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Beydoun MA, Beydoun HA, Hu YH, El-Hajj ZW, Georgescu MF, Noren Hooten N, Li Z, Weiss J, Lyall DM, Waldstein SR, Hedges DW, Gale SD, Launer LJ, Evans MK, Zonderman AB. Helicobacter pylori, persistent infection burden and structural brain imaging markers. Brain Commun 2024; 6:fcae088. [PMID: 38529358 PMCID: PMC10961948 DOI: 10.1093/braincomms/fcae088] [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: 03/28/2023] [Revised: 01/11/2024] [Accepted: 03/11/2024] [Indexed: 03/27/2024] Open
Abstract
Persistent infections, whether viral, bacterial or parasitic, including Helicobacter pylori infection, have been implicated in non-communicable diseases, including dementia and other neurodegenerative diseases. In this cross-sectional study, data on 635 cognitively normal participants from the UK Biobank study (2006-21, age range: 40-70 years) were used to examine whether H. pylori seropositivity (e.g. presence of antibodies), serointensities of five H. pylori antigens and a measure of total persistent infection burden were associated with selected brain volumetric structural MRI (total, white, grey matter, frontal grey matter (left/right), white matter hyperintensity as percent intracranial volume and bi-lateral sub-cortical volumes) and diffusion-weighted MRI measures (global and tract-specific bi-lateral fractional anisotropy and mean diffusivity), after an average 9-10 years of lag time. Persistent infection burden was calculated as a cumulative score of seropositivity for over 20 different pathogens. Multivariable-adjusted linear regression analyses were conducted, whereby selected potential confounders (all measures) and intracranial volume (sub-cortical volumes) were adjusted, with stratification by Alzheimer's disease polygenic risk score tertile when exposures were H. pylori antigen serointensities. Type I error was adjusted to 0.007. We report little evidence of an association between H. pylori seropositivity and persistent infection burden with various volumetric outcomes (P > 0.007, from multivariable regression models), unlike previously reported in past research. However, H. pylori antigen serointensities, particularly immunoglobulin G against the vacuolating cytotoxin A, GroEL and outer membrane protein antigens, were associated with poorer tract-specific white matter integrity (P < 0.007), with outer membrane protein serointensity linked to worse outcomes in cognition-related tracts such as the external capsule, the anterior limb of the internal capsule and the cingulum, specifically at low Alzheimer's disease polygenic risk. Vacuolating cytotoxin A serointensity was associated with greater white matter hyperintensity volume among individuals with mid-level Alzheimer's disease polygenic risk, while among individuals with the highest Alzheimer's disease polygenic risk, the urease serointensity was consistently associated with reduced bi-lateral caudate volumes and the vacuolating cytotoxin A serointensity was linked to reduced right putamen volume (P < 0.007). Outer membrane protein and urease were associated with larger sub-cortical volumes (e.g. left putamen and right nucleus accumbens) at middle Alzheimer's disease polygenic risk levels (P < 0.007). Our results shed light on the relationship between H. pylori seropositivity, H. pylori antigen levels and persistent infection burden with brain volumetric structural measures. These data are important given the links between infectious agents and neurodegenerative diseases, including Alzheimer's disease, and can be used for the development of drugs and preventive interventions that would reduce the burden of those diseases.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Yi-Han Hu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Ziad W El-Hajj
- Department of Biology, McGill University, Montreal, QC H3A 1B1, Canada
| | - Michael F Georgescu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Zhiguang Li
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA 94305, USA
| | - Donald M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, Scotland, UK
| | - Shari R Waldstein
- Department of Psychology, University of Maryland, Catonsville, MD 21250, USA
- Division of Gerontology, Geriatrics, and Palliative Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA
| | - Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
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Cole KL, Boehme AK, Thacker EL, Longstreth WT, Brown BL, Gale SD, Hedges DW, Anderson JK, Elkind MS. Hospital-Acquired Infection at Time of Stroke and Cognitive Decline: The Cardiovascular Health Study. Cerebrovasc Dis 2023:000533568. [PMID: 37871579 PMCID: PMC11035480 DOI: 10.1159/000533568] [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: 03/06/2023] [Accepted: 08/09/2023] [Indexed: 10/25/2023] Open
Abstract
Introduction Hospital-acquired infections (HAIs) after stroke are associated with additional morbidity and mortality, but whether HAIs increase long-term cognitive decline in stroke patients is unknown. We hypothesized that older adults with incident stroke with HAI experience faster cognitive decline than those having stroke without HAI and those without stroke. Methods We performed a longitudinal analysis in the population-based prospective Cardiovascular Health Study. Medicare-eligible participants aged >65 years with and without incident stroke had cognition assessed annually. HAIs were assessed by hospital discharge codes. Global cognitive function was assessed annually by Modified Mini-Mental State Examination (3MSE) and executive function by Digit Symbol Substitution Test (DSST). We used linear mixed models to estimate the mean decline and 95% confidence intervals (95% CI) for 3MSE and DSST scores by incident stroke and HAI status, adjusted for demographics and vascular risk factors. Results Among 5,443 participants >65 years without previous history of stroke, 393 participants had stroke with HAI (SI), 766 had a stroke only (SO), and 4,284 had no stroke (NS) throughout a maximum 9-year follow-up. For 3MSE, compared with NS participants, SO participants had a similar adjusted mean decline (additional 0.08 points/year, 95%CI -0.15, 0.31), while SI participants had a more rapid decline (additional 0.28 points/year, 95%CI 0.16, 0.40). Adjusted mean decline was 0.20 points/year faster (95%CI -0.05, 0.45) among SI than SO participants. For DSST, compared with NS participants, SO participants had a faster adjusted mean decline (additional 0.17 points/year (95%CI 0.003, 0.33), as did SI participants (additional 0.27 points/year (95%CI 0.19, 0.35). Conclusion Stroke, when accompanied by HAI, leads to a faster long-term decline in cognitive ability than in those without stroke. The clinical and public health implications of the effect of infection on post-stroke cognitive decline warrant further attention.
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Affiliation(s)
- Kyril L. Cole
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Amelia K. Boehme
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Evan L. Thacker
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | - William T. Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle, WA, USA
| | - Bruce L. Brown
- Department of Psychology and the Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Shawn D. Gale
- Department of Psychology and the Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Dawson W. Hedges
- Department of Psychology and the Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Jacqueline K. Anderson
- Department of Public Health, Brigham Young University, Provo, UT, USA
- Department of Psychology and the Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Mitchell S.V. Elkind
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Beydoun MA, Beydoun HA, Gale SD, Hedges D, Weiss J, Li Z, Erickson LD, Noren Hooten N, Launer LJ, Evans MK, Zonderman AB. Cardiovascular health, infection burden and their interactive association with brain volumetric and white matter integrity outcomes in the UK Biobank. Brain Behav Immun 2023; 113:91-103. [PMID: 37393057 PMCID: PMC11040741 DOI: 10.1016/j.bbi.2023.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/31/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Cardiovascular health is associated with brain magnetic resonance imaging (MRI) markers of pathology and infections may modulate this association. METHODS Using data from 38,803 adults (aged 40-70 years) and followed-up for 5-15 years, we tested associations of prevalent total (47.5%) and hospital-treated infection burden (9.7%) with brain structural and diffusion-weighted MRI (i.e., sMRI and dMRI, respectively) common in dementia phenome. Poor white matter tissue integrity was operationalized with lower global and tract-specific fractional anisotropy (FA) and higher mean diffusivity (MD). Volumetric sMRI outcomes included total, gray matter (GM), white matter (WM), frontal bilateral GM, white matter hyperintensity (WMH), and selected based on previous associations with dementia. Cardiovascular health was measured with Life's Essential 8 score (LE8) converted to tertiles. Multiple linear regression models were used, adjusting for intracranial volumes (ICV) for subcortical structures, and for demographic, socio-economic, and the Alzheimer's Disease polygenic risk score for all outcomes, among potential confounders. RESULTS In fully adjusted models, hospital-treated infections were inversely related to GM (β ± SE: -1042 ± 379, p = 0.006) and directly related to WMH as percent of ICV (Loge transformed) (β ± SE:+0.026 ± 0.007, p < 0.001). Both total and hospital-treated infections were associated with poor WMI, while the latter was inversely related to FA within the lowest LE8 tertile (β ± SE:-0.0011 ± 0.0003, p < 0.001, PLE8×IB < 0.05), a pattern detected for GM, Right Frontal GM, left accumbens and left hippocampus volumes. Within the uppermost LE8 tertile, total infection burden was linked to smaller right amygdala while being associated with larger left frontal GM and right putamen volumes, in the overall sample. Within that uppermost tertile of LE8, caudate volumes were also positively associated with hospital-treated infections. CONCLUSIONS Hospital-treated infections had more consistent deleterious effects on volumetric and white matter integrity brain neuroimaging outcomes compared with total infectious burden, particularly in poorer cardiovascular health groups. Further studies are needed in comparable populations, including longitudinal studies with multiple repeats on neuroimaging markers.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, United States.
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States
| | - Shawn D Gale
- Department of Psychology and the Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Dawson Hedges
- Department of Psychology and the Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA, United States
| | - Zhiguang Li
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, United States
| | - Lance D Erickson
- Department of Sociology, Brigham Young University, Provo, UT, United States
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, United States
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, United States
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, United States
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, United States
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Merkley TL, Halter C, Graul B, Gale SD, Junge C, Reading M, Jarvis S, Greer K, Squires C, Bigler ED, Taylor HG, Vannatta K, Gerhardt CA, Rubin KH, Stancin T, Yeates KO, Cobia D. Regional Cortical Thickness Correlates of Intellectual Abilities Differ in Children With Traumatic Brain Injury Versus Those With Orthopedic Injury in the Chronic Post-Injury Phase. J Neurotrauma 2023; 40:2063-2072. [PMID: 37294204 PMCID: PMC10623066 DOI: 10.1089/neu.2022.0524] [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: 06/10/2023] Open
Abstract
A decline in intellectual functioning (intelligence quotient [IQ]) is often observed following more severe forms of traumatic brain injury (TBI) and is a useful index for long-term outcome. Identifying brain correlates of IQ can serve to inform developmental trajectories of behavior in this population. Using magnetic resonance imaging (MRI), we examined the relationship between intellectual abilities and patterns of cortical thickness in children with a history of TBI or with orthopedic injury (OI) in the chronic phase of injury recovery. Participants were 47 children with OI and 58 children with TBI, with TBI severity ranging from complicated-mild to severe. Ages ranged from 8 to 14 years old, with an average age of 10.47 years, and an injury-to-test range of ∼1-5 years. The groups did not differ in age or sex. The intellectual ability estimate (full-scale [FS]IQ-2) was derived from a two-form (Vocabulary and Matrix Reasoning subtests) Wechsler Abbreviated Scale of Intelligence (WASI). MRI data were processed using the FreeSurfer toolkit and harmonized across data collection sites using neuroComBat procedures, while holding demographic features (i.e., sex, socioeconomic status [SES]), TBI status, and FSIQ-2 constant. Separate general linear models per group (TBI and OI) and a single interaction model with all participants were conducted with all significant results withstanding correction for multiple comparisons via permutation testing. Intellectual ability was higher (p < 0.001) in the OI group (FSIQ-2 = 110.81) than in the TBI group (FSIQ-2 = 99.81). In children with OI, bi-hemispheric regions, including the right pre-central gyrus and precuneus and bilateral inferior temporal and left occipital areas were related to IQ, such that higher IQ was associated with thicker cortex in these regions. In contrast, only cortical thickness in the right pre-central gyrus and bilateral cuneus positively related to IQ in children with TBI. Significant interaction effects were found in the bilateral temporal, parietal, and occipital lobes and left frontal regions, indicating that the relationship between IQ and cortical thickness differed between groups in these regions. Changes in cortical associations with IQ after TBI may reflect direct injury effects and/or adaptation in cortical structure and intellectual functioning, particularly in the bilateral posterior parietal and inferior temporal regions. This suggests that the substrates of intellectual ability are particularly susceptible to acquired injury in the integrative association cortex. Longitudinal work is needed to account for normal developmental changes and to investigate how cortical thickness and intellectual functioning and their association change over time following TBI. Improved understanding of how TBI-related cortical thickness alterations relate to cognitive outcome could lead to improved predictions of outcome following brain injury.
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Affiliation(s)
- Tricia L. Merkley
- Department of Psychology and Brigham Young University, Provo, Utah, USA
- Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Colt Halter
- Department of Psychology and Brigham Young University, Provo, Utah, USA
| | - Benjamin Graul
- Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Shawn D. Gale
- Department of Psychology and Brigham Young University, Provo, Utah, USA
- Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Chase Junge
- Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Madeleine Reading
- Department of Psychology and Brigham Young University, Provo, Utah, USA
| | - Sierra Jarvis
- Department of Psychology and Brigham Young University, Provo, Utah, USA
| | - Kaitlyn Greer
- Department of Psychology and Brigham Young University, Provo, Utah, USA
| | - Chad Squires
- Department of Psychology and Brigham Young University, Provo, Utah, USA
| | - Erin D. Bigler
- Department of Psychology and Brigham Young University, Provo, Utah, USA
- Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - H. Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kathryn Vannatta
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia A. Gerhardt
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Kenneth H. Rubin
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Terry Stancin
- MetroHealth System, Case Western Reserve University, Cleveland, Ohio, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Derin Cobia
- Department of Psychology and Brigham Young University, Provo, Utah, USA
- Neuroscience Center, Brigham Young University, Provo, Utah, USA
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Erickson LD, White DS, Bassett P, Gale SD, Brown BL, Hedges D. Cognitive function in UK adults seropositive for Helicobacter pylori. PLoS One 2023; 18:e0286731. [PMID: 37285350 DOI: 10.1371/journal.pone.0286731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/22/2023] [Indexed: 06/09/2023] Open
Abstract
Associated with gastritis, peptic-ulcer disease, and gastric carcinoma, Helicobacter pylori (H. pylori) also has been associated with decreased cognitive function and dementia. In this study, we used data from the UK Biobank to further examine associations between H. pylori seropositivity and serointensity and performance on several cognitive tasks in adults 40 to 70 years of age (M = 55.3, SD = 8.1). In these analyses, H. pylori seropositivity (i.e., either positive or negative for H. pylori) and serointensity (concentration of antibodies against H. pylori antigens) in adjusted models were associated with worse function on tasks of Numeric memory, Reasoning, and errors on the Pairs matching test but better function on the Tower rearrangement task. Together, these findings suggest that H. pylori seropositivity and serointensity might be associated with worse cognitive function in this age group.
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Affiliation(s)
| | - David S White
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah
| | - Pierce Bassett
- The Neuroscience Center, Brigham Young University, Provo, Utah
| | - Shawn D Gale
- The Neuroscience Center, Brigham Young University, Provo, Utah
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Bruce L Brown
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Dawson Hedges
- The Neuroscience Center, Brigham Young University, Provo, Utah
- Department of Psychology, Brigham Young University, Provo, Utah
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Catchpole A, Zabriskie BN, Bassett P, Embley B, White D, Gale SD, Hedges D. Association between Toxoplasma gondii Infection and Type-1 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2023; 20:4436. [PMID: 36901457 PMCID: PMC10001633 DOI: 10.3390/ijerph20054436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
Type-1 diabetes, an autoimmune disease characterized by damage to pancreatic insulin-producing beta cells, is associated with adverse renal, retinal, cardiovascular, and cognitive outcomes, possibly including dementia. Moreover, the protozoal parasite Toxoplasma gondii has been associated with type-1 diabetes. To better characterize the association between type-1 diabetes and Toxoplasma gondii infection, we conducted a systematic review and meta-analysis of published studies that evaluated the relationship between type-1 diabetes and Toxoplasma gondii infection. A random-effects model based on nine primary studies (total number of participants = 2655) that met our inclusion criteria demonstrated a pooled odds ratio of 2.45 (95% confidence interval, 0.91-6.61). Removing one outlying study increased the pooled odds ratio to 3.38 (95% confidence interval, 2.09-5.48). These findings suggest that Toxoplasma gondii infection might be positively associated with type-1 diabetes, although more research is needed to better characterize this association. Additional research is required to determine whether changes in immune function due to type-1 diabetes increase the risk of infection with Toxoplasma gondii, infection with Toxoplasma gondii increases the risk of type-1 diabetes, or both processes occur.
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Affiliation(s)
- Ashley Catchpole
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA
| | | | - Pierce Bassett
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA
| | - Bradley Embley
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA
| | - David White
- The Department of Micro and Molecular Biology, Brigham Young University, Provo, UT 84602, USA
- The Department of Psychology, Brigham Young University, Provo, UT 84602, USA
| | - Shawn D. Gale
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA
- The Department of Psychology, Brigham Young University, Provo, UT 84602, USA
| | - Dawson Hedges
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA
- The Department of Psychology, Brigham Young University, Provo, UT 84602, USA
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Levan A, Fegter O, Gale SD. Social Skills Differences in Children with Epilepsy and Nonepileptic Seizures. Journal of Pediatric Epilepsy 2022. [DOI: 10.1055/s-0042-1750303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractResearch has shown that children experiencing epileptic seizures (ES) or non-ESs (NES) exhibit cognitive and behavioral deficits, but no research has examined social skills differences between the two groups. A better understanding of social skills differences between these two groups might allow for the development of more targeted interventions. The purpose of this study was to examine social skills differences between children with ES and children with NES, using the Social Skills Improvement Scale (SSIS). A total of 43 children were recruited from the epilepsy monitoring units at Phoenix Children's Hospital and Primary Children's Medical Center. The epilepsy group consisted of 28 participants (50% female, mean age at testing = 11.79, standard deviation [SD] = 3.12), and the NES group consisted of 15 participants (67% female; mean age at testing = 12.62, SD = 3.33). Parents and children completed the SSIS Rating Scales. No group differences were found between children with ES and children with NES on social skills measures. However, children in both groups rated their social skills as being in the average range, while parents of children in both groups rated their children's social skills as being in the below average range. Limitations to this study and directions for future research are discussed.
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Affiliation(s)
- Ashley Levan
- Department of Psychology, St. Louis Children's Hospital, St. Louis, Missouri, United States
| | - Ollie Fegter
- Department of Psychology, Brigham Young University, Provo, Utah, United States
| | - Shawn D. Gale
- Department of Psychology, Brigham Young University, Provo, Utah, United States
- The Neuroscience Center, Brigham Young University, Provo, Utah, United States
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Erickson LD, Hedges D, Stone A, Brown BL, Embley B, Gale SD. Association between toxocariasis seropositivity and serointensity and cognitive function in older U.S. adults. Folia Parasitol (Praha) 2022; 69. [DOI: 10.14411/fp.2022.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 03/12/2022] [Indexed: 11/19/2022]
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Gale SD, Erickson LD, Brown BL, Hedges DW. Cytomegalovirus is not associated with cognitive function in UK adults aged 40 to 70 years. Psychiatry Res 2022; 309:114410. [PMID: 35091160 DOI: 10.1016/j.psychres.2022.114410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 01/15/2022] [Accepted: 01/20/2022] [Indexed: 11/26/2022]
Abstract
Infecting much of the world's population, the herpesviridae virus cytomegalovirus has been associated with lower cognitive function in some but not all studies. In this study, we further investigate associations between cytomegalovirus and cognitive function in a community-based sample of adults aged 40 to 70 years (M = 55.3; SD = 8.1) from the United Kingdom. Adjusted multiple-regression modeling showed no significant associations between cytomegalovirus and performance on nine cognitive tasks. Further, in adjusted interaction models, age, sex, educational attainment, and income did not moderate associations between cytomegalovirus and cognitive function. In this community-based adult sample, cytomegalovirus was not associated with cognitive function.
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Affiliation(s)
- Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, UT, United States; The Neuroscience Center, Brigham Young University, Provo, UT, United States.
| | - Lance D Erickson
- Department of Sociology, Brigham Young University, Provo, UT, United States
| | - Bruce L Brown
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, UT, United States; The Neuroscience Center, Brigham Young University, Provo, UT, United States
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Erickson LD, Hedges DW, Brown BL, Embley B, Gale SD. Association between Cognitive Function and Depression with Human T-Cell Lymphotropic Virus 1 Seropositivity and Serointensity in UK Adults. Pathogens 2021; 10:pathogens10111409. [PMID: 34832565 PMCID: PMC8622850 DOI: 10.3390/pathogens10111409] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
Several viral, bacterial, and parasitic diseases have been associated with cognitive function and neuropsychiatric outcomes in humans, including human T-cell lymphotropic virus 1 (HTLV-1). In this study, we sought to further generalize previously reported associations of cognitive function and depression with HTLV-1 seropositivity and serointensity using a community-based sample of adults aged approximately 40 to 70 years (mean = 55.3 years) from the United Kingdom. In this sample, the results of adjusted linear regression models showed no associations of HTLV-1 seropositivity or serointensity with reasoning, pairs-matching, or reaction-time cognitive tasks or with depression. In addition, neither age, sex, educational attainment, nor income moderated associations of HTLV-1 seropositivity or serointensity with cognitive function or depression. In this middle-aged to older middle-aged adult community sample, HTLV-1 seropositivity and serointensity do not appear to be associated with reasoning, pairs-matching, and reaction-time tasks or with depression.
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Affiliation(s)
- Lance D. Erickson
- Department of Sociology, Brigham Young University, Provo, UT 84602, USA;
| | - Dawson W. Hedges
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (D.W.H.); (B.L.B.)
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA;
| | - Bruce L. Brown
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (D.W.H.); (B.L.B.)
| | - Bradley Embley
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA;
| | - Shawn D. Gale
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (D.W.H.); (B.L.B.)
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA;
- Correspondence: ; Tel.: +1-801-422-9757
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Gale SD, Erickson LD, Brown BL, Hedges DW. Examining the Relationship between Toxoplasma gondii and Seropositivity and Serointensity and Depression in Adults from the United Kingdom and the United States: A Cross-Sectional Study. Pathogens 2021; 10:pathogens10091101. [PMID: 34578136 PMCID: PMC8470860 DOI: 10.3390/pathogens10091101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/03/2022] Open
Abstract
Infecting approximately one-third of the world’s population, the neurotropic protozoan Toxoplasma gondii has been associated with cognition and several neuropsychiatric diseases including schizophrenia and bipolar disorder. Findings have been mixed, however, about the relationship between Toxoplasma gondii and depression, with some studies reporting positive associations and others finding no associations. To further investigate the association between Toxoplasma gondii and depression, we used data from the UK Biobank and the National Health and Examination Survey (NHANES). Results from adjusted multiple-regression modeling showed no significant associations between Toxoplasma gondii and depression in either the UK Biobank or NHANES datasets. Further, we found no significant interactions between Toxoplasma gondii and age, sex, educational attainment, and income in either dataset that affected the association between Toxoplasma gondii and depression. These results from two community-based datasets suggest that in these samples, Toxoplasma gondii is not associated with depression. Differences between our findings and other findings showing an association between Toxoplasma gondii and depression could be due to several factors including differences in socioeconomic variables, differences in Toxoplasma gondii strain, and use of different covariates in statistical modeling.
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Affiliation(s)
- Shawn D. Gale
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (B.L.B.); (D.W.H.)
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA
- Correspondence: ; Tel.: +1-801-422-9757
| | - Lance D. Erickson
- Department of Sociology, Brigham Young University, Provo, UT 84602, USA;
| | - Bruce L. Brown
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (B.L.B.); (D.W.H.)
| | - Dawson W. Hedges
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (B.L.B.); (D.W.H.)
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA
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Wall VL, Kestle JRW, Fulton JB, Gale SD. Social-emotional functioning in pediatric hydrocephalus: comparison of the Hydrocephalus Outcome Questionnaire to the Behavior Assessment System for Children. J Neurosurg Pediatr 2021; 28:572-578. [PMID: 34416725 DOI: 10.3171/2021.5.peds2178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hydrocephalus can impact all areas of health, including physical, cognitive, and social-emotional functioning. The social-emotional health of children who have had surgery for hydrocephalus is not well characterized. In this study, the authors sought to examine social-emotional functioning using the Behavior Assessment System for Children, Third Edition (BASC-3) and the Hydrocephalus Outcome Questionnaire (HOQ) in 66 children aged 5 to 17 years. METHODS Caregivers of pediatric patients with hydrocephalus completed the BASC-3 and the HOQ. BASC-3 internalizing, externalizing, and executive functioning caregiver-reported scores were compared with the BASC-3 normative sample using one-sample t-tests to evaluate overall social-emotional functioning. BASC-3 scores were correlated with the social-emotional domain of the HOQ using Pearson's r to determine if the HOQ accurately captured the social-emotional functioning of children with hydrocephalus in a neurosurgery setting. BASC-3 and HOQ scores of children with different etiologies of hydrocephalus were compared using the Kruskal-Wallis one-way analysis of variance to determine if differences existed between the following etiologies: intraventricular hemorrhage secondary to prematurity, myelomeningocele, communicating congenital hydrocephalus, aqueductal stenosis, or other. RESULTS Children with hydrocephalus of all etiologies had more difficulties with social-emotional functioning compared with normative populations. Children with different hydrocephalus etiologies differed in executive functioning and overall HOQ scores but not in internalizing symptoms, externalizing symptoms, or social-emotional HOQ scores. The social-emotional domain of the HOQ correlated more strongly with the BASC-3 than did the physical and cognitive domains. CONCLUSIONS These results have provided evidence that children who have had surgery for hydrocephalus may be at increased risk of social-emotional and behavioral difficulties, but etiology may not be particularly helpful in predicting what kinds or degree of difficulty. The results of this study also support the convergent and divergent validity of the social-emotional domain of the HOQ.
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Affiliation(s)
- Vanessa L Wall
- 1Department of Psychology, Brigham Young University, Provo.,2Department of Neurosurgery, University of Utah, Salt Lake City
| | - John R W Kestle
- 2Department of Neurosurgery, University of Utah, Salt Lake City
| | - John B Fulton
- 3Department of Pediatric Behavioral Health, Primary Children's Hospital, Salt Lake City.,4Department of Pediatrics, University of Utah, Salt Lake City; and
| | - Shawn D Gale
- 1Department of Psychology, Brigham Young University, Provo.,5Neuroscience Center, Brigham Young University, Provo, Utah
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Gale SD, Erickson LD, Thacker EL, Mitchell EL, Brown BL, Hedges DW. Toxoplasma gondii seropositivity and serointensity and cognitive function in adults. PLoS Negl Trop Dis 2020; 14:e0008733. [PMID: 33057346 PMCID: PMC7561134 DOI: 10.1371/journal.pntd.0008733] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/18/2020] [Indexed: 12/13/2022] Open
Abstract
Infecting approximately one-third of the world's human population, Toxoplasma gondii has been associated with cognitive function. Here, we sought to further characterize the association between Toxoplasma gondii and cognitive function in a community sample of adults aged approximately 40 to70 years. Using adjusted linear regression models, we found associations of Toxoplasma gondii seropositivity with worse reasoning (b = -.192, p < .05) and matrix pattern completion (b = -.681, p < .01), of higher anti-Toxoplasma gondii p22 antibody levels with worse reasoning (b = -.078, p < .01) and slower Trails (numeric) performance (b = 5.962, p < .05), of higher anti-Toxoplasma gondii sag1 levels with worse reasoning (b = -.081, p < .05) and worse matrix pattern completion (b = -.217, p < .05), and of higher mean of the anti-Toxoplasma gondii p22 and sag1 levels with worse reasoning (b = -.112, p < .05), slower Trails (numeric) performance (b = 9.195, p < .05), and worse matrix pattern completion (b = -.245, p < .05). Neither age nor educational attainment moderated associations between the measures of Toxoplasma gondii seropositivity or serointensity. Sex, however, moderated the association between the sag1 titer and digit-symbol substitution and the association between the mean of the p22 and sag1 levels and digit-symbol substitution, and income moderated the association between Toxoplasma gondii seropositivity and numeric memory and the association between the p22 level and symbol-digit substitution. Based on the available neuropsychological tasks in this study, Toxoplasma gondii seropositivity and serointensity were associated with some aspects of poorer executive function in adults.
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Affiliation(s)
- Shawn D. Gale
- Department of Psychology, Brigham Young University, Provo, Utah
- The Neuroscience Center, Brigham Young University, Provo, Utah
- * E-mail:
| | | | - Evan L. Thacker
- Department of Public Health, Brigham Young University, Provo, Utah
| | | | - Bruce L. Brown
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Dawson W. Hedges
- Department of Psychology, Brigham Young University, Provo, Utah
- The Neuroscience Center, Brigham Young University, Provo, Utah
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Gale SD, Erickson LD, Anderson JE, Brown BL, Hedges DW. Association between exposure to air pollution and prefrontal cortical volume in adults: A cross-sectional study from the UK biobank. Environ Res 2020; 185:109365. [PMID: 32222630 DOI: 10.1016/j.envres.2020.109365] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 01/17/2020] [Accepted: 03/08/2020] [Indexed: 05/18/2023]
Abstract
Associated with numerous cognitive and behavioral functions and with several diseases, the prefrontal cortex is vulnerable to environmental insult. Among other factors, toxins in air pollution have been associated with damage to the prefrontal cortex in children and older adults. We used data from the UK Biobank to assess further associations between an array of toxins in air pollution and gray matter in the prefrontal cortex including the left and right frontal poles, left and right superior frontal gyri, left and right frontal medial cortex, left and right orbitofrontal cortex, and left and right frontal opercula, using multivariate models adjusted for covariates that possibly could confound the association between air pollution and volume of prefrontal gray matter. The results showed inverse associations between PM 2.5, PM 10, and nitrogen oxides and prefrontal volume in models adjusted for age, sex, education, socioeconomic status, race-ethnicity, self-rated overall health, body mass index, total brain volume, smoking status, and alcohol use frequency. Education appeared to moderate the association between air pollution and prefrontal volume. The data in these analyses came from regions whose mean PM 2.5 was near the upper limit and whose mean PM 10 was under those recommended by the World Health Organization. These findings suggest that comparatively low levels of air pollution might be associated with reduced volume of the prefrontal cortex.
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Affiliation(s)
- Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, UT, USA; The Neuroscience Center, Brigham Young University, Provo, UT, USA.
| | - Lance D Erickson
- Department of Sociology, Brigham Young University, Provo, UT, USA
| | | | - Bruce L Brown
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, UT, USA; The Neuroscience Center, Brigham Young University, Provo, UT, USA
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Abstract
Caused by the neuroinvasive nematodes Toxocara canis and Toxocara cati, human toxocariasis has a worldwide distribution with seroprevalence in humans associated with low socioeconomic status and low educational attainment. Third-stage Toxocara larvae can invade human tissues, including the brain and spine, where they can result in encephalitis, meningitis, and inflammation. Toxocara infection in animal models has been associated with cognitive and behavioural changes. In humans, preliminary cross-sectional research suggests that Toxocara seropositivity is associated with worse cognitive function in children and adults. Additional preliminary cross-sectional findings suggest associations between Toxocara seropositivity and neuropsychiatric function, including schizophrenia and neurologic conditions such as epilepsy. Given the widespread distribution of human toxocariasis and early evidence suggesting that it can be associated with cognitive and neuropsychiatric function in humans, additional research regarding the effects of toxocariasis on the human brain is required.
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Affiliation(s)
- Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, UT, United States; The Neuroscience Centre, Brigham Young University, Provo, UT, United States.
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, UT, United States; The Neuroscience Centre, Brigham Young University, Provo, UT, United States
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Hedges DW, Erickson LD, Gale SD, Anderson JE, Brown BL. Association between exposure to air pollution and thalamus volume in adults: A cross-sectional study. PLoS One 2020; 15:e0230829. [PMID: 32226035 PMCID: PMC7105117 DOI: 10.1371/journal.pone.0230829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/09/2020] [Indexed: 11/18/2022] Open
Abstract
Background Air pollution has been associated with cognitive function and brain volume. While most previous research has examined the association between air pollution and brain volume in cortical structures or total brain volume, less research has investigated associations between exposure to air pollution and subcortical structures, including the thalamus. Further, the few available previous studies investigating associations between air pollution and thalamic volume have shown mixed results. Methods In this study, we evaluated the association between PM2.5, PM2.5–10, PM10, nitrogen dioxide, and nitrogen oxides and volume of the thalamus in adults using the UK Biobank resource, a large community-based sample, while adjusting for multiple covariates that could confound an association between air pollution and thalamic volume. Results In adjusted models, the left but not right thalamus volume was significantly inversely associated with PM2.5–10, although there were no significant associations between PM2.5, PM10, nitrogen dioxide, and nitrogen oxides with either left or right thalamic volumes. In addition, interactions between age and PM2.5–10 and PM10 were inversely associated with thalamic volume, such that thalamic volume in older people appeared more vulnerable to the adverse effects of PM2.5–10 and PM10, and interactions between educational attainment and PM2.5, nitrogen dioxide, and nitrogen oxides and between self-rated health and PM2.5–10 were positively associated with thalamic volume, such that higher educational attainment and better self-rated health appeared protective against the adverse effects of air pollution on the thalamus. Conclusion These findings suggest a possible association between thalamic volume and air pollution particularly in older people and in people with comparatively low educational attainment at levels of air pollution found in the United Kingdom.
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Affiliation(s)
- Dawson W. Hedges
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
- The Neuroscience Center, Brigham Young University, Provo, Utah, United States of America
- * E-mail:
| | - Lance D. Erickson
- Department of Sociology, Brigham Young University, Provo, Utah, United States of America
| | - Shawn D. Gale
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
- The Neuroscience Center, Brigham Young University, Provo, Utah, United States of America
| | - Jacqueline E. Anderson
- The Neuroscience Center, Brigham Young University, Provo, Utah, United States of America
| | - Bruce L. Brown
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
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Erickson LD, Gale SD, Anderson JE, Brown BL, Hedges DW. Association between Exposure to Air Pollution and Total Gray Matter and Total White Matter Volumes in Adults: A Cross-Sectional Study. Brain Sci 2020; 10:E164. [PMID: 32182984 PMCID: PMC7139378 DOI: 10.3390/brainsci10030164] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/04/2020] [Accepted: 03/11/2020] [Indexed: 12/13/2022] Open
Abstract
Total brain gray-matter and white-matter volumes can be indicators of overall brain health. Among the factors associated with gray-matter and white-matter volumes is exposure to air pollution. Using data from the UK Biobank, we sought to determine associations between several components of air pollution-PM2.5, PM2.5-10, PM10, nitrogen dioxide, and nitrogen oxides-and total gray-matter and total white-matter volumes in multivariable regression models in a large sample of adults. We found significant inverse associations between PM2.5 concentration and total white-matter volume and between PM2.5, PM2.5-10, PM10, nitrogen dioxide, and nitrogen oxide concentrations and total gray-matter volume in models adjusted for age, sex, body-mass index, self-assessment of overall health, frequency of alcohol use, smoking status, educational attainment, and income. These findings of pollutant-associated decreases in total gray-matter and total white-matter volumes are in the context of mean PM2.5 concentrations near the upper limit of the World Health Organization's recommendations. Similarly, mean PM10 concentrations were below the recommended upper limit, and nitrogen dioxide concentration was slightly above. Still, there are many areas in the world with much higher concentrations of these pollutants, which could be associated with larger effects. If replicated, these findings suggest that air pollution could be a risk factor for neurodegeneration.
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Affiliation(s)
- Lance D. Erickson
- Department of Sociology, Brigham Young University, Provo, UT 84602, USA;
| | - Shawn D. Gale
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (B.L.B.); (D.W.H.)
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA;
| | | | - Bruce L. Brown
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (B.L.B.); (D.W.H.)
| | - Dawson W. Hedges
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (B.L.B.); (D.W.H.)
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA;
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Hedges DW, Erickson LD, Kunzelman J, Brown BL, Gale SD. Association between exposure to air pollution and hippocampal volume in adults in the UK Biobank. Neurotoxicology 2019; 74:108-120. [DOI: 10.1016/j.neuro.2019.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/11/2019] [Accepted: 06/16/2019] [Indexed: 12/19/2022]
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Hedges DW, Berrett AN, Erickson LD, Brown BL, Thacker EL, Gale SD. Cardiovascular factors moderate the association of infection burden with cognitive function in young to middle-aged U.S. adults. PLoS One 2019; 14:e0218476. [PMID: 31194855 PMCID: PMC6564032 DOI: 10.1371/journal.pone.0218476] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Infectious diseases might affect cognitive aging and dementia risk, possibly via neuroinflammation. Similarly, risk factors for cardiovascular and cerebrovascular diseases are associated with cognitive function and dementia. We hypothesized that cardiovascular risk factors moderate the association of exposure to infectious diseases with cognitive function. METHODS We studied 5662 participants aged 20 to 59 years from the third National Health and Nutrition Examination Survey (1988-1994) in the United States. We used linear regression to investigate whether the Framingham general cardiovascular risk index moderated the association of infection burden based on exposure to eight different infectious diseases with cognitive functioning as measured by the Symbol Digit Substitution, Serial Digit Learning, and Reaction Time tests. RESULTS The multiplicative interaction between the infection-burden index and the cardiovascular-risk index was associated with performance on the Symbol Digit Substitution (B = .019 [95% CI: .008, .031], p < .001) but not on the Serial Digit Learning (B = .034 [95% CI: -.025, .094]) or for Reaction Time (B = -.030 [95% CI: -.848, .787]). Participants with a lower cardiovascular risk appeared to be more resilient against the potential adverse effects of higher infection burden on the Symbol Digit Substitution task. CONCLUSIONS Participants at zero risk for a cardiovascular event in the next 10 years had no differences in processing speed with increasing exposure to infectious disease, whereas participants with higher risk for a cardiovascular event had worse processing speed with increased exposure to infectious disease.
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Affiliation(s)
- Dawson W. Hedges
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
- The Neuroscience Center, Brigham Young University, Provo, Utah, United States of America
| | - Andrew N. Berrett
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Lance D. Erickson
- Department of Sociology, Brigham Young University, Provo, Utah, United States of America
| | - Bruce L. Brown
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Evan L. Thacker
- Department of Public Health, Brigham Young University, Provo, Utah, United States of America
| | - Shawn D. Gale
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
- The Neuroscience Center, Brigham Young University, Provo, Utah, United States of America
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Berrett AN, Gale SD, Erickson LD, Thacker EL, Brown BL, Hedges DW. Toxoplasma gondii seropositivity and substance use in US adults. Folia Parasitol (Praha) 2018; 65. [PMID: 30213919 DOI: 10.14411/fp.2018.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/29/2018] [Indexed: 12/31/2022]
Abstract
The intracellular parasite Toxoplasma gondii (Nicolle et Manceaux, 1908) infects humans resulting in acute toxoplasmosis, an infection that in immunocompetent people is typically mild but results in persistent latent toxoplasmosis. In that T. gondii appears to affect dopamine synthesis and because addicting drugs affect midbrain dopamine transmission, latent toxoplasmosis could influence substance use. Using both the third and continuous National Health and Nutrition Examination Surveys from the US Centers for Disease Control and Prevention, we used logistic regression to test for associations between T. gondii seropositivity and subject self-report of having ever used tobacco, alcohol, marijuana, cocaine, heroin, or methamphetamine. In the third NHANES dataset, which included data for tobacco, alcohol, marijuana and cocaine, T. gondii seropositivity was associated with a reduced likelihood of self-reported marijuana (OR = 0.71 [95% CI: 0.58; 0.87]; p = 0.001) and cocaine use (OR = 0.72 [95% CI: 0.56; 0.91]; p = 0.006). In the continuous National Health and Nutrition Examination Surveys dataset, which included data for all six substances, T. gondii seropositivity was associated with a reduced likelihood of self-reported tobacco (OR = 0.87 [95% CI: 0.76; 1.00]; p = 0.044), marijuana (OR = 0.60 [95% CI: 0.50; 0.72]; p < 0.001), heroin (OR = 0.60 [95% CI: 0.42; 0.85]; p = 0.005) and methamphetamine use (OR = 0.54 [95% CI: 0.38; 0.77]; p = 0.001). We observed interactions between sex and T. gondii seropositivity in the prediction of self-reported use of tobacco and alcohol. Further, T. gondii seropositivity appeared to remove the protective effect of education and economic status against self-reported cigarette smoking. These findings suggest that T. gondii seropositivity may be inversely associated with some but not all types of substance use in US adults.
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Affiliation(s)
- Andrew N Berrett
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America.,The Neuroscience Center, Brigham Young University, Provo, Utah, United States of America
| | - Lance D Erickson
- Department of Sociology, Brigham Young University, Provo, Utah, United States of America
| | - Evan L Thacker
- Department of Public Health, Brigham Young University, Provo, Utah, United States of America This article contains supporting information (S1) online at http://folia.paru.cas.cz/suppl/2018-65-011.pdf
| | - Bruce L Brown
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America.,The Neuroscience Center, Brigham Young University, Provo, Utah, United States of America
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Gale SD, Berrett AN, Erickson LD, Brown BL, Hedges DW. Association between virus exposure and depression in US adults. Psychiatry Res 2018; 261:73-79. [PMID: 29287239 DOI: 10.1016/j.psychres.2017.12.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/03/2017] [Accepted: 12/14/2017] [Indexed: 02/05/2023]
Abstract
Mood disorders are common mental illnesses. Among the factors associated with major depression are exposures to infectious diseases including hepatitis C, influenza, varicella-zoster, and herpes viruses. In this study, we sought to evaluate further associations between viral exposure and depression. From the US Center for Disease Control's National Health and Nutrition Examination Survey, we obtained data about depression status, antidepressant use, exposure to hepatitis A, hepatitis B, herpes simplex virus type 1, herpes simplex virus type 2, human immunodeficiency virus, and cytomegalovirus, and sociodemographic variables and evaluated associations between depression and viral exposure in adjusted multivariable models. Herpes simplex virus type 2 was associated with an increased risk of depression, whereas hepatitis A, hepatitis B, and herpes simplex virus type 1 were not. Higher cytomegalovirus antibody levels were associated with depression in subjects seropositive for cytomegalovirus. In conclusion, exposure to herpes simplex virus type 2 and possibly cytomegalovirus are associated with depression in an adult US sample.
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Affiliation(s)
- Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, UT, United States; The Neuroscience Center, Brigham Young University, Provo, UT, United States.
| | - Andrew N Berrett
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Lance D Erickson
- Department of Sociology, Brigham Young University, Provo, UT, United States
| | - Bruce L Brown
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, UT, United States; The Neuroscience Center, Brigham Young University, Provo, UT, United States
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Berrett AN, Gale SD, Erickson LD, Brown BL, Hedges DW. Helicobacter pylori moderates the association between 5-MTHF concentration and cognitive function in older adults. PLoS One 2018; 13:e0190475. [PMID: 29364915 PMCID: PMC5783346 DOI: 10.1371/journal.pone.0190475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/11/2017] [Indexed: 01/02/2023] Open
Abstract
Objective To explore potential interactions between folate-cycle factors and Helicobacter pylori seropositivity in the prediction of cognitive function. Methods We used data obtained from the 1999–2000 continuous National Health and Nutrition Examination Survey produced by the United States’ Centers for Disease Control and Prevention. Using Ordinary Least Squares regression, we tested for associations between multiple folate-cycle factors, Helicobacter pylori seropositivity, and cognitive function assessed by the digit symbol coding subtest of the Wechsler Adult Intelligence Scale-III. We then tested for interactions between each of the folate-cycle factors and Helicobacter pylori in the prediction of cognitive function. Results Although Helicobacter pylori seropositivity, 5-methyltetrahydrofolate, vitamin B-12, and homocysteine were not associated with performance on the digit symbol coding task, Helicobacter pylori seropositivity interacted with 5-methyltetrahydrofolate concentration to predict performance on the digit symbol coding task. The Helicobacter pylori seropositive group performed worse on the digit symbol coding task as 5-methyltetrahydrofolate concentration decreased. Conclusion The interaction between Helicobacter pylori seropositivity and reduced folate-cycle factor 5-methyltetrahydrofolate might impair aspects of cognitive function.
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Affiliation(s)
- Andrew N Berrett
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
- The Neuroscience Center, Brigham Young University, Provo, Utah, United States of America
| | - Lance D Erickson
- Department of Sociology, Brigham Young University, Provo, Utah, United States of America
| | - Bruce L Brown
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
- The Neuroscience Center, Brigham Young University, Provo, Utah, United States of America
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Hedges DW, Berrett AN, Erickson LD, Brown BL, Gale SD. Association between infection burden and adult height. Econ Hum Biol 2017; 27:275-280. [PMID: 28926748 DOI: 10.1016/j.ehb.2017.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 06/07/2023]
Abstract
Although highly heritable, adult height is also associated with numerous environmental factors, including exposure to infection. Particularly in developing regions of the world, infection burden appears to slow growth during childhood. Using a large database representative of the US population, we examined associations between adult height and leg length and an infection-burden index based on past exposure to Toxocara species, Toxoplasmosis gondii, cytomegalovirus, hepatitis A, hepatitis B, hepatitis C, herpes simplex virus 1, and herpes simplex virus 2. In models controlled for age, sex, educational attainment, socioeconomic status, and race-ethnicity, we found that the infection-burden index predicted height (β=-0.10 [95% CI: -0.15, -0.05], p .001<0.001) but not leg length (β=-0.04 [95% CI: -0.12, 0.04], p=0.357). Both sex and race-ethnicity moderated this association. In addition, exposures to Toxocara species, cytomegalovirus, and hepatitis A were each individually associated with reduced height and reduced leg length. While associations between growth and infection have been found principally in children in developing regions of the world, our findings suggest that the effects of infection on height may persist into adulthood even in developed nations.
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Affiliation(s)
- Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, UT, United States; The Neuroscience Center, Brigham Young University, Provo, UT, United States.
| | - Andrew N Berrett
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Lance D Erickson
- Department of Sociology, Brigham Young University, Provo, UT, United States
| | - Bruce L Brown
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, UT, United States; The Neuroscience Center, Brigham Young University, Provo, UT, United States
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Berrett AN, Erickson LD, Gale SD, Stone A, Brown BL, Hedges DW. Toxocara Seroprevalence and Associated Risk Factors in the United States. Am J Trop Med Hyg 2017; 97:1846-1850. [PMID: 29016316 DOI: 10.4269/ajtmh.17-0542] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Caused by the parasitic nematodes Toxocara canis and cati, toxocariasis in humans can result in covert toxocariasis, ocular toxocariasis, visceral larval migrans, and neurotoxocariasis. A common infection, toxocariasis exposure varies widely within and between countries, with a previous estimate of Toxocara seroprevalence using data from 1988 to 1994 in the United States of approximately 13%. Age, poverty, sex, educational attainment, ethnicity, and region have been associated with Toxocara seroprevalence. In this study, we sought to determine the seroprevalence of and factors associated with Toxocara seropositivity in the United States using data from the National Health and Nutrition Examination Survey from 2011 to 2014 to provide a more recent estimate of Toxocara seroprevalence in the United States. We found an overall Toxocara seroprevalence of 5.1%. Increasing age, male sex, low educational attainment, low income, and immigration status each was associated with Toxocara seropositivity. Mexican Americans had reduced odds of exposure. These findings show that exposure to Toxocara continues in the United States and that several demographic factors influence the risk of exposure.
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Affiliation(s)
| | | | - Shawn D Gale
- The Neuroscience Center, Brigham Young University, Provo, Utah.,Department of Psychology, Brigham Young University, Provo, Utah
| | - Allison Stone
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Bruce L Brown
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, Utah.,The Neuroscience Center, Brigham Young University, Provo, Utah
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25
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Wyman CP, Gale SD, Hedges-Muncy A, Erickson LD, Wilson E, Hedges DW. Association between Toxoplasma gondii seropositivity and memory function in nondemented older adults. Neurobiol Aging 2017; 53:76-82. [PMID: 28235681 PMCID: PMC5482532 DOI: 10.1016/j.neurobiolaging.2017.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 01/19/2017] [Accepted: 01/24/2017] [Indexed: 02/06/2023]
Abstract
Toxoplasma gondii (T. gondii) seropositivity may be associated with decreased memory in older adults. To further investigate the association between T. gondii seropositivity and memory in nondemented older adults, we obtained serum samples from 114 nondemented older adults evaluated by the Alzheimer's Disease and Research Center at Washington University in St. Louis, Missouri, USA. We determined T. gondii seropositivity and anti-T. gondii IgG antibody titer and examined associations with memory function while controlling for socioeconomic status, education level, age, and apolipoprotein E4 status. There were few associations between T. gondii seropositivity or anti-T. gondii IgG antibodies and memory, although there was some support suggesting an interaction between anti-T. gondii and sex. In the seropositive-only sample, there was an inverse relationship between anti-T. gondii titer and performance on the selective reminding test. Overall, we found little evidence of an association between impaired memory function and T. gondii seropositivity and anti-T. gondii IgG antibodies in this sample of nondemented older adults.
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Affiliation(s)
- Cynthia P Wyman
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, UT, USA; The Neuroscience Center, Brigham Young University, Provo, UT, USA.
| | | | - Lance D Erickson
- Department of Sociology, Brigham Young University, Provo, UT, USA
| | - Eric Wilson
- Department of Microbiology & Molecular Biology, Brigham Young University, Provo, UT, USA
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, UT, USA; The Neuroscience Center, Brigham Young University, Provo, UT, USA
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26
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Wright KL, Kirwan CB, Gale SD, Levan AJ, Hopkins RO. Long-term cognitive and neuroanatomical stability in patients with anoxic amnesia: A Case Report. Brain Inj 2017; 31:709-716. [PMID: 28350252 DOI: 10.1080/02699052.2017.1285051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Anoxia can result in selective hippocampal damage with associated impairments in declarative memory. Whilst memory impairments and brain structures are thought to be stable, there are little data regarding the effects of ageing or change over time in patients with amnesia from anoxic brain injury. METHODS To assess change over time, we compared structural magnetic resonance imaging (MRI) with data obtained over ten years previously in two well-characterized patients with amnesia (JRW and RS) who experienced an anoxic brain injury. Six healthy, age-matched control participants were recruited to compare brain volumes with the patients at Time 2. Wechsler adult intelligence scale-revised and Wechsler memory scale-revised scores were compared to scores on the same tests administered 13 and 19 years prior. RESULTS Patients with amnesia had significantly smaller hippocampal volumes than controls, but comparable medial temporal lobe and ventricular volumes. Memory, intellectual function and brain volumes were stable over time. CONCLUSION Patients with an amnesia due to anoxia have memory impairments and smaller hippocampal volumes compared to controls; however, memory, intelligence and structural volumes remain stable over time. At ages 50 and 57, they do not appear to have early age-associated cognitive decline that is sometimes observed in patients with traumatic brain injury.
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Affiliation(s)
- Kacie L Wright
- a Psychology Department , Brigham Young University , Provo , Utah , USA
| | - C Brock Kirwan
- a Psychology Department , Brigham Young University , Provo , Utah , USA.,b Neuroscience Center, Brigham Young University , Provo , Utah , USA
| | - Shawn D Gale
- a Psychology Department , Brigham Young University , Provo , Utah , USA.,b Neuroscience Center, Brigham Young University , Provo , Utah , USA
| | - Ashley J Levan
- a Psychology Department , Brigham Young University , Provo , Utah , USA
| | - Ramona O Hopkins
- a Psychology Department , Brigham Young University , Provo , Utah , USA.,b Neuroscience Center, Brigham Young University , Provo , Utah , USA.,c Department of Medicine, Pulmonary and Critical Care Division , Intermountain Medical Center , Murray , Utah , USA.,d Center for Humanizing Critical Care, Intermountain Healthcare , Murray , Utah , USA
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27
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Berrett AN, Gale SD, Erickson LD, Brown BL, Hedges DW. Folate and Inflammatory Markers Moderate the Association Between Helicobacter pylori Exposure and Cognitive Function in US Adults. Helicobacter 2016; 21:471-480. [PMID: 26935014 DOI: 10.1111/hel.12303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/12/2022]
Abstract
BACKGROUND Helicobacter pylori (H. pylori) infection is associated with cognitive deficits in humans, an association potentially mediated or moderated by folate concentration or inflammation. MATERIALS AND METHODS We used the National Health and Nutrition Examination Survey (NHANES) datasets to examine whether folate concentration or inflammation mediates or moderates the relationship between H. pylori and cognitive function. Models were performed using linear, Poisson, and zero-inflated Poisson regression, and we performed separate analyses for groups aged 20-59 and 60-90 years with sample sizes ranging from 700 to 1700. RESULTS We did not find evidence of mediation in either age group. In the 20- to 59-year group, interactions between H. pylori and ferritin (p values ranging from .004 to .039) were associated with worse processing speed, better working memory, and worse reaction time. Interactions between H. pylori and fibrinogen (p values ranging from .023 to .045), C-reactive protein (CRP) (p = .023), and the inflammatory index (p = .045) were associated with worse processing speed. In 60- to 90-year-olds, H. pylori interacted with ferritin and the inflammatory index to predict fewer mathematical errors (p values of .036 and .023). Interactions with folate (p values of .016 and .006) and C-reactive protein (p values ranging from <.001 to .048) were inconsistent in directionality. CONCLUSIONS In this dataset, representative of the US population, inflammation and folate concentrations moderated but did not mediate the association between H. pylori seropositivity and cognition.
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Affiliation(s)
| | - Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, Utah.,The Neuroscience Center, Brigham Young University, Provo, Utah
| | | | - Bruce L Brown
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, Utah.,The Neuroscience Center, Brigham Young University, Provo, Utah
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Berrett AN, Gale SD, Erickson LD, Brown BL, Hedges DW. No association between latent toxoplasmosis and multiple body measures in U.S. adults. Folia Parasitol (Praha) 2016; 63. [PMID: 27827337 DOI: 10.14411/fp.2016.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/30/2016] [Indexed: 11/19/2022]
Abstract
Toxoplasma gondii (Nicolle et Manceaux, 1908) is an intracellular parasite that can cause ongoing latent infection persisting for the duration of a non-definitive host's life. Affecting approximately one-third of the world's population, latent toxoplasmosis has been associated with neuropsychological outcomes and a previous report suggested an association between latent toxoplasmosis and adult height. Given the large number of people with latent toxoplasmosis and its potential associations with human height, we sought to better understand the association between latent toxoplasmosis and human morphology by evaluating seropositivity for T. gondii and multiple body measures reported in the National Health and Nutrition Examination Survey III (NHANES III) and in the more recent continuous NHANES data sets from the United States Centers for Disease Control and Prevention for which data on T. gondii are available. In these analyses, latent toxoplasmosis was not associated with any of the body measures assessed in the NHANES datasets even after taking into account interactions between latent toxoplasmosis and testosterone suggesting that in these samples, latent toxoplasmosis is not associated with adult morphology including height.
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Affiliation(s)
- Andrew N Berrett
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, Utah, USA.,The Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Lance D Erickson
- Department of Sociology, Brigham Young University, Provo, Utah, USA This article contains supporting information (Tables S1-S3) online at http://folia.paru.cas.cz/suppl/2016-63-034.pdf
| | - Bruce L Brown
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, Utah, USA.,The Neuroscience Center, Brigham Young University, Provo, Utah, USA
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Gale SD, Berrett AN, Brown B, Erickson LD, Hedges DW. No association between current depression and latent toxoplasmosis in adults. Folia Parasitol (Praha) 2016; 63. [PMID: 27827340 DOI: 10.14411/fp.2016.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022]
Abstract
Changes in behaviour and cognition have been associated with latent infection from the apicomplexan protozoan Toxoplasma gondii (Nicolle et Manceaux, 1908) in both animal and human studies. Further, neuropsychiatric disorders such as schizophrenia have also been associated with latent toxoplasmosis. Previously, we found no association between T. gondii immunoglobulin G antibody (IgG) seropositivity and depression in human adults between the ages of 20 and 39 years (n = 1 846) in a sample representative of the United States collected by the Centers for Disease Control as part of a National Health and Nutrition Examination Survey (NHANES) from three datasets collected between 1999-2004. In the present study, we used NHANES data collected between 2009 and 2012 that included subjects aged 20 to 80 years (n = 5 487) and used the Patient Health Questionnaire 9 (PHQ-9) to assess depression with the overall aim of testing the stability of the results of the prior study. In the current study, the seroprevalence of T. gondii was 13%. The percentage of subjects reporting clinical levels of depression assessed with the PHQ-9 was 8%. As before, we found no association between T. gondii IgG seroprevalence and depression (OR = 1.01, 95% CI = 0.81-1.25; p = 0.944) while controlling for sex, educational attainment, race-ethnicity, age, poverty-to-income ratio and cigarette smoking. We also found no positive associations between anti-T. gondii antibody titre and depression (OR = 1.00, 95% CI = 0.96-1.06; p = 0.868). Moreover, we found no association between T. gondii seroprevalence or antibody titre and suicidal ideation (seroprevalence: OR = 1.22, 95% CI = .85-1.75; p = 0.277, titre: OR = 1.05, 95% CI = 0.98-1.14; p = 0.177). Defining depression to also include subjects currently taking antidepressant medication even with non-elevated questionnaires did not find evidence of a positive association between latent toxoplasmosis and depression. In the present study, neither T. gondii seroprevalence nor anti-T. gondii antibody titre was positively associated with depression or suicidal ideation among subjects aged 20 to 80 years.
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Affiliation(s)
- Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, Utah, USA.,The Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Andrew N Berrett
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Bruce Brown
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Lance D Erickson
- Department of Sociology, Brigham Young University, Provo, Utah, USA
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, Utah, USA.,The Neuroscience Center, Brigham Young University, Provo, Utah, USA
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Mietchen J, Gale SD, Jensen CD. Parent-Reported Deficits in Executive Function and Sleep-Disordered Breathing in Adolescent Behavioral Weight Loss Program Participants. J Pediatr Neuropsychol 2016. [DOI: 10.1007/s40817-016-0017-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Previously we demonstrated sex differences in episodic memory in healthy elderly and suggested that normative data be separated by sex. The present study extended the exploration of sex differences on memory measures into two clinical populations, mild cognitive impairment (MCI) and Alzheimer's disease (AD). Seventy-six subjects with MCI and 101 subjects with AD diagnosed by a multidisciplinary team were included. These two groups were also compared to a group of 177 healthy elderly control participants. Sex differences on the Rey Auditory Verbal Learning Test (RAVLT; total and delayed recall) raw scores and Brief Visuospatial Memory Test-Revised (BVMT-R) were demonstrated within the healthy but not the MCI or AD groups. Calculating z scores by sex for both dementing groups based on the healthy controls suggested a larger performance gap between healthy and dementing women than between healthy and dementing men. MCI females were on average 0.48 standard deviations lower for total verbal learning compared to healthy female controls than were MCI males when compared to healthy male controls. For verbal delayed recall the gap was even larger (SD = 1.09). Similarly, on the BVMT-R, a measure of visual memory, the difference was 0.60 standard deviations for total visual learning and 0.99 standard deviations for delayed recall. This same sex difference, with females showing greater impairment compared to the controls group than did the males, was also present within the AD group. The greater memory impairment in dementing females rather than males when compared to sex-matched healthy controls was unlikely to be due to more severe illness since females performed equivalently to males on the Clinical Dementia Rating Scale, Mini-Mental Status Examination, and Dementia Rating Scale, and were also similar for age, education, and apolipoprotein status. The present study suggested relatively greater memory impairment in females with MCI or AD than in controls.
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Affiliation(s)
- Shawn D Gale
- a Department of Psychology , Brigham Young University , Provo , UT , USA.,b Neuroscience Center , Brigham Young University , Provo , UT , USA
| | - Leslie Baxter
- c Department of Neuroimaging , Barrow Neurological Institute , Phoenix , AZ , USA
| | - Juliann Thompson
- a Department of Psychology , Brigham Young University , Provo , UT , USA
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Erickson LD, Gale SD, Berrett A, Brown BL, Hedges DW. Association between toxocariasis and cognitive function in young to middle-aged adults. Folia Parasitol (Praha) 2015; 62. [DOI: 10.14411/fp.2015.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/04/2015] [Indexed: 11/19/2022]
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Zhang M, Gale SD, Erickson LD, Brown BL, Woody P, Hedges DW. Cognitive function in older adults according to current socioeconomic status. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2015; 22:534-43. [PMID: 25565407 DOI: 10.1080/13825585.2014.997663] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cognitive function may be influenced by education, socioeconomic status, sex, and health status. Furthermore, aging interacts with these factors to influence cognition and dementia risk in late life. Factors that may increase or decrease successful cognitive aging are of critical importance, particularly if they are modifiable. The purpose of this study was to determine if economic status in late life is associated with cognition independent of socioeconomic status in early life. Cross-sectional demographic, socioeconomic, and cognitive function data were obtained in 2592 older adults (average age 71.6 years) from the Center for Disease Control's National Health and Nutrition Examination Survey (NHANES) and analyzed with linear regression modeling. Cognitive function, as measured with a test of processing speed, was significantly associated with poverty index scores after adjusting for educational attainment as an estimate of childhood socioeconomic status, ethnic background, age, health status, and sex (P < 0.001). Our findings suggest that current economic status is independently associated with cognitive function in adults over age 60 years.
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Affiliation(s)
- Michael Zhang
- a Department of Psychology , Brigham Young University , Provo , UT , USA
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Gale SD, Brown BL, Berrett A, Erickson LD, Hedges DW. Association between latent toxoplasmosis and major depression, generalised anxiety disorder and panic disorder in human adults. Folia Parasitol (Praha) 2014. [DOI: 10.14411/fp.2014.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Gale SD, Brown BL, Berrett A, Erickson LD, Hedges DW. Association between latent toxoplasmosis and major depression, generalised anxiety disorder and panic disorder in human adults. Folia Parasitol (Praha) 2014; 61:285-292. [PMID: 25185399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Latent infection with the apicomplexan Toxoplasma gondii (Nicolle et Manceaux, 1908) has been associated with schizophrenia, bipolar disorder and self-harm behaviour. However, the potential relationship between T. gondii immunoglobulin G antibody (IgG) seropositivity and generalised-anxiety disorder (GAD) and panic disorder (PD) has not been investigated. The associations between serum reactivity to T. gondii and major depressive disorder (MDD), GAD and PD were evaluated in a total sample of 1 846 adult participants between the ages of 20 and 39 years from the United States Center for Disease Control's National Health and Nutrition Examination Survey (NHANES). Approximately 16% of the overall sample was seropositive for T. gondii and 7% of the sample met criteria for MDD, 2% for GAD and 2% for PD. There were no significant associations between T. gondii IgG seroprevalence and MDD (OR = 0.484, 95% CI = 0.186-1.258), GAD (OR = 0.737, 95% CI = 0.218-2.490) or PD (OR = 0.683, 95% CI = 0.206-2.270) controlling for sex, ethnicity, poverty-to-income ratio and educational attainment. However, limited evidence suggested a possible association between absolute antibody titres for T. gondii and GAD and PD but not MDD. Toxoplasma gondii seroprevalence was not associated with MDD, GAD or PD within the context of the limitations of this study, although there may be an association of T. gondii serointensity with and GAD and PD, which requires further study.
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Affiliation(s)
- Shawn D. Gale
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Caleb M. Pearson
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Department of Clinical Neuropsychology, Phoenix, AZ, USA
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Hill SW, Gale SD, Pearson C, Smith K. Neuropsychological outcome following minimal access subtemporal selective amygdalohippocampectomy. Seizure 2012; 21:353-60. [DOI: 10.1016/j.seizure.2012.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/29/2012] [Accepted: 03/01/2012] [Indexed: 10/28/2022] Open
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Hill SW, Gale SD. Predicting psychogenic nonepileptic seizures with the Personality Assessment Inventory and seizure variables. Epilepsy Behav 2011; 22:505-10. [PMID: 21907626 DOI: 10.1016/j.yebeh.2011.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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: 06/15/2011] [Revised: 07/28/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
Abstract
Early identification of likely cases of psychogenic nonepileptic seizures may prompt earlier and more appropriate diagnosis and treatment. This study investigated the validity of multiple independent self-report variables in predicting psychogenic nonepileptic versus epileptic seizures. One hundred forty-three patients with psychogenic nonepileptic seizures and 129 patients with epileptic seizures were compared with the Personality Assessment Inventory, age at seizure onset, years since first seizure, and length of seizures. Diagnostic prediction was made by analyses of variance and logistic regressions. Cut scores were developed for the multivariate predictors with maximal sensitivity and specificity. The Personality Assessment Inventory conversion subscale (SOM-C), years since first seizure, and length of seizures provided 84% correct classification. Ninety-six percent of patients meeting cut scores of SOM-C ≥70, years since first seizure ≤8, and length of seizures ≥3 minutes were diagnosed with psychogenic nonepileptic seizures. Results demonstrated good ability to identify likely cases of psychogenic nonepileptic seizurs by multiple predictors that are easily and cost-effectively obtainable.
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Affiliation(s)
- Stacy W Hill
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, AZ 85013, USA.
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Asmussen SB, Kirlin KA, Gale SD, Chung SS. Differences in self-reported depressive symptoms between patients with epileptic and psychogenic nonepileptic seizures. Seizure 2009; 18:564-6. [DOI: 10.1016/j.seizure.2009.05.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 05/15/2009] [Indexed: 11/30/2022] Open
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Abstract
PRIMARY OBJECTIVES Acute Respiratory Distress Syndrome (ARDS) is characterized by severe acute lung injury, hypoxemia and is associated with neurological and cognitive impairments. This study assessed quantitative brain and ventricular volumes in survivors of ARDS with brain computed tomography (CT) scans compared to normal controls. It also compared the medical and cognitive outcome data of patients with ARDS with and without CT scans. RESEARCH DESIGN Observational cohort study. METHODS Sixty-six consecutive acute respiratory distress patients, of which 15 patients with ARDS underwent brain CT and 51 patients had no brain imaging. Brain CT scans from 15 survivors of ARDS were compared to age- and sex-matched normal controls. Clinical radiological findings and ventricular volumes, brain volume and generalized brain atrophy. RESULTS The patients with ARDS and brain imaging had cognitive impairments, significant brain atrophy, ventricular enlargement and 53% had atrophy or lesions by radiological report. CONCLUSIONS Clinicians need to be aware that ARDS can cause significant long-term brain-related morbidity manifest by brain atrophy, lesions and neurocognitive impairments.
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Affiliation(s)
- Ramona O Hopkins
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, USA.
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Abstract
Two studies were conducted to determine the frequency of processing speed difficulties relative to estimates of other problem-solving abilities in children with and without traumatic brain injury (TBI). The two samples consisted of 213 normally functioning school-age children and 65 TBI children and 19 trauma controls. All children were administered the WISC-III/IV Vocabulary, Block Design, and Coding subtests. The frequency of children in each sample having a Coding subtest score of 3 or 4 scale points below the Vocabulary or Block Design score (whichever one was lower) was calculated. Using a 3-point scale difference, the presence of processing speed deficits relative to other cognitive abilities in the school sample was low (5.2%), and was equivalent to that demonstrated by trauma controls (5.3%). However, in the TBI sample, 18 out of 65 TBI patients (27.7%) showed this same pattern. Using a 4-point discrepancy scale, 3.3% of normal children and 16.9% of TBI children showed this pattern. The frequency of this pattern increased with severity of TBI, using two different but related classification systems. These preliminary findings require cross validation in a larger sample before definite conclusions can be reached.
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Affiliation(s)
- George P Prigatano
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
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Gale SD, Baxter LC, Bottiggi KA. P3‐131: Attenuated sex difference in verbal memory in mild cognitive impairment and Alzheimer's disease. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gale SD, Baxter L, Connor DJ, Herring A, Comer J. Sex differences on the Rey Auditory Verbal Learning Test and the Brief Visuospatial Memory Test-Revised in the elderly: normative data in 172 participants. J Clin Exp Neuropsychol 2007; 29:561-7. [PMID: 17564921 DOI: 10.1080/13803390600864760] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Rey Auditory Verbal Learning Test (RAVLT) and the Brief Visuospatial Memory Test-Revised (BVMT-R) are frequently used in assessing dementia. Though sex differences in verbal learning and memory have been reported, normative data for the elderly often do not separate males and females. No studies provide normative data for both the RAVLT and the BVMT-R in the same elderly sample. Finally, normative data for those over age 79 are unavailable for the BVMT-R. Therefore, the purpose of this study was to evaluate sex differences on these two tests, provide normative data in 172 healthy volunteers between the ages of 60 and 89 (inclusive), and extend the age range of BVMT-R normative data. Females consistently outperformed males. However, only performance on the RAVLT warranted separation of normative data by sex. Age and sex differences as well as usage of these normative data in a clinical setting are discussed.
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Affiliation(s)
- Shawn D Gale
- Barrow Neurological Institute, Phoenix, AZ 85013, USA.
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Trivedi MA, Ward MA, Hess TM, Gale SD, Dempsey RJ, Rowley HA, Johnson SC. Longitudinal changes in global brain volume between 79 and 409 days after traumatic brain injury: relationship with duration of coma. J Neurotrauma 2007; 24:766-71. [PMID: 17518532 PMCID: PMC2627781 DOI: 10.1089/neu.2006.0205] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Neuropathological and experimental animal studies indicate that traumatic brain injury (TBI) results in long-term, neurodegenerative changes. Structural image evaluation using normalization of atrophy (SIENA) offers an automated analysis of the subtle changes in percent brain volume change (%BVC) associated with TBI. In the present study, SIENA was used to evaluate %BVC in individuals who had sustained a mild to severe TBI. We obtained three-dimensional (3D) T1-weighted anatomical magnetic resonance imaging (MRI) scans approximately 79 days and again 409 days post-injury. TBI patients (n = 37) displayed significantly greater decline in %BVC (-1.43%) relative to a normal comparison group (+0.1%, n = 30). Greater %BVC was associated with longer duration of post-injury coma. These results confirm previous findings from cross-sectional studies and argue that the brain undergoes continued structural change for several months post-injury.
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Affiliation(s)
- Mehul A Trivedi
- William S. Middleton Memorial VA Hospital, Geriatric Research Education and Clinical Center (GRECC), Madison, Wisconsin 53705, USA
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Abstract
BACKGROUND Magnetic resonance imaging (MRI) studies have shown diffuse cerebral atrophy following traumatic brain injury. In the past, quantitative volumetric analysis of these changes was carried out by manually tracing specific regions of interest. In contrast, voxel based morphometry (VBM) is a fully automated technique that allows examination of the whole brain on a voxel by voxel basis. OBJECTIVE To use VBM to evaluate changes in grey matter concentration following traumatic brain injury. METHODS Nine patients with a history of traumatic brain injury (ranging from mild to severe) about one year previously were compared with nine age and sex matched healthy volunteers. T1 weighted three dimensional MRI images were acquired and then analysed with statistical parametric mapping software (SPM2). The patients with traumatic brain injury also completed cognitive testing to determine whether regional grey matter concentration correlated with a measure of attention and initial injury severity. RESULTS Compared with controls, the brain injured patients had decreased grey matter concentration in multiple brain regions including frontal and temporal cortices, cingulate gyrus, subcortical grey matter, and the cerebellum. Decreased grey matter concentration correlated with lower scores on tests of attention and lower Glasgow coma scale scores. CONCLUSIONS Using VBM, regions of decreased grey matter concentration were observed in subjects with traumatic brain injury compared with well matched controls. In the brain injured patients, there was a relation between grey matter concentration and attentional ability.
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Affiliation(s)
- S D Gale
- Department of Clinical Neuropsychology, Barrow Neurological Institute, 222 W Thomas Rd, Suite 315, Phoenix, Arizona 85013, USA.
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Abstract
Eight healthy volunteers and seven post-acute patients with a history of severe traumatic brain injury (TBI) performed the Halstead Finger Tapping Test while undergoing functional magnetic resonance imaging (fMRI). Patients with TBI were on average 18.5 years post-trauma and at that time had normal or near normal tapping speeds. The fMRI analysis revealed greater bilateral frontal activation in healthy controls while tapping only in the right hand compared to patients with TBI. The maximum area of activation differences involved the supplementary motor area. Voxel-based morphometry (VBM) failed to reveal signs of atrophy to explain these findings. Different patterns of brain activation in patients with TBI compared to healthy controls may be seen even when the level of behavioural performance of patients is generally within normal limits.
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Affiliation(s)
- George P Prigatano
- Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
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Gale SD, Hopkins RO. Effects of hypoxia on the brain: neuroimaging and neuropsychological findings following carbon monoxide poisoning and obstructive sleep apnea. J Int Neuropsychol Soc 2004; 10:60-71. [PMID: 14751008 DOI: 10.1017/s1355617704101082] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2002] [Revised: 04/09/2003] [Indexed: 11/05/2022]
Abstract
Hypoxia damages multiple organ systems especially those with high oxygen utilization such as the central nervous system. The purpose of this study was to compare the neuropathological and neuropsychological effects of hypoxia in patients with either carbon monoxide poisoning or obstructive sleep apnea. Neuroimaging revealed evidence of hippocampal atrophy in both groups although a linear relationship between hippocampal volume and memory performance was found only for selected tests and only in the sleep apnea group. There were significant correlations between hippocampal volume and performance on measures related to nonverbal/information processing. Generalized brain atrophy, as measured by the ventricle-to-brain ratio, was more common in the carbon monoxide poisoning group compared to the obstructive sleep apnea group. Performance on tests of executive function improved following treatment with nasal continuous positive airway pressure treatment in the obstructive sleep apnea group but there was no associated improvement in general intellectual function. We found that hypoxia due to obstructive sleep apnea and CO poisoning resulted in neuropathological changes and neuropsychological impairments. The observed group differences provide insight into the relationship between etiology of injury, neuropathological changes, and clinical presentation.
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Affiliation(s)
- Shawn D Gale
- Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
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Abstract
The purpose of this study was to assess the feasibility of utilizing low-current stimulation for F-wave generation, thereby avoiding the discomfort of repetitive supramaximal stimulation. We employed the same technique as is used for generating F waves in the conventional way, except for using a stimulating current that was just strong enough to evoke a motor response on the oscilloscope. This usually required a stimulus of about 10-15 mA at 0.2-ms duration. Both median nerves of 30 subjects were evaluated with this technique and with F waves generated by the conventional technique in the same subjects. Amplitudes were larger when using supramaximal current stimulation. However, there was no statistical difference between F-wave latencies, chronodispersion, and persistence (penetrance) elicited with maximal and low-current stimulation. This procedure should represent a significant improvement for patient comfort during electrodiagnostic procedures involving F-wave studies.
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Affiliation(s)
- Margarete DiBenedetto
- Department of Physical Medicine and Rehabilitation, University of Virginia, 545 Ray C Hunt Drive, Suite 240, PO Box 801004, Charlottesville, Virginia 22908-1004, USA.
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Diamond PT, Gale SD, Evans BA. Relationship of initial hematocrit level to discharge destination and resource utilization after ischemic stroke: a pilot study. Arch Phys Med Rehabil 2003; 84:964-7. [PMID: 12881817 DOI: 10.1016/s0003-9993(03)00009-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine the association between initial hematocrit level at the time of ischemic stroke, discharge destination, and resource utilization. DESIGN Case series. SETTING University hospital. PARTICIPANTS A total of 1012 consecutive patients with ischemic stroke admitted to a university health system between August 3, 1995, and June 24, 1999. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Length of stay, hospital cost, and discharge disposition. RESULTS Of 1012 patients presenting with ischemic stroke, 58% were discharged home, 10% were discharged home with home care services, 15% were discharged to a rehabilitation hospital, 11% were discharged to a skilled or intermediate care facility, and 6% died. After adjusting for age, sex, race, and comorbidities, a significant association (P=.009) existed between discharge outcome and initial hematocrit level. The probability of achieving an equivalent or less favorable outcome increased at both high and low hematocrit levels, with a minimum probability at a hematocrit level of approximately 45%. CONCLUSIONS An association exists between hematocrit level at the time of ischemic stroke and discharge outcome. Midrange hematocrit levels appear to be associated with discharge to home rather than to an inpatient rehabilitation unit or to a nursing facility. Further study is indicated to examine the relationship among hematocrit level, stroke severity, and outcome.
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Affiliation(s)
- Paul T Diamond
- Department of Physical Medicine and Rehabilitation and Health Evaluation Sciences, University of Virginia Health System Charlatosville, VA 22908-1004, USA.
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Abstract
PURPOSE This case highlights the clinical features and course of recovery of a patient presenting to the rehabilitation service with posterior-variant alien hand syndrome (AHS) following thalamic stroke. METHODS Single case report. RESULTS Clinical signs and symptoms included mild hemiparesis, dyspraxia, dysmetria, primary sensory loss and hemispatial neglect. Autonomous movements and personification of the affected extremity which were ego-syntonic in nature were characteristic of posterior-variant AHS. The associated neurological impairments resolved early during the course of rehabilitation and the patient made excellent functional gains. CONCLUSION This case highlights the distinguishing features differentiating posterior-variant AHS from more classical AHS and underscores the excellent prognosis of this variant.
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Affiliation(s)
- B C Pack
- Physical Medicine & Rehabilitation Department, University of Virginia, School of Medicine, Virginia, USA.
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