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Wood Alexander M, Wu CY, Coughlan GT, Puri T, Buckley RF, Palta P, Swardfager W, Masellis M, Galea LAM, Einstein G, Black SE, Rabin JS. Associations Between Age at Menopause, Vascular Risk, and 3-Year Cognitive Change in the Canadian Longitudinal Study on Aging. Neurology 2024; 102:e209298. [PMID: 38569140 DOI: 10.1212/wnl.0000000000209298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/13/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Mounting evidence supports sex differences in Alzheimer disease (AD) risk. Vascular and hormonal factors may together contribute to AD risk in female adults. We investigated whether age at menopause, vascular risk, and history of hormone therapy (HT) containing estrogens together influence cognition over a 3-year follow-up period. We hypothesized that earlier menopause and elevated vascular risk would have a synergistic association with lower cognitive scores at follow-up and that HT containing estrogens would attenuate this synergistic association to preserve cognition. METHODS We used data from postmenopausal female participants and age-matched male participants in the Canadian Longitudinal Study on Aging. Vascular risk was calculated using a summary score of elevated blood pressure, antihypertensive medications, elevated low-density lipoprotein cholesterol, diabetes, smoking, and obesity. Cognition was measured with a global cognitive composite at baseline and 3-year follow-up. Linear models tested independent and interactive associations of age at menopause, vascular risk, and HT history with cognition at 3-year follow-up, adjusting for baseline cognition, baseline age, years of education, and test language (English/French). RESULTS We included 8,360 postmenopausal female participants (mean age at baseline = 65.0 ± 8.53 years, mean age at menopause = 50.1 ± 4.62 years) and 8,360 age-matched male participants for comparison. There was an interaction between age at menopause and vascular risk, such that earlier menopause and higher vascular risk were synergistically associated with lower cognitive scores at follow-up (β = 0.013, 95% CI 0.001-0.025, p = 0.03). In stratified analyses, vascular risk was associated with lower cognitive scores in female participants with earlier menopause (menopausal ages 35-48 years; β = -0.044, 95% CI -0.066 to -0.022, p < 0.001), but not average (ages 49-52 years; β = -0.007, 95% CI -0.027 to 0.012, p = 0.46) or later menopause (ages 53-65 years; β = 0.003, 95% CI -0.020 to 0.025, p = 0.82). The negative association of vascular risk with cognition in female participants with earlier menopause was stronger than the equivalent association in age-matched male participants. HT history did not further modify the synergistic association of age at menopause and vascular risk with follow-up cognition (β = -0.005, 95% CI -0.032 to 0.021, p = 0.69). DISCUSSION Endocrine and vascular processes may synergistically contribute to increased risk of cognitive decline in female adults. These findings have implications for the development of sex-specific dementia prevention strategies.
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Affiliation(s)
- Madeline Wood Alexander
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Che-Yuan Wu
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Gillian T Coughlan
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Tanvi Puri
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Rachel F Buckley
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Priya Palta
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Walter Swardfager
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Mario Masellis
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Liisa A M Galea
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Gillian Einstein
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Sandra E Black
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Jennifer S Rabin
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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Wood Alexander M, Einstein G, Rabin JS. Estrogen-Only Hormone Therapy and Dementia. JAMA 2024:2817758. [PMID: 38635246 DOI: 10.1001/jama.2024.4074] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
| | - Gillian Einstein
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
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Gopinath G, Scantlebury N, Sewell IJ, Rohringer CR, Sivadas S, McSweeney M, Boshmaf SZ, Lam B, Hamani C, Abrahao A, Schwartz ML, Lipsman N, Rabin JS. Changes in Caregiver Burden Following Unilateral Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor. Mov Disord Clin Pract 2024. [PMID: 38576099 DOI: 10.1002/mdc3.14034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/11/2024] [Accepted: 03/12/2024] [Indexed: 04/06/2024] Open
Affiliation(s)
- Georgia Gopinath
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Nadia Scantlebury
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Isabella J Sewell
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Camryn R Rohringer
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Shayan Sivadas
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Melissa McSweeney
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Silina Z Boshmaf
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Benjamin Lam
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Clement Hamani
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Agessandro Abrahao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Michael L Schwartz
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nir Lipsman
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jennifer S Rabin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Nichols E, Rabin JS. Declining motor and cognitive functioning and the role of gait in dementia. Lancet Healthy Longev 2024:S2666-7568(24)00049-7. [PMID: 38582096 DOI: 10.1016/s2666-7568(24)00049-7] [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] [Received: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024] Open
Affiliation(s)
- Emma Nichols
- Center for Economic and Social Research and Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
| | - Jennifer S Rabin
- Dr Sandra Black Center for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada
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Ruthirakuhan M, Swardfager W, Xiong L, MacIntosh BJ, Rabin JS, Lanctôt KL, Ottoy J, Ramirez J, Keith J, Black SE. Investigating the impact of hypertension with and without diabetes on Alzheimer's disease risk: A clinico-pathological study. Alzheimers Dement 2024; 20:2766-2778. [PMID: 38425134 PMCID: PMC11032528 DOI: 10.1002/alz.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Hypertension and diabetes are common cardiovascular risk factors that increase Alzheimer's disease (AD) risk. However, it is unclear whether AD risk differs in hypertensive individuals with and without diabetes. METHODS Cognitively normal individuals (N = 11,074) from the National Alzheimer's Coordinating Center (NACC) were categorized as having (1) hypertension with diabetes (HTN+/DM+), (2) hypertension without diabetes (HTN+/DM-), or (3) neither (HTN-/DM-). AD risk in HTN+/DM+ and HTN+/DM- was compared to HTN-/DM-. This risk was then investigated in those with AD neuropathology (ADNP), cerebral amyloid angiopathy (CAA), cerebrovascular neuropathology (CVNP), arteriolosclerosis, and atherosclerosis. Finally, AD risk in HTN-/DM+ was compared to HTN-/DM-. RESULTS Seven percent (N = 830) of individuals developed AD. HTN+/DM+ (hazard ratio [HR] = 1.31 [1.19-1.44]) and HTN+/DM- (HR = 1.24 [1.17-1.32]) increased AD risk compared to HTN-/DM-. AD risk was greater in HTN+/DM+ with ADNP (HR = 2.10 [1.16-3.79]) and CAA (HR = 1.52 [1.09-2.12]), and in HTN+/DM- with CVNP (HR = 1.54 [1.17-2.03]). HTN-/DM+ also increased AD risk (HR = 1.88 [1.30-2.72]) compared to HTN-/DM-. DISCUSSION HTN+/DM+ and HTN+/DM- increased AD risk compared to HTN-/DM-, but pathological differences between groups suggest targeted therapies may be warranted based on cardiovascular risk profiles. HIGHLIGHTS AD risk was studied in hypertensive (HTN+) individuals with/without diabetes (DM+/-). HTN+/DM+ and HTN+/DM- both had an increased risk of AD compared to HTN-/DM-. Post mortem analysis identified neuropathological differences between HTN+/DM+ and HTN+/DM-. In HTN+/DM+, AD risk was greater in those with AD neuropathology and CAA. In HTN+/DM-, AD risk was greater in those with cerebrovascular neuropathology.
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Affiliation(s)
- Myuri Ruthirakuhan
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Walter Swardfager
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
| | - Lisa Xiong
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
| | - Bradley J. MacIntosh
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
| | - Jennifer S. Rabin
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of NeurologyDepartment of MedicineSunnybrook Health Sciences CentreTorontoOntarioCanada
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
| | - Krista L. Lanctôt
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Department of PsychiatrySunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Julie Ottoy
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Joel Ramirez
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Julia Keith
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Anatomic PathologySunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Sandra E. Black
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of NeurologyDepartment of MedicineSunnybrook Health Sciences CentreTorontoOntarioCanada
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Lapa JDS, Duarte JFS, Campos ACP, Davidson B, Nestor SM, Rabin JS, Giacobbe P, Lipsman N, Hamani C. Adverse Effects of Deep Brain Stimulation for Treatment-Resistant Depression: A Scoping Review. Neurosurgery 2024:00006123-990000000-01096. [PMID: 38511957 DOI: 10.1227/neu.0000000000002910] [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] [Received: 12/08/2023] [Accepted: 01/24/2024] [Indexed: 03/22/2024] Open
Abstract
Deep brain stimulation (DBS) is an emerging therapy for treatment-resistant depression (TRD). Although adverse effects have been reported in early-phase and a few randomized clinical trials, little is known about its overall safety profile, which has been assumed to be similar to that of DBS for movement disorders. The objective of this study was to pool existing safety data on DBS for TRD. Following PRISMA guidelines, PubMed was searched for English articles describing adverse outcomes after DBS for TRD. Studies were included if they reported at least 5 patients with a minimal follow-up of 6 months. After abstract (n = 607) and full-article review (n = 127), 28 articles reporting on 353 patients met criteria for final inclusion. Follow-up of the studies retrieved ranged from 12 to 96 months. Hemorrhages occurred in 0.8% of patients and infections in 10.2%. The rate of completed suicide was 2.5%. Development or worsening of depressive symptoms, anxiety, and mania occurred in 18.4%, 9.1%, and 5.1%, respectively. There were some differences between targets, but between-study heterogeneity precluded statistical comparisons. In conclusion, DBS for TRD is associated with surgical and psychiatric adverse events. Hemorrhage and infection occur at rates within an accepted range for other DBS applications. The risk of suicide after DBS for TRD is 2.5% but may not represent a significant deviation from the natural history of TRD. Finally, risks of worsening depression, anxiety, and the incidence of mania should be acknowledged when considering DBS for TRD.
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Affiliation(s)
- Jorge D S Lapa
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Department Neurosurgery, Hospital de Cirurgia, Aracaju, Sergipe, Brazil
| | - Joel F S Duarte
- Department Neurosurgery, Neurological Institute of Curitiba, Curitiba, Brazil
| | | | - Benjamin Davidson
- Sunnybrook Research Institute, Toronto, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Sean M Nestor
- Sunnybrook Research Institute, Toronto, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jennifer S Rabin
- Sunnybrook Research Institute, Toronto, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Peter Giacobbe
- Sunnybrook Research Institute, Toronto, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Clement Hamani
- Sunnybrook Research Institute, Toronto, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Ryoo SW, Anita NZ, Perlman G, Xiong LY, Wu CY, Wood M, Rabin JS, Mitchell J, Swardfager W. Insulin-like growth factor-1 and cognition in normoglycemia, prediabetes, and type 2 diabetes mellitus. Psychoneuroendocrinology 2024; 161:106946. [PMID: 38198904 DOI: 10.1016/j.psyneuen.2023.106946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/23/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The relationship between insulin-like growth factor-1 (IGF-1) and cognition has been studied in healthy individuals, but not extensively with regards to insulin resistance and type 2 diabetes mellitus (T2DM). In this retrospective observational study, we investigated relationships of IGF-1 with memory and executive function across people with normoglycemia, prediabetes, and T2DM. METHODS Data from the Midlife in the United States (MIDUS) study were used. Episodic memory and executive function were assessed using the Brief Test of Adult Cognition by Telephone approximately 21.42 ± 12.10 months prior to measuring IGF-1 levels from a fasting blood sample. Normoglycemia was identified as individuals without a physician diagnosis of diabetes and glycated hemoglobin (HbA1c) ≤5.6%. Prediabetes was identified as those without a physician diagnosis of diabetes and HbA1c between 5.7%-6.4%. T2DM was identified as anyone with a physician diagnosis of diabetes, or HbA1c ≥6.5%, or anyone using an oral hypoglycemic medication. The associations were assessed using linear regressions controlling for age, sex, education, body mass index, C-reactive protein, HbA1c or homeostatic model of insulin resistance, MIDUS wave, exercise, smoking status, sleep quality, alcohol intake, oral hypoglycemic use, and insulin use. RESULTS The study included 1400 participants, which consisted of 583 normoglycemic (48.4% female, mean age 51.0 ± 12.2 years), 512 prediabetes (58.4% female, mean age 57.3 ± 11.8 years), and 305 T2DM participants (53.8% female, mean age 57.6 ± 11.5 years). Peripheral IGF-1 concentrations were lower (F2,1397 = 28.29, p < 0.001) in people with prediabetes or T2DM, vs. normoglycemia. Participants with prediabetes or T2DM had lower episodic memory (F2,1397 = 9.21, p < 0.001) and executive function (F2,1397 = 20.29, p < 0.001) composite z-scores than people with normoglycemia. Higher IGF-1 concentrations were associated with better executive performance in individuals with prediabetes (β = 0.115 [0.028, 0.202], p = 0.010), but not in individuals with normoglycemia or T2DM. An interaction between IGF-1 and sex in predicting executive function was observed in the prediabetes group (β = -0.344, p = 0.042), where the relationship was weaker in females (β = 0.106 [-0.012, 0.224], p = 0.077) than males (β = 0.251 [0.123, 0.380], p < 0.001). No associations were seen between IGF-1 and memory. CONCLUSION The results suggest that peripheral IGF-1 concentrations may be related to executive function, and that the relationship may be sex-specific and dependent on diabetes status.
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Affiliation(s)
- Si Won Ryoo
- Department of Pharmacology and Toxicology- University of Toronto, Medical Sciences Building, 1 King's College Circle Room 4207, Toronto ON M5S 1A8, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada; University Health Network Toronto Rehabilitation Institute - Rumsey Centre Cardiac Rehabilitation, 347 Rumsey Rd, East York ON M4G 2V6, Canada
| | - Natasha Z Anita
- Department of Pharmacology and Toxicology- University of Toronto, Medical Sciences Building, 1 King's College Circle Room 4207, Toronto ON M5S 1A8, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada; University Health Network Toronto Rehabilitation Institute - Rumsey Centre Cardiac Rehabilitation, 347 Rumsey Rd, East York ON M4G 2V6, Canada
| | - George Perlman
- Research Institute of McGill University Health Centre, 1001 Decarie Blvd, Montreal QC H4A 3J1, Canada
| | - Lisa Y Xiong
- Department of Pharmacology and Toxicology- University of Toronto, Medical Sciences Building, 1 King's College Circle Room 4207, Toronto ON M5S 1A8, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada
| | - Che-Yuan Wu
- Department of Pharmacology and Toxicology- University of Toronto, Medical Sciences Building, 1 King's College Circle Room 4207, Toronto ON M5S 1A8, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada
| | - Madeline Wood
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada; Rehabilitation Sciences Institute - University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Suite 160, Toronto ON M5G 1V7, Canada
| | - Jennifer S Rabin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada; Rehabilitation Sciences Institute - University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Suite 160, Toronto ON M5G 1V7, Canada; Division of Neurology, Department of Medicine - University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, Toronto ON M5S 3H2, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada
| | - Jane Mitchell
- Department of Pharmacology and Toxicology- University of Toronto, Medical Sciences Building, 1 King's College Circle Room 4207, Toronto ON M5S 1A8, Canada
| | - Walter Swardfager
- Department of Pharmacology and Toxicology- University of Toronto, Medical Sciences Building, 1 King's College Circle Room 4207, Toronto ON M5S 1A8, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada; University Health Network Toronto Rehabilitation Institute - Rumsey Centre Cardiac Rehabilitation, 347 Rumsey Rd, East York ON M4G 2V6, Canada.
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8
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Lauzon C, Chiasso D, Rabin JS, Ciaramelli E, Rosenbaum RS. Ventromedial Prefrontal Cortex Does Not Play a Selective Role in Pattern Separation. J Cogn Neurosci 2024; 36:435-446. [PMID: 38060255 DOI: 10.1162/jocn_a_02096] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Humans have the capacity to form new memories of events that are, at times, highly similar to events experienced in the past, as well as the capacity to integrate and associate new information within existing knowledge structures. The former process relies on mnemonic discrimination and is believed to depend on hippocampal pattern separation, whereas the latter is believed to depend on generalization signals and conceptual categorization supported by the neocortex. Here, we examine whether and how the ventromedial prefrontal cortex (vMPFC) supports discrimination and generalization on a widely used task that was primarily designed to tax hippocampal processes. Ten individuals with lesions to the vMPFC and 46 neurotypical control participants were administered an adapted version of the mnemonic similarity task [Stark, S. M., Yassa, M. A., Lacy, J. W., & Stark, C. E. L. A task to assess behavioral pattern separation (BPS) in humans: Data from healthy aging and mild cognitive impairment. Neuropsychologia, 51, 2442-2449, 2013], which assesses the ability to distinguish previously learned images of everyday objects (targets) from unstudied, highly similar images (lures) and dissimilar images (foils). Relative to controls, vMPFC-lesioned individuals showed intact discrimination of lures from targets but a propensity to mistake studied targets and similar lures for dissimilar foils. This pattern was accompanied by inflated confidence despite low accuracy when responding to similar lures. These findings demonstrate a more general role of the vMPFC in memory retrieval, rather than a specific role in supporting pattern separation.
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Affiliation(s)
- Claire Lauzon
- Department of Psychology and Centre for Vision Research, York University, Toronto, Canada
- Rotman Research Institute, Toronto, Canada
| | - Daniel Chiasso
- Centre for Studies and Research in Cognitive Neuroscience, University of Bologna, Italy
| | - Jennifer S Rabin
- University of Toronto, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Elisa Ciaramelli
- Centre for Studies and Research in Cognitive Neuroscience, University of Bologna, Italy
- Department of Psychology 'Renzo Canestrari', University of Bologna, Bologna, Italy
| | - R Shayna Rosenbaum
- Department of Psychology and Centre for Vision Research, York University, Toronto, Canada
- Rotman Research Institute, Toronto, Canada
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9
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Scantlebury N, Rabin JS, De Schlichting E, Hamani C, Schwartz ML, Lipsman N, Abrahao A. Reply: Evaluating the Scope and Safety of Bilateral MRgFUS Thalamotomy for Essential Tremor: A Critical Analysis. Mov Disord Clin Pract 2024; 11:320-321. [PMID: 38169118 PMCID: PMC10928345 DOI: 10.1002/mdc3.13970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Nadia Scantlebury
- Harquail Centre for Neuromodulation, Sunnybrook Research InstituteTorontoONCanada
| | - Jennifer S. Rabin
- Harquail Centre for Neuromodulation, Sunnybrook Research InstituteTorontoONCanada
- Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoONCanada
- Division of Neurology, Department of MedicineSunnybrook Health Sciences Centre, University of TorontoTorontoONCanada
- Rehabilitation Sciences Institute, University of TorontoTorontoONCanada
| | - Emmanuel De Schlichting
- Division of Neurosurgery, Department of SurgerySunnybrook Health Sciences Centre, University of TorontoTorontoONCanada
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Research InstituteTorontoONCanada
- Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoONCanada
- Division of Neurosurgery, Department of SurgerySunnybrook Health Sciences Centre, University of TorontoTorontoONCanada
| | - Michael L. Schwartz
- Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoONCanada
- Division of Neurosurgery, Department of SurgerySunnybrook Health Sciences Centre, University of TorontoTorontoONCanada
| | - Nir Lipsman
- Harquail Centre for Neuromodulation, Sunnybrook Research InstituteTorontoONCanada
- Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoONCanada
- Division of Neurosurgery, Department of SurgerySunnybrook Health Sciences Centre, University of TorontoTorontoONCanada
| | - Agessandro Abrahao
- Harquail Centre for Neuromodulation, Sunnybrook Research InstituteTorontoONCanada
- Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoONCanada
- Division of Neurology, Department of MedicineSunnybrook Health Sciences Centre, University of TorontoTorontoONCanada
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10
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Yang HS, Yau WYW, Carlyle BC, Trombetta BA, Zhang C, Shirzadi Z, Schultz AP, Pruzin JJ, Fitzpatrick CD, Kirn DR, Rabin JS, Buckley RF, Hohman TJ, Rentz DM, Tanzi RE, Johnson KA, Sperling RA, Arnold SE, Chhatwal JP. Plasma VEGFA and PGF impact longitudinal tau and cognition in preclinical Alzheimer's disease. Brain 2024:awae034. [PMID: 38315899 DOI: 10.1093/brain/awae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/08/2023] [Accepted: 12/21/2023] [Indexed: 02/07/2024] Open
Abstract
Vascular dysfunction is increasingly recognized as an important contributor to the pathogenesis of Alzheimer's disease. Alterations in vascular endothelial growth factor (VEGF) pathways have been implicated as potential mechanisms. However, the specific impact of VEGF proteins in preclinical Alzheimer's disease and their relationships with other Alzheimer's disease and vascular pathologies during this critical early period remain to be elucidated. We included 317 older adults from the Harvard Aging Brain Study, a cohort of individuals who were cognitively unimpaired at baseline and followed longitudinally for up to 12 years. Baseline VEGF family protein levels (VEGFA, VEGFC, VEGFD, PGF, and FLT1) were measured in fasting plasma using high-sensitivity immunoassays. Using linear mixed effects models, we examined the interactive effects of baseline plasma VEGF proteins and amyloid PET burden (Pittsburgh Compound-B) on longitudinal cognition (Preclinical Alzheimer Cognitive Composite-5). We further investigated if effects on cognition were mediated by early neocortical tau accumulation (Flortaucipir PET burden in the inferior temporal cortex) or hippocampal atrophy. Lastly, we examined the impact of adjusting for baseline cardiovascular risk score or white matter hyperintensity volume. Baseline plasma VEGFA and PGF each showed a significant interaction with amyloid burden on prospective cognitive decline. Specifically, low VEGFA and high PGF were associated with greater cognitive decline in individuals with elevated amyloid, i.e. those on the Alzheimer's disease continuum. Concordantly, low VEGFA and high PGF were associated with accelerated longitudinal tau accumulation in those with elevated amyloid. Moderated mediation analyses confirmed that accelerated tau accumulation fully mediated the effects of low VEGFA and partially mediated (31%) the effects of high PGF on faster amyloid-related cognitive decline. The effects of VEGFA and PGF on tau and cognition remained significant after adjusting for cardiovascular risk score or white matter hyperintensity volume. There were concordant but non-significant associations with longitudinal hippocampal atrophy. Together, our findings implicate low VEGFA and high PGF in accelerating early neocortical tau pathology and cognitive decline in preclinical Alzheimer's disease. Additionally, our results underscore the potential of these minimally-invasive plasma biomarkers to inform the risk of Alzheimer's disease progression in the preclinical population. Importantly, VEGFA and PGF appear to capture distinct effects from vascular risks and cerebrovascular injury. This highlights their potential as new therapeutic targets, in combination with anti-amyloid and traditional vascular risk reduction therapies, to slow the trajectory of preclinical Alzheimer's disease and delay or prevent the onset of cognitive decline.
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Affiliation(s)
- Hyun-Sik Yang
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Wai-Ying W Yau
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Becky C Carlyle
- Harvard Medical School, Boston, MA 02115, USA
- Alzheimer's Clinical and Translational Research Unit, Department of Neurology, Massachusetts General Hospital, Charlestown, MA 02129, USA
- Department of Physiology, Anatomy & Genetics, and Kavli Institute for Nanoscience Discovery, University of Oxford, Oxford, UK
| | - Bianca A Trombetta
- Alzheimer's Clinical and Translational Research Unit, Department of Neurology, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Can Zhang
- Harvard Medical School, Boston, MA 02115, USA
- Alzheimer's Clinical and Translational Research Unit, Department of Neurology, Massachusetts General Hospital, Charlestown, MA 02129, USA
- Genetics and Aging Research Unit, McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Zahra Shirzadi
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Aaron P Schultz
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Jeremy J Pruzin
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Banner Alzheimer's Institute, Phoenix, AZ 85006, USA
| | | | - Dylan R Kirn
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Jennifer S Rabin
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Rachel F Buckley
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Timothy J Hohman
- Vanderbilt Memory and Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Dorene M Rentz
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Rudolph E Tanzi
- Harvard Medical School, Boston, MA 02115, USA
- Genetics and Aging Research Unit, McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Keith A Johnson
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Steven E Arnold
- Harvard Medical School, Boston, MA 02115, USA
- Alzheimer's Clinical and Translational Research Unit, Department of Neurology, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Jasmeer P Chhatwal
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
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11
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Ruthirakuhan M, Wood Alexander M, Cogo-Moreira H, Robinson T, Amariglio R, Buckley RF, Sperling RA, Swardfager W, Black SE, Rabin JS. Investigating the Factor Structure of the Preclinical Alzheimer Cognitive Composite and Cognitive Function Index across Racial/Ethnic, Sex, and Aβ Status Groups in the A4 Study. J Prev Alzheimers Dis 2024; 11:48-55. [PMID: 38230716 DOI: 10.14283/jpad.2023.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Disparities in Alzheimer's disease (AD) are well-documented among different racial/ethnic groups and between sex/genders. Neuropsychological assessment provides important information about cognitive changes and can offer valuable insights into disparities. However, neuropsychological measures must be comparable across racial/ethnic and sex/gender groups to accurately interpret disparities. OBJECTIVES To evaluate measurement invariance (equivalence) of the Preclinical Alzheimer Cognitive Composite (PACC) and the Cognitive Function Index across racial/ethnic, sex/gender, and β-amyloid (Aβ) status groups. DESIGN, SETTING, PARTICIPANTS Cross-sectional analysis of screening data from the Anti-Amyloid in Asymptomatic AD (A4) Study. The study enrolled participants aged 65-85 from sites across the United States, Canada, Australia, and Japan. MEASUREMENTS Participants completed the PACC and the Cognitive Function Index. Participants classified as cognitively normal also underwent a Positron Emission Tomography (PET) scan to determine Aβ status. RESULTS Participants self-identified as non-Hispanic White (n=5241), non-Hispanic Black (n=267), Asian (n=228), or Hispanic White (n=225) as well as male (n=2885) or female (n=3076). Among those who underwent a PET scan, 3115 were classified as Aβ- and 1309 were classified as Aβ+. We found support for a one-factor model for both the PACC and Cognitive Function Index across the full sample and in samples stratified by race/ethnicity, sex/gender, and Aβ status. The one-factor model of the PACC and Cognitive Function Index demonstrated scalar measurement invariance across racial/ethnic, sex/gender, and Aβ status groups. CONCLUSIONS Our findings suggest that performance on the PACC and Cognitive Function Index can be compared across the racial/ethnic, sex/gender, and Aβ status groups examined in this study.
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Affiliation(s)
- M Ruthirakuhan
- Jennifer Rabin, PhD, C.Psych, Sunnybrook Health Sciences Centre, Room M6-178, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada, Phone: 416-480-6100 ext. 83737, E-mail:
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12
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Jiang G, Rabin JS, Black SE, Swardfager W, MacIntosh BJ. A Blood-Based Lipid Profile Associated With Hippocampal Volume and Brain Resting-State Activation Within Obese Adults from the UK Biobank. Brain Connect 2023; 13:578-588. [PMID: 37930726 DOI: 10.1089/brain.2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Objectives: Obesity and dyslipidemia may be associated with hippocampal alterations and may increase the risk of neurodegeneration. This study studied hippocampal anatomical and functional association with a lipid profile based on high-density lipoprotein, low-density lipoprotein, and triglyceride related to dyslipidemia in obese and nonobese adults. A whole-brain analysis was also conducted to examine the effect of dyslipidemia on resting-state function across the brain. Participants and Methods: In total, 553 UK Biobank participants comprised three groups based on body mass index (BMI) rankings: obese adults with high BMI (OHigh, n = 184, 32.7 kg/m2 ≤ BMI ≤53.4 kg/m2), obese adults with a lower BMI (OLow, n = 182, 30.3 kg/m2 ≤ BMI ≤32.6 kg/m2), and nonobese controls (n = 187). Structural MRI and functional MRI data were accessed. The fractional amplitude of low-frequency fluctuations (fALFFs) maps was calculated to reflect resting-state brain activity. A lipid health factor was created using principal component analysis. Linear models tested for associations between the lipid health score and hippocampal MRI readouts. Results: With a higher lipid health factor corresponding to a lower dyslipidemia risk, we found a positive correlation between hippocampal volume with the lipid health factor exclusively in group OLow (p = 0.01). We also found a positive association between the lipid health factor and hippocampal fALFF in group OHigh (p = 0.02). Additional fALFF voxel-wise analysis to group OHigh also implicated that the premotor cortex, amygdala, thalamus, subcallosal cortex, temporal fusiform cortex, and middle temporal gyrus brain regions are related with lipid. Conclusion: The study finds novel associations among circulating lipid, hippocampal structure, and hippocampal function exclusively in the obese adults.
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Affiliation(s)
- Guocheng Jiang
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Medical Biophysics and University of Toronto, University of Toronto, Toronto, Canada
| | - Jennifer S Rabin
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sandra E Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, Toronto, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Sandra E Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, Toronto, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Walter Swardfager
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Sandra E Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, University of Toronto, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Medical Biophysics and University of Toronto, University of Toronto, Toronto, Canada
- Sandra E Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, Toronto, Canada
- Computational Radiology and Artificial Intelligence Unit, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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Ng E, Nestor SM, Rabin JS, Hamani C, Lipsman N, Giacobbe P. Seasonal pattern and depression outcomes from repetitive transcranial magnetic stimulation. Psychiatry Res 2023; 329:115525. [PMID: 37820574 DOI: 10.1016/j.psychres.2023.115525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
Individuals with major depressive disorder (MDD) may exhibit a seasonal pattern. The impact of a seasonal pattern in depressive symptoms on rTMS outcomes is unexplored. A retrospective analysis was performed on patients with MDD receiving open-label high frequency rTMS to the left dorsolateral prefrontal cortex. Having a seasonal pattern was defined as scoring ≥ 12 on the Personal Inventory for Depression and Seasonal Affective Disorder (PIDS). Primary outcomes included improvement in the Hamilton Depression Rating Scale (HAMD) and remission. Secondary analyses included the use of the self-rated Quick Inventory of Depressive Symptomatology (QIDS) to assess for changes in atypical neurovegetative symptoms. Multiple linear regression, multiple logistic regression, and linear mixed effects analyses were performed. 46 % (58/127) of the sample had a seasonal pattern. Seasonal pattern did not significantly influence improvement in HAMD (PIDS < 12, 7.8, SD 5.9; PIDS ≥ 12, 10.4, SD 4.9 or remission (PIDS < 12, 30 %; PIDS ≥ 12, 34 %). There were equivalent degrees of improvement in atypical neurovegetative symptoms over time as assessed using the QIDS. Depression with seasonal pattern was found to respond to rTMS treatment similarly to depression without seasonal pattern, suggesting that this may be a viable treatment for this group.
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Affiliation(s)
- Enoch Ng
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Sean M Nestor
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada; Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Harquail Centre for Neuromodulation, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - Jennifer S Rabin
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Harquail Centre for Neuromodulation, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Division of Neurology, Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Toronto, ON M5S 3Hs, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Clement Hamani
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Harquail Centre for Neuromodulation, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Surgery, University of Toronto, 149 College Street, Toronto, ON M5T 1P5, Canada
| | - Nir Lipsman
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Harquail Centre for Neuromodulation, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Surgery, University of Toronto, 149 College Street, Toronto, ON M5T 1P5, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada; Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Harquail Centre for Neuromodulation, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
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14
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Churchill NW, Roudaia E, Jean Chen J, Gilboa A, Sekuler A, Ji X, Gao F, Lin Z, Masellis M, Goubran M, Rabin JS, Lam B, Cheng I, Fowler R, Heyn C, Black SE, MacIntosh BJ, Graham SJ, Schweizer TA. Persistent post-COVID headache is associated with suppression of scale-free functional brain dynamics in non-hospitalized individuals. Brain Behav 2023; 13:e3212. [PMID: 37872889 PMCID: PMC10636408 DOI: 10.1002/brb3.3212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION Post-acute coronavirus disease 2019 (COVID-19) syndrome (PACS) is a growing concern, with headache being a particularly debilitating symptom with high prevalence. The long-term effects of COVID-19 and post-COVID headache on brain function remain poorly understood, particularly among non-hospitalized individuals. This study focused on the power-law scaling behavior of functional brain dynamics, indexed by the Hurst exponent (H). This measure is suppressed during physiological and psychological distress and was thus hypothesized to be reduced in individuals with post-COVID syndrome, with greatest reductions among those with persistent headache. METHODS Resting-state blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging data were collected for 57 individuals who had COVID-19 (32 with no headache, 14 with ongoing headache, 11 recovered) and 17 controls who had cold and flu-like symptoms but tested negative for COVID-19. Individuals were assessed an average of 4-5 months after COVID testing, in a cross-sectional, observational study design. RESULTS No significant differences in H values were found between non-headache COVID-19 and control groups., while those with ongoing headache had significantly reduced H values, and those who had recovered from headache had elevated H values, relative to non-headache groups. Effects were greatest in temporal, sensorimotor, and insular brain regions. Reduced H in these regions was also associated with decreased BOLD activity and local functional connectivity. CONCLUSIONS These findings provide new insights into the neurophysiological mechanisms that underlie persistent post-COVID headache, with reduced BOLD scaling as a potential biomarker that is specific to this debilitating condition.
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Affiliation(s)
- Nathan W. Churchill
- Neuroscience Research Program, St. Michael's HospitalTorontoOntarioCanada
- Keenan Research Centre for Biomedical Science, St. Michael's HospitalTorontoOntarioCanada
- Physics DepartmentToronto Metropolitan UniversityTorontoOntarioCanada
| | - Eugenie Roudaia
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
| | - J. Jean Chen
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Institute of Biomedical EngineeringUniversity of TorontoTorontoOntarioCanada
| | - Asaf Gilboa
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
- Department of PsychologyUniversity of TorontoTorontoOntarioCanada
| | - Allison Sekuler
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
- Department of PsychologyUniversity of TorontoTorontoOntarioCanada
- Department of Psychology, Neuroscience & BehaviourMcMaster UniversityHamiltonOntarioCanada
| | - Xiang Ji
- LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Fuqiang Gao
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Zhongmin Lin
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Physical Sciences PlatformSunnybrook Research InstituteTorontoOntarioCanada
| | - Mario Masellis
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Maged Goubran
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Physical Sciences PlatformSunnybrook Research InstituteTorontoOntarioCanada
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
| | - Jennifer S. Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
- Rehabilitation Sciences InstituteUniversity of TorontoTorontoOntarioCanada
| | - Benjamin Lam
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Ivy Cheng
- Evaluative Clinical SciencesSunnybrook Research InstituteTorontoOntarioCanada
- Integrated Community ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Robert Fowler
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Emergency & Critical Care Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Chris Heyn
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - Sandra E. Black
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Bradley J. MacIntosh
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Physical Sciences PlatformSunnybrook Research InstituteTorontoOntarioCanada
- Computational Radiology & Artificial Intelligence Unit, Division of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
| | - Simon J. Graham
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Physical Sciences PlatformSunnybrook Research InstituteTorontoOntarioCanada
| | - Tom A. Schweizer
- Neuroscience Research Program, St. Michael's HospitalTorontoOntarioCanada
- Keenan Research Centre for Biomedical Science, St. Michael's HospitalTorontoOntarioCanada
- Faculty of Medicine (Neurosurgery)University of TorontoTorontoOntarioCanada
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15
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Scantlebury N, Rohringer CR, Rabin JS, Yunusova Y, Huang Y, Jones RM, Meng Y, Hamani C, McKinlay S, Gopinath G, Sewell IJ, Marzouqah R, McSweeney M, Lam B, Hynynen K, Schwartz ML, Lipsman N, Abrahao A. Safety of Bilateral Staged Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor. Mov Disord Clin Pract 2023; 10:1559-1561. [PMID: 37868927 PMCID: PMC10585969 DOI: 10.1002/mdc3.13882] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/09/2023] [Accepted: 08/12/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- Nadia Scantlebury
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
| | - Camryn R. Rohringer
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
| | - Jennifer S. Rabin
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
- Rehabilitation Sciences Institute, University of TorontoTorontoOntarioCanada
| | - Yana Yunusova
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Rehabilitation Sciences Institute, University of TorontoTorontoOntarioCanada
- Department of Speech‐Language PathologyUniversity of TorontoTorontoOntarioCanada
- Toronto Rehabilitation Institute, University Health NetworkTorontoOntarioCanada
| | - Yuexi Huang
- Physical Sciences Platform, Sunnybrook Research InstituteTorontoOntarioCanada
| | - Ryan M. Jones
- Physical Sciences Platform, Sunnybrook Research InstituteTorontoOntarioCanada
| | - Ying Meng
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Clement Hamani
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Scotia McKinlay
- Department of Speech‐Language PathologyUniversity of TorontoTorontoOntarioCanada
- Toronto Western Hospital, University Health NetworkTorontoOntarioCanada
| | - Georgia Gopinath
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Isabella J. Sewell
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Reeman Marzouqah
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Rehabilitation Sciences Institute, University of TorontoTorontoOntarioCanada
- Department of Speech‐Language PathologyUniversity of TorontoTorontoOntarioCanada
- Toronto Rehabilitation Institute, University Health NetworkTorontoOntarioCanada
| | - Melissa McSweeney
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Benjamin Lam
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Kullervo Hynynen
- Physical Sciences Platform, Sunnybrook Research InstituteTorontoOntarioCanada
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
| | - Michael L. Schwartz
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Nir Lipsman
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Agessandro Abrahao
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
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16
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Wu CY, Iskander C, Wang C, Xiong LY, Shah BR, Edwards JD, Kapral MK, Herrmann N, Lanctôt KL, Masellis M, Swartz RH, Cogo-Moreira H, MacIntosh BJ, Rabin JS, Black SE, Saskin R, Swardfager W. Association of sulfonylureas with the risk of dementia: A population-based cohort study. J Am Geriatr Soc 2023; 71:3059-3070. [PMID: 37218376 DOI: 10.1111/jgs.18397] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/09/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Sulfonylureas are oral glucose-lowering medications positioned as a second-line therapy for type 2 diabetes. Evidence relating them to cognitive decline has been mixed. The objective was to determine whether sulfonylurea use was associated with a differential risk of dementia compared with dipeptidyl peptidase-4 (DPP4) inhibitor use. METHODS Using administrative data from residents in Ontario, Canada, adults aged ≥66 years who were new users of a sulfonylurea or a DPP4 inhibitor from June 14, 2011, to March 31, 2021 entered this population-based retrospective cohort study. Dementia was ascertained using a validated algorithm for Alzheimer's disease and related dementias. Propensity-score weighted Cox proportional hazards models were used to obtain adjusted hazard ratios (aHR) and confidence intervals (CI) for time to incident dementia. The observation window started at 1 year after cohort entry to mitigate protopathic bias due to delayed diagnosis. The primary analysis used an intention-to-treat exposure definition. A separate propensity-score weighted analysis was conducted to explore within-class differences in dementia risk among sulfonylurea new users selected from the primary cohort. RESULTS Among 107,806 DPP4 inhibitor new users and 37,030 sulfonylurea new users, sulfonylureas compared with DPP4 inhibitors were associated with a higher risk of dementia (18.4/1000 person-years; aHR [95% CI] = 1.09 [1.04-1.15]) over a mean follow-up of 4.82 years from cohort entry. Glyburide compared to gliclazide exhibited a higher dementia risk (aHR [95% CI] = 1.17 [1.03-1.32]). CONCLUSION New use of a sulfonylurea especially glyburide was associated with a higher dementia risk compared with new use of a DPP4 inhibitor in older adults with diabetes.
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Affiliation(s)
- Che-Yuan Wu
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | | | - Lisa Y Xiong
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Baiju R Shah
- ICES, Toronto, Ontario, Canada
- Divisions of Endocrinology and Obstetric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jodi D Edwards
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | - Moira K Kapral
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- KITE University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Toronto Dementia Research Alliance, Toronto, Ontario, Canada
| | - Mario Masellis
- Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Richard H Swartz
- Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hugo Cogo-Moreira
- Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Faculty of Education, ICT, and Learning, Østfold University College, Halden, Norway
| | - Bradley J MacIntosh
- Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Computational Radiology & Artificial Intelligence (CRAI), Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Jennifer S Rabin
- Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Dementia Research Alliance, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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17
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Wood ME, Xiong LY, Wong YY, Buckley RF, Swardfager W, Masellis M, Lim ASP, Nichols E, Joie RL, Casaletto KB, Kumar RG, Dams-O'Connor K, Palta P, George KM, Satizabal CL, Barnes LL, Schneider JA, Binet AP, Villeneuve S, Pa J, Brickman AM, Black SE, Rabin JS. Sex differences in associations between APOE ε2 and longitudinal cognitive decline. Alzheimers Dement 2023; 19:4651-4661. [PMID: 36994910 PMCID: PMC10544702 DOI: 10.1002/alz.13036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION We examined whether sex modifies the association between APOE ε2 and cognitive decline in two independent samples. METHODS We used observational data from cognitively unimpaired non-Hispanic White (NHW) and non-Hispanic Black (NHB) adults. Linear mixed models examined interactive associations of APOE genotype (ε2 or ε4 carrier vs. ε3/ε3) and sex on cognitive decline in NHW and NHB participants separately. RESULTS In both Sample 1 (N = 9766) and Sample 2 (N = 915), sex modified the association between APOE ε2 and cognitive decline in NHW participants. Specifically, relative to APOE ε3/ε3, APOE ε2 protected against cognitive decline in men but not women. Among APOE ε2 carriers, men had slower decline than women. Among APOE ε3/ε3 carriers, cognitive trajectories did not differ between sexes. There were no sex-specific associations of APOE ε2 with cognition in NHB participants (N = 2010). DISCUSSION In NHW adults, APOE ε2 may protect men but not women against cognitive decline. HIGHLIGHTS We studied sex-specific apolipoprotein E (APOE) ε2 effects on cognitive decline. In non-Hispanic White (NHW) adults, APOE ε2 selectively protects men against decline. Among men, APOE ε2 was more protective than APOE ε3/ε3. In women, APOE ε2 was no more protective than APOE ε3/ε3. Among APOE ε2 carriers, men had slower decline than women. There were no sex-specific APOE ε2 effects in non-Hispanic Black (NHB) adults.
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Affiliation(s)
- Madeline E Wood
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Y Xiong
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Yuen Yan Wong
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Rachel F Buckley
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Florey Institute, University of Melbourne, Parkville, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andrew S P Lim
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Emma Nichols
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Kaitlin B Casaletto
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Raj G Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Priya Palta
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Kristen M George
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, California, USA
| | - Claudia L Satizabal
- Department of Population Health Science and Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexa Pichette Binet
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sylvia Villeneuve
- Centre for Studies on Prevention of Alzheimer's Disease (StoP-AD), Douglas Mental Health University Institute, Centre for Studies on the Prevention of Alzheimer's Disease (StoP-AD), Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Judy Pa
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Sandra E Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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18
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Ourry V, Binette AP, St-Onge F, Strikwerda-Brown C, Chagnot A, Poirier J, Breitner J, Arenaza-Urquijo EM, Rabin JS, Buckley R, Gonneaud J, Marchant NL, Villeneuve S. How Do Modifiable Risk Factors Affect Alzheimer's Disease Pathology or Mitigate Its Effect on Clinical Symptom Expression? Biol Psychiatry 2023:S0006-3223(23)01562-7. [PMID: 37689129 DOI: 10.1016/j.biopsych.2023.09.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/11/2023] [Accepted: 09/03/2023] [Indexed: 09/11/2023]
Abstract
Epidemiological studies show that modifiable risk factors account for approximately 40% of the population variability in risk of developing dementia, including sporadic Alzheimer's disease (AD). Recent findings suggest that these factors may also modify disease trajectories of people with autosomal-dominant AD. With positron emission tomography imaging, it is now possible to study the disease many years before its clinical onset. Such studies can provide key knowledge regarding pathways for either the prevention of pathology or the postponement of its clinical expression. The former "resistance pathway" suggests that modifiable risk factors could affect amyloid and tau burden decades before the appearance of cognitive impairment. Alternatively, the resilience pathway suggests that modifiable risk factors may mitigate the symptomatic expression of AD pathology on cognition. These pathways are not mutually exclusive and may appear at different disease stages. Here, in a narrative review, we present neuroimaging evidence that supports both pathways in sporadic AD and autosomal-dominant AD. We then propose mechanisms for their protective effect. Among possible mechanisms, we examine neural and vascular mechanisms for the resistance pathway. We also describe brain maintenance and functional compensation as bases for the resilience pathway. Improved mechanistic understanding of both pathways may suggest new interventions.
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Affiliation(s)
- Valentin Ourry
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Alexa Pichet Binette
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; Clinical Memory Research Unit, Department of Clinical Sciences, Lunds Universitet, Malmö, Sweden
| | - Frédéric St-Onge
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Cherie Strikwerda-Brown
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Audrey Chagnot
- UK Dementia Research Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Judes Poirier
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - John Breitner
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Eider M Arenaza-Urquijo
- Environment and Health over the Lifecourse Programme, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer S Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Buckley
- Melbourne School of Psychological Sciences University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Julie Gonneaud
- Normandie University, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Natalie L Marchant
- Division of Psychiatry, University College London, London, United Kingdom
| | - Sylvia Villeneuve
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
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19
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Zebarth J, Kamal R, Perlman G, Ouk M, Xiong LY, Yu D, Lin WZ, Ramirez J, Masellis M, Goubran M, MacIntosh BJ, Black SE, Cogo-Moreira H, Scott CJM, Bartha R, Symons S, Haddad SMH, Ozzoude M, Nanayakkara N, Beaton D, Arnott S, Dowlatshahi D, Swartz RH, Saposnik G, Grimes D, Lang A, Fischer CE, Frank A, Kumar S, Pollock BG, Tang-Wai D, Finger E, Rabin JS, Swardfager W. Perivascular spaces mediate a relationship between diabetes and other cerebral small vessel disease markers in cerebrovascular and neurodegenerative diseases. J Stroke Cerebrovasc Dis 2023; 32:107273. [PMID: 37542762 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) and hypertension are risk factors for cerebral small vessel disease (SVD); however, few studies have characterised their relationships with MRI-visible perivascular spaces (PVS). MRI was used to quantify deep (d) and periventricular (p) white matter hyperintensities (WMH), lacunes, PVS in the white matter (wmPVS) or basal ganglia (bgPVS), and diffusion metrics in white matter. Patients with T2DM had greater wmPVS volume and there were greater wmPVS volumes in patients with T2DM and hypertension together. Counterfactual moderated mediation models found indirect effects of T2DM on volumes of other SVD and diffusion markers that were mediated by wmPVS: pWMH, dWMH, periventricular lacunes, and deep lacunes, and progression of deep lacunes over 1 year, in patients with hypertension, but not in patients without hypertension. Studying the regulation of cortical perivascular fluid dynamics may reveal mechanisms that mediate the impact of T2DM on cerebral small vessels.
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Affiliation(s)
- Julia Zebarth
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences building 1 Kings College Circle Room 4207, Toronto, Ontario M5S 1A8, Canada
| | - Radia Kamal
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences building 1 Kings College Circle Room 4207, Toronto, Ontario M5S 1A8, Canada
| | - George Perlman
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences building 1 Kings College Circle Room 4207, Toronto, Ontario M5S 1A8, Canada
| | - Michael Ouk
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences building 1 Kings College Circle Room 4207, Toronto, Ontario M5S 1A8, Canada
| | - Lisa Y Xiong
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences building 1 Kings College Circle Room 4207, Toronto, Ontario M5S 1A8, Canada
| | - Di Yu
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences building 1 Kings College Circle Room 4207, Toronto, Ontario M5S 1A8, Canada
| | - William Z Lin
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences building 1 Kings College Circle Room 4207, Toronto, Ontario M5S 1A8, Canada
| | - Joel Ramirez
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Mario Masellis
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Maged Goubran
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Princess Margret Cancer Research Tower 101 College Street Room 15-701, Toronto M5G 1L7, Canada
| | - Bradley J MacIntosh
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Princess Margret Cancer Research Tower 101 College Street Room 15-701, Toronto M5G 1L7, Canada
| | - Sandra E Black
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Hugo Cogo-Moreira
- Department of Education, Østfold University College, 1757 B R A Veien 4, Halden 1757, Norway
| | - Christopher J M Scott
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Western University, Medical Sciences building Room M407, London, Ontario N6A 5C1, Canada
| | - Sean Symons
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Seyyed M H Haddad
- Center for Functional and Metabolic Mapping, Robarts Research Institute, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Miracle Ozzoude
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Nuwan Nanayakkara
- Robarts Research Institute, University of Western Ontario, 100 Perth Drive, London, Ontario N6A 5K8, Canada
| | - Derek Beaton
- Data Science and Advanced Analytics (DSAA), St. Michael's Hospital, Unity Health Toronto, 36 Queen Street East, Toronto, Ontario M5B 1W8, Canada
| | - Stephen Arnott
- Rotman Research Institute, Baycrest Centre, 3560 Bathurst Street, Toronto, Ontario M6A 2E1, Canada
| | - Dariush Dowlatshahi
- Division of Neurology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, 725 Parkdale Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Richard H Swartz
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Research Unit, Division of Neurology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - David Grimes
- Division of Neurology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, 725 Parkdale Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Anthony Lang
- Krembil Research Institute, University Health Network, 60 Leonard Ave, Toronto, Ontario M5T 0S8, Canada; Division of Neurology, Temerty Faculty of Medicine, University of Toronto, Medical Sciences building 1 Kings College Circle Room 4207, Toronto, Ontario M5S 1A8, Canada; Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada
| | - Corinne E Fischer
- Keenan Research Centre for Biomedical Science, Unity Health, 209 Victoria Street, Toronto, Ontario M5B 1T8, Canada
| | - Andrew Frank
- Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario K1R 6M1, Canada
| | - Sanjeev Kumar
- Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto M5T 1R8, Canada
| | - Bruce G Pollock
- Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences building 1 Kings College Circle Room 4207, Toronto, Ontario M5S 1A8, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health 475 Spadina Avenue, Toronto, Ontario M5S 2S1, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto M5T 1R8, Canada
| | - David Tang-Wai
- Krembil Research Institute, University Health Network, 60 Leonard Ave, Toronto, Ontario M5T 0S8, Canada; Division of Neurology, Temerty Faculty of Medicine, University of Toronto, Medical Sciences building 1 Kings College Circle Room 4207, Toronto, Ontario M5S 1A8, Canada; Toronto Western Hospital, University Health Network Memory Clinic, 399 Bathurst Street, Toronto M5T 2S8, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Western University, 550 Wellington Road, London, Ontario N6C 0A7, Canada
| | - Jennifer S Rabin
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, Toronto, Ontario M5S 1A8, Canada
| | - Walter Swardfager
- Dr. Sandra Black Center for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences building 1 Kings College Circle Room 4207, Toronto, Ontario M5S 1A8, Canada; Thunder Bay Regional Health Research Institute, 1040 Oliver Road, Thunder Bay, Ontario P7B 7A5, Canada.
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20
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Davidson B, Scherer M, Giacobbe P, Nestor S, Abrahao A, Rabin JS, Phung L, Lin FH, Lipsman N, Milosevic L, Hamani C. Mood biomarkers of response to deep brain stimulation in depression measured with a sensing system. Brain Stimul 2023; 16:1371-1373. [PMID: 37696354 DOI: 10.1016/j.brs.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023] Open
Affiliation(s)
- Benjamin Davidson
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Canada.
| | - Maximilian Scherer
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Canada
| | - Peter Giacobbe
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Sean Nestor
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Agessandro Abrahao
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Canada; Department of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jennifer S Rabin
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Liane Phung
- Sunnybrook Research Institute, Toronto, Canada
| | | | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Canada
| | - Luka Milosevic
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Canada
| | - Clement Hamani
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Canada.
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21
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Robinson T, Klinger H, Buckley R, Deters KD, Quiroz YT, Rentz D, Rabin JS, Sperling RA, Amariglio RE. Subjective cognitive decline across ethnoracial groups in the A4 study. Alzheimers Dement 2023; 19:4084-4093. [PMID: 37218387 PMCID: PMC10524317 DOI: 10.1002/alz.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION The associations between subjective cognitive decline (SCD), cognition, and amyloid were explored across diverse participants in the A4 study. METHODS Five thousand one hundred and fifty-one non-Hispanic White, 262 non-Hispanic Black, 179 Hispanic-White, and 225 Asian participants completed the Preclinical Alzheimer Cognitive Composite (PACC), self- and study partner-reported Cognitive Function Index (CFI). A subsample underwent amyloid positron emission tomography (18 F-florbetapir) (N = 4384). We examined self-reported CFI, PACC, amyloid, and study partner-reported CFI by ethnoracial group. RESULTS The associations between PACC-CFI and amyloid-CFI were moderated by race. The relationships were weaker or non-significant in non-Hispanic Black and Hispanic White groups. Depression and anxiety scores were stronger predictors of CFI in these groups. Despite group differences in the types of study partners, self- and study partner-CFI were congruent across groups. DISCUSSION SCD may not uniformly relate to cognition or AD biomarkers in different ethnoracial groups. Nonetheless, self- and study partner-SCD were congruent despite differences in study partner type. Highlights Association between SCD and objective cognition was moderated by ethnoracial group. Association between SCD and amyloid was moderated by ethnoracial group. Depression and anxiety were stronger predictors of SCD in Black and Hispanic groups. Study-partner and self-reported SCD are congruent across groups. Study-partner report was consistent despite difference in study partner types.
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Affiliation(s)
- Talia Robinson
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston MA, 02115, USA
| | - Hannah Klinger
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Rachel Buckley
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston MA, 02115, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
- Melbourne School of Psychological Science and Florey Institute, University of Melbourne, Victoria, 3052, Australia
| | - Kacie D. Deters
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Yakeel T. Quiroz
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Dorene Rentz
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston MA, 02115, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, 02115, USA
| | - Jennifer S. Rabin
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada, M4N 3M5
- Rehabilitation Sciences Institute, University of Toronto, Canada, M5G 1V7
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Reisa A. Sperling
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston MA, 02115, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, 02115, USA
| | - Rebecca E. Amariglio
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston MA, 02115, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, 02115, USA
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22
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Nestor SM, Giacobbe P, Abrahao A, Davidson B, Rabin JS, Lipsman N, Hamani C. Advances in deep brain stimulation for the treatment of post-traumatic stress disorder. Expert Rev Med Devices 2023; 20:995-998. [PMID: 37930275 DOI: 10.1080/17434440.2023.2280023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Sean M Nestor
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Davidson
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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23
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Nichols E, Brickman AM, Casaletto KB, Dams-O’Connor K, George KM, Kumar RG, Palta P, Rabin JS, Satizabal CL, Schneider J, Pa J, La Joie R. AD and non-AD mediators of the pathway between the APOE genotype and cognition. Alzheimers Dement 2023; 19:2508-2519. [PMID: 36516004 PMCID: PMC10264550 DOI: 10.1002/alz.12885] [Citation(s) in RCA: 2] [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: 08/30/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The apolipoprotein E (APOE) genotype is a driver of cognitive decline and dementia. We used causal mediation methods to characterize pathways linking the APOE genotype to late-life cognition through Alzheimer's disease (AD) and non-AD neuropathologies. METHODS We analyzed autopsy data from 1671 individuals from the Religious Orders Study, Memory and Aging Project, and Minority Aging Research Study (ROS/MAP/MARS) studies with cognitive assessment within 5 years of death and autopsy measures of AD (amyloid beta (Aβ), neurofibrillary tangles), vascular (athero/arteriolo-sclerosis, micro-infarcts/macro-infarcts), and non-AD neurodegenerative neuropathologies (TAR DNA protein 43 [TDP-43], Lewy bodies, amyloid angiopathy, hippocampal sclerosis). RESULTS The detrimental effect of APOE ε4 on cognition was mediated by summary measures of AD and non-AD neurodegenerative neuropathologies but not vascular neuropathologies; effects were strongest in individuals with dementia. The protective effect of APOE ε2 was partly mediated by AD neuropathology and stronger in women than in men. DISCUSSION The APOE genotype influences cognition and dementia through multiple neuropathological pathways, with implications for different therapeutic strategies targeting people at increased risk for dementia. HIGHLIGHTS Both apolipoprotein E (APOE) ε2 and APOE ε4 effects on late-life cognition are mediated by AD neuropathology. The estimated mediated effects of most measures of AD neuropathology were similar. Non-Alzheimer's disease (AD) neurodegenerative pathologies mediate the effect of ε4 independently from AD. Non-AD vascular pathologies did not mediate the effect of the APOE genotype on cognition. The protective effect of APOE ε2 on cognition was stronger in women.
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Affiliation(s)
- Emma Nichols
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD, USA
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer’s Disease
and the Aging Brain, Department of Neurology, College of Physicians and Surgeons,
Columbia University, New York, NY, USA
| | - Kaitlin B. Casaletto
- Memory and Aging Center, Department of Neurology, Weill
Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance, Icahn
School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Kristen M. George
- Department of Public Health Sciences, University of
California Davis School of Medicine, Davis, CA, USA
| | - Raj G. Kumar
- Department of Rehabilitation and Human Performance, Icahn
School of Medicine at Mount Sinai, New York, NY, USA
| | - Priya Palta
- Departments of Medicine and Epidemiology, Columbia
University Irving Medical Center, New York, NY, USA
| | - Jennifer S. Rabin
- Division of Neurology, Department of Medicine, Sunnybrook
Health Sciences Centre, University of Toronto, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain
Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of
Toronto, Canada
| | - Claudia L. Satizabal
- Department of Population Health Science and Biggs
Institute for Alzheimer’s and Neurodegenerative Diseases, UT Health San
Antonio, San Antonio, TX, USA
- Department of Neurology, Boston University School of
Medicine, Boston, MA, USA
| | - Julie Schneider
- Rush Alzheimer’s Disease Center, Chicago, IL,
USA
- Rush University Medical Center, Chicago, IL, USA
| | - Judy Pa
- Department of Neuroscience, University of California San
Diego, San Diego, CA, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill
Institute for Neurosciences, University of California, San Francisco, CA, USA
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24
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Rabin JS, Gopinath G, McSweeney M, Scantlebury N, Rohringer CR, Sewell IJ, Abrahao A, Jones RM, Huang Y, Lam B, Hamani C, Giacobbe P, Nestor SM, Hynynen K, Schwartz ML, Lipsman N. Patient satisfaction following unilateral MR-guided focused ultrasound for tremor: Who is satisfied and who is not? Parkinsonism Relat Disord 2023; 112:105439. [PMID: 37263158 DOI: 10.1016/j.parkreldis.2023.105439] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Jennifer S Rabin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, M5G 1V7, Canada.
| | - Georgia Gopinath
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada
| | - Melissa McSweeney
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada
| | - Nadia Scantlebury
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada
| | - Camryn R Rohringer
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada
| | - Isabella J Sewell
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada
| | - Agessandro Abrahao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada
| | - Ryan M Jones
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada
| | - Yuexi Huang
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada
| | - Benjamin Lam
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada
| | - Clement Hamani
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada
| | - Peter Giacobbe
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada
| | - Sean M Nestor
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada
| | - Kullervo Hynynen
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Michael L Schwartz
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada
| | - Nir Lipsman
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada
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Rabin JS, Giacobbe P, Nestor SM. A transdiagnostic approach to transcranial magnetic stimulation. Lancet Psychiatry 2023; 10:236-237. [PMID: 36898402 DOI: 10.1016/s2215-0366(23)00061-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Jennifer S Rabin
- Hurvitz Brain Sciences Program, University of Toronto, Toronto, ON M4N 3M5, Canada; Harquail Centre for Neuromodulation, University of Toronto, Toronto, ON M4N 3M5, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON M4N 3M5, Canada; Sunnybrook Health Sciences Centre and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Peter Giacobbe
- Hurvitz Brain Sciences Program, University of Toronto, Toronto, ON M4N 3M5, Canada; Harquail Centre for Neuromodulation, University of Toronto, Toronto, ON M4N 3M5, Canada; Department of Psychiatry, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Sean M Nestor
- Hurvitz Brain Sciences Program, University of Toronto, Toronto, ON M4N 3M5, Canada; Harquail Centre for Neuromodulation, University of Toronto, Toronto, ON M4N 3M5, Canada; Department of Psychiatry, University of Toronto, Toronto, ON M4N 3M5, Canada
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Churchill NW, Roudaia E, Chen JJ, Gilboa A, Sekuler A, Ji X, Gao F, Lin Z, Jegatheesan A, Masellis M, Goubran M, Rabin JS, Lam B, Cheng I, Fowler R, Heyn C, Black SE, MacIntosh BJ, Graham SJ, Schweizer TA. Effects of post-acute COVID-19 syndrome on the functional brain networks of non-hospitalized individuals. Front Neurol 2023; 14:1136408. [PMID: 37051059 PMCID: PMC10083436 DOI: 10.3389/fneur.2023.1136408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
IntroductionThe long-term impact of COVID-19 on brain function remains poorly understood, despite growing concern surrounding post-acute COVID-19 syndrome (PACS). The goal of this cross-sectional, observational study was to determine whether there are significant alterations in resting brain function among non-hospitalized individuals with PACS, compared to symptomatic individuals with non-COVID infection.MethodsData were collected for 51 individuals who tested positive for COVID-19 (mean age 41±12 yrs., 34 female) and 15 controls who had cold and flu-like symptoms but tested negative for COVID-19 (mean age 41±14 yrs., 9 female), with both groups assessed an average of 4-5 months after COVID testing. None of the participants had prior neurologic, psychiatric, or cardiovascular illness. Resting brain function was assessed via functional magnetic resonance imaging (fMRI), and self-reported symptoms were recorded.ResultsIndividuals with COVID-19 had lower temporal and subcortical functional connectivity relative to controls. A greater number of ongoing post-COVID symptoms was also associated with altered functional connectivity between temporal, parietal, occipital and subcortical regions.DiscussionThese results provide preliminary evidence that patterns of functional connectivity distinguish PACS from non-COVID infection and correlate with the severity of clinical outcome, providing novel insights into this highly prevalent disorder.
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Affiliation(s)
- Nathan W. Churchill
- Neuroscience Research Program, St. Michael’s Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
- Physics Department, Toronto Metropolitan University, Toronto, ON, Canada
- *Correspondence: Nathan W. Churchill,
| | - Eugenie Roudaia
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
| | - J. Jean Chen
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Asaf Gilboa
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Allison Sekuler
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Xiang Ji
- LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Fuqiang Gao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Zhongmin Lin
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Aravinthan Jegatheesan
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Mario Masellis
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Maged Goubran
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jennifer S. Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Benjamin Lam
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ivy Cheng
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Integrated Community Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert Fowler
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Emergency and Critical Care Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Chris Heyn
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Sandra E. Black
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Bradley J. MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
- Computational Radiology and Artificial Intelligence Unit, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Simon J. Graham
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Tom A. Schweizer
- Neuroscience Research Program, St. Michael’s Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
- Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, ON, Canada
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Cogo‐Moreira H, Krance SH, Wu C, Lanctôt KL, Herrmann N, Black SE, MacIntosh BJ, Rabin JS, Eid M, Swardfager W. State, trait, and accumulated features of the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS‐Cog) in mild Alzheimer's disease. Alzheimers Dement (N Y) 2023; 9:e12376. [PMID: 36994227 PMCID: PMC10040491 DOI: 10.1002/trc2.12376] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/14/2022] [Accepted: 01/13/2023] [Indexed: 03/29/2023]
Abstract
Background The Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS‐Cog) is used to assess decline in memory, language, and praxis in Alzheimer's disease (AD). Methods A latent state–trait model with autoregressive effects was used to determine how much of the ADAS‐Cog item measurement was reliable, and of that, how much of the information was occasion specific (state) versus consistent (trait or accumulated from one visit to the next). Results Participants with mild AD (n = 341) were assessed four times over 24 months. Praxis items were generally unreliable as were some memory items. Language items were generally the most reliable, and this increased over time. Only two ADAS‐Cog items showed reliability >0.70 at all four assessments, word recall (memory) and naming (language). Of the reliable information, language items exhibited greater consistency (63.4% to 88.2%) than occasion specificity, and of the consistent information, language items tended to reflect effects of AD progression that accumulated from one visit to the next (35.5% to 45.3%). In contrast, reliable information from praxis items tended to come from trait information. The reliable information in the memory items reflected more consistent than occasion‐specific information, but they varied between items in the relative amounts of trait versus accumulated effects. Conclusions Although the ADAS‐Cog was designed to track cognitive decline, most items were unreliable, and each item captured different amounts of information related to occasion‐specific, trait, and accumulated effects of AD over time. These latent properties complicate the interpretation of trends seen in ordinary statistical analyses of trials and other clinical studies with repeated ADAS‐Cog item measures. Highlights Studies have described unfavorable psychometric properties of the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS‐Cog), bringing into question its ability to track changes in cognition uniformly over time. There remains a need to estimate how much of the ADAS‐Cog measurement is reliable, of that how much is occasion specific versus consistent, and of the consistent information, how much represents enduring traits versus autoregressive effects (i.e., effects of Alzheimer's disease [AD] progression carried over from one assessment to the next). A latent state–trait model with autoregressive effects in mild AD found most items to be unreliable, and each item to capture different amounts of occasion‐specific, trait, and autoregressive information. Language items, specifically, naming and the memory item word recall, were the most reliable. Psychometric idiosyncrasies of individual items complicate the interpretation of their summed score, biasing ordinary statistical analyses of repeated measures in mild AD. Future studies should consider item trajectories individually.
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Affiliation(s)
- Hugo Cogo‐Moreira
- Department of EducationICT and LearningØstfold University CollegeHaldenNorway
| | - Saffire H. Krance
- Schulich School of Medicine and DentistryUniversity of Western OntarioLondonOntarioCanada
- Sandra Black Centre for Brain Resilience and RecoverySunnybrook Research InstituteTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Che‐Yuan Wu
- Sandra Black Centre for Brain Resilience and RecoverySunnybrook Research InstituteTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Pharmacology & ToxicologyUniversity of TorontoTorontoOntarioCanada
| | - Krista L. Lanctôt
- Sandra Black Centre for Brain Resilience and RecoverySunnybrook Research InstituteTorontoOntarioCanada
- Department of Pharmacology & ToxicologyUniversity of TorontoTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Division of NeurologyDepartment of MedicineSunnybrook Health Sciences CentreTorontoOntarioCanada
- KITE Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Nathan Herrmann
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Sandra E. Black
- Sandra Black Centre for Brain Resilience and RecoverySunnybrook Research InstituteTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Bradley J. MacIntosh
- Sandra Black Centre for Brain Resilience and RecoverySunnybrook Research InstituteTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Deparment of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
| | - Jennifer S. Rabin
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
- Rehabilitation Sciences InstituteUniversity of TorontoTorontoOntarioCanada
| | - Michael Eid
- Department of Education and PsychologyFreie Universität BerlinBerlinGermany
| | - Walter Swardfager
- Sandra Black Centre for Brain Resilience and RecoverySunnybrook Research InstituteTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Pharmacology & ToxicologyUniversity of TorontoTorontoOntarioCanada
- KITE Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
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Meng Y, Goubran M, Rabin JS, McSweeney M, Ottoy J, Pople CB, Huang Y, Storace A, Ozzoude M, Bethune A, Lam B, Swardfager W, Heyn C, Abrahao A, Davidson B, Hamani C, Aubert I, Zetterberg H, Ashton NJ, Karikari TK, Blennow K, Black SE, Hynynen K, Lipsman N. Blood-brain barrier opening of the default mode network in Alzheimer's disease with magnetic resonance-guided focused ultrasound. Brain 2023; 146:865-872. [PMID: 36694943 PMCID: PMC10226733 DOI: 10.1093/brain/awac459] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/13/2022] [Accepted: 11/06/2022] [Indexed: 01/26/2023] Open
Abstract
The blood-brain barrier (BBB) protects the brain but is also an important obstacle for the effective delivery of therapeutics in Alzheimer's disease and other neurodegenerative disorders. Transcranial magnetic resonance-guided focused ultrasound (MRgFUS) has been shown to reversibly disrupt the BBB. However, treatment of diffuse regions across the brain along with the effect on Alzheimer's disease relevant pathology need to be better characterized. This study is an open-labelled single-arm trial (NCT04118764) to investigate the feasibility of modulating BBB permeability in the default mode network and the impact on cognition, amyloid and tau pathology as well as BBB integrity. Nine participants [mean age 70.2 ± 7.2 years, mean Mini-Mental State Examination (MMSE) 21.9] underwent three biweekly procedures with follow-up visits up to 6 months. The BBB permeability of the bilateral hippocampi, anterior cingulate cortex and precuneus was transiently increased without grade 3 or higher adverse events. Participants did not experience worsening trajectory of cognitive decline (ADAS-cog11, MMSE). Whole brain vertex-based analysis of the 18F-florbetaben PET imaging demonstrated clusters of modest SUVR reduction in the right parahippocampal and inferior temporal lobe. However, CSF and blood biomarkers did not demonstrate any amelioration of Alzheimer's disease pathology (P-tau181, amyloid-β42/40 ratio), nor did it show persistent BBB dysfunction (plasma PDGFRbeta and CSF-to-plasma albumin ratio). This study provides neuroimaging and fluid biomarker data to characterize the safety profile of MRgFUS BBB modulation in neurodegeneration as a potential strategy for enhanced therapeutic delivery.
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Affiliation(s)
- Ying Meng
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Maged Goubran
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Hurvitz Brain Sciences Research Program, Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Jennifer S Rabin
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Hurvitz Brain Sciences Research Program, Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Melissa McSweeney
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Julie Ottoy
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Christopher B Pople
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Yuexi Huang
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Alexandra Storace
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Miracle Ozzoude
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Allison Bethune
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Benjamin Lam
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Hurvitz Brain Sciences Research Program, Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Walter Swardfager
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Hurvitz Brain Sciences Research Program, Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Chinthaka Heyn
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Agessandro Abrahao
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Hurvitz Brain Sciences Research Program, Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Benjamin Davidson
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Clement Hamani
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Hurvitz Brain Sciences Research Program, Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Isabelle Aubert
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Hurvitz Brain Sciences Research Program, Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at The University of Gothenburg, 405 30 Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 413 45 Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London W1T 7NF, UK
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at The University of Gothenburg, 405 30 Mölndal, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Institute Clinical Neuroscience Institute, London SE5 9RX, UK
- NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London SE5 8AF, UK
| | - Thomas K Karikari
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at The University of Gothenburg, 405 30 Mölndal, Sweden
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at The University of Gothenburg, 405 30 Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 413 45 Mölndal, Sweden
| | - Sandra E Black
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Hurvitz Brain Sciences Research Program, Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Kullervo Hynynen
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Hurvitz Brain Sciences Research Program, Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
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Wu CY, Iskander C, Wang C, Xiong LY, Shah BR, Edwards JD, Kapral MK, Herrmann N, Lanctôt KL, Masellis M, Swartz RH, Cogo-Moreira H, MacIntosh BJ, Rabin JS, Black SE, Saskin R, Swardfager W. Association of Sodium-Glucose Cotransporter 2 Inhibitors With Time to Dementia: A Population-Based Cohort Study. Diabetes Care 2023; 46:297-304. [PMID: 36508692 DOI: 10.2337/dc22-1705] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Type 2 diabetes (T2D) increases dementia risk, but clear evidence to recommend interventions that can mitigate that risk remains lacking. This population-based retrospective cohort study aimed to determine whether new use of sodium-glucose cotransporter 2 (SGLT2) inhibitors compared with dipeptidyl peptidase 4 (DPP-4) inhibitors was associated with lower dementia risk. RESEARCH DESIGN AND METHODS Ontario residents aged ≥66 years who were new users of an SGLT2 inhibitor or a DPP-4 inhibitor from 1 July 2016 to 31 March 2021 entered the cohort. Incident dementia was identified using a validated algorithm for Alzheimer's disease and related dementias. Propensity score-weighted Cox proportional hazards models were used to obtain adjusted hazard ratios (aHR) and CIs for time to incident dementia. To address reverse causality and disease latency, the observation window started at 1-year lag time from cohort entry. The primary analysis followed intention-to-treat exposure definition, and a secondary as-treated analysis was performed. RESULTS Among 106,903 individuals, SGLT2 inhibitors compared with DPP-4 inhibitors were associated with lower risk of dementia (14.2/1,000 person-years; aHR 0.80 [95% CI 0.71-0.89]) over a mean follow-up of 2.80 years from cohort entry. When stratified by different SGLT2 inhibitors, dapagliflozin exhibited the lowest risk (aHR 0.67 [95% CI 0.53-0.84]), followed by empagliflozin (aHR 0.78 [95% CI 0.69-0.89]), whereas canagliflozin showed no association (aHR 0.96 [95% CI 0.80-1.16]). The as-treated analysis observed a larger association (aHR 0.66 [95% CI 0.57-0.76]) than the intention-to-treat analysis. CONCLUSIONS SGLT2 inhibitors showed an association with lower dementia risk in older people with T2D. Randomized controlled trials are warranted.
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Affiliation(s)
- Che-Yuan Wu
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | | | - Lisa Y Xiong
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Baiju R Shah
- ICES, Toronto, Ontario, Canada
- Divisions of Endocrinology and Obstetric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jodi D Edwards
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | - Moira K Kapral
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- KITE University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Toronto Dementia Research Alliance, Toronto, Ontario, Canada
| | - Mario Masellis
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Richard H Swartz
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hugo Cogo-Moreira
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Faculty of Education, ICT, and Learning, Østfold University College, Halden, Norway
| | - Bradley J MacIntosh
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Computational Radiology & Artificial Intelligence, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Jennifer S Rabin
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Dementia Research Alliance, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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So I, Meusel LAC, Sharma B, Monette GA, Colella B, Wheeler AL, Rabin JS, Mikulis DJ, Green REA. Longitudinal Patterns of Functional Connectivity in Moderate-to-Severe Traumatic Brain Injury. J Neurotrauma 2023; 40:665-682. [PMID: 36367163 DOI: 10.1089/neu.2022.0242] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Longitudinal neuroimaging studies aid our understanding of recovery mechanisms in moderate-to-severe traumatic brain injury (TBI); however, there is a dearth of longitudinal functional connectivity research. Our aim was to characterize longitudinal functional connectivity patterns in two clinically important brain networks, the frontoparietal network (FPN) and the default mode network (DMN), in moderate-to-severe TBI. This inception cohort study of prospectively collected longitudinal data used resting-state functional magnetic resonance imaging (fMRI) to characterize functional connectivity patterns in the FPN and DMN. Forty adults with moderate-to-severe TBI (mean ± standard deviation [SD]; age = 39.53 ± 16.49 years, education = 13.92 ± 3.20 years, lowest Glasgow Coma Scale score = 6.63 ± 3.24, sex = 70% male) were scanned at approximately 0.5, 1-1.5, and 3+ years post-injury. Seventeen healthy, uninjured participants (mean ± SD; age = 38.91 ± 15.57 years, education = 15.11 ± 2.71 years, sex = 29% male) were scanned at baseline and approximately 11 months afterwards. Group independent component analyses and linear mixed-effects modeling with linear splines that contained a knot at 1.5 years post-injury were employed to investigate longitudinal network changes, and associations with covariates, including age, sex, and injury severity. In patients with TBI, functional connectivity in the right FPN increased from approximately 0.5 to 1.5 years post-injury (unstandardized estimate = 0.19, standard error [SE] = 0.07, p = 0.009), contained a slope change in the opposite direction, from positive to negative at 1.5 years post-injury (estimate = -0.21, SE = 0.11, p = 0.009), and marginally declined afterwards (estimate = -0.10, SE = 0.06, p = 0.079). Functional connectivity in the DMN increased from approximately 0.5 to 1.5 years (estimate = 0.15, SE = 0.05, p = 0.006), contained a slope change in the opposite direction, from positive to negative at 1.5 years post-injury (estimate = -0.19, SE = 0.08, p = 0.021), and was estimated to decline from 1.5 to 3+ years (estimate = -0.04, SE = 0.04, p = 0.303). Similarly, the left FPN increased in functional connectivity from approximately 0.5 to 1.5 years post-injury (estimate = 0.15, SE = 0.05, p = 0.002), contained a slope change in the opposite direction, from positive to negative at 1.5 years post-injury (estimate = -0.18, SE = 0.07, p = 0.008), and was estimated to decline thereafter (estimate = -0.04, SE = 0.03, p = 0.254). At approximately 0.5 years post-injury, patients showed hypoconnectivity compared with healthy, uninjured participants at baseline. Covariates were not significantly associated in any of the models. Findings of early improvement but a tapering and possible decline in connectivity thereafter suggest that compensatory effects are time-limited. These later reductions in connectivity mirror growing evidence of behavioral and structural decline in chronic moderate-to-severe TBI. Targeting such declines represents a novel avenue of research and offers potential for improving clinical outcomes.
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Affiliation(s)
- Isis So
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,KITE Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Liesel-Ann C Meusel
- KITE Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Bhanu Sharma
- KITE Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Department of Medical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Georges A Monette
- Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | - Brenda Colella
- KITE Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Anne L Wheeler
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - David J Mikulis
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Imaging, Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada
| | - Robin E A Green
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,KITE Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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31
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Yu D, Liang N, Zebarth J, Shen Q, Ozzoude M, Goubran M, Rabin JS, Ramirez J, Scott CJM, Gao F, Bartha R, Symons S, Haddad SMH, Berezuk C, Tan B, Kwan D, Hegele RA, Dilliott AA, Nanayakkara ND, Binns MA, Beaton D, Arnott SR, Lawrence‐Dewar JM, Hassan A, Dowlatshahi D, Mandzia J, Sahlas D, Casaubon L, Saposnik G, Otoki Y, Lanctôt KL, Masellis M, Black SE, Swartz RH, Taha AY, Swardfager W. Soluble Epoxide Hydrolase Derived Linoleic Acid Oxylipins, Small Vessel Disease Markers, and Neurodegeneration in Stroke. J Am Heart Assoc 2022; 12:e026901. [PMID: 36583428 PMCID: PMC9973594 DOI: 10.1161/jaha.122.026901] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Cerebral small vessel disease is associated with higher ratios of soluble-epoxide hydrolase derived linoleic acid diols (12,13-dihydroxyoctadecenoic acid [DiHOME] and 9,10-DiHOME) to their parent epoxides (12(13)-epoxyoctadecenoic acid [EpOME] and 9(10)-EpOME); however, the relationship has not yet been examined in stroke. Methods and Results Participants with mild to moderate small vessel stroke or large vessel stroke were selected based on clinical and imaging criteria. Metabolites were quantified by ultra-high-performance liquid chromatography-mass spectrometry. Volumes of stroke, lacunes, white matter hyperintensities, magnetic resonance imaging visible perivascular spaces, and free water diffusion were quantified from structural and diffusion magnetic resonance imaging (3 Tesla). Adjusted linear regression models were used for analysis. Compared with participants with large vessel stroke (n=30), participants with small vessel stroke (n=50) had a higher 12,13-DiHOME/12(13)-EpOME ratio (β=0.251, P=0.023). The 12,13-DiHOME/12(13)-EpOME ratio was associated with more lacunes (β=0.266, P=0.028) but not with large vessel stroke volumes. Ratios of 12,13-DiHOME/12(13)-EpOME and 9,10-DiHOME/9(10)-EpOME were associated with greater volumes of white matter hyperintensities (β=0.364, P<0.001; β=0.362, P<0.001) and white matter MRI-visible perivascular spaces (β=0.302, P=0.011; β=0.314, P=0.006). In small vessel stroke, the 12,13-DiHOME/12(13)-EpOME ratio was associated with higher white matter free water diffusion (β=0.439, P=0.016), which was specific to the temporal lobe in exploratory regional analyses. The 9,10-DiHOME/9(10)-EpOME ratio was associated with temporal lobe atrophy (β=-0.277, P=0.031). Conclusions Linoleic acid markers of cytochrome P450/soluble-epoxide hydrolase activity were associated with small versus large vessel stroke, with small vessel disease markers consistent with blood brain barrier and neurovascular-glial disruption, and temporal lobe atrophy. The findings may indicate a novel modifiable risk factor for small vessel disease and related neurodegeneration.
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Affiliation(s)
- Di Yu
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Department of Pharmacology and ToxicologyUniversity of TorontoTorontoCanada
| | - Nuanyi Liang
- Department of Food Science and TechnologyUniversity of CaliforniaDavisCA
| | - Julia Zebarth
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Department of Pharmacology and ToxicologyUniversity of TorontoTorontoCanada
| | - Qing Shen
- Department of Food Science and TechnologyUniversity of CaliforniaDavisCA
| | - Miracle Ozzoude
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | - Maged Goubran
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences CentreTorontoCanada,Department of Medical BiophysicsUniversity of TorontoTorontoCanada
| | - Jennifer S. Rabin
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences CentreTorontoCanada,Division of Neurology, Department of MedicineSunnybrook Health Sciences CentreTorontoCanada,Rehabilitation Sciences InstituteUniversity of TorontoTorontoCanada
| | - Joel Ramirez
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | - Christopher J. M. Scott
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | - Fuqiang Gao
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | - Robert Bartha
- Department of Medical BiophysicsWestern UniversityLondonCanada,Center for Functional and Metabolic Mapping, Robarts Research InstituteWestern UniversityLondonCanada
| | - Sean Symons
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | | | - Courtney Berezuk
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | - Brian Tan
- Rotman Research Institute, Baycrest Health Sciences CentreTorontoCanada
| | - Donna Kwan
- Centre for Neuroscience StudiesQueen’s UniversityKingstonCanada
| | | | | | | | - Malcolm A. Binns
- Rotman Research Institute, Baycrest Health Sciences CentreTorontoCanada,Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
| | - Derek Beaton
- Rotman Research Institute, Baycrest Health Sciences CentreTorontoCanada
| | - Stephen R. Arnott
- Rotman Research Institute, Baycrest Health Sciences CentreTorontoCanada
| | - Jane M. Lawrence‐Dewar
- Thunder Bay Regional Health Research InstituteNorthern Ontario School of Medicine UniversityThunder BayCanada
| | - Ayman Hassan
- Thunder Bay Regional Health Research InstituteNorthern Ontario School of Medicine UniversityThunder BayCanada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), Ottawa Hospital Research InstituteUniversity of OttawaOttawaCanada
| | - Jennifer Mandzia
- Department of Clinical Neurological Sciences, Schulich School of Medicine and DentistryWestern UniversityLondonCanada
| | - Demetrios Sahlas
- Division of Neurology, Department of Medicine, Faculty of Health SciencesMcMaster UniversityHamiltonCanada
| | - Leanne Casaubon
- Krembil Research InstituteUniversity Health NetworkTorontoCanada
| | - Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Research Unit, Division of Neurology, St. Michael’s HospitalUniversity of TorontoTorontoCanada
| | - Yurika Otoki
- Division of Agricultural Chemistry, Graduate School of Agricultural ScienceTohoku UniversitySendaiJapan
| | - Krista L. Lanctôt
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Department of Pharmacology and ToxicologyUniversity of TorontoTorontoCanada,Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada,Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | - Mario Masellis
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Division of Neurology, Department of MedicineSunnybrook Health Sciences CentreTorontoCanada,Department of Neurology, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Sandra E. Black
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Division of Neurology, Department of MedicineSunnybrook Health Sciences CentreTorontoCanada,Department of Neurology, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Richard H. Swartz
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Division of Neurology, Department of MedicineSunnybrook Health Sciences CentreTorontoCanada,Department of Neurology, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Ameer Y. Taha
- Department of Food Science and TechnologyUniversity of CaliforniaDavisCA
| | - Walter Swardfager
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Department of Pharmacology and ToxicologyUniversity of TorontoTorontoCanada,Toronto Rehabilitation InstituteUniversity Health NetworkTorontoCanada
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Kim WSH, Ji X, Roudaia E, Chen JJ, Gilboa A, Sekuler A, Gao F, Lin Z, Jegatheesan A, Masellis M, Goubran M, Rabin JS, Lam B, Cheng I, Fowler R, Heyn C, Black SE, Graham SJ, MacIntosh BJ. MRI Assessment of Cerebral Blood Flow in Nonhospitalized Adults Who Self-Isolated Due to COVID-19. J Magn Reson Imaging 2022. [PMID: 36472248 PMCID: PMC9877942 DOI: 10.1002/jmri.28555] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/25/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neurological symptoms associated with coronavirus disease 2019 (COVID-19), such as fatigue and smell/taste changes, persist beyond infection. However, little is known of brain physiology in the post-COVID-19 timeframe. PURPOSE To determine whether adults who experienced flu-like symptoms due to COVID-19 would exhibit cerebral blood flow (CBF) alterations in the weeks/months beyond infection, relative to controls who experienced flu-like symptoms but tested negative for COVID-19. STUDY TYPE Prospective observational. POPULATION A total of 39 adults who previously self-isolated at home due to COVID-19 (41.9 ± 12.6 years of age, 59% female, 116.5 ± 62.2 days since positive diagnosis) and 11 controls who experienced flu-like symptoms but had a negative COVID-19 diagnosis (41.5 ± 13.4 years of age, 55% female, 112.1 ± 59.5 since negative diagnosis). FIELD STRENGTH AND SEQUENCES A 3.0 T; T1-weighted magnetization-prepared rapid gradient and echo-planar turbo gradient-spin echo arterial spin labeling sequences. ASSESSMENT Arterial spin labeling was used to estimate CBF. A self-reported questionnaire assessed symptoms, including ongoing fatigue. CBF was compared between COVID-19 and control groups and between those with (n = 11) and without self-reported ongoing fatigue (n = 28) within the COVID-19 group. STATISTICAL TESTS Between-group and within-group comparisons of CBF were performed in a voxel-wise manner, controlling for age and sex, at a family-wise error rate of 0.05. RESULTS Relative to controls, the COVID-19 group exhibited significantly decreased CBF in subcortical regions including the thalamus, orbitofrontal cortex, and basal ganglia (maximum cluster size = 6012 voxels and maximum t-statistic = 5.21). Within the COVID-19 group, significant CBF differences in occipital and parietal regions were observed between those with and without self-reported on-going fatigue. DATA CONCLUSION These cross-sectional data revealed regional CBF decreases in the COVID-19 group, suggesting the relevance of brain physiology in the post-COVID-19 timeframe. This research may help elucidate the heterogeneous symptoms of the post-COVID-19 condition. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 3.
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Affiliation(s)
- William S H Kim
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Xiang Ji
- LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eugenie Roudaia
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada
| | - J Jean Chen
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Asaf Gilboa
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Allison Sekuler
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Fuqiang Gao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zhongmin Lin
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Aravinthan Jegatheesan
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maged Goubran
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Lam
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ivy Cheng
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Integrated Community Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Fowler
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Emergency & Critical Care Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Chris Heyn
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Computational Radiology & Artificial Intelligence Unit, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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33
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Hamani C, Davidson B, Corchs F, Abrahao A, Nestor SM, Rabin JS, Nyman AJ, Phung L, Goubran M, Levitt A, Talakoub O, Giacobbe P, Lipsman N. Deep brain stimulation of the subgenual cingulum and uncinate fasciculus for the treatment of posttraumatic stress disorder. Sci Adv 2022; 8:eadc9970. [PMID: 36459550 PMCID: PMC10936049 DOI: 10.1126/sciadv.adc9970] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/17/2022] [Indexed: 06/17/2023]
Abstract
Deep brain stimulation (DBS) has been investigated for neuropsychiatric disorders. In this phase 1 trial, we treated four posttraumatic stress disorder (PTSD) patients with DBS delivered to the subgenual cingulum and the uncinate fasciculus. In addition to validated clinical scales, patients underwent neuroimaging studies and psychophysiological assessments of fear conditioning, extinction, and recall. We show that the procedure is safe and potentially effective (55% reduction in Clinical Administered PTSD Scale scores). Posttreatment imaging data revealed metabolic activity changes in PTSD neurocircuits. During psychophysiological assessments, patients with PTSD had higher skin conductance responses when tested for recall compared to healthy controls. After DBS, this objectively measured variable was significantly reduced. Last, we found that a ratio between recall of extinguished and nonextinguished conditioned responses had a strong correlation with clinical outcome. As this variable was recorded at baseline, it may comprise a potential biomarker of treatment response.
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Affiliation(s)
- Clement Hamani
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Benjamin Davidson
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Felipe Corchs
- Department of Psychiatry, Institute of Psychiatry, University of São Paulo, SP 05403-903, Brazil
| | - Agessandro Abrahao
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON M4N 3M5, Canada
| | - Sean M. Nestor
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Jennifer S. Rabin
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON M4N 3M5, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Alexander J. Nyman
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Liane Phung
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Maged Goubran
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Anthony Levitt
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Omid Talakoub
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Peter Giacobbe
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
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34
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Casaletto KB, Nichols E, Aslanyan V, Simone SM, Rabin JS, La Joie R, Brickman AM, Dams‐O'Connor K, Palta P, Kumar RG, George KM, Satizabal CL, Schneider JA, Pa J. Sex‐specific mediational effects of microglial activation on Alzheimer’s disease proteinopathy in older adults. Alzheimers Dement 2022. [DOI: 10.1002/alz.062739] [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: 12/24/2022]
Affiliation(s)
- Kaitlin B Casaletto
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco San Francisco CA USA
| | - Emma Nichols
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Vahan Aslanyan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California Los Angeles CA USA
| | | | | | - Renaud La Joie
- Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco San Francisco CA USA
| | | | | | - Priya Palta
- Columbia University Irving Medical Center New York NY USA
| | - Raj G. Kumar
- Icahn School of Medicine at Mount Sinai New York NY USA
| | | | | | - Julie A Schneider
- Department of Pathology, Rush University Medical Center Chicago IL USA
| | - Judy Pa
- Stevens Neuroimaging and Informatics Institute, University of Southern California Los Angeles CA USA
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35
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Rabin JS, Nichols E, La Joie R, Casaletto KB, Palta P, Dams‐O'Connor K, Kumar RG, George KM, Satizabal CL, Schneider JA, Pa J, Brickman AM. Cerebral amyloid angiopathy interacts with parenchymal beta‐amyloid to promote tau and cognitive decline. Alzheimers Dement 2022. [DOI: 10.1002/alz.066555] [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: 12/24/2022]
Affiliation(s)
- Jennifer S. Rabin
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute Toronto ON Canada
- Rehabilitation Sciences Institute, University of Toronto Toronto ON Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
| | - Emma Nichols
- Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
- Institute for Health Metrics and Evaluation Seattle WA USA
| | - Renaud La Joie
- Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco San Francisco CA USA
| | - Kaitlin B Casaletto
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco San Francisco CA USA
| | - Priya Palta
- Columbia University Irving Medical Center New York NY USA
| | | | - Raj G. Kumar
- Icahn School of Medicine at Mount Sinai New York NY USA
| | | | - Claudia L Satizabal
- University of Texas Health Sciences Center San Antonio TX USA
- Boston University and the NHLBI’s Framingham Heart Study Boston MA USA
| | - Julie A Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center Chicago IL USA
| | - Judy Pa
- University of Southern California Los Angeles CA USA
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36
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Crawford‐Holland LM, Rabin JS, Fornazzari LR, Schweizer TA, Fischer CE, Munoz DG, Kumar S, Black SE, Freedman M, Borrie M, Frank AR, Pasternak SH, Pollock BG, Rajji TK, Seitz D, Tang‐Wai DF, Tartaglia C, Kwan D, Tan B. Smoking Gun? Effect of smoking history on cognition in AD and MCI. Alzheimers Dement 2022. [DOI: 10.1002/alz.068722] [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: 12/24/2022]
Affiliation(s)
| | | | - Luis R Fornazzari
- Keenan Research Centre for Biomedical Science, the Li Ka Shing Knowledge Institute, St. Michael’s Hospital Toronto ON Canada
| | - Tom A. Schweizer
- Keenan Research Centre for Biomedical Science, the Li Ka Shing Knowledge Institute, St. Michael’s Hospital Toronto ON Canada
| | - Corinne E. Fischer
- Keenan Research Centre for Biomedical Science, the Li Ka Shing Knowledge Institute, St. Michael’s Hospital Toronto ON Canada
| | - David G. Munoz
- Keenan Research Centre for Biomedical Science, the Li Ka Shing Knowledge Institute, St. Michael’s Hospital Toronto ON Canada
| | - Sanjeev Kumar
- Adult Neurodevelopment and Geriatric Psychiatry Division CAMH Toronto ON Canada
| | - Sandra E. Black
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto Toronto ON Canada
| | - Morris Freedman
- Rotman Research Institute, Baycrest Health Sciences Toronto ON Canada
| | - Michael Borrie
- Lawson Health Research Institute, Western University London ON Canada
| | | | | | - Bruce G. Pollock
- Adult Neurodevelopment and Geriatric Psychiatry Division CAMH Toronto ON Canada
| | - Tarek K. Rajji
- Adult Neurodevelopment and Geriatric Psychiatry Division CAMH Toronto ON Canada
| | | | - David F. Tang‐Wai
- Rotman Research Institute, Baycrest Health Sciences Toronto ON Canada
| | | | - Donna Kwan
- Ontario Neurodegenerative Disease Research Initiative Toronto ON Canada
| | - Brian Tan
- Rotman Research Institute Toronto ON Canada
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37
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Yau WW, Shirzadi Z, Rabin JS, Properzi MJ, Schultz AP, Rentz DM, Johnson KA, Sperling RA, Chhatwal JP. Longitudinal tau burden partially mediates synergistic influence of vascular risk and amyloid‐beta on cognitive decline in clinically normal older adults. Alzheimers Dement 2022. [DOI: 10.1002/alz.068274] [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: 12/24/2022]
Affiliation(s)
| | - Zahra Shirzadi
- Massachusetts General Hospital, Brigham and Women’s Hospital,Harvard Medical School Boston MA USA
| | | | | | - Aaron P. Schultz
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
| | - Dorene M. Rentz
- Brigham and Women's Hospital, Harvard Medical School Boston MA USA
| | - Keith A. Johnson
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
- Brigham and Women's Hospital, Harvard Medical School Boston MA USA
| | - Reisa A. Sperling
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
- Brigham and Women's Hospital, Harvard Medical School Boston MA USA
| | - Jasmeer P. Chhatwal
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
- Brigham and Women's Hospital, Harvard Medical School Boston MA USA
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38
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Wood M, Xiong LY, Buckley RF, Swardfager W, Masellis M, Black SE, Rabin JS. Sex differences in the protective effects of
APOE
ε2 on longitudinal cognitive decline. Alzheimers Dement 2022. [DOI: 10.1002/alz.066798] [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: 12/24/2022]
Affiliation(s)
- Madeline Wood
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
- Rehabilitation Sciences Institute, University of Toronto Toronto ON Canada
| | - Lisa Y. Xiong
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
- Department of Pharmacology & Toxicology, University of Toronto Toronto ON Canada
| | - Rachel F. Buckley
- Melbourne School of Psychological Sciences, University of Melbourne Melbourne VIC Australia
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School Boston MA USA
- The Florey Institute of Neuroscience and Mental Health Parkville Australia
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
- Department of Pharmacology & Toxicology, University of Toronto Toronto ON Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
- Division of Neurology, Department of Medicine, University of Toronto Toronto ON Canada
| | - Sandra E. Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
- Division of Neurology, Department of Medicine, University of Toronto Toronto ON Canada
| | - Jennifer S. Rabin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
- Rehabilitation Sciences Institute, University of Toronto Toronto ON Canada
- Division of Neurology, Department of Medicine, University of Toronto Toronto ON Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute Toronto ON Canada
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39
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Shirzadi Z, Yau WW, Rabin JS, Buckley RF, Properzi MJ, Fu JF, Hsieh S, Thibault EG, Mojiri‐Forooshani P, Goubran M, MacIntosh BJ, Black SE, Price JC, Johnson KA, Sperling RA, Chhatwal JP, Schultz AP. Cerebrovascular injury markers explain the effect of systemic vascular risk on cognitive decline in older adults with lower amyloid burden. Alzheimers Dement 2022. [DOI: 10.1002/alz.066686] [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: 12/24/2022]
Affiliation(s)
- Zahra Shirzadi
- Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School Boston MA USA
| | | | | | - Rachel F. Buckley
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
| | | | | | - Stephanie Hsieh
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
| | - Emma G. Thibault
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
| | | | - Maged Goubran
- Sunnybrook Research Institute, University of Toronto Toronto ON Canada
| | | | - Sandra E. Black
- Sunnybrook Research Institute, University of Toronto Toronto ON Canada
| | - Julie C Price
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
| | - Keith A. Johnson
- Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School Boston MA USA
| | - Reisa A. Sperling
- Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School Boston MA USA
| | | | - Aaron P. Schultz
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
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40
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Yau WW, Shirzadi Z, Rabin JS, Properzi MJ, Schultz AP, Rentz DM, Johnson KA, Sperling RA, Chhatwal JP. Longitudinal tau burden partially mediates synergistic influence of vascular risk and amyloid‐beta on cognitive decline in clinically normal older adults. Alzheimers Dement 2022. [DOI: 10.1002/alz.067488] [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: 12/24/2022]
Affiliation(s)
| | - Zahra Shirzadi
- Massachusetts General Hospital, Brigham and Women’s Hospital,Harvard Medical School Boston MA USA
| | | | | | | | - Dorene M. Rentz
- Brigham and Women's Hospital, Harvard Medical School Boston MA USA
| | - Keith A. Johnson
- Brigham and Women's Hospital, Harvard Medical School Boston MA USA
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
| | - Reisa A. Sperling
- Brigham and Women's Hospital, Harvard Medical School Boston MA USA
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
| | - Jasmeer P. Chhatwal
- Brigham and Women's Hospital, Harvard Medical School Boston MA USA
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
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41
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Wu C, Iskander C, Wang C, Xiong LY, Shah BR, Edwards JD, Kapral MK, Herrmann N, Lanctôt KL, Masellis M, Swartz RH, Cogo‐Moreira H, MacIntosh BJ, Rabin JS, Black SE, Saskin R, Swardfager W. Association of sodium‐glucose cotransporter‐2 inhibitors versus dipeptidyl peptidase‐4 inhibitors with time to dementia: a population‐based cohort study. Alzheimers Dement 2022. [DOI: 10.1002/alz.069035] [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: 12/24/2022]
Affiliation(s)
- Che‐Yuan Wu
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
| | | | | | - Lisa Y. Xiong
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
| | - Baiju R. Shah
- ICES Toronto ON Canada
- Sunnybrook Health Sciences Centre Toronto ON Canada
| | - Jodi D. Edwards
- ICES Ottawa ON Canada
- University of Ottawa Heart Institute Ottawa ON Canada
- University of Ottawa Ottawa ON Canada
| | - Moira K. Kapral
- University of Toronto Toronto ON Canada
- ICES Toronto ON Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
- Sunnybrook Health Sciences Centre Toronto ON Canada
| | - Krista L. Lanctôt
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
- Sunnybrook Health Sciences Centre Toronto ON Canada
- Toronto Dementia Research Alliance Toronto ON Canada
- KITE UHN Toronto Rehabilitation Institute Toronto ON Canada
| | - Mario Masellis
- Sunnybrook Research Institute Toronto ON Canada
- Sunnybrook Health Sciences Centre Toronto ON Canada
| | - Richard H. Swartz
- University of Toronto Toronto ON Canada
- ICES Toronto ON Canada
- Sunnybrook Health Sciences Centre Toronto ON Canada
| | | | - Bradley J. MacIntosh
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
| | - Jennifer S. Rabin
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
| | - Sandra E. Black
- Sunnybrook Research Institute Toronto ON Canada
- Sunnybrook Health Sciences Centre Toronto ON Canada
- Toronto Dementia Research Alliance Toronto ON Canada
| | | | - Walter Swardfager
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
- KITE UHN Toronto Rehabilitation Institute Toronto ON Canada
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42
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Xiong LY, Yu D, Liang N, Shen Q, Hegele R, Ramirez J, Goubran M, Rabin JS, Lanctôt KL, Black SE, Tartaglia C, Lang AE, Tan B, Symons S, Taha AY, Swardfager W. Peripheral blood leukotriene B4 and E4 as biomarkers in Alzheimer’s disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.068991] [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: 12/24/2022]
Affiliation(s)
- Lisa Y. Xiong
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
| | - Di Yu
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
| | | | - Qing Shen
- University of California, Davis Davis CA USA
| | | | | | | | - Jennifer S. Rabin
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
| | - Krista L. Lanctôt
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
| | - Sandra E. Black
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
| | | | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson’s Disease and Morton and Gloria Shulman Movement Disorders Clinic Toronto ON Canada
| | - Brian Tan
- Rotman Research Institute Toronto ON Canada
| | - Sean Symons
- Sunnybrook Health Sciences Centre Toronto ON Canada
| | | | - Walter Swardfager
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
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43
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Johnstone S, Lowe DJE, Kozak-Bidzinski K, Sanches M, Castle DJ, Rabin JS, Rabin RA, George TP. Neurocognitive moderation of repetitive transcranial magnetic stimulation (rTMS) effects on cannabis use in schizophrenia: a preliminary analysis. Schizophr 2022; 8:99. [PMCID: PMC9668838 DOI: 10.1038/s41537-022-00303-2] [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] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022]
Abstract
AbstractRepetitive transcranial magnetic stimulation (rTMS) is a promising treatment for cannabis use disorder in schizophrenia; however, gaps in the literature remain as to the potential role of neurocognitive functioning in treatment response. We evaluated the moderating role of select cognitive functions including baseline executive functioning, verbal memory, and sustained attention, and we explore the mediating role of changes in task performance on changes in cannabis use in both active and sham rTMS groups. Participants underwent high-frequency (20 Hz) rTMS applied to the bilateral dorsolateral prefrontal cortex 5x/week for 4 weeks. Weekly self-report of cannabis use and semi-quantitative urinary carboxy-tetrahydrocannabinol levels were recorded. A neurocognitive battery assessing verbal memory, visuospatial working memory, verbal working memory, sustained attention, delayed discounting, and complex planning was administered pre- and post-treatment. Better baseline performance on tasks assessing sustained attention, delayed discounting, and complex planning moderated the extent to which participants in the active group reduced cannabis use. There were no significant indirect pathways between treatment, changes in neuropsychological performance, and changes in cannabis use; however, active rTMS improved complex planning and sustained attention. These preliminary findings suggest that there is a moderating role of sustained attention, delayed discounting, and complex planning on the effects of rTMS on cannabis use. Further, mediation models suggest rTMS may exert direct effects on cannabis use independent of its effects on cognitive functioning in people with SCZ. Trial Registration: clinicaltrials.gov: NCT03189810.
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44
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Rohringer CR, Sewell IJ, Gandhi S, Isen J, Davidson B, McSweeney M, Swardfager W, Scantlebury N, Swartz RH, Hamani C, Giacobbe P, Nestor SM, Yunusova Y, Lam B, Schwartz ML, Lipsman N, Abrahao A, Rabin JS. Cognitive effects of unilateral thalamotomy for tremor: a meta-analysis. Brain Commun 2022; 4:fcac287. [PMID: 36440102 PMCID: PMC9683603 DOI: 10.1093/braincomms/fcac287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/19/2022] [Accepted: 11/01/2022] [Indexed: 02/26/2024] Open
Abstract
Tremor is a debilitating symptom that can lead to functional impairment. Pharmacotherapy is often successful, but up to 50% of patients are resistant to medications or cannot tolerate side effects. Thalamotomy to the ventral intermediate nucleus of the thalamus is a surgical intervention for refractory tremor. Thalamotomy surgeries include radiofrequency and incisionless procedures, such as Gamma Knife radiosurgery and magnetic resonance-guided focused ultrasound. Cognitive changes following thalamotomy have been inconsistently reported across studies. We performed a meta-analysis to summarize the impact of unilateral thalamotomy to the ventral intermediate nucleus of the thalamus across multiple cognitive domains. We searched MEDLINE, Embase Classic, Embase and EBM Reviews for relevant studies. Neuropsychological tests were categorized into seven cognitive domains: global cognition, verbal memory, non-verbal memory, executive function, phonemic fluency, semantic fluency and visuospatial processing. We calculated standardized mean differences as Hedges' g and 95% confidence intervals of the change between pre- and postoperative cognitive scores. Pooling of standardized mean differences across studies was performed using random-effects models. Risk of bias across studies and quality of evidence for each cognitive domain were assessed with the National Institute of Health quality assessment tool and the GRADEpro Guideline Development Tool, respectively. Of the 1251 records reviewed, eight studies met inclusion criteria. We included 193 patients with essential tremor, Parkinson's disease, or multiple sclerosis in the meta-analysis. There was a small significant decline in phonemic fluency [standardized mean difference = -0.29, 95% confidence interval: (-0.52, -0.05), P = 0.017] and a trend towards a decline in semantic fluency [standardized mean difference = -0.19, 95% confidence interval: (-0.40, 0.01), P = 0.056]. No postoperative changes were observed in the other cognitive domains (P values >0.14). In secondary analyses, we restricted the analyses to studies using magnetic resonance-guided focused ultrasound given its growing popularity and more precise targeting. In those analyses, there was no evidence of cognitive decline across any domain (P values >0.37). In terms of risk of bias, five studies were rated as 'good' and three studies were rated as 'fair'. According to GRADEpro guidelines, the certainty of the effect for all cognitive domains was low. This study provides evidence that unilateral thalamotomy to the ventral intermediate nucleus of the thalamus is relatively safe from a cognitive standpoint, however, there may be a small decline in verbal fluency. Magnetic resonance-guided focused ultrasound might have a more favourable postoperative cognitive profile compared with other thalamotomy techniques.
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Affiliation(s)
- Camryn R Rohringer
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Isabella J Sewell
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Shikha Gandhi
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Jonah Isen
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Benjamin Davidson
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Melissa McSweeney
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Nadia Scantlebury
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Richard H Swartz
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Clement Hamani
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Peter Giacobbe
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Sean M Nestor
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Yana Yunusova
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON M5G 1V7, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada
| | - Benjamin Lam
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Michael L Schwartz
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Nir Lipsman
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Agessandro Abrahao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Jennifer S Rabin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada
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45
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Yau WYW, Shirzadi Z, Yang HS, Ikoba AP, Rabin JS, Properzi MJ, Kirn DR, Schultz AP, Rentz DM, Johnson KA, Sperling RA, Chhatwal JP. Tau Mediates Synergistic Influence of Vascular Risk and Aβ on Cognitive Decline. Ann Neurol 2022; 92:745-755. [PMID: 35880989 PMCID: PMC9650958 DOI: 10.1002/ana.26460] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Elevated vascular risk and beta-amyloid (Aβ) burden have been synergistically associated with cognitive decline in preclinical Alzheimer's disease (AD), although the underlying mechanisms remain unclear. We examined whether accelerated longitudinal tau accumulation mediates the vascular risk-Aβ interaction on cognitive decline. METHODS We included 175 cognitively unimpaired older adults (age 70.5 ± 8.0 years). Baseline vascular risk was quantified using the office-based Framingham Heart Study general cardiovascular disease risk score (FHS-CVD). Baseline Aβ burden was measured with Pittsburgh Compound-B positron emission tomography (PET). Tau burden was measured longitudinally (3.6 ± 1.5 years) with Flortaucipir PET, focusing on inferior temporal cortex (ITC). Cognition was assessed longitudinally (7.0 ± 2.0 years) using the Preclinical Alzheimer's Cognitive Composite. Linear mixed effects models examined the interactive effects of baseline vascular risk and Aβ on longitudinal ITC tau. Additionally, moderated mediation was used to determine whether tau accumulation mediated the FHS-CVD*Aβ effect on cognitive decline. RESULTS We observed a significant interaction between elevated baseline FHS-CVD and Aβ on greater ITC tau accumulation (p = 0.004), even in individuals with Aβ burden below the conventional threshold for amyloid positivity. Examining individual vascular risk factors, we found elevated systolic blood pressure and body mass index showed independent interactions with Aβ on longitudinal tau (both p < 0.0001). ITC tau accumulation mediated 33% of the interactive association of FHS-CVD and Aβ on cognitive decline. INTERPRETATION Vascular risks interact with subthreshold levels of Aβ to promote cognitive decline, partially by accelerating early neocortical tau accumulation. Our findings support vascular risk reduction, especially treating hypertension and obesity, to attenuate Aβ-related tau pathology and reduce late-life cognitive decline. ANN NEUROL 2022;92:745-755.
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Affiliation(s)
- Wai-Ying Wendy Yau
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Zahra Shirzadi
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Hyun-Sik Yang
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA
| | - Akpevweoghene P Ikoba
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Jennifer S Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Michael J Properzi
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Dylan R Kirn
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Aaron P Schultz
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Dorene M Rentz
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA
| | - Keith A Johnson
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Jasmeer P Chhatwal
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA
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Casaletto KB, Nichols E, Aslanyan V, Simone SM, Rabin JS, La Joie R, Brickman AM, Dams-O’Connor K, Palta P, Kumar RG, George KM, Satizabal CL, Schneider J, Pa J. Sex-specific effects of microglial activation on Alzheimer's disease proteinopathy in older adults. Brain 2022; 145:3536-3545. [PMID: 35869598 PMCID: PMC10233295 DOI: 10.1093/brain/awac257] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/20/2022] [Accepted: 06/22/2022] [Indexed: 02/03/2023] Open
Abstract
Females show a disproportionate burden of Alzheimer's disease pathology and higher Alzheimer's disease dementia prevalences compared to males, yet the mechanisms driving these vulnerabilities are unknown. There is sexual dimorphism in immunological functioning, and neuroimmune processes are implicated in Alzheimer's disease genesis. Using neuropathology indicators from human brain tissue, we examined the mediational role of microglial activation on the relationship between amyloid and tau and how it differs by sex. 187 decedents (64% female; 89 mean age at death; 62% non-demented) from the Rush Memory and Aging Project completed neuropathological evaluations with brain tissue quantified for microglial activation, amyloid-β and tau. Proportion of morphologically activated microglia was determined via immunohistochemistry (HLA-DP-DQ-DR) and morphological staging (stage I, II or III). Amyloid-β and tau burden were quantified via immunohistochemistry (M00872 or AT8, respectively). Using causal counterfactual modelling, we estimated the mediational effect of microglial activation on the amyloid-β to tau relationship in the whole sample and stratified by sex (amyloid-β → microglial activation → tau). Alternative models tested the role of microglia activation as the precipitating event (microglial activation → amyloid-β → tau). Microglial activation significantly mediated 33% [95% confidence interval (CI) 10-67] of the relationship between amyloid-β and tau in the whole sample; stratified analyses suggested this effect was stronger and only statistically significant in females. 57% (95% CI 22-100) of the effect of amyloid-β on tau was mediated through microglial activation in females, compared to 19% (95% CI 0-64) in males. Regional analyses suggested that mediational effects were driven by greater cortical versus subcortical microglial activation. Relationships were independent of cerebrovascular disease indices. Alternative models suggested that in females, microglial activation was a significant exposure both preceding the amyloid-β to tau relationship (mediational effect: 50%, 95% CI 23-90) and directly related to tau burden (microglia direct effect: 50%, 95% CI 10-77). By contrast, in males, only the direct effect of microglial activation to tau reached significance (74%, 95% CI 32-100) (mediational effect: 26%, 95% CI 0-68). Our models suggest a reciprocal, bidirectional relationship between amyloid-β and microglial activation that significantly accounts for tau burden in females. By contrast, in males, direct independent (non-mediational) relationships between microglial activation or amyloid-β with tau were observed. Microglial activation may be disproportionately important for Alzheimer's disease pathogenesis in females. Determining sex-specific vulnerabilities to Alzheimer's disease development both inform fundamental pathophysiology and support precision health approaches for this heterogeneous disease.
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Affiliation(s)
- Kaitlin B Casaletto
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Emma Nichols
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vahan Aslanyan
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Department of Neurology, University of Southern California, Los Angeles, CA, USA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Jennifer S Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Priya Palta
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Raj G Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristen M George
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Claudia L Satizabal
- Department of Population Health Science and Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Julie Schneider
- Rush Alzheimer’s Disease Center, Rush University, Chicago, IL, USA
| | - Judy Pa
- Department of Neurosciences, Alzheimer’s Disease Cooperative Study (ADCS), University of California, San Diego, CA, USA
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47
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Sorkhou M, Rabin RA, Rabin JS, Kloiber S, McIntyre RS, George TP. Effects of 28 days of cannabis abstinence on cognition in major depressive disorder: A pilot study. Am J Addict 2022; 31:454-462. [PMID: 35690891 DOI: 10.1111/ajad.13305] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cannabis is a widely used substance that may impair select cognitive domains, including attention and memory. Problematic cannabis use is a common clinical problem among patients with major depressive disorder (MDD). Few studies have investigated the effects of cannabis abstinence on cognition in MDD. Thus, our study aimed to determine whether a 28-day period of cannabis abstinence is associated with improvements in cognition in patients with MDD and comorbid cannabis use disorder (CUD). METHODS We evaluated the effects of 28 days of cannabis abstinence on cognition in MDD patients with comorbid CUD facilitated by contingency management, motivational interviewing, psychoeducation, and coping-skills training (N = 11). Primary outcomes included Baseline to Day 28 changes in verbal memory and learning, while secondary outcomes included Baseline to Day 28 changes in working memory, visuospatial working memory (VSWM), visual search speed, mental flexibility, response inhibition, attention, manual dexterity, and fine motor movement. RESULTS Eight participants (72.7%) met the pre-specified criteria for cannabis abstinence and three participants significantly reduced their cannabis use (≥90%). Visual search speed, selective attention, and VSWM improved over the study period. These improvements were not associated with changes in cannabis metabolite levels from baseline to endpoint. DISCUSSION AND CONCLUSIONS Our findings suggest that 28 days of cannabis abstinence may improve select cognitive domains in patients with MDD and comorbid CUD. SCIENTIFIC SIGNIFICANCE This is the first study to longitudinally examine the effects of cannabis on cognition in MDD. CLINICAL TRIAL Effects of Cannabis Abstinence on Symptoms and Cognition in Depression (NCT03624933; https://www. CLINICALTRIALS gov).
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Affiliation(s)
- Maryam Sorkhou
- Institute of Medical Sciences (IMS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Rachel A Rabin
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Jennifer S Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Stefan Kloiber
- Institute of Medical Sciences (IMS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Adult Psychiatry and Health Systems Division, CAMH, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Institute of Medical Sciences (IMS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Mood Disorders Psychopharmacology Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Tony P George
- Institute of Medical Sciences (IMS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Addictions Divisions, Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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48
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Ottoy J, Ozzoude M, Zukotynski K, Adamo S, Scott C, Gaudet V, Ramirez J, Swardfager W, Cogo-Moreira H, Lam B, Bhan A, Mojiri P, Kang MS, Rabin JS, Kiss A, Strother S, Bocti C, Borrie M, Chertkow H, Frayne R, Hsiung R, Laforce RJ, Noseworthy MD, Prato FS, Sahlas DJ, Smith EE, Kuo PH, Sossi V, Thiel A, Soucy JP, Tardif JC, Black SE, Goubran M. Vascular burden and cognition: Mediating roles of neurodegeneration and amyloid PET. Alzheimers Dement 2022; 19:1503-1517. [PMID: 36047604 DOI: 10.1002/alz.12750] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
It remains unclear to what extent cerebrovascular burden relates to amyloid beta (Aβ) deposition, neurodegeneration, and cognitive dysfunction in mixed disease populations with small vessel disease and Alzheimer's disease (AD) pathology. In 120 subjects, we investigated the association of vascular burden (white matter hyperintensity [WMH] volumes) with cognition. Using mediation analyses, we tested the indirect effects of WMH on cognition via Aβ deposition (18 F-AV45 positron emission tomography [PET]) and neurodegeneration (cortical thickness or 18 F fluorodeoxyglucose PET) in AD signature regions. We observed that increased total WMH volume was associated with poorer performance in all tested cognitive domains, with the strongest effects observed for semantic fluency. These relationships were mediated mainly via cortical thinning, particularly of the temporal lobe, and to a lesser extent serially mediated via Aβ and cortical thinning of AD signature regions. WMH volumes differentially impacted cognition depending on lobar location and Aβ status. In summary, our study suggests mainly an amyloid-independent pathway in which vascular burden affects cognitive function via localized neurodegeneration. HIGHLIGHTS: Alzheimer's disease often co-exists with vascular pathology. We studied a unique cohort enriched for high white matter hyperintensities (WMH). High WMH related to cognitive impairment of semantic fluency and executive function. This relationship was mediated via temporo-parietal atrophy rather than metabolism. This relationship was, to lesser extent, serially mediated via amyloid beta and atrophy.
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Affiliation(s)
- Julie Ottoy
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Miracle Ozzoude
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Zukotynski
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Departments of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada.,Department of Medical Imaging, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina Adamo
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Scott
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Gaudet
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Walter Swardfager
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Hugo Cogo-Moreira
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Education, ICT and Learning, Østfold University College, Halden, Norway
| | - Benjamin Lam
- Department of Medicine (Division of Neurology), University of Toronto, Toronto, Ontario, Canada
| | - Aparna Bhan
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Parisa Mojiri
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Min Su Kang
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Strother
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,The Rotman Research Institute Baycrest, University of Toronto, Toronto, Ontario, Canada
| | - Christian Bocti
- Département de Médecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michael Borrie
- Lawson Health Research Institute, Western University, London, Ontario, Canada
| | - Howard Chertkow
- Jewish General Hospital and Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Richard Frayne
- Departments of Radiology and Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Robin Hsiung
- Physics and Astronomy Department and DM Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Jr Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, Université Laval, Quebec City, Quebec, Canada
| | - Michael D Noseworthy
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Frank S Prato
- Lawson Health Research Institute, Western University, London, Ontario, Canada
| | | | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Phillip H Kuo
- Department of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Vesna Sossi
- Physics and Astronomy Department and DM Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Thiel
- Jewish General Hospital and Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Jean-Paul Soucy
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Sandra E Black
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine (Division of Neurology), University of Toronto, Toronto, Ontario, Canada.,Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maged Goubran
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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49
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Rabin JS, Pruzin J, Scott M, Yang HS, Hampton O, Hsieh S, Schultz AP, Buckley RF, Hedden T, Rentz D, Johnson KA, Sperling RA, Chhatwal JP. Association of β-Amyloid and Vascular Risk on Longitudinal Patterns of Brain Atrophy. Neurology 2022; 99:e270-e280. [PMID: 35473760 PMCID: PMC9302937 DOI: 10.1212/wnl.0000000000200551] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Vascular risk factors and elevated β-amyloid (Aβ) are commonly observed together among older adults. Here, we examined the interactive vs independent effects of systemic vascular risk and Aβ burden on longitudinal gray matter atrophy and how their co-occurrence may be related to cognitive decline in a cohort of clinically normal adults. A secondary goal was to examine whether vascular risk influences gray matter atrophy independently from markers of white matter injury. METHODS Participants were 196 adults (age 73.8 ± 6.1 years) from the Harvard Aging Brain Study. Baseline Aβ burden was quantified with Pittsburgh compound B PET. Baseline vascular risk was measured with the Framingham Heart Study cardiovascular disease risk score. Brain atrophy was quantified longitudinally with structural MRI over a median of 4.50 (±1.26) years. Cognition was assessed yearly with the Preclinical Alzheimer Cognitive Composite over a median of 6.25 (±1.40) years. Linear mixed-effects models examined vascular risk and Aβ burden as interactive vs independent predictors of gray matter atrophy, with adjustment for age, sex, years of education, APOE ε4 status, intracranial volume (when appropriate), and their interactions with time. In subsequent models, we adjusted for markers of white matter injury to determine whether vascular risk accelerated brain atrophy independently from diffusion- and fluid-attenuated inversion recovery (FLAIR)-based markers. Mediation analyses examined whether brain atrophy mediated the interactive association of vascular risk and Aβ burden on cognitive decline. RESULTS Higher vascular risk and elevated Aβ burden interacted to predict more severe atrophy in frontal and temporal lobes, thalamus, and striatum. Higher Aβ burden, but not vascular risk, was associated with more severe atrophy in parietal and occipital lobes, as well as the hippocampus. Adjusting for diffusion- and FLAIR-based markers of white matter injury had little impact on the above associations. Gray matter atrophy mediated the association between vascular risk and cognitive decline at higher levels of Aβ burden. DISCUSSION We observed an interaction between elevated vascular risk and higher Aβ burden with longitudinal brain atrophy, which in turn influenced cognitive decline. These results support vascular risk factor management as a potential intervention to slow neurodegeneration and cognitive decline in preclinical Alzheimer disease.
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Affiliation(s)
- Jennifer S Rabin
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeremy Pruzin
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Matthew Scott
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hyun-Sik Yang
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Olivia Hampton
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephanie Hsieh
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aaron P Schultz
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rachel F Buckley
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Trey Hedden
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dorene Rentz
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Keith A Johnson
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Reisa A Sperling
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jasmeer P Chhatwal
- From the Department of Psychiatry (J.S.R.), Department of Neurology (J.P., M.S., H.-S.Y., O.H., S.H., A.P.S., R.F.B., D.R., K.A.J., R.A.S., J.P.C.), Department of Radiology (A.P.S., K.A.J., R.A.S.), Athinoula A. Martinos Center for Biomedical Imaging, and Department of Radiology (K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.S.R.), Division of Neurology, Sunnybrook Health Sciences Centre, and Rehabilitation Sciences Institute (J.S.R.), University of Toronto; Harquail Centre for Neuromodulation (J.S.R.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Banner Alzheimer's Institute (J.P.), Phoenix, AZ; Department of Neurology (H.-S.Y., D.R., K.A.J., R.A.S., J.P.C.), Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Florey Institute (R.F.B.), and Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Australia; and Department of Neurology (T.H.), Icahn School of Medicine at Mount Sinai, New York, NY.
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Rabin JS, Nichols E, La Joie R, Casaletto KB, Palta P, Dams-O'Connor K, Kumar RG, George KM, Satizabal CL, Schneider JA, Pa J, Brickman AM. Cerebral amyloid angiopathy interacts with neuritic amyloid plaques to promote tau and cognitive decline. Brain 2022; 145:2823-2833. [PMID: 35759327 DOI: 10.1093/brain/awac178] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 12/12/2022] Open
Abstract
Accumulating data suggest that cerebrovascular disease contributes to Alzheimer's disease pathophysiology and progression toward dementia. Cerebral amyloid angiopathy is a form of cerebrovascular pathology that results from the build-up of β-amyloid in the vessel walls. Cerebral amyloid angiopathy commonly co-occurs with Alzheimer's disease pathology in the ageing brain and increases the risk of Alzheimer's disease dementia. In the present study, we examined whether cerebral amyloid angiopathy influences tau deposition and cognitive decline independently or synergistically with parenchymal β-amyloid burden. Secondly, we examined whether tau burden mediates the association between cerebral amyloid angiopathy and cognitive decline. We included data from autopsied subjects recruited from one of three longitudinal clinical-pathological cohort studies: the Rush Memory and Aging Project, the Religious Orders Study and the Minority Aging Research Study. Participants completed annual clinical and cognitive evaluations and underwent brain autopsy. Cerebral amyloid angiopathy pathology was rated as none, mild, moderate or severe. Bielschowsky silver stain was used to visualize neuritic β-amyloid plaques and neurofibrillary tangles. We used linear regression and linear mixed models to test independent versus interactive associations of cerebral amyloid angiopathy and neuritic plaque burden with tau burden and longitudinal cognitive decline, respectively. We used causal mediation models to examine whether tau mediates the association between cerebral amyloid angiopathy and cognitive decline. The study sample included 1722 autopsied subjects (age at baseline = 80.2 ± 7.1 years; age at death = 89.5 ± 6.7 years; 68% females). Cerebral amyloid angiopathy interacted with neuritic plaques to accelerate tau burden and cognitive decline. Specifically, those with more severe cerebral amyloid angiopathy pathology and higher levels of neuritic plaque burden had greater tau burden and faster cognitive decline. We also found that tau mediated the association between cerebral amyloid angiopathy and cognitive decline among participants with higher neuritic plaque burden. In summary, more severe levels of cerebral amyloid angiopathy and higher parenchymal β-amyloid burden interacted to promote cognitive decline indirectly via tau deposition. These results highlight the dynamic interplay between cerebral amyloid angiopathy and Alzheimer's disease pathology in accelerating progression toward dementia. These findings have implications for Alzheimer's disease clinical trials and therapeutic development.
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Affiliation(s)
- Jennifer S Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada M4N 3M5.,Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada M4N 3M5.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada M5G 1V7
| | - Emma Nichols
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA 94158
| | - Kaitlin B Casaletto
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA 94158
| | - Priya Palta
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Raj G Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Kristen M George
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Claudia L Satizabal
- Department of Population Health Science and Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Judy Pa
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA 10032
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