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Kerner N, Goldberg TE, Cohen HR, Phillips JG, Cohen DE, Andrews H, Pelton G, Devanand DP. Sleep-wake behavior, perceived fatigability, and cognitive reserve in older adults. Alzheimers Dement 2024. [PMID: 38690777 DOI: 10.1002/alz.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION The effects of sleep-wake behavior on perceived fatigability and cognitive abilities when performing daily activities have not been investigated across levels of cognitive reserve (CR). METHODS CR Index Questionnaire (CRIq) data were collected and subjected to moderated mediation analysis. RESULTS In amnestic mild cognitive impairment (aMCI; n = 41), CR moderated sleep-related impairments (SRIs), and fatigability at low CR (CRIq < 105.8, p = 0.004) and mean CR (CRIq = 126.9, p = 0.03) but not high CR (CRIq > 145.9, p = 0.65) levels. SRI affected cognitive abilities mediated by fatigability at low CR (p < 0.001) and mean CR (p = 0.003) levels. In healthy controls (n = 13), SRI in fatigability did not alter cognitive abilities across CR levels; controls had higher leisure scores than patients with aMCI (p = 0.003, effect size = 0.93). DISCUSSION SRI can amplify impaired cognitive abilities through exacerbation of fatigability in patients with aMCI with below-mean CR. Therefore, improving sleep-wake regulation and leisure activities may protect against fatigability and cognitive decline. HIGHLIGHTS Clinical fatigue and fatigability cannot be alleviated by rest. Clinical fatigability disrupts daily activities during preclinical Alzheimer's. High cognitive reserve mitigates sleep-wake disturbance effects. High cognitive reserve attenuates clinical fatigability effects on daily functioning. Untreated obstructive sleep apnea potentiates Alzheimer's pathology in the brain.
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Affiliation(s)
- Nancy Kerner
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Terry E Goldberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Hannah R Cohen
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Julia G Phillips
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Daniel E Cohen
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Howard Andrews
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Gregory Pelton
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- The GH Sergievsky Center and the Taub Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Davangere P Devanand
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- The GH Sergievsky Center and the Taub Institute, Columbia University Irving Medical Center, New York, New York, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
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Zhang A, Wengler K, Zhu X, Horga G, Goldberg TE, Lee S. Altered hierarchical gradients of intrinsic neural timescales in mild cognitive impairment and Alzheimer's disease. J Neurosci 2024:e2024232024. [PMID: 38658167 DOI: 10.1523/jneurosci.2024-23.2024] [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: 10/19/2023] [Revised: 03/08/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
Alzheimer's disease (AD) is a devastating neurodegenerative disease that affects millions of seniors in the US. Resting-state functional magnetic resonance imaging (rs-fMRI) is widely used to study neurophysiology in AD and its prodromal condition, mild cognitive impairment (MCI). The intrinsic neural timescale (INT), which can be estimated through the magnitude of the autocorrelation of neural signals from rs-fMRI, is thought to quantify the duration that neural information is stored in a local circuit. Such heterogeneity of the timescales forms a basis of the brain functional hierarchy and captures an aspect of circuit dynamics relevant to excitation/inhibition balance, which is broadly relevant for cognitive functions. Given that, we applied rs-fMRI to test whether distinct changes of INT at different hierarchies are present in people with MCI, those progressing to AD (called Converter), and AD patients of both sexes. Linear mixed effect model was implemented to detect altered hierarchical gradients across populations followed by pairwise comparisons to identify regional differences. High similarities between AD and Converter were observed. Specifically, the inferior temporal, caudate, pallidum areas exhibit significant alterations in both AD and Converter. Distinct INT related pathological changes in MCI and AD were found. For AD/Converter, neural information is stored for a longer time in lower hierarchical areas, while higher levels of hierarchy seem to be preferentially impaired in MCI leading to a less pronounced hierarchical gradients. These results inform that the INT holds great potential as an additional measure for AD prediction, even a stable biomarker for clinical diagnosis.Significance Statement We observed high similarities of intrinsic neural timescales (INT) between patients with Alzheimer's Disease (AD) and people that will later progress to AD (called Converter), deviating from cognitively normal individuals. This indicates that pathological excitation/inhibition imbalance already started before the conversion to AD. We also revealed distinct pathophysiological changes in stable mild cognitive impairment (MCI) and AD/Converter. For the AD and Converter, neural information is stored for a longer time in lower brain hierarchical areas; while higher levels of the hierarchy seem to be preferentially impaired in stable MCI. These results suggest the potential for INT as an additional measure for AD prediction, even a stable biomarker for clinical diagnosis.
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Affiliation(s)
- Aiying Zhang
- New York State Psychiatric Institute, NY 10032, USA
- Department of Psychiatry, Columbia University, NY 10032, USA
| | - Kenneth Wengler
- New York State Psychiatric Institute, NY 10032, USA
- Department of Psychiatry, Columbia University, NY 10032, USA
| | - Xi Zhu
- New York State Psychiatric Institute, NY 10032, USA
- Department of Psychiatry, Columbia University, NY 10032, USA
| | - Guillermo Horga
- New York State Psychiatric Institute, NY 10032, USA
- Department of Psychiatry, Columbia University, NY 10032, USA
| | - Terry E Goldberg
- New York State Psychiatric Institute, NY 10032, USA
- Department of Psychiatry, Columbia University, NY 10032, USA
- Department of Anesthesiology, Columbia University Irving Medical Center, NY 10032, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, NY 10032, USA
| | - Seonjoo Lee
- New York State Psychiatric Institute, NY 10032, USA
- Department of Psychiatry, Columbia University, NY 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, NY 10032, USA
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Jacobson PT, Vilarello BJ, Tervo JP, Waring NA, Gudis DA, Goldberg TE, Devanand DP, Overdevest JB. Associations between olfactory dysfunction and cognition: a scoping review. J Neurol 2024; 271:1170-1203. [PMID: 38217708 DOI: 10.1007/s00415-023-12057-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Strong evidence suggests that olfactory dysfunction (OD) can predict additional neurocognitive decline in neurodegenerative conditions such as Alzheimer's and Parkinson's diseases. However, research exploring olfaction and cognition in younger populations is limited. The aim of this review is to evaluate cognitive changes among non-elderly adults with non-COVID-19-related OD. METHODS We performed a structured comprehensive literature search of PubMed, Ovid Embase, Web of Science, and Cochrane Library in developing this scoping review. The primary outcome of interest was the association between OD and cognitive functioning in adults less than 60 years of age. RESULTS We identified 2878 studies for title and abstract review, with 167 undergoing full text review, and 54 selected for data extraction. Of these, 34 studies reported on populations of individuals restricted to the ages of 18-60, whereas the remaining 20 studies included a more heterogeneous population with the majority of individuals in this target age range in addition to some above the age of 60. The etiologies for smell loss among the included studies were neuropsychiatric disorders (37%), idiopathic cause (25%), type 2 diabetes (7%), trauma (5%), infection (4%), intellectual disability (4%), and other (18%). Some studies reported numerous associations and at times mixed, resulting in a total number of associations greater than the included number of 54 studies. Overall, 21/54 studies demonstrated a positive association between olfaction and cognition, 7/54 demonstrated no association, 25/54 reported mixed results, and only 1/54 demonstrated a negative association. CONCLUSION Most studies demonstrate a positive correlation between OD and cognition, but the data are mixed with associations less robust in this young adult population compared to elderly adults. Despite the heterogeneity in study populations and outcomes, this scoping review serves as a starting point for further investigation on this topic. Notably, as many studies in this review involved disorders that may have confounding effects on both olfaction and cognition, future research should control for these confounders and incorporate non-elderly individuals with non-psychiatric causes of smell loss.
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Affiliation(s)
- Patricia T Jacobson
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Brandon J Vilarello
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jeremy P Tervo
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Nicholas A Waring
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Terry E Goldberg
- Department of Psychiatry, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - D P Devanand
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Psychiatry, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
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Lawrence RE, Jaffe C, Zhao Y, Wang Y, Goldberg TE. Clinical Trials Studying Suicide Risk Reduction: Who is Excluded From Participation. Arch Suicide Res 2024:1-14. [PMID: 38419392 DOI: 10.1080/13811118.2024.2322128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The use of exclusion criteria in clinical trials can cause research participants to differ markedly from clinical populations, which negatively impacts generalizability of results. This study identifies and quantifies common and recurring exclusion criteria in clinical trials studying suicide risk reduction, and estimates their impact on eligibility among a clinical sample of adults in an emergency department with high suicide risk. METHOD Recent trials were identified by searching PubMed (terms suicide, efficacy, effectiveness, limited to clinical trials in prior 5 years). Common exclusion criteria were identified using Qualitative Content Analysis. A retrospective chart review examined a one-month sample of all adults receiving psychiatric evaluation in a large urban academic emergency department. RESULTS The search yielded 27 unique clinical trials studying suicide risk reduction as a primary or secondary outcome. After research fundamentals (e.g. informed consent, language fluency), the most common exclusion criteria involved psychosis (77.8%), cognitive problems (66.7%), and substance use (63.0%). In the clinical sample of adults with high suicide risk (N = 232), psychosis exclusions would exclude 53.0% of patients and substance use exclusions would exclude 67.2% of patients. Overall, 5.6% of emergency psychiatry patients would be eligible for clinical trials that use common exclusion criteria. CONCLUSIONS Recent clinical trials studying suicide risk reduction have low generalizability to emergency psychiatry patients with high suicide risk. Trials enrolling persons with psychosis and substance use in particular are needed to improve generalizability to this clinical population.
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DeSerisy M, Wall MM, Goldberg TE, Batistuzzo MC, Keyes K, de Joode NT, Lochner C, Marincowitz C, Narayan M, Anand N, Rapp AM, Stein DJ, Simpson HB, Margolis AE. Assessing harmonized intelligence measures in a multinational study. Glob Ment Health (Camb) 2024; 11:e22. [PMID: 38572246 PMCID: PMC10988151 DOI: 10.1017/gmh.2024.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/23/2024] [Accepted: 02/11/2024] [Indexed: 04/05/2024] Open
Abstract
Studies examining the neurocognitive and circuit-based etiology of psychiatric illness are moving toward inclusive, global designs. A potential confounding effect of these associations is general intelligence; however, an internationally validated, harmonized intelligence quotient (IQ) measure is not available. We describe the procedures used to measure IQ across a five-site, multinational study and demonstrate the harmonized measure's cross-site validity. Culturally appropriate intelligence measures were selected: four short-form Wechsler intelligence tests (Brazil, Netherlands, South Africa, United States) and the Binet Kamat (India). Analyses included IQ scores from 255 healthy participants (age 18-50; 42% male). Regression analyses tested between-site differences in IQ scores, as well as expected associations with sociodemographic factors (sex, socioeconomic status, education) to assess validity. Harmonization (e.g., a priori selection of tests) yielded the compatibility of IQ measures. Higher IQ was associated with higher socioeconomic status, suggesting good convergent validity. No association was found between sex and IQ at any site, suggesting good discriminant validity. Associations between higher IQ and higher years of education were found at all sites except the United States. Harmonized IQ scores provide a measure of IQ with evidence of good validity that can be used in neurocognitive and circuit-based studies to control for intelligence across global sites.
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Affiliation(s)
- Mariah DeSerisy
- Columbia University Medical Center, Mailman School of Public Health, Columbia University, New York, NY, USA
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
| | - Melanie M. Wall
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- Department of Psychiatry, The New York State Psychiatric Institute, New York, NY, USA
| | - Terry E. Goldberg
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
| | - Marcelo C. Batistuzzo
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, Brazil
| | - Katherine Keyes
- Columbia University Medical Center, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Niels T. de Joode
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Anatomy and Neuroscience, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Christine Lochner
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Clara Marincowitz
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Madhuri Narayan
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Institute of National Importance (INI), Bangalore, India
| | - Nitin Anand
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Institute of National Importance (INI), Bangalore, India
| | - Amy M. Rapp
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- Department of Psychiatry, The New York State Psychiatric Institute, New York, NY, USA
| | - Dan J. Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - H. Blair Simpson
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- Department of Psychiatry, The New York State Psychiatric Institute, New York, NY, USA
| | - Amy E. Margolis
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- Department of Psychiatry, The New York State Psychiatric Institute, New York, NY, USA
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Goldberg TE, Devanand DP, Fang Z, Kim H, Rueppel E, Tucker A, Carlson S, Lee S. Effects of APOE e4 and Neuropathological Diagnoses on Neuropsychiatric Symptoms: Mediation Analyses and Likely Causation in an Integrated NACC Database. Biol Psychiatry Cogn Neurosci Neuroimaging 2024:S2451-9022(24)00045-4. [PMID: 38336168 DOI: 10.1016/j.bpsc.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND We sought to identify paths from APOE e4 to neurobehaviors itemized on a neuropsychiatric inventory that involved neuropathologies associated with e4 (amyloid, tau, cerebral amyloid angiopathy, and Lewy bodies) or cognition mediators (memory or global cognitive status), as well as direct paths from e4 to neurobehaviors. METHODS A total of 1199 cases with available neurobehavioral, cognition and neuropathological data were included. We conducted a series of causal mediation analyses in R in which e4 always served as the independent variable and Neuropsychiatric Inventory (NPI) neurobehavioral items, when included in the mediation, the outcome. Neuropathologies or cognition served as mediators. RESULTS Multiple significant indirect paths from e4 through neuropathologies to neurobehaviors were identified. More refined analyses indicated that neuritic plaques and Braak stage drove the findings. A significant direct effect of e4 to memory was also identified. Additionally, Lewy body disease, when treated as an exposure, had a direct effect on hallucinations consistent with features of the disease. CONCLUSIONS We found strong evidence for partial mediation of NPI symptoms by cognition, suggesting that cognitive limitations may have promoted maladaptive behavior. In addition, neuritic amyloid plaque levels and Braak stage, but not diffuse amyloid plaque extent, were key in NPI mediated associations suggesting the possibility that synaptic failure play an important role in multiple neurobehavioral symptoms in dementia, including psychosis. Last, we found strong evidence that e4 may have direct effects on cognition when we used verbal episodic memory but not global cognitive status, as an outcome.
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Affiliation(s)
- Terry E Goldberg
- Department of Psychiatry, Columbia University Medical Center, NYC, NY; Department of Anesthesiology, Columbia University Medical Center, NYC, NY.
| | - D P Devanand
- Department of Psychiatry, Columbia University Medical Center, NYC, NY; Department of Neurology, Columbia University Medical Center, NYC, NY
| | - Zhiqian Fang
- Department of Psychiatry, Columbia University Medical Center, NYC, NY; Data Science Institute, Columbia University
| | - Hyun Kim
- Department of Psychiatry, Columbia University Medical Center, NYC, NY
| | - Elizabeth Rueppel
- Department of Psychiatry, Columbia University Medical Center, NYC, NY
| | - Aren Tucker
- Department of Psychiatry, Columbia University Medical Center, NYC, NY
| | - Scott Carlson
- Department of Psychiatry, Columbia University Medical Center, NYC, NY
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Medical Center, NYC, NY; Data Science Institute, Columbia University
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Goldberg TE, Devanand DP, Fang Z, Kim H, Rueppel E, Tucker A, Carlson S, Lee S. Effects of APOE e4 and Neuropathological Diagnoses on Neuropsychiatric Symptoms: Mediation Analyses and Likely Causation in an Integrated NACC Database. medRxiv 2024:2024.01.30.24301966. [PMID: 38352477 PMCID: PMC10863015 DOI: 10.1101/2024.01.30.24301966] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Background Our goal in this study was to identify paths from APOE e4 to neurobehaviors itemized on a neuropsychiatric inventory that involved neuropathologies associated with e4 (amyloid, tau, cerebral amyloid angiopathy, and Lewy bodies) or cognition mediators (memory or global cognitive status), as well as direct paths from e4 to cognition or neurobehaviors. Methods A total of 1199 cases with available neurobehavioral, cognition and neuropathological data were included. We then conducted a series of causal mediation analyses in R in which e4 always served as the independent variable and Neuropsychiatric Inventory (NPI) neurobehavioral items, when included in the mediation, the outcome. Neuropathologies or cognition served as mediators. Results Multiple significant indirect paths from e4 through neuropathologies to neurobehaviors were identified. More refined analyses indicated that neuritic plaques and Braak stage, but not extent of diffuse amyloid plaques, drove the findings. A significant direct effect of e4 to memory was also identified. Additionally, Lewy body disease, when treated as an exposure, had a direct effect on hallucinations in keeping with known features of the disease. Conclusions We found strong evidence for partial mediation of NPI symptoms by cognition, suggesting that cognitive limitations that may have influenced understanding (or misunderstanding) the environment with impacts on maladaptive behavior. In addition, neuritic amyloid plaque levels and Braak stage, but not diffuse amyloid plaque extent, were key in NPI mediated associations suggesting the possibility that synaptic failure play an important role in multiple neurobehavioral symptoms in dementia, including psychosis. Last, we found strong evidence that e4 may have direct effects on cognition when we used verbal episodic memory as an outcome, suggesting that medial temporal regions that support memory may be sensitive to non-amyloidogenic and non-tau related pathophysiological processes.
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Affiliation(s)
- Terry E Goldberg
- Department of Psychiatry, Columbia University Medical Center, NYC, NY
- Department of Anesthesiology, Columbia University Medical Center, NYC, NY
| | - D P Devanand
- Department of Psychiatry, Columbia University Medical Center, NYC, NY
- Department of Neurology, Columbia University Medical Center, NYC, NY
| | - Zhiqian Fang
- Department of Psychiatry, Columbia University Medical Center, NYC, NY
- Data Science Institute, Columbia University
| | - Hyun Kim
- Department of Psychiatry, Columbia University Medical Center, NYC, NY
| | - Elizabeth Rueppel
- Department of Psychiatry, Columbia University Medical Center, NYC, NY
| | - Aren Tucker
- Department of Psychiatry, Columbia University Medical Center, NYC, NY
| | - Scott Carlson
- Department of Psychiatry, Columbia University Medical Center, NYC, NY
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Medical Center, NYC, NY
- Data Science Institute, Columbia University
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Devanand DP, Jeste DV, Stroup TS, Goldberg TE. Overview of late-onset psychoses. Int Psychogeriatr 2024; 36:28-42. [PMID: 36866576 DOI: 10.1017/s1041610223000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Several etiologies can underlie the development of late-onset psychosis, defined by first psychotic episode after age 40 years. Late-onset psychosis is distressing to patients and caregivers, often difficult to diagnose and treat effectively, and associated with increased morbidity and mortality. METHODS The literature was reviewed with searches in Pubmed, MEDLINE, and the Cochrane library. Search terms included "psychosis," "delusions," hallucinations," "late onset," "secondary psychoses," "schizophrenia," bipolar disorder," "psychotic depression," "delirium," "dementia," "Alzheimer's," "Lewy body," "Parkinson's, "vascular dementia," and "frontotemporal dementia." This overview covers the epidemiology, clinical features, neurobiology, and therapeutics of late-onset psychoses. RESULTS Late-onset schizophrenia, delusional disorder, and psychotic depression have unique clinical characteristics. The presentation of late-onset psychosis requires investigation for underlying etiologies of "secondary" psychosis, which include neurodegenerative, metabolic, infectious, inflammatory, nutritional, endocrine, and medication toxicity. In delirium, psychosis is common but controlled evidence is lacking to support psychotropic medication use. Delusions and hallucinations are common in Alzheimer's disease, and hallucinations are common in Parkinson's disease and Lewy body dementia. Psychosis in dementia is associated with increased agitation and a poor prognosis. Although commonly used, no medications are currently approved for treating psychosis in dementia patients in the USA and nonpharmacological interventions need consideration. CONCLUSION The plethora of possible causes of late-onset psychosis requires accurate diagnosis, estimation of prognosis, and cautious clinical management because older adults have greater susceptibility to the adverse effects of psychotropic medications, particularly antipsychotics. Research is warranted on developing and testing efficacious and safe treatments for late-onset psychotic disorders.
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Affiliation(s)
- D P Devanand
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
| | - Dilip V Jeste
- Departments of Psychiatry, Neurosciences University of California San Diego, La Jolla, USA
| | - T Scott Stroup
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
| | - Terry E Goldberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
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Nwosu A, Qian M, Phillips J, Hellegers CA, Rushia S, Sneed J, Petrella JR, Goldberg TE, Devanand DP, Doraiswamy PM. Computerized Cognitive Training in Mild Cognitive Impairment: Findings in African Americans and Caucasians. J Prev Alzheimers Dis 2024; 11:149-154. [PMID: 38230727 DOI: 10.14283/jpad.2023.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND African Americans with MCI may be at increased risk for dementia compared to Caucasians. The effect of race on the efficacy of cognitive training in MCI is unclear. METHODS We used data from a two-site, 78-week randomized trial of MCI comparing intensive, home-based, computerized training with Web-based cognitive games or Web-based crossword puzzles to examine the effect of race on outcomes. The study outcomes were changes from baseline in cognitive and functional scales as well as MRI-measured changes in hippocampal volume and cortical thickness. Analyses used linear models adjusted for baseline scores. This was an exploratory study. RESULTS A total of 105 subjects were included comprising 81 whites (77.1%) and 24 African Americans (22.8%). The effect of race on the change from baseline in ADAS-Cog-11 was not significant. The effect of race on change from baseline to week 78 in the Functional Activities Questionnaire (FAQ) was significant with African American participants' FAQ scores showing greater improvements at weeks 52 and 78 (P = 0.009, P = 0.0002, respectively) than white subjects. Within the CCT cohort, FAQ scores for African American participants showed greater improvement between baseline and week 78, compared to white participants randomized to CCT (P = 0.006). There was no effect of race on the UPSA. There was no effect of race on hippocampal or cortical thickness outcomes. CONCLUSIONS Our preliminary findings suggest that web-based cognitive training programs may benefit African Americans with MCI at least as much as Caucasians, and highlight the need to further study underrepresented minorities in AD prevention trials. (Supported by the National Institutes of Health, National Institute on Aging; ClinicalTrials.gov number, NCT03205709.).
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Affiliation(s)
- A Nwosu
- Adaora Nwosu, Neurocognitive Disorders Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA,
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Motter JN, Rushia SN, Qian M, Ndouli C, Nwosu A, Petrella JR, Doraiswamy PM, Goldberg TE, Devanand DP. Expectancy Does Not Predict 18-month Treatment Outcomes with Cognitive Training in Mild Cognitive Impairment. J Prev Alzheimers Dis 2024; 11:71-78. [PMID: 38230719 DOI: 10.14283/jpad.2023.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Computerized cognitive training (CCT) has emerged as a potential treatment option for mild cognitive impairment (MCI). It remains unclear whether CCT's effect is driven in part by expectancy of improvement. OBJECTIVES This study aimed to determine factors associated with therapeutic expectancy and the influence of therapeutic expectancy on treatment effects in a randomized clinical trial of CCT versus crossword puzzle training (CPT) for older adults with MCI. DESIGN Randomized clinical trial of CCT vs CPT with 78-week follow-up. SETTING Two-site study - New York State Psychiatric Institute and Duke University Medical Center. PARTICIPANTS 107 patients with MCI. INTERVENTION 12 weeks of intensive training with CCT or CPT with follow-up booster training over 78 weeks. MEASUREMENTS Patients rated their expectancies for CCT and CPT prior to randomization. RESULTS Patients reported greater expectancy for CCT than CPT. Lower patient expectancy was associated with lower global cognition at baseline and older age. Expectancy did not differ by sex or race. There was no association between expectancy and measures of everyday functioning, hippocampus volume, or apolipoprotein E genotype. Expectancy was not associated with change in measures of global cognition, everyday functioning, and hippocampus volume from baseline to week 78, nor did expectancy interact with treatment condition. CONCLUSIONS While greater cognitive impairment and increased age was associated with low expectancy of improvement, expectancy was not associated with the likelihood of response to treatment with CPT or CCT.
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Affiliation(s)
- J N Motter
- Jeffrey N. Motter, Department of Psychiatry, Division of Geriatric Psychiatry, 1051 Riverside Drive, New York, NY 10032, United States.
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11
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Goldberg TE, Lee S, Devanand DP, Schneider LS. Comparison of relative change with effect size metrics in Alzheimer's disease clinical trials. J Neurol Neurosurg Psychiatry 2023; 95:2-7. [PMID: 37979967 DOI: 10.1136/jnnp-2023-331941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/20/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Per cent slowing of decline is frequently used as a metric of outcome in Alzheimer's disease (AD) clinical trials, but it may be misleading. Our objective was to determine whether per cent slowing of decline or Cohen's d is the more valid and informative measure of efficacy. METHODS Outcome measures of interest were per cent slowing of decline; Cohen's d effect size and number-needed-to-treat (NNT). Data from a graphic were used to model the inter-relationships among Cohen's d, placebo decline in raw score units and per cent slowing of decline with active treatment. NNTs were computed based on different magnitudes of d. Last, we tabulated recent AD anti-amyloid clinical trials that reported per cent slowing and for which we computed their respective d's and NNTs. RESULTS We demonstrated that d and per cent slowing were potentially independent. While per cent slowing of decline was dependent on placebo decline and did not include variance in its computation, d was dependent on both group mean difference and pooled SD. We next showed that d was a critical determinant of NNT, such that NNT was uniformly smaller when d was larger. In recent AD associated trials including those focused on anti-amyloid biologics, d's were below 0.23 and thus considered small, while per cent slowing was in the 22-29% range and NNTs ranged from 14 to 18. CONCLUSIONS Standardised effect size is a more meaningful outcome than per cent slowing of decline because it determines group overlap, which can directly influence NNT computations, and yield information on the likelihood of minimum clinically important differences. In AD, greater use of effect sizes, NNTs, rather than relative per cent slowing, will improve the ability to interpret clinical trial results and evaluate the clinical meaningfulness of statistically significant results.
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Affiliation(s)
- Terry E Goldberg
- Geriatric Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Seonjoo Lee
- Biostatistics, Columbia University Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Davangere P Devanand
- Geriatric Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Lon S Schneider
- Psychiatry and the Behavioral Sciences, USC Keck School of Medicine, Los Angeles, California, USA
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Cohen DE, Kim H, Levine A, Devanand DP, Lee S, Goldberg TE. Effects of age on the relationship between sleep quality and cognitive performance: Findings from the Human Connectome Project-Aging cohort. Int Psychogeriatr 2023:1-11. [PMID: 38047419 DOI: 10.1017/s1041610223000911] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
BACKGROUND The association between sleep quality and cognition is widely established, but the role of aging in this relationship is largely unknown. OBJECTIVE To examine how age impacts the sleep-cognition relationship and determine whether there are sensitive ranges when the relationship between sleep and cognition is modified. This investigation could help identify individuals at risk for sleep-related cognitive impairment. SUBJECTS Sample included 711 individuals (ages 36.00-89.8359.66 ± 14.9155.7 % female) from the Human Connectome Project-Aging (HCP-A). METHODS The association between sleep quality (Pittsburgh Sleep Quality Index, PSQI) and cognition (Crystallized Cognition Composite and Fluid Cognition Composite from the NIH Toolbox, the Trail Making Test, TMT, and the Rey Auditory Verbal Learning Test, RAVLT) was measured using linear regression models, with sex, race, use of sleep medication, hypertension, and years of education as covariates. The interaction between sleep and age on cognition was tested using the moderation analysis, with age as both continuous linear and nonlinear (quadratic) terms. RESULTS There was a significant interaction term between the PSQI and nonlinear age term (age2) on TMT-B (p = 0.02) and NIH Toolbox crystallized cognition (p = 0.02), indicating that poor sleep quality was associated with worse performance on these measures (sensitive age ranges 50-75 years for TMT-B and 66-70 years for crystallized cognition). CONCLUSIONS The sleep-cognition relationship may be modified by age. Individuals in the middle age to early older adulthood age band may be most vulnerable to sleep-related cognitive impairment.
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Affiliation(s)
- Daniel E Cohen
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Hyun Kim
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Alina Levine
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA
| | - Davangere P Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Seonjoo Lee
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Terry E Goldberg
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA
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13
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Lawrence RE, Bernstein A, Jaffe C, Zhao Y, Wang Y, Goldberg TE. Eligibility of emergency psychiatry patients for clinical trials studying depression. J Affect Disord 2023; 342:10-15. [PMID: 37683939 DOI: 10.1016/j.jad.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Differences often exist between people with depression who are eligible for clinical trials and those seen in clinical practice. The impact of exclusion criteria on eligibility has been previously reported for inpatients and outpatients, but has not been assessed for emergency psychiatry patients; a group that overlaps with inpatients and outpatients but also has important distinctives. Understanding the frequencies of commonly used exclusion criteria in this population could inform interpretation of existing data (generalizability) and highlight opportunities/needs for future trials. METHODS We reviewed 67 clinical trials studying depression using Qualitative Content Analysis to identify common and recurring exclusion criteria. We examined the frequency of these exclusion criteria among a clinical sample of emergency psychiatry patients. RESULTS Most clinical trials had exclusions for basic research requirements, age, symptom severity, psychosis, and substance use. Applying 9 commonly used exclusion criteria to the clinical population resulted in a 3.3 % eligibility rate (95 % CI 1.2 %-7.0 %). Exclusions for psychosis (85.1 % of trials), substance use (83.6 % of trials), and suicide risk (65.7 % of trials) would likely exclude 93 % of emergency psychiatry patients. The prevalence of psychosis, substance use, and suicide risk was much higher among emergency psychiatry patients than among previously studied populations. LIMITATIONS Some eligibility criteria could not be measured. The Qualitative Content Analysis consolidated similar exclusion criteria, losing potentially important nuances in wordings. CONCLUSIONS Exclusion criteria commonly used in contemporary clinical trials of depression limit generalizability to emergency psychiatry patients, due in large part to exclusions for psychosis, substance use, and suicide risk.
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Affiliation(s)
- Ryan E Lawrence
- Department of Psychiatry, Columbia University Medical Center, Director of the Comprehensive Psychiatric Emergency Program at New York - Presbyterian Hospital, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Adam Bernstein
- Creedmoor Psychiatric Center, Queens, NY, United States of America.
| | - Chaya Jaffe
- New York State Psychiatric Institute, United States of America.
| | - Yinjun Zhao
- Department of Biostatistics, Mailman School of Public Health, Columbia University, United States of America.
| | - Yuanjia Wang
- Department of Biostatistics, Columbia University, United States of America.
| | - Terry E Goldberg
- Department of Psychiatry, Columbia University, Columbia University Medical Center, United States of America.
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Vilarello BJ, Jacobson PT, Tervo JP, Gallagher LW, Caruana FF, Gary JB, Saak TM, Gudis DA, Joseph PV, Goldberg TE, Devanand D, Overdevest JB. BMI Increases in Individuals with COVID-19-Associated Olfactory Dysfunction. Nutrients 2023; 15:4538. [PMID: 37960191 PMCID: PMC10648323 DOI: 10.3390/nu15214538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Reports suggest COVID-19-associated olfactory dysfunction (OD) may result in alterations in dietary behaviors and perceived weight change, but few studies using psychophysical evaluation of post-COVID-19-associated chemosensory dysfunction and body mass index (BMI) exist. The purpose of this study is to assess the impact of both quantitative and qualitative features of COVID-19-associated OD on BMI; (2) Methods: Recruitment of thirty-one participants with self-reported OD in the form of quantitative loss with and without qualitative features. Surveys with questions specific to qualitative olfactory function, Sniffin' Sticks tests, and BMI measures were completed at two visits, one year apart. Group differences were assessed with Wilcoxon signed-rank tests and the Holm-Bonferroni method; (3) Results: Individuals with persistent quantitative OD (n = 15) and self-reported parosmia (n = 19) showed statistically significant increases in BMI after 1 year (p = 0.004, adjusted α = 0.0125; p = 0.011, adjusted α = 0.0167). Controls with transient quantitative OD (n = 16) and participants without self-reported parosmia (n = 12) showed no statistically significant changes in BMI over the same time period (p = 0.079, adjusted α = 0.05; p = 0.028, adjusted α = 0.025); (4) Conclusions: This study shows an association between COVID-19-associated OD and BMI, suggesting olfaction may play a role in altering dietary habits and nutrition in this population. Larger study cohorts are needed to further evaluate this relationship.
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Affiliation(s)
- Brandon J. Vilarello
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Patricia T. Jacobson
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Jeremy P. Tervo
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Liam W. Gallagher
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Francesco F. Caruana
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Joseph B. Gary
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Tiana M. Saak
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - David A. Gudis
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Paule V. Joseph
- National Institute of Alcohol Abuse and Alcoholism, Section of Sensory Science and Metabolism & National Institute of Nursing Research, Bethesda, MD 20892, USA
| | - Terry E. Goldberg
- Department of Psychiatry, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, USA
| | - D.P. Devanand
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Psychiatry, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Jonathan B. Overdevest
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, USA
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15
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Kim H, Zhu X, Zhao Y, Bell SA, Gehrman PR, Cohen D, Devanand DP, Goldberg TE, Lee S. Resting-state functional connectivity changes in older adults with sleep disturbance and the role of amyloid burden. Mol Psychiatry 2023; 28:4399-4406. [PMID: 37596355 PMCID: PMC10842478 DOI: 10.1038/s41380-023-02214-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/19/2023] [Accepted: 08/02/2023] [Indexed: 08/20/2023]
Abstract
Sleep and related disorders could lead to changes in various brain networks, but little is known about the role of amyloid β (Aβ) burden-a key Alzheimer's disease (AD) biomarker-in the relationship between sleep disturbance and altered resting state functional connectivity (rsFC) in older adults. This cross-sectional study examined the association between sleep disturbance, Aβ burden, and rsFC using a large-scale dataset from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Sample included 489 individuals (53.6% cognitively normal, 32.5% mild cognitive impairment, and 13.9% AD) who had completed sleep measures (Neuropsychiatric Inventory), PET Aβ data, and resting-state fMRI scans at baseline. Within and between rsFC of the Salience (SN), the Default Mode (DMN) and the Frontal Parietal network (FPN) were compared between participants with sleep disturbance versus without sleep disturbance. The interaction between Aβ positivity and sleep disturbance was evaluated using the linear regressions, controlling for age, diagnosis status, gender, sedatives and hypnotics use, and hypertension. Although no significant main effect of sleep disturbance was found on rsFC, a significant interaction term emerged between sleep disturbance and Aβ burden on rsFC of SN (β = 0.11, P = 0.006). Specifically, sleep disturbance was associated with SN hyperconnectivity, only with the presence of Aβ burden. Sleep disturbance may lead to altered connectivity in the SN when Aβ is accumulated in the brain. Individuals with AD pathology may be at increased risk for sleep-related aberrant rsFC; therefore, identifying and treating sleep problems in these individuals may help prevent further disease progression.
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Affiliation(s)
- Hyun Kim
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
- Area Brain Aging and Mental Health, New York State Psychiatric Institute, New York, NY, USA.
| | - Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Division of Anxiety, Mood, Eating, and Related Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Yiming Zhao
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sophie A Bell
- Area Brain Aging and Mental Health, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Philip R Gehrman
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Daniel Cohen
- Area Brain Aging and Mental Health, New York State Psychiatric Institute, New York, NY, USA
| | - D P Devanand
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Area Brain Aging and Mental Health, New York State Psychiatric Institute, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Terry E Goldberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Area Brain Aging and Mental Health, New York State Psychiatric Institute, New York, NY, USA
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Area Brain Aging and Mental Health, New York State Psychiatric Institute, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA
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Zhang A, Wengler K, Zhu X, Horga G, Goldberg TE, Lee S. Altered hierarchical gradients of intrinsic neural timescales in mild cognitive impairment and Alzheimer's disease. bioRxiv 2023:2023.09.26.559549. [PMID: 37808862 PMCID: PMC10557723 DOI: 10.1101/2023.09.26.559549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Alzheimer's disease (AD) is a devastating neurodegenerative disease that affects millions of older adults in the US and worldwide. Resting-state functional magnetic resonance imaging (rs-fMRI) has become a widely used neuroimaging tool to study neurophysiology in AD and its prodromal condition, mild cognitive impairment (MCI). The intrinsic neural timescale (INT), which can be estimated through the magnitude of the autocorrelation of intrinsic neural signals using rs-fMRI, is thought to quantify the duration that neural information is stored in a local cortical circuit. The heterogeneity of the timescales is considered to be a basis of the functional hierarchy in the brain. In addition, INT captures an aspect of circuit dynamics relevant to excitation/inhibition (E/I) balance, which is thought to be broadly relevant for cognitive functions. Here we examined its relevance to AD. We used rs-fMRI data of 904 individuals from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. The subjects were divided into 4 groups based on their baseline and end-visit clinical status, which were cognitively normal (CN), stable MCI, Converter, and AD groups. Linear mixed effect model and pairwise comparison were implemented to investigate the large-scale hierarchical organization and local differences. We observed high similarities between AD and Converter groups. Specifically, among the eight identified ROIs with distinct INT alterations in AD, three ROIs (inferior temporal, caudate, pallidum areas) exhibit stable and significant alteration in AD converter. In addition, distinct INT related pathological changes in stable MCI and AD/Converter were found. For AD and Converter groups, neural information is stored for a longer time in lower hierarchical order areas, while higher levels of hierarchy seem to be preferentially impaired in stable MCI leading to a less pronounced hierarchical gradient effect. These results inform that the INT holds great potential as an additional measure for AD prediction, a stable biomarker for clinical diagnosis and an important therapeutic target in AD.
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Motter JN, Choi J, Lee S, Goldberg TE, Albert S, Devanand DP. Association of Performance on Olfactory and Cognitive Screening Tests With Conversion to Dementia in a Biracial Cohort of Older Adults. Neurology 2023; 101:e1046-e1055. [PMID: 37414570 PMCID: PMC10491446 DOI: 10.1212/wnl.0000000000207578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/10/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Odor identification deficits are associated with transition to dementia, whereas intact odor identification and global cognition test performance may identify lack of transition. The purpose of this study was to examine intact odor identification and global cognition as prognostic indicators of lack of transition to dementia in a biracial (Black and White) cohort. METHODS In a community-dwelling sample of older adults from the Health, Aging, and Body Composition study, odor identification was measured using the Brief Smell Identification Test (BSIT), and global cognition was measured using the Teng Modified Mini-Mental State Examination (3MS). Survival analyses for dementia transition over 4 and 8 years of follow-up used Cox proportional hazards models. RESULTS A total of 2,240 participants had an average age of 75.5 years (SD 2.8). Approximately 52.7% were female individuals. Approximately 36.7% were Black and 63.3% were White individuals. Impaired odor identification (hazard ratio [HR] 2.29, 95% CI 1.79-2.94, p < 0.001) and global cognition (HR 3.31, 95% CI 2.26-4.84, p < 0.001) were each independently associated with transition to dementia (n = 281). Odor identification remained robustly associated with transition to dementia for Black (HR 2.02, 95% CI 1.36-3.00, p < 0.001, n = 821) and White participants (HR 2.45, 95% CI 1.77-3.38, p < 0.001, n = 1,419), whereas global cognition was associated with transition among Black participants only (HR 5.06, 95% CI 3.18-8.07, p < 0.001). ApoE genotype was consistently associated with transition among White participants only (HR 1.75, 95% CI 1.20-2.54, p < 0.01). Among participants with intact performance on both odor identification (BSIT ≥9/12 correct) and global cognition (3MS ≥ 78/100 correct), 8.8% transitioned to dementia over 8 years. Intact performance on both measures had high positive predictive value for identifying individuals who did not transition to dementia over 4 years (0.98 for ages 70-75 years with only 2.3% transitioning, 0.94 for ages 76-82 years with only 5.8% transitioning). DISCUSSION Odor identification testing paired with a global cognitive screening test identified individuals at low risk of transition to dementia in a biracial community cohort with a pronounced effect in the eighth decade of life. Identification of such individuals can reduce the need for extensive investigation to establish a diagnosis. Odor identification deficits showed utility in both Black and White participants, unlike the race-dependent utility of a global cognitive test and ApoE genotype.
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Affiliation(s)
- Jeffrey N Motter
- From the Department of Psychiatry (J.N.M., S.L., T.E.G., D.P.D.), Columbia University, New York; Division of Geriatric Psychiatry (J.N.M., T.E.G., D.P.D.), and Division of Mental Health Data Science (J.C., S.L.), New York State Psychiatric Institute, New York; Department of Biostatistics (S.L.), Columbia University, New York, NY; and Department of Behavioral and Community Health Sciences (S.A.), Graduate School of Public Health, University of Pittsburgh, PA.
| | - Jongwoo Choi
- From the Department of Psychiatry (J.N.M., S.L., T.E.G., D.P.D.), Columbia University, New York; Division of Geriatric Psychiatry (J.N.M., T.E.G., D.P.D.), and Division of Mental Health Data Science (J.C., S.L.), New York State Psychiatric Institute, New York; Department of Biostatistics (S.L.), Columbia University, New York, NY; and Department of Behavioral and Community Health Sciences (S.A.), Graduate School of Public Health, University of Pittsburgh, PA
| | - Seonjoo Lee
- From the Department of Psychiatry (J.N.M., S.L., T.E.G., D.P.D.), Columbia University, New York; Division of Geriatric Psychiatry (J.N.M., T.E.G., D.P.D.), and Division of Mental Health Data Science (J.C., S.L.), New York State Psychiatric Institute, New York; Department of Biostatistics (S.L.), Columbia University, New York, NY; and Department of Behavioral and Community Health Sciences (S.A.), Graduate School of Public Health, University of Pittsburgh, PA
| | - Terry E Goldberg
- From the Department of Psychiatry (J.N.M., S.L., T.E.G., D.P.D.), Columbia University, New York; Division of Geriatric Psychiatry (J.N.M., T.E.G., D.P.D.), and Division of Mental Health Data Science (J.C., S.L.), New York State Psychiatric Institute, New York; Department of Biostatistics (S.L.), Columbia University, New York, NY; and Department of Behavioral and Community Health Sciences (S.A.), Graduate School of Public Health, University of Pittsburgh, PA
| | - Steven Albert
- From the Department of Psychiatry (J.N.M., S.L., T.E.G., D.P.D.), Columbia University, New York; Division of Geriatric Psychiatry (J.N.M., T.E.G., D.P.D.), and Division of Mental Health Data Science (J.C., S.L.), New York State Psychiatric Institute, New York; Department of Biostatistics (S.L.), Columbia University, New York, NY; and Department of Behavioral and Community Health Sciences (S.A.), Graduate School of Public Health, University of Pittsburgh, PA
| | - Davangere P Devanand
- From the Department of Psychiatry (J.N.M., S.L., T.E.G., D.P.D.), Columbia University, New York; Division of Geriatric Psychiatry (J.N.M., T.E.G., D.P.D.), and Division of Mental Health Data Science (J.C., S.L.), New York State Psychiatric Institute, New York; Department of Biostatistics (S.L.), Columbia University, New York, NY; and Department of Behavioral and Community Health Sciences (S.A.), Graduate School of Public Health, University of Pittsburgh, PA
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18
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Lawrence RE, Bernstein A, Jaffe C, Goldberg TE. In clinical trials, efficacy vs. effectiveness language is confusing. J Clin Epidemiol 2023; 159:345-347. [PMID: 37263517 DOI: 10.1016/j.jclinepi.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Ryan E Lawrence
- Associate Professor of Psychiatry at Columbia University Medical Center, Director of the Comprehensive Psychiatric Emergency Program at New York - Presbyterian Hospital, and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Adam Bernstein
- Psychiatry Resident, Creedmoor Psychiatric Center, Queens, NY, USA
| | - Chaya Jaffe
- Research Assistant, New York State Psychiatric Institute, New York, NY, USA
| | - Terry E Goldberg
- Professor of Medical Psychology (in Psychiatry), Columbia University Medical Center, New York, NY, USA
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19
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Vilarello BJ, Jacobson PT, Tervo JP, Waring NA, Gudis DA, Goldberg TE, Devanand DP, Overdevest JB. Olfaction and neurocognition after COVID-19: a scoping review. Front Neurosci 2023; 17:1198267. [PMID: 37457004 PMCID: PMC10339825 DOI: 10.3389/fnins.2023.1198267] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/01/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction COVID-19 induces both acute and chronic neurological changes. Existing evidence suggests that chemosensory changes, particularly olfactory loss, may reflect central neurological dysfunction in neurodegenerative diseases and mark progression from mild cognitive impairment to Alzheimer's. This scoping review summarizes the available literature to evaluate the relationship between neurocognition and olfaction in young to middle-aged adults with minimal comorbidities following COVID-19 infection. Methods A literature search of PubMed, Ovid Embase, Web of Science, and Cochrane Library was conducted. Studies underwent title/abstract and full text screening by two reviewers, with a third reviewer resolving any conflicts. Remaining studies underwent data extraction. Results Seventeen studies were eligible for data extraction after the review process, where 12 studies found significantly poorer cognition in those suffering from olfactory dysfunction, four studies showed no association between cognition and olfaction, and one study reported lower anosmia prevalence among patients with cognitive impairment. Conclusion The majority of studies in this review find that olfactory dysfunction is associated with poorer cognition. More rigorous studies are needed to further elucidate the relationship between olfaction and cognition after COVID-19.
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Affiliation(s)
- Brandon J. Vilarello
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Patricia T. Jacobson
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, United States
| | - Jeremy P. Tervo
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Nicholas A. Waring
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - David A. Gudis
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, United States
| | - Terry E. Goldberg
- Department of Psychiatry, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, United States
| | - D. P. Devanand
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Department of Psychiatry, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, United States
| | - Jonathan B. Overdevest
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, United States
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20
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Howard RS, Goldberg TE, Luo J, Munoz C, Schneider LS. Reliability of the NACC Telephone-administered Neuropsychological Battery (T-cog) and Montreal Cognitive Assessment for participants in the USC ADRC. Alzheimers Dement (Amst) 2023; 15:e12406. [PMID: 36911358 PMCID: PMC9994164 DOI: 10.1002/dad2.12406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 03/10/2023]
Abstract
Introduction Restrictions during the COVID-19 pandemic necessitated remote administration of neuropsychological testing. We assessed the test-retest reliability for a telephone-administered cognitive battery, recommended for use in the National Institute on Aging Alzheimer's Disease Research Center (ADRC). Methods 64 participants in the University of Southern California ADRC clinical core underwent repeat telephone evaluation using the T-cog Neuropsychological Battery. Reliability was measured by intraclass correlation coefficient (ICC) for continuous variables and weighted Kappa coefficient for categorical variables. Mean scores for Montreal Cognitive Assessment (MoCA) total and Craft Story 21 Immediate and Delayed Recall were compared using paired t tests. Results Mean age was 74.8 (8.3 standard deviation); 73.4% were female. ICCs ranged from 0.52 to 0.84, indicating moderate test-retest reliability except for number span backward, which showed poor reliability. Weighted Kappa for MoCA items ranged from -0.016 to 0.734; however, relatively good observed agreement was seen across all items (70.3% to 98.4%). Although MoCA total scores did not significantly change, Craft Story 21 Immediate and Delayed Recall mean scores increased between first and second administrations (P < 0.0001). Discussion Test-retest reliability for the T-cog Neuropsychological Battery is adequate. The variation seen in testing is similar to results seen from face-to-face testing, with Craft Story 21 recall showing modest and expected practice effects. Highlights Moderate test-retest reliability is seen in most measures of the National Alzheimer's Coordinating Center Neuropsychological Test Battery and the Montreal Cognitive Assessment (MoCA).Intraclass correlation coefficients ranged from 0.52 to 0.84, except for number Span backward.Weighted Kappa for MoCA items varied, but good observed agreement was seen.MoCA total mean score did not change significantly between administrations.Craft Story 21 Immediate and Delayed Recall means increased on repeat testing (P < 0.0001).
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Affiliation(s)
| | - Terry E. Goldberg
- Department of PsychiatryColumbia University Medical CenterNew YorkNew YorkUSA
| | - James Luo
- Keck School of Medicine of USCLos AngelesCaliforniaUSA
| | - Cynthia Munoz
- Keck School of Medicine of USCLos AngelesCaliforniaUSA
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21
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Petrella JR, Michael AM, Qian M, Nwosu A, Sneed J, Goldberg TE, Devanand DP, Doraiswamy PM. Impact of Computerized Cognitive Training on Default Mode Network Connectivity in Subjects at Risk for Alzheimer's Disease: A 78-week Randomized Controlled Trial. J Alzheimers Dis 2023; 91:483-494. [PMID: 36442202 PMCID: PMC9881022 DOI: 10.3233/jad-220946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) represents a high risk group for Alzheimer's disease (AD). Computerized Cognitive Games Training (CCT) is an investigational strategy to improve targeted functions in MCI through the modulation of cognitive networks. OBJECTIVE The goal of this study was to examine the effect of CCT versus a non-targeted active brain exercise on functional cognitive networks. METHODS 107 patients with MCI were randomized to CCT or web-based crossword puzzles. Resting-state functional MRI (fMRI) was obtained at baseline and 18 months to evaluate differences in fMRI measured within- and between-network functional connectivity (FC) of the default mode network (DMN) and other large-scale brain networks: the executive control, salience, and sensorimotor networks. RESULTS There were no differences between crosswords and games in the primary outcome, within-network DMN FC across all subjects. However, secondary analyses suggest differential effects on between-network connectivity involving the DMN and SLN, and within-network connectivity of the DMN in subjects with late MCI. Paradoxically, in both cases, there was a decrease in FC for games and an increase for the crosswords control (p < 0.05), accompanied by lesser cognitive decline in the crosswords group. CONCLUSION Results do not support a differential impact on within-network DMN FC between games and crossword puzzle interventions. However, crossword puzzles might result in cognitively beneficial remodeling between the DMN and other networks in more severely impaired MCI subjects, parallel to the observed clinical benefits.
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Affiliation(s)
- Jeffrey R. Petrella
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Andrew M. Michael
- Duke Institute for Brain Sciences and the Duke Center for the Study of Aging and Human Development, Durham, NC, USA
| | - Min Qian
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Adaora Nwosu
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Joel Sneed
- Department of Psychology, Queens College, City University of New York, Flushing, NY, USA
- Department of Psychology The Graduate Center, City University of New York, New York, NY, USA
| | - Terry E. Goldberg
- Department of Psychiatry, Columbia University Medical Center, and the New York Psychiatry Institute, New York, NY, USA
| | - Davangere P. Devanand
- Department of Psychiatry, Columbia University Medical Center, and the New York Psychiatry Institute, New York, NY, USA
| | - P. Murali Doraiswamy
- Duke Institute for Brain Sciences and the Duke Center for the Study of Aging and Human Development, Durham, NC, USA
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
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22
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Goldberg TE, Wang Y, Hua M, Garcia P, Whittington RA, Moitra V. Association of Delirium with Long‐term Cognitive Decline: An Update. Alzheimers Dement 2022. [DOI: 10.1002/alz.063736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Yuanjia Wang
- Columbia University Irving Medical Center New York NY USA
| | - May Hua
- Columbia University Irving Medical Center New York NY USA
| | - Paul Garcia
- Columbia University Irving Medical Center New York NY USA
| | | | - Vivek Moitra
- Columbia University Irving Medical Center New York NY USA
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23
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Devanand DP, Goldberg TE, Qian M, Rushia SN, Sneed JR, Andrews HF, Nino I, Phillips J, Pence ST, Linares AR, Hellegers CA, Michael AM, Kerner NA, Petrella JR, Doraiswamy PM. Computerized Games versus Crosswords Training in Mild Cognitive Impairment. NEJM Evid 2022; 1:10.1056/evidoa2200121. [PMID: 37635843 PMCID: PMC10457124 DOI: 10.1056/evidoa2200121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) increases the risk of dementia. The efficacy of cognitive training in patients with MCI is unclear. METHODS In a two-site, single-blinded, 78-week trial, participants with MCI - stratified by age, severity (early/late MCI), and site - were randomly assigned to 12 weeks of intensive, home-based, computerized training with Web-based cognitive games or Web-based crossword puzzles, followed by six booster sessions. In mixed-model analyses, the primary outcome was change from baseline in the 11-item Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) score, a 70 point scale in which higher scores indicate greater cognitive impairment at 78 weeks, adjusted for baseline. Secondary outcomes included change from baseline in neuropsychological composite score, University of California San Diego Performance-Based Skills Assessment (functional outcome) score, and Functional Activities Questionnaire (functional outcome) score at 78 weeks, adjusted for baseline. Changes in hippocampal volume and cortical thickness on magnetic resonance imaging were assessed. RESULTS Among 107 participants (n=51 [games]; n=56 [crosswords]), ADAS-Cog score worsened slightly for games and improved for crosswords at week 78 (least squares [LS] means difference, -1.44; 95% confidence interval [CI], -2.83 to -0.06; P=0.04). From baseline to week 78, mean ADAS-Cog score worsened for games (9.53 to 9.93) and improved for crosswords (9.59 to 8.61). The late MCI subgroup showed similar results (LS means difference, -2.45; SE, 0.89; 95% CI, -4.21 to -0.70). Among secondary outcomes, the Functional Activities Questionnaire score worsened more with games than with crosswords at week 78 (LS means difference, -1.08; 95% CI, -1.97 to -0.18). Other secondary outcomes showed no differences. Decreases in hippocampal volume and cortical thickness were greater for games than for crosswords (LS means difference, 34.07; SE, 17.12; 95% CI, 0.51 to 67.63 [hippocampal volume]; LS means difference, 0.02; SE, 0.01; 95% CI, 0.00 to 0.04 [cortical thickness]). CONCLUSIONS Home-based computerized training with crosswords demonstrated superior efficacy to games for the primary outcome of baseline-adjusted change in ADAS-Cog score over 78 weeks. (Supported by the National Institutes of Health, National Institute on Aging; ClinicalTrials.gov number, NCT03205709.).
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Affiliation(s)
- D P Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Medical Center, New York
| | - Terry E Goldberg
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Medical Center, New York
- Department of Anesthesiology, Columbia University Medical Center, New York
| | - Min Qian
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York
| | - Sara N Rushia
- The Graduate Center, City University of New York, New York
- Queens College, City University of New York, Flushing, NY
| | - Joel R Sneed
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Medical Center, New York
- Department of Anesthesiology, Columbia University Medical Center, New York
- The Graduate Center, City University of New York, New York
| | - Howard F Andrews
- Department of Psychiatry, Columbia University Medical Center, New York
| | - Izael Nino
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Medical Center, New York
| | - Julia Phillips
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Medical Center, New York
| | - Sierra T Pence
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC
| | - Alexandra R Linares
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC
| | - Caroline A Hellegers
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC
| | | | - Nancy A Kerner
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Medical Center, New York
| | | | - P Murali Doraiswamy
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC
- Duke Institute for Brain Sciences, Duke University, Durham, NC
- Center for the Study of Aging and Human Development and the Division of Geriatrics, Duke University School of Medicine, Durham, NC
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24
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Motter JN, Choi J, Lee S, Goldberg TE, Devanand DP. Intact olfactory and cognitive abilities predict lack of transition to dementia in a biracial sample of older adults. Alzheimers Dement 2022. [DOI: 10.1002/alz.066216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jeffrey N Motter
- New York State Psychiatric Institute New York NY USA
- Columbia University Irving Medical Center New York NY USA
| | - Jongwoo Choi
- New York State Psychiatric Institute New York NY USA
| | - Seonjoo Lee
- New York State Psychiatric Institute New York NY USA
- Columbia University Irving Medical Center New York NY USA
| | - Terry E. Goldberg
- New York State Psychiatric Institute New York NY USA
- Columbia University Irving Medical Center New York NY USA
| | - Davangere P. Devanand
- New York State Psychiatric Institute New York NY USA
- Columbia University Irving Medical Center New York NY USA
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25
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Kim H, Lee S, Bell SA, Levine A, Carlson S, Gordon ML, Devanand DP, Rivera AM, Brickman AM, Harvey PD, Schneider LS, Goldberg TE. Cognitive Correlates of the No Practice Effects (NPE) Battery: Factor Analyses from the Novel Cognitive and Functional Measures for Alzheimer’s Disease Prevention Trials (NoMAD). Alzheimers Dement 2022. [DOI: 10.1002/alz.069462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Hyun Kim
- Columbia University Irving Medical Center New York NY USA
| | - Seonjoo Lee
- Columbia University Irving Medical Center New York NY USA
- New York State Psychiatric Institute New York NY USA
- Mailman School of Public Health, Columbia University New York NY USA
| | | | - Alina Levine
- New York State Psychiatric Institute New York NY USA
| | - Scott Carlson
- New York State Psychiatric Institute New York NY USA
| | - Marc L. Gordon
- The Litwin‐Zucker Research Center, The Feinstein Institutes for Medical Research Manhasset NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead NY USA
| | - Davangere P. Devanand
- Columbia University Irving Medical Center New York NY USA
- New York State Psychiatric Institute New York NY USA
- Columbia University, College of Physicians and Surgeons New York NY USA
| | - Andres M. Rivera
- Columbia University Irving Medical Center New York NY USA
- Columbia University New York NY USA
| | - Adam M. Brickman
- Columbia University Irving Medical Center New York NY USA
- Columbia University New York NY USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York Presbyterian Hospital New York NY USA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University New York NY USA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons New York NY USA
| | | | - Lon S. Schneider
- Alzheimer’s Disease Research Center, Keck School of Medicine, University of Southern California Los Angeles CA USA
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California Los Angeles CA USA
- Keck School of Medicine of USC Los Angeles CA USA
| | - Terry E. Goldberg
- Columbia University Irving Medical Center New York NY USA
- Columbia University, College of Physicians and Surgeons New York NY USA
- Columbia Univbersity Medical Center New York NY USA
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26
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Devanand DP, Lee S, Huey ED, Goldberg TE. Neuropsychiatric Symptoms and Neuropathological diagnoses of Alzheimer’s Disease and Related Dementias. Alzheimers Dement 2022. [DOI: 10.1002/alz.062891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Davangere P. Devanand
- Columbia University Irving Medical Center New York NY USA
- New York State Psychiatric Institute New York NY USA
| | - Seonjoo Lee
- Columbia University Irving Medical Center New York NY USA
| | - Edward D Huey
- Columbia University Irving Medical Center New York NY USA
| | - Terry E. Goldberg
- Columbia University Irving Medical Center New York NY USA
- New York State Psychiatric Institute New York NY USA
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27
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Kim H, Devanand DP, Carlson S, Goldberg TE. Apolipoprotein E Genotype e2: Neuroprotection and Its Limits. Front Aging Neurosci 2022; 14:919712. [PMID: 35912085 PMCID: PMC9329577 DOI: 10.3389/fnagi.2022.919712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
In this review, we comprehensively, qualitatively, and critically synthesized several features of APOE-e2, a known APOE protective variant, including its associations with longevity, cognition, and neuroimaging, and neuropathology, all in humans. If e2’s protective effects—and their limits—could be elucidated, it could offer therapeutic windows for Alzheimer’s disease (AD) prevention or amelioration. Literature examining e2 within the years 1994–2021 were considered for this review. Studies on human subjects were selectively reviewed and were excluded if observation of e2 was not specified. Effects of e2 were compared with e3 and e4, separately and as a combined non-e2 group. Our examination of existing literature indicated that the most robust protective role of e2 is in longevity and AD neuropathologies, but e2’s effect on cognition and other AD imaging markers (brain structure, function, and metabolism) were inconsistent, thus inconclusive. Notably, e2 was associated with greater risk of non-AD proteinopathies and a disadvantageous cerebrovascular profile. We identified multiple methodological shortcomings of the literature on brain function and cognition that could have contributed to inconsistent and potentially misleading findings. We make careful interpretations of existing findings and provide directions for research strategies that could effectively examine the independent and unbiased effect of e2 on AD risk.
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Affiliation(s)
- Hyun Kim
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Department of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Davangere P. Devanand
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Department of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, United States
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
| | - Scott Carlson
- Department of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Terry E. Goldberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Department of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, United States
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, United States
- *Correspondence: Terry E. Goldberg,
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28
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Kim JH, Hua M, Whittington RA, Lee J, Liu C, Ta CN, Marcantonio ER, Goldberg TE, Weng C. A machine learning approach to identifying delirium from electronic health records. JAMIA Open 2022; 5:ooac042. [PMID: 35663114 PMCID: PMC9152701 DOI: 10.1093/jamiaopen/ooac042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/01/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
The identification of delirium in electronic health records (EHRs) remains difficult due to inadequate assessment or under-documentation. The purpose of this research is to present a classification model that identifies delirium using retrospective EHR data. Delirium was confirmed with the Confusion Assessment Method for the Intensive Care Unit. Age, sex, Elixhauser comorbidity index, drug exposures, and diagnoses were used as features. The model was developed based on the Columbia University Irving Medical Center EHR data and further validated with the Medical Information Mart for Intensive Care III dataset. Seventy-six patients from Surgical/Cardiothoracic ICU were included in the model. The logistic regression model achieved the best performance in identifying delirium; mean AUC of 0.874 ± 0.033. The mean positive predictive value of the logistic regression model was 0.80. The model promises to identify delirium cases with EHR data, thereby enable a sustainable infrastructure to build a retrospective cohort of delirium. Delirium is a commonly observed complication in hospitalized patients, especially with intensive care. While signs and symptoms of delirium could be observed and well managed during the hospital stay, less is known about the long-term complication of delirium after discharge. In order to monitor the long-term sequelae of delirium, the correct identification of delirium patients is crucial. Currently, the retrospective identification of delirium patients is limited due to the under-coding of delirium diagnosis in electronic health records. We proposed a simple machine-learning model to retrospectively identify patients who experienced delirium during their intensive care unit stay. The model could be used to identify missed delirium cases and the establishment of a delirium cohort for long-term monitoring and surveillance.
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Affiliation(s)
- Jae Hyun Kim
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - May Hua
- Department of Anesthesiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Robert A Whittington
- Department of Anesthesiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Junghwan Lee
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Cong Liu
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Casey N Ta
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Edward R Marcantonio
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Terry E Goldberg
- Department of Anesthesiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
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29
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Kim H, Levine A, Cohen D, Gehrman P, Zhu X, Devanand DP, Lee S, Goldberg TE. The Role of Amyloid, Tau, and APOE Genotype on the Relationship Between Informant-Reported Sleep Disturbance and Alzheimer’s Disease Risks. J Alzheimers Dis 2022; 87:1567-1580. [DOI: 10.3233/jad-215417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The association between sleep and Alzheimer’s disease (AD) biomarkers are well-established, but little is known about how they interact to change the course of AD. Objective: To determine the potential interaction between sleep disturbance and Aβ, tau, and APOE4 on brain atrophy and cognitive decline. Methods: Sample included 351 participants (mean age 72.01 ± 6.67, 50.4%female) who were followed for approximately 5 years as part of the Alzheimer’s Disease Neuroimaging Initiative. Informant-reported sleep disturbance (IRSD) was measured using the Neuropsychiatric Inventory (NPI). Changes in magnetic resonance imaging (MRI)-measured AD signature brain regions and cognitive performance and IRSD’s interaction with cerebrospinal fluid amyloid-β (Aβ42) and p-Tau depositions and APOE4 status were examined using the linear mixed models. Results: Baseline IRSD was not significantly associated with the rate of atrophy after adjusting for covariates (age, sex, education, total NPI severity score, and sleep medications). However, there was a significant interaction between IRSD and AD biomarkers on faster atrophy rates in multiple brain regions, including the cortical and middle temporal volumes. Post-hoc analyses indicated that Aβ and p-Tau/Aβ predicted a faster decline in these regions/domains in IRSD, compared with biomarker-negative individuals with IRSD (ps≤0.001). There was a significant IRSD*APOE4 interaction for brain atrophy rate (ps≤0.02) but not for cognition. Conclusion: IRSD may increase the future risk of AD by contributing to faster brain atrophy and cognitive decline when combined with the presence of AD biomarkers and APOE4. Early intervention for sleep disturbance could help reduce the risk of developing AD.
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Affiliation(s)
- Hyun Kim
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Divisionof Geriatric Psychiatry, New York State Psychiatric Institute, NewYork, NY, USA
| | - Alina Levine
- Division of Mental Health DataScience, New York State Psychiatric Institute, New York, NY, USA
| | - Daniel Cohen
- Divisionof Geriatric Psychiatry, New York State Psychiatric Institute, NewYork, NY, USA
| | - Philip Gehrman
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Divisionof Geriatric Psychiatry, New York State Psychiatric Institute, NewYork, NY, USA
| | - Davangere P. Devanand
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Divisionof Geriatric Psychiatry, New York State Psychiatric Institute, NewYork, NY, USA
- Department ofNeurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Seonjoo Lee
- Division of Mental Health DataScience, New York State Psychiatric Institute, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Terry E. Goldberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Divisionof Geriatric Psychiatry, New York State Psychiatric Institute, NewYork, NY, USA
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA
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Carlson S, Kim H, Devanand DP, Goldberg TE. Novel approaches to measuring neurocognitive functions in Alzheimer's disease clinical trials. Curr Opin Neurol 2022; 35:240-248. [PMID: 35175975 PMCID: PMC10020887 DOI: 10.1097/wco.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We comprehensively examined recent advancements in developing novel cognitive measures that could significantly enhance detection of outcome changes in Alzheimer's disease clinical trials. Previously established measures were largely limited in their ability to detect subtle cognitive declines in preclinical stages of Alzheimer's disease, particularly due to weak psychometric properties (including practice effects and ceiling effects) and requirement of in-person visits that impacted ascertainment. RECENT FINDINGS We present novel cognitive measures that were designed to exhibit reduced practice effects and stronger correlations with Alzheimer's disease biomarkers. In addition, we summarized some recent efforts in developing remote testing measures protocols that are aimed to overcome the limitations and inconvenience of in-person testing, and digital phenotyping, which analyses subtle forms of digital behaviour indicative of cognitive phenotypes. We discuss each measure's prognostic accuracy and potential utility in Alzheimer's disease research while also commenting on their limitations. We also describe our study, the Development of Novel Measures for Alzheimer's Disease Prevention Trials (NoMAD), that employed a parallel group design in which novel measures and established measures are compared in a clinical trials armature. SUMMARY Overall, we believe that these recent developments offer promising improvements in accurately detecting clinical and preclinical cognitive changes in the Alzheimer's disease spectrum; however, further validation of their psychometric properties and diagnostic accuracies is warranted before reliably implementing these novel measures in Alzheimer's disease clinical trials.
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Affiliation(s)
- Scott Carlson
- Department of Geriatric Psychiatry, New York State Psychiatric Institute, NY, USA
| | - Hyun Kim
- Department of Geriatric Psychiatry, New York State Psychiatric Institute, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, NY, USA
| | - Davangere P. Devanand
- Department of Geriatric Psychiatry, New York State Psychiatric Institute, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, NY, USA
| | - Terry E. Goldberg
- Department of Geriatric Psychiatry, New York State Psychiatric Institute, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, NY, USA
- Department of Anesthesiology, Columbia University Irving Medical Center, NY, USA
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Devanand DP, Lee S, Huey ED, Goldberg TE. Associations Between Neuropsychiatric Symptoms and Neuropathological Diagnoses of Alzheimer Disease and Related Dementias. JAMA Psychiatry 2022; 79:359-367. [PMID: 35171235 PMCID: PMC8851371 DOI: 10.1001/jamapsychiatry.2021.4363] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Understanding associations of Alzheimer disease (AD) and related dementias (ADRD) pathologies with common neuropsychiatric symptoms (NPS) may have implications for diagnosis and management. OBJECTIVE To evaluate ADRD neuropathological diagnoses and NPS without consideration of clinical diagnosis. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study evaluated 1808 brains from 39 sites in the US National Alzheimer Coordinating Center v. 10 collection for participants among whom the Neuropsychiatric Inventory Questionnaire (NPIQ) was administered annually. Brain autopsy diagnoses of AD, Lewy body disease (LBD), cerebral amyloid angiopathy, frontotemporal lobar degeneration, cerebrovascular disease, hippocampal sclerosis, and no known pathology were examined. Autopsy data collected from January 2012 to January 2018 were deidentified and compiled into the publicly available v. 10 database. Data were analyzed from February 2021 to August 2021. MAIN OUTCOMES AND MEASURES The primary outcome was NPIQ domain score, if present at any time point, and mean NPIQ domain score during follow-up was secondary. Associations of ADRD diagnoses with 12 NPIQ symptom domains were examined in regression analyses, correcting for multiple comparisons. RESULTS The study sample of 1808 adults had a mean (SD) age of 80.0 (11.0) years, and 987 participants (54.6%) were male. Apathy was the most prevalent NPS, reaching 80% (203 of 254 individuals) in those with hippocampal sclerosis. Cerebrovascular disease showed few NPS associations. Frontotemporal lobar degeneration was associated with increased apathy, increased disinhibition, and decreased psychosis and agitation compared with AD. Hippocampal sclerosis was associated with increased apathy (odds ratio, 2.60; 95% CI; 1.86-3.66, false discovery rate controlled P < .001) and disinhibition (odds ratio, 2.15; 95% CI, 1.63-2.84; false discovery rate controlled P < .001). In multiple regression analyses that included concomitant neuropathologies, the main findings remained. More severe pathology was consistently associated with increased NPS (eg, LBD was associated with an increase in hallucinations from brain stem [β, 0.23; 95% CI, 0.07-0.76; P = .02] to limbic [β, 1.69; 95% CI, 1.27-2.27; P < .001] to neocortical [β, 4.49; 95% CI, 3.27-6.16; P < .001] pathology). Hallucinations were more common in participants with AD and LBD (168 of 534 [31.5%]) compared with those with AD without LBD (152 of 704 [21.6%]) and those with LBD without AD (23 of 119 [19.6%]). CONCLUSIONS AND RELEVANCE In this cohort study of 1808 brains from the US National Alzheimer Coordinating Center, patients with LBD and AD showed a higher prevalence of hallucinations compared with those with LBD without AD. Neuropsychiatric symptom criteria of apathy and disinhibition in behavioral variant frontotemporal lobar degeneration were supported in this study. In hippocampal sclerosis, the findings of increased apathy and disinhibition merit further investigation. Severity of neuropathology was associated with NPS severity, indicating that NPS may reflect underlying ADRD pathology and highlighting the importance of diagnosing and treating NPS.
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Affiliation(s)
- Davangere P. Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York
| | - Seonjoo Lee
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
- Division of Mental Health Data Science, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York
| | - Edward D. Huey
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York
| | - Terry E. Goldberg
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York
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Doraiswamy PM, Goldberg TE, Qian M, Linares AR, Nwosu A, Nino I, D'Antonio J, Phillips J, Ndouli C, Hellegers C, Michael AM, Petrella JR, Andrews H, Sneed J, Devanand DP. Validity of the Web-Based, Self-Directed, NeuroCognitive Performance Test in Mild Cognitive Impairment. J Alzheimers Dis 2022; 86:1131-1136. [PMID: 35180109 DOI: 10.3233/jad-220015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Digital cognitive tests offer several potential advantages over established paper-pencil tests but have not yet been fully evaluated for the clinical evaluation of mild cognitive impairment. OBJECTIVE The NeuroCognitive Performance Test (NCPT) is a web-based, self-directed, modular battery intended for repeated assessments of multiple cognitive domains. Our objective was to examine its relationship with the Alzheimer's Disease Assessment Scale-Cognition Subscale (ADAS-Cog) and Mini-Mental State Examination (MMSE) as well as with established paper-pencil tests of cognition and daily functioning in mild cognitive impairment (MCI). METHODS We used Spearman correlations, regressions and principal components analysis followed by a factor analysis (varimax rotated) to examine our objectives. RESULTS In MCI subjects, the NCPT composite is significantly correlated with both a composite measure of established tests (r = 0.77, p < 0.0001) as well as with the ADAS-Cog (r = 0.55, p < 0.0001). Both NCPT and paper-pencil test batteries had a similar factor structure that included a large "g" component with a high eigenvalue. The correlation for the analogous tests (e.g., Trails A and B, learning memory tests) were significant (p < 0.0001). Further, both the NCPT and established tests significantly (p < 0.01) predicted the University of California San Diego Performance-Based Skills Assessment and Functional Activities Questionnaire, measures of daily functioning. CONCLUSION The NCPT, a web-based, self-directed, computerized test, shows high concurrent validity with established tests and hence offers promise for use as a research or clinical tool in MCI. Despite limitations such as a relatively small sample, absence of control group and cross-sectional nature, these findings are consistent with the growing literature on the promise of self-directed, web-based cognitive assessments for MCI.
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Affiliation(s)
- P Murali Doraiswamy
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA.,Duke Institute for Brain Sciences, Durham, NC, USA
| | - Terry E Goldberg
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatry Institute, New York, NY, USA
| | - Min Qian
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Alexandra R Linares
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Adaora Nwosu
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Izael Nino
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatry Institute, New York, NY, USA
| | - Jessica D'Antonio
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatry Institute, New York, NY, USA
| | - Julia Phillips
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatry Institute, New York, NY, USA
| | - Charlie Ndouli
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatry Institute, New York, NY, USA
| | - Caroline Hellegers
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | | | - Jeffrey R Petrella
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Joel Sneed
- Department of Psychology, Queens College, City University of New York, Flushing, NY, USA.,Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA
| | - Davangere P Devanand
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatry Institute, New York, NY, USA
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Choi J, Lee S, Motter JN, Kim H, Andrews H, Doraiswamy PM, Devanand DP, Goldberg TE. Models of depressive pseudoamnestic disorder. A&D Transl Res & Clin Interv 2022; 8:e12335. [PMCID: PMC9746884 DOI: 10.1002/trc2.12335] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Jongwoo Choi
- Division of Mental Health Data Science New York State Psychiatric Institute New York New York USA
| | - Seonjoo Lee
- Division of Mental Health Data Science New York State Psychiatric Institute New York New York USA
- Department of Biostatistics Mailman School of Public Health Columbia University New York New York USA
- Department of Psychiatry Columbia University Medical Center New York New York USA
| | - Jeffrey N. Motter
- Division of Geriatric Psychiatry New York State Psychiatric Institute New York New York USA
| | - Hyun Kim
- Division of Geriatric Psychiatry New York State Psychiatric Institute New York New York USA
| | - Howard Andrews
- Department of Biostatistics Mailman School of Public Health Columbia University New York New York USA
- Department of Psychiatry Columbia University Medical Center New York New York USA
| | - P. Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences Duke University School of Medicine Durham North Carolina USA
| | - D. P. Devanand
- Division of Geriatric Psychiatry New York State Psychiatric Institute New York New York USA
| | - Terry E. Goldberg
- Department of Psychiatry Columbia University Medical Center New York New York USA
- Division of Geriatric Psychiatry New York State Psychiatric Institute New York New York USA
- Department of Anesthesiology Columbia University Medical Center New York New York USA
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Zoghbi AW, Dhindsa RS, Goldberg TE, Mehralizade A, Motelow JE, Wang X, Alkelai A, Harms MB, Lieberman JA, Markx S, Goldstein DB. High-impact rare genetic variants in severe schizophrenia. Proc Natl Acad Sci U S A 2021; 118:e2112560118. [PMID: 34903660 PMCID: PMC8713775 DOI: 10.1073/pnas.2112560118] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 02/04/2023] Open
Abstract
Extreme phenotype sequencing has led to the identification of high-impact rare genetic variants for many complex disorders but has not been applied to studies of severe schizophrenia. We sequenced 112 individuals with severe, extremely treatment-resistant schizophrenia, 218 individuals with typical schizophrenia, and 4,929 controls. We compared the burden of rare, damaging missense and loss-of-function variants between severe, extremely treatment-resistant schizophrenia, typical schizophrenia, and controls across mutation intolerant genes. Individuals with severe, extremely treatment-resistant schizophrenia had a high burden of rare loss-of-function (odds ratio, 1.91; 95% CI, 1.39 to 2.63; P = 7.8 × 10-5) and damaging missense variants in intolerant genes (odds ratio, 2.90; 95% CI, 2.02 to 4.15; P = 3.2 × 10-9). A total of 48.2% of individuals with severe, extremely treatment-resistant schizophrenia carried at least one rare, damaging missense or loss-of-function variant in intolerant genes compared to 29.8% of typical schizophrenia individuals (odds ratio, 2.18; 95% CI, 1.33 to 3.60; P = 1.6 × 10-3) and 25.4% of controls (odds ratio, 2.74; 95% CI, 1.85 to 4.06; P = 2.9 × 10-7). Restricting to genes previously associated with schizophrenia risk strengthened the enrichment with 8.9% of individuals with severe, extremely treatment-resistant schizophrenia carrying a damaging missense or loss-of-function variant compared to 2.3% of typical schizophrenia (odds ratio, 5.48; 95% CI, 1.52 to 19.74; P = 0.02) and 1.6% of controls (odds ratio, 5.82; 95% CI, 3.00 to 11.28; P = 2.6 × 10-8). These results demonstrate the power of extreme phenotype case selection in psychiatric genetics and an approach to augment schizophrenia gene discovery efforts.
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Affiliation(s)
- Anthony W Zoghbi
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030;
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032
- Office of Mental Health, New York State Psychiatric Institute, New York, NY 10032
| | - Ryan S Dhindsa
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032
- Department of Molecular and Human Genetics, Jan and Dan Duncan Neurological Research Institute, Houston, TX 77030
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY 10032
| | - Terry E Goldberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032
- Office of Mental Health, New York State Psychiatric Institute, New York, NY 10032
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY 10032
| | - Aydan Mehralizade
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032
- Office of Mental Health, New York State Psychiatric Institute, New York, NY 10032
| | - Joshua E Motelow
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY 10032
- Department of Pediatrics, Division of Critical Care and Hospital Medicine, Columbia University Irving Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital of New York, New York, NY 10032
| | - Xinchen Wang
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY 10032
- Waypoint Bio, New York, NY 10014
| | - Anna Alkelai
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY 10032
| | - Matthew B Harms
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032
- Center for Motor Neuron Biology and Disease, Columbia University Irving Medical Center, New York, NY 10032
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032
- Office of Mental Health, New York State Psychiatric Institute, New York, NY 10032
| | - Sander Markx
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032;
- Office of Mental Health, New York State Psychiatric Institute, New York, NY 10032
| | - David B Goldstein
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032;
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY 10032
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Kerner N, Espejo K, Bell SA, Pollina J, Goldberg TE, Devanand DP. Association between sleep health and cognitive reserve in older adults with cognitive concerns. Alzheimers Dement 2021. [DOI: 10.1002/alz.057893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nancy Kerner
- New York State Psychiatric Institute New York NY USA
- Columbia University, College of Physicians and Surgeons New York NY USA
| | | | | | - Julianna Pollina
- Columbia University, College of Physicians and Surgeons New York NY USA
| | - Terry E. Goldberg
- New York State Psychiatric Institute New York NY USA
- Columbia University, College of Physicians and Surgeons New York NY USA
| | - Davangere P Devanand
- New York State Psychiatric Institute New York NY USA
- Columbia University, College of Physicians and Surgeons New York NY USA
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Devanand DP, Lee S, Huey ED, Goldberg TE. Impact of Alzheimer’s disease and related disorders neuropathology on neuropsychiatric symptoms during life. Alzheimers Dement 2021. [DOI: 10.1002/alz.051487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Davangere P Devanand
- New York State Psychiatric Institute, Columbia University Medical Center New York NY USA
- Columbia University Medical Center New York NY USA
| | | | - Edward D. Huey
- Columbia University Medical Center New York NY USA
- Columbia University New York NY USA
| | - Terry E. Goldberg
- Columbia University Irving Medical Center New York NY USA
- New York State Psychiatric Institute New York NY USA
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Bell SA, Kim H, Cohen HR, Lee S, Rivera AM, Brickman AM, Harvey PD, Schneider LS, Gordon ML, Goldberg TE. Correlations between neuropsychological performance and functional measures: Preliminary findings from the novel cognitive and functional measure for Alzheimer’s Disease prevention trials (NoMAD). Alzheimers Dement 2021. [DOI: 10.1002/alz.054180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Hyun Kim
- New York State Psychiatric Institute New York NY USA
- Columbia University Irving Medical Center New York NY USA
| | | | - Seonjoo Lee
- New York State Psychiatric Institute New York NY USA
- Columbia University New York NY USA
| | | | | | | | - Lon S. Schneider
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California Los Angeles CA USA
| | - Marc L. Gordon
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead NY USA
- The Litwin‐Zucker Research Center, The Feinstein Institutes for Medical Research Manhasset NY USA
| | - Terry E. Goldberg
- New York State Psychiatric Institute New York NY USA
- Columbia University Irving Medical Center New York NY USA
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Goldberg TE, Chen C, Wang Y, Jung E, Swanson A, Ing C, Garcia PS, Whittington RA, Moitra V. Association of Delirium With Long-term Cognitive Decline: A Meta-analysis. JAMA Neurol 2021; 77:1373-1381. [PMID: 32658246 DOI: 10.1001/jamaneurol.2020.2273] [Citation(s) in RCA: 200] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Delirium is associated with increased hospital costs, health care complications, and increased mortality. Long-term consequences of delirium on cognition have not been synthesized and quantified via meta-analysis. Objective To determine if an episode of delirium was an independent risk factor for long-term cognitive decline, and if it was, whether it was causative or an epiphenomenon in already compromised individuals. Data Sources A systematic search in PubMed, Cochrane, and Embase was conducted from January 1, 1965, to December 31, 2018. A systematic review guided by Preferred Reporting Items for Systematic Reviews and Meta-analyses was conducted. Search terms included delirium AND postoperative cognitive dysfunction; delirium and cognitive decline; delirium AND dementia; and delirium AND memory. Study Selection Inclusion criteria for studies included contrast between groups with delirium and without delirium; an objective continuous or binary measure of cognitive outcome; a final time point of 3 or more months after the delirium episode. The electronic search was conducted according to established methodologies and was executed on October 17, 2018. Data Extraction and Synthesis Three authors extracted data on individual characteristics, study design, and outcome, followed by a second independent check on outcome measures. Effect sizes were calculated as Hedges g. If necessary, binary outcomes were also converted to g. Only a single effect size was calculated for each study. Main Outcomes and Measures The planned main outcome was magnitude of cognitive decline in Hedges g effect size in delirium groups when contrasted with groups that did not experience delirium. Results Of 1583 articles, data subjected from the 24 studies (including 3562 patients who experienced delirium and 6987 controls who did not) were included in a random-effects meta-analysis for pooled effect estimates and random-effects meta-regressions to identify sources of study variance. One study was excluded as an outlier. There was a significant association between delirium and long-term cognitive decline, as the estimated effect size (Hedges g) for 23 studies was 0.45 (95% CI, 0.34-0.57; P < .001). In all studies, the group that experienced delirium had worse cognition at the final time point. The I2 measure of between-study variability in g was 0.81. A multivariable meta-regression suggested that duration of follow-up (longer with larger gs), number of covariates controlled (greater numbers were associated with smaller gs), and baseline cognitive matching (matching was associated with larger gs) were significant sources of variance. More specialized subgroup and meta-regressions were consistent with predictions that suggested that delirium may be a causative factor in cognitive decline. Conclusions and Relevance In this meta-analysis, delirium was significantly associated with long-term cognitive decline in both surgical and nonsurgical patients.
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Affiliation(s)
- Terry E Goldberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York
| | - Chen Chen
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Yuanjia Wang
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Eunice Jung
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Antoinette Swanson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Caleb Ing
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York
| | - Paul S Garcia
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York
| | - Robert A Whittington
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York
| | - Vivek Moitra
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York
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Kerner N, Cohen H, Scodes J, Bell S, Goldberg TE, Westwood A, Devanand DP. Understanding the effect of fatigue on the association between sleep disturbances and cognitive function ability among cognitively impaired older adults. Alzheimers Dement 2020. [DOI: 10.1002/alz.040590] [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: 10/22/2022]
Affiliation(s)
- Nancy Kerner
- Columbia University New York NY USA
- New York State Psychiatric Institute New York NY USA
| | - Hannah Cohen
- New York State Psychiatric Institute New York NY USA
| | | | - Sophie Bell
- New York State Psychiatric Institute New York NY USA
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Ing C, Jackson WM, Zaccariello MJ, Goldberg TE, McCann ME, Grobler A, Davidson A, Sun L, Li G, Warner DO. Prospectively assessed neurodevelopmental outcomes in studies of anaesthetic neurotoxicity in children: a systematic review and meta-analysis. Br J Anaesth 2020; 126:433-444. [PMID: 33250180 DOI: 10.1016/j.bja.2020.10.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/08/2020] [Accepted: 10/18/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Whether exposure to a single general anaesthetic (GA) in early childhood causes long-term neurodevelopmental problems remains unclear. METHODS PubMed/MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library were searched from inception to October 2019. Studies evaluating neurodevelopmental outcomes and prospectively enrolling children exposed to a single GA procedure compared with unexposed children were identified. Outcomes common to at least three studies were evaluated using random-effects meta-analyses. RESULTS Full-scale intelligence quotient (FSIQ); the parentally reported Child Behavior Checklist (CBCL) total, externalising, and internalising problems scores; and Behavior Rating Inventory of Executive Function (BRIEF) scores were assessed. Of 1644 children identified, 841 who had a single exposure to GA were evaluated. The CBCL problem scores were significantly higher (i.e. worse) in exposed children: mean score difference (CBCL total: 2.3 [95% confidence interval {CI}: 1.0-3.7], P=0.001; CBCL externalising: 1.9 [95% CI: 0.7-3.1], P=0.003; and CBCL internalising problems: 2.2 [95% CI: 0.9-3.5], P=0.001). Differences in BRIEF were not significant after multiple comparison adjustment. Full-scale intelligence quotient was not affected by GA exposure. Secondary analyses evaluating the risk of these scores exceeding predetermined clinical thresholds found that GA exposure was associated with increased risk of CBCL internalising behavioural deficit (risk ratio [RR]: 1.47; 95% CI: 1.08-2.02; P=0.016) and impaired BRIEF executive function (RR: 1.68; 95% CI: 1.23-2.30; P=0.001). CONCLUSIONS Combining results of studies utilising prospectively collected outcomes showed that a single GA exposure was associated with statistically significant increases in parent reports of behavioural problems with no difference in general intelligence.
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Affiliation(s)
- Caleb Ing
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.
| | - William M Jackson
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Terry E Goldberg
- Department of Psychiatry and Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Mary-Ellen McCann
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Anneke Grobler
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Andrew Davidson
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Australia
| | - Lena Sun
- Departments of Anesthesiology and Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Guohua Li
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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Bodner KA, Goldberg TE, Devanand DP, Doraiswamy PM. Advancing Computerized Cognitive Training for MCI and Alzheimer's Disease in a Pandemic and Post-pandemic World. Front Psychiatry 2020; 11:557571. [PMID: 33329097 PMCID: PMC7732551 DOI: 10.3389/fpsyt.2020.557571] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/26/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Kaylee A. Bodner
- Neurocognitive Disorders Program, Departments of Psychiatry and Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Terry E. Goldberg
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, United States
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - D. P. Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, United States
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - P. Murali Doraiswamy
- Neurocognitive Disorders Program, Departments of Psychiatry and Medicine, Duke University School of Medicine, Durham, NC, United States
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Goldberg TE, Huey ED, Devanand DP. Associations of APOE e2 genotype with cerebrovascular pathology: a postmortem study of 1275 brains. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-323746. [PMID: 33148816 DOI: 10.1136/jnnp-2020-323746] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We assessed the association of apolipoprotein E (APOE) genotype with cerebrovascular disease (CVD) in a large neuropathological database maintained by the National Alzheimer's Coordinating Center (NACC). Such a comprehensive investigation of APOE and CVD pathology has not heretofore been conducted. We focused on APOE e2, an established neuroprotective genetic variant against Alzheimer's disease. METHODS To implement these objectives APOE associations in the NACC database of 1275 brains with 11 CVD pathologies, including old and recent infarcts, haemorrhages, cerebral amyloid angiopathy (CAA) and arteriosclerosis, were examined. These pathologies were uniformly and semiquantitatively measured across 39 Alzheimer's Disease Center sites. We used χ2 statistics and ordinal regression to assess the significance of associations and Bonferroni corrected for multiple comparisons. RESULTS Of the cases, 98 were e2/e3 or e2/e2 genotypes ('e2' carriers), 621 were e3 homozygotes ('e3' group), and 556 were e4/e3 (442) or e4/e4 (114) genotypes ('e4' group). Results indicated that the APOE e4 allele significantly increased risk for CAA. After stratification by CAA presence/absence, we found that in those cases in which CAA was present, APOE e2 significantly increased risk for gross haemorrhage. All other associations were negative. CONCLUSIONS In this, the largest study of APOE e2 effects on pathologically verified CVD, e2 was not protective against any CVD pathology compared with e3 homozygotes, including CAA. Regarding the latter pathology, e4 was associated with increases in its severity. Furthermore, and perhaps unexpectedly, e2 significantly increased risk of acute/subacute gross haemorrhage in the presence of CAA. Thus, there were limits to e2 neuroprotection against amyloidosis, despite its known and large protective effects against diffuse and neuritic amyloid plaques compared with e3/e3 and e4 carriers in this very collection.
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Affiliation(s)
- Terry E Goldberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Edward D Huey
- Psychiatry and Anesthesiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Davangere P Devanand
- Psychiatry and Anesthesiology, Columbia University Irving Medical Center, New York, New York, USA
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Goldberg TE, Huey ED, Devanand DP. Association of APOE e2 genotype with Alzheimer's and non-Alzheimer's neurodegenerative pathologies. Nat Commun 2020; 11:4727. [PMID: 32948752 PMCID: PMC7501268 DOI: 10.1038/s41467-020-18198-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/28/2020] [Indexed: 12/14/2022] Open
Abstract
The apolipoprotein E (APOE) gene contains both the major common risk variant for late onset Alzheimer's disease (AD), e4, and the major neuroprotective variant, e2. Here we examine the association of APOE e2 with multiple neurodegenerative pathologies, leveraging the NACC v. 10 database of 1557 brains that included 130 e2 carriers and 679 e4 carriers in order to examine potential neuroprotective effects. For AD-related pathologies of amyloid plaques and Braak stage, e2 had large and highly significant protective effects contrasted with e3/e3 and e4 carriers with odds ratios of about 0.50 for e3 contrasts and 0.10 for e4 contrasts. When we separately examined e2/e4 carriers, risk for AD pathologies was similar to that of e4 carriers, not e2 carriers. For multiple fronto-temporal lobar pathologies and tauopathies, e2 was not significantly associated with pathology. In sum, we found that e2 was associated with large but circumscribed protective effects.
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Affiliation(s)
- Terry E Goldberg
- Psychiatry and Anesthesiology, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 126, New York, NY, 10032, USA.
| | - Edward D Huey
- Psychiatry and Neurology, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 126, New York, NY, 10032, USA
| | - D P Devanand
- Psychiatry and Neurology, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 126, New York, NY, 10032, USA
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Goldberg TE, Harvey PD, Devanand DP, Keefe RSE, Gomar JJ. Development of an UPSA Short Form for Use in Longitudinal Studies in the Early Alzheimer's Disease Spectrum. J Prev Alzheimers Dis 2020; 7:179-183. [PMID: 32463071 DOI: 10.14283/jpad.2019.51] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In individuals with only mild or very mild cognitive attenuations (i.e., so-called pre-clinical AD), performance-based measures of function may be superior to informant-based measures because of increased sensitivity, greater reliability, and fewer ceiling effects. OBJECTIVE We sought to determine if a performance-based measure of everyday function would demonstrate adequate psychometric properties and validity in the context of serial assessment over a one-year period in patients with Mild Cognitive Impairment (MCI) and early stage Alzheimer's disease (AD). DESIGN Participants were assessed with the performance-based measure at baseline, six weeks, and one year. SETTING A specialized center for the assessment and treatment of AD. PARTICIPANTS Three groups of subjects participated: a healthy subjects (HS) older cognitively intact group (N=43), an MCI group (N=20), and an AD group (N=26). MEASUREMENTS A three subtest short form of the UCSD Performance-Based Skills Assessment (UPSA) (called the UPSA-3) was the measure of interest. It consisted of the Communication, Planning, and Finance subtests. RESULTS Mixed model repeated measures were used to assess performance over time. Large group effects were present (HS>MCI>AD). Additionally, the AD and MCI groups demonstrated declines over one year, while the HS group remained stable (group x time interaction p=.11). The MCI/AD group demonstrated adequate test-retest reliability and did not demonstrate ceiling or floor effects. CONCLUSION Our data indicate that the UPSA-3 is suitable for clinical trials in that it has adequate ecological coverage and reasonable psychometric properties, and perhaps most importantly, demonstrates validity in serial assessments.
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Affiliation(s)
- T E Goldberg
- Dr. Jesus J. Gomar, Litwin-Zucker Alzheimer's Disease Center, Feinstein Institute, Manhassett, NY, USA, , Telephone: 516-562-0420, Fax: 516-562-0401
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Schneider LS, Goldberg TE. Composite cognitive and functional measures for early stage Alzheimer's disease trials. Alzheimers Dement (Amst) 2020; 12:e12017. [PMID: 32432155 PMCID: PMC7233425 DOI: 10.1002/dad2.12017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/18/2019] [Accepted: 02/03/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Composite scales have been advanced as primary outcomes in early stage Alzheimer's disease trials, and endorsed by the U.S. Food and Drug Administration (FDA) for pivotal trials. They are generally composed of several neurocognitive subscales and may include clinical and functional activity scales. METHODS We summarized the development of 12 composite scales intended as outcomes for clinical trials and assessed their characteristics. RESULTS Composite scales have been constructed from past observational and clinical trial databases by selecting components of individual neuropsychological tests previously used in clinical trials. The atheoretical approaches to combining scales into a composite scale that have often been used risk omitting clinically important measures and so may include redundant, irrelevant, or noncontributory tests. The deliberate combining of neurocognitive scales with functional activity scales provides arbitrary weightings that also may be clinically irrelevant or obscure change in a particular domain. Basic psychometric information is lacking for most of the composites. DISCUSSION Although composite scales are desirable for pivotal clinical trials because they, in principle, provide for a single, primary outcome combining neurocognitive and/or functional domains, they have substantial limitations, including their common derivations, inattention to basic psychometric principles, redundancy, absence of alternate forms, and, arguably, the inclusion of functional measures in some. In effect, any currently used composite is undergoing validation through its use in a trial. The assumption that a composite, by its construction alone, is more likely than an individual measure to detect an effect from any particular drug and that the effect is more clinically relevant or valid has not been demonstrated.
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Affiliation(s)
| | - Terry E Goldberg
- Department of Psychiatry Columbia University Medical Center New York New York
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Schneider LS, Goldberg TE. Response to peer commentaries: Composite cognitive and functional measures for early stage Alzheimer's disease trials. Alzheimers Dement (Amst) 2020; 12:e12024. [PMID: 32432156 PMCID: PMC7233419 DOI: 10.1002/dad2.12024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/02/2022]
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Wang G, Kennedy RE, Goldberg TE, Fowler ME, Cutter GR, Schneider LS. Using practice effects for targeted trials or sub-group analysis in Alzheimer's disease: How practice effects predict change over time. PLoS One 2020; 15:e0228064. [PMID: 32084191 PMCID: PMC7034859 DOI: 10.1371/journal.pone.0228064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/23/2019] [Accepted: 01/07/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To describe the presence of practice effects in persons with Alzheimer disease (AD) or mild cognitive impairment (MCI) and to evaluate how practice effects affect cognitive progression and the outcome of clinical trials. METHODS Using data from a meta-database consisting of 18 studies including participants from the Alzheimer disease Cooperative Study (ADCS) and the Alzheimer Disease Neuroimaging Initiative (ADNI) with ADAS-Cog11 as the primary outcome, we defined practice effects based on the improvement in the first two ADAS-Cog11 scores and then estimated the presence of practice effects and compared the cognitive progression between participants with and without practice effects. The robustness of practice effects was investigated using CDR SB, an outcome independent the definition itself. Furthermore, we evaluated how practice effects can affect sample size estimation. RESULTS The overall percent of practice effects for AD participants was 39.0% and 53.3% for MCI participants. For AD studies, the mean change from baseline to 2 years was 12.8 points for the non-practice effects group vs 7.4 for the practice effects group; whereas for MCI studies, it was 4.1 for non-practice effects group vs 0.2 for the practice effects group. AD participants without practice effects progressed 0.9 points faster than those with practice effects over a period of 2 years in CDR-SB; whereas for MCI participants, the difference is 0.7 points. The sample sizes can be different by over 35% when estimated based on participants with/without practice effects. CONCLUSION Practice effects were prevalent and robust in persons with AD or MCI and affected the cognitive progression and sample size estimation. Planning of future AD or MCI clinical trials should account for practice effects to avoid underpower or considers target trials or stratification analysis based on practice effects.
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Affiliation(s)
- Guoqiao Wang
- Division of Biostatistics, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Richard E. Kennedy
- Comprehensive Center of Aging Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Terry E. Goldberg
- Department of Psychiatry, Columbia University, New York, New York, United States of America
| | - Mackenzie E. Fowler
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Gary R. Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Lon S. Schneider
- Department of Psychiatry and The Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
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Petrides G, Malur C, Braga RJ, Bailine SH, Schooler NR, Malhotra AK, Kane JM, Sanghani S, Goldberg TE, John M, Mendelowitz A. Electroconvulsive Therapy Augmentation in Clozapine-Resistant Schizophrenia: A Prospective, Randomized Study. Focus (Am Psychiatr Publ) 2020; 17:76-82. [PMID: 32015718 DOI: 10.1176/appi.focus.17106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from Am J Psychiatry 2015; 172:52-58).
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Affiliation(s)
- Terry E. Goldberg
- Division of Geriatric Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
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Garcia-Alvarez L, Gomar JJ, Sousa A, Garcia-Portilla MP, Goldberg TE. Breadth and depth of working memory and executive function compromises in mild cognitive impairment and their relationships to frontal lobe morphometry and functional competence. Alzheimers Dement (Amst) 2019; 11:170-179. [PMID: 30911598 PMCID: PMC6416209 DOI: 10.1016/j.dadm.2018.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The extent of working memory (WM) and executive function (EF) impairment in mild cognitive impairment (MCI) is not well-characterized. METHODS We compared 48 patients with MCI, 124 noncognitively impaired elderly healthy controls, and 57 patients with Alzheimer's disease (AD) on multiple WM/EF measures, frontal lobe integrity indexes, and functioning. RESULTS Patients with MCI demonstrated worse performance on nearly all WM/EF tests. This profile of impairment was refined in a factor analysis that identified three primary WM/EF constructs: WM storage; speed and controlled visual search; and manipulation of information and problem solving. EF impairments were associated with reductions in prefrontal cortical thickness. WM/EF accounted for over 50% of the variance in functional competence. DISCUSSION In MCI, WM/EF impairments are far from rare, based on specific compromises to frontal cortex circuitry, and are associated with loss of everyday functioning. WM/EF impairments, even at this potentially prodromal stage of AD, have clinically deleterious consequences.
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Affiliation(s)
- Leticia Garcia-Alvarez
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain
- Fundación para la Investigación e Innovación Biosanitaria del Principado de Asturias (Finba), Oviedo, Spain
| | - Jesus J. Gomar
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain
- The Litwin-Zucker Alzheimer's Research Center, The Feinstein Institute for Medical Research, Manhasset, NY, USA
- FIDMAG Hermanas Hospitalarias Research Foundation, SantBoi de Llobregat, Spain
| | - Amber Sousa
- The Litwin-Zucker Alzheimer's Research Center, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Maria P. Garcia-Portilla
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain
- Fundación para la Investigación e Innovación Biosanitaria del Principado de Asturias (Finba), Oviedo, Spain
| | - Terry E. Goldberg
- Division of Geriatric Psychiatry, Psychiatry, Columbia University Medical Center, NY, USA
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