlife, cases had higher body mass index than controls (mean difference (MD) = 0.59 units, 95% confidence interval (CI): 0.39, 0.80), lower physical activity (MD = -1.41 metabolic equivalent of task-hours/week, 95% CI: -2.07, -0.71), and worse A-MeDi scores (MD = -0.16 points, 95% CI: -0.26, -0.06). From midlife through later life, compared with controls, cases had consistently lower A-MeDi scores but a deceleration of weight gain and a faster decrease in physical activity. In conclusion, maintaining a healthy lifestyle since midlife may help reduce cognitive decline in aging. At older ages, both deceleration of weight gain and a decrease in physical activity may reflect early signs of cognitive impairment.
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Affiliation(s)
- Maude Wagner
- Bordeaux Population Health Research Center, Institut National de la Santé et de la Recherche Médicale Unité 1219, and University of Bordeaux, Institut de Santé Publique d’Epidémiologie et de Développement, Bordeaux, France
| | - Francine Grodstein
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cécile Proust-Lima
- Bordeaux Population Health Research Center, Institut National de la Santé et de la Recherche Médicale Unité 1219, and University of Bordeaux, Institut de Santé Publique d’Epidémiologie et de Développement, Bordeaux, France
| | - Cécilia Samieri
- Bordeaux Population Health Research Center, Institut National de la Santé et de la Recherche Médicale Unité 1219, and University of Bordeaux, Institut de Santé Publique d’Epidémiologie et de Développement, Bordeaux, France
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Thomas A, Baillet M, Proust-Lima C, Féart C, Helmer C, Catheline G, Samieri C. Association entre les acides gras polyinsaturés oméga-3 à longue chaîne, l’atrophie cérébrale, le déclin cognitif et le risque de démence–cohorte des 3-Cités–Bordeaux. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Foubert-Samier A, Pavy-Le Traon A, Guillet F, Le-Goff M, Helmer C, Tison F, Rascol O, Proust-Lima C, Meissner WG. Disease progression and prognostic factors in multiple system atrophy: A prospective cohort study. Neurobiol Dis 2020; 139:104813. [PMID: 32087288 DOI: 10.1016/j.nbd.2020.104813] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 10/25/2022] Open
Abstract
Multiple system atrophy (MSA) is a rare neurodegenerative disease, with limited understanding of disease progression and prognostic factors. We leveraged the data of a large prospective cohort of MSA to study both clinical progression and survival and assess their determinants. All consecutive patients seen at the French Reference Centre for MSA since 2007 were included in a prospective cohort with an annual follow-up including the Unified MSA Rating Scale (UMSARS). We used joint models to evaluate the risk of death, the mean trajectory of each UMSARS subscale and to determine the potential factors. Investigated factors included gender, age at baseline, MSA subtype, diagnosis certainty, type of first symptoms and the duration between symptom onset and the first visit. Among the 261 MSA patients included in our cohort, the median duration of clinical follow-up was 2.1 years (up to 10.3 years) and the median survival was 4.0 years since the first visit. Main factors for poor survival were the progression over time of UMSARS score (I + II and IV) and the severity of orthostatic hypotension. MSA subtype had no effect on progression or survival. The UMSARS I + II score progressed faster over time in subjects with autonomic dysfunction as the initial feature and in women. Despite a faster progression, women and men had similar survival. From this large MSA cohort, we confirm the rapid progression and poor prognosis of MSA. We provide additional evidence for a negative impact of early autonomic dysfunction and the severity of orthostatic hypotension on both disease progression and survival.
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Affiliation(s)
- Alexandra Foubert-Samier
- French Reference Centre for MSA, University Hospital Bordeaux, Bordeaux, France; Inserm, UMR1219, Bordeaux Population Health Research Center, univ. Bordeaux, ISPED, F33000 Bordeaux, France; Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux University, Bordeaux, France.
| | - Anne Pavy-Le Traon
- French Reference Centre for MSA, University Hospital Toulouse, Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, Inserm U 1048, Toulouse University, Toulouse, France
| | - Florian Guillet
- Inserm, UMR1219, Bordeaux Population Health Research Center, univ. Bordeaux, ISPED, F33000 Bordeaux, France
| | - Mélanie Le-Goff
- Inserm, UMR1219, Bordeaux Population Health Research Center, univ. Bordeaux, ISPED, F33000 Bordeaux, France
| | - Catherine Helmer
- Inserm, UMR1219, Bordeaux Population Health Research Center, univ. Bordeaux, ISPED, F33000 Bordeaux, France; Inserm, CIC 1401 Bordeaux, Clinical Epidemiology Unit, F-33000 Bordeaux, France
| | - François Tison
- French Reference Centre for MSA, University Hospital Bordeaux, Bordeaux, France; Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux University, Bordeaux, France
| | - Olivier Rascol
- French Reference Centre for MSA, University Hospital Toulouse, Toulouse, France; Inserm, Toulouse University and CHU Toulouse, Clinical Investigation Center CIC 1436 and Departments of Neurosciences and Clinical Pharmacology, Toulouse, France
| | - Cécile Proust-Lima
- Inserm, UMR1219, Bordeaux Population Health Research Center, univ. Bordeaux, ISPED, F33000 Bordeaux, France; Inserm, CIC 1401 Bordeaux, Clinical Epidemiology Unit, F-33000 Bordeaux, France
| | - Wassilios G Meissner
- French Reference Centre for MSA, University Hospital Bordeaux, Bordeaux, France; Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux University, Bordeaux, France; Dept. Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
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Amieva H, Meillon C, Proust-Lima C, Dartigues JF. Is Low Psychomotor Speed a Marker of Brain Vulnerability in Late Life? Digit Symbol Substitution Test in the Prediction of Alzheimer, Parkinson, Stroke, Disability, and Depression. Dement Geriatr Cogn Disord 2020; 47:297-305. [PMID: 31466055 DOI: 10.1159/000500597] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 02/22/2019] [Accepted: 04/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dementia, stroke, depression, and disability are frequent in late life and are major causes of quality of life disruption and family burden. Even though each of these disorders relies on specific pathogenic processes, a common clinical manifestation is psychomotor slowing. OBJECTIVE We assessed the relevance of a simple marker of low psychomotor speed in predicting several brain outcomes: dementia, Alzheimer's disease (AD), Parkinson's disease (PD), stroke, depressive symptoms, and disability in activities of daily living (ADL) and instrumental ADL (IADL). METHODS PAQUID is a population-based study involving 3,777 individuals aged 65 or older prospectively followed-up with repeated clinical evaluations. After 10 years, 437 participants developed dementia, 333 developed AD, 71 developed PD, 207 reported incident stroke, 404 developed disability in ADL, 994 in IADL, and 494 developed depressive symptomology. Psychomotor speed was measured with the digit symbol substitution test (DSST). Cox proportional hazards models controlled for several confounders assessed the risk of incident outcomes. RESULTS Participants with low DSST performance had increased risk of incident all-type dementia (hazard ratio [HR] 3.41, p < 0.0001) and AD-type dementia (HR 3.18, p < 0.0001). Higher risk for PD (HR 2.98, p = 0.04), IADL (HR 1.82, p < 0.0001), ADL disability (HR 1.95, p = 0.001), depressive symptoms (HR 1.53, p = 0.03), and a statistical trend for stroke (HR 1.88, p = 0.09) was also found. CONCLUSION Low psychomotor speed is associated with an increased risk of developing various brain outcomes: dementia, AD, PD, disability, depressive symptoms, and marginally stroke. Low psychomotor speed may be the consequence of a number of discrete cerebral abnormalities and could be considered as a marker of brain vulnerability. In clinical practice, a low score in DSST should be seen as a warning sign of possible negative evolution.
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Affiliation(s)
- Hélène Amieva
- INSERM, U1219, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France,
| | - Céline Meillon
- INSERM, U1219, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| | - Cécile Proust-Lima
- INSERM, U1219, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
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Taddé BO, Jacqmin-Gadda H, Dartigues JF, Commenges D, Proust-Lima C. Dynamic modeling of multivariate dimensions and their temporal relationships using latent processes: Application to Alzheimer's disease. Biometrics 2019; 76:886-899. [PMID: 31647111 DOI: 10.1111/biom.13168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 06/10/2018] [Revised: 09/20/2019] [Accepted: 10/16/2019] [Indexed: 11/28/2022]
Abstract
Alzheimer's disease gradually affects several components including the cerebral dimension with brain atrophies, the cognitive dimension with a decline in various functions, and the functional dimension with impairment in the daily living activities. Understanding how such dimensions interconnect is crucial for Alzheimer's disease research. However, it requires to simultaneously capture the dynamic and multidimensional aspects and to explore temporal relationships between dimensions. We propose an original dynamic structural model that accounts for all these features. The model defines dimensions as latent processes and combines a multivariate linear mixed model and a system of difference equations to model trajectories and temporal relationships between latent processes in finely discrete time. Dimensions are simultaneously related to their observed (possibly multivariate) markers through nonlinear equations of observation. Parameters are estimated in the maximum likelihood framework enjoying a closed form for the likelihood. We demonstrate in a simulation study that this dynamic model in discrete time benefits the same causal interpretation of temporal relationships as models defined in continuous time as long as the discretization step remains small. The model is then applied to the data of the Alzheimer's Disease Neuroimaging Initiative. Three longitudinal dimensions (cerebral anatomy, cognitive ability, and functional autonomy) measured by six markers are analyzed, and their temporal structure is contrasted between different clinical stages of Alzheimer's disease.
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Affiliation(s)
- Bachirou O Taddé
- INSERM, Bordeaux Population Health Research Center, UMR1219, University of Bordeaux, ISPED, Bordeaux, France
| | - Hélène Jacqmin-Gadda
- INSERM, Bordeaux Population Health Research Center, UMR1219, University of Bordeaux, ISPED, Bordeaux, France
| | - Jean-François Dartigues
- INSERM, Bordeaux Population Health Research Center, UMR1219, University of Bordeaux, ISPED, Bordeaux, France
| | - Daniel Commenges
- INSERM, Bordeaux Population Health Research Center, UMR1219, University of Bordeaux, ISPED, Bordeaux, France
| | - Cécile Proust-Lima
- INSERM, Bordeaux Population Health Research Center, UMR1219, University of Bordeaux, ISPED, Bordeaux, France
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Proust-Lima C, Philipps V, Dartigues JF. A joint model for multiple dynamic processes and clinical endpoints: Application to Alzheimer's disease. Stat Med 2019; 38:4702-4717. [PMID: 31386222 DOI: 10.1002/sim.8328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/12/2019] [Accepted: 06/28/2019] [Indexed: 12/24/2022]
Abstract
As other neurodegenerative diseases, Alzheimer's disease, the most frequent dementia in the elderly, is characterized by multiple progressive impairments in the brain structure and in clinical functions such as cognitive functioning and functional disability. Until recently, these components were mostly studied independently because no joint model for multivariate longitudinal data and time to event was available in the statistical community. Yet, these components are fundamentally interrelated in the degradation process toward dementia and should be analyzed together. We thus propose a joint model to simultaneously describe the dynamics of multiple correlated components. Each component, defined as a latent process, is measured by one or several continuous markers (not necessarily Gaussian). Rather than considering the associated time to diagnosis as in standard joint models, we assume diagnosis corresponds to the passing above a covariate-specific threshold (to be estimated) of a pathological process that is modeled as a combination of the component-specific latent processes. This definition captures the clinical complexity of diagnoses such as dementia diagnosis but also benefits from simplifications for the computation of maximum likelihood estimates. We show that the model and estimation procedure can also handle competing clinical endpoints. The estimation procedure, implemented in an R package, is validated by simulations and the method is illustrated on a large French population-based cohort of cerebral aging in which we focused on the dynamics of three clinical manifestations and the associated risk of dementia and death before dementia.
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Affiliation(s)
- Cécile Proust-Lima
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, F-33000, Bordeaux, France
| | - Viviane Philipps
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, F-33000, Bordeaux, France
| | - Jean-François Dartigues
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, F-33000, Bordeaux, France
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Low DY, Lefèvre-Arbogast S, González-Domínguez R, Urpi-Sarda M, Micheau P, Petera M, Centeno D, Durand S, Pujos-Guillot E, Korosi A, Lucassen PJ, Aigner L, Proust-Lima C, Hejblum BP, Helmer C, Andres-Lacueva C, Thuret S, Samieri C, Manach C. Diet-Related Metabolites Associated with Cognitive Decline Revealed by Untargeted Metabolomics in a Prospective Cohort. Mol Nutr Food Res 2019; 63:e1900177. [PMID: 31218777 PMCID: PMC6790579 DOI: 10.1002/mnfr.201900177] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 02/14/2019] [Revised: 05/24/2019] [Indexed: 12/21/2022]
Abstract
Scope Untargeted metabolomics may reveal preventive targets in cognitive aging, including within the food metabolome. Methods and results
A case‐control study nested in the prospective Three‐City study includes participants aged ≥65 years and initially free of dementia. A total of 209 cases of cognitive decline and 209 controls (matched for age, gender, education) with slower cognitive decline over up to 12 years are contrasted. Using untargeted metabolomics and bootstrap‐enhanced penalized regression, a baseline serum signature of 22 metabolites associated with subsequent cognitive decline is identified. The signature includes three coffee metabolites, a biomarker of citrus intake, a cocoa metabolite, two metabolites putatively derived from fish and wine, three medium‐chain acylcarnitines, glycodeoxycholic acid, lysoPC(18:3), trimethyllysine, glucose, cortisol, creatinine, and arginine. Adding the 22 metabolites to a reference predictive model for cognitive decline (conditioned on age, gender, education and including ApoE‐ε4, diabetes, BMI, and number of medications) substantially increases the predictive performance: cross‐validated Area Under the Receiver Operating Curve = 75% [95% CI 70–80%] compared to 62% [95% CI 56–67%]. Conclusions The untargeted metabolomics study supports a protective role of specific foods (e.g., coffee, cocoa, fish) and various alterations in the endogenous metabolism responsive to diet in cognitive aging.
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Affiliation(s)
- Dorrain Yanwen Low
- Human Nutrition Unit, INRA, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Sophie Lefèvre-Arbogast
- Bordeaux Population Health Research Center, Inserm, University of Bordeaux, UMR 1219, F-33000, Bordeaux, France
| | - Raúl González-Domínguez
- Nutrition, Food Science and Gastronomy Department, Faculty of Pharmacy and Food Science, CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, University of Barcelona, Av Joan XXIII 27-31, 08028, Barcelona, Spain
| | - Mireia Urpi-Sarda
- Nutrition, Food Science and Gastronomy Department, Faculty of Pharmacy and Food Science, CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, University of Barcelona, Av Joan XXIII 27-31, 08028, Barcelona, Spain
| | - Pierre Micheau
- Human Nutrition Unit, INRA, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Melanie Petera
- Université Clermont Auvergne, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, F-63000, Clermont-Ferrand, France
| | - Delphine Centeno
- Université Clermont Auvergne, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, F-63000, Clermont-Ferrand, France
| | - Stephanie Durand
- Université Clermont Auvergne, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, F-63000, Clermont-Ferrand, France
| | - Estelle Pujos-Guillot
- Université Clermont Auvergne, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, F-63000, Clermont-Ferrand, France
| | - Aniko Korosi
- Brain Plasticity Group, SILS-CNS, University of Amsterdam, Science Park 904, 1098 XH, Amsterdam, The Netherlands
| | - Paul J Lucassen
- Brain Plasticity Group, SILS-CNS, University of Amsterdam, Science Park 904, 1098 XH, Amsterdam, The Netherlands
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, 5020, Austria
| | - Cécile Proust-Lima
- Bordeaux Population Health Research Center, Inserm, University of Bordeaux, UMR 1219, F-33000, Bordeaux, France
| | | | - Catherine Helmer
- Bordeaux Population Health Research Center, Inserm, University of Bordeaux, UMR 1219, F-33000, Bordeaux, France
| | - Cristina Andres-Lacueva
- Nutrition, Food Science and Gastronomy Department, Faculty of Pharmacy and Food Science, CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, University of Barcelona, Av Joan XXIII 27-31, 08028, Barcelona, Spain
| | - Sandrine Thuret
- Department of Basic and Clinical Neuroscience, Maurice Wohl Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9NU, UK
| | - Cécilia Samieri
- Bordeaux Population Health Research Center, Inserm, University of Bordeaux, UMR 1219, F-33000, Bordeaux, France
| | - Claudine Manach
- Human Nutrition Unit, INRA, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
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Lespinasse J, Proust-Lima C, Mangin JF, Bertin H, Pasquier F, Ousset PJ, Dubois B, Blanc F, Hanon O, Paquet C, Tison F, Gabelle A, Ceccaldi M, Annweiler C, David R, Godefroy O, Rouch-Leroyer I, Benetos A, Moreaud O, Sellal F, Jalenques I, Vandel P, Habert MO, Chupin M, Chêne G, Dufouil C. O1‐06‐04: ASSOCIATION BETWEEN HYPERTENSION AND ALZHEIMER'S DISEASE AND RELATED CAUSES OF DEMENTIA: A PATHWAYS ANALYSIS IN THE MEMENTO COHORT. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4550] [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: 10/25/2022]
Affiliation(s)
- Jérémie Lespinasse
- Bordeaux University Hospital Bordeaux France
- Centre INSERM, Institut de Santé Publique d'Epidémiologie et de Développement, Bordeaux School of Public Health Université de Bordeaux Bordeaux France
| | - Cécile Proust-Lima
- Centre INSERM, Institut de Santé Publique d'Epidémiologie et de Développement, Bordeaux School of Public Health Université de Bordeaux Bordeaux France
| | - Jean-Francois Mangin
- Neurospin, CEA Paris Saclay University Gif-sur-Yvette France
- CATI Multicenter Neuroimaging Platform Paris France
| | - Hugo Bertin
- CATI Multicenter Neuroimaging Platform Paris France
| | | | | | - Bruno Dubois
- Sorbonne Université AP-HP, Alzheimer Precision Medicine, Hôpital de la Pitié-Salpêtrière Paris France
| | - Frederic Blanc
- Memory Resource and Research Center of Strasbourg Hôpitaux Universitaires de Strasbourg Strasbourg France
| | - Olivier Hanon
- Memory Resource and Research Center of Paris Broca AP-HP, Hôpital Broca Paris France
| | - Claire Paquet
- Memory Resource and Research Center of Paris Nord, AP-HP Groupe Hospitalier Saint-Louis Lariboisière Fernand Widal Paris France
| | - François Tison
- Memory Resource and Research Center of Bordeaux, CHU de Bordeaux Hôpital Pellegrin Bordeaux France
| | - Audrey Gabelle
- Memory Resource and Research Center of Montpellier, CHU de Montpellier Hôpital Gui de Chauliac Montpellier France
| | - Mathieu Ceccaldi
- Memory Resource and Research Center of Marseille, CHU de Marseille Hôpital de La Timone Marseille France
| | - Cedric Annweiler
- Memory Resource and Research Center of Angers CHU d'Angers Angers France
| | - Renaud David
- Memory Resource and Research Center of Nice, CHU de Nice Institut Claude Pompidou Nice France
| | - Olivier Godefroy
- Memory Resource and Research Center of Amiens, CHU Amiens Picardie Hôpital Nord Amiens France
| | - Isabelle Rouch-Leroyer
- Memory Resource and Research Center of Saint-Etienne, CHU de Saint-Etienne Hôpital Nord Saint-Etienne France
| | | | - Olivier Moreaud
- Memory Resource and Research Center of Grenoble, CHU de Grenoble Alpes Hôpital de la Tronche Grenoble France
| | - François Sellal
- Memory Resource and Research Center of Strasbourg/Colmar Hôpitaux Civils de Colmar Colmar France
| | - Isabelle Jalenques
- Memory Resource and Research Center of Clermont-Ferrand CHU de Clermont-Ferrand Clermont-Ferrand France
| | - Pierre Vandel
- Memory Resource and Research Center of Besançon, CHU de Besançon Hôpital Jean Minjoz, Hôpital Saint-Jacques Besançon France
| | - Marie-Odile Habert
- CATI Multicenter Neuroimaging Platform Paris France
- Laboratoire d'Imagerie Biomédicale Sorbonne Universités, UPMC Univ Paris 06, INSERM, CNRS Paris France
| | - Marie Chupin
- CATI Multicenter Neuroimaging Platform Paris France
- Sorbonne Universités, UPMC, Universite Paris, INSERM, CNRS, Institut du Cerveau et la Moelle AP-HP - Hôpital Pitié-Salpêtrière Paris France
| | - Geneviève Chêne
- Bordeaux University Hospital Bordeaux France
- Centre INSERM, Institut de Santé Publique d'Epidémiologie et de Développement, Bordeaux School of Public Health Université de Bordeaux Bordeaux France
- Bordeaux University Bordeaux France
| | - Carole Dufouil
- Bordeaux University Hospital Bordeaux France
- Centre INSERM, Institut de Santé Publique d'Epidémiologie et de Développement, Bordeaux School of Public Health Université de Bordeaux Bordeaux France
- Bordeaux University Bordeaux France
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Wagner M, Grodstein F, Proust-Lima C, Samieri C. P3-537: TRAJECTORIES OF LIFESTYLE FACTORS FROM MIDLIFE THROUGH LATE-LIFE AND SUBSEQUENT COGNITIVE DECLINE IN WOMEN. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3573] [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: 11/17/2022]
Affiliation(s)
- Maude Wagner
- Université de Bordeaux, Inserm; Bordeaux Population Health Research Center, UMR 1219; Bordeaux France
| | - Francine Grodstein
- Brigham and Women's Hospital; Boston MA USA
- Brigham and Women's Hospital/Harvard Medical School; Boston MA USA
- Harvard T. H. Chan School of Public Health; Boston MA USA
| | - Cécile Proust-Lima
- Centre INSERM U1219, Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Bordeaux School of Public Health; Université de Bordeaux; Bordeaux France
| | - Cécilia Samieri
- Université de Bordeaux, Inserm; Bordeaux Population Health Research Center, UMR 1219; Bordeaux France
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Lefèvre-Arbogast S, Low DY, González-Domínguez R, Urpi-Sarda M, Micheau P, Petera M, Centeno D, Durand S, Pujos-Guillot E, Korosi A, Lucassen PJ, Aigner L, Proust-Lima C, Hejblum BP, Helmer C, Andres-Lacueva C, Thuret S, Manach C, Samieri C. P1‐011: UNTARGETED METABOLOMICS IN A PROSPECTIVE COHORT TO IDENTIFY DIET‐RELATED METABOLITES ASSOCIATED WITH AGE‐RELATED COGNITIVE DECLINE. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.036] [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: 10/25/2022]
Affiliation(s)
| | | | | | - Mireia Urpi-Sarda
- Faculty of Pharmacy and Food Science University of Barcelona Barcelona Spain
| | - Pierre Micheau
- University Clermont Auvergne, INRA, UNH Clermont-Ferrand France
| | - Melanie Petera
- University Clermont Auvergne, INRA, UNH, PFEM Clermont-Ferrand France
| | - Delphine Centeno
- University Clermont Auvergne, INRA, UNH, PFEM Clermont-Ferrand France
| | - Stephanie Durand
- University Clermont Auvergne, INRA, UNH, PFEM Clermont-Ferrand France
| | | | - Aniko Korosi
- Brain Plasticity Group, SILS-CNS University of Amsterdam Amsterdam Netherlands
| | - Paul J. Lucassen
- Brain Plasticity Group, SILS-CNS University of Amsterdam Amsterdam Netherlands
| | - Ludwig Aigner
- Paracelsus Medical University Salzburg Salzburg Austria
| | - Cécile Proust-Lima
- Centre INSERM, Institut de Santé Publique, d'Epidémiologie et de Développement, Bordeaux School of Public Health Université de Bordeaux Bordeaux France
| | - Boris P. Hejblum
- University Bordeaux, Inserm Bordeaux Population Health Research Center Bordeaux France
- Inria SISTM, Bordeaux Sud-Ouest Bordeaux France
| | - Catherine Helmer
- University Bordeaux, Inserm Bordeaux Population Health Research Center Bordeaux France
| | | | - Sandrine Thuret
- King's College London Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute London United Kingdom
| | - Claudine Manach
- University Clermont Auvergne, INRA, UNH Clermont-Ferrand France
| | - Cécilia Samieri
- University Bordeaux, Inserm Bordeaux Population Health Research Center Bordeaux France
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Lefevre-Arbogast S, Thuret S, Helmer C, Proust-Lima C, Hejblum B, Samieri C. Signature lipidique précoce du déclin cognitif chez le sujet âgé. NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.01.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lefevre-Arbogast S, Low-Yanwen D, Hejblum B, Helmer C, Micheau P, Proust-Lima C, Thuret S, Manach C, Samieri C. Métabolomique, métabolome alimentaire et déclin cognitif du sujet âgé. NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.01.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ferrer L, Putter H, Proust-Lima C. Individual dynamic predictions using landmarking and joint modelling: Validation of estimators and robustness assessment. Stat Methods Med Res 2018; 28:3649-3666. [DOI: 10.1177/0962280218811837] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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]
Abstract
After the diagnosis of a disease, one major objective is to predict cumulative probabilities of events such as clinical relapse or death from the individual information collected up to a prediction time, usually including biomarker repeated measurements. Several competing estimators have been proposed, mainly from two approaches: joint modelling and landmarking. These approaches differ by the information used, the model assumptions and the complexity of the computational procedures. This paper aims to review the two approaches, precisely define the derived estimators of dynamic predictions and compare their performances notably in case of misspecification. The ultimate goal is to provide key elements for the use of individual dynamic predictions in clinical practice. Prediction of two competing causes of prostate cancer progression from the history of prostate-specific antigen is used as a motivated example. We formally define the quantity to estimate and its estimators, propose techniques to assess the uncertainty around predictions and validate them. We then conduct an in-depth simulation study compare the estimators in terms of prediction error, discriminatory power, efficiency and robustness to model assumptions. We show that prediction tools should be handled with care, in particular by properly specifying models and estimators.
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Affiliation(s)
- Loïc Ferrer
- INSERM, UMR1219, Univ. Bordeaux, ISPED, Bordeaux, France
| | - Hein Putter
- Leiden University Medical Center, Leiden, the Netherlands
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Wagner M, Helmer C, Tzourio C, Berr C, Proust-Lima C, Samieri C. Evaluation of the Concurrent Trajectories of Cardiometabolic Risk Factors in the 14 Years Before Dementia. JAMA Psychiatry 2018; 75:1033-1042. [PMID: 30043038 PMCID: PMC6233804 DOI: 10.1001/jamapsychiatry.2018.2004] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Cardiometabolic risk factors have been associated with an increased risk of dementia; yet, the optimal targets and time window for the management of cardiometabolic health to prevent dementia remain unknown. OBJECTIVES To model concurrently and compare the trajectories of cardiometabolic risk factors up to 14 years preceding diagnosis in individuals with dementia and matched controls free of dementia. DESIGN, SETTING, AND PARTICIPANTS A case-control study nested within the Three-City study, a French population-based cohort of older persons (≥65 years), included 6 home visits with neuropsychological testing between 1999 and 2014. Data analysis was performed in September 2017. A total of 785 incident dementia cases and 3140 controls matched by sex, age, educational level, and cohort center at the time of diagnosis were evaluated. EXPOSURES Repeated measures of body mass index (BMI) and systolic (SBP) and diastolic (DBP) blood pressure, high-density lipoprotein (HDL-C) and low-density lipoprotein cholesterol (LDL-C), triglycerides, and glycemia levels between 1999 and 2014. MAIN OUTCOMES AND MEASURES Incidence of dementia based on systematic detection and validated diagnosis. RESULTS A total of 785 cases and 3140 controls (2530 [65%] women; mean [SD] age, 76 [5] years) were included in the study. Cases presented a faster decline in BMI, slower increase of SBP and constantly lower DBP. Mean values (95% CI) 14 years before diagnosis (-14 years) and at diagnosis (year 0) for the most common profile were BMI, 26.1 (25.6-26.5) and 24.8 (24.5-25.1) for a case, and 25.7 (25.4-26.1) and 25.3 (25.0-25.5) for a control; for SBP, 135.2 (131.8-138.7) and 142.1 (140.3-143.9) mm Hg for a case, and 135.8 (132.9-138.6) and 144.9 (143.7-146.1) mm Hg for a control; for DBP, 76.5 (74.7-78.5) and 74.0 (73.1-74.9) mm Hg for a case, and 76.7 (75.1-78.3) and 75.0 (74.2-75.7) mm Hg for a control. In contrast, glycemia was higher among cases (mean fasting glucose values [95% CI] at -14 years and year 0: 89.4 [86.9-92.1] and 96.4 [93.7-99.3] mg/dL for a case, and 87.1 [85.1-89.2] and 95.3 [93.5-97.1] mg/dL for a control), with a significant case-control difference from -1.6 to -14 years prior to diagnosis. There were no significant case-control differences in trajectories of blood lipid levels (mean values [95% CI] at -14 years and year 0: for HDL-C, 70.6 [67.6-73.9] and 61.3 [58.9-63.8] mg/dL for a case, and 70.4 [67.5-73.3] and 62.3 [60.2-64.3] mg/dL for a control; for LDL-C: 147.2 [140.5-154.5] and 141.6 [136.6-146.7] mg/dL for a case, and 144.3 [138.7-150.4] and 141.2 [137.5-145.2] mg/dL for a control; for triglycerides: 115.5 [103.6-149.1] and 112.6 [104.8-120.9] mg/dL for a case, and 112.5 [103.8-144.4] and 109.7 [105.0-114.8] mg/dL for a control). CONCLUSIONS AND RELEVANCE In this large cohort of older persons, BMI declined in prodromal dementia, possibly reflecting early preclinical changes. Lower BP prior to dementia may reflect both a consequence and a contributing factor for the disease, whereas higher blood glucose levels may constitute a risk factor for dementia in the older age range. Overall, these findings suggest that elevated glycemia, low BP, and weight loss may be primary targets for the management of cardiometabolic health for primary and secondary prevention of dementia in the older age range.
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Affiliation(s)
- Maude Wagner
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, F-33000 Bordeaux, France
| | - Catherine Helmer
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, F-33000 Bordeaux, France
| | - Christophe Tzourio
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, CHU, F-33000 Bordeaux, France
| | - Claudine Berr
- University of Montpellier, Inserm, Neuropsychiatry: Epidemiological and Clinical Research, UMR U1061, F-34000 Montpellier, France
| | - Cécile Proust-Lima
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, F-33000 Bordeaux, France
| | - Cécilia Samieri
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, F-33000 Bordeaux, France
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Grasset L, Jacqmin-Gadda H, Proust-Lima C, Pérès K, Amieva H, Dartigues JF, Helmer C. Temporal Trends in the Level and Decline of Cognition and Disability in an Elderly Population: The PAQUID Study. Am J Epidemiol 2018; 187:2168-2176. [PMID: 29893786 DOI: 10.1093/aje/kwy118] [Citation(s) in RCA: 6] [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] [Received: 12/01/2017] [Accepted: 06/04/2018] [Indexed: 11/14/2022] Open
Abstract
In line with declining trends in dementia incidence, we compared the cognitive and functional evolution of 2 "generations" of elderly individuals aged 78-88 years, who were included 10 years apart in the French Personnes Agées Quid cohort (n = 612 in 1991-1992 and n = 628 in 2001-2002) and followed-up for 12 years with assessments of cognition and disability. The impact of specific risk factors on this evolution was evaluated. Differences between the generations in baseline levels and decline over time were estimated using a joint model to account for differential attrition. Compared with the first generation, the second generation had higher performances at baseline on 4 cognitive tests (from P < 0.005). Differences in global cognition, verbal fluency, and processing speed, but not in working memory, were mostly explained by improvement in educational level. The second generation also exhibited less cognitive decline in verbal fluency and working memory. Progression of disability was less over the follow-up period for the second generation than for the first. The cognitive state of this elderly population improved, partially due to improvements in educational level.
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Affiliation(s)
- Leslie Grasset
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Hélène Jacqmin-Gadda
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Cécile Proust-Lima
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Karine Pérès
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Hélène Amieva
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Jean-François Dartigues
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Bordeaux University Hospital, Memory Consultation, Memory Resource and Research Centre, Bordeaux, France
| | - Catherine Helmer
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
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Samieri C, Perier MC, Gaye B, Proust-Lima C, Helmer C, Dartigues JF, Berr C, Tzourio C, Empana JP. Association of Cardiovascular Health Level in Older Age With Cognitive Decline and Incident Dementia. JAMA 2018; 320:657-664. [PMID: 30140876 PMCID: PMC6142948 DOI: 10.1001/jama.2018.11499] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [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: 01/23/2023]
Abstract
IMPORTANCE Evidence is limited regarding the relation between cardiovascular health level and dementia risk. OBJECTIVE To investigate the association between cardiovascular health level, defined using the 7-item tool from the American Heart Association (AHA), and risk of dementia and cognitive decline in older persons. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study of persons aged 65 years or older from Bordeaux, Dijon, and Montpellier, France, without history of cardiovascular diseases or dementia at baseline who underwent repeated in-person neuropsychological testing (January 1999-July 2016) and systematic detection of incident dementia (date of final follow-up, July 26, 2016). EXPOSURES The number of the AHA's Life's Simple 7 metrics at recommended optimal level (nonsmoking, body mass index <25, regular physical activity, eating fish twice a week or more and fruits and vegetables at least 3 times a day, cholesterol <200 mg/dL [untreated], fasting glucose <100 mg/dL [untreated], and blood pressure <120/80 mm Hg [untreated]; score range, 0-7) and a global cardiovascular health score (range, 0-14; poor, intermediate, and optimal levels of each metric assigned a value of 0, 1, and 2, respectively). MAIN OUTCOMES AND MEASURES Incident dementia validated by an expert committee and change in a composite score of global cognition (in standard units, with values indicating distance from population means, 0 equal to the mean, and +1 and -1 equal to 1 SD above and below the mean). RESULTS Among 6626 participants (mean age, 73.7 years; 4200 women [63.4%]), 2412 (36.5%), 3781 (57.1%), and 433 (6.5%) had 0 to 2, 3 to 4, and 5 to 7 health metrics at optimal levels, respectively, at baseline. Over a mean follow-up duration of 8.5 (range, 0.6-16.6) years, 745 participants had incident adjudicated dementia. Compared with the incidence rate of dementia of 1.76 (95% CI, 1.38-2.15) per 100 person-years among those with 0 or 1 health metrics at optimal levels, the absolute differences in incident dementia rates for 2, 3, 4, 5, and 6 to 7 metrics were, respectively, -0.26 (95% CI, -0.48 to -0.04), -0.59 (95% CI, -0.80 to -0.38), -0.43 (95% CI, -0.65 to -0.21), -0.93 (95% CI, -1.18 to -0.68), and -0.96 (95% CI, -1.37 to -0.56) per 100 person-years. In multivariable models, the hazard ratios for dementia were 0.90 (95% CI, 0.84-0.97) per additional optimal metric and 0.92 (95% CI, 0.89-0.96) per additional point on the global score. Furthermore, the gain in global cognition associated with each additional optimal metric at baseline was 0.031 (95% CI, 0.009-0.053) standard units at inclusion, 0.068 (95% CI, 0.045-0.092) units at year 6, and 0.072 (95% CI, 0.042-0.102) units at year 12. CONCLUSIONS AND RELEVANCE In this cohort of older adults, increased numbers of optimal cardiovascular health metrics and a higher cardiovascular health score were associated with a lower risk of dementia and lower rates of cognitive decline. These findings may support the promotion of cardiovascular health to prevent risk factors associated with cognitive decline and dementia.
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Affiliation(s)
- Cécilia Samieri
- Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
| | - Marie-Cécile Perier
- Université de Paris-Descartes, INSERM, Paris Cardiovascular Research Center, Paris, France
| | - Bamba Gaye
- Université de Paris-Descartes, INSERM, Paris Cardiovascular Research Center, Paris, France
| | - Cécile Proust-Lima
- Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
| | - Catherine Helmer
- Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
- INSERM CIC-1401 Bordeaux, Clinical Epidemiology Unit, Bordeaux, France
| | - Jean-François Dartigues
- Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
- CHU Bordeaux, Bordeaux, France
| | - Claudine Berr
- Université de Montpellier, INSERM, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Christophe Tzourio
- Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
- CHU Bordeaux, Bordeaux, France
| | - Jean-Philippe Empana
- Université de Paris-Descartes, INSERM, Paris Cardiovascular Research Center, Paris, France
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Wagner M, Helmer C, Tzourio C, Berr C, Proust-Lima C, Samieri C. O3‐11‐02: LONG‐TERM TRAJECTORIES OF CARDIOMETABOLIC RISK FACTORS IN PRODROMAL DEMENTIA: THE THREE‐CITY STUDY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2832] [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)
- Maude Wagner
- University Bordeaux, InsermBordeaux Population Health Research CenterBordeauxFrance
| | - Catherine Helmer
- University Bordeaux, InsermBordeaux Population Health Research CenterBordeauxFrance
| | - Christophe Tzourio
- University Bordeaux, InsermBordeaux Population Health Research CenterBordeauxFrance
| | - Claudine Berr
- University MontpellierInserm, Neuropsychiatry: Epidemiological and Clinical ResearchMontpellierFrance
| | - Cécile Proust-Lima
- University Bordeaux, InsermBordeaux Population Health Research CenterBordeauxFrance
| | - Cecilia Samieri
- University Bordeaux, InsermBordeaux Population Health Research CenterBordeauxFrance
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