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Rantins P, Ly M, Clark AL, Weigand AJ, Durazo AA, Merritt VC, Bangen KJ, Thomas KR. Research Letter: TBI Severity Moderates the Association Between Subjective and Objective Attention in Older Veterans. J Head Trauma Rehabil 2024; 39:239-246. [PMID: 37712765 PMCID: PMC10920393 DOI: 10.1097/htr.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVE This study examined the moderating effect of traumatic brain injury (TBI) history on subjective and objective cognition across multiple cognitive domains. SETTING, PARTICIPANTS, AND DESIGN Participants included 242 Vietnam-era veterans with a history of no TBI (n = 86), mild TBI (n = 74), or moderate-to-severe TBI (n = 82) from the observational Department of Defense-Alzheimer's Disease Neuroimaging Initiative (DoD-ADNI) study. MAIN MEASURES Objective cognition was the outcome and was measured using neuropsychological measures in the domains of memory, attention/executive functioning, and language. Subjective cognition was measured using the memory, divided attention, and language subscales from the Everyday Cognition (ECog) measure. TBI severity status was the moderating variable. RESULTS Veterans with a history of moderate-to-severe TBI had a stronger negative association between subjective and objective attention relative to participants without a TBI ( P = .002). Although this association did not differ between mild TBI and no TBI history groups ( P = .100), the association between subjective and objective attention for the mild TBI group was intermediate to the no TBI and moderate-to-severe TBI history groups. TBI status did not moderate associations between subjective and objective memory or language. CONCLUSION Results highlight the importance of assessing subjective and objective cognition in older veterans and the relevance of attention in the context of TBI history. More work is needed to better understand the intersection of TBI and aging and how these factors may be used to guide individualized assessment and treatment approaches for older veterans.
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Affiliation(s)
- Peter Rantins
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Monica Ly
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
| | - Alexandra L. Clark
- Department of Psychology, University of Texas at Austin,
Austin, TX, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San
Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Alin Alshaheri Durazo
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Victoria C. Merritt
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH),
VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J. Bangen
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
| | - Kelsey R. Thomas
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
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Edmonds EC, Thomas KR, Rapcsak SZ, Lindemer SL, Delano-Wood L, Salmon DP, Bondi MW. Data-driven classification of cognitively normal and mild cognitive impairment subtypes predicts progression in the NACC dataset. Alzheimers Dement 2024. [PMID: 38574399 DOI: 10.1002/alz.13793] [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: 06/14/2023] [Revised: 10/20/2023] [Accepted: 02/23/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Data-driven neuropsychological methods can identify mild cognitive impairment (MCI) subtypes with stronger associations to dementia risk factors than conventional diagnostic methods. METHODS Cluster analysis used neuropsychological data from participants without dementia (mean age = 71.6 years) in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (n = 26,255) and the "normal cognition" subsample (n = 16,005). Survival analyses examined MCI or dementia progression. RESULTS Five clusters were identified: "Optimal" cognitively normal (oCN; 13.2%), "Typical" CN (tCN; 28.0%), Amnestic MCI (aMCI; 25.3%), Mixed MCI-Mild (mMCI-Mild; 20.4%), and Mixed MCI-Severe (mMCI-Severe; 13.0%). Progression to dementia differed across clusters (oCN < tCN < aMCI < mMCI-Mild < mMCI-Severe). Cluster analysis identified more MCI cases than consensus diagnosis. In the "normal cognition" subsample, five clusters emerged: High-All Domains (High-All; 16.7%), Low-Attention/Working Memory (Low-WM; 22.1%), Low-Memory (36.3%), Amnestic MCI (16.7%), and Non-amnestic MCI (naMCI; 8.3%), with differing progression rates (High-All < Low-WM = Low-Memory < aMCI < naMCI). DISCUSSION Our data-driven methods outperformed consensus diagnosis by providing more precise information about progression risk and revealing heterogeneity in cognition and progression risk within the NACC "normal cognition" group.
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Affiliation(s)
- Emily C Edmonds
- Banner Alzheimer's Institute, Tucson, Arizona, USA
- Departments of Neurology and Psychology, University of Arizona, Tucson, Arizona, USA
| | - Kelsey R Thomas
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Steven Z Rapcsak
- Banner Alzheimer's Institute, Tucson, Arizona, USA
- Departments of Neurology and Psychology, University of Arizona, Tucson, Arizona, USA
- Department of Speech, Language, & Hearing Sciences, University of Arizona, Tucson, Arizona, USA
| | | | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
- Psychology Service, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - David P Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
- Psychology Service, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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Dean LT, Chung SE, Gross AL, Clay OJ, Willis SL, McDonough IM, Thomas KR, Marsiske M, Aysola J, Thorpe RJ, Felix C, Berkowitz M, Coe NB. Does Consumer Credit Precede or Follow Health Among Older Adults? An Investigation in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Trial. Innov Aging 2024; 8:igae016. [PMID: 38511203 PMCID: PMC10953618 DOI: 10.1093/geroni/igae016] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Indexed: 03/22/2024] Open
Abstract
Background and Objectives Consumer credit has shown increasing relevance to the health of older adults; however, studies have not been able to assess the extent to which creditworthiness influences future health or health influences future creditworthiness. We assessed the relationships between 4-year pre and postmorbid consumer credit history and self-rated physical and mental health outcomes among older adults. Research Design and Methods Generalized estimating equations models assessed pre and postmorbid credit history (credit scores, derogatory accounts, and unpaid accounts in collections) and the onset of poor self-rated health (SF-36 score <50) among 1,740 participants aged 65+ in the Advanced Cognitive Training for Independent and Vital Elderly study from 2001 to 2017, linked to TransUnion consumer credit data. Results In any given year, up to 1/4 of participants had a major derogatory, unpaid, or collections account, and up to 13% of the sample had poor health. Each 50-point increase in credit score trended toward a 5% lower odds of poor health in the next 1 year, a 6% lower odds in the next 2 years, and a statistically significant finding of 13% lower odds by 3 years. A drop in credit score was associated with a 10% greater odds of poor health in the next year, and having a major derogatory account was associated with an 86% greater odds of poor health in the next 3 years. After poor health onset, credit scores continued to see significant losses up to the 3 years, with larger decrements over time. Discussion and Implications Having a major derogatory account or a sudden loss in credit may be a time to monitor older adults for changes in health. After a downturn in health, supporting older adults to manage their debt may help stabilize their credit.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shang-En Chung
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- University of Alabama at Birmingham Alzheimer’s Disease Research Center, Birmingham, Alabama, USA
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Ian M McDonough
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System and Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Jaya Aysola
- Department of Medicine and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Alzheimer’s Disease Resource Center for Minority Aging Research, Baltimore, Maryland, USA
| | - Cynthia Felix
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Melissa Berkowitz
- Department of Medical Ethics and Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Norma B Coe
- Department of Medical Ethics and Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Clark AL, Thomas KR, Ortega N, Haley AP, Duarte A, O'Bryant S. Empirically derived psychosocial-behavioral phenotypes in Black/African American and Hispanic/Latino older adults enrolled in HABS-HD: Associations with AD biomarkers and cognitive outcomes. Alzheimers Dement 2024; 20:1360-1373. [PMID: 37990803 PMCID: PMC10917046 DOI: 10.1002/alz.13544] [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: 07/25/2023] [Revised: 09/21/2023] [Accepted: 10/14/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Identification of psychosocial-behavioral phenotypes to understand within-group heterogeneity in risk and resiliency to Alzheimer's disease (AD) within Black/African American and Hispanic/Latino older adults is essential for the implementation of precision health approaches. METHODS A cluster analysis was performed on baseline measures of socioeconomic resources (annual income, social support, occupational complexity) and psychiatric distress (chronic stress, depression, anxiety) for 1220 racially/ethnically minoritized adults enrolled in the Health and Aging Brain Study-Health Disparities (HABS-HD). Analyses of covariance adjusting for sociodemographic factors examined phenotype differences in cognition and plasma AD biomarkers. RESULTS The cluster analysis identified (1) Low Resource/High Distress (n = 256); (2) High Resource/Low Distress (n = 485); and (3) Low Resource/Low Distress (n = 479) phenotypes. The Low Resource/High Distress phenotype displayed poorer cognition and higher plasma neurofilament light chain; differences between the High Resource/Low Distress and Low Resource/Low Distress phenotypes were minimal. DISCUSSION The identification of psychosocial-behavioral phenotypes within racially/ethnically minoritized older adults is crucial to the development of targeted AD prevention and intervention efforts.
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Affiliation(s)
- Alexandra L. Clark
- Department of PsychologyThe University of Texas at AustinAustinTexasUSA
- Research ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Kelsey R. Thomas
- Research ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California San Diego Medical SchoolLa JollaCaliforniaUSA
| | - Nazareth Ortega
- Department of PsychologyThe University of Texas at AustinAustinTexasUSA
| | - Andreana P. Haley
- Department of PsychologyThe University of Texas at AustinAustinTexasUSA
| | - Audrey Duarte
- Department of PsychologyThe University of Texas at AustinAustinTexasUSA
| | - Sid O'Bryant
- Institute for Translational ResearchUniversity of North Texas Health Science CenterFort WorthTexasUSA
- Department of Family MedicineUniversity of North Texas Health Science CenterFort WorthTexasUSA
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Edwards L, Thomas KR, Weigand AJ, Edmonds EC, Clark AL, Brenner EK, Banks SJ, Gilbert PE, Nation DA, Delano-Wood L, Bondi MW, Bangen KJ. Pulse pressure and APOE ε4 dose interact to affect cerebral blood flow in older adults without dementia. Cereb Circ Cogn Behav 2024; 6:100206. [PMID: 38328026 PMCID: PMC10847851 DOI: 10.1016/j.cccb.2024.100206] [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] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/20/2023] [Accepted: 01/14/2024] [Indexed: 02/09/2024]
Abstract
This study assessed whether the effect of vascular risk on cerebral blood flow (CBF) varies by gene dose of apolipoprotein (APOE) ε4 alleles. 144 older adults without dementia from the Alzheimer's Disease Neuroimaging Initiative underwent arterial spin labeling and T1-weighted MRI, APOE genotyping, fluorodeoxyglucose positron emission tomography (FDG-PET), lumbar puncture, and blood pressure (BP) assessment. Vascular risk was assessed using pulse pressure (systolic BP - diastolic BP). CBF was examined in six AD-vulnerable regions: entorhinal cortex, hippocampus, inferior temporal cortex, inferior parietal cortex, rostral middle frontal gyrus, and medial orbitofrontal cortex. Linear regressions tested the interaction between APOE ε4 dose and pulse pressure on CBF in each region, adjusting for age, sex, cognitive classification, antihypertensive medication use, FDG-PET, reference CBF region, and AD biomarker positivity. There was a significant interaction between pulse pressure and APOE ɛ4 dose on CBF in the entorhinal cortex, hippocampus, and inferior parietal cortex, such that higher pulse pressure was associated with lower CBF only among ε4 homozygous participants. These findings demonstrate that the association between pulse pressure and regional CBF differs by APOE ε4 dose, suggesting that targeting modifiable vascular risk factors may be particularly important for those genetically at risk for AD.
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Affiliation(s)
- Lauren Edwards
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Kelsey R. Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emily C. Edmonds
- Banner Alzheimer's Institute, Tucson, AZ, USA
- Departments of Neurology and Psychology, University of Arizona, Tucson, AZ, USA
| | - Alexandra L. Clark
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Einat K. Brenner
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Sarah J. Banks
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Paul E. Gilbert
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Daniel A. Nation
- Department of Psychology, University of California Irvine, Irvine, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Thomas KR, Clark AL, Weigand AJ, Edwards L, Durazo AA, Membreno R, Luu B, Rantins P, Ly MT, Rotblatt LJ, Bangen KJ, Jak AJ. Cognition and Amyloid-β in Older Veterans: Characterization and Longitudinal Outcomes of Data-Derived Phenotypes. J Alzheimers Dis 2024; 99:417-427. [PMID: 38669550 DOI: 10.3233/jad-240077] [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: 04/28/2024]
Abstract
Background Within older Veterans, multiple factors may contribute to cognitive difficulties. Beyond Alzheimer's disease (AD), psychiatric (e.g., PTSD) and health comorbidities (e.g., TBI) may also impact cognition. Objective This study aimed to derive subgroups based on objective cognition, subjective cognitive decline (SCD), and amyloid burden, and then compare subgroups on clinical characteristics, biomarkers, and longitudinal change in functioning and global cognition. Methods Cluster analysis of neuropsychological measures, SCD, and amyloid PET was conducted on 228 predominately male Vietnam-Era Veterans from the Department of Defense-Alzheimer's Disease Neuroimaging Initiative. Cluster-derived subgroups were compared on baseline characteristics as well as 1-year changes in everyday functioning and global cognition. Results The cluster analysis identified 3 groups. Group 1 (n = 128) had average-to-above average cognition with low amyloid burden. Group 2 (n = 72) had the lowest memory and language, highest SCD, and average amyloid burden; they also had the most severe PTSD, pain, and worst sleep quality. Group 3 (n = 28) had the lowest attention/executive functioning, slightly low memory and language, elevated amyloid and the worst AD biomarkers, and the fastest rate of everyday functioning and cognitive decline. CONCLUSIONS Psychiatric and health factors likely contributed to Group 2's low memory and language performance. Group 3 was most consistent with biological AD, yet attention/executive function was the lowest score. The complexity of older Veterans' co-morbid conditions may interact with AD pathology to show attention/executive dysfunction (rather than memory) as a prominent early symptom. These results could have important implications for the implementation of AD-modifying drugs in older Veterans.
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Affiliation(s)
- Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra L Clark
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Lauren Edwards
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Alin Alshaheri Durazo
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Rachel Membreno
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Britney Luu
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Peter Rantins
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Monica T Ly
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lindsay J Rotblatt
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Amy J Jak
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Alshaheri Durazo A, Weigand AJ, Bangen KJ, Membreno R, Mudaliar S, Thomas KR. Type 2 Diabetes Moderates the Association Between Amyloid and 1-Year Change in Everyday Functioning in Older Veterans. J Alzheimers Dis 2024; 97:219-228. [PMID: 38160359 DOI: 10.3233/jad-230917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) affects ∼25% of Veterans, a prevalence rate double that of the general population. T2DM is associated with greater dementia risk and has been shown to exacerbate the impact of Alzheimer's disease (AD) risk factors on declines in daily functioning; however, there are few studies that investigate these patterns in older Veterans. OBJECTIVE This study sought to determine whether T2DM moderates the association between amyloid-β (Aβ) positron emission tomography (PET) and 1-year change in everyday functioning in older Veterans. METHODS One-hundred-ninety-eight predominately male Vietnam-Era Veterans without dementia from the Department of Defense-Alzheimer's Disease Neuroimaging Initiative (DoD-ADNI) with (n = 74) and without (n = 124) T2DM completed Aβ PET imaging and everyday functioning measures, including the Clinical Dementia Rating-Sum of Boxes (CDR-SB) and Everyday Cognition (ECog). Linear mixed effects models tested the moderating role of T2DM on the association between Aβ PET and 1-year change in everyday functioning. RESULTS The 3-way T2DM×Aβ PET×time interaction was significant for CDR-SB (p < 0.001) as well as the Memory (p = 0.007) and Language (p = 0.011) subscales from the ECog. Greater amyloid burden was associated with greater increases in functional difficulties, but only in Veterans with T2DM. CONCLUSIONS Higher Aβ was only associated with declines in everyday functioning over 1 year in Veterans with T2DM. Given that people with T2DM are more likely to have co-occurring cerebrovascular disease, the combination of multiple neuropathologies may result in faster declines. Future studies should examine how diabetes duration, severity, and medications impact these associations.
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Affiliation(s)
- Alin Alshaheri Durazo
- San Diego State University, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA, USA
- University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Rachel Membreno
- San Diego State University, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Sunder Mudaliar
- VA San Diego Healthcare System, San Diego, CA, USA
- University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA, USA
- University of California, San Diego School of Medicine, La Jolla, CA, USA
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Bangen KJ, Calcetas AT, Thomas KR, Wierenga C, Smith CN, Bordyug M, Brenner EK, Wing D, Chen C, Liu TT, Zlatar ZZ. Greater accelerometer-measured physical activity is associated with better cognition and cerebrovascular health in older adults. J Int Neuropsychol Soc 2023; 29:859-869. [PMID: 36789631 PMCID: PMC10425574 DOI: 10.1017/s1355617723000140] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVES Physical activity (PA) may help maintain brain structure and function in aging. Since the intensity of PA needed to effect cognition and cerebrovascular health remains unknown, we examined associations between PA and cognition, regional white matter hyperintensities (WMH), and regional cerebral blood flow (CBF) in older adults. METHOD Forty-three older adults without cognitive impairment underwent magnetic resonance imaging (MRI) and comprehensive neuropsychological assessment. Waist-worn accelerometers objectively measured PA for approximately one week. RESULTS Higher time spent in moderate to vigorous PA (MVPA) was uniquely associated with better memory and executive functioning after adjusting for all light PA. Higher MVPA was also uniquely associated with lower frontal WMH volume although the finding was no longer significant after additionally adjusting for age and accelerometer wear time. MVPA was not associated with CBF. Higher time spent in all light PA was uniquely associated with higher CBF but not with cognitive performance or WMH volume. CONCLUSIONS Engaging in PA may be beneficial for cerebrovascular health, and MVPA in particular may help preserve memory and executive function in otherwise cognitively healthy older adults. There may be differential effects of engaging in lighter PA and MVPA on MRI markers of cerebrovascular health although this needs to be confirmed in future studies with larger samples. Future randomized controlled trials that increase PA are needed to elucidate cause-effect associations between PA and cerebrovascular health.
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Affiliation(s)
- Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Amanda T Calcetas
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Christina Wierenga
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Christine N Smith
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA
| | - Maria Bordyug
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Einat K Brenner
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - David Wing
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Conan Chen
- Center for Functional MRI and Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Thomas T Liu
- Center for Functional MRI and Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Zvinka Z Zlatar
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Membreno R, Thomas KR, Calcetas AT, Edwards L, Bordyug M, Showell M, Stanfill M, Brenner EK, Walker KS, Rotblatt LJ, Brickman AM, Edmonds EC, Bangen KJ. Regional White Matter Hyperintensities Relate to Specific Cognitive Abilities in Older Adults Without Dementia. Alzheimer Dis Assoc Disord 2023; 37:303-309. [PMID: 38015423 PMCID: PMC10664788 DOI: 10.1097/wad.0000000000000585] [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: 07/03/2023] [Accepted: 09/06/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION White matter hyperintensities (WMHs) are magnetic resonance imaging markers of small vessel cerebrovascular disease that are associated with cognitive decline and clinical Alzheimer disease. Previous studies have often focused on global or total WMH; less is known about associations of regional WMHs and cognitive abilities among older adults without dementia. METHODS A total of 610 older adults with normal cognition (n=302) or mild cognitive impairment (n=308) from the Alzheimer's Disease Neuroimaging Initiative underwent neuropsychological testing and magnetic resonance imaging. Linear regression models examined associations between regional WMH volumes and cognition, adjusting for age, sex, education, apolipoprotein E ε4 allele frequency, and pulse pressure. RESULTS Among all participants, greater regional WMH volume in all lobes was associated with poorer performance on memory and speed/executive functioning. Among participants with normal cognition, greater temporal and occipital WMH volumes were associated with poorer memory, whereas no regional WMH volumes were associated with speed/executive function. DISCUSSION Results show that greater regional WMH volume relates to poorer cognitive functioning-even among those with normal cognition. Together with results from previous studies, our findings raise the possibility that WMH may be a useful therapeutic target and/or important effect modifier in treatment or prevention dementia trials.
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Affiliation(s)
| | - Kelsey R. Thomas
- Research Service, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
| | | | - Lauren Edwards
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Maria Bordyug
- Department of Psychiatry, University of California San Diego
| | - Maya Showell
- Research Service, VA San Diego Healthcare System
| | | | | | | | - Lindsay J. Rotblatt
- Psychology Service, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University
- Gertrude H. Sergievsky Center, Columbia University
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Emily C. Edmonds
- Banner Alzheimer’s Institute
- Department of Psychology, University of Arizona, Tucson, AZ
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
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10
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Dean LT, Chung SE, Gross AL, Clay OJ, Willis SL, Crowe M, McDonough IM, Thomas KR, Marsiske M, Aysola J, Thorpe RJ, Felix C, Berkowitz M, Coe NB. Does Consumer Credit Precede or Follow Changes in Cognitive Impairment Among Older Adults? An Investigation in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Trial. J Aging Health 2023; 35:84S-94S. [PMID: 37994853 DOI: 10.1177/08982643221113715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVES We assessed the relationships between pre- and post-morbid consumer credit history (credit scores, debts unpaid, or in collections) and classification of mild (or greater) cognitive impairment (MCI). METHODS Generalized Estimating Equation models assessed pre-and post-morbid credit history and MCI risk among 1740 participants aged 65+ in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, linked to TransUnion consumer credit data. RESULTS Each 50-point increase in credit score was associated with up to 8% lower odds of MCI in the next 3 years. In contrast, new unpaid collections over doubled the odds of having MCI in the next 3 years. MCI was associated with subsequent credit score declines and a 47%-71% greater risk of having a new unpaid collection in the next 4 years. DISCUSSION Credit declines may signal risk for future MCI. MCI may lead to financial challenges that warrant credit monitoring interventions for older adults.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shang-En Chung
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham Alzheimer's Disease Research Center, Birmingham, AL, USA
| | | | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ian M McDonough
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System and Department of Psychiatry, San Diego School of Medicine, University of California, San Diego, CA, USA
| | | | - Jaya Aysola
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
| | - Cynthia Felix
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melissa Berkowitz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Norma B Coe
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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11
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Aiken-Morgan AT, McDonough IM, Parisi JM, Clay OJ, Thomas KR, Rotblatt LJ, Thorpe RJ, Marsiske M. Associations Between Body Mass Index and Cognitive Change in the ACTIVE Study: Variations by Race and Social Determinants of Health. J Aging Health 2023; 35:59S-73S. [PMID: 37994849 DOI: 10.1177/08982643221109645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Objectives: The current study examines relationships between Body Mass Index (BMI) and cognitive performance and change in processing speed, memory, and reasoning, while accounting for variations by race and the influence of social determinants of health. Methods: Secondary data analysis of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, which included participants who self-identified as African American or Black (n = 728) and White (n = 2028). Latent growth curve modeling was used to assess study aims. Results: Increases in BMI were associated with less cognitive decline over 10 years across each cognition domain. Race moderation effects were noted for speed and memory. Relationships between BMI and cognitive trajectories were mediated by economic stability for speed and reasoning. Discussion: Overall, these findings are consistent with the "obesity paradox." Further research is needed to elucidate patterns of results by race.
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Affiliation(s)
- Adrienne T Aiken-Morgan
- Department of Psychiatry, University of North Carolina - Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Ian M McDonough
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Jeanine M Parisi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama, Birmingham, AL, USA
| | - Kelsey R Thomas
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Lindsay J Rotblatt
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Roland J Thorpe
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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12
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Weigand AJ, Ortiz G, Walker KS, Galasko DR, Bondi MW, Thomas KR. APOE differentially moderates cerebrospinal fluid and plasma phosphorylated tau181 associations with multi-domain cognition. Neurobiol Aging 2023; 125:1-8. [PMID: 36780762 DOI: 10.1016/j.neurobiolaging.2022.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 01/19/2023]
Abstract
Biofluid markers of phosphorylated tau181 (p-tau181) are increasingly popular for the detection of early Alzheimer's pathologic changes. However, the differential dynamics of cerebrospinal fluid (CSF) and plasma p-tau181 remain under investigation. We studied 727 participants from the Alzheimer's Disease Neuroimaging Initiative with plasma and CSF p-tau181 data, apolipoprotein (APOE) ε4 carrier status, amyloid positron emission tomography (PET) imaging, and neuropsychological data. Higher levels of plasma and CSF p-tau181 were observed among APOE ε4 carriers. CSF and plasma p-tau181 were significantly associated with memory, and this effect was greater in APOE ε4 carriers. However, whereas CSF p-tau181 was not significantly associated with language or attention/executive function among ε4 carriers or non-carriers, APOE ε4 status moderated the association of plasma p-tau181 with both language and attention/executive function. These findings lend support to the notion that p-tau181 biofluid markers are useful in measuring AD pathologic changes but also suggest that CSF and plasma p-tau181 have unique properties and dynamics that should be considered when using these markers in research and clinical practice.
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Affiliation(s)
- Alexandra J Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Gema Ortiz
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Kayla S Walker
- San Diego State University, Department of Psychology, San Diego, CA, USA
| | - Douglas R Galasko
- VA San Diego Healthcare System, San Diego, CA, USA; University of California San Diego, Department of Neurosciences, La Jolla, CA, USA
| | - Mark W Bondi
- VA San Diego Healthcare System, San Diego, CA, USA; University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA, USA; University of California San Diego, Department of Psychiatry, La Jolla, CA, USA.
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13
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Brenner EK, Thomas KR, Weigand AJ, Edwards L, Edmonds EC, Bondi MW, Bangen KJ. Cognitive reserve moderates the association between cerebral blood flow and language performance in older adults with mild cognitive impairment. Neurobiol Aging 2023; 125:83-89. [PMID: 36868071 PMCID: PMC10824498 DOI: 10.1016/j.neurobiolaging.2023.01.012] [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: 11/04/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
Higher cognitive reserve (CR) may offer protection from cognitive changes associated with reduced cerebral blood flow (CBF). We investigated CR as a moderator of the effect of CBF on cognition in older adults with mild cognitive impairment (MCI; N = 46) and those who are cognitively unimpaired (CU; N = 101). Participants underwent arterial spin labeling MRI, which was used to quantify CBF in 4 a priori regions. Estimated verbal intelligence quotient (VIQ) served as a proxy for CR. Multiple linear regressions examined whether VIQ moderated associations between CBF and cognition and whether this differed by cognitive status. Outcomes included memory and language performance. There were 3-way interactions (CBF*VIQ*cognitive status) on category fluency when examining hippocampal, superior frontal, and inferior frontal CBF. Follow-up analyses revealed that, within the MCI but not CU group, there were CBF*VIQ interactions on fluency in all a priori regions examined, where there were stronger, positive associations between CBF and fluency at higher VIQ. Conclusion: In MCI, higher CR plays a role in strengthening CBF-fluency associations.
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Affiliation(s)
- Einat K Brenner
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Kelsey R Thomas
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Alexandra J Weigand
- UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA, USA
| | - Lauren Edwards
- UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA, USA
| | - Emily C Edmonds
- Banner Alzheimer's Institute, Tucson, AZ, USA; Departments of Neurology and Psychology, University of Arizona, Tucson, AZ, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J Bangen
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA
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14
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Crocker LD, Sullan MJ, Jurick SM, Thomas KR, Davey DK, Hoffman SN, Twamley EW, Jak AJ. Baseline executive functioning moderates treatment-related changes in quality of life in veterans with posttraumatic stress disorder and comorbid traumatic brain injury. J Trauma Stress 2023; 36:94-105. [PMID: 36204974 DOI: 10.1002/jts.22883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) treatment has been associated with improvement in quality of life (QOL); however, little is known about factors that moderate treatment-related changes in QOL, particularly cognitive factors. Executive functioning (EF) is important for success across all aspects of everyday life and predicts better psychological and physical health. EF is important to QOL, but more work is needed to better understand the association between EF and QOL improvements following interventions. We hypothesized that poorer baseline EF would be associated with less improvement in overall life satisfaction and satisfaction with health following PTSD treatment. U.S. veterans who served after the September 11, 2001 terrorist attacks (post 9-11; N = 80) with PTSD and a history of mild-to-moderate traumatic brain injury were randomized to standard cognitive processing therapy (CPT) or CPT combined with cognitive rehabilitation (SMART-CPT). Multilevel modeling was used to examine whether baseline EF performance was associated with changes in QOL scores from pretreatment to follow-up across both groups. Results indicated that poorer baseline performance on EF tests of working memory and inhibition were associated with less treatment-related improvements in general life satisfaction and satisfaction with health, rs = .26-.36. Treatment condition did not moderate any results. Future research should examine whether implementing EF-focused techniques before and/or concurrently with CPT for individuals with poorer baseline working memory and inhibition enhances QOL treatment gains, particularly in terms of general life and health-related satisfaction.
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Affiliation(s)
- Laura D Crocker
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
| | - Molly J Sullan
- Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Sarah M Jurick
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Delaney K Davey
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Samantha N Hoffman
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Elizabeth W Twamley
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Amy J Jak
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
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15
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Edwards L, Thomas KR, Weigand AJ, Edmonds EC, Clark AL, Walker KS, Brenner EK, Nation DA, Maillard P, Bondi MW, Bangen KJ. White Matter Hyperintensity Volume and Amyloid-PET Synergistically Impact Memory Independent of Tau-PET in Older Adults Without Dementia. J Alzheimers Dis 2023; 94:695-707. [PMID: 37302031 PMCID: PMC10357163 DOI: 10.3233/jad-221209] [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] [Accepted: 05/06/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) and cerebrovascular disease are common, co-existing pathologies in older adults. Whether the effects of cerebrovascular disease and AD biomarkers on cognition are additive or synergistic remains unclear. OBJECTIVE To examine whether white matter hyperintensity (WMH) volume moderates the independent association between each AD biomarker and cognition. METHODS In 586 older adults without dementia, linear regressions tested the interaction between amyloid-β (Aβ) positron emission tomography (PET) and WMH volume on cognition, independent of tau-PET. We also tested the interaction between tau-PET and WMH volume on cognition, independent of Aβ-PET. RESULTS Adjusting for tau-PET, the quadratic effect of WMH interacted with Aβ-PET to impact memory. There was no interaction between either the linear or quadratic effect of WMH and Aβ-PET on executive function. There was no interaction between WMH volume and tau-PET on either cognitive measure. CONCLUSION Results suggest that cerebrovascular lesions act synergistically with Aβ to affect memory, independent of tau, highlighting the importance of incorporating vascular pathology into biomarker assessment of AD.
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Affiliation(s)
- Lauren Edwards
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Kelsey R. Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emily C. Edmonds
- Banner Alzheimer’s Institute, Tucson, AZ, USA
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Alexandra L. Clark
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | | | - Einat K. Brenner
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Daniel A. Nation
- Department of Psychology, University of California Irvine, Irvine, CA, USA
| | - Pauline Maillard
- Department of Neurology, University of California, Davis, Davis, CA, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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16
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Jones JD, Rivas R, Luna K, Ryczek CA, Thomas KR. Subjective cognitive complaints are important in PD-MCI criteria: Associations with CSF markers and cognitive decline. Parkinsonism Relat Disord 2023; 106:105221. [PMID: 36442366 PMCID: PMC10775883 DOI: 10.1016/j.parkreldis.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION According to the Movement Disorder Society (MDS), subjective cognitive complaints (SCC) are a diagnostic criterion for PD-mild cognitive impairment (PD-MCI); however, studies often do not incorporate SCC when classifying PD-MCI. This inconsistent use may reflect mixed findings regarding the association between SCC and objective measures of cognitive impairment. Our study aimed to describe the extent that inclusion/exclusion of SCC affects the occurrence of PD-MCI, and if the inclusion of SCC is associated with faster cognitive decline and cerebrospinal fluid markers (CSF) of alpha-synuclein, amyloid beta, total tau, and phophorylated-tau. METHODS Individuals with PD (N = 358) from the PPMI cohort whom completed measures of neuropsychological performance, subjective cognitive complaints, motor severity, and CSF markers were included. Participants were classified as cognitively normal (CN), PD-MCI with subjective cognitive complaints (PD-MCI + SCC) and PD-MCI without subjective cognitive complaints (PD-MCI -SCC). RESULTS PD-MCI rates were consistently higher (16.5-19.1%) across the 5 years when SCC was not included in the diagnostic criteria as opposed to when SCC was included (4.4-11.0%). PD-MCI + SCC experienced greater cognitive decline and had significantly higher levels of tau/ab and p-tau/ab relative to both the CN and PD-MCI - SCC groups. CONCLUSIONS Inconsistent implementation of an SCC requirement in PD-MCI classifications may have important implications in terms of the occurrence of PD-MCI and its prognostic value. Classifying PD-MCI only using neuropsychological cut-off criterion, without regard to SCC, may lead to higher rates of PD-MCI. Inclusions of SCC in PD-MCI criteria in newly diagnosed PD participants may strengthen the ability to detect individuals at risk for future cognitive decline, though it is possible that this decline is related to Alzheimer's disease changes rather than worse PD pathology.
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Affiliation(s)
- Jacob D Jones
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA.
| | - Rhiannon Rivas
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA
| | - Kenya Luna
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA
| | - Cameron A Ryczek
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA
| | - Kelsey R Thomas
- Veteran Affairs San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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17
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Brenner EK, Weigand AJ, Edwards L, Thomas KR, Edmonds EC, Bondi MW, Bangen KJ. Brain Derived Neurotrophic Factor Interacts with White Matter Hyperintensities to Influence Processing Speed and Hippocampal Volume in Older Adults. J Alzheimers Dis 2023; 93:141-149. [PMID: 36970903 DOI: 10.3233/jad-221178] [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: 05/09/2023]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is a neurotrophin that plays an important role in regulating synaptic activity and plasticity. OBJECTIVE Given that type-2 diabetes (T2DM) increases the risk of cognitive decline, and studies have suggested lower BDNF levels may be a risk factor of diabetic neurovascular complications, we sought to investigate total white matter hyperintensities (WMH) as a moderator of the effect of BDNF on hippocampal volume and cognition. METHODS Older adults without dementia from the Alzheimer's Disease Neuroimaging Initiative (N = 454 including 49 with T2DM and 405 without diabetes) underwent neuropsychological evaluation, magnetic resonance imaging to quantify hippocampal and WMH volumes, and blood draw to assess BDNF. RESULTS Adjusting for age, sex, and APOE ɛ4 carrier status, there was a significant interaction between total WMH and BDNF on bilateral hippocampal volume in the non-T2DM group (t = 2.63, p = 0.009). Examination of main effect models with a dichotomous high/low BNDF group revealed a significant main effect for low BDNF (t = -4.98, p < 0.001), such that as WMH increased, bilateral hippocampal volume decreased. There was also a significant interaction between total WMH and BDNF on processing speed in the non-T2DM group (t = 2.91, p = 0.004). There was a significant main effect for low BDNF (t = -3.55, p < 0.001) such that as WMH increased, processing speed decreased. The interactions were not significant in the T2DM group. CONCLUSION These results further elucidate the protective role that BDNF plays on cognition, as well as the cognitive effects of WMH.
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Affiliation(s)
- Einat K Brenner
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Alexandra J Weigand
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Lauren Edwards
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Kelsey R Thomas
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Mark W Bondi
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J Bangen
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
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18
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Clark AL, Weigand AJ, Clay OJ, Owens J, Fiala J, Crowe M, Marsiske M, Thomas KR. Associations between social determinants of health and 10-year change in everyday functioning within Black/African American and White older adults enrolled in ACTIVE. Alz & Dem Diag Ass & Dis Mo 2022; 14:e12385. [PMID: 36514539 PMCID: PMC9732812 DOI: 10.1002/dad2.12385] [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] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/31/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
Introduction Given prior work showing racial differences on baseline social determinants of health (SDoH) and 10-year trajectories of everyday functioning, we examined associations between SDoH and longitudinal everyday functioning performance in Black/African American and White older adults. Methods Participants were 2505 older adults (Mage = 73.5; 28% Black/African American) without dementia. SDoH included economic stability/status, education access/quality, health-care access, neighborhood/built environment, and social/community contexts. The Observed Tasks of Daily Living (OTDL) measured everyday functioning and was administered at baseline and 1-, 2-, 3-, 5-, and 10-year visits. Results Across the sample, social and community context and economic stability/status were associated with steeper age-related OTDL declines (βs = 0.05 to 0.07, Ps < 0.001). Lower levels of social and community context (β = 0.08, P = 0.002) and economic stability/status (β = 0.07, P = 0.04) were associated with OTDL linear age declines in Black/African American participants, but not in White participants (Ps > 0.30). Discussion Inequities across SDoH accelerate age-related declines in everyday functioning among Black/African American older adults.
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Affiliation(s)
- Alexandra L. Clark
- Department of PsychologyCollege of Liberal ArtsUniversity of Texas at AustinAustinTexasUSA
| | - Alexandra J. Weigand
- Department of PsychiatrySchool of MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Olivio J. Clay
- Department of Psychology, College of Arts and SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Joshua Owens
- Department of Clinical and Health Psychology, College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Jacob Fiala
- Department of Clinical and Health Psychology, College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Michael Crowe
- Department of Psychology, College of Arts and SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Kelsey R. Thomas
- Department of PsychiatrySchool of MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA,Research Services, VA San Diego Healthcare System (VASDHS)San DiegoCaliforniaUSA
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19
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Menendez NR, Smirnov DS, Thomas KR, Bondi MW, Gollan TH, Jacobs DM, Galasko DR, Salmon DP. Word Generation from Letter and Semantic Categories Across the Alzheimer’s Disease Spectrum. Alzheimers Dement 2022. [DOI: 10.1002/alz.065996] [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)
| | | | - Kelsey R. Thomas
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Mark W. Bondi
- University of California San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
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20
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Ortiz G, Weigand AJ, Cooper S, Smirnov DS, Salmon DP, Galasko DR, Bangen KJ, Thomas KR. Neuropsychiatric symptoms impact associations between plasma neurofilament light and cognition in individuals with Lewy body pathology, but not in Alzheimer’s disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.064400] [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)
- Gema Ortiz
- VA San Diego Healthcare System San Diego CA USA
| | - Alexandra J. Weigand
- VA San Diego Healthcare System San Diego CA USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
- University of California, School of Medicine, San Diego San Diego CA USA
| | | | | | - David P. Salmon
- University of California San Diego La Jolla CA USA
- Shiley‐Marcos Alzheimer’s Disease Research Center La Jolla CA USA
| | - Douglas R. Galasko
- VA San Diego Healthcare System San Diego CA USA
- University of California San Diego La Jolla CA USA
- Shiley‐Marcos Alzheimer’s Disease Research Center La Jolla CA USA
| | - Katherine J. Bangen
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Kelsey R. Thomas
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
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21
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Thomas KR, Weigand AJ, Edwards LC, Edmonds EC, Bangen KJ, Ortiz G, Walker KS, Bondi MW. Tau levels are higher in objective subtle cognitive decline, but not subjective memory complaint. Alzheimers Dement 2022. [DOI: 10.1002/alz.066178] [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)
- Kelsey R. Thomas
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | - Lauren C. Edwards
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | | | - Katherine J. Bangen
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Gema Ortiz
- VA San Diego Healthcare System San Diego CA USA
| | - Kayla S. Walker
- VA San Diego Healthcare System San Diego CA USA
- San Diego State University San Diego CA USA
| | - Mark W. Bondi
- VA San Diego Healthcare System San Diego CA USA
- University of California San Diego La Jolla CA USA
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Calcetas AT, Bangen KJ, Thomas KR, Smith CN, Bordyug M, Brenner EK, Zlatar Z. The association of accelerometer‐measured physical activity, white matter hyperintensity volume, and cognition in normal aging. Alzheimers Dement 2022. [DOI: 10.1002/alz.063750] [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)
| | - Katherine J. Bangen
- University of California, San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
| | - Kelsey R. Thomas
- University of California, San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
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Brenner EK, Edwards L, Thomas KR, Weigand AJ, Edmonds EC, Bondi MW, Bangen KJ. Cognitive Reserve Moderates the Association Between Cerebral Blood Flow and Language Performance in Older Adults with Mild Cognitive Impairment. Alzheimers Dement 2022. [DOI: 10.1002/alz.062810] [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)
| | - Lauren Edwards
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | - Kelsey R. Thomas
- University of California, San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | | | - Mark W. Bondi
- VA San Diego Healthcare System San Diego CA USA
- University of California San Diego La Jolla CA USA
| | - Katherine J. Bangen
- University of California, San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
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24
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Weigand AJ, Ortiz G, Walker KS, Galasko DR, Bondi MW, Thomas KR. Differential impact of APOE on associations between phosphorylated tau 181 and multi‐domain cognitive outcomes using cerebrospinal fluid and plasma markers. Alzheimers Dement 2022. [DOI: 10.1002/alz.067840] [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)
- Alexandra J. Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | - Gema Ortiz
- VA San Diego Healthcare System San Diego CA USA
| | - Kayla S. Walker
- VA San Diego Healthcare System San Diego CA USA
- San Diego State University San Diego CA USA
| | - Douglas R. Galasko
- VA San Diego Healthcare System San Diego CA USA
- Shiley‐Marcos Alzheimer's Disease Research Center La Jolla CA USA
- University of California San Diego La Jolla CA USA
| | - Mark W. Bondi
- VA San Diego Healthcare System San Diego CA USA
- University of California San Diego La Jolla CA USA
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Weigand AJ, Edwards L, Thomas KR, Bangen KJ, Bondi MW. Comprehensive characterization of elevated tau PET signal in the absence of amyloid-beta. Brain Commun 2022; 4:fcac272. [PMID: 36382220 PMCID: PMC9651027 DOI: 10.1093/braincomms/fcac272] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 07/07/2022] [Accepted: 10/24/2022] [Indexed: 02/03/2023] Open
Abstract
Recently proposed biomarker-only diagnostic frameworks propose that amyloid-beta is necessary for placement on the Alzheimer's disease continuum, whereas tau in the absence of amyloid-beta is considered to be a non-Alzheimer's disease pathologic change. Similarly, the pathologic designation of tau in the absence of amyloid-beta is characterized as primary age-related tauopathy and separable from Alzheimer's disease. Our study sought to identify an early-to-moderate tau stage with minimal amyloid-beta using PET imaging and characterize these individuals in terms of clinical, cognitive and biological features. Seven hundred and three participants from the Alzheimer's Disease Neuroimaging Initiative were classified into one of the four groups (A-/T-, A-/T+, A+/T- and A+/T+) based on PET positivity or negativity for cortical amyloid-beta (A-/A+) and early-to-moderate stage (i.e. meta-temporal) tau (T-/T+). These groups were then compared on demographic and clinical features, vascular risk, multi-domain neuropsychological performance, multi-domain subjective cognitive complaints, apolipoprotein E epsilon-4 carrier status and cortical thickness across Alzheimer's disease-vulnerable regions. The proportion of participants classified in each group was as follows: 47.23% A-/T-, 13.51% A-/T+, 12.23% A+/T- and 27.03% A+/T+. Results indicated that the A-/T+ and A+/T+ groups did not statistically differ on age, sex, depression levels, vascular risk and cortical thickness across temporal and parietal regions. Additionally, both A-/T+ and A+/T+ groups showed significant associations between memory performance and cortical thickness of temporal regions. Despite the different pathologic terminology used for A-/T+ and A+/T+, these groups did not statistically differ on a number of clinical, cognitive and biomarker features. Although it remains unclear whether A-/T+ reflects a pathologic construct separable from Alzheimer's disease, our results provide evidence that this group typically characterized as 'non-Alzheimer's pathologic change' or 'primary age-related tauopathy' should be given increased attention, given some similarities in cognitive and biomarker characteristics to groups traditionally considered to be on the Alzheimer's continuum.
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Affiliation(s)
- Alexandra J Weigand
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA 92120, USA
| | - Lauren Edwards
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA 92120, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Mark W Bondi
- Correspondence to: Mark W. Bondi, PhD ABPP-CN, VA San Diego Healthcare System (116B) 3350 La Jolla Village Drive, San Diego, CA 92161, USA E-mail:
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Calcetas AT, Thomas KR, Edmonds EC, Holmqvist SL, Edwards L, Bordyug M, Delano-Wood L, Brickman AM, Bondi MW, Bangen KJ, For The Alzheimer's Disease Neuroimaging Initiative. Increased regional white matter hyperintensity volume in objectively-defined subtle cognitive decline and mild cognitive impairment. Neurobiol Aging 2022; 118:1-8. [PMID: 35809348 PMCID: PMC9838569 DOI: 10.1016/j.neurobiolaging.2022.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/10/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 02/03/2023]
Abstract
White matter hyperintensities (WMH), a marker of small vessel cerebrovascular disease, increase risk of developing mild cognitive impairment (MCI) and Alzheimer's disease (AD). Less is known about the extent and pattern of WMH in pre-MCI stages, such as among those with objectively-defined subtle cognitive decline (Obj-SCD). Five hundred and fifty-nine Alzheimer's Disease Neuroimaging Initiative participants (170 cognitively unimpaired [CU]; 83 Obj-SCD; 306 MCI) free of clinical dementia or stroke completed neuropsychological testing and MRI exams. ANCOVA models compared cognitive groups on regional WMH adjusting for age, sex, and apolipoprotein E (APOE) ɛ4 frequency. Compared with the CU group, those with Obj-SCD had greater temporal, occipital, and frontal WMH whereas those with MCI had higher WMH volume across all regions (p's < 0.01). No differences in WMH volume were observed between the Obj-SCD and MCI groups (p's > 0.05). Findings add to growing evidence of associations between Obj-SCD and imaging biomarkers, providing support for utility of these criteria to capture subtle cognitive changes that are biologically based.
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Affiliation(s)
- Amanda T Calcetas
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Kelsey R Thomas
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Emily C Edmonds
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Lauren Edwards
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Maria Bordyug
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA; Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J Bangen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
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27
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Thomas KR, Weigand AJ, Edwards LC, Edmonds EC, Bangen KJ, Ortiz G, Walker KS, Bondi MW. Tau levels are higher in objective subtle cognitive decline but not subjective memory complaint. Alzheimers Res Ther 2022; 14:114. [PMID: 35996158 PMCID: PMC9394026 DOI: 10.1186/s13195-022-01060-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The 2018 NIA-AA Alzheimer's Disease (AD) Research Framework states that subtle cognitive decline in cognitively unimpaired individuals can be measured by subjective reports or evidence of objective decline on neuropsychological measures. Both subjective memory complaint (SMC) and objective subtle cognitive decline (Obj-SCD) have been shown to be associated with future cognitive decline and AD biomarkers. We examined whether there are differences in tau PET levels between (a) SMC- vs. SMC+ participants, (b) Obj-SCD- vs. Obj-SCD+ participants, and (c) participants with overlapping vs. discrepant SMC and Obj-SCD classifications. METHODS Cognitively unimpaired participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI; n = 236) were classified at baseline as positive or negative for SMC (SMC- n = 77; SMC+ n = 159) based on the first 12 items of the Cognitive Change Index and/or classified as positive or negative for Obj-SCD (Obj-SCD- n = 173; Obj-SCD+ n = 63) based on previously defined neuropsychological criteria. Analyses of covariance, adjusting for age, sex, APOE ε4 carrier status, and pulse pressure, examined the group differences in tau PET (AV-1451) using a composite standardized uptake variable ratio (SUVR) for regions consistent with Braak stage III/IV. The chi-squared tests examined the tau positivity rates across the groups. RESULTS Obj-SCD+ participants had higher tau continuous SUVR levels (p = .035, ηp2 = .019) and higher rates of tau positivity (15.8% Obj-SCD- vs. 30.2% Obj-SCD+) than Obj-SCD- participants. Neither tau levels (p = .381, ηp2 = .003) nor rates of tau positivity (18.2% SMC- and 20.1% SMC+) differed between the SMC groups. There was very little agreement between SMC and Obj-SCD classifications (42%; κ = 0.008, p = .862). Participants who were Obj-SCD+ without SMC had the highest tau PET levels and differed from participants who were SMC+ without Obj-SCD (p = .022). Tau levels in participants with both SMC and Obj-SCD did not differ from those with only Obj-SCD (p = .216). Tau positivity rates across the SMC-/Obj-SCD-, SMC+/Obj-SCD-, SMC-/Obj-SCD+, and SMC+/Obj-SCD+ groups were 10.5%, 18.1%, 40.0%, and 25.6%, respectively. CONCLUSION Participants with Obj-SCD had a greater tau PET burden than those without Obj-SCD, but SMC was not associated with higher tau levels. The combination of SMC and Obj-SCD did not have higher tau levels than Obj-SCD alone. Findings add to the evidence that the Obj-SCD classification is associated with AD biomarkers and faster cognitive decline in ADNI participants, but further work is needed to validate this approach in more representative/diverse cohorts.
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Affiliation(s)
- Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, Building 13, 3350 La Jolla Village Drive (151), San Diego, CA, 92161, USA.
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA.
| | - Alexandra J Weigand
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Lauren C Edwards
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | | | - Katherine J Bangen
- Research Service, VA San Diego Healthcare System, Building 13, 3350 La Jolla Village Drive (151), San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
| | - Gema Ortiz
- Research Service, VA San Diego Healthcare System, Building 13, 3350 La Jolla Village Drive (151), San Diego, CA, 92161, USA
| | - Kayla S Walker
- Research Service, VA San Diego Healthcare System, Building 13, 3350 La Jolla Village Drive (151), San Diego, CA, 92161, USA
- San Diego State University, San Diego, CA, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
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Holmqvist SL, Thomas KR, Brenner EK, Edmonds EC, Calcetas A, Edwards L, Bordyug M, Bangen KJ. Longitudinal Intraindividual Cognitive Variability Is Associated With Reduction in Regional Cerebral Blood Flow Among Alzheimer's Disease Biomarker-Positive Older Adults. Front Aging Neurosci 2022; 14:859873. [PMID: 35875798 PMCID: PMC9300445 DOI: 10.3389/fnagi.2022.859873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/06/2022] [Indexed: 02/03/2023] Open
Abstract
Intraindividual variability (IIV) across neuropsychological measures within a single testing session is a promising marker predictive of cognitive decline and development of Alzheimer's disease (AD). We have previously shown that greater IIV is cross-sectionally associated with reduced cerebral blood flow (CBF), but not with cortical thickness or brain volume, in older adults without dementia who were amyloid beta (Aβ) positive. However, there is little known about the association between change in IIV and CBF over time. Therefore, we examined 12-month longitudinal change in IIV and interactions of IIV and AD biomarker status on changes in regional CBF. Fifty-three non-demented Alzheimer's Disease Neuroimaging Initiative (ADNI) participants underwent lumbar puncture to obtain cerebrospinal fluid (CSF) at baseline and neuropsychological testing and magnetic resonance imaging (MRI) exams at baseline and 12-month follow-up evaluation. IIV was calculated as the intraindividual standard deviation across 6 demographically-corrected neuropsychological measures. Pulsed arterial spin labeling (ASL) MRI was acquired to quantify CBF and FreeSurfer-derived a priori CBF regions of interest (ROIs) were examined. AD biomarker positivity was determined using a published CSF p-tau/Aβ ratio cut-score. Change scores were calculated for IIV, CBF, and mean neuropsychological performance from baseline to 12 months. Hierarchical linear regression models showed that after adjusting for age and gender, there was a significant interaction between IIV change and biomarker-positivity (p-tau/Aβ+) for change in entorhinal and hippocampal CBF but not for the other ROIs. Specifically, increases in IIV were associated with reductions in entorhinal and hippocampal CBF among individuals who were biomarker-positive (n = 21). In contrast, there were no significant associations between change in IIV and CBF among those who were biomarker-negative (n = 32). Findings remained similar when analyses were performed adjusting for change in mean level of neuropsychological performance. Changes in IIV may be sensitive to changes in regional hypoperfusion in AD-vulnerable regions among AD biomarker-positive individuals, above and beyond demographics and mean neuropsychological performance. These findings provide further evidence supporting IIV as a potential marker of cerebrovascular brain changes in individuals at risk for dementia.
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Affiliation(s)
- Sophia L. Holmqvist
- Research Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Kelsey R. Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Einat K. Brenner
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Emily C. Edmonds
- Research Service, VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Amanda Calcetas
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Lauren Edwards
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Maria Bordyug
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,*Correspondence: Katherine J. Bangen,
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Sanderson-Cimino M, Elman JA, Tu XM, Gross AL, Panizzon MS, Gustavson DE, Bondi MW, Edmonds EC, Eppig JS, Franz CE, Jak AJ, Lyons MJ, Thomas KR, Williams ME, Kremen WS. Practice Effects in Mild Cognitive Impairment Increase Reversion Rates and Delay Detection of New Impairments. Front Aging Neurosci 2022; 14:847315. [PMID: 35547623 PMCID: PMC9083463 DOI: 10.3389/fnagi.2022.847315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/21/2022] [Indexed: 01/27/2023] Open
Abstract
Objective Cognitive practice effects (PEs) can delay detection of progression from cognitively unimpaired to mild cognitive impairment (MCI). They also reduce diagnostic accuracy as suggested by biomarker positivity data. Even among those who decline, PEs can mask steeper declines by inflating cognitive scores. Within MCI samples, PEs may increase reversion rates and thus impede detection of further impairment. Within an MCI sample at baseline, we evaluated how PEs impact prevalence, reversion rates, and dementia progression after 1 year. Methods We examined 329 baseline Alzheimer's Disease Neuroimaging Initiative MCI participants (mean age = 73.1; SD = 7.4). We identified test-naïve participants who were demographically matched to returnees at their 1-year follow-up. Since the only major difference between groups was that one completed testing once and the other twice, comparison of scores in each group yielded PEs. PEs were subtracted from each test to yield PE-adjusted scores. Biomarkers included cerebrospinal fluid phosphorylated tau and amyloid beta. Cox proportional models predicted time until first dementia diagnosis using PE-unadjusted and PE-adjusted diagnoses. Results Accounting for PEs increased MCI prevalence at follow-up by 9.2% (272 vs. 249 MCI), and reduced reversion to normal by 28.8% (57 vs. 80 reverters). PEs also increased stability of single-domain MCI by 12.0% (164 vs. 147). Compared to PE-unadjusted diagnoses, use of PE-adjusted follow-up diagnoses led to a twofold increase in hazard ratios for incident dementia. We classified individuals as false reverters if they reverted to cognitively unimpaired status based on PE-unadjusted scores, but remained classified as MCI cases after accounting for PEs. When amyloid and tau positivity were examined together, 72.2% of these false reverters were positive for at least one biomarker. Interpretation Even when PEs are small, they can meaningfully change whether some individuals with MCI retain the diagnosis at a 1-year follow-up. Accounting for PEs resulted in increased MCI prevalence and altered stability/reversion rates. This improved diagnostic accuracy also increased the dementia-predicting ability of MCI diagnoses.
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Affiliation(s)
- Mark Sanderson-Cimino
- University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA, United States,Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States,*Correspondence: Mark Sanderson-Cimino,
| | - Jeremy A. Elman
- Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States,Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Xin M. Tu
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States,Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, United States
| | - Matthew S. Panizzon
- Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States,Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Daniel E. Gustavson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mark W. Bondi
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States,Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Emily C. Edmonds
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States,Research Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Joel S. Eppig
- Rehabilitation Institute of Washington, Seattle, WA, United States
| | - Carol E. Franz
- Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States,Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Amy J. Jak
- Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States,Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
| | - Kelsey R. Thomas
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States,Research Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - McKenna E. Williams
- University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA, United States,Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States
| | - William S. Kremen
- Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States,Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States,Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
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30
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Thomas KR, Weigand AJ, Cota IH, Edmonds EC, Wierenga CE, Bondi MW, Bangen KJ. Intrusion errors moderate the relationship between blood glucose and regional cerebral blood flow in cognitively unimpaired older adults. Brain Imaging Behav 2022; 16:219-227. [PMID: 34415491 PMCID: PMC8825619 DOI: 10.1007/s11682-021-00495-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 02/03/2023]
Abstract
Regional cerebral blood flow (CBF) has a complex relationship with cognitive functioning such that cognitively unimpaired individuals at risk for Alzheimer's disease (AD) may show regional hyperperfusion, while those with cognitive impairment typically show hypoperfusion. Diabetes and word-list intrusion errors are both linked to greater risk of cognitive decline and dementia. Our study examined associations between fasting blood glucose, word-list intrusion errors, and regional CBF. 113 cognitively unimpaired older adults had arterial spin labeling MRI to measure CBF in a priori AD vulnerable regions: medial temporal lobe (MTL), inferior parietal lobe (IPL), precuneus, medial orbitofrontal cortex (mOFC), and pericalcarine (control region). Hierarchical linear regressions, adjusting for demographics, vascular risk, and reference CBF region, examined the main effect of blood glucose on regional CBF as well as whether intrusions moderated this relationship. Higher glucose was associated with higher CBF in the precuneus (β = .134, 95% CI = .007 to .261, p = .039), IPL (β = .173, 95% CI = .072 to .276, p = .001), and mOFC (β = .182, 95% CI = .047 to .320, p = .009). There was no main effect of intrusions on CBF across regions. However, the glucose x intrusions interaction was significant such that having higher glucose levels and more intrusion errors was associated with reduced CBF in the MTL (β = -.186, 95% CI = -.334 to -.040, p = .013) and precuneus (β = -.146, 95% CI = -.273 to -.022, p = .022). These findings may reflect early neurovascular dysregulation, whereby higher CBF is needed to maintain unimpaired cognition in individuals with higher glucose levels. However, lower regional CBF in unimpaired participants with both higher glucose and more intrusions suggests a failure in this early compensatory mechanism that may signal a decrease in neural activity in AD vulnerable regions.
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Affiliation(s)
- Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (151), San Diego, CA, USA.
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Isabel H Cota
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (151), San Diego, CA, USA
| | - Emily C Edmonds
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (151), San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Christina E Wierenga
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (151), San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J Bangen
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (151), San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Graves LV, Edmonds EC, Thomas KR, Weigand AJ, Cooper S, Stickel AM, Zlatar ZZ, Clark AL, Bondi MW. Diagnostic accuracy and differential associations between ratings of functioning and neuropsychological performance in non-Hispanic Black and White older adults. Clin Neuropsychol 2022; 36:287-310. [PMID: 34499580 PMCID: PMC8849565 DOI: 10.1080/13854046.2021.1971766] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ObjectiveWe recently demonstrated that relative to consensus-based methods, actuarial methods may improve diagnostic accuracy across the continuum of cognitively normal (CN), mild cognitive impairment (MCI), and dementia in the overall National Alzheimer's Coordinating Center (NACC) cohort. However, the generalizability and comparative utility of current methods of diagnosing MCI and dementia due to Alzheimer's disease and related disorders (ADRD) are significantly understudied in non-Hispanic Black (NHB) older adults. Thus, we extended our previous investigation to more specifically explore the utility of consensus-based and actuarial diagnostic methods in NHB older adults.Method: We compared baseline consensus and actuarial diagnostic rates, and associations of ratings of functioning with neuropsychological performance and diagnostic outcomes, in NHB (n = 963) and non-Hispanic White (NHW; n = 4577) older adults in the NACC cohort.Results: 60.0% of the NHB subsample, versus 29.2% of the NHW subsample, included participants who met actuarial criteria for MCI despite being classified as CN or impaired-not-MCI per consensus. Additionally, associations between ratings of functioning and neuropsychological performance were less consistent in NHB participants than in NHW participants.Conclusions: Our results provide evidence of differential degrees of association between reported functioning and neuropsychological performance in NHB and NHW older adults, which may contribute to racial group differences in diagnostic rates, and prompt consideration of the strengths and weaknesses of consensus-based and actuarial diagnostic approaches in assessing neurocognitive functioning in NHB older adults.
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Affiliation(s)
- Lisa V. Graves
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Emily C. Edmonds
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Kelsey R. Thomas
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Shanna Cooper
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Ariana M. Stickel
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Zvinka Z. Zlatar
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Alexandra L. Clark
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Mark W. Bondi
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Sanderson‐Cimino M, Elman JA, Tu XM, Gross AL, Panizzon MS, Gustavson DE, Bondi MW, Edmonds EC, Eglit GM, Eppig JS, Franz CE, Jak AJ, Lyons MJ, Thomas KR, Williams ME, Kremen WS. Cognitive practice effects delay diagnosis of MCI: Implications for clinical trials. Alzheimers Dement (N Y) 2022; 8:e12228. [PMID: 35128027 PMCID: PMC8804942 DOI: 10.1002/trc2.12228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/12/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Practice effects (PEs) on cognitive tests obscure decline, thereby delaying detection of mild cognitive impairment (MCI). Importantly, PEs may be present even when there are performance declines, if scores would have been even lower without prior test exposure. We assessed how accounting for PEs using a replacement-participants method impacts incident MCI diagnosis. METHODS Of 889 baseline cognitively normal (CN) Alzheimer's Disease Neuroimaging Initiative (ADNI) participants, 722 returned 1 year later (mean age = 74.9 ± 6.8 at baseline). The scores of test-naïve demographically matched "replacement" participants who took tests for the first time were compared to returnee scores at follow-up. PEs-calculated as the difference between returnee follow-up scores and replacement participants scores-were subtracted from follow-up scores of returnees. PE-adjusted cognitive scores were then used to determine if individuals were below the impairment threshold for MCI. Cerebrospinal fluid amyloid beta, phosphorylated tau, and total tau were used for criterion validation. In addition, based on screening and recruitment numbers from a clinical trial of amyloid-positive individuals, we estimated the effect of earlier detection of MCI by accounting for cognitive PEs on a hypothetical clinical trial in which the key outcome was progression to MCI. RESULTS In the ADNI sample, PE-adjusted scores increased MCI incidence by 19% (P < .001), increased proportion of amyloid-positive MCI cases (+12%), and reduced proportion of amyloid-positive CNs (-5%; P's < .04). Additional calculations showed that the earlier detection and increased MCI incidence would also substantially reduce necessary sample size and study duration for a clinical trial of progression to MCI. Cost savings were estimated at ≈$5.41 million. DISCUSSION Detecting MCI as early as possible is of obvious importance. Accounting for cognitive PEs with the replacement-participants method leads to earlier detection of MCI, improved diagnostic accuracy, and can lead to multi-million-dollar cost reductions for clinical trials.
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Affiliation(s)
- Mark Sanderson‐Cimino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
- Center for Behavior Genetics of AgingUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
| | - Jeremy A. Elman
- Center for Behavior Genetics of AgingUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
- Department of PsychiatrySchool of MedicineUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
| | - Xin M. Tu
- Department of PsychiatrySchool of MedicineUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
- Family Medicine and Public HealthUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
- Sam and Rose Stein Institute for Research on AgingUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
| | - Alden L. Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Matthew S. Panizzon
- Center for Behavior Genetics of AgingUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
- Department of PsychiatrySchool of MedicineUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
| | - Daniel E. Gustavson
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Mark W. Bondi
- Department of PsychiatrySchool of MedicineUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
- Psychology ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Emily C. Edmonds
- Department of PsychiatrySchool of MedicineUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
- Research ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Graham M.L. Eglit
- Center for Behavior Genetics of AgingUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
- Department of PsychiatrySchool of MedicineUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
- Sam and Rose Stein Institute for Research on AgingUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
| | | | - Carol E. Franz
- Center for Behavior Genetics of AgingUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
- Department of PsychiatrySchool of MedicineUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
| | - Amy J. Jak
- Center for Behavior Genetics of AgingUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
- Center of Excellence for Stress and Mental HealthVeterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Michael J. Lyons
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Kelsey R. Thomas
- Department of PsychiatrySchool of MedicineUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
- Research ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - McKenna E. Williams
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
- Center for Behavior Genetics of AgingUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
| | - William S. Kremen
- Center for Behavior Genetics of AgingUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
- Department of PsychiatrySchool of MedicineUniversity of CaliforniaSan DiegoLa JollaCaliforniaUSA
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Weigand AJ, Macomber AJ, Walker KS, Edwards L, Thomas KR, Bangen KJ, Nation DA, Bondi MW. Interactive Effects of Pulse Pressure and Tau Imaging on Longitudinal Cognition. J Alzheimers Dis 2022; 89:633-640. [PMID: 35938247 PMCID: PMC9904538 DOI: 10.3233/jad-220026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies have demonstrated that both tau and cardiovascular risk are associated with cognitive decline, but the possible synergistic effects of these pathologic markers remain unclear. OBJECTIVE To explore the interaction of AD biomarkers with a specific vascular risk marker (pulse pressure) on longitudinal cognition. METHODS Participants included 139 older adults from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Biomarkers of tau, amyloid-β (Aβ), and vascular risk (pulse pressure) were assessed. Neuropsychological assessment provided memory, language, and executive function domain composite scores at baseline and 1-year follow-up. Multiple linear regression examined interactive effects of pulse pressure with tau PET independent of Aβ PET and Aβ PET independent of tau PET on baseline and 1-year cognitive outcomes. RESULTS The interaction between pulse pressure and tau PET significantly predicted 1-year memory performance such that the combined effect of high pulse pressure and high tau PET levels was associated with lower memory at follow-up but not at baseline. In contrast, Aβ PET did not significantly interact with pulse pressure to predict baseline or 1-year outcomes in any cognitive domain. Main effects revealed a significant effect of tau PET on memory, and no significant effects of Aβ PET or pulse pressure on any cognitive domain. CONCLUSION Results indicate that tau and an indirect marker of arterial stiffening (pulse pressure) may synergistically contribute to memory decline, whereas Aβ may have a lesser role in predicting cognitive progression. Tau and vascular pathology (particularly in combination) may represent valuable targets for interventions intended to slow cognitive decline.
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Affiliation(s)
- Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | | | | | - Lauren Edwards
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | - Kelsey R. Thomas
- Department of Psychiatry, University of California San Diego,VA San Diego Healthcare System; Department of Psychology
| | - Katherine J. Bangen
- Department of Psychiatry, University of California San Diego,VA San Diego Healthcare System; Department of Psychology
| | | | - Mark W. Bondi
- Department of Psychiatry, University of California San Diego,University of California Irvine
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Thomas KR, Bangen KJ, Weigand AJ, Ortiz G, Walker KS, Salmon DP, Bondi MW, Edmonds EC. Cognitive Heterogeneity and Risk of Progression in Data-Driven Subtle Cognitive Decline Phenotypes. J Alzheimers Dis 2022; 90:323-331. [PMID: 36120785 PMCID: PMC9661321 DOI: 10.3233/jad-220684] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is increasing recognition of cognitive and pathological heterogeneity in early-stage Alzheimer's disease and other dementias. Data-driven approaches have demonstrated cognitive heterogeneity in those with mild cognitive impairment (MCI), but few studies have examined this heterogeneity and its association with progression to MCI/dementia in cognitively unimpaired (CU) older adults. OBJECTIVE We identified cluster-derived subgroups of CU participants based on comprehensive neuropsychological data and compared baseline characteristics and rates of progression to MCI/dementia or a Dementia Rating Scale (DRS) of ≤129 across subgroups. METHODS Hierarchical cluster analysis was conducted on individual baseline neuropsychological test scores from 365 CU participants in the UCSD Shiley-Marcos Alzheimer's Disease Research Center longitudinal cohort. Cox regressions examined the risk of progression to consensus diagnosis of MCI or dementia, or to DRS score ≤129, by cluster group. RESULTS Cluster analysis identified 5 groups: All-Average (n = 139), Low-Visuospatial (n = 46), Low-Executive (n = 51), Low-Memory/Language (n = 83), and Low-All Domains (n = 46). Subgroups had unique demographic and clinical characteristics. Rates of progression to MCI/dementia or to DRS ≤129 were faster for all subgroups (Low-All Domains progressed the fastest > Low Memory/Language≥Low-Visuospatial and Low-Executive) relative to the All-Average subgroup. CONCLUSION Faster progression in the Low-Visuospatial, Low-Executive, and Low-Memory/Language groups compared to the All-Average group suggests that there are multiple pathways and/or unique subtle cognitive decline profiles that ultimately lead to a diagnosis of MCI/dementia. Use of comprehensive neuropsychological test batteries that assess several domains may be a key first step toward an individualized approach to early detection and fewer missed opportunities for early intervention.
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Affiliation(s)
- Kelsey R. Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Gema Ortiz
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Kayla S. Walker
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - David P. Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Emily C. Edmonds
- Banner Alzheimer’s Institute, Tucson, AZ, USA
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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Clark AL, Solders SK, Thomas KR, Bangen KJ. White Matter Microstructure is Associated with Serum Clusterin and Everyday Functioning in a Sample of Nondemented Older Adults. Curr Alzheimer Res 2021; 18:1118-1126. [PMID: 34961443 DOI: 10.2174/1567205019666211227102350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/16/2021] [Accepted: 11/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although clusterin-a protein involved in lipid metabolism, amyloid beta clearance, and myelination-has been linked to gray matter atrophy within samples of older adults at risk for Alzheimer's disease, research exploring associations with white matter (WM) micro- and macro- structural markers are largely limited. OBJECTIVE The current study [1] explored associations between serum clusterin protein levels and WM micro- and macro- structural markers, and [2] clarified whether variations in WM fractional anisotropy (FA) were associated with functional abilities within in a racially homogenous sample of relatively well-educated older adults free of dementia. METHODS Participants underwent magnetic resonance imaging (MRI) brain exams and a blood draw and completed a performance-based measure of everyday functioning. Multiple linear regression adjusting for age, sex, APOE e4 positivity, and vascular risk were used to explore serum clusterin associations with WM metrics, as well clarify potential links between WM microstructure and everyday functioning. RESULTS Higher serum clusterin was associated with lower FA in several thalamocortical (anterior and posterior internal capsule, posterior thalamic radiation; ßs = -.32 to -.37, ps = .01 to .02) and association fiber tracts (external capsule, superior longitudinal fasciculus; ßs = -.32 to -.40, ps = .02). Serum clusterin was not associated with white matter hyperintensity volume (ß = .14, p = .28), but higher FA of several WM tracts was associated with better performance on the Independent Living Scale (ßs = .37 to .53, ps = .006 to .03). CONCLUSIONS Serum clusterin is differentially associated with WM metrics, and WM microstructure is associated with everyday functioning.
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Affiliation(s)
- Alexandra L Clark
- Department of Psychology, The University of Texas at Austin; 2Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Seraphina K Solders
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Kelsey R Thomas
- Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Katherine J Bangen
- Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
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Holmqvist SL, Thomas KR, Edmonds EC, Calcetas AT, Edwards L, Bangen KJ. Higher intraindividual variability in neuropsychological test performance is associated with reduced cerebral blood flow in older adults. Alzheimers Dement 2021. [DOI: 10.1002/alz.051240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Kelsey R. Thomas
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Emily C. Edmonds
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | | | - Lauren Edwards
- UCSD/SDSU Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | - Katherine J. Bangen
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
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Thomas KR, Bangen KJ, Edmonds EC, Weigand AJ, Walker KS, Bondi MW, Galasko DR. Objective subtle cognitive decline is associated with a more rapid increase in plasma phosphorylated‐tau181 levels over time. Alzheimers Dement 2021. [DOI: 10.1002/alz.050039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kelsey R. Thomas
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Katherine J. Bangen
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Emily C. Edmonds
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | - Kayla S. Walker
- San Diego State University, Advancing Diversity in Aging Research Program San Diego CA USA
| | - Mark W. Bondi
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Doug R. Galasko
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
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Calcetas AT, Thomas KR, Edmonds EC, Holmqvist SL, Edwards L, Bordyug M, Delano‐Wood L, Brickman AM, Bondi MW, Bangen KJ. Increased regional white matter hyperintensity volume in objectively‐defined subtle cognitive decline and mild cognitive impairment. Alzheimers Dement 2021. [DOI: 10.1002/alz.056421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Kelsey R. Thomas
- University of California, San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
| | - Emily C. Edmonds
- University of California, San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
| | | | - Lauren Edwards
- SDSU/UC San Diego Joint Doctoral Program San Diego CA USA
| | | | - Lisa Delano‐Wood
- University of California, San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
- Shiley‐Marcos Alzheimer's Disease Research Center La Jolla CA USA
| | | | - Mark W. Bondi
- University of California, San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
- Shiley‐Marcos Alzheimer's Disease Research Center La Jolla CA USA
| | - Katherine J. Bangen
- University of California, San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
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Werhane ML, Thomas KR, Bangen KJ, Weigand AJ, Edmonds EC, Nation DA, Sundermann EE, Bondi MW, Delano-Wood L. Arterial Stiffening Moderates the Relationship Between Type-2 Diabetes Mellitus and White Matter Hyperintensity Burden in Older Adults With Mild Cognitive Impairment. Front Aging Neurosci 2021; 13:716638. [PMID: 34759811 PMCID: PMC8574966 DOI: 10.3389/fnagi.2021.716638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cerebrovascular dysfunction has been proposed as a possible mechanism underlying cognitive impairment in the context of type 2 diabetes mellitus (DM). Although magnetic resonance imaging (MRI) evidence of cerebrovascular disease, such as white matter hyperintensities (WMH), is often observed in DM, the vascular dynamics underlying this pathology remain unclear. Thus, we assessed the independent and combined effects of DM status and different vascular hemodynamic measures (i.e., systolic, diastolic, and mean arterial blood pressure and pulse pressure index [PPi]) on WMH burden in cognitively unimpaired (CU) older adults and those with mild cognitive impairment (MCI). Methods: 559 older adults (mean age: 72.4 years) from the Alzheimer's Disease Neuroimaging Initiative were categorized into those with diabetes (DM+; CU = 43, MCI = 34) or without diabetes (DM-; CU = 279; MCI = 203). Participants underwent BP assessment, from which all vascular hemodynamic measures were derived. T2-FLAIR MRI was used to quantify WMH burden. Hierarchical linear regression, adjusting for age, sex, BMI, intracranial volume, CSF amyloid, and APOE ε4 status, examined the independent and interactive effects of DM status and each vascular hemodynamic measure on total WMH burden. Results: The presence of DM (p = 0.046), but not PPi values (p = 0.299), was independently associated with greater WMH burden overall after adjusting for covariates. Analyses stratified by cognitive status revealed a significant DM status x PPi interaction within the MCI group (p = 0.001) such that higher PPi values predicted greater WMH burden in the DM + but not DM- group. No significant interactions were observed in the CU group (all ps > 0.05). Discussion: Results indicate that higher PPi values are positively associated with WMH burden in diabetic older adults with MCI, but not their non-diabetic or CU counterparts. Our findings suggest that arterial stiffening and reduced vascular compliance may have a role in development of cerebrovascular pathology within the context of DM in individuals at risk for future cognitive decline. Given the specificity of these findings to MCI, future exploration of the sensitivity of earlier brain markers of vascular insufficiency (i.e., prior to macrostructural white matter changes) to the effects of DM and arterial stiffness/reduced vascular compliance in CU individuals is warranted.
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Affiliation(s)
- Madeleine L. Werhane
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Kelsey R. Thomas
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Katherine J. Bangen
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Alexandra J. Weigand
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, United States
| | - Emily C. Edmonds
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Daniel A. Nation
- Department of Psychological Sciences, University of California, Irvine, Irvine, CA, United States
| | - Erin E. Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Mark W. Bondi
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Lisa Delano-Wood
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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Clark AL, Weigand AJ, Bangen KJ, Thomas KR, Eglit GM, Bondi MW, Delano‐Wood L. Higher cerebrospinal fluid tau is associated with history of traumatic brain injury and reduced processing speed in Vietnam-era veterans: A Department of Defense Alzheimer's Disease Neuroimaging Initiative (DOD-ADNI) study. Alzheimers Dement (Amst) 2021; 13:e12239. [PMID: 34692979 PMCID: PMC8515227 DOI: 10.1002/dad2.12239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/08/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Our goal was to determine whether cognitive and cerebrospinal fluid (CSF) markers of tau and amyloid beta 1-42 (Aβ42) differ between Vietnam-era veterans with and without history of traumatic brain injury (TBI) and whether TBI moderates the association between CSF markers and neurocognitive functioning. METHODS A total of 102 male participants (52 TBI, 50 military controls [MCs]; mean age = 68) were included. Levels of CSF Aβ42, tau phosphorylated at the threonine 181 position (p-tau), and total tau (t-tau) were quantified. Group differences in CSF markers and cognition as well as the moderating effect of TBI on CSF and cognition associations were explored. RESULTS Relative to MCs, the TBI group showed significantly higher p-tau (P = .01) and t-tau (P = .02), but no differences in amyloid (P = .09). TBI history moderated the association between CSF tau and performance on a measure of processing speed (t-tau: P = .04; p-tau: P = .02). DISCUSSION Tau accumulation may represent a mechanism of dementia risk in older veterans with remote TBI.
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Affiliation(s)
- Alexandra L. Clark
- Department of PsychologyUniversity of Texas at AustinAustinTexasUSA
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- Department of Psychiatry, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Alexandra J. Weigand
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical PsychologySan Diego State University/University of CaliforniaSan DiegoCaliforniaUSA
| | - Katherine J. Bangen
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- Department of Psychiatry, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Kelsey R. Thomas
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- Department of Psychiatry, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Graham M.L. Eglit
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- Department of Psychiatry, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Mark W. Bondi
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- Department of Psychiatry, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Lisa Delano‐Wood
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- Department of Psychiatry, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
- Center of Excellence for Stress and Mental HealthVASDHSLa JollaCaliforniaUSA
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Thomas KR, Bangen KJ, Edmonds EC, Weigand AJ, Walker KS, Bondi MW, Galasko DR. Objective subtle cognitive decline and plasma phosphorylated tau181: Early markers of Alzheimer's disease-related declines. Alzheimers Dement (Amst) 2021; 13:e12238. [PMID: 34692978 PMCID: PMC8515224 DOI: 10.1002/dad2.12238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Objectively-defined subtle cognitive decline (Obj-SCD) and plasma phosphorylated-tau181 (p-tau181) are promising early Alzheimer's disease (AD) markers. However, associations between Obj-SCD and p-tau181, and their combined prognostic potential, are unknown. METHODS Baseline and 4-year longitudinal p-tau181 changes were compared across cognitively unimpaired (CU; n = 402), Obj-SCD (n = 199), and mild cognitive impairment (MCI; n = 346) groups. CU and Obj-SCD participants were further classified as p-tau181-positive or negative. RESULTS CU and Obj-SCD has lower baseline p-tau181 than MCI and did not differ from one another. Longitudinally, Obj-SCD had the steepest p-tau181 increase. Obj-SCD/p-tau181-positive participants had the fastest rates of amyloid accumulation, cognitive decline, and functional decline. CONCLUSIONS Despite assumptions that cognitive changes invariably follow biomarker changes, early neuropsychological difficulties may emerge before/concurrently with plasma p-tau181 changes. Combining Obj-SCD and p-tau181, two potentially accessible early markers, was associated with the faster declines in AD-related outcomes.
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Affiliation(s)
- Kelsey R. Thomas
- Research ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Katherine J. Bangen
- Research ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Emily C. Edmonds
- Research ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Alexandra J. Weigand
- San Diego State University/University of California Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
| | - Kayla S. Walker
- Research ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
- Advancing Diversity in Aging Research (ADAR) ProgramSan Diego State UniversitySan DiegoCaliforniaUSA
| | - Mark W. Bondi
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
- Psychology ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Douglas R. Galasko
- Department of NeurosciencesUniversity of California San Diego School of MedicineLa JollaCaliforniaUSA
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Edmonds EC, Smirnov DS, Thomas KR, Graves LV, Bangen KJ, Delano-Wood L, Galasko DR, Salmon DP, Bondi MW. Data-Driven vs Consensus Diagnosis of MCI: Enhanced Sensitivity for Detection of Clinical, Biomarker, and Neuropathologic Outcomes. Neurology 2021; 97:e1288-e1299. [PMID: 34376506 PMCID: PMC8480404 DOI: 10.1212/wnl.0000000000012600] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/01/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Given prior work demonstrating that mild cognitive impairment (MCI) can be empirically differentiated into meaningful cognitive subtypes, we applied actuarial methods to comprehensive neuropsychological data from the University of California San Diego Alzheimer's Disease Research Center (ADRC) in order to identify cognitive subgroups within ADRC participants without dementia and to examine cognitive, biomarker, and neuropathologic trajectories. METHODS Cluster analysis was performed on baseline neuropsychological data (n = 738; mean age 71.8). Survival analysis examined progression to dementia (mean follow-up 5.9 years). CSF Alzheimer disease (AD) biomarker status and neuropathologic findings at follow-up were examined in a subset with available data. RESULTS Five clusters were identified: optimal cognitively normal (CN; n = 130) with above-average cognition, typical CN (n = 204) with average cognition, nonamnestic MCI (naMCI; n = 104), amnestic MCI (aMCI; n = 216), and mixed MCI (mMCI; n = 84). Progression to dementia differed across MCI subtypes (mMCI > aMCI > naMCI), with the mMCI group demonstrating the highest rate of CSF biomarker positivity and AD pathology at autopsy. Actuarial methods classified 29.5% more of the sample with MCI and outperformed consensus diagnoses in capturing those who had abnormal biomarkers, progressed to dementia, or had AD pathology at autopsy. DISCUSSION We identified subtypes of MCI and CN with differing cognitive profiles, clinical outcomes, CSF AD biomarkers, and neuropathologic findings over more than 10 years of follow-up. Results demonstrate that actuarial methods produce reliable cognitive phenotypes, with data from a subset suggesting unique biological and neuropathologic signatures. Findings indicate that data-driven algorithms enhance diagnostic sensitivity relative to consensus diagnosis for identifying older adults at risk for cognitive decline.
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Affiliation(s)
- Emily C Edmonds
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla.
| | - Denis S Smirnov
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Kelsey R Thomas
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Lisa V Graves
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Katherine J Bangen
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Lisa Delano-Wood
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Douglas R Galasko
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - David P Salmon
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Mark W Bondi
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
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Bangen KJ, Thomas KR, Sanchez DL, Edmonds EC, Weigand AJ, Delano-Wood L, Bondi MW. Entorhinal Perfusion Predicts Future Memory Decline, Neurodegeneration, and White Matter Hyperintensity Progression in Older Adults. J Alzheimers Dis 2021; 81:1711-1725. [PMID: 33967041 DOI: 10.3233/jad-201474] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Altered cerebral blood flow (CBF) has been linked to increased risk for Alzheimer's disease (AD). However, whether altered CBF contributes to AD risk by accelerating cognitive decline remains unclear. It also remains unclear whether reductions in CBF accelerate neurodegeneration and development of small vessel cerebrovascular disease. OBJECTIVE To examine associations between CBF and trajectories of memory performance, regional brain atrophy, and global white matter hyperintensity (WMH) volume. METHOD 147 Alzheimer's Disease Neuroimaging Initiative participants free of dementia underwent arterial spin labeling (ASL) magnetic resonance imaging (MRI) to measure CBF and serial neuropsychological and structural MRI examinations. Linear mixed effects models examined 5-year rate of change in memory and 4-year rate of change in regional brain atrophy and global WMH volumes as a function of baseline regional CBF. Entorhinal and hippocampal CBF were examined in separate models. RESULTS Adjusting for demographic characteristics, pulse pressure, apolipoprotein E ɛ4 positivity, cerebrospinal fluid p-tau/Aβ ratio, and neuronal metabolism (i.e., fluorodeoxyglucose standardized uptake value ratio), lower baseline entorhinal CBF predicted faster rates of decline in memory as well as faster entorhinal thinning and WMH progression. Hippocampal CBF did not predict cognitive or brain structure trajectories. CONCLUSION Findings highlight the importance of early cerebrovascular dysfunction in AD risk and suggest that entorhinal CBF as measured by noninvasive ASL MRI is a useful biomarker predictive of future cognitive decline and of risk of both.
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Affiliation(s)
- Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Danielle L Sanchez
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Emily C Edmonds
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J Weigand
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
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Sullan MJ, Crocker LD, Thomas KR, Orff HJ, Davey DK, Jurick SM, Twamley EW, Norman SB, Schiehser DM, Aupperle R, Jak AJ. Baseline sleep quality moderates symptom improvement in veterans with comorbid PTSD and TBI receiving trauma-focused treatment. Behav Res Ther 2021; 143:103892. [PMID: 34091276 DOI: 10.1016/j.brat.2021.103892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023]
Abstract
Poor sleep quality is common among Veterans with posttraumatic stress disorder (PTSD) and history of traumatic brain injury (TBI). However, the relationship between sleep quality and treatment outcomes following trauma-focused interventions is less well-understood in this population. We sought to better understand whether 1) sleep quality changed as a result of trauma-focused treatment and 2) if baseline sleep quality moderated psychological and neurobehavioral treatment outcomes. Our sample consisted of 100 Iraq/Afghanistan era Veterans with PTSD and history of mild to moderate TBI who were randomized to one of two trauma-focused treatments: 1) Cognitive Processing Therapy (CPT) or 2) combined CPT and Cognitive Symptom Management and Rehabilitation Therapy (SMART-CPT). Self-reported sleep quality, psychiatric symptoms (PTSD and depression), and neurobehavioral concerns were assessed at multiple timepoints throughout the study. Multilevel modeling showed sleep quality did not improve, regardless of treatment condition. However, worse baseline sleep quality was associated with less improvement in PTSD symptoms and cognitive complaints. There was no effect of baseline sleep quality on change in depression symptoms. These findings suggest that more targeted treatments to address sleep quality either prior to or in conjunction with trauma-focused therapy may help to improve treatment outcomes for Veterans with comorbid PTSD and TBI history.
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Affiliation(s)
- Molly J Sullan
- Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Laura D Crocker
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA
| | - Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Henry J Orff
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Delaney K Davey
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA
| | - Sarah M Jurick
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Sonya B Norman
- Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA; National Center for PTSD, White River Junction, VT, USA
| | - Dawn M Schiehser
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Robin Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, USA; School of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Amy J Jak
- Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA.
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Thomas KR, Osuna JR, Weigand AJ, Edmonds EC, Clark AL, Holmqvist S, Cota IH, Wierenga CE, Bondi MW, Bangen KJ. Regional hyperperfusion in older adults with objectively-defined subtle cognitive decline. J Cereb Blood Flow Metab 2021; 41:1001-1012. [PMID: 32615887 PMCID: PMC8054731 DOI: 10.1177/0271678x20935171] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 12/20/2019] [Revised: 04/21/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
Abstract
Although cerebral blood flow (CBF) alterations are associated with Alzheimer's disease (AD), CBF patterns across prodromal stages of AD remain unclear. Therefore, we investigated patterns of regional CBF in 162 Alzheimer's Disease Neuroimaging Initiative participants characterized as cognitively unimpaired (CU; n = 80), objectively-defined subtle cognitive decline (Obj-SCD; n = 31), or mild cognitive impairment (MCI; n = 51). Arterial spin labeling MRI quantified regional CBF in a priori regions of interest: hippocampus, inferior temporal gyrus, inferior parietal lobe, medial orbitofrontal cortex, and rostral middle frontal gyrus. Obj-SCD participants had increased hippocampal and inferior parietal CBF relative to CU and MCI participants and increased inferior temporal CBF relative to MCI participants. CU and MCI groups did not differ in hippocampal or inferior parietal CBF, but CU participants had increased inferior temporal CBF relative to MCI participants. There were no CBF group differences in the two frontal regions. Thus, we found an inverted-U pattern of CBF signal across prodromal AD stages in regions susceptible to early AD pathology. Hippocampal and inferior parietal hyperperfusion in Obj-SCD may reflect early neurovascular dysregulation, whereby higher CBF is needed to maintain cognitive functioning relative to MCI participants, yet is also reflective of early cognitive inefficiencies that distinguish Obj-SCD from CU participants.
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Affiliation(s)
- Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Jessica R Osuna
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J Weigand
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emily C Edmonds
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra L Clark
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Sophia Holmqvist
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Isabel H Cota
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Christina E Wierenga
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Clark AL, Weigand AJ, Thomas KR, Solders SK, Delano-Wood L, Bondi MW, Bernier RA, Sundermann EE, Banks SJ, Bangen KJ. Elevated Inflammatory Markers and Arterial Stiffening Exacerbate Tau but Not Amyloid Pathology in Older Adults with Mild Cognitive Impairment. J Alzheimers Dis 2021; 80:1451-1463. [PMID: 33682714 DOI: 10.3233/jad-201382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Age-related cerebrovascular and neuroinflammatory processes have been independently identified as key mechanisms of Alzheimer's disease (AD), although their interactive effects have yet to be fully examined. OBJECTIVE The current study examined 1) the influence of pulse pressure (PP) and inflammatory markers on AD protein levels and 2) links between protein biomarkers and cognitive function in older adults with and without mild cognitive impairment (MCI). METHODS This study included 218 ADNI (81 cognitively normal [CN], 137 MCI) participants who underwent lumbar punctures, apolipoprotein E (APOE) genotyping, and cognitive testing. Cerebrospinal (CSF) levels of eight pro-inflammatory markers were used to create an inflammation composite, and amyloid-beta 1-42 (Aβ42), phosphorylated tau (p-tau), and total tau (t-tau) were quantified. RESULTS Multiple regression analyses controlling for age, education, and APOE ɛ4 genotype revealed significant PP x inflammation interactions for t-tau (B = 0.88, p = 0.01) and p-tau (B = 0.84, p = 0.02); higher inflammation was associated with higher levels of tau within the MCI group. However, within the CN group, analyses revealed a significant PP x inflammation interaction for Aβ42 (B = -1.01, p = 0.02); greater inflammation was associated with higher levels of Aβ42 (indicative of lower cerebral amyloid burden) in those with lower PP. Finally, higher levels of tau were associated with poorer memory performance within the MCI group only (p s < 0.05). CONCLUSION PP and inflammation exert differential effects on AD CSF proteins and provide evidence that vascular risk is associated with greater AD pathology across our sample of CN and MCI older adults.
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Affiliation(s)
- Alexandra L Clark
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Alexandra J Weigand
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,San Diego State University/University of California, San Diego (SDSU/UCSD), La Jolla, CA, USA
| | - Kelsey R Thomas
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Seraphina K Solders
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Lisa Delano-Wood
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Mark W Bondi
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Rachel A Bernier
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Erin E Sundermann
- University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Sarah J Banks
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J Bangen
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
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Bangen KJ, Thomas KR, Weigand AJ, Edmonds EC, Clark AL, Solders S, Delano-Wood L, Galasko DR, Bondi MW. Elevated plasma neurofilament light predicts a faster rate of cognitive decline over 5 years in participants with objectively-defined subtle cognitive decline and MCI. Alzheimers Dement 2021; 17:1756-1762. [PMID: 33860596 DOI: 10.1002/alz.12324] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Neurofilament light (NFL) reflects neuroaxonal damage and is implicated in mild cognitive impairment (MCI) and Alzheimer's disease (AD). Little is known about NFL in pre-MCI stages, such as in individuals with objectively-defined subtle cognitive decline (Obj-SCD). METHODS Two hundred ninety-four participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) underwent baseline blood draw and serial neuropsychological testing over 5 years of follow-up. RESULTS Individuals with Obj-SCD and MCI showed elevated baseline plasma NFL relative to the cognitively normal (CN) group. Across the sample, elevated NFL predicted faster rate of cognitive and functional decline. Within the Obj-SCD and MCI groups, higher NFL levels predicted faster rate of decline in memory and preclinical AD composite score compared to the CN group. DISCUSSION Findings demonstrate the utility of plasma NFL as a biomarker of early AD-related changes, and provide support for the use of Obj-SCD criteria in clinical research to better capture subtle cognitive changes.
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Affiliation(s)
- Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Alexandra J Weigand
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Emily C Edmonds
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Alexandra L Clark
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Seraphina Solders
- Department of Neuroscience, University of California, San Diego, La Jolla, California, USA
| | - Lisa Delano-Wood
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Douglas R Galasko
- Department of Neuroscience, University of California, San Diego, La Jolla, California, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
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O'Shea DM, Thomas KR, Asken B, Lee AK, Davis JD, Malloy PF, Salloway SP, Correia S. Adding cognition to AT(N) models improves prediction of cognitive and functional decline. Alzheimers Dement (Amst) 2021; 13:e12174. [PMID: 33816757 PMCID: PMC8012408 DOI: 10.1002/dad2.12174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION This study sought to determine whether adding cognition to a model with Alzheimer's disease biomarkers based on the amyloid, tau, and neurodegeneration/neuronal injury-AT(N)-biomarker framework predicts rates of cognitive and functional decline in older adults without dementia. METHODS The study included 465 participants who completed amyloid positron emission tomography, cerebrospinal fluid phosphorylated tau, structural magnetic resonance imaging, and serial neuropsychological testing. Using the AT(N) framework and a newly validated cognitive metric as the independent variables, we used linear mixed effects models to examine a 4-year rate of change in cognitive and functional measures. RESULTS The inclusion of baseline cognitive status improved model fit in predicting rate of decline in outcomes above and beyond biomarker variables. Specifically, those with worse cognitive functioning at baseline had faster rates of memory and functional decline over a 4-year period, even when accounting for AT(N). DISCUSSION Including a newly validated measure of baseline cognition may improve clinical prognosis in non-demented older adults beyond the use of AT(N) biomarkers alone.
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Affiliation(s)
- Deirdre M. O'Shea
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Kelsey R. Thomas
- Research Service, VA San Diego Healthcare SystemUniversity of California San DiegoSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California, San Diego, La JollaCAUSA
| | - Breton Asken
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Athene K.W. Lee
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Jennifer D. Davis
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Paul F. Malloy
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Stephen P. Salloway
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Stephen Correia
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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Sundermann EE, Thomas KR, Bangen KJ, Weigand AJ, Eppig JS, Edmonds EC, Wong CG, Bondi MW, Delano-Wood L. Prediabetes Is Associated With Brain Hypometabolism and Cognitive Decline in a Sex-Dependent Manner: A Longitudinal Study of Nondemented Older Adults. Front Neurol 2021; 12:551975. [PMID: 33679574 PMCID: PMC7933503 DOI: 10.3389/fneur.2021.551975] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Although type 2 diabetes is a well-known risk factor for Alzheimer's disease (AD), little is known about how its precursor-prediabetes-impacts neuropsychological function and brain health. Thus, we examined the relationship between prediabetes and AD-related biological and cognitive/clinical markers in a well-characterized sample drawn from the Alzheimer's Disease Neuroimaging Initiative. Additionally, because women show higher rates of AD and generally more atherogenic lipid profiles than men, particularly in the context of diabetes, we examined whether sex moderates any observed associations. The total sample of 911 nondemented and non-diabetic participants [normal control = 540; mild cognitive impairment (MCI) = 371] included 391 prediabetic (fasting blood glucose: 100-125 mg/dL) and 520 normoglycemic individuals (age range: 55-91). Linear mixed effects models, adjusted for demographics and vascular and AD risk factors, examined the independent and interactive effects of prediabetes and sex on 2-6 year trajectories of FDG-PET measured cerebral metabolic glucose rate (CMRglu), hippocampal/intracranial volume ratio (HV/IV), cerebrospinal fluid phosphorylated tau-181/amyloid-β1-42 ratio (p-tau181/Aβ1-42), cognitive function (executive function, language, and episodic memory) and the development of dementia. Analyses were repeated in the MCI subsample. In the total sample, prediabetic status had an adverse effect on CMRglu across time regardless of sex, whereas prediabetes had an adverse effect on executive function across time in women only. Within the MCI subsample, prediabetic status was associated with lower CMRglu and poorer executive function and language performance across time within women, whereas these associations were not seen within men. In the total sample and MCI subsample, prediabetes did not relate to HV/IV, p-tau181/Aβ1-42, memory function or dementia risk regardless of sex; however, among incident dementia cases, prediabetic status related to earlier age of dementia onset in women but not in men. Results suggest that prediabetes may affect cognition through altered brain metabolism, and that women may be more vulnerable to the negative effects of glucose intolerance.
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Affiliation(s)
- Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Kelsey R Thomas
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Katherine J Bangen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Joel S Eppig
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Emily C Edmonds
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Christina G Wong
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
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Rotblatt LJ, Aiken-Morgan AT, Marsiske M, Horgas AL, Thomas KR. Do Associations Between Vascular Risk and Mild Cognitive Impairment Vary by Race? J Aging Health 2021; 35:898264320984357. [PMID: 33497299 PMCID: PMC8310897 DOI: 10.1177/0898264320984357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: Given prevalence differences of mild cognitive impairment (MCI) among Black and white older adults, this study aimed to examine whether overall vascular risk factor (VRF) burden and individual VRF associations with amnestic (aMCI) and nonamnestic (naMCI) MCI status varied by Black/white race. Methods: Participants included 2755 older adults without dementia from the ACTIVE study. Comprehensive neuropsychological criteria were used to classify cognitively normal, aMCI, and naMCI. VRFs were primarily defined using subjective report and medication data. Multinomial logistic regression was run predicting MCI subtype. Results: Greater overall VRF burden, high cholesterol, and obesity evinced greater odds of naMCI in Black participants than whites. Across participants, diabetes and hypertension were associated with increased odds of aMCI and naMCI, respectively. Discussion: Results may reflect known systemic inequities on dimensions of social determinants of health for Black older adults. Continued efforts toward examining underlying mechanisms contributing to these findings are critical.
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Affiliation(s)
- Lindsay J. Rotblatt
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | | | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Ann L. Horgas
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL
| | - Kelsey R. Thomas
- Veterans Affairs San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California San Diego, La Jolla, CA
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