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Karstens AJ, Christianson TJ, Lundt ES, Machulda MM, Mielke MM, Fields JA, Kremers WK, Graff-Radford J, Vemuri P, Jack CR, Knopman DS, Petersen RC, Stricker NH. Mayo normative studies: regression-based normative data for ages 30-91 years with a focus on the Boston Naming Test, Trail Making Test and Category Fluency. J Int Neuropsychol Soc 2024; 30:389-401. [PMID: 38014536 PMCID: PMC11014770 DOI: 10.1017/s1355617723000760] [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] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Normative neuropsychological data are essential for interpretation of test performance in the context of demographic factors. The Mayo Normative Studies (MNS) aim to provide updated normative data for neuropsychological measures administered in the Mayo Clinic Study of Aging (MCSA), a population-based study of aging that randomly samples residents of Olmsted County, Minnesota, from age- and sex-stratified groups. We examined demographic effects on neuropsychological measures and validated the regression-based norms in comparison to existing normative data developed in a similar sample. METHOD The MNS includes cognitively unimpaired adults ≥30 years of age (n = 4,428) participating in the MCSA. Multivariable linear regressions were used to determine demographic effects on test performance. Regression-based normative formulas were developed by first converting raw scores to normalized scaled scores and then regressing on age, age2, sex, and education. Total and sex-stratified base rates of low scores (T < 40) were examined in an older adult validation sample and compared with Mayo's Older Americans Normative Studies (MOANS) norms. RESULTS Independent linear regressions revealed variable patterns of linear and/or quadratic effects of age (r2 = 6-27% variance explained), sex (0-13%), and education (2-10%) across measures. MNS norms improved base rates of low performance in the older adult validation sample overall and in sex-specific patterns relative to MOANS. CONCLUSIONS Our results demonstrate the need for updated norms that consider complex demographic associations on test performance and that specifically exclude participants with mild cognitive impairment from the normative sample.
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Affiliation(s)
- Aimee J. Karstens
- Division of Neurocognitive Disorders, Department of
Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Teresa J. Christianson
- Division of Biomedical Statistics and Informatics,
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily S. Lundt
- Division of Biomedical Statistics and Informatics,
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary M. Machulda
- Division of Neurocognitive Disorders, Department of
Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle M. Mielke
- Department of Epidemiology and Prevention, Wake Forest
University School of Medicine, Winston-Salem, NC, USA
- Department of Gerontology and Geriatric Medicine, Wake
Forest University School of Medicine, Winston-Salem, NC, USA
| | - Julie A. Fields
- Division of Neurocognitive Disorders, Department of
Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter K. Kremers
- Division of Biomedical Statistics and Informatics,
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | | - Nikki H. Stricker
- Division of Neurocognitive Disorders, Department of
Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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Simons RL, Ong ML, Lei MK, Beach SRH, Zhang Y, Philibert R, Mielke MM. Racial discrimination during middle age predicts higher serum phosphorylated tau and neurofilament light chain levels a decade later: A study of aging black Americans. Alzheimers Dement 2024. [PMID: 38597292 DOI: 10.1002/alz.13751] [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: 09/01/2023] [Revised: 01/02/2024] [Accepted: 01/29/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Recent evidence suggests that exposure to the stress of racism may increase the risk of dementia for Black Americans. METHODS The present study used 17 years of data from a sample of 255 Black Americans to investigate the extent to which exposure to racial discrimination predicts subsequent changes in serum Alzheimer's Disease Research Center (ADRC) biomarkers: serum phosphorylated tau181(p-tau181), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP). We hypothesized that racial discrimination assessed during middle age would predict increases in these serum biomarkers as the participants aged into their 60s. RESULTS Our findings indicate that exposure to various forms of racial discrimination during a person's 40s and early 50s predicts an 11-year increase in both serum p-tau181 and NfL. Racial discrimination was not associated with subsequent levels of GFAP. DISCUSSION These findings suggest that racial discrimination in midlife may contribute to increased AD pathology and neurodegeneration later in life. HIGHLIGHTS A 17-year longitudinal study of Black Americans. Assessments of change in serum p-tau181, neurofilament light, and glial fibrillary acidic protein. Exposure to racial discrimination during middle age predicted increases in p-tau181 and neurofilament light. Education was positively related to both p-tau181 and exposure to racial discrimination.
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Affiliation(s)
- Ronald L Simons
- Department of Sociology, University of Georgia, Athens, Georgia, USA
| | - Mei Ling Ong
- Center for Family Research, University of Georgia, Athens, Georgia, USA
| | - Man-Kit Lei
- Department of Sociology, University of Georgia, Athens, Georgia, USA
| | - Steven R H Beach
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Yue Zhang
- Department of Sociology, University of Georgia, Athens, Georgia, USA
| | - Robert Philibert
- Department of Psychiatry, University of Iowa School of Medicine, Iowa City, Iowa, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Lu Y, Pike JR, Hoogeveen R, Walker K, Raffield L, Selvin E, Avery C, Engel S, Mielke MM, Garcia T, Heiss G, Palta P. Nonalcoholic Fatty Liver Disease and Longitudinal Change in Imaging and Plasma Biomarkers of Alzheimer Disease and Vascular Pathology. Neurology 2024; 102:e209203. [PMID: 38471046 PMCID: PMC11033987 DOI: 10.1212/wnl.0000000000209203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Prospective measures of plasma and cerebral MRI biomarkers of Alzheimer disease (AD) and vascular neuropathology provide an opportunity to investigate possible mechanisms linking liver disease and dementia. We aimed to quantify the association of midlife nonalcoholic fatty liver disease (NAFLD) with change in plasma and brain MRI biomarkers of AD and vascular neuropathology. METHODS We included participants from the Atherosclerosis Risk in Communities Study with brain MRI measurements of white matter hyperintensity (WMH) volume and temporal-parietal lobe cortical thickness meta region of interest (ROI) at up to 2 different visits, in 2011-13 and 2016-19, and plasma biomarkers of β-amyloid (Aβ)42:40, phosphorylated tau at threonine 181, and neurofilament light (NfL) were measured up to 3 times in 1993-95, 2011-13, and 2016-19. NAFLD was categorized using the fatty liver index in 1990-92. Multivariate linear regression was performed for associations between midlife NAFLD and change in plasma and brain MRI biomarkers of AD and vascular neuropathology. The primary models adjusted for demographics, Apolipoprotein E, alcohol use, and kidney function. RESULTS Among 1,706 participants (mean age 56 years, 62% female, 28% Black), midlife NAFLD vs no NAFLD was associated with greater late-life WMH volume (difference per SD 0.19, 95% CI 0.06-0.31) and faster late-life WMH increase over 6 years (difference in annual change, SD 0.28, 95% CI 0.05-0.51), suggesting accumulating vascular pathology. Midlife NAFLD vs no NAFLD was also associated with AD biomarkers in midlife (lower Aβ42:40 [SD -0.21, 95% CI -0.39 to -0.04] measured in 1993-95) and late life (lower Aβ42:40 [SD -0.13, 95% CI -0.23 to -0.03] and lower temporal-parietal lobe cortical thickness meta ROI [SD -0.16, 95% CI -0.28 to -0.05] measured in 2011-13). Although midlife NfL was lower in individuals with vs without midlife NAFLD, those with NAFLD exhibited a faster rate of NfL increase that accelerated over time. DISCUSSION Midlife NAFLD shows associations with AD and accumulating vascular pathology, revealing potential pathways linking liver function to dementia. Plasma biomarkers of neuropathology and neuronal injury may serve as easily measurable and dynamic indicators for monitoring the impacts of impaired liver function on brain health.
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Affiliation(s)
- Yifei Lu
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - James R Pike
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ron Hoogeveen
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Keenan Walker
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Laura Raffield
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Elizabeth Selvin
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christy Avery
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Stephanie Engel
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michelle M Mielke
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Tanya Garcia
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Gerardo Heiss
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Priya Palta
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
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Shue F, White LJ, Hendrix R, Ulrich J, Henson RL, Knight W, Martens YA, Wang N, Roy B, Starling SC, Ren Y, Xiong C, Asmann YW, Syrjanen JA, Vassilaki M, Mielke MM, Timsina J, Sung YJ, Cruchaga C, Holtzman DM, Bu G, Petersen RC, Heckman MG, Kanekiyo T. CSF biomarkers of immune activation and Alzheimer's disease for predicting cognitive impairment risk in the elderly. Sci Adv 2024; 10:eadk3674. [PMID: 38569027 PMCID: PMC10990276 DOI: 10.1126/sciadv.adk3674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/23/2024] [Indexed: 04/05/2024]
Abstract
The immune system substantially influences age-related cognitive decline and Alzheimer's disease (AD) progression, affected by genetic and environmental factors. In a Mayo Clinic Study of Aging cohort, we examined how risk factors like APOE genotype, age, and sex affect inflammatory molecules and AD biomarkers in cerebrospinal fluid (CSF). Among cognitively unimpaired individuals over 65 (N = 298), we measured 365 CSF inflammatory molecules, finding age, sex, and diabetes status predominantly influencing their levels. We observed age-related correlations with AD biomarkers such as total tau, phosphorylated tau-181, neurofilament light chain (NfL), and YKL40. APOE4 was associated with lower Aβ42 and higher SNAP25 in CSF. We explored baseline variables predicting cognitive decline risk, finding age, CSF Aβ42, NfL, and REG4 to be independently correlated. Subjects with older age, lower Aβ42, higher NfL, and higher REG4 at baseline had increased cognitive impairment risk during follow-up. This suggests that assessing CSF inflammatory molecules and AD biomarkers could predict cognitive impairment risk in the elderly.
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Affiliation(s)
- Francis Shue
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Launia J. White
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Rachel Hendrix
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jason Ulrich
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rachel L. Henson
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - William Knight
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Yuka A. Martens
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ni Wang
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Bhaskar Roy
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Yingxue Ren
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Chengjie Xiong
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO 93110, USA
| | - Yan W. Asmann
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Jeremy A. Syrjanen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN 55905, USA
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN 55905, USA
| | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN 55905, USA
| | - Jigyasha Timsina
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 93110, USA
| | - Yun Ju Sung
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 93110, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 93110, USA
| | - David M. Holtzman
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Guojun Bu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Michael G. Heckman
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Takahisa Kanekiyo
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
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Lista S, Mapstone M, Caraci F, Emanuele E, López-Ortiz S, Martín-Hernández J, Triaca V, Imbimbo C, Gabelle A, Mielke MM, Nisticò R, Santos-Lozano A, Imbimbo BP. A critical appraisal of blood-based biomarkers for Alzheimer's disease. Ageing Res Rev 2024; 96:102290. [PMID: 38580173 DOI: 10.1016/j.arr.2024.102290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/18/2024] [Accepted: 03/31/2024] [Indexed: 04/07/2024]
Abstract
Biomarkers that predict the clinical onset of Alzheimer's disease (AD) enable the identification of individuals in the early, preclinical stages of the disease. Detecting AD at this point may allow for more effective therapeutic interventions and optimized enrollment for clinical trials of novel drugs. The current biological diagnosis of AD is based on the AT(N) classification system with the measurement of brain deposition of amyloid-β (Aβ) ("A"), tau pathology ("T"), and neurodegeneration ("N"). Diagnostic cut-offs for Aβ1-42, the Aβ1-42/Aβ1-40 ratio, tau and hyperphosphorylated-tau concentrations in cerebrospinal fluid have been defined and may support AD clinical diagnosis. Blood-based biomarkers of the AT(N) categories have been described in the AD continuum. Cross-sectional and longitudinal studies have shown that the combination of blood biomarkers tracking neuroaxonal injury (neurofilament light chain) and neuroinflammatory pathways (glial fibrillary acidic protein) enhance sensitivity and specificity of AD clinical diagnosis and improve the prediction of AD onset. However, no international accepted cut-offs have been identified for these blood biomarkers. A kit for blood Aβ1-42/Aβ1-40 is commercially available in the U.S.; however, it does not provide a diagnosis, but simply estimates the risk of developing AD. Although blood-based AD biomarkers have a great potential in the diagnostic work-up of AD, they are not ready for the routine clinical use.
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Affiliation(s)
- Simone Lista
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Valladolid 47012, Spain.
| | - Mark Mapstone
- Department of Neurology, Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA 92697, USA.
| | - Filippo Caraci
- Department of Drug and Health Sciences, University of Catania, Catania 95125, Italy; Neuropharmacology and Translational Neurosciences Research Unit, Oasi Research Institute-IRCCS, Troina 94018, Italy.
| | | | - Susana López-Ortiz
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Valladolid 47012, Spain.
| | - Juan Martín-Hernández
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Valladolid 47012, Spain.
| | - Viviana Triaca
- Institute of Biochemistry and Cell Biology (IBBC), National Research Council (CNR), Rome 00015, Italy.
| | - Camillo Imbimbo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia 27100, Italy.
| | - Audrey Gabelle
- Memory Resources and Research Center, Montpellier University of Excellence i-site, Montpellier 34295, France.
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA.
| | - Robert Nisticò
- School of Pharmacy, University of Rome "Tor Vergata", Rome 00133, Italy; Laboratory of Pharmacology of Synaptic Plasticity, EBRI Rita Levi-Montalcini Foundation, Rome 00143, Italy.
| | - Alejandro Santos-Lozano
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Valladolid 47012, Spain; Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid 28041, Spain.
| | - Bruno P Imbimbo
- Department of Research and Development, Chiesi Farmaceutici, Parma 43122, Italy.
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Sintini I, Singh NA, Li D, Mielke MM, Machulda MM, Schwarz CG, Senjem ML, Jack CR, Lowe VJ, Graff-Radford J, Josephs KA, Whitwell JL. Plasma glial fibrillary acidic protein in the visual and language variants of Alzheimer's disease. Alzheimers Dement 2024. [PMID: 38528318 DOI: 10.1002/alz.13713] [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: 09/25/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Glial fibrillary acidic protein (GFAP) in plasma is a proxy for astrocytic activity and is elevated in amyloid-β (Aβ)-positive individuals, making GFAP a potential blood-based biomarker for Alzheimer's disease (AD). METHODS We assessed plasma GFAP in 72 Aβ-positive participants diagnosed with the visual or language variant of AD who underwent Aβ- and tau-PET. Fifty-nine participants had follow-up imaging. Linear regression was applied on GFAP and imaging quantities. RESULTS GFAP did not correlate with Aβ- or tau-PET cross-sectionally. There was a limited positive correlation between GFAP and rates of tau accumulation, particularly in the language variant of AD, although associations were weaker after removing one outlier patient with the highest GFAP level. DISCUSSION Among Aβ-positive AD participants with atypical presentations, plasma GFAP did not correlate with levels of AD pathology on PET, suggesting that the associations between GFAP and AD pathology might plateau during the advanced phase of the disease.
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Affiliation(s)
- Irene Sintini
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Danni Li
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Dugani SB, Lahr BD, Xie H, Mielke MM, Bailey KR, Vella A. County Rurality and Incidence and Prevalence of Diagnosed Diabetes in the United States. Mayo Clin Proc 2024:S0025-6196(23)00572-4. [PMID: 38506780 DOI: 10.1016/j.mayocp.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To examine differences in the incidence and prevalence of diagnosed diabetes by county rurality. PATIENTS AND METHODS This observational, cross-sectional study used US Centers for Disease Control and Prevention data from 2004 through 2019 for county estimates of incidence and prevalence of diagnosed diabetes. County rurality was based on 6 levels (large central metro counties [most urban] to noncore counties [most rural]). Weighted least squares regression was used to relate rurality with diabetes incidence rates (IRs; per 1000 adults) and prevalence (percentage) in adults aged 20 years or older after adjusting for county-level sociodemographic factors (eg, food environment, health care professionals, inactivity, obesity). RESULTS Overall, in 3148 counties and county equivalents, the crude IR and prevalence of diabetes were highest in noncore counties. In age and sex ratio-adjusted models, the IR of diabetes increased monotonically with increasing rurality (P<.001), whereas prevalence had a weak, nonmonotonic but statistically significant increase (P=.002). Further adjustment for sociodemographic factors including food environment, health care professionals, inactivity, and obesity attenuated differences in incidence across rurality levels, and reversed the pattern for prevalence (prevalence ratios [vs large central metro] ranged from 0.98 [95% CI, 0.97 to 0.99] for large fringe metro to 0.94 [95% CI, 0.93 to 0.96] for noncore). In region-stratified analyses adjusted for sociodemographic factors including inactivity and obesity, increasing rurality was inversely associated with incidence in the Midwest and West only and inversely associated with prevalence in all regions. CONCLUSION The crude incidence and prevalence of diagnosed diabetes increased with increasing county rurality. After accounting for sociodemographic factors including food environment, health care professionals, inactivity, and obesity, county rurality showed no association with incidence and an inverse association with prevalence. Therefore, interventions targeting modifiable sociodemographic factors may reduce diabetes disparities by region and rurality.
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Affiliation(s)
- Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN; Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | - Brian D Lahr
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Hui Xie
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Michelle M Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kent R Bailey
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Adrian Vella
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
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8
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Jack CR, Wiste HJ, Algeciras‐Schimnich A, Weigand SD, Figdore DJ, Lowe VJ, Vemuri P, Graff‐Radford J, Ramanan VK, Knopman DS, Mielke MM, Machulda MM, Fields J, Schwarz CG, Cogswell PM, Senjem ML, Therneau TM, Petersen RC. Comparison of plasma biomarkers and amyloid PET for predicting memory decline in cognitively unimpaired individuals. Alzheimers Dement 2024; 20:2143-2154. [PMID: 38265198 PMCID: PMC10984437 DOI: 10.1002/alz.13651] [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: 09/01/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND We compared the ability of several plasma biomarkers versus amyloid positron emission tomography (PET) to predict rates of memory decline among cognitively unimpaired individuals. METHODS We studied 645 Mayo Clinic Study of Aging participants. Predictor variables were age, sex, education, apolipoprotein E (APOE) ε4 genotype, amyloid PET, and plasma amyloid beta (Aβ)42/40, phosphorylated tau (p-tau)181, neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and p-tau217. The outcome was a change in a memory composite measure. RESULTS All plasma biomarkers, except NfL, were associated with mean memory decline in models with individual biomarkers. However, amyloid PET and plasma p-tau217, along with age, were key variables independently associated with mean memory decline in models combining all predictors. Confidence intervals were narrow for estimates of population mean prediction, but person-level prediction intervals were wide. DISCUSSION Plasma p-tau217 and amyloid PET provide useful information about predicting rates of future cognitive decline in cognitively unimpaired individuals at the population mean level, but not at the individual person level.
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Affiliation(s)
| | - Heather J. Wiste
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | - Stephen D. Weigand
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Dan J. Figdore
- Department of Laboratory MedicineMayo ClinicRochesterMinnesotaUSA
| | - Val J. Lowe
- Department of Nuclear MedicineMayo ClinicRochesterMinnesotaUSA
| | | | | | | | | | - Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Mary M. Machulda
- Department of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Julie Fields
- Department of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | | | | | | | - Terry M. Therneau
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
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9
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Lu Y, Pike JR, Hoogeveen RC, Walker KA, Raffield LM, Selvin E, Avery CL, Engel SM, Mielke MM, Garcia T, Palta P. Liver integrity and the risk of Alzheimer's disease and related dementias. Alzheimers Dement 2024; 20:1913-1922. [PMID: 38153336 PMCID: PMC10947929 DOI: 10.1002/alz.13601] [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: 05/18/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION We examined midlife (1990-1992, mean age 57) and late-life (2011-2013, mean age 75) nonalcoholic fatty liver disease (NAFLD) and aminotransferase with incident dementia risk through 2019 in the Atherosclerosis Risk in Communities (ARIC) Study. METHODS We characterized NAFLD using the fatty liver index and fibrosis-4, and we categorized aminotransferase using the optimal equal-hazard ratio (HR) approach. We estimated HRs for incident dementia ascertained from multiple data sources. RESULTS Adjusted for demographics, alcohol consumption, and kidney function, individuals with low, intermediate, and high liver fibrosis in midlife (HRs: 1.45, 1.40, and 2.25, respectively), but not at older age, had higher dementia risks than individuals without fatty liver. A U-shaped association was observed for alanine aminotransferase with dementia risk, which was more pronounced in late-life assessment. DISCUSSION Our findings highlight dementia burden in high-prevalent NAFLD and the important feature of late-life aminotransaminase as a surrogate biomarker linking liver hypometabolism to dementia. Highlights Although evidence of liver involvement in dementia development has been documented in animal studies, the evidence in humans is limited. Midlife NAFLD raised dementia risk proportionate to severity. Late-life NAFLD was not associated with a high risk of dementia. Low alanine aminotransferase was associated with an elevated dementia risk, especially when measured in late life.
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Affiliation(s)
- Yifei Lu
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - James Russell Pike
- Department of Biostatistics, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Ron C. Hoogeveen
- Department of Medicine, Baylor College of MedicineOne Baylor PlazaHoustonTexasUSA
| | - Keenan A. Walker
- Laboratory of Behavioral NeuroscienceNational Institute on AgingBaltimoreMarylandUSA
| | - Laura M. Raffield
- Department of Genetics, School of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Elizabeth Selvin
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Christy L. Avery
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Stephanie M. Engel
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Tanya Garcia
- Department of Biostatistics, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Priya Palta
- Department of Neurology, School of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Fielding RA, Atkinson EJ, Aversa Z, White TA, Heeren AA, Mielke MM, Cummings SR, Pahor M, Leeuwenburgh C, LeBrasseur NK. Biomarkers of Cellular Senescence Predict the Onset of Mobility Disability and Are Reduced by Physical Activity in Older Adults. J Gerontol A Biol Sci Med Sci 2024; 79:glad257. [PMID: 37948612 PMCID: PMC10851672 DOI: 10.1093/gerona/glad257] [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: 07/30/2023] [Indexed: 11/12/2023] Open
Abstract
Studies in mice and cross-sectional studies in humans support the premise that cellular senescence is a contributing mechanism to age-associated deficits in physical function. We tested the hypotheses that circulating proteins secreted by senescent cells are (i) associated with the incidence of major mobility disability (MMD), the development of persistent mobility disability (PMMD), and decrements in physical functioning in older adults, and (ii) influenced by physical activity (PA). Using samples and data obtained longitudinally from the Lifestyle Interventions in Elders Study clinical trial, we measured a panel of 27 proteins secreted by senescent cells. Among 1 377 women and men randomized to either a structured PA intervention or a healthy aging (HA) intervention, we observed significant associations between several senescence biomarkers, most distinctly vascular endothelial growth factor A (VEGFA), tumor necrosis factor receptor 1 (TNFR1), and matrix metallopeptidase 7 (MMP7), and the onset of both MMD and PMMD. Moreover, VEGFA, GDF15, osteopontin, and other senescence biomarkers were associated with reductions in short physical performance battery scores. The change in senescence biomarkers did not differ between PA and HA participants. In the whole cohort, higher levels of PA were associated with significantly greater reductions in 10 senescence-related proteins at 12 and/or 24 months. These data reinforce cellular senescence as a contributing mechanism of age-associated functional decline and the potential for PA to attenuate this hallmark of aging. Clinical Trials Registration Number: NCT01072500.
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Affiliation(s)
- Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - Elizabeth J Atkinson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Zaira Aversa
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas A White
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda A Heeren
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Steven R Cummings
- Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Marco Pahor
- Institute on Aging, University of Florida, Gainesville, Florida, USA
| | | | - Nathan K LeBrasseur
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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11
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Stricker NH, Stricker JL, Frank RD, Fan WZ, Christianson TJ, Patel JS, Karstens AJ, Kremers WK, Machulda MM, Fields JA, Graff-Radford J, Jack CR, Knopman DS, Mielke MM, Petersen RC. Stricker Learning Span criterion validity: a remote self-administered multi-device compatible digital word list memory measure shows similar ability to differentiate amyloid and tau PET-defined biomarker groups as in-person Auditory Verbal Learning Test. J Int Neuropsychol Soc 2024; 30:138-151. [PMID: 37385974 PMCID: PMC10756923 DOI: 10.1017/s1355617723000322] [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] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The Stricker Learning Span (SLS) is a computer-adaptive digital word list memory test specifically designed for remote assessment and self-administration on a web-based multi-device platform (Mayo Test Drive). We aimed to establish criterion validity of the SLS by comparing its ability to differentiate biomarker-defined groups to the person-administered Rey's Auditory Verbal Learning Test (AVLT). METHOD Participants (N = 353; mean age = 71, SD = 11; 93% cognitively unimpaired [CU]) completed the AVLT during an in-person visit, the SLS remotely (within 3 months) and had brain amyloid and tau PET scans available (within 3 years). Overlapping groups were formed for 1) those on the Alzheimer's disease (AD) continuum (amyloid PET positive, A+, n = 125) or not (A-, n = 228), and those with biological AD (amyloid and tau PET positive, A+T+, n = 55) vs no evidence of AD pathology (A-T-, n = 195). Analyses were repeated among CU participants only. RESULTS The SLS and AVLT showed similar ability to differentiate biomarker-defined groups when comparing AUROCs (p's > .05). In logistic regression models, SLS contributed significantly to predicting biomarker group beyond age, education, and sex, including when limited to CU participants. Medium (A- vs A+) to large (A-T- vs A+T+) unadjusted effect sizes were observed for both SLS and AVLT. Learning and delay variables were similar in terms of ability to separate biomarker groups. CONCLUSIONS Remotely administered SLS performed similarly to in-person-administered AVLT in its ability to separate biomarker-defined groups, providing evidence of criterion validity. Results suggest the SLS may be sensitive to detecting subtle objective cognitive decline in preclinical AD.
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Affiliation(s)
- Nikki H Stricker
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - John L Stricker
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Ryan D Frank
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Winnie Z Fan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Jay S Patel
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Aimee J Karstens
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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12
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Cogswell PM, Lundt ES, Therneau TM, Wiste HJ, Graff‐Radford J, Algeciras‐Schimnich A, Lowe VJ, Mielke MM, Schwarz CG, Senjem ML, Gunter JL, Knopman DS, Vemuri P, Petersen RC, Jack Jr CR. Modeling the temporal evolution of plasma p-tau in relation to amyloid beta and tau PET. Alzheimers Dement 2024; 20:1225-1238. [PMID: 37963289 PMCID: PMC10916944 DOI: 10.1002/alz.13539] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION The timing of plasma biomarker changes is not well understood. The goal of this study was to evaluate the temporal co-evolution of plasma and positron emission tomography (PET) Alzheimer's disease (AD) biomarkers. METHODS We included 1408 Mayo Clinic Study of Aging and Alzheimer's Disease Research Center participants. An accelerated failure time (AFT) model was fit with amyloid beta (Aβ) PET, tau PET, plasma p-tau217, p-tau181, and glial fibrillary acidic protein (GFAP) as endpoints. RESULTS Individual timing of plasma p-tau progression was strongly associated with Aβ PET and GFAP progression. In the population, GFAP became abnormal first, then Aβ PET, plasma p-tau, and tau PET temporal meta-regions of interest when applying cut points based on young, cognitively unimpaired participants. DISCUSSION Plasma p-tau is a stronger indicator of a temporally linked response to elevated brain Aβ than of tau pathology. While Aβ deposition and a rise in GFAP are upstream events associated with tau phosphorylation, the temporal link between p-tau and Aβ PET was the strongest. HIGHLIGHTS Plasma p-tau progression was more strongly associated with Aβ than tau PET. Progression on plasma p-tau was associated with Aβ PET and GFAP progression. P-tau181 and p-tau217 become abnormal after Aβ PET and before tau PET. GFAP became abnormal first, before plasma p-tau and Aβ PET.
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Affiliation(s)
| | - Emily S. Lundt
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Terry M. Therneau
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Heather J. Wiste
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | | | - Val J. Lowe
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
| | - Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | | | - Matthew L. Senjem
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
- Department of Information TechnologyMayo ClinicRochesterMinnesotaUSA
| | | | | | | | - Ronald C. Petersen
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
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13
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Lee JK, Frank RD, Christenson LR, Fields JA, Rocca WA, Mielke MM. Associations of reproductive factors and exogenous estrogens with global and domain-specific cognition in later life. Alzheimers Dement 2024; 20:63-73. [PMID: 37450421 PMCID: PMC10787812 DOI: 10.1002/alz.13394] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Few studies have comprehensively examined the impact of reproductive factors (i.e., reproductive window, parity, hormonal contraception [HC], and menopausal hormone therapy [MHT]) on global and domain-specific cognition in later life. METHODS We studied a population-based sample of 2458 women (median age 74.2 years) residing in Olmsted County, Minnesota; participants underwent a clinical evaluation and comprehensive cognitive testing. RESULTS The length of a woman's reproductive window was not associated with cognition. Higher parity was associated with greater cognitive decline in all domains. Ever HC use was associated with less decline in all domains. Ever MHT use was associated with greater decline in global cognition and all domain-specific z-scores except visuospatial; results were driven by women who initiated MHT 5 or more years after menopause. Additional adjustments for APOE and vascular-related covariates did not attenuate the results. DISCUSSION Multiple reproductive risk factors are associated with cognitive decline in later life. HIGHLIGHTS The length of a woman's reproductive window was not associated with cognition longitudinally. Greater parity was associated with greater cognitive decline longitudinally. Ever HC use was associated with less decline in global cognition and all domain-specific z-scores longitudinally (all p < 0.01). Ever MHT use was associated with greater decline in global cognition and all domain-specific z-scores except visuospatial longitudinally (all p < 0.01). The greatest cognitive decline was among women who initiated MHT more than 5 years after menopause.
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Affiliation(s)
- Jillian K. Lee
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Ryan D. Frank
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | - Julie A. Fields
- Division of Neurocognitive DisordersDepartment of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Walter A. Rocca
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Women's Health Research CenterMayo ClinicRochesterMinnesotaUSA
| | - Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
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14
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St. Sauver JL, Weston SA, Atkinson EJ, Mc Gree ME, Mielke MM, White TA, Heeren AA, Olson JE, Rocca WA, Palmer AK, Cummings SR, Fielding RA, Bielinski SJ, LeBrasseur NK. Biomarkers of cellular senescence and risk of death in humans. Aging Cell 2023; 22:e14006. [PMID: 37803875 PMCID: PMC10726868 DOI: 10.1111/acel.14006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023] Open
Abstract
A robust and heterogenous secretory phenotype is a core feature of most senescent cells. In addition to mediators of age-related pathology, components of the senescence associated secretory phenotype (SASP) have been studied as biomarkers of senescent cell burden and, in turn, biological age. Therefore, we hypothesized that circulating concentrations of candidate senescence biomarkers, including chemokines, cytokines, matrix remodeling proteins, and growth factors, could predict mortality in older adults. We assessed associations between plasma levels of 28 SASP proteins and risk of mortality over a median follow-up of 6.3 years in 1923 patients 65 years of age or older with zero or one chronic condition at baseline. Overall, the five senescence biomarkers most strongly associated with an increased risk of death were GDF15, RAGE, VEGFA, PARC, and MMP2, after adjusting for age, sex, race, and the presence of one chronic condition. The combination of biomarkers and clinical and demographic covariates exhibited a significantly higher c-statistic for risk of death (0.79, 95% confidence interval (CI): 0.76-0.82) than the covariates alone (0.70, CI: 0.67-0.74) (p < 0.001). Collectively, these findings lend further support to biomarkers of cellular senescence as informative predictors of clinically important health outcomes in older adults, including death.
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Affiliation(s)
| | - Susan A. Weston
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | | | - Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Thomas A. White
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
| | - Amanda A. Heeren
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
| | - Janet E. Olson
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Walter A. Rocca
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Women's Health Research Center, Mayo ClinicRochesterMinnesotaUSA
| | - Allyson K. Palmer
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
- Division of Hospital Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Steven R. Cummings
- Departments of Medicine, Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Research Institute, California Pacific Medical CenterSan FranciscoCaliforniaUSA
| | - Roger A. Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBostonMassachusettsUSA
| | | | - Nathan K. LeBrasseur
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
- Paul F. Glenn Center for the Biology of Aging ResearchMayo ClinicRochesterMinnesotaUSA
- Department of Physical Medicine and RehabilitationMayo ClinicRochesterMinnesotaUSA
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15
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Ramanan VK, Gebre RK, Graff-Radford J, Hofrenning E, Algeciras-Schimnich A, Figdore DJ, Lowe VJ, Mielke MM, Knopman DS, Ross OA, Jack CR, Petersen RC, Vemuri P. Genetic risk scores enhance the diagnostic value of plasma biomarkers of brain amyloidosis. Brain 2023; 146:4508-4519. [PMID: 37279785 PMCID: PMC10629762 DOI: 10.1093/brain/awad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 06/08/2023] Open
Abstract
Blood-based biomarkers offer strong potential to revolutionize diagnosis, trial enrolment and treatment monitoring in Alzheimer's disease (AD). However, further advances are needed before these biomarkers can achieve wider deployment beyond selective research studies and specialty memory clinics, including the development of frameworks for optimal interpretation of biomarker profiles. We hypothesized that integrating Alzheimer's disease genetic risk score (AD-GRS) data would enhance the diagnostic value of plasma AD biomarkers by better capturing extant disease heterogeneity. Analysing 962 individuals from a population-based sample, we observed that an AD-GRS was independently associated with amyloid PET levels (an early marker of AD pathophysiology) over and above APOE ε4 or plasma p-tau181, amyloid-β42/40, glial fibrillary acidic protein or neurofilament light chain. Among individuals with a high or moderately high plasma p-tau181, integrating AD-GRS data significantly improved classification accuracy of amyloid PET positivity, including the finding that the combination of a high AD-GRS and high plasma p-tau181 outperformed p-tau181 alone in classifying amyloid PET positivity (88% versus 68%; P = 0.001). A machine learning approach incorporating plasma biomarkers, demographics and the AD-GRS was highly accurate in predicting amyloid PET levels (90% training set; 89% test set) and Shapley value analyses (an explainer method based in cooperative game theory) indicated that the AD-GRS and plasma biomarkers had differential importance in explaining amyloid deposition across individuals. Polygenic risk for AD dementia appears to account for a unique portion of disease heterogeneity, which could non-invasively enhance the interpretation of blood-based AD biomarker profiles in the population.
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Affiliation(s)
- Vijay K Ramanan
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Robel K Gebre
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Ekaterina Hofrenning
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Daniel J Figdore
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
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Mielke MM, Dage JL, Frank RD, Algeciras-Schimnich A, Knopman DS, Lowe VJ, Bu G, Vemuri P, Graff-Radford J, Jack CR, Petersen RC. Author Correction: Performance of plasma phosphorylated tau 181 and 217 in the community. Nat Med 2023; 29:2954. [PMID: 36216947 DOI: 10.1038/s41591-022-02066-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Michelle M Mielke
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
- Department of Epidemiology and Prevention, School of Medicine, Wake Forest University, Winston-Salem, NC, USA.
| | - Jeffrey L Dage
- Stark Neurosciences Research Institute, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Ryan D Frank
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Guojun Bu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - Ronald C Petersen
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Mielke MM, Kapoor E, Geske JR, Fields JA, LeBrasseur NK, Morrow MM, Winham SJ, Faubion LL, Castillo AM, Hofrenning EI, Bailey KR, Rocca WA, Kantarci K. Long-term effects of premenopausal bilateral oophorectomy with or without hysterectomy on physical aging and chronic medical conditions. Menopause 2023; 30:1090-1097. [PMID: 37699239 PMCID: PMC10615715 DOI: 10.1097/gme.0000000000002254] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
OBJECTIVE We examined the long-term effects of premenopausal bilateral oophorectomy (PBO) with or without concurrent or preceding hysterectomy on physical and cognitive function and on odds of chronic conditions. METHODS We enrolled 274 women with PBO with or without concurrent or preceding hysterectomy and 240 referents aged 55 years and older who were residents of Olmsted County, MN as of the PBO or index date. Chronic conditions were assessed via medical record abstraction. Cognitive diagnoses were based on neurocognitive testing. A physical function assessment included measures of strength and mobility. Multivariable regression models compared characteristics for women with PBO <46 years, PBO 46-49 years, and referent women with adjustments for age and other confounders. RESULTS The clinical visits (median age, 67 years) were a median of 22 years after the PBO or index date. Of 274 women with PBO, 161 (59%) were <46 years at PBO and 113 (41%) were 46-49 years. Compared with referents, women with a history of PBO <46 years had increased odds of arthritis (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.06-2.55), asthma (OR, 1.74; 95% CI, 1.03-2.93), obstructive sleep apnea (OR, 2.00; 95% CI, 1.23-3.26), and bone fractures (OR, 2.86; 95% CI, 1.17-6.98), and walked a shorter mean distance on a 6-minute walk test ( b = -18.43; P = 0.034). Compared with referents, women with a history of PBO at age 46-49 years had increased odds of arthritis (OR, 1.92; 95% CI, 1.16-3.18) and obstructive sleep apnea (OR, 2.21; 95% CI, 1.33-3.66). There were no significant differences in cognitive status in women with PBO compared with referents. CONCLUSIONS Women with a history of PBO with or without concurrent or preceding hysterectomy, especially at age <46 years, have more chronic conditions in late mid-life compared with referents.
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Affiliation(s)
- Michelle M. Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ekta Kapoor
- Mayo Clinic Center for Women’s Health, Mayo Clinic, Rochester, MN
- Women’s Health Research Center, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Jennifer R. Geske
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Julie A. Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Nathan K. LeBrasseur
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Melissa M. Morrow
- University of Texas Medical Branch, Department of Nutrition, Metabolism & Rehabilitation Sciences, Galveston, TX
| | - Stacey J. Winham
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Anna M. Castillo
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Kent R. Bailey
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Walter A. Rocca
- Women’s Health Research Center, Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
- Department of Neurology, Mayo Clinic, Rochester, MN
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Li D, Singh S, Zhang CD, Kaur RJ, Ebbehoj A, Atkinson EJ, Achenbach SJ, Stricker NH, Mielke MM, Rocca W, Bancos I. Risk of dementia and psychiatric or sleep disorders after diagnosis of adrenal adenomas: a population-based cohort study. Eur J Endocrinol 2023; 189:429-437. [PMID: 37801659 PMCID: PMC10581402 DOI: 10.1093/ejendo/lvad135] [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: 05/02/2023] [Revised: 07/25/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE Adrenal adenomas are commonly encountered in clinical practice. To date, population-based data on their impact on cognition, mental health, and sleep are lacking. We aimed to study possible associations between adrenal adenomas and dementia, psychiatric or sleep disorders. DESIGN Population-based cohort study, Olmsted County, MN, 1995-2017. METHODS Patients with adrenal adenoma and absent overt hormone excess were age- and sex-matched 1:1 to a referent person without adrenal adenoma. Outcomes were baseline and incident diagnoses of dementia, psychiatric or sleep disorders, assessed using ICD codes. RESULTS Of 1004 patients with adrenal adenomas, 582 (58%) were women, and median age at diagnosis was 63 years. At baseline, and after adjusting for age, sex, education, BMI, and tobacco use, patients with adenoma had higher odds of depression (adjusted odds ratio, aOR: 1.3, 95% CI, 1.1-1.6), anxiety (aOR: 1.4, 95% CI, 1.1-1.8), and substance abuse (aOR: 2.4, 95% CI, 1.7-3.4) compared to referents. During a median follow-up of 6.8 years, and after adjusting for age, sex, socioeconomic status, BMI, tobacco, and substance abuse, patients demonstrated a higher risk of psychiatric and sleep disorders [adjusted hazard ratio (95% CI)]: depression [1.7 (1.3-2.2)], anxiety [1.4, CI (1.1-1.7)], insomnia [1.4 (1.0-1.9)], sleep-related breathing disorders [1.5 (1.1-1.9)], hypersomnias [2.1 (1.0-4.2)], parasomnias [2.1 (1.0-4.2)], and sleep-related movement disorders [1.5 (1.0-2.1)], but not dementia. CONCLUSIONS Patients with adenomas demonstrate a higher incidence of psychiatric and sleep disorders, possibly due to the underlying subtle increase in cortisol secretion.
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Affiliation(s)
- Dingfeng Li
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
- Endocrinology and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Sumitabh Singh
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
| | - Catherine D Zhang
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
- Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Ravinder Jeet Kaur
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
| | - Andreas Ebbehoj
- Department of Clinical Medicine, Department of Endocrinology and Diabetes, Aarhus University, Aarhus 8200, Denmark
| | - Elizabeth J Atkinson
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
| | - Sara J Achenbach
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
| | - Nikki H Stricker
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, United States
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States
| | - Walter Rocca
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
- Women’s Health Research Center, Mayo Clinic, Rochester, MN 55905, United States
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
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Ramanan VK, Graff-Radford J, Syrjanen J, Shir D, Algeciras-Schimnich A, Lucas J, Martens YA, Carrasquillo MM, Day GS, Ertekin-Taner N, Lachner C, Willis FB, Knopman DS, Jack CR, Petersen RC, Vemuri P, Graff-Radford N, Mielke MM. Association of Plasma Biomarkers of Alzheimer Disease With Cognition and Medical Comorbidities in a Biracial Cohort. Neurology 2023; 101:e1402-e1411. [PMID: 37580163 PMCID: PMC10573134 DOI: 10.1212/wnl.0000000000207675] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 02/03/2023] [Accepted: 06/06/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recent advances in blood-based biomarkers offer the potential to revolutionize the diagnosis and management of Alzheimer disease (AD), but additional research in diverse populations is critical. We assessed the profiles of blood-based AD biomarkers and their relationships to cognition and common medical comorbidities in a biracial cohort. METHODS Participants were evaluated through the Mayo Clinic Jacksonville Alzheimer Disease Research Center and matched on age, sex, and cognitive status. Plasma AD biomarkers (β-amyloid peptide 1-42 [Aβ42/40], plasma tau phosphorylated at position 181 [p-tau181], glial fibrillary acidic protein [GFAP], and neurofilament light) were measured using the Quanterix SiMoA HD-X analyzer. Cognition was assessed with the Mini-Mental State Examination. Wilcoxon rank sum tests were used to assess for differences in plasma biomarker levels by sex. Linear models tested for associations of self-reported race, chronic kidney disease (CKD), and vascular risk factors with plasma AD biomarker levels. Additional models assessed for interactions between race and plasma biomarkers in predicting cognition. RESULTS The sample comprised African American (AA; N = 267) and non-Hispanic White (NHW; N = 268) participants, including 69% female participants and age range 43-100 (median 80.2) years. Education was higher in NHW participants (median 16 vs 12 years, p < 0.001) while APOE ε4 positivity was higher in AA participants (43% vs 34%; p = 0.04). We observed no differences in plasma AD biomarker levels between AA and NHW participants. These results were unchanged after stratifying by cognitive status (unimpaired vs impaired). Although the p-tau181-cognition association seemed stronger in NHW participants while the Aβ42/40-cognition association seemed stronger in AA participants, these findings did not survive after excluding individuals with CKD. Female participants displayed higher GFAP (177.5 pg/mL vs 157.73 pg/mL; p = 0.002) and lower p-tau181 (2.62 pg/mL vs 3.28 pg/mL; p = 0.001) levels than male participants. Diabetes was inversely associated with GFAP levels (β = -0.01; p < 0.001). DISCUSSION In a biracial community-based sample of adults, we observed that sex differences, CKD, and vascular risk factors, but not self-reported race, contributed to variation in plasma AD biomarkers. Although some prior studies have reported primary effects of race/ethnicity, our results reinforce the need to account for broad-based medical and social determinants of health (including sex, systemic comorbidities, and other factors) in effectively and equitably deploying plasma AD biomarkers in the general population.
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Affiliation(s)
- Vijay K Ramanan
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Jonathan Graff-Radford
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Jeremy Syrjanen
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Dror Shir
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Alicia Algeciras-Schimnich
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - John Lucas
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Yuka A Martens
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Minerva M Carrasquillo
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Gregory S Day
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Nilüfer Ertekin-Taner
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christian Lachner
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Floyd B Willis
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - David S Knopman
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Clifford R Jack
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ronald C Petersen
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Prashanthi Vemuri
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Neill Graff-Radford
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michelle M Mielke
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
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20
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Moser ED, Manemann SM, Larson NB, St Sauver JL, Takahashi PY, Mielke MM, Rocca WA, Olson JE, Roger VL, Remaley AT, Decker PA, Killian JM, Bielinski SJ. Association Between Fluctuations in Blood Lipid Levels Over Time With Incident Alzheimer Disease and Alzheimer Disease-Related Dementias. Neurology 2023; 101:e1127-e1136. [PMID: 37407257 PMCID: PMC10513892 DOI: 10.1212/wnl.0000000000207595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/12/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Prevention strategies for Alzheimer disease and Alzheimer disease-related dementias (AD/ADRDs) are urgently needed. Lipid variability, or fluctuations in blood lipid levels at different points in time, has not been examined extensively and may contribute to the risk of AD/ADRD. Lipid panels are a part of routine screening in clinical practice and routinely available in electronic health records (EHR). Thus, in a large geographically defined population-based cohort, we investigated the variation of multiple lipid types and their association to the development of AD/ADRD. METHODS All residents living in Olmsted County, Minnesota on the index date January 1, 2006, aged 60 years or older without an AD/ADRD diagnosis were identified. Persons with ≥3 lipid measurements including total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), or high-density lipoprotein cholesterol (HDL-C) in the 5 years before index date were included. Lipid variation was defined as any change in individual's lipid levels over time regardless of direction and was measured using variability independent of the mean (VIM). Associations between lipid variation quintiles and incident AD/ADRD were assessed using Cox proportional hazards regression. Participants were followed through 2018 for incident AD/ADRD. RESULTS The final analysis included 11,571 participants (mean age 71 years; 54% female). Median follow-up was 12.9 years with 2,473 incident AD/ADRD cases. After adjustment for confounding variables including sex, race, baseline lipid measurements, education, BMI, and lipid-lowering treatment, participants in the highest quintile of total cholesterol variability had a 19% increased risk of incident AD/ADRD, and those in highest quintile of triglycerides, variability had a 23% increased risk. DISCUSSION In a large EHR derived cohort, those in the highest quintile of variability for total cholesterol and triglyceride levels had an increased risk of incident AD/ADRD. Further studies to identify the mechanisms behind this association are needed.
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Affiliation(s)
- Ethan D Moser
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Sheila M Manemann
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Nicholas B Larson
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jennifer L St Sauver
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Paul Y Takahashi
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Michelle M Mielke
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Walter A Rocca
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Janet E Olson
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Véronique L Roger
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Alan T Remaley
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Paul A Decker
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jill M Killian
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Suzette J Bielinski
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
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Morrow MM, Schafer MJ, Kantarci K, Mielke MM, Vachon CM, Winham SJ. Leadership Development in Early Career Scientists: Themes and Feedback from Executive Coaching and Mindful Leadership Training. J Womens Health (Larchmt) 2023; 32:877-882. [PMID: 37585518 PMCID: PMC10457600 DOI: 10.1089/jwh.2023.0024] [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: 08/18/2023] Open
Abstract
Background: Career development is essential for all academic stages, but particularly critical for the growth and retention of early career scientists. In addition to scientific technical training, professional skill development is crucial for the upward transition from postdoctoral trainee to early faculty member and beyond. Building leadership skills, specifically, is an important component of professional development, and the evaluation and reporting of professional development are important to improve and enhance the impact of programs. Methods: The purpose of this article is to share the program evaluation performed on leadership development activities, including executive coaching and mindful leadership training provided to a small group of early career scientists who participated in the National Institutes of Health (NIH)-funded Mayo Clinic Specialized Center of Research Excellence (SCORE) in Sex Differences Career Enhancement Core and Building Interdisciplinary Research Careers in Women's Health (BIRCWH) K12 programs during 2020-2022. Results: Eighty-seven percent of participants rated their satisfaction with the executive coaching program as "Very Satisfied" or "Satisfied," and 75% of participants were "Very Satisfied" or "Satisfied" with the mindful leadership training program. The findings of this program evaluation highlight the value of communication skills for navigating precarious situations, building self-efficacy and intentionality in making and holding boundaries for an individual's time and energy. Further, the individualized small group format of the activities allowed for deeper introspection and peer to peer connection. Conclusion: The identification of common themes within the Mayo Clinic program provides guidance to other academic environments on areas where they can support their early career scientists.
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Affiliation(s)
- Melissa M.B. Morrow
- Center for Health Promotion, Performance, and Rehabilitation Research, Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, Texas, USA
| | - Marissa J. Schafer
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle M. Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Celine M. Vachon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Stacey J. Winham
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
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22
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van Kruining D, Losen M, Crivelli SM, de Jong JJA, Jansen JFA, Backes WH, Monereo‐Sánchez J, van Boxtel MPJ, Köhler S, Linden DEJ, Schram MT, Mielke MM, Martinez‐Martinez P. Plasma ceramides relate to mild cognitive impairment in middle-aged men: The Maastricht Study. Alzheimers Dement (Amst) 2023; 15:e12459. [PMID: 37675435 PMCID: PMC10478166 DOI: 10.1002/dad2.12459] [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] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 09/08/2023]
Abstract
Introduction There is an urgent need for biomarkers identifying individuals at risk of early-stage cognitive impairment. Using cross-sectional data from The Maastricht Study, this study included 197 individuals with mild cognitive impairment (MCI) and 200 cognitively unimpaired individuals aged 40 to 75, matched by age, sex, and educational level. Methods We assessed the association of plasma sphingolipid and ceramide transfer protein (CERT) levels with MCI and adjusted for potentially confounding risk factors. Furthermore, the relationship of plasma sphingolipids and CERTs with magnetic resonance imaging brain volumes was assessed and age- and sex-stratified analyses were performed. Results Associations of plasma ceramide species C18:0 and C24:1 and combined plasma ceramide chain lengths (ceramide risk score) with MCI were moderated by sex, but not by age, and higher levels were associated with MCI in men. No associations were found among women. In addition, higher levels of ceramide C20:0, C22:0, and C24:1, but not the ceramide risk score, were associated with larger volume of the hippocampus after controlling for covariates, independent of MCI. Although higher plasma ceramide C18:0 was related to higher plasma CERT levels, no association of CERT levels was found with MCI or brain volumes. Discussion Our results warrant further analysis of plasma ceramides as potential markers for MCI in middle-aged men. In contrast to previous studies, no associations of plasma sphingolipids with MCI or brain volumes were found in women, independent of age. These results highlight the importance of accounting for sex- and age-related factors when examining sphingolipid and CERT metabolism related to cognitive function.
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Affiliation(s)
- Daan van Kruining
- School for Mental Health and NeuroscienceFaculty of HealthMedicine, and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtthe Netherlands
| | - Mario Losen
- School for Mental Health and NeuroscienceFaculty of HealthMedicine, and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtthe Netherlands
| | - Simone M. Crivelli
- Department of PhysiologyUniversity of Kentucky College of MedicineLexingtonKentuckyUSA
| | - Joost J. A. de Jong
- School for Mental Health and NeuroscienceFaculty of HealthMedicine, and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical Center+ (MUMC+)Maastrichtthe Netherlands
| | - Jacobus F. A. Jansen
- School for Mental Health and NeuroscienceFaculty of HealthMedicine, and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical Center+ (MUMC+)Maastrichtthe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhoventhe Netherlands
| | - Walter H. Backes
- School for Mental Health and NeuroscienceFaculty of HealthMedicine, and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical Center+ (MUMC+)Maastrichtthe Netherlands
| | - Jennifer Monereo‐Sánchez
- School for Mental Health and NeuroscienceFaculty of HealthMedicine, and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical Center+ (MUMC+)Maastrichtthe Netherlands
| | - Martin P. J. van Boxtel
- School for Mental Health and NeuroscienceFaculty of HealthMedicine, and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtthe Netherlands
| | - Sebastian Köhler
- School for Mental Health and NeuroscienceFaculty of HealthMedicine, and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtthe Netherlands
| | - David E. J. Linden
- School for Mental Health and NeuroscienceFaculty of HealthMedicine, and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtthe Netherlands
| | - Miranda T. Schram
- School for Mental Health and NeuroscienceFaculty of HealthMedicine, and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Internal MedicineMaastricht University Medical Center+ (MUMC+)Maastrichtthe Netherlands
- Heart and Vascular CenterMaastricht University Medical Center+ (MUMC+)Maastrichtthe Netherlands
- School for Cardiovascular Diseases (CARIM)Faculty of HealthMedicine, and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | - Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Pilar Martinez‐Martinez
- School for Mental Health and NeuroscienceFaculty of HealthMedicine, and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtthe Netherlands
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Bermudez C, Graff-Radford J, Syrjanen JA, Stricker NH, Algeciras-Schimnich A, Kouri N, Kremers WK, Petersen RC, Jack CR, Knopman DS, Dickson DW, Nguyen AT, Reichard RR, Murray ME, Mielke MM, Vemuri P. Plasma biomarkers for prediction of Alzheimer's disease neuropathologic change. Acta Neuropathol 2023; 146:13-29. [PMID: 37269398 PMCID: PMC10478071 DOI: 10.1007/s00401-023-02594-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/12/2023] [Revised: 05/14/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
While plasma biomarkers for Alzheimer's disease (AD) are increasingly being evaluated for clinical diagnosis and prognosis, few population-based autopsy studies have evaluated their utility in the context of predicting neuropathological changes. Our goal was to investigate the utility of clinically available plasma markers in predicting Braak staging, neuritic plaque score, Thal phase, and overall AD neuropathological change (ADNC).We utilized a population-based prospective study of 350 participants with autopsy and antemortem plasma biomarker testing using clinically available antibody assay (Quanterix) consisting of Aβ42/40 ratio, p-tau181, GFAP, and NfL. We utilized a variable selection procedure in cross-validated (CV) logistic regression models to identify the best set of plasma predictors along with demographic variables, and a subset of neuropsychological tests comprising the Mayo Clinic Preclinical Alzheimer Cognitive Composite (Mayo-PACC). ADNC was best predicted with plasma GFAP, NfL, p-tau181 biomarkers along with APOE ε4 carrier status and Mayo-PACC cognitive score (CV AUC = 0.798). Braak staging was best predicted using plasma GFAP, p-tau181, and cognitive scores (CV AUC = 0.774). Neuritic plaque score was best predicted using plasma Aβ42/40 ratio, p-tau181, GFAP, and NfL biomarkers (CV AUC = 0.770). Thal phase was best predicted using GFAP, NfL, p-tau181, APOE ε4 carrier status and Mayo-PACC cognitive score (CV AUC = 0.754). We found that GFAP and p-tau provided non-overlapping information on both neuritic plaque and Braak stage scores whereas Aβ42/40 and NfL were mainly useful for prediction of neuritic plaque scores. Separating participants by cognitive status improved predictive performance, particularly when plasma biomarkers were included. Plasma biomarkers can differentially inform about overall ADNC pathology, Braak staging, and neuritic plaque score when combined with demographics and cognitive variables and have significant utility for earlier detection of AD.
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Affiliation(s)
- Camilo Bermudez
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA.
| | | | - Jeremy A Syrjanen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Nikki H Stricker
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Naomi Kouri
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | | | - David S Knopman
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | | | - Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Bornhorst JA, Figdore D, Campbell MR, Pazdernik VK, Mielke MM, Petersen RC, Algeciras-Schimnich A. Corrigendum to "Plasma neurofilament light chain (NfL) reference interval determination in an age-stratified cognitively unimpaired cohort" [Clin. Chim. Acta 535 (2022) 153-156]. Clin Chim Acta 2023; 546:117396. [PMID: 37244142 DOI: 10.1016/j.cca.2023.117396] [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: 05/29/2023]
Affiliation(s)
- Joshua A Bornhorst
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester Minnesota, USA
| | - Daniel Figdore
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester Minnesota, USA
| | - Michelle R Campbell
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester Minnesota, USA
| | - Vanessa K Pazdernik
- Department of Quantitative Health Sciences, Mayo Clinic Rochester Minnesota, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Kodishala C, Hulshizer CA, Kronzer VL, Davis JM, Ramanan VK, Vassilaki M, Mielke MM, Crowson CS, Myasoedova E. Dr. Kodishala et al reply. J Rheumatol 2023; 50:853. [PMID: 36379572 DOI: 10.3899/jrheum.221021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota
| | | | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Michelle M Mielke
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Elena Myasoedova
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota;
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
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Mielke MM, Frank RD, Christenson LR, Fields JA, Rocca WA, Garovic VD. Association of Hypertensive Disorders of Pregnancy With Cognition in Later Life. Neurology 2023; 100:e2017-e2026. [PMID: 36859405 PMCID: PMC10186223 DOI: 10.1212/wnl.0000000000207134] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/23/2022] [Accepted: 01/17/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies of hypertensive disorders of pregnancy (HDP), including gestational or chronic hypertension (GH/CH) and preeclampsia/eclampsia (PE/E), suggest associations with early-life and mid-life cognition but have been limited by self-report or use of diagnostic codes, exclusion of nulliparous women, and lack of measurement of cognition in later life. We examined the effects of any HDP, GH/CH, PE/E, and nulliparity on cognition in later life. METHODS Participants included 2,239 women (median age 73) enrolled in the Mayo Clinic Study of Aging with medical record-abstracted pregnancy information. A cognitive battery of 9 tests was conducted every 15 months. Global cognitive and domain-specific z scores (memory, executive/attention, visuospatial, and language) were outcomes. Linear mixed-effect models evaluated associations between pregnancy history (all normotensive, any HPD, HPD subtype [GH/CH, PE/E], or nulliparous) and cognitive decline, adjusting for age and education. Additional models adjusted for APOE, smoking, hypertension, dyslipidemia, body mass index (BMI), diabetes, stroke, and heart disease. Interactions between pregnancy history and age or education on cognitive performance were examined. RESULTS Of the 2,239 women, 1,854 (82.8%) had at least 1 pregnancy (1,607 all normotensive, 100 GH/CH, and 147 PE/E); 385 (17.2%) were nulliparous. Cognitive performance did not cross-sectionally differ for women with a history of any HDP, GH/CH, or PE/E vs women with a history of all normotensive pregnancies; women who were nulliparous had lower global and domain-specific cognition (all p < 0.05) in age- and education-adjusted models. There was an interaction (p = 0.015) between nulliparity and education such that the lower cognitive performance was most pronounced among nulliparous women with ≤12 years of education (beta = -0.42, p < 0.001) vs 12 + years (b = -0.11, p = 0.049). Longitudinally, women with any HDP had greater declines in global cognition and attention/executive z scores compared with women with all normotensive pregnancies. When stratified by HDP type, only women with PE/E had greater declines in global cognition (beta = -0.04, p < 0.001), language (beta = -0.03, p = 0.001), and attention (beta = -0.04, p < 0.001) z scores. Adjustment for vascular risk factors, BMI, smoking, and APOE did not attenuate results. DISCUSSION Women with a history of HDP, especially PE/E, are at greater risk of cognitive decline in later life.
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Affiliation(s)
- Michelle M Mielke
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Ryan D Frank
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Luke R Christenson
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Julie A Fields
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Walter A Rocca
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Vesna D Garovic
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
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Jack CR, Wiste HJ, Algeciras-Schimnich A, Figdore DJ, Schwarz CG, Lowe VJ, Ramanan VK, Vemuri P, Mielke MM, Knopman DS, Graff-Radford J, Boeve BF, Kantarci K, Cogswell PM, Senjem ML, Gunter JL, Therneau TM, Petersen RC. Predicting amyloid PET and tau PET stages with plasma biomarkers. Brain 2023; 146:2029-2044. [PMID: 36789483 PMCID: PMC10151195 DOI: 10.1093/brain/awad042] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/20/2022] [Accepted: 01/21/2023] [Indexed: 02/16/2023] Open
Abstract
Staging the severity of Alzheimer's disease pathology using biomarkers is useful for therapeutic trials and clinical prognosis. Disease staging with amyloid and tau PET has face validity; however, this would be more practical with plasma biomarkers. Our objectives were, first, to examine approaches for staging amyloid and tau PET and, second, to examine prediction of amyloid and tau PET stages using plasma biomarkers. Participants (n = 1136) were enrolled in either the Mayo Clinic Study of Aging or the Alzheimer's Disease Research Center; had a concurrent amyloid PET, tau PET and blood draw; and met clinical criteria for cognitively unimpaired (n = 864), mild cognitive impairment (n = 148) or Alzheimer's clinical syndrome with dementia (n = 124). The latter two groups were combined into a cognitively impaired group (n = 272). We used multinomial regression models to estimate discrimination [concordance (C) statistics] among three amyloid PET stages (low, intermediate, high), four tau PET stages (Braak 0, 1-2, 3-4, 5-6) and a combined amyloid and tau PET stage (none/low versus intermediate/high severity) using plasma biomarkers as predictors separately within unimpaired and impaired individuals. Plasma analytes, p-tau181, Aβ1-42 and Aβ1-40 (analysed as the Aβ42/Aβ40 ratio), glial fibrillary acidic protein and neurofilament light chain were measured on the HD-X Simoa Quanterix platform. Plasma p-tau217 was also measured in a subset (n = 355) of cognitively unimpaired participants using the Lilly Meso Scale Discovery assay. Models with all Quanterix plasma analytes along with risk factors (age, sex and APOE) most often provided the best discrimination among amyloid PET stages (C = 0.78-0.82). Models with p-tau181 provided similar discrimination of tau PET stages to models with all four plasma analytes (C = 0.72-0.85 versus C = 0.73-0.86). Discriminating a PET proxy of intermediate/high from none/low Alzheimer's disease neuropathological change with all four Quanterix plasma analytes was excellent but not better than p-tau181 only (C = 0.88 versus 0.87 for unimpaired and C = 0.91 versus 0.90 for impaired). Lilly p-tau217 outperformed the Quanterix p-tau181 assay for discriminating high versus intermediate amyloid (C = 0.85 versus 0.74) but did not improve over a model with all Quanterix plasma analytes and risk factors (C = 0.85 versus 0.83). Plasma analytes along with risk factors can discriminate between amyloid and tau PET stages and between a PET surrogate for intermediate/high versus none/low neuropathological change with accuracy in the acceptable to excellent range. Combinations of plasma analytes are better than single analytes for many staging predictions with the exception that Quanterix p-tau181 alone usually performed equivalently to combinations of Quanterix analytes for tau PET discrimination.
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Affiliation(s)
- Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Heather J Wiste
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Dan J Figdore
- Department of Laboratory Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Val J Lowe
- Department of Nuclear Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Vijay K Ramanan
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | - Terry M Therneau
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
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Aggarwal NT, Mielke MM. Sex Differences in Alzheimer's Disease. Neurol Clin 2023; 41:343-358. [PMID: 37030962 PMCID: PMC10321561 DOI: 10.1016/j.ncl.2023.01.001] [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: 04/10/2023]
Abstract
Reviewing the research presented in this article, it is evident that from an epidemiological perspective, it is important to evaluate the extent to which findings of sex and gender differences in Alzheimer's dementia (AD) are due to differences in longevity, survival bias, and comorbidities. Medical, genetic, psychosocial, and behavioral factors, in addition to hormonal factors, can differentially affect the risk and progression of AD in women versus men. Further, evaluation of sex differences in AD progression and the trajectory of change in cognitive function, neuroimaging, cerebrospinal fluid (CSF), and blood-based biomarkers of AD is needed. Finally, identifying sex differences in AD biomarkers and change across the lifespan is critical for the planning of prevention trials to reduce the risk of developing AD.
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Affiliation(s)
- Neelum T Aggarwal
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 West Harrison Street, Suite 1000, Chicago, IL 60612, USA.
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Vila-Castelar C, Udeh-Momoh C, Aggarwal NT, Mielke MM. Sex and gender considerations in dementia: a call for global research. Nat Aging 2023; 3:463-465. [PMID: 37202511 PMCID: PMC10331726 DOI: 10.1038/s43587-023-00374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Studies have identified sex and/or gender differences in Alzheimer’s disease, but few have examined other dementias. We highlight sex and gender differences in other dementias, discuss sociocultural factors and provide a framework for future global studies.
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Affiliation(s)
- Clara Vila-Castelar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chinedu Udeh-Momoh
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
- Global Brain Health Institute (GBHI), University of California, San Francisco, CA, USA
| | - Neelum T Aggarwal
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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30
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St Sauver JL, LeBrasseur NK, Rocca WA, Olson JE, Bielinski SJ, Sohn S, Weston SA, McGree ME, Mielke MM. Cohort study examining associations between ceramide levels and risk of multimorbidity among persons participating in the Mayo Clinic Biobank. BMJ Open 2023; 13:e069375. [PMID: 37085302 PMCID: PMC10124265 DOI: 10.1136/bmjopen-2022-069375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE Ceramides have been associated with several ageing-related conditions but have not been studied as a general biomarker of multimorbidity (MM). Therefore, we determined whether ceramide levels are associated with the rapid development of MM. DESIGN Retrospective cohort study. SETTING Mayo Clinic Biobank. PARTICIPANTS 1809 persons in the Mayo Clinic Biobank ≥65 years without MM at the time of enrolment, and with ceramide levels assayed from stored plasma. PRIMARY OUTCOME MEASURE Persons were followed for a median of 5.7 years through their medical records to identify new diagnoses of 20 chronic conditions. The number of new conditions was divided by the person-years of follow-up to calculate the rate of accumulation of new chronic conditions. RESULTS Higher levels of C18:0 and C20:0 were associated with a more rapid rate of accumulation of chronic conditions (C18:0 z score RR: 1.30, 95% CI: 1.10 to 1.53; C20:0 z score RR: 1.26, 95% CI: 1.07 to 1.49). Higher C18:0 and C20:0 levels were also associated with an increased risk of hypertension and coronary artery disease. CONCLUSIONS C18:0 and C20:0 were associated with an increased risk of cardiometabolic conditions. When combined with biomarkers specific to other diseases of ageing, these ceramides may be a useful component of a biomarker panel for predicting accelerated ageing.
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Affiliation(s)
- Jennifer L St Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan K LeBrasseur
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter A Rocca
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Janet E Olson
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Suzette J Bielinski
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunghwan Sohn
- Department of Artificial Intelligence & Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Susan A Weston
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Michaela E McGree
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle M Mielke
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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31
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Tian Q, Montero-Odasso M, Buchman AS, Mielke MM, Espinoza S, DeCarli CS, Newman AB, Kritchevsky SB, Rebok GW, Resnick SM, Thambisetty M, Verghese J, Ferrucci L. Dual cognitive and mobility impairments and future dementia - Setting a research agenda. Alzheimers Dement 2023; 19:1579-1586. [PMID: 36637077 PMCID: PMC10101877 DOI: 10.1002/alz.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 01/14/2023]
Abstract
Dual cognitive and mobility impairments are associated with an increased risk of dementia. Recent studies examining temporal trajectories of mobility and cognitive function in aging found that dual decline is associated with higher dementia risk than memory decline or gait decline only. Although initial data show that individuals with dual decline or impairment have excessive cardiovascular and metabolic risk factors, the causes of dual decline or what underlies dual decline with a high risk of dementia remain largely unknown. In December 2021, the National Institute on Aging Intramural and Extramural Programs jointly organized a workshop on Biology Underlying Moving and Thinking to explore the hypothesis that older persons with dual decline may develop dementia through a specific pathophysiological pathway. The working group discussed assessment methods for dual decline and possible mechanisms connecting dual decline with dementia risk and pinpointed the most critical questions to be addressed from a translational perspective.
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Affiliation(s)
- Qu Tian
- Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
| | - Manuel Montero-Odasso
- Schulich School of Medicine and Dentistry, Department of Medicine and Division of Geriatric Medicine, The University of Western Ontario, London, ON, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Michelle M. Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Sara Espinoza
- Division of Geriatrics, Gerontology & Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, TX, USA
- Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, Audie Murphy Veterans Hospital, San Antonio, TX, USA
| | | | - Anne B. Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen B. Kritchevsky
- Department of Internal Medicine: Gerontology & Geriatric Medicine, The Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - George W. Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer’s Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
| | - Susan M. Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Madhav Thambisetty
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
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Simons RL, Ong ML, Lei MK, Beach SRH, Zhang Y, Philibert R, Mielke MM. Changes in Loneliness, BDNF, and Biological Aging Predict Trajectories in a Blood-Based Epigenetic Measure of Cortical Aging: A Study of Older Black Americans. Genes (Basel) 2023; 14:genes14040842. [PMID: 37107599 PMCID: PMC10138024 DOI: 10.3390/genes14040842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/17/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
A recent epigenetic measure of aging has developed based on human cortex tissue. This cortical clock (CC) dramatically outperformed extant blood-based epigenetic clocks in predicting brain age and neurological degeneration. Unfortunately, measures that require brain tissue are of limited utility to investigators striving to identify everyday risk factors for dementia. The present study investigated the utility of using the CpG sites included in the CC to formulate a peripheral blood-based cortical measure of brain age (CC-Bd). To establish the utility of CC-Bd, we used growth curves with individually varying time points and longitudinal data from a sample of 694 aging African Americans. We examined whether three risk factors that have been linked to cognitive decline—loneliness, depression, and BDNFm—predicted CC-Bd after controlling for several factors, including three new-generation epigenetic clocks. Our findings showed that two clocks—DunedinPACE and PoAm—predicted CC-BD, but that increases in loneliness and BDNFm continued to be robust predictors of accelerated CC-Bd even after taking these effects into account. This suggests that CC-Bd is assessing something more than the pan-tissue epigenetic clocks but that, at least in part, brain health is also associated with the general aging of the organism.
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Affiliation(s)
- Ronald L. Simons
- Department of Sociology, University of Georgia, Athens, GA 30602, USA
- Correspondence: ; Tel.: +1-706-424-2626
| | - Mei Ling Ong
- Center for Family Research, University of Georgia, Athens, GA 30602, USA
| | - Man-Kit Lei
- Department of Sociology, University of Georgia, Athens, GA 30602, USA
| | | | - Yue Zhang
- Department of Sociology, University of Georgia, Athens, GA 30602, USA
| | - Robert Philibert
- Department of Psychiatry, University of Iowa School of Medicine, Iowa City, IA 52242, USA
| | - Michelle M. Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
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Windham BG, Griswold ME, Ranadive R, Sullivan KJ, Mosley TH, Mielke MM, Jack CR, Knopman D, Petersen R, Vemuri P. Relationships of Cerebral Perfusion With Gait Speed Across Systolic Blood Pressure Levels and Age: A Cohort Study. J Gerontol A Biol Sci Med Sci 2023; 78:514-520. [PMID: 35640170 PMCID: PMC9977228 DOI: 10.1093/gerona/glac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study aimed to examine if the association of cerebral perfusion with gait speed differs across systolic blood pressure (SBP) and age. METHODS Cerebral perfusion was measured via arterial spin labeled (ASL)-MRI among community-dwelling adults aged 31-94 years in the population-based Mayo Clinic Study of Aging. Usual gait speed was assessed over 5.6 meters on an electronic mat. Sex- and body mass index (BMI)-adjusted linear regression models estimated cross-sectional gait speed associations with ASL and modifying effects of age and SBP using 3-way and 2-way interaction terms between continuous age, SBP, and ASL. Results report estimated differences in gait speed per standard deviation (SD) lower ASL for exemplar SBPs and ages. RESULTS Among 479 participants (mean age 67.6 years; 44% women; mean gait speed 1.17 m/s), ASL relations to gait speed varied by age (ASL-x-age interaction: p = .001) and SBP (ASL-x-SBP interaction: p = .009). At an SBP of 120 mmHg, each SD lower ASL was associated with a 0.04 m/s (95% confidence interval [CI]: 0.01, 0.07) slower gait speed at 65 years, 0.07 m/s (0.04, 0.10) at 75 years, and 0.09 m/s (0.05, 0.13) at 85 years. At an SBP of 140 mmHg, ASL associations with gait speed were attenuated to 0.01 (-0.01, 0.04), 0.04 (0.02, 0.06), and 0.06 (0.04, 0.09) m/s slower gait speed at ages 65, 75, and 85, respectively. CONCLUSION Poorer cerebral perfusion is associated with clinically meaningful slower gait speeds, particularly with older age, while higher perfusion markedly attenuates age differences in gait speed.
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Affiliation(s)
- B Gwen Windham
- Address correspondence to: B. Gwen Windham, MD, MHS, Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, USA. E-mail:
| | - Michael E Griswold
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Radhikesh Ranadive
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kevin J Sullivan
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Thomas H Mosley
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michelle M Mielke
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dave Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ron Petersen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashanthi Vemuri
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Lu Y, Pike JR, Hoogeveen RC, Walker K, Raffield LM, Selvin E, Avery CL, Mielke MM, Garcia T, Palta P. Abstract P501: Midlife and Late-Life Non-Alcoholic Fatty Liver Disease and Incident Dementia: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Introduction:
Associations of nonalcoholic fatty liver disease (NAFLD) with dementia are controversial. The full spectrum of NAFLD from simple steatosis to fibrosis has been less investigated.
Hypothesis:
The severity of NAFLD, especially with the stage of liver fibrosis, is associated with dementia.
Methods:
The associations between midlife (1990-92, N=9283, mean age 57, female 55%) and late-life (2011-13, N=5138, mean age 75, female 58%) NAFLD and all cause dementia were quantified by Cox regression. NAFLD was characterized using the fatty liver index and liver fibrosis assessment model (FIB-4). Dementia was adjudicated and ascertained through Dec. 31, 2019 from neuropsychological assessments, annual participant or informant contact, and medical record surveillance. We used Cox models with adjustment for demographics, APOE ε4, alcohol, and kidney function. Additional adjustments were made for metabolic factors to explore the independent contribution of NAFLD to dementia.
Results:
During a median follow-up of 24.5 years after midlife NAFLD assessment, 1854 participants developed dementia. During a median of 6.3 years in late-life, there were 893 dementia cases. A graded increase in dementia risk across the spectrum of NAFLD was observed at midlife (p-trend <0.001), but not at older age (
Figure
). In fact, NAFLD in late-life tended to be protective against dementia. After adjusting for the metabolic factors, the associations remained statistically significant in some categories.
Conclusions:
Remodeling of hepatic architecture and dysregulation in hepatocellular function in NAFLD at midlife plausibly induce peripheral promoters of neurodegeneration and may expose a large segment of the population to increased risk of dementia. The inverse association of NAFLD with dementia at late-life requires further investigation, possibly reflecting the depletion of susceptibles, the reversibility of NAFLD due to weight loss, and the lack of accuracy in identifying NAFLD using clinical prediction models at older age.
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Affiliation(s)
- Yifei Lu
- UNC at Chapel Hill, Chapel Hill, NC
| | - James R Pike
- Univ of North Carolina, Chapel Hill, United States Minor Outlying Islands
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Sprung J, Laporta ML, Knopman DS, Petersen RC, Mielke MM, Jack CR, Martin DP, Hanson AC, Schroeder DR, Schulte PJ, Przybelski SA, Valencia Morales DJ, Weingarten TN, Vemuri P, Warner DO. Association of Indication for Hospitalization With Subsequent Amyloid Positron Emission Tomography and Magnetic Resonance Imaging Biomarkers. J Gerontol A Biol Sci Med Sci 2023; 78:304-313. [PMID: 35279026 PMCID: PMC9951063 DOI: 10.1093/gerona/glac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hospitalization in older age is associated with accelerated cognitive decline, typically preceded by neuropathologic changes. We assess the association between indication for hospitalization and brain neurodegeneration. METHODS Included were participants from the Mayo Clinic Study of Aging, a population-based longitudinal study, with ≥1 brain imaging available in those older than 60 years of age between 2004 and 2017. Primary analyses used linear mixed-effects models to assess association of hospitalization with changes in longitudinal trajectory of cortical thinning, amyloid accumulation, and white matter hyperintensities (WMH). Additional analyses were performed with imaging outcomes dichotomized (normal vs abnormal) using Cox proportional hazards regression. RESULTS Of 2 480 participants, 1 966 had no hospitalization and 514 had ≥1 admission. Hospitalization was associated with accelerated cortical thinning (annual slope change -0.003 mm [95% confidence interval (CI) -0.005 to -0.001], p = .002), but not amyloid accumulation (0.003 [95% CI -0.001 to 0.006], p = .107), or WMH increase (0.011 cm3 [95% CI -0.001 to 0.023], p = .062). Interaction analyses assessing whether trajectory changes are dependent on admission type (medical vs surgical) found interactions for all outcomes. While surgical hospitalizations were not, medical hospitalizations were associated with accelerated cortical thinning (-0.004 mm [95% CI -0.008 to -0.001, p = .014); amyloid accumulation (0.010, [95% CI 0.002 to 0.017, p = .011), and WMH increase (0.035 cm3 [95% CI 0.012 to 0.058, p = .006). Hospitalization was not associated with developing abnormal cortical thinning (p = .407), amyloid accumulation (p = .596), or WMH/infarctions score (p = .565). CONCLUSIONS Medical hospitalizations were associated with accelerated cortical thinning, amyloid accumulation, and WMH increases. These changes were modest and did not translate to increased risk for crossing the abnormality threshold.
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Affiliation(s)
- Juraj Sprung
- Address correspondence to: Juraj Sprung, MD, PhD, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. E-mail:
| | - Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Michelle M Mielke
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David P Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew C Hanson
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Darrell R Schroeder
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Phillip J Schulte
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott A Przybelski
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Fautsch KJ, Block DR, Graff-Radford J, Wang F, Craver EC, Hodge DO, Cutsforth-Gregory JK, Kilgore KP, Petersen RC, Knopman DS, Flanagan E, Toledano M, Mielke MM, Bhatti MT, Chen JJ. Population-Based Evaluation of Total Protein in Cerebrospinal Fluid. Mayo Clin Proc 2023; 98:239-251. [PMID: 36737114 PMCID: PMC10134077 DOI: 10.1016/j.mayocp.2022.10.012] [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: 03/07/2022] [Revised: 08/23/2022] [Accepted: 10/07/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To present a normal range of cerebrospinal fluid (CSF) protein levels in a community-based population and to evaluate factors that contribute to CSF protein level variability. PATIENTS AND METHODS Samples of CSF protein were obtained from participants aged 32 to 95 years who underwent lumbar puncture (LP) between November 1, 2007, and October 1, 2017, as part of the Mayo Clinic Study of Aging, a longitudinal, population-based study of residents of Olmsted County, Minnesota. RESULTS A total of 633 participants (58.1% male; 99.1% White; mean ± SD age, 70.9±11.6 years) underwent LP with recorded CSF protein level. Mean ± SD CSF protein level was 52.2±18.4 mg/dL (to convert to mg/L, multiply by 10), with a 95% reference interval of 24.0 to 93.4 mg/dL (range, 14.0-148.0 mg/dL). Spinal stenosis and arterial hypertension were associated with higher CSF protein levels on univariable analysis (P<.001). Increasing age, male sex, and diabetes were all independently associated with higher CSF protein levels on multivariable analysis (P<.001). In the 66 participants with repeated LPs within 2.5 years, the coefficient of repeatability was 26.1 mg/dL. Eleven participants (16.7%) had a CSF protein level difference of 20 mg/dL or more between serial LPs, and 4 (6.1%) had a difference of 25 mg/dL or more. There was a trend toward greater CSF protein level variability in patients with spinal stenosis (P=.054). CONCLUSION This large population-based study showed that CSF protein level can vary significantly among individuals. Elevated CSF protein level was independently associated with older age, male sex, and diabetes and is higher than listed in many laboratories. These findings emphasize the necessity of evidence-based reevaluation and standardization of CSF protein metrics.
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Affiliation(s)
- Kalli J Fautsch
- Department of Ophthalmology, Mayo Clinic, Rochester, MN; University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
| | - Darci R Block
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Feng Wang
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
| | - Emily C Craver
- Department of Quantitative Health Sciences/Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
| | - David O Hodge
- Department of Quantitative Health Sciences/Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | | | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN; Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic, Rochester, MN
| | - M Tariq Bhatti
- Department of Ophthalmology, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN.
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Lilek J, Ajroud K, Feldman AZ, Krishnamachari S, Ghourchian S, Gefen T, Spencer CL, Kawles A, Mao Q, Tranovich JF, Jack CR, Mesulam MM, Reichard RR, Zhang H, Murray ME, Knopman D, Dickson DW, Petersen RC, Smith B, Ashe KH, Mielke MM, Nelson KM, Flanagan ME. Accumulation of pTau231 at the Postsynaptic Density in Early Alzheimer's Disease. J Alzheimers Dis 2023; 92:241-260. [PMID: 36744338 PMCID: PMC10041451 DOI: 10.3233/jad-220848] [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: 12/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Phosphorylated cytoplasmic tau inclusions correlate with and precede cognitive deficits in Alzheimer's disease (AD). However, pathological tau accumulation and relationships to synaptic changes remain unclear. OBJECTIVE To address this, we examined postmortem brain from 50 individuals with the full spectrum of AD (clinically and neuropathologically). Total tau, pTau231, and AMPA GluR1 were compared across two brain regions (entorhinal and middle frontal cortices), as well as clinically stratified groups (control, amnestic mild cognitive impairment, AD dementia), NIA-AA Alzheimer's Disease Neuropathologic Change designations (Not, Low, Intermediate, High), and Braak tangle stages (1-6). Significant co-existing pathology was excluded to isolate changes attributed to pathologic AD. METHODS Synaptosomal fractionation and staining were performed to measure changes in total Tau, pTau231, and AMPA GluR1. Total Tau and pTau231 were quantified in synaptosomal fractions using Quanterix Simoa HD-X. RESULTS Increasing pTau231 in frontal postsynaptic fractions correlated positively with increasing clinical and neuropathological AD severity. Frontal cortex is representative of early AD, as it does not become involved by tau tangles until late in AD. Entorhinal total tau was significantly higher in the amnestic mild cognitive impairment group when compared to AD, but only after accounting for AD associated synaptic changes. Alterations in AMPA GluR1 observed in the entorhinal cortex, but not middle frontal cortex, suggest that pTau231 mislocalization and aggregation in postsynaptic structures may impair glutamatergic signaling by promoting AMPA receptor dephosphorylation and internalization. CONCLUSION Results highlight the potential effectiveness of early pharmacological interventions targeting pTau231 accumulation at the postsynaptic density.
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Affiliation(s)
- Jaclyn Lilek
- Department of Pathology, Northwestern University, Illinois, USA
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
| | - Kaouther Ajroud
- Department of Pathology, Northwestern University, Illinois, USA
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
| | | | | | | | - Tamar Gefen
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Illinois, USA
| | - Callen L. Spencer
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
| | - Allegra Kawles
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
| | - Qinwen Mao
- Department of Pathology, Northwestern University, Illinois, USA
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
| | | | | | - M-Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
- Department of Neurology, Northwestern University, Illinois, USA
| | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Minnesota, USA
| | - Hui Zhang
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
- Division of Biostatistics, Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Illinois, USA
| | | | - David Knopman
- Department of Neurology, Mayo Clinic, Minnesota, USA
| | | | | | - Benjamin Smith
- Department of Neurology, University of Minnesota, Minnesota, USA
- N. Bud Grossman Center for Memory Research and Care, University of Minnesota, Minnesota, USA
| | - Karen H. Ashe
- Department of Neurology, University of Minnesota, Minnesota, USA
- N. Bud Grossman Center for Memory Research and Care, University of Minnesota, Minnesota, USA
- Institute for Translational Neuroscience, University of Minnesota, Minnesota, USA
- Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Minnesota, USA
| | - Michelle M. Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kathryn M. Nelson
- Department of Medicinal Chemistry, Institute for Therapeutics Discovery and Development, University of Minnesota, Minnesota, USA
| | - Margaret E. Flanagan
- Department of Pathology, Northwestern University, Illinois, USA
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
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Kodishala C, Hulshizer CA, Kronzer VL, Davis JM, Ramanan VK, Vassilaki M, Mielke MM, Crowson CS, Myasoedova E. Risk Factors for Dementia in Patients With Incident Rheumatoid Arthritis: A Population-Based Cohort Study. J Rheumatol 2023; 50:48-55. [PMID: 35840149 PMCID: PMC9812854 DOI: 10.3899/jrheum.220200] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 06/30/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Growing evidence suggests that patients with rheumatoid arthritis (RA) have increased risk for dementia. We assessed risk factors for incident dementia in an inception cohort of patients with RA. METHODS This retrospective population-based cohort study included residents of 8 counties in Minnesota who were ≥ 50 years of age when they met 1987 American College of Rheumatology criteria for incident RA between 1980 and 2014 and were followed until death/migration or December 31, 2019. Patients with dementia before RA incidence were excluded. Incident dementia was defined as 2 relevant International Classification of Diseases, 9th or 10th revision codes at least 30 days apart. Data on sociodemographics, disease characteristics, cardiovascular/cerebrovascular disease (CVD) risk factors, and comorbidities were abstracted from medical records. RESULTS The study included 886 patients with RA (mean age 65.1 yrs, 65.2% female). During the follow-up period (median 8.5 yrs), 103 patients developed dementia. After adjusting for age, sex, and calendar year of RA incidence, older age at RA incidence (HR 1.14 per 1 year increase, 95% CI 1.12-1.17), rheumatoid nodules (HR 1.76, 95% CI 1.05-2.95), hypertension (HR 1.84, 95% CI 1.19-2.85), presence of large joint swelling (HR 2.03, 95% CI 1.14-3.60), any CVD (HR 2.25, 95% CI 1.38-3.66), particularly ischemic stroke (HR 3.16, 95% CI 1.84-5.43) and heart failure (HR 1.82, 95% CI 1.10-3.00), anxiety (HR 1.86, 95% CI 1.16-2.97), and depression (HR 2.63, 95% CI 1.76-3.93) were associated with increased risk of dementia. After adjusting for CVD risk factors and any CVD, all covariates listed above were still significantly associated with risk of dementia. CONCLUSION Apart from age, hypertension, depression, and anxiety, all of which are universally recognized risk factors for dementia, clinically active RA and presence of CVD were associated with an elevated risk of dementia incidence among patients with RA.
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Affiliation(s)
- Chanakya Kodishala
- C. Kodishala, MBBS, DM, V.L. Kronzer, MD, MSCI, J.M. Davis III, MD, Division of Rheumatology, Mayo Clinic
| | | | - Vanessa L Kronzer
- C. Kodishala, MBBS, DM, V.L. Kronzer, MD, MSCI, J.M. Davis III, MD, Division of Rheumatology, Mayo Clinic
| | - John M Davis
- C. Kodishala, MBBS, DM, V.L. Kronzer, MD, MSCI, J.M. Davis III, MD, Division of Rheumatology, Mayo Clinic
| | | | - Maria Vassilaki
- M. Vassilaki, MD, PhD, Department of Quantitative Health Sciences, Mayo Clinic
| | - Michelle M Mielke
- M.M. Mielke, PhD, Department of Quantitative Health Sciences, Department of Neurology, Mayo Clinic
| | - Cynthia S Crowson
- C.S. Crowson, PhD, Division of Rheumatology, Department of Quantitative Health Sciences, Mayo Clinic
| | - Elena Myasoedova
- E. Myasoedova, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
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Shir D, Mielke MM, Hofrenning EI, Lesnick TG, Knopman DS, Petersen RC, Jack CR, Algeciras-Schimnich A, Vemuri P, Graff-Radford J. Associations of Neurodegeneration Biomarkers in Cerebrospinal Fluid with Markers of Alzheimer's Disease and Vascular Pathology. J Alzheimers Dis 2023; 92:887-898. [PMID: 36806507 PMCID: PMC10193844 DOI: 10.3233/jad-221015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND The National Institute on Aging-Alzheimer's Association Research Framework proposes defining Alzheimer's disease by grouping imaging and fluid biomarkers by their respective pathologic processes. The AT(N) structure proposes several neurodegenerative fluid biomarkers (N) including total tau (t-tau), neurogranin (Ng), and neurofilament light chain (NfL). However, pathologic drivers influencing each biomarker remain unclear. OBJECTIVE To determine whether cerebrospinal fluid (CSF)-neurodegenerative biomarkers (N) map differentially to Alzheimer's disease pathology measured by Aβ42 (an indicator of amyloidosis, [A]), p-tau (an indicator of tau deposition, [T]), and MRI vascular pathology indicators (measured by white-matter integrity, infarcts, and microbleeds [V]). METHODS Participants were from Mayo Clinic Study of Aging (MCSA) with CSF measures of NfL, Ng, t-tau, Aβ42, and p-tau and available MRI brain imaging. Linear models assessed associations between CSF neurodegeneration (N) markers, amyloid markers (A), tau (T), and vascular pathology (V). RESULTS Participants (n = 408) had a mean age of 69.2±10.7; male, 217 (53.2%); cognitively unimpaired, 359 (88%). All three neurodegeneration biomarkers correlated with age (p < 0.001 for NfL and t-tau, p = 0.018 for Ng). Men had higher CSF-NfL levels; women had higher Ng (p < 0.001). NfL and t-tau levels correlated with infarcts (p = 0.009, p = 0.034 respectively); no biomarkers correlated with white-matter integrity. N biomarkers correlated with p-tau levels (T, p < 0.001). Higher Aβ42 levels associated with higher N-biomarker levels but only among cognitively unimpaired (A, p < 0.001). CONCLUSION The influence of vascular pathology in the general population on CSF (N) biomarkers is modest, with greater influence of infarcts than white-matter disruption. Neurodegeneration markers more closely correlated with tau than amyloid markers.
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Affiliation(s)
- Dror Shir
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota 55905, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, 27101
| | | | - Timothy G. Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - David S. Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Ronald C. Petersen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Clifford R. Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Murray ME, Moloney CM, Kouri N, Syrjanen JA, Matchett BJ, Rothberg DM, Tranovich JF, Sirmans TNH, Wiste HJ, Boon BDC, Nguyen AT, Reichard RR, Dickson DW, Lowe VJ, Dage JL, Petersen RC, Jack CR, Knopman DS, Vemuri P, Graff-Radford J, Mielke MM. Global neuropathologic severity of Alzheimer's disease and locus coeruleus vulnerability influences plasma phosphorylated tau levels. Mol Neurodegener 2022; 17:85. [PMID: 36575455 PMCID: PMC9795667 DOI: 10.1186/s13024-022-00578-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/26/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Advances in ultrasensitive detection of phosphorylated tau (p-tau) in plasma has enabled the use of blood tests to measure Alzheimer's disease (AD) biomarker changes. Examination of postmortem brains of participants with antemortem plasma p-tau levels remains critical to understanding comorbid and AD-specific contribution to these biomarker changes. METHODS We analyzed 35 population-based Mayo Clinic Study of Aging participants with plasma p-tau at threonine 181 and threonine 217 (p-tau181, p-tau217) available within 3 years of death. Autopsied participants included cognitively unimpaired, mild cognitive impairment, AD dementia, and non-AD neurodegenerative disorders. Global neuropathologic scales of tau, amyloid-β, TDP-43, and cerebrovascular disease were examined. Regional digital pathology measures of tau (phosphorylated threonine 181 and 217 [pT181, pT217]) and amyloid-β (6F/3D) were quantified in hippocampus and parietal cortex. Neurotransmitter hubs reported to influence development of tangles (nucleus basalis of Meynert) and amyloid-β plaques (locus coeruleus) were evaluated. RESULTS The strongest regional associations were with parietal cortex for tau burden (p-tau181 R = 0.55, p = 0.003; p-tau217 R = 0.66, p < 0.001) and amyloid-β burden (p-tau181 R = 0.59, p < 0.001; p-tau217 R = 0.71, p < 0.001). Linear regression analysis of global neuropathologic scales explained 31% of variability in plasma p-tau181 (Adj. R2 = 0.31) and 59% in plasma p-tau217 (Adj. R2 = 0.59). Neither TDP-43 nor cerebrovascular disease global scales independently contributed to variability. Global scales of tau pathology (β-coefficient = 0.060, p = 0.016) and amyloid-β pathology (β-coefficient = 0.080, p < 0.001) independently predicted plasma p-tau217 when modeled together with co-pathologies, but only amyloid-β (β-coefficient = 0.33, p = 0.021) significantly predicted plasma p-tau181. While nucleus basalis of Meynert neuron count/mm2 was not associated with plasma p-tau levels, a lower locus coeruleus neuron count/mm2 was associated with higher plasma p-tau181 (R = -0.50, p = 0.007) and higher plasma p-tau217 (R = -0.55, p = 0.002). Cognitive scores (Adj. R2 = 0.25-0.32) were predicted by the global tau scale, but not by the global amyloid-β scale or plasma p-tau when modeled simultaneously. CONCLUSIONS Higher soluble plasma p-tau levels may be the result of an intersection between insoluble deposits of amyloid-β and tau accumulation in brain, and may be associated with locus coeruleus degeneration.
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Affiliation(s)
- Melissa E. Murray
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Christina M. Moloney
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Naomi Kouri
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Jeremy A. Syrjanen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Billie J. Matchett
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Darren M. Rothberg
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Jessica F. Tranovich
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Tiffany N. Hicks Sirmans
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Heather J. Wiste
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Baayla D. C. Boon
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Aivi T. Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Dennis W. Dickson
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN USA
| | - Jeffrey L. Dage
- Department of Neurology, Indiana University, Indianapolis, IN USA
| | | | | | | | | | | | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
- Wake Forest University School of Medicine, Winston-Salem, NC USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, 525 Vine, 5th floor, Winston-Salem, NC 27157 USA
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Stricker NH, Twohy EL, Albertson SM, Karstens AJ, Kremers WK, Machulda MM, Fields JA, Jack CR, Knopman DS, Mielke MM, Petersen RC. Mayo-PACC: A parsimonious preclinical Alzheimer's disease cognitive composite comprised of public-domain measures to facilitate clinical translation. Alzheimers Dement 2022. [PMID: 36565459 DOI: 10.1002/alz.12895] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We aimed to define a Mayo Preclinical Alzheimer's disease Cognitive Composite (Mayo-PACC) that prioritizes parsimony and use of public domain measures to facilitate clinical translation. METHODS Cognitively unimpaired participants aged 65 to 85 at baseline with amyloid PET imaging were included, yielding 428 amyloid negative (A-) and 186 amyloid positive (A+) individuals with 7 years mean follow-up. Sensitivity to amyloid-related cognitive decline was examined using slope estimates derived from linear mixed models (difference in annualized change across A+ and A- groups). We compared differences in rates of change between Mayo-PACC and other composites (A+ > A- indicating more significant decline in A+). RESULTS All composites showed sensitivity to amyloid-related longitudinal cognitive decline (A+ > A- annualized change p < 0.05). Comparisons revealed that Mayo-PACC (AVLT sum of trials 1-5+6+delay, Trails B, animal fluency) showed comparable longitudinal sensitivity to other composites. DISCUSSION Mayo-PACC performs similarly to other composites and can be directly translated to the clinic.
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Affiliation(s)
- Nikki H Stricker
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin L Twohy
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Sabrina M Albertson
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Aimee J Karstens
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter K Kremers
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary M Machulda
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julie A Fields
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
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Stricker NH, Twohy EL, Albertson SM, Christianson TJ, Stricker JL, Machulda MM, Karstens AJ, Patel JS, Kremers WK, Hassenstab JJ, Jack CR, Knopman DS, Mielke MM, Petersen RC. Diagnostic accuracy of the Stricker Learning Span and Mayo Test Drive Composite for amnestic Mild Cognitive Impairment. Alzheimers Dement 2022. [DOI: 10.1002/alz.063190] [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]
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Warner NS, Hanson AC, Schulte PJ, Habermann EB, Warner DO, Mielke MM. Prescription opioids and longitudinal changes in cognitive function in older adults: A population-based observational study. J Am Geriatr Soc 2022; 70:3526-3537. [PMID: 36117241 PMCID: PMC9771934 DOI: 10.1111/jgs.18030] [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: 04/05/2022] [Revised: 07/27/2022] [Accepted: 08/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Opioids are frequently prescribed to alleviate pain in older adults, yet the relationships between prescription opioids and long-term cognitive function are unclear. METHODS In this analysis of the Mayo Clinic Study of Aging, a longitudinal population-based cohort study of older adults with formal neuropsychological testing and cognitive evaluations performed every 15 months, the associations between prescription opioids, global and domain-specific cognitive function, and mild cognitive impairment were evaluated through time-dependent linear mixed effects and Cox proportional hazards models. RESULTS Four thousand two hundred eighteen participants (51% male) were included with enrollment between 11/1/2004 and 4/1/2019 and median age of 76 (interquartile range 72, 82) years. Two thousand nine hundred seventy-seven subjects (71%) received at least 1 opioid prescription during a median follow-up of 7.5 (5.0, 10.7) years. Overall, there was an estimated 0.096 reduction in the global cognitive Z-score per year, including decreases of 0.050 in memory, 0.080 in language, 0.044 in visual-spatial cognition, and 0.112 in attention. In multivariable analyses, each receipt of an opioid prescription resulted in an additional -0.007 (95% CI -0.009, -0.005) change in global cognitive Z-score (p < 0.001), with significant effects seen in the domains of memory (-0.005, 95% CI -0.007, -0.003; p < 0.001), language (-0.002, 95% CI -0.003, 0.000; p = 0.024) and attention (-0.004, 95% CI -0.006, -0.002; p < 0.001) but not visual-spatial function (0.000, 95% CI -0.001, 0.001; p = 0.897). Opioid prescriptions were associated with incident mild cognitive impairment (MCI) in adjusted analysis (hazard ratio 1.21, 95% CI 1.04, 1.42; p = 0.014). CONCLUSION Prescription opioids are associated with small but statistically significant declines in long-term cognitive function in older adults, which may represent effects of opioids or other related factors.
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Affiliation(s)
- Nafisseh S. Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Andrew C. Hanson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Elizabeth B. Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - David O. Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
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Nguyen AT, Kouri N, Labuzan SA, Przybelski SA, Lesnick TG, Raghavan S, Reid RI, Reichard RR, Knopman DS, Petersen RC, Jack CR, Mielke MM, Dickson DW, Graff-Radford J, Murray ME, Vemuri P. Neuropathologic scales of cerebrovascular disease associated with diffusion changes on MRI. Acta Neuropathol 2022; 144:1117-1125. [PMID: 35841412 PMCID: PMC9637622 DOI: 10.1007/s00401-022-02465-w] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 01/26/2023]
Abstract
Summarizing the multiplicity and heterogeneity of cerebrovascular disease (CVD) features into a single measure has been difficult in both neuropathology and imaging studies. The objective of this work was to evaluate the association between neuroimaging surrogates of CVD and two available neuropathologic CVD scales in those with both antemortem imaging CVD measures and postmortem CVD evaluation. Individuals in the Mayo Clinic Study of Aging with MRI scans within 5 years of death (N = 51) were included. Antemortem CVD measures were computed from diffusion MRI (dMRI), FLAIR, and T2* GRE imaging modalities and compared with postmortem neuropathologic findings using Kalaria and Strozyk Scales. Of all the neuroimaging measures, both regional and global dMRI measures were associated with Kalaria and Strozyk Scales (p < 0.05) and modestly correlated with global cognitive performance. The major conclusions from this study were: (i) microstructural white matter injury measurements using dMRI may be meaningful surrogates of neuropathologic CVD scales, because they aid in capturing diffuse (and early) changes to white matter and secondary neurodegeneration due to lesions; (ii) vacuolation in the corpus callosum may be associated with white matter changes measured on antemortem dMRI imaging; (iii) Alzheimer's disease neuropathologic change did not associate with neuropathologic CVD scales; and (iv) future work should be focused on developing better quantitative measures utilizing dMRI to optimally assess CVD-related neuropathologic changes.
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Affiliation(s)
- Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Naomi Kouri
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Sydney A Labuzan
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Scott A Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Timothy G Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Sheelakumari Raghavan
- Department of Radiology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Robert I Reid
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Clifford R Jack
- Department of Radiology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michelle M Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA.
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Fielding RA, Atkinson EJ, Aversa Z, White TA, Heeren AA, Achenbach SJ, Mielke MM, Cummings SR, Pahor M, Leeuwenburgh C, LeBrasseur NK. Associations between biomarkers of cellular senescence and physical function in humans: observations from the lifestyle interventions for elders (LIFE) study. GeroScience 2022; 44:2757-2770. [PMID: 36367600 PMCID: PMC9768064 DOI: 10.1007/s11357-022-00685-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022] Open
Abstract
Cellular senescence is a plausible mediator of age-associated declines in physical performance. To test this premise, we examined cross-sectional associations between circulating components of the senescence-associated secretory phenotype (SASP) and measures of physical function and muscle strength in 1377 older adults. We showed significant associations between multiple SASP proteins and the short physical performance battery (SPPB), its subcomponents (gait speed, balance, chair rise time), and 400-m walk time. Activin A, ICAM1, MMP7, VEGFA, and eotaxin showed strong associations based on gradient boost machine learning (GBM), and, when combined with other proteins, effectively identified participants at the greatest risk for mobility disability (SPPB score [Formula: see text] 7). Senescence biomarkers were also associated with lower grip strength, and GBM identified PARC, ADAMTS13, and RANTES as top candidates in females, and MMP2, SOST, and MCP1 in males. These findings highlight an association between senescence biomarkers and physical performance in older adults. ClinicalTrials.gov Identifier: NCT01072500.
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Affiliation(s)
- Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA
| | | | - Zaira Aversa
- Robert and Arlene Kogod Center On Aging, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Thomas A White
- Robert and Arlene Kogod Center On Aging, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Amanda A Heeren
- Robert and Arlene Kogod Center On Aging, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sara J Achenbach
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Cummings
- Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Marco Pahor
- Institute On Aging, University of Florida, Gainesville, FL, USA
| | | | - Nathan K LeBrasseur
- Robert and Arlene Kogod Center On Aging, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
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Hansson O, Edelmayer RM, Boxer AL, Carrillo MC, Mielke MM, Rabinovici GD, Salloway SP, Sperling RA, Zetterberg H, Teunissen CE. The Alzheimer's Association Appropriate Use Recommendations for Blood Biomarkers in Alzheimer’s Disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.070020] [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)
- Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Mälmo, Lund University Malmö Sweden
- Memory Clinic, Skåne University Hospital Malmö Sweden
| | | | - Adam L. Boxer
- Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco San Francisco CA USA
| | | | | | - Gil D. Rabinovici
- Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco San Francisco CA USA
| | | | - Reisa A. Sperling
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Massachusetts General Hospital, Harvard Medical School Boston MA USA
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital Mölndal Sweden
- UK Dementia Research Institute at UCL London United Kingdom
- UCL Institute of Neurology, Queen Square London United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay Hong Kong China
| | - Charlotte E. Teunissen
- Neurochemistry Lab, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam Netherlands
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Stricker NH, Twohy EL, Albertson SM, Christianson TJ, Stricker JL, Machulda MM, Karstens AJ, Kremers WK, Hassenstab JJ, Jack CR, Knopman DS, Mielke MM, Petersen RC. Convergent and criterion validity of a computer adaptive self‐administered word list memory test and the Mayo Test Drive composite: correlations with traditional measures and group difference by PET imaging biomarker status in persons without dementia. Alzheimers Dement 2022. [DOI: 10.1002/alz.063723] [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]
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48
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Patel JS, Christianson TJ, Karstens AJ, Stricker JL, Kremers WK, Jack CR, Knopman DS, Mielke MM, Petersen RC, Stricker NH. An examination of the usability of the Mayo Test Drive remote cognitive testing platform in older adults with and without cognitive impairment. Alzheimers Dement 2022; 18 Suppl 2:e063691. [DOI: 10.1002/alz.063691] [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]
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49
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Hansson O, Edelmayer RM, Boxer AL, Carrillo MC, Mielke MM, Rabinovici GD, Salloway S, Sperling R, Zetterberg H, Teunissen CE. The Alzheimer's Association appropriate use recommendations for blood biomarkers in Alzheimer's disease. Alzheimers Dement 2022; 18:2669-2686. [PMID: 35908251 PMCID: PMC10087669 DOI: 10.1002/alz.12756] [Citation(s) in RCA: 142] [Impact Index Per Article: 71.0] [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: 05/11/2022] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 01/31/2023]
Abstract
Blood-based markers (BBMs) have recently shown promise to revolutionize the diagnostic and prognostic work-up of Alzheimer's disease (AD), as well as to improve the design of interventional trials. Here we discuss in detail further research needed to be performed before widespread use of BBMs. We already now recommend use of BBMs as (pre-)screeners to identify individuals likely to have AD pathological changes for inclusion in trials evaluating disease-modifying therapies, provided the AD status is confirmed with positron emission tomography (PET) or cerebrospinal fluid (CSF) testing. We also encourage studying longitudinal BBM changes in ongoing as well as future interventional trials. However, BBMs should not yet be used as primary endpoints in pivotal trials. Further, we recommend to cautiously start using BBMs in specialized memory clinics as part of the diagnostic work-up of patients with cognitive symptoms and the results should be confirmed whenever possible with CSF or PET. Additional data are needed before use of BBMs as stand-alone diagnostic AD markers, or before considering use in primary care.
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Affiliation(s)
- Oskar Hansson
- ClinicalMemory Research UnitDepartment of Clinical Sciences MalmöLund UniversityMalmöSweden
- Memory ClinicSkåne University HospitalMalmöSweden
| | | | - Adam L. Boxer
- Department of NeurologyUniversity of California San FranciscoMemory and Aging CenterSan FranciscoCaliforniaUSA
| | | | - Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Gil D. Rabinovici
- Department of NeurologyUniversity of California San FranciscoMemory and Aging CenterSan FranciscoCaliforniaUSA
| | - Stephen Salloway
- Departments of Neurology and PsychiatryAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Reisa Sperling
- Centerfor Alzheimer Research and TreatmentBrigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Henrik Zetterberg
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologyThe Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
- Department of Neurodegenerative DiseaseUCL Institute of NeurologyQueen SquareLondonUK
- UK Dementia Research Institute at UCLLondonUK
- Hong Kong Center for Neurodegenerative DiseasesClear Water BayHong KongPeople's Republic of China
| | - Charlotte E. Teunissen
- NeurochemistryLaboratoryDepartment of Clinical ChemistryAmsterdam University Medical CentersVrije UniversiteitAmsterdam NeuroscienceAmsterdamthe Netherlands
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50
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Graff‐Radford J, Mielke MM, Hofrenning EI, Kouri N, Lesnick T, Moloney CM, Rabinstein A, Cabrera‐Rodriguez JN, Rothberg DM, Przybelski SA, Petersen RC, Knopman DS, Dickson DW, Nguyen AT, Murray ME, Vemuri P. Plasma Biomarkers of Amyloid and Neurodegeneration predictive of Neuropathologic Scales of Cerebrovascular Disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.067350] [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]
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