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Buchholz A, Deme P, Betz JF, Brandt J, Haughey N, Cervenka MC. A randomized feasibility trial of the modified Atkins diet in older adults with mild cognitive impairment due to Alzheimer's disease. Front Endocrinol (Lausanne) 2024; 15:1182519. [PMID: 38505743 PMCID: PMC10949529 DOI: 10.3389/fendo.2024.1182519] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 02/05/2024] [Indexed: 03/21/2024] Open
Abstract
Background Alzheimer's disease (AD) is increasing in prevalence, but effective treatments for its cognitive impairment remain severely limited. This study investigates the impact of ketone body production through dietary manipulation on memory in persons with mild cognitive impairment due to early AD and explores potential mechanisms of action. Methods We conducted a 12-week, parallel-group, controlled feasibility trial of a ketogenic diet, the modified Atkins diet (MAD), compared to a control diet in patients with cognitive impairments attributed to AD. We administered neuropsychological assessments, including memory tests, and collected blood samples at baseline and after 12 weeks of intervention. We performed untargeted lipidomic and targeted metabolomic analyses on plasma samples to detect changes over time. Results A total of 839 individuals were screened to yield 38 randomized participants, with 20 assigned to receive MAD and 18 assigned to receive a control diet. Due to attrition, only 13 in the MAD arm and nine in the control arm were assessed for the primary endpoint, with two participants meeting ketosis levels used to define MAD adherence criteria. The average change from baseline in the Memory Composite Score was 1.37 (95% CI: -0.87, 4.90) points higher in the MAD group compared to the control group. The effect size of the intervention on baseline MAD change was moderate (Cohen's D = 0.57, 95% CI: -0.67, 1.33). In the 15 participants (nine MAD, six control) assessed for lipidomic and metabolomic-lipidomics and metabolomics, 13 metabolites and 10 lipids showed significant changes from baseline to 12 weeks, including triacylglycerols (TAGs, 50:5, 52:5, and 52:6), sphingomyelins (SM, 44:3, 46:0, 46:3, and 48:1), acetoacetate, fatty acylcarnitines, glycerol-3-phosphate, and hydroxy fatty acids. Conclusions Attrition was greatest between baseline and week 6. All participants retained at week 6 completed the study. Despite low rates of adherence by criteria defined a priori, lipidomic and metabolomic analyses indicate significant changes from baseline in circulating lipids and metabolites between MAD and control participants at 12-week postrandomization, and MAD participants showed greater, albeit nonsignificant, improvement in memory.
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Affiliation(s)
- Alison Buchholz
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Pragney Deme
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joshua F. Betz
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason Brandt
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Norman Haughey
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mackenzie C. Cervenka
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Andersen ZJ, Zhang J, Lim YH, So R, Jørgensen JT, Mortensen LH, Napolitano GM, Cole-Hunter T, Loft S, Bhatt S, Hoek G, Brunekreef B, Westendorp R, Ketzel M, Brandt J, Lange T, Kølsen-Fisher T. Long-Term Exposure to AIR Pollution and COVID-19 Mortality and Morbidity in DENmark: Who Is Most Susceptible? (AIRCODEN). Res Rep Health Eff Inst 2023:1-41. [PMID: 38286761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Early ecological studies have suggested a link between air pollution and Coronavirus Diseases 2019 (COVID-19); however, the evidence from individual-level prospective cohort studies is still sparse. Here, we have examined, in a general population, whether long-term exposure to air pollution is associated with the risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and developing severe COVID-19, resulting in hospitalization or death and who is most susceptible. We also examined whether long-term exposure to air pollution is associated with hospitalization or death due to COVID-19 in those who have tested positive for SARS-CoV-2. METHODS We included all Danish residents 30 years or older who resided in Denmark on March 1, 2020. and followed them in the National COVID-19 Surveillance System until first positive test (incidence), COVID-19 hospitalization, or death until April 26, 2021. We estimated mean levels of nitrogen dioxide (NO2), particulate matter with an aerodynamic diameter <2.5 μm (PM2.5), black carbon (BC), and ozone (O3) at cohort participants' residence in 2019 by the Danish Eulerian Hemispheric Model/Urban Background Model. We used Cox proportional hazard models to estimate the associations of air pollutants with COVID-19 incidence, hospitalization, and mortality adjusting for age, sex, and socioeconomic status (SES) at the individual and area levels. We examined effect modification by age, sex, SES (education, income, wealth, employment), and comorbidities with cardiovascular disease, respiratory disease, acute lower respiratory infections, diabetes, lung cancer, and dementia. We used logistic regression to examine association of air pollutants with COVID-19-related hospitalization or death among SARS-CoV-2 positive patients, adjusting for age, sex, individual- and area-level SES. RESULTS Of 3,721,810 people, 138,742 were infected, 11,270 hospitalized, and 2,557 died from COVID-19 during 14 months of follow-up. We detected strong positive associations with COVID-19 incidence, with hazard ratio (HR) and 95% confidence interval (CI) of 1.10 (CI: 1.05-1.14) per 0.5-μg/m3 increase in PM2.5 and 1.18 (CI: 1.14-1.23) per 3.6-μg/m3 increase in NO2. For COVID-19 hospitalizations and for COVID-19 deaths, corresponding HRs and 95% CIs were 1.09 (CI: 1.01-1.17) and 1.19 (CI: 1.12-1.27), respectively for PM2.5, and 1.23 (CI: 1.04-1.44) and 1.18 (CI: 1.03-1.34), respectively for NO2. We also found strong positive and statistically significant associations with BC and negative associations with O3. Associations were strongest in those aged 65 years old or older, participants with the lowest SES, and patients with chronic cardiovascular, respiratory, metabolic, lung cancer, and neurodegenerative disease. Among 138,742 individuals who have tested positive for SARS-Cov-2, we detected positive association with COVID-19 hospitalizations (N = 11,270) with odds ratio and 95% CI of 1.04 (CI: 1.01- 1.08) per 0.5-μg/m3 increase in PM2.5 and 1.06 (CI: 1.01-1.12) per 3.6-μg/m3 increase in NO2, but no association with PM with an aerodynamic diameter <10 μm (PM10), BC, or O3, and no association between any of the pollutants and COVID-19 mortality (N = 2,557). CONCLUSIONS This large nationwide study provides strong new evidence in support of association between long-term exposure to air pollution and COVID-19.
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Affiliation(s)
- Z J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - J Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - Y-H Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - R So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - J T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - L H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
- Statistics Denmark, Copenhagen, Denmark
| | - G M Napolitano
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - T Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - S Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - S Bhatt
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - G Hoek
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - B Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - Rgj Westendorp
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - M Ketzel
- Department of Environmental Science, Aarhus University, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, United Kingdom
| | - J Brandt
- Climate, Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - T Lange
- Department of Public Health, University of Copenhagen, Denmark
| | - T Kølsen-Fisher
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark
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Grasa G, Díaz M, Fernández J, Amieiro A, Brandt J, Abanades J. Blast Furnace Gas decarbonisation through Calcium Assisted Steel-mill Off-gas Hydrogen production. Experimental and modelling approach. Chem Eng Res Des 2023. [DOI: 10.1016/j.cherd.2023.01.047] [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: 02/01/2023]
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Marsh EB, Khan S, Llinas RH, Walker KA, Brandt J. Multidomain cognitive dysfunction after minor stroke suggests generalized disruption of cognitive networks. Brain Behav 2022; 12:e2571. [PMID: 35421284 PMCID: PMC9120906 DOI: 10.1002/brb3.2571] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Although small strokes typically result in "good" functional outcomes, significant cognitive impairment can occur. This longitudinal study examined a cohort of patients with minor stroke to determine the pattern of deficits, evolution over time, and factors associated with outcome. METHODS Patients admitted to the hospital with their first clinical minor stroke (NIH Stroke Scale [NIHSS] ≤ 10, absence of severe hemiparesis, aphasia, or neglect) were assessed at 1 month post-infarct, and a subset were followed over time (with 6- and 12-month evaluations). Composite scores at each time point were generated for global cognition, verbal memory, spatial memory, motor speed, processing speed, and executive function. Paired t-tests evaluated change in scores over time. Regression models identified factors associated with initial performance and better recovery. RESULTS Eighty patients were enrolled, evaluated at 1 month, and prospectively followed. The average age of the participants was 62.3 years, and mean education was 13.5 years. The average stroke volume was 6.6 cc; mean NIHSS score was 2.8. At 1 month, cognitive scores were below the normative range and > 1 standard deviation below the patient's peak ("recovery") score for every cognitive domain, strongly suggesting that they were well below patients' prestroke baselines. Forty-eight patients followed up at 6 months, and 39 at 12 months. Nearly all (98%) patients significantly improved in global cognition (averaged across domains) between 1 and 6 months. Between 6 and 12 months, recovery was variable. Higher education, occupational class, and Caucasian race were associated with higher recovery scores for most domains. CONCLUSIONS Cognitive impairment across multiple domains is common following minor stroke regardless of infarct location, suggesting a global process such as network dysfunction that improves over 6 months. Degree of recovery can be predicted using baseline factors.
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Affiliation(s)
- Elisabeth B Marsh
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheena Khan
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rafael H Llinas
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Keenan A Walker
- National Institute on Aging, Laboratory of Behavioral Neuroscience, The National Institutes of Health, Baltimore, Maryland, USA
| | - Jason Brandt
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Glatthorn H, Sauer M, Brandt J, Ananth C. P–773 Infertility treatment and the risk of small for gestational age births: a population-based study in the United States. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
What is the association between infertility treatments and small for gestational age (SGA) births?
Summary answer
Women who conceived pregnancies with any infertility treatment had a decreased risk of SGA <10th, <5th and <3rd percentiles compared to naturally conceived pregnancies.
What is known already
Assisted reproductive technology (ART) and other infertility treatments have long been associated with an increased risk of SGA births, which confers a greater risk of perinatal morbidity and mortality compared to appropriate for gestational age births.
Study design, size, duration
This is a cross-sectional study of 16,836,228 births in the United States (US) between 2015–2019. The exposure group included women who underwent any infertility treatment, including ART and prescribed fertility enhancing medications. The comparison group included those who had naturally conceived pregnancies. The primary outcome was SGA birth, defined as sex-specific birthweight <10th percentile for gestational age. Secondary outcomes included SGA <5th and <3rd percentile births.
Participants/materials, setting, methods
Pregnant subjects (n = 16,836,228) in the US who delivered non-malformed, singleton live births between 24–44 weeks’ gestational age. We estimated risk of SGA births in relation to any infertility treatment from fitting log-linear Poisson regression models with robust variance. Risk ratios (RR) and 95% confidence intervals (CI) were estimated as the effect measure before and after adjusting for confounders. We also performed a sensitivity analysis to correct for potential non-differential exposure misclassification and unmeasured confounding biases.
Main results and the role of chance
During the study period, 1.4% (n = 231,177) of non-malformed singleton live births resulted from infertility treatments (0.8% ART and 0.6% fertility enhancing medications). Of these, 9.4% (n = 21,771) of pregnancies conceived with infertility treatment were complicated by SGA <10th percentile compared to 11.9% (n = 1,755,925) of naturally conceived pregnancies. For pregnancies conceived with infertility treatment versus naturally conceived pregnancies, the adjusted RR for SGA <10th percentile was 1.07 (95% CI 1.06, 1.08). However, after correction for misclassification bias and unmeasured confounding, infertility treatment was found to be protective for SGA and conferred a 27% reduced risk of SGA <10th percentile (bias-corrected RR 0.73, 95% CI 0.53, 0.85). These trends were similar for analyses stratified by exposure to ART and fertility enhancing medications and secondary SGA outcomes, including SGA <5th and <3rd percentile.
Limitations, reasons for caution
All information collected on infertility treatment relies on self-reporting by patients and recording by hospital staff at the time of delivery, which likely resulted in underreporting of infertility treatments. Additionally, we cannot determine the impact of interventions that were not recorded, such as intrauterine insemination (IUI).
Wider implications of the findings: Compared to naturally conceived pregnancies, exposure to infertility treatment is associated with reduction in the risk of SGA births. These findings, which are contrary to some published reports, likely reflect changes in the modern practice of infertility care in the US, and importantly, robust analysis of the national data.
Trial registration number
Not applicable
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Affiliation(s)
- H Glatthorn
- Rutgers Robert Wood Johnson Medical School, Obstetrics- Gynecology and Reproductive Sciences, New Brunswick- NJ, USA
| | - M Sauer
- Rutgers Robert Wood Johnson Medical School, Obstetrics- Gynecology and Reproductive Sciences, New Brunswick- NJ, USA
| | - J Brandt
- Rutgers Robert Wood Johnson Medical School, Obstetrics- Gynecology and Reproductive Sciences, New Brunswick- NJ, USA
- Rutgers Robert Wood Johnson Medical School, Division of Maternal Fetal Medicine, New Brunswick- NJ, USA
| | - C Ananth
- Rutgers Robert Wood Johnson Medical School, Obstetrics- Gynecology and Reproductive Sciences, New Brunswick- NJ, USA
- Rutgers Robert Wood Johnson Medical School, Division of Epidemiology and Biostatistics, New Brunswick- NJ, USA
- Rutgers School of Public Health, Department of Biostatistics and Epidemiology, Piscataway- NJ, USA
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey CVI-NJ, New Brunswick- NJ, USA
- Rutgers Robert Wood Johnson Medical School, Environmental and Occupational Health Sciences Institute EOHSI, New Brunswick- NJ, USA
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Farley G, Sauer M, Brandt J, Ananth C. P–776 Singleton pregnancies conceived with infertility treatments and the risk of
neonatal and infant mortality. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is maternal infertility treatment associated with an increased risk of neonatal and infant mortality when compared to natural conception?
Summary answer
Infertility treatment is associated with a 70% increased adjusted risk of neonatal mortality. This association is strongly mediated by preterm delivery.
What is known already
The number of assisted reproduction technology (ART) cycles performed in the United States (US) increased by 39% from 142,435 cycles in 2007 to 197,737 in 2016. Within this growing experience, several studies described an increased risk of preterm delivery, low birth weight, congenital malformations, neonatal intensive care unit admission, stillbirth, and perinatal mortality among singletons conceived through ART compared to those conceived naturally. Experts have called for ART patients to be advised of potential increased risk for adverse perinatal outcomes and for obstetricians to manage these pregnancies as high risk.
Study design, size, duration
This is a cross-sectional study of 11,289,466 pregnancies in the United States (US) from 2015–2017 that resulted in a non-malformed singleton live birth. The exposure group includes births resulting from any infertility treatment method, including ART and fertility-enhancing drugs. The control group includes births resulting from natural conceptions. The primary outcomes measured were neonatal (within 1 month), post-neonatal (1 month to a year), and infant (up to 1 year) mortality.
Participants/materials, setting, methods
Pregnancies (n = 11,289,466) resulting in a non-malformed singleton live birth in the US from 2015–2017. Associations were estimated from log-linear Poisson regression models with robust variance. Risk ratio (RR) and 95% confidence interval (CI) were derived as the effect measure with adjustments for confounders. The impact of exposure misclassification and unmeasured confounding biases were assessed. A causal mediation analysis of the infertility treatment-mortality association with preterm delivery (<37 weeks) was performed.
Main results and the role of chance
Any infertility treatment was documented in 1.3% (n = 142,215) of singleton live births during the study period. Any infertility treatment was associated with a 70% increased adjusted risk of neonatal mortality (RR 1.70, 95% CI 1.54–1.88), with an even higher risk for early neonatal (RR 1.82, 95% CI 1.63–2.05) than late neonatal (RR 1.37, 95% CI 1.11–1.69) mortality. These risks were similar among pregnancies conceived through ART and treatment with fertility-enhancing drugs. The mediation analysis showed that 68% (95% CI 59–81) of the total effect of infertility treatment on neonatal mortality was mediated through preterm delivery. In a sensitivity analysis, following corrections for exposure misclassification and unmeasured confounding biases, these risks were higher for early neonatal (bias-corrected RR [RRbc] 2.94 95% CIbc 2.16–4.01), but not for late neonatal (RRbc 1.04, 95% CIbc 0.68–1.59) mortality.
Limitations, reasons for caution
Limitations of the study include the potential underreporting of infertility treatment on birth certificates and potential confounding from sociodemographic characteristics that were not accounted for in this study.
Wider implications of the findings: Pregnancies conceived with infertility treatment are associated with increased neonatal mortality and this association is mediated by the increased risk of preterm delivery. Knowledge of this risk should be shared with prospective couples consulting for fertility care in order to best provide adequate informed consent.
Trial registration number
Not applicable
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Affiliation(s)
- G Farley
- Rutgers Robert Wood Johnson Medical School, MD Candidate, New Brunswick, USA
| | - M Sauer
- Rutgers Robert Wood Johnson Medical School, Department of Obstetrics Gynecology and Reproductive Sciences, New Brunswick, USA
| | - J Brandt
- Rutgers Robert Wood Johnson Medical School, Department of Obstetrics Gynecology and Reproductive Sciences, New Brunswick, USA
| | - C Ananth
- Rutgers Robert Wood Johnson Medical School, Department of Obstetrics Gynecology and Reproductive Sciences, New Brunswick, USA
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Frommeyer G, Brandt J, Ellermann C, Wolfes J, Eckardt L. Dexmedetomidine reduces ventricular arrhythmias in a model of drug-induced QT-prolongation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Dexmedetomidine is increasingly employed for conscious sedation during electrophysiological procedures. Recent experimental data have suggested direct effects of dexmedetomidine on cardiac electrophysiology. The aim of the present study was to assess the effects of dexmedetomidin on drug-induced QT-prolongation.
Methods and results
In 12 isolated rabbit hearts the macrolide antibiotic erythromycin (300μM) was infused as a potent Ikr blocker after obtaining baseline data. Eight endo- and epicardial monophasic action potentials and a simultaneously recorded 12-lead ECG showed a significant prolongation of QT-interval (+25ms, p<0.05) accompanied by a moderate increase of action potential duration (APD, +5ms, p=ns) after infusion of erythromycin as compared with baseline. Effective refractory period (ERP) was also elevated (+33ms, p<0.05). Erythromycin (+26ms, p<0.05) also significantly increased spatial dispersion of repolarisation. Additional infusion of dexmedetomidine (3μM) resulted in a rather stable QT-interval (+7ms, p=ns) and APD (+7ms, p=ns) as compared with sole erythromycin treatment. Of note, a significant decrease of spatial dispersion (−24ms, p<0.05) was observed while ERP was moderately increased (+13ms, p=ns).
Lowering of potassium concentration in bradycardic AV-blocked hearts resulted in the occurrence of early afterdepolarizations (EAD) and drug induced proarrhythmia with torsade de pointes in 6 of 12 erythromycin-treated hearts (40 episodes). Additional infusion of dexmedetomidine reduced the occurrence of torsade de pointes (4 of 12 hearts, 9 episodes).
Conclusion
Infusion of dexmedetomidine resulted in a reduction of spatial dispersion of repolarization in the presence of a prolonged repolarization period. This resulted in a reduction of torsade de pointes with dexmedetomidine. Furthermore, an increase of ventricular refractory periods reduced inducibility of ventricular arrhythmias. Thus, in an experimental setting dexmedetomidine shows significant antiarrhythmic effects, which may influence electrophysiologic findings during clinical electrophysiologic studies. This needs to be studied in the clinical setting.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Frommeyer
- University Medical Center, Clinic for Cardiology II - Electrophysiology, Münster, Germany
| | - J Brandt
- University Medical Center, Clinic for Cardiology II - Electrophysiology, Münster, Germany
| | - C Ellermann
- University Medical Center, Clinic for Cardiology II - Electrophysiology, Münster, Germany
| | - J Wolfes
- University Medical Center, Clinic for Cardiology II - Electrophysiology, Münster, Germany
| | - L Eckardt
- University Medical Center, Clinic for Cardiology II - Electrophysiology, Münster, Germany
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Johnson EL, Krauss GL, Kucharska-Newton A, Albert MS, Brandt J, Walker KA, Yasar S, Knopman DS, Vossel KA, Gottesman RF. Dementia in late-onset epilepsy: The Atherosclerosis Risk in Communities study. Neurology 2020; 95:e3248-e3256. [PMID: 33097597 DOI: 10.1212/wnl.0000000000011080] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine the risk of dementia after the development of late-onset epilepsy. METHODS We used data from the Atherosclerosis Risk in Communities (ARIC) cohort study, which started in 1987 to 1989 with 15,792 mostly Black and White men and women from 4 US communities. We identified late-onset epilepsy (LOE; seizures starting at age 67 or later) from linked Medicare claims data. We used a Cox proportional hazards regression model to evaluate associations between LOE and dementia through 2017 as ascertained from neuropsychological testing, interviews, and hospital discharge surveillance, and we used multinomial logistic regression to assess the risk of dementia and mild cognitive impairment in the subset with full neuropsychological assessments available. We adjusted for demographics and vascular and Alzheimer disease risk factors. RESULTS Of 9,033 ARIC participants with sufficient Medicare coverage data (4,980 [55.1%] female, 1993 [22.1%] Black), 671 met the definition of LOE. Two hundred seventy-nine (41.6%) participants with and 1,408 (16.8%) without LOE developed dementia (p < 0.001). After a diagnosis of LOE, the adjusted hazard ratio for developing subsequent dementia was 3.05 (95% confidence interval 2.65-3.51). The median time to dementia ascertainment after the onset of LOE was 3.66 years (quartile 1-3, 1.28-8.28 years). INTERPRETATION The risk of incident dementia is substantially elevated in individuals with LOE. Further work is needed to explore causes for the increased risk of dementia in this growing population.
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Affiliation(s)
- Emily L Johnson
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis.
| | - Gregory L Krauss
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Anna Kucharska-Newton
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Marilyn S Albert
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Jason Brandt
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Keenan A Walker
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Sevil Yasar
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - David S Knopman
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Keith A Vossel
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Rebecca F Gottesman
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
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Brandt J, Buchholz A, Henry-Barron B, Vizthum D, Avramopoulos D, Cervenka MC. Preliminary Report on the Feasibility and Efficacy of the Modified Atkins Diet for Treatment of Mild Cognitive Impairment and Early Alzheimer's Disease. J Alzheimers Dis 2020; 68:969-981. [PMID: 30856112 DOI: 10.3233/jad-180995] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ketone bodies, the products of fat metabolism, are a source of energy for the brain and are available even when glucose supplies are inadequate (such as with severe carbohydrate deprivation) or its metabolism is faulty (as it is in Alzheimer's disease). This phase I/II randomized clinical trial examined the feasibility of using a modified Atkins diet (MAD) to induce ketogenesis in persons with mild cognitive impairment (MCI) or early AD, and the effect of this diet on memory and other clinical outcomes. In the first 2.5 years of active recruitment, only 27 eligible and willing patients enrolled. After extensive assessment and education, they and their study partners were randomly assigned for 12 weeks to either the MAD or the National Institute on Aging (NIA) recommended diet for seniors. As of April 2018, 9 patients in the MAD arm and 5 in the NIA arm have completed the trial. In spite of extensive teaching, coaching, and monitoring, adherence to both diets was only fair. Among those in the MAD arm who generated at least trace amounts of urinary ketones, there was a large (effect size = 0.53) and statistically significant (p = 0.03) increase in Memory Composite Score between the baseline and week-6 assessment. MAD participants also reported increased energy between baseline and week-6 assessment. Despite challenges to implementing this trial, resulting in a small sample, our preliminary data suggest that the generation of even trace ketones might enhance episodic memory and patient-reported vitality in very early AD.
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Affiliation(s)
- Jason Brandt
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison Buchholz
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bobbie Henry-Barron
- Institute for Clinical and Translational Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diane Vizthum
- Institute for Clinical and Translational Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dimitrios Avramopoulos
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Institute of Genetic Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mackenzie C Cervenka
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Johnson EL, Krauss GL, Walker KA, Brandt J, Kucharska-Newton A, Mosley TH, Yasar S, Gottesman RF. Late-onset epilepsy and 25-year cognitive change: The Atherosclerosis Risk in Communities (ARIC) study. Epilepsia 2020; 61:1764-1773. [PMID: 32710450 PMCID: PMC7718433 DOI: 10.1111/epi.16616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/10/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To define the association between late-onset epilepsy (LOE) and 25-year change in cognitive performance. METHODS The Atherosclerosis Risk in Communities (ARIC) study is a multicenter longitudinal cohort study with participants from four U.S. communities. From linked Medicare claims, we identified cases of LOE, defined as ≥2 seizure-related diagnostic codes starting at age ≥67. The ARIC cohort underwent evaluation with in-person visits at intervals of 3-15 years. Cognition was evaluated 4 times over >25 years (including before the onset of seizures) using the Delayed Word Recall Test (DWRT), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT); a global z-score was also calculated. We compared the longitudinal cognitive changes of participants with and without LOE, adjusting for demographics and LOE risk factors. RESULTS From 8033 ARIC participants with midlife cognitive testing and Medicare claims data available (4523 [56%] female, 1392 [17%] Black), we identified 585 cases of LOE. The rate of cognitive decline was increased on all measures in the participants who developed LOE compared to those without LOE. On the measure of global cognition, participants with LOE declined by -0.43 z-score points more over 25 years than did participants without epilepsy (95% confidence interval [CI] -0.59 to -0.27). Prior to the onset of seizures, cognitive decline was more rapid on the DWRT, DSST, and global z-scores in those who would later develop LOE than it was in non-LOE participants. Results were similar after excluding data from participants with dementia. SIGNIFICANCE Global cognition, verbal memory, executive function, and word fluency declined faster over time in persons developing LOE than without LOE. Declines in cognition preceding LOE suggest these are linked; it will be important to investigate causes for midlife cognitive declines associated with LOE.
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Affiliation(s)
- Emily L Johnson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gregory L Krauss
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Keenan A Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jason Brandt
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anna Kucharska-Newton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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11
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Affiliation(s)
- Victor A. Del Bene
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason Brandt
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Smith GS, Mills KA, Pontone GM, Anderson WS, Perepezko KM, Brasic J, Zhou Y, Brandt J, Butson CR, Holt DP, Mathews WB, Dannals RF, Wong DF, Mari Z. Effect of STN DBS on vesicular monoamine transporter 2 and glucose metabolism in Parkinson's disease. Parkinsonism Relat Disord 2019; 64:235-241. [PMID: 31053531 DOI: 10.1016/j.parkreldis.2019.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is an established treatment for Parkinson's Disease (PD). Despite the improvement of motor symptoms in most patients by sub-thalamic nucleus (STN) DBS and its widespread use, the neurobiological mechanisms are not completely understood. The objective of the present study was to elucidate the effects of subthalamic nucleus (STN) DBS in PD on the dopamine system and neural circuitry, employing high-resolution positron emission tomography (PET) imaging. The hypotheses tested were that STN DBS would decrease the striatal vesicular monoamine transporter (VMAT2), secondary to an increase in dopamine concentrations, and would decrease striatal cerebral metabolism and increase cortical cerebral metabolism. METHODS PET imaging of the vesicular monoamine transporter (VMAT2) and cerebral glucose metabolism was performed prior to DBS surgery and after 4-6 months of STN stimulation in seven PD patients (mean age 67 ± 7). RESULTS The patients demonstrated significant improvement in motor and neuropsychiatric symptoms after STN DBS. Decreased VMAT2 was observed in the caudate, putamen and associative striatum and in extra-striatal, cortical and limbic regions. Cerebral glucose metabolism was decreased in striatal sub-regions and increased in temporal and parietal cortices and the cerebellum. Decreased striatal VMAT2 was correlated with decreased striatal and increased cortical and limbic metabolism. Improvement of depressive symptoms was correlated with decreased VMAT2 in striatal and extra-striatal regions and with striatal decreases and cortical increases in metabolism. CONCLUSIONS The present results support further investigation of the role of VMAT2, and associated changes in neural circuitry in the improvement of motor and non-motor symptoms with STN DBS in PD.
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Affiliation(s)
- Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Kelly A Mills
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Greg M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - W Stanley Anderson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kate M Perepezko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Brasic
- Section of High Resolution Brain PET, Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yun Zhou
- Section of High Resolution Brain PET, Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason Brandt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher R Butson
- Scientific Computing & Imaging (SCI) Institute, Departments of Biomedical Engineering, Neurology, Neurosurgery & Psychiatry, University of Utah, USA
| | - Daniel P Holt
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William B Mathews
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert F Dannals
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dean F Wong
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Section of High Resolution Brain PET, Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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Mills KA, Donohue K, Swaminathan A, Leoutsakos JM, Smith G, Brandt J. Neuropsychological predictors of patient-reported cognitive decline after deep brain stimulation in Parkinson's disease. J Clin Exp Neuropsychol 2019; 41:219-228. [PMID: 30296894 PMCID: PMC6380950 DOI: 10.1080/13803395.2018.1526889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is effective for treatment of motor complications of dopaminergic therapy in Parkinson's disease (PD) but occasionally has been associated with multidomain cognitive decline. Patient- and caregiver-reported cognitive decline are clinically meaningful and increasingly recognized as important to consider when evaluating therapeutic interventions for PD. OBJECTIVE The objective was to assess presurgical neuropsychological and clinical factors associated with PD patient- and caregiver-reported cognitive decline in two or more domains after DBS. METHOD A single telephone survey was used to assess patient- and caregiver-reported cognitive decline in five domains at both one and four months after DBS surgery. Decline in two or more domains was considered multidomain cognitive decline (MDCD). Baseline demographic, clinical, and neuropsychological factors were compared in those with or without MDCD. Preoperative neuropsychological measures were evaluated as risk factors and regressed on the presence of MDCD, with demographic covariates, using multiple logistic regression. RESULTS Preoperative performance in verbal recognition memory, language knowledge, and verbal processing decline were associated with postoperative, patient-reported MDCD in the first four weeks. MDCD at four months after DBS was associated with worse preoperative verbal reasoning, verbal recall, and semantic verbal fluency. Caregiver-reported MDCD one month after DBS was associated with poorer baseline verbal memory recognition accuracy/discriminability, visuospatial problem solving, and constructional praxis. CONCLUSION Poor presurgical performance in verbal memory recognition, language processing, and visuospatial performance is associated with patient- or caregiver-reported decline following DBS surgery. Posterior cortical dysfunction seems to portend significant self-reported cognitive decline following deep brain stimulation.
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Affiliation(s)
- Kelly A Mills
- a Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Kristyn Donohue
- b Department of Psychiatry & Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Aathman Swaminathan
- a Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Jeannie-Marie Leoutsakos
- b Department of Psychiatry & Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Gwenn Smith
- b Department of Psychiatry & Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Jason Brandt
- a Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
- b Department of Psychiatry & Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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14
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Brandt J, Scotté F, Jordan K. Patient-reported outcomes (PROs) as a routine measure for cancer inpatients: the final missing piece of the puzzle? Ann Oncol 2019; 30:167-169. [PMID: 30481270 DOI: 10.1093/annonc/mdy524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- J Brandt
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - F Scotté
- Medical Oncology and Supportive Care Department, Foch Hospital, Suresnes, France
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.
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15
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Brunet HE, Caldwell JZK, Brandt J, Miller JB. Influence of sex differences in interpreting learning and memory within a clinical sample of older adults. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2019; 27:18-39. [PMID: 30663493 DOI: 10.1080/13825585.2019.1566433] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sex is an important factor to consider when evaluating memory with older adults. This present study aimed to examine sex differences in memory within a clinical sample of older adults (N = 1084). Raw learning and recall scores on the Hopkins Verbal Learning Test, Revised (HVLT-R) and Brief Visuospatial Memory Test, Revised (BVMT-R) were compared between sexes within the entire sample and cohorts stratified by age. Within the entire sample, women outperformed men in HVLT-R learning and recall, and there were no sex differences in BVMT-R performance. These sex differences, however, were absent or reversed for those with impaired HVLT-R performance and functional deficits, indicating that women retain an early advantage in verbal memory, which is lost with greater indication of disease severity. These findings indicate that women retain an advantage in verbal learning and memory, at least before significant levels of impairment, within a sample of older adults seen at an outpatient neurology clinic, which may have implications for diagnosing memory disorders.
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Affiliation(s)
- Hannah E Brunet
- Neurological Institute, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, USA
| | - Jessica Z K Caldwell
- Neurological Institute, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, USA
| | - Jason Brandt
- Department of Psychiatry and Behavioral Sciences, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Justin B Miller
- Neurological Institute, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, USA
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16
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Stuttgen K, Dvoskin R, Bollinger J, McCague A, Shpritz B, Brandt J, Mathews D. Risk perception before and after presymptomatic genetic testing for Huntington's disease: Not always what one might expect. Mol Genet Genomic Med 2018; 6:1140-1147. [PMID: 30393972 PMCID: PMC6305678 DOI: 10.1002/mgg3.494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/12/2018] [Accepted: 10/02/2018] [Indexed: 11/19/2022] Open
Abstract
Background In 1983, Huntington's disease (HD) was the first genetic disease mapped using DNA polymorphisms. Shortly thereafter, presymptomatic genetic testing for HD began in the context of two research studies. One of these trials was at the Johns Hopkins University Huntington's Disease Center. Methods As part of the protocol, risk perception (RP) values were collected at 16 time points before and after testing. The current study investigated changes in RP scores before and after genetic testing. Of the 186 participants with pre‐ and post‐testing RP values, 39 also had contemporaneous research clinic notes and recent semi‐structured interviews available for analysis. Results The data reveal tremendous diversity in RP. While the RP scores of most individuals change in the way one would expect, 27% of participants demonstrated unexpected changes in RP after disclosure. A significantly higher proportion of individuals who received an expanded repeat result had unexpected changes in RP, compared with those who received normal repeat results. Conclusions The data suggest that individuals’ RP is influenced by more than merely the results of genetic testing. This finding is important for genetic counselors and healthcare providers, as it suggests that even comprehensive patient education and disclosure of genetic test results may not ensure that people fully appreciate their disease risk.
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Affiliation(s)
- Kelsey Stuttgen
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland.,Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Dvoskin
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
| | - Juli Bollinger
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
| | - Allison McCague
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland.,Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barnett Shpritz
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason Brandt
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Debra Mathews
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
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Urdén G, Johansson U, Chmielewska J, Brandt J, Wiman B. Monoclonal Antibodies Towards the Fast Inhibitor of Tissue Plasminogen Activator from Human Plasma and Serum. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryHybridoma cells were produced by fusing mouse myeloma cells (SP 2/0 - Ag 14) with spleen cells from a Balb/c mouse, previously immunized with the partially purified complex between tissue plasminogen activator (t-PA) and its fast inhibitor from human plasma (serum). Screening with a radioimmunoassay revealed a number of hybridomas secreting antibodies directed towards the complex. Of these, about 1/3 reacted both with the complex and t-PA, whereas about 2/3 reacted only with the complex. Three of the latter hybridomas, producing antibodies directed towards the inhibitor-moiety in the complex have been cloned and the antibodies were studied in detail. PA-inhibitor activity in plasma or serum and t-PA/PA-inhibitor complex could be specifically adsorbed on all three insolubilized monoclonal antibodies (MCI, MC2 and MC3). None of the antibodies seems to be directed against structures of vital importance for the functional activity of the PA-inhibitor. In accordance with this finding the antibody with the highest avidity (MCI) reacts equally well with the PA-inhibitor alone or in complex with t-PA. A radioimmunoassay was devloped with this antibody and significant displacement was obtained with samples with PA-inhibitor concentrations above 2 AU/mL. In 13 plasma samples with different levels of PA-inhibitory activity a significant correlation was obtained when comparing this activity with the PA-inhibitor antigen as measured with the radioimmunoassay (r = 0.88).
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Affiliation(s)
- G Urdén
- The Department of Clinical Chemistry and Blood Coagulation, Karolinska Institute, Stockholm, Sweden
| | - Ulla Johansson
- The Department of Hematological Research, Kabi Vitrum AB, Stockholm, Sweden
| | - Joanna Chmielewska
- The Department of Clinical Chemistry and Blood Coagulation, Karolinska Institute, Stockholm, Sweden
| | - J Brandt
- The Department of Hematological Research, Kabi Vitrum AB, Stockholm, Sweden
| | - B Wiman
- The Department of Clinical Chemistry and Blood Coagulation, Karolinska Institute, Stockholm, Sweden
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Lafaille-Magnan ME, Leoutsakos JMS, Fontaine D, Madjar C, Kat J, Tremblay-Mercier J, Savard M, Brandt J, Breitner JC. P1‐585: CROSSTALK BETWEEN ENGLISH AND FRENCH FORMS OF THE RBANS IN AN ALZHEIMER'S DISEASE PREVENTION TRIAL. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.597] [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)
- Marie-Elyse Lafaille-Magnan
- Centre for Studies on Prevention of Alzheimer's Disease (StoP‐AD Centre)Douglas Mental Health InstituteMontrealQCCanada
| | | | - David Fontaine
- Centre for Studies on Prevention of Alzheimer's Disease (StoP‐AD Centre)Douglas Mental Health InstituteMontrealQCCanada
| | | | | | - Jennifer Tremblay-Mercier
- Centre for Studies on Prevention of Alzheimer's Disease (StoP‐AD Centre)Douglas Hospital Research CentreMontrealQCCanada
| | | | - Jason Brandt
- The Johns Hopkins UniversitySchool of MedicineBaltimoreMDUSA
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Baensch D, Bonnemeier H, Brandt J, Bode F, Svendsen JH, Belke R, Buchholz A, Suling A, Wegscheider K. P442Patient selection and clinical characteristics for single chamber ICD with additional atrial sensing capabilities: a subgroup analysis of the randomised controlled NORDIC ICD trial. Europace 2018. [DOI: 10.1093/europace/euy015.252] [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: 11/15/2022] Open
Affiliation(s)
| | - H Bonnemeier
- University Medical Center of Schleswig-Holstein, Campus Kiel, Department of Internal Medicine III Cardiology and Angiology, Kiel, Germany
| | - J Brandt
- Skane University Hospital, Thoracic Surgery, Lund, Sweden
| | - F Bode
- Sana Clinic Ostholstein, Center for Internal and Intensive Care Medicine, Oldenburg, Germany
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | | | - A Buchholz
- University Medical Center Hamburg Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg, Germany
| | - A Suling
- University Medical Center Hamburg Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg, Germany
| | - K Wegscheider
- University Medical Center Hamburg Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg, Germany
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Affiliation(s)
- Jason Brandt
- Department of Psychiatry and Behavioral Sciences, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
OBJECTIVE Mnemonists, memory champions, and persons with highly superior autobiographical memory (HSAM) are apparently rare breeds, with no more than a few dozen cases of each described in the neuroscientific literature. This report describes a newly discovered HSAM case who has extraordinary memory for a wider range of material than has heretofore been described. METHOD Subject MM was interviewed about his personal life and administered standard clinical tests of cognition and personality, as well as experimental tasks assessing personal and generic episodic and semantic memory. Finally, he was studied with high resolution structural MRI of the medial temporal lobes, as well as brain connectivity analysis using resting-state functional MRI. RESULTS MM's ability to recall general factual information, historical facts and dates, sports statistics, and popular culture, as well as personal life experiences, is exceptional, even though he performs in only the average range on tests of intellect and new learning ability. Unlike most mnemonists, he denies using any specific mnemonic strategy and, unlike many other HSAM cases, is unable to recall highly specific details of days in his adult life. Structural brain imaging in MM reveals atypical anatomy in his left temporal lobe, and functional neuroimaging suggests greater than usual connectivity of the left hippocampus with premotor, prefrontal and retrosplenial cingulate cortex. CONCLUSIONS These observations are discussed in the context of previous studies of mnemonists and HSAM cases, some of which implicate hyperconnectivity among components of an expanded memory network in extraordinary memory retrieval. (PsycINFO Database Record
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Affiliation(s)
- Jason Brandt
- Psychiatry and Behavioral Sciences and Department of Neurology, The Johns Hopkins University School of Medicine
| | - Arnold Bakker
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine
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22
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Gerlach K, Tomuschat C, Finke R, Staege MS, Brütting C, Brandt J, Jordan B, Schwesig R, Rosemeier A, Delank KS, Kornhuber ME, Emmer A. Experimental Arthritis in the Rat Induced by the Superantigen Staphylococcal Enterotoxin A. Scand J Immunol 2017; 85:191-196. [PMID: 28128856 DOI: 10.1111/sji.12530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/21/2017] [Indexed: 11/29/2022]
Abstract
The pathogenesis of rheumatoid arthritis (RA) is incompletely understood. Human endogenous retroviruses (HERVs) and their superantigenic envelope protein (env) have been implicated in the pathogenesis of RA. In the present investigation, the arthritogenic potential of the superantigen staphylococcal enterotoxin A (SEA) has been investigated. In the present investigation, the bacterial superantigen staphylococcal enterotoxin A (SEA) was injected into the right knee joint of 15 Lewis rats. Further nine animals received saline. Animals were sacrificed one, five and 10 days after the injection, respectively. The antigens CD3, CD4, CD8, MHC class I, MHC class II, Pax5 and CD138 were investigated by immunohistochemistry on cryo-sections. After intra-articular SEA injection, the inflammation was initially dominated by CD8+ T cells. In the course of the investigation, the numbers of CD4+, Pax5+, CD138+ and MHC class II+ cells increased. CD3 was expressed in low numbers as compared to CD8. After saline injection, no similar inflammatory response has been detected. The arthritis induced by the superantigen SEA may be a novel model for inflammatory joint diseases, that is rheumatoid arthritis or juvenile idiopathic arthritis.
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Affiliation(s)
- K Gerlach
- Department of Paediatric Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.,Department of Paediatrics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - C Tomuschat
- Department of Paediatric Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - R Finke
- Department of Paediatric Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - M S Staege
- Department of Paediatrics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - C Brütting
- Department of Paediatrics, Martin Luther University Halle-Wittenberg, Halle, Germany.,Department of Neurology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - J Brandt
- Department of Orthopaedics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - B Jordan
- Department of Neurology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - R Schwesig
- Department of Orthopaedics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - A Rosemeier
- Department of Orthopaedics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - K-S Delank
- Department of Orthopaedics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - M E Kornhuber
- Department of Neurology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - A Emmer
- Department of Neurology, Martin Luther University Halle-Wittenberg, Halle, Germany
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23
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Barrett FS, Workman CI, Sair HI, Savonenko AV, Kraut MA, Sodums DJ, Joo JJ, Nassery N, Marano CM, Munro CA, Brandt J, Zhou Y, Wong DF, Smith GS. Association between serotonin denervation and resting-state functional connectivity in mild cognitive impairment. Hum Brain Mapp 2017; 38:3391-3401. [PMID: 28379618 DOI: 10.1002/hbm.23595] [Citation(s) in RCA: 9] [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: 10/26/2016] [Revised: 03/14/2017] [Accepted: 03/20/2017] [Indexed: 01/20/2023] Open
Abstract
Resting-state functional connectivity alterations have been demonstrated in Alzheimer's disease (AD) and mild cognitive impairment (MCI) before the observation of AD neuropathology, but mechanisms driving these changes are not well understood. Serotonin neurodegeneration has been observed in MCI and AD and is associated with cognitive deficits and neuropsychiatric symptoms, but the role of the serotonin system in relation to brain network dysfunction has not been a major focus of investigation. The current study investigated the relationship between serotonin transporter availability (SERT; measured using positron emission tomography) and brain network functional connectivity (measured using resting-state functional MRI) in 20 participants with MCI and 21 healthy controls. Two SERT regions of interest were selected for the analysis: the Dorsal Raphe Nuclei (DRN) and the precuneus which represent the cell bodies of origin and a cortical target of projections of the serotonin system, respectively. Both regions show decreased SERT in MCI compared to controls and are the site of early AD pathology. Average resting-state functional connectivity did not differ between MCI and controls. Decreased SERT in DRN was associated with lower hippocampal resting-state connectivity in MCI participants compared to controls. Decreased SERT in the right precuneus was also associated with lower resting-state connectivity of the retrosplenial cortex to the dorsal lateral prefrontal cortex and higher resting-state connectivity of the retrosplenial cortex to the posterior cingulate and in patients with MCI but not in controls. These results suggest that a serotonergic mechanism may underlie changes in brain functional connectivity in MCI. Hum Brain Mapp 38:3391-3401, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Frederick S Barrett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford I Workman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Haris I Sair
- Department of Radiology and Radiological Sciences, Division of Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alena V Savonenko
- Department of Pathology (Neuropathology), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael A Kraut
- Department of Radiology and Radiological Sciences, Division of Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Devin J Sodums
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jin J Joo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Najlla Nassery
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher M Marano
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia A Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason Brandt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yun Zhou
- Department of Radiology and Radiological Sciences, Section of High Resolution Brain PET Imaging, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dean F Wong
- Department of Radiology and Radiological Sciences, Section of High Resolution Brain PET Imaging, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Radiology and Radiological Sciences, Division of Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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24
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Mills KA, Mari Z, Pontone GM, Pantelyat A, Zhang A, Yoritomo N, Powers E, Brandt J, Dawson TM, Rosenthal LS. Cognitive impairment in Parkinson's disease: Association between patient-reported and clinically measured outcomes. Parkinsonism Relat Disord 2016; 33:107-114. [PMID: 27733275 PMCID: PMC5154808 DOI: 10.1016/j.parkreldis.2016.09.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/16/2016] [Accepted: 09/24/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND In Parkinson's disease, the association between objective and patient-reported measures of cognitive dysfunction is unknown and highly relevant to research and clinical care. OBJECTIVE To determine which cognitive domain-specific Montreal Cognitive Assessment (MoCA) subscores are most strongly associated with patient-reported cognitive impairment on question 1 (Q1) of the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). METHODS We analyzed data from 759 PD participants and 481 persons without PD with in a retrospective, cross sectional analysis using data from the NINDS Parkinson's Disease Biomarkers Program (PDBP), a longitudinal, multicenter biomarker study. The relationship between a patient-reported cognitive rating (MDS-UPDRS q1.1) and objective cognitive assessments (MoCA) was assessed using multinomial logistic regression modeling and the outcomes reported as conditional odds ratios (cOR's) representing the relative odds of a participant reporting cognitive impairment that is "slight" versus "normal" on MDS-UPDRSq1.1 for a one unit increase in a MoCA sub-score, adjusted for age and education. RESULTS In PD participants, changes in visuospatial-executive performance and memory had the most significant impact on subjective cognitive impairment. A 1-point increase in visuospatial-executive function decreased the chance of reporting a MDS-UPDRS Q1 score of "slight" versus "normal" by a factor of 0.686 (p < 0.001) and each 1 point improvement in delayed recall decreased the odds of reporting "slight" cognitive impairment by a factor of 0.836 (p < 0.001). CONCLUSIONS Conversion from a PD patient's report of "normal" to "slight" cognitive impairment may be associated with changes in visuospatial-executive dysfunction and memory more than other cognitive domains.
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Affiliation(s)
- Kelly A Mills
- Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Corresponding author. Johns Hopkins Dept. of Neurology, 600 N. Wolfe Street, Meyer 6-181D, Baltimore, MD, 21287, United States.
| | - Zoltan Mari
- Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| | - Gregory M Pontone
- Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| | - Alexander Pantelyat
- Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| | - Angela Zhang
- Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| | - Nadine Yoritomo
- Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| | - Emma Powers
- Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| | - Jason Brandt
- Division of Medical Psychology, Dept. of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 218, Baltimore, MD, 21287, United States
| | - Ted M Dawson
- Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States; Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, United States; Solomon H. Snyder Department of Neuroscience, United States; Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, 21205, United States
| | - Liana S Rosenthal
- Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
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25
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Taylor J, Anderson WS, Brandt J, Mari Z, Pontone GM. Neuropsychiatric Complications of Parkinson Disease Treatments: Importance of Multidisciplinary Care. Am J Geriatr Psychiatry 2016; 24:1171-1180. [PMID: 27746069 PMCID: PMC5136297 DOI: 10.1016/j.jagp.2016.08.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 06/07/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 12/14/2022]
Abstract
Although Parkinson disease (PD) is defined clinically by its motor symptoms, it is increasingly recognized that much of the disability and worsened quality of life experienced by patients with PD is attributable to psychiatric symptoms. The authors describe a model of multidisciplinary care that enables these symptoms to be effectively managed. They describe neuropsychiatric complications of PD itself and pharmacologic and neurostimulation treatments for parkinsonian motor symptoms and discuss the management of these complications. Specifically, they describe the clinical associations between motor fluctuations and anxiety and depressive symptoms, the compulsive overuse of dopaminergic medications prescribed for motor symptoms (the dopamine dysregulation syndrome), and neuropsychiatric complications of these medications, including impulse control disorders, psychosis, and manic syndromes. Optimal management of these problems requires close collaboration across disciplines because of the potential for interactions among the pathophysiologic process of PD, motor symptoms, dopaminergic drugs, and psychiatric symptoms. The authors emphasize how their model of multidisciplinary care facilitates close collaboration among psychiatrists, other mental health professionals, neurologists, and functional neurosurgeons and how this facilitates effective care for patients who develop the specific neuropsychiatric complications discussed.
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Affiliation(s)
- Jacob Taylor
- Department of Psychiatry, Brigham and Women's Hospital,The Stanley Center for Psychiatric Research at The Broad Institute
| | | | - Jason Brandt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins Hospital
| | - Gregory M. Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital
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26
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Brandt J, Borgquist S, Almquist M, Manjer J. Thyroid function and survival following breast cancer. Br J Surg 2016; 103:1649-1657. [DOI: 10.1002/bjs.10284] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/08/2016] [Accepted: 07/02/2016] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Thyroid function has been associated with breast cancer risk, and breast cancer cell growth and proliferation. It is not clear whether thyroid function affects prognosis following breast cancer but, if so, this could have an important clinical impact. The present study analysed prospectively collected measurements of free tri-iodothyronine (T3), free thyroxine (T4), thyroid-stimulating hormone (TSH) and thyroid peroxidase antibodies (TPO-Ab) in relation to breast cancer survival.
Methods
The Malmö Diet and Cancer Study is a prospective cohort study of 17 035 women in Sweden. Study enrolment was conducted between 1991 and 1996. Patients with incident breast cancer were identified through record linkage with cancer registries until 31 December 2006. Information on vital status was collected from the Swedish Cause of Death Registry, with the endpoint breast cancer mortality (31 December 2013). Hazard ratios (HRs) with 95 per cent confidence intervals (c.i.) were obtained by Cox proportional hazards analysis.
Results
Some 766 patients with incident breast cancer were identified, of whom 551 were eligible for analysis. Compared with patients in the first free T4 tertile, breast cancer mortality was lower among those in the second tertile (HR 0·49, 95 per cent c.i. 0·28 to 0·84). There was an indication, although non-significant, of lower breast cancer mortality among patients in the second TSH tertile (HR 0·63, 0·37 to 1·09) and in those with positive TPO-Ab status (HR 0·61, 0·30 to 1·23). Free T3 showed no clear association with mortality.
Conclusion
In the present study, there was a positive association between free T4 levels and improved breast cancer survival.
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Affiliation(s)
- J Brandt
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Plastic Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - S Borgquist
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - M Almquist
- Department of Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - J Manjer
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Plastic Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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27
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Nelson A, Bilder RM, O'Connor M, Brandt J, Weintraub S, Bauer RM. Response to Bodin and Grote regarding postdoctoral recruitment in clinical neuropsychology. Clin Neuropsychol 2016; 30:651-9. [DOI: 10.1080/13854046.2016.1188990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Rappold T, Laflam A, Hori D, Brown C, Brandt J, Mintz CD, Sieber F, Gottschalk A, Yenokyan G, Everett A, Hogue CW. Evidence of an association between brain cellular injury and cognitive decline after non-cardiac surgery. Br J Anaesth 2016; 116:83-9. [PMID: 26675953 DOI: 10.1093/bja/aev415] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is common after non-cardiac surgery, but the mechanism is unclear. We hypothesized that decrements in cognition 1 month after non-cardiac surgery would be associated with evidence of brain injury detected by elevation of plasma concentrations of S100β, neuron-specific enolase (NSE), and/or the brain-specific protein glial fibrillary acid protein (GFAP). METHODS One hundred and forty-nine patients undergoing shoulder surgery underwent neuropsychological testing before and then 1 month after surgery. Plasma was collected before and after anaesthesia. We determined the relationship between plasma biomarker concentrations and individual neuropsychological test results and a composite cognitive functioning score (mean Z-score). RESULTS POCD (≥-1.5 sd decrement in Z-score from baseline) was present in 10.1% of patients 1 month after surgery. There was a negative relationship between higher plasma GFAP concentrations and lower postoperative composite Z-scores {estimated slope=-0.14 [95% confidence interval (CI) -0.24 to -0.04], P=0.005} and change from baseline in postoperative scores on the Rey Complex Figure Test copy trial (P=0.021), delayed recall trial (P=0.010), and the Symbol Digit Modalities Test (P=0.004) after adjustment for age, sex, history of hypertension and diabetes. A similar relationship was not observed with S100β or NSE concentrations. CONCLUSIONS Decline in cognition 1 month after shoulder surgery is associated with brain cellular injury as demonstrated by elevated plasma GFAP concentrations.
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Affiliation(s)
- T Rappold
- Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Laflam
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Hori
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Brown
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Brandt
- Departments of Psychiatry and Behavioral Sciences and Neurology, Johns Hopkins University School of Medicine and the Department of Mental Health, Bloomberg School of Public Health, Baltimore, MD, USA
| | - C D Mintz
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - F Sieber
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Gottschalk
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Yenokyan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Everett
- Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - C W Hogue
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans, Zayed 6208B, Baltimore, MD 21287, USA
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29
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Puente AN, Cohen ML, Aita S, Brandt J. Behavioral Ratings of Executive Functioning Explain Instrumental Activities of Daily Living beyond Test Scores in Parkinson's Disease. Clin Neuropsychol 2016; 30:95-106. [PMID: 26789092 DOI: 10.1080/13854046.2015.1133847] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Executive dysfunction is common in Parkinson's disease (PD), yet the relationship between executive functioning (EF) and instrumental activities of daily living (IADLs) is inconsistent. This inconsistency may be due to the limited relationship between EF test scores and behaviors. Rating scales provide a potential way to supplement test scores in predicting patient's ability to complete IADLs by capturing a wide range of EF behaviors in their everyday environment. We hypothesized that informant-rated EF would provide incremental validity in predicting IADLs above and beyond EF test scores. METHODS Eighty-five patients were selected from a clinical neuropsychological database of PD patients evaluated for deep brain stimulation surgery at The Johns Hopkins Hospital between September 2006 and January 2015. Hierarchical regression was completed to determine the relationship between an EF behavioral rating scale (i.e., FrSBe), EF test scores, and IADLs. RESULTS The EF behavioral rating scale added incremental validity to neuropsychological test scores in predicting IADLs. CONCLUSIONS Behavioral ratings of EF may provide additional information about how PD patients' EF is influencing their everyday life.
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Affiliation(s)
- Antonio Nicolas Puente
- a Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Matthew L Cohen
- c Department of Physical Therapy , University of Delaware , Newark , DE , USA
| | - Stephen Aita
- d Deparment of Psychology , University of South Alabama , Mobile , AL , USA
| | - Jason Brandt
- a Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,b Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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30
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Chan KS, Gross AL, Pezzin LE, Brandt J, Kasper JD. Harmonizing Measures of Cognitive Performance Across International Surveys of Aging Using Item Response Theory. J Aging Health 2015; 27:1392-414. [PMID: 26526748 DOI: 10.1177/0898264315583054] [Citation(s) in RCA: 12] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To harmonize measures of cognitive performance using item response theory (IRT) across two international aging studies. METHOD Data for persons ≥65 years from the Health and Retirement Study (HRS, N = 9,471) and the English Longitudinal Study of Aging (ELSA, N = 5,444). Cognitive performance measures varied (HRS fielded 25, ELSA 13); 9 were in common. Measurement precision was examined for IRT scores based on (a) common items, (b) common items adjusted for differential item functioning (DIF), and (c) DIF-adjusted all items. RESULTS Three common items (day of date, immediate word recall, and delayed word recall) demonstrated DIF by survey. Adding survey-specific items improved precision but mainly for HRS respondents at lower cognitive levels. DISCUSSION IRT offers a feasible strategy for harmonizing cognitive performance measures across other surveys and for other multi-item constructs of interest in studies of aging. Practical implications depend on sample distribution and the difficulty mix of in-common and survey-specific items.
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Affiliation(s)
- Kitty S Chan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alden L Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jason Brandt
- Johns Hopkins University School of Medicine, Baltimore, MD, USA The Copper Ridge Institute, Sykesville, MD, USA
| | - Judith D Kasper
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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31
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Cohen ML, Aita S, Mari Z, Brandt J. The Unique and Combined Effects of Apathy and Depression on Cognition in Parkinson’s Disease. JPD 2015; 5:351-9. [DOI: 10.3233/jpd-140484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Matthew L. Cohen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen Aita
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychology, Loyola University of Maryland, Baltimore, MD, USA
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason Brandt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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32
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Ross CA, Pantelyat A, Kogan J, Brandt J. Determinants of functional disability in Huntington's disease: role of cognitive and motor dysfunction. Mov Disord 2015; 29:1351-8. [PMID: 25216368 DOI: 10.1002/mds.26012] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [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: 07/28/2014] [Revised: 08/06/2014] [Accepted: 08/07/2014] [Indexed: 11/10/2022] Open
Abstract
The clinical syndrome of Huntington's disease (HD) is notable for a triad of motor, cognitive, and emotional features. All HD patients eventually become occupationally disabled; however, the factors that render HD patients unable to maintain employment have not been extensively studied. This review begins by discussing the clinical triad of HD, highlighting the distinction in the motor disorder between involuntary movements, such as chorea, and voluntary movement impairment, with the latter contributing more to functional disability. Cognitive disorder clearly contributes to disability, though the relative contribution compared to motor is difficult to unravel, especially because many of the tests used to asses "cognition" have a strong motor component. The role of emotional changes in disability needs more study. The literature on contributions to functional disability, driving impairment, and nursing home placement is reviewed. Relevant experience is presented from the long-standing JHU HD observational study on motor versus cognitive onset, as well as on cognitive and motor features at the time when individuals discontinued working. Finally, we briefly review government policies in several countries on disability determination. We interpret the data from our own studies and from the literature to indicate that there is usually a close relationship between cognitive and motor dysfunction, and that it is critical to take both into consideration in determining disability. © 2014 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Christopher A Ross
- Division of Neurobiology, Department of Psychiatry, Departments of Neurology, Neuroscience, and Pharmacology, and Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Zhu CW, Scarmeas N, Ornstein K, Albert M, Brandt J, Blacker D, Sano M, Stern Y. Health-care use and cost in dementia caregivers: Longitudinal results from the Predictors Caregiver Study. Alzheimers Dement 2015; 11:444-54. [PMID: 24637299 PMCID: PMC4164583 DOI: 10.1016/j.jalz.2013.12.018] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 12/06/2013] [Accepted: 12/11/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the effects of caregiver and patient characteristics on caregivers' medical care use and cost. METHODS One hundred forty-seven caregiver/patient dyads were followed annually for 6 years in three academic Alzheimer's disease centers in the United States. Logistic, negative binomial, and generalized linear mixed models were used to examine overall effects of caregiver/patient characteristics on caregivers' hospitalizations, doctor visits, outpatient tests and procedures, and prescription and over-the-counter medications. RESULTS Patients' comorbid conditions and dependence were associated with increased health-care use and costs of caregivers. Increases in caregiver depressive symptoms are associated with increases in multiple domains of caregivers' health-care use and costs. DISCUSSION Findings suggest expanding our focus on dementia patients to include family caregivers to obtain a fuller picture of effects of caregiving. Primary care providers should integrate caregivers' needs in health-care planning and delivery. Clinical interventions that treat patients and caregivers as a whole will likely achieve the greatest beneficial effects.
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Affiliation(s)
- Carolyn W Zhu
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA.
| | - Nikolaos Scarmeas
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain; Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA; Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Katherine Ornstein
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA; Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Marilyn Albert
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Jason Brandt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA; The Copper Ridge Institute, Sykesville, MD, USA
| | - Deborah Blacker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary Sano
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA; James J. Peters VA Medical Center, Bronx, NY, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain; Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA; Department of Neurology, Columbia University Medical Center, New York, NY, USA
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Vercammen F, No author NA, Brandt J, Brantegem L, Ducatelle L. Haemangiosarcoma in a captive Asiatic lion (Panthera leo persica). Open Vet J 2015. [DOI: 10.5455/ovj.2015.v5.i1.p52] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A 2.7-year-old male captive Asiatic lion (Panthera leo persica) died unexpectedly without preceding symptoms. Gross necropsy revealed liver and lung tumours, which proved to be haemangiosarcomas by histopathology. Some of the liver tumours were ruptured, leading to massive intra-abdominal haemorrhage and death. Haemangiosarcomas are rare in domestic and exotic felids, occurring in skin, thoracic-abdominal cavity and bones. Although these tumours mainly appear to be occurring in older cats, they are sometimes observed in younger animals, as in the present case. This is the first description of haemangiosarcoma in a young Asiatic lion.
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Vejre H, Vesterager J, Andersen P, Olafsson A, Brandt J, Dalgaard T. Does cadastral division of area-based ecosystem services obstruct comprehensive management? Ecol Modell 2015. [DOI: 10.1016/j.ecolmodel.2014.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vercammen F, Brandt J, Brantegem LV, Bosseler L, Ducatelle R. Haemangiosarcoma in a captive Asiatic lion (Panthera leo persica). Open Vet J 2015; 5:52-5. [PMID: 26623366 PMCID: PMC4629570] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/10/2015] [Indexed: 11/14/2022] Open
Abstract
A 2.7-year-old male captive Asiatic lion (Panthera leo persica) died unexpectedly without preceding symptoms. Gross necropsy revealed liver and lung tumours, which proved to be haemangiosarcomas by histopathology. Some of the liver tumours were ruptured, leading to massive intra-abdominal haemorrhage and death. Haemangiosarcomas are rare in domestic and exotic felids, occurring in skin, thoracic-abdominal cavity and bones. Although these tumours mainly appear to be occurring in older cats, they are sometimes observed in younger animals, as in the present case. This is the first description of haemangiosarcoma in a young Asiatic lion.
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Affiliation(s)
- F. Vercammen
- Centre for Research and Conservation, Royal Zoological Society of Antwerp, K. Astridplein 26, B-2018 Antwerp, Belgium,Corresponding Author: Dr. Francis Vercammen. Centre for Research and Conservation, Royal Zoological Society of Antwerp, K. Astridplein 26, B-2018 Antwerp, Belgium. Tel.: +3232024548. E-mail:
| | - J. Brandt
- Centre for Research and Conservation, Royal Zoological Society of Antwerp, K. Astridplein 26, B-2018 Antwerp, Belgium
| | - L. Van Brantegem
- Department of Pathology, Bacteriology and Avian Medicine, Faculty of Veterinary Medicine, University of Ghent, Salisburylaan 133, B-9820 Merelbeke, Belgium
| | - L. Bosseler
- Department of Pathology, Bacteriology and Avian Medicine, Faculty of Veterinary Medicine, University of Ghent, Salisburylaan 133, B-9820 Merelbeke, Belgium
| | - R. Ducatelle
- Department of Pathology, Bacteriology and Avian Medicine, Faculty of Veterinary Medicine, University of Ghent, Salisburylaan 133, B-9820 Merelbeke, Belgium
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Brandt J, Rogerson M, Al-Joudi H, Reckess G, Shpritz B, Umeh CC, Aljehani N, Mills K, Mari Z. Betting on DBS: Effects of subthalamic nucleus deep brain stimulation on risk taking and decision making in patients with Parkinson's disease. Neuropsychology 2014; 29:622-631. [PMID: 25486385 DOI: 10.1037/neu0000164] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Concerns persist that deep brain stimulation (DBS) for Parkinson's disease (PD) increases impulsivity or induces excessive reward seeking. We report here the performance of PD patients with implanted subthalamic nucleus electrodes, with stimulation on and off, on 3 laboratory tasks of risk taking and decision making. They are compared with PD patients maintained on medication and healthy participants. METHODS AND RESULTS In the Game of Dice Task, a test of "risky" decision making, PD patients with or without DBS made highest risk bets more often and ended up with less money than did healthy participants. There was a trend for DBS stimulation to ameliorate this effect. Deal or No-Deal is an "ambiguous" decision-making task that assessed preference for risk (holding on to one's briefcase) over a "sure thing" (accepting the banker's offer). Here, DBS patients were more conservative with stimulation on than with it off. They accepted smaller offers from the banker and won less money in the DBS-on condition. Overall, the 2 PD groups won less money than did healthy participants. The Framing Paradigm assessed willingness to gamble on a fixed (unambiguous) prize depending on whether the reward was "framed" as a loss or a gain. Nonsurgical PD patients tended to be more risk-averse than were healthy participants, whereas DBS patients were more willing to gamble for gains as well as losses both on and off stimulation. CONCLUSIONS On risky decision-making tasks, DBS patients took more risks than did healthy participants, but stimulation may temper this tendency. In contrast, in an ambiguous-risk situation, DBS patients were more risk-averse (conservative) than were healthy participants, and this tendency was greatest with stimulation.
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Gross AL, Brandt J, Bandeen-Roche K, Carlson MC, Stuart EA, Marsiske M, Rebok GW. Do older adults use the method of loci? Results from the ACTIVE study. Exp Aging Res 2014; 40:140-63. [PMID: 24625044 DOI: 10.1080/0361073x.2014.882204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED BACKGROUND/STUDY CONTEXT: The method of loci (MoL) is a complex visuospatial mnemonic strategy. Previous research suggests that older adults could potentially benefit from using the MoL, but that it is too attentionally demanding for them to use in practice. The authors evaluated the hypotheses that training can increase the use of MoL, and that MoL use is associated with better memory. METHODS The authors analyzed skip patterns on response forms for the Auditory Verbal Learning Test (AVLT) in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE; N = 1401) trial using 5 years of longitudinal follow-up. RESULTS At baseline, 2% of participants skipped spaces. Fewer than 2% of control participants skipped spaces at any visit across 5 years, but 25% of memory-trained participants, taught the MoL, did so. Participants who skipped spaces used more serial clustering, a hallmark of the MoL (p < .001). Trained participants who skipped spaces showed greater memory improvement after training than memory-trained participants who did not skip spaces (Cohen's d = .84, p = .007), and did not differ in the subsequent rate of long-term memory decline through up to 5 years of follow-up. CONCLUSION Despite being attentionally demanding, this study suggests that after training, the MoL is used by up to 25% of older adults, and that its use is associated with immediate memory improvement that was sustained through the course of follow-up. Findings are consistent with the notion that older adults balance complexity with novelty in strategy selection, and that changes in strategies used following memory training result in observable qualitative and quantitative differences in memory performance.
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Affiliation(s)
- Alden L Gross
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
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Blanchet X, Cesarek K, Brandt J, Herwald H, Teupser D, Küchenhoff H, Karshovska E, Mause SF, Siess W, Wasmuth H, Soehnlein O, Koenen RR, Weber C, von Hundelshausen P. Inflammatory role and prognostic value of platelet chemokines in acute coronary syndrome. Thromb Haemost 2014; 112:1277-87. [PMID: 25183015 DOI: 10.1160/th14-02-0139] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 07/01/2014] [Indexed: 01/13/2023]
Abstract
Activated platelets and neutrophils exacerbate atherosclerosis. Platelets release the chemokines CXCL4, CXCL4L1 and CCL5, whereas myeloperoxidase (MPO) and azurocidin are neutrophil-derived. We investigated whether plasma levels of these platelet and neutrophil mediators are affected by the acute coronary syndrome (ACS), its medical treatment, concomitant clinical or laboratory parameters, and predictive for the progression of coronary artery disease (CAD). In an observational study, the association of various factors with plasma concentrations of platelet chemokines and neutrophil mediators in 204 patients, either upon admission with ACS and 6 hours later or without ACS or CAD, was determined by multiple linear regression. Mediator release was further analysed after activation of blood with ACS-associated triggers such as plaque material. CXCL4, CXCL4L1, CCL5, MPO and azurocidin levels were elevated in ACS. CXCL4 and CCL5 but not CXCL4L1 or MPO were associated with platelet counts and CRP. CXCL4 (in association with heparin treatment) and MPO declined over 6 hours during ACS. Elevated CCL5 was associated with a progression of CAD. Incubating blood with plaque material, PAR1 and PAR4 activation induced a marked release of CXCL4 and CCL5, whereas CXCL4L1 and MPO were hardly or not altered. Platelet chemokines and neutrophil products are concomitantly elevated in ACS and differentially modulated by heparin treatment. CCL5 levels during ACS predict a progression of preexisting CAD. Platelet-derived products appear to dominate the inflammatory response during ACS, adding to the emerging evidence that ACS per se may promote vascular inflammation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - P von Hundelshausen
- Dr. Philipp von Hundelshausen, Institute for Cardiovascular Prevention, Ludwig-Maximilians University (LMU), Pettenkoferstr. 9, 80336 Munich, Germany, Tel.: +49 89 5160 4359, Fax: +49 89 5160 4352, E-mail:
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Spira AP, Yager C, Brandt J, Smith GS, Zhou Y, Mathur A, Kumar A, Brašić JR, Wong DF, Wu MN. Objectively Measured Sleep and β-amyloid Burden in Older Adults: A Pilot Study. SAGE Open Med 2014; 2. [PMID: 25621174 PMCID: PMC4304392 DOI: 10.1177/2050312114546520] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background/aims: Although disturbed sleep is associated with cognitive deficits, the association between sleep disturbance and Alzheimer’s disease pathology is unclear. In this pilot study, we examined the extent to which sleep duration, sleep quality, and sleep-disordered breathing are associated with β-amyloid (Aβ) deposition in the brains of living humans. Methods: We studied 13 older adults (8 with normal cognition and 5 with mild cognitive impairment). Participants completed neuropsychological testing, polysomnography, and Aβ imaging with [11C]-Pittsburgh compound B. Results: Among participants with mild cognitive impairment, higher apnea–hypopnea index and oxygen desaturation index were associated with greater Aβ deposition, globally and regionally in the precuneus. There were no significant associations between sleep-disordered breathing and Aβ deposition among cognitively normal participants. There were no significant associations between sleep duration or sleep fragmentation and Aβ deposition. Conclusion: These preliminary results suggest that among older adults with mild cognitive impairment, greater sleep-disordered breathing severity is associated with greater Aβ deposition.
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Affiliation(s)
- Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD ; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Christopher Yager
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jason Brandt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD ; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD ; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD ; The Copper Ridge Institute, Sykesville, MD
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Yun Zhou
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD
| | - Anil Mathur
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD
| | - Anil Kumar
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD
| | - James R Brašić
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD
| | - Dean F Wong
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD ; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD ; Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD ; Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mark N Wu
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD ; Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD
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Razlighi QR, Stallard E, Brandt J, Blacker D, Albert M, Scarmeas N, Kinosian B, Yashin AI, Stern Y. A new algorithm for predicting time to disease endpoints in Alzheimer's disease patients. J Alzheimers Dis 2014; 38:661-8. [PMID: 24064468 DOI: 10.3233/jad-131142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The ability to predict the length of time to death and institutionalization has strong implications for Alzheimer's disease patients and caregivers, health policy, economics, and the design of intervention studies. OBJECTIVE To develop and validate a prediction algorithm that uses data from a single visit to estimate time to important disease endpoints for individual Alzheimer's disease patients. METHOD Two separate study cohorts (Predictors 1, N = 252; Predictors 2, N = 254), all initially with mild Alzheimer's disease, were followed for 10 years at three research centers with semiannual assessments that included cognition, functional capacity, and medical, psychiatric, and neurologic information. The prediction algorithm was based on a longitudinal Grade of Membership model developed using the complete series of semiannually-collected Predictors 1 data. The algorithm was validated on the Predictors 2 data using data only from the initial assessment to predict separate survival curves for three outcomes. RESULTS For each of the three outcome measures, the predicted survival curves fell well within the 95% confidence intervals of the observed survival curves. Patients were also divided into quintiles for each endpoint to assess the calibration of the algorithm for extreme patient profiles. In all cases, the actual and predicted survival curves were statistically equivalent. Predictive accuracy was maintained even when key baseline variables were excluded, demonstrating the high resilience of the algorithm to missing data. CONCLUSION The new prediction algorithm accurately predicts time to death, institutionalization, and need for full-time care in individual Alzheimer's disease patients; it can be readily adapted to predict other important disease endpoints. The algorithm will serve an unmet clinical, research, and public health need.
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Affiliation(s)
- Qolamreza R Razlighi
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Abstract
Most approaches to the detection of presymptomatic or prodromal Alzheimer's disease require the costly collection and analysis of biological samples or neuroimaging measurements. The Dementia Risk Assessment (DRA) was developed to facilitate this detection by collecting self-report and proxy-report of dementia risk variables and episodic memory performance on a free Internet website. We now report two validation studies. In Study 1, 130 community-residing older adults seeking memory screening at senior health fairs were tested using the Mini-Cog, and were then observed while taking the DRA. They were compared to a demographically-matched subsample from our anonymous Internet sample. Participants seeking memory screening had more dementia risk factors and obtained lower scores on the DRA's recognition memory test (RMT) than their Internet controls. In addition, those who failed the Mini-Cog obtained much lower scores on the RMT than those who passed the Mini-Cog. In Study 2, 160 older adults seeking evaluation of cognitive difficulties took the DRA prior to diagnostic evaluations at outpatient dementia clinics. Patients who ultimately received the diagnosis of a dementia syndrome scored significantly lower on the RMT than those diagnosed with other conditions or deemed normal. Lower education, family history of dementia, presence of hypercholesterolemia and diabetes, and memory test score distinguished the dementia and no-dementia groups with around 82% accuracy. In addition, score on the RMT correlated highly with scores on other instruments widely used to detect cognitive decline. These findings support the concurrent validity of the DRA for detecting prevalent cognitive impairment. Prospective studies of cognitively normal persons who subsequently develop dementia will be necessary to establish its predictive validity.
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Affiliation(s)
- Jason Brandt
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA The Copper Ridge Institute, Sykesville, MD, USA
| | | | - Allan Anderson
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA The Copper Ridge Institute, Sykesville, MD, USA
| | - Alden L Gross
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
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Gu Y, Scarmeas N, Cosentino S, Brandt J, Albert M, Blacker D, Dubois B, Stern Y. Change in Body Mass Index Before and After Alzheimer’s Disease Onset. Curr Alzheimer Res 2014; 11:349-56. [DOI: 10.2174/1567205010666131120110930] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 11/02/2013] [Accepted: 11/09/2013] [Indexed: 11/22/2022]
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Cosentino S, Zahodne LB, Brandt J, Blacker D, Albert M, Dubois B, Stern Y. Social cognition in Alzheimer's disease: a separate construct contributing to dependence. Alzheimers Dement 2014; 10:818-26. [PMID: 24656839 DOI: 10.1016/j.jalz.2013.12.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 11/20/2013] [Accepted: 12/15/2013] [Indexed: 10/25/2022]
Abstract
The extent to which social cognitive changes reflect a discrete constellation of symptoms dissociable from general cognitive changes in Alzheimer's disease (AD) is unclear. Moreover, whether social cognitive symptoms contribute to disease severity and progression is unknown. The current multicenter study investigated cross-sectional and longitudinal associations between social cognition measured with six items from the Blessed Dementia Rating Scale, general cognition, and dependence in 517 participants with probable AD. Participants were monitored every 6 months for 5.5 years. Results from multivariate latent growth curve models adjusted for sex, age, education, depression, and recruitment site revealed that social cognition and general cognition were unrelated cross-sectionally and throughout time. However, baseline levels of each were related independently to dependence, and change values of each were related independently to change in dependence. These findings highlight the separability of social and general cognition in AD. Results underscore the relevance of considering social cognition when modeling disease and estimating clinical outcomes related to patient disability.
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Affiliation(s)
- Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Laura B Zahodne
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Jason Brandt
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deborah Blacker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruno Dubois
- Université Pierre et Marie Curie (Sorbonne Université), Paris, France; UMRS 975, Institut du Cerveau et de la Moelle Epinière, Institut National de la Santé et de la Recherche Médicale, Paris, France; Institut de la Mémoire et de la Maladie d'Alzheimer, Paris, France; Centre de Références Démences Rares, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Reckess GZ, Brandt J, Luis CA, Zandi P, Martin B, Breitner JCS. Screening by telephone in the Alzheimer's disease anti-inflammatory prevention trial. J Alzheimers Dis 2014; 36:433-43. [PMID: 23645097 DOI: 10.3233/jad-130113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Compared with in-person assessment methods, telephone screening for dementia and other cognitive syndromes may improve efficiency of large population studies or prevention trials. We used data from the Alzheimer's Disease Anti-Inflammatory Prevention Trial to compare performance of a four-test Telephone Assessment Battery (TAB) that included the Telephone Interview for Cognitive Status (TICS) to that of a traditional in-person Cognitive Assessment Battery. Among 1,548 elderly participants with valid telephone and in-person screening results obtained within 90 days of each other, 225 persons were referred for a full cognitive diagnostic evaluation that was completed within six months of screening. Drawing on results from this panel of 225 individuals, we used the Capture-Recapture method to estimate population numbers of cognitively impaired participants. The latter estimates enabled us to compare the performance characteristics of the two screening batteries at specified cut-offs for detection of dementia and milder forms of impairment. Although our results provide relatively imprecise estimates of the performance characteristics of the two batteries, a comparison of their relative performance suggests that, at selected cut-off points, the TAB produces results broadly comparable to in-person screening and may be slightly more sensitive in detecting mild impairment. TAB performance characteristics also appeared slightly better than those of the TICS alone. Given its benefits in time and cost when screening for cognitive disorders, telephone screening should be considered for large samples.
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Affiliation(s)
- Gila Z Reckess
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Henriksen M, Brandt J, Iyer S, Thielens N, Hansen S. Characterization of the interaction between Collectin 11 (CL-11, CL-K1) and nucleic acids. Mol Immunol 2013. [DOI: 10.1016/j.molimm.2013.05.187] [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: 11/17/2022]
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Bell SG, Matsumoto M, Shaw SJ, Brandt J, Krauss GL. New antiepileptic drug safety information is not transmitted systematically and accepted by U.S. neurologists. Epilepsy Behav 2013; 29:36-40. [PMID: 23933628 DOI: 10.1016/j.yebeh.2013.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 05/01/2013] [Revised: 06/03/2013] [Accepted: 06/08/2013] [Indexed: 11/29/2022]
Abstract
We surveyed U.S. neurologists in order to evaluate their knowledge of, and sources for, recent FDA safety warnings regarding antiepileptic drugs (AEDs) and whether they incorporate this information into their practices. Survey respondents (N=505) were predominantly board-certified American Academy of Neurology members. Approximately 20% of respondent neurologists were not aware of warnings about four drug safety risks: suicidality with newer AEDs, increased birth defect risks from in utero divalproex exposure, impaired cognitive development from in utero divalproex exposure, and the requirement of haplotype screening in patients of Asian descent starting carbamazepine. Most respondents were aware of a recommendation for haplotype screening, yet did not routinely perform the safety screening, and 18 reported patients that had hypersensitivity reactions to carbamazepine. Respondents learned about drug safety risks from varied sources; only notifications from specialty organizations were associated with accurate knowledge of drug safety warnings. Most surveyed neurologists would prefer implementing "a formal warning process via specialty organizations" with e-mails of updated product insert warnings.
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Affiliation(s)
- Sarah G Bell
- Johns Hopkins University, Department of Neurology, 600 N. Wolfe St., Meyer 2-147, Baltimore, MD 21287, USA
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48
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Baraliakos X, Heldmann F, Callhoff J, Listing J, Appelboom T, Brandt J, Van den Bosch F, Breban M, Burmester GR, Dougados M, Emery P, Gaston H, Grunke M, Van Der Horst-Bruinsma IE, Landewé R, Leirisalo-Repo M, Sieper J, De Vlam K, Pappas D, Kiltz, U, Van Der Heijde D, Braun J. Which spinal lesions are associated with new bone formation in patients with ankylosing spondylitis treated with anti-TNF agents? A long-term observational study using MRI and conventional radiography. Ann Rheum Dis 2013; 73:1819-25. [DOI: 10.1136/annrheumdis-2013-203425] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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49
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Gu Y, Scarmeas N, Cosentino SA, Brandt J, Albert M, Blacker D, Dubois B, Mayeux R, Stern Y. P1–157: Body mass change in Alzheimer's disease. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.05.380] [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: 11/28/2022]
Affiliation(s)
- Yian Gu
- Columbia University New York New York United States
| | | | | | - Jason Brandt
- Johns Hopkins University School of Medicine Baltimore Maryland United States
| | - Marilyn Albert
- Johns Hopkins University Baltimore Maryland United States
| | - Deborah Blacker
- Massachusetts General Hospital/Harvard Medical School, Harvard School of Public Health Charlestown Massachusetts United States
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Rao V, McCann U, Bergey A, Han D, Brandt J, Schretlen DJ. Correlates of Apathy During the First Year After Traumatic Brain Injury. Psychosomatics 2013; 54:403-4. [DOI: 10.1016/j.psym.2013.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 12/31/2012] [Indexed: 10/26/2022]
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