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Beagle AJ, Prasad PA, Hubbard CC, Walderich S, Oreper S, Abe-Jones Y, Fang MC, Kangelaris KN. Associations Between Volume of Early Intravenous Fluid and Hospital Outcomes in Septic Patients With and Without Heart Failure: A Retrospective Cohort Study. Crit Care Explor 2024; 6:e1082. [PMID: 38694845 PMCID: PMC11057813 DOI: 10.1097/cce.0000000000001082] [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] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVES To evaluate the relationship between early IV fluid volume and hospital outcomes, including death in-hospital or discharge to hospice, in septic patients with and without heart failure (HF). DESIGN A retrospective cohort study using logistic regression with restricted cubic splines to assess for nonlinear relationships between fluid volume and outcomes, stratified by HF status and adjusted for propensity to receive a given fluid volume in the first 6 hours. An ICU subgroup analysis was performed. Secondary outcomes of vasopressor use, mechanical ventilation, and length of stay in survivors were assessed. SETTING An urban university-based hospital. PATIENTS A total of 9613 adult patients were admitted from the emergency department from 2012 to 2021 that met electronic health record-based Sepsis-3 criteria. Preexisting HF diagnosis was identified by the International Classification of Diseases codes. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 1449 admissions from patients with HF. The relationship between fluid volume and death or discharge to hospice was nonlinear in patients without HF, and approximately linear in patients with HF. Receiving 0-15 mL/kg in the first 6 hours was associated with lower likelihood of death or discharge to hospice compared with 30-45 mL/kg (odds ratio = 0.61; 95% CI, 0.41-0.90; p = 0.01) in HF patients, but no significant difference for non-HF patients. A similar pattern was identified in ICU admissions and some secondary outcomes. Volumes larger than 15-30 mL/kg for non-HF patients and 30-45 mL/kg for ICU-admitted non-HF patients were not associated with improved outcomes. CONCLUSIONS Early fluid resuscitation showed distinct patterns of potential harm and benefit between patients with and without HF who met Sepsis-3 criteria. Restricted cubic splines analysis highlighted the importance of considering nonlinear fluid outcomes relationships and identified potential points of diminishing returns (15-30 mL/kg across all patients without HF and 30-45 mL/kg when admitted to the ICU). Receiving less than 15 mL/kg was associated with better outcomes in HF patients, suggesting small volumes may be appropriate in select patients. Future studies may benefit from investigating nonlinear fluid-outcome associations and a focus on other conditions like HF.
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Affiliation(s)
- Alexander J Beagle
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Priya A Prasad
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Colin C Hubbard
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sven Walderich
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sandra Oreper
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Yumiko Abe-Jones
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Margaret C Fang
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Kirsten N Kangelaris
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
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2
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Prasad PA, Esmaili AM, Oreper S, Beagle AJ, Hubbard C, Raffel KE, Abe‐Jones Y, Fang MC, Liu KD, Matthay MA, Kangelaris KN. Timing of antibiotic treatment identifies distinct clinical presentations among patients presenting with suspected septic shock. J Am Coll Emerg Physicians Open 2024; 5:e13149. [PMID: 38596320 PMCID: PMC11002635 DOI: 10.1002/emp2.13149] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/11/2024] Open
Abstract
Objective Recent clinical guidelines for sepsis management emphasize immediate antibiotic initiation for suspected septic shock. Though hypotension is a high-risk marker of sepsis severity, prior studies have not considered the precise timing of hypotension in relation to antibiotic initiation and how clinical characteristics and outcomes may differ. Our objective was to evaluate antibiotic initiation in relation to hypotension to characterize differences in sepsis presentation and outcomes in patients with suspected septic shock. Methods Adults presenting to the emergency department (ED) June 2012-December 2018 diagnosed with sepsis (Sepsis-III electronic health record [EHR] criteria) and hypotension (non-resolving for ≥30 min, systolic blood pressure <90 mmHg) within 24 h. We categorized patients who received antibiotics before hypotension ("early"), 0-60 min after ("immediate"), and >60 min after ("late") treatment. Results Among 2219 patients, 55% received early treatment, 13% immediate, and 32% late. The late subgroup often presented to the ED with hypotension (median 0 min) but received antibiotics a median of 191 min post-ED presentation. Clinical characteristics notable for this subgroup included higher prevalence of heart failure and liver disease (p < 0.05) and later onset of systemic inflammatory response syndrome (SIRS) criteria compared to early/immediate treatment subgroups (median 87 vs. 35 vs. 20 min, p < 0.0001). After adjustment, there was no difference in clinical outcomes among treatment subgroups. Conclusions There was significant heterogeneity in presentation and timing of antibiotic initiation for suspected septic shock. Patients with later treatment commonly had hypotension on presentation, had more hypotension-associated comorbidities, and developed overt markers of infection (eg, SIRS) later. While these factors likely contribute to delays in clinician recognition of suspected septic shock, it may not impact sepsis outcomes.
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Affiliation(s)
- Priya A. Prasad
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Armond M. Esmaili
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Sandra Oreper
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Colin Hubbard
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Katie E. Raffel
- Division of Hospital MedicineSchool of MedicineUniversity of ColoradoDenverColoradoUSA
| | - Yumiko Abe‐Jones
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Margaret C. Fang
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Kathleen D. Liu
- Division of Pulmonary and Critical Care MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Division of NephrologyDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Michael A. Matthay
- Division of Pulmonary and Critical Care MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Cardiovascular Research InstituteUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Kirsten N. Kangelaris
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Beagle AJ, Sunwoo BY, Olin RL, Schwartz BS, Block BL. It's All in the Timing. N Engl J Med 2023; 389:940-947. [PMID: 37672698 DOI: 10.1056/nejmcps2307176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Alexander J Beagle
- From the Department of Medicine (A.J.B.), Divisions of Hematology and Oncology (R.L.O.), Infectious Diseases (B.S.S.), and Pulmonary, Critical Care, Allergy, and Sleep Medicine (B.L.B.), University of California, San Francisco, San Francisco, and the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla (B.Y.S.)
| | - Bernie Y Sunwoo
- From the Department of Medicine (A.J.B.), Divisions of Hematology and Oncology (R.L.O.), Infectious Diseases (B.S.S.), and Pulmonary, Critical Care, Allergy, and Sleep Medicine (B.L.B.), University of California, San Francisco, San Francisco, and the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla (B.Y.S.)
| | - Rebecca L Olin
- From the Department of Medicine (A.J.B.), Divisions of Hematology and Oncology (R.L.O.), Infectious Diseases (B.S.S.), and Pulmonary, Critical Care, Allergy, and Sleep Medicine (B.L.B.), University of California, San Francisco, San Francisco, and the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla (B.Y.S.)
| | - Brian S Schwartz
- From the Department of Medicine (A.J.B.), Divisions of Hematology and Oncology (R.L.O.), Infectious Diseases (B.S.S.), and Pulmonary, Critical Care, Allergy, and Sleep Medicine (B.L.B.), University of California, San Francisco, San Francisco, and the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla (B.Y.S.)
| | - Brian L Block
- From the Department of Medicine (A.J.B.), Divisions of Hematology and Oncology (R.L.O.), Infectious Diseases (B.S.S.), and Pulmonary, Critical Care, Allergy, and Sleep Medicine (B.L.B.), University of California, San Francisco, San Francisco, and the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla (B.Y.S.)
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Kim KX, Dale CL, Ranasinghe KG, Kothare H, Beagle AJ, Lerner H, Mizuiri D, Gorno-Tempini ML, Vossel K, Nagarajan SS, Houde JF. Impaired Speaking-Induced Suppression in Alzheimer's Disease. eNeuro 2023; 10:ENEURO.0056-23.2023. [PMID: 37221089 PMCID: PMC10249944 DOI: 10.1523/eneuro.0056-23.2023] [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: 02/17/2023] [Accepted: 04/04/2023] [Indexed: 05/25/2023] Open
Abstract
Alzheimer's disease (AD) is a neurodegenerative disease involving cognitive impairment and abnormalities in speech and language. Here, we examine how AD affects the fidelity of auditory feedback predictions during speaking. We focus on the phenomenon of speaking-induced suppression (SIS), the auditory cortical responses' suppression during auditory feedback processing. SIS is determined by subtracting the magnitude of auditory cortical responses during speaking from listening to playback of the same speech. Our state feedback control (SFC) model of speech motor control explains SIS as arising from the onset of auditory feedback matching a prediction of that feedback onset during speaking, a prediction that is absent during passive listening to playback of the auditory feedback. Our model hypothesizes that the auditory cortical response to auditory feedback reflects the mismatch with the prediction: small during speaking, large during listening, with the difference being SIS. Normally, during speaking, auditory feedback matches its predictions, then SIS will be large. Any reductions in SIS will indicate inaccuracy in auditory feedback prediction not matching the actual feedback. We investigated SIS in AD patients [n = 20; mean (SD) age, 60.77 (10.04); female (%), 55.00] and healthy controls [n = 12; mean (SD) age, 63.68 (6.07); female (%), 83.33] through magnetoencephalography (MEG)-based functional imaging. We found a significant reduction in SIS at ∼100 ms in AD patients compared with healthy controls (linear mixed effects model, F (1,57.5) = 6.849, p = 0.011). The results suggest that AD patients generate inaccurate auditory feedback predictions, contributing to abnormalities in AD speech.
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Affiliation(s)
- Kyunghee X Kim
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA 94117
| | - Corby L Dale
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94117
| | - Kamalini G Ranasinghe
- Department of Neurology, University of California San Francisco, San Francisco, CA 94158
| | - Hardik Kothare
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94117
| | - Alexander J Beagle
- Department of Neurology, University of California San Francisco, San Francisco, CA 94158
| | - Hannah Lerner
- Department of Neurology, University of California San Francisco, San Francisco, CA 94158
| | - Danielle Mizuiri
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94117
| | | | - Keith Vossel
- Department of Neurology, University of California San Francisco, San Francisco, CA 94158
| | - Srikantan S Nagarajan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94117
| | - John F Houde
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA 94117
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5
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Vossel K, Ranasinghe KG, Beagle AJ, La A, Ah Pook K, Castro M, Mizuiri D, Honma SM, Venkateswaran N, Koestler M, Zhang W, Mucke L, Howell MJ, Possin KL, Kramer JH, Boxer AL, Miller BL, Nagarajan SS, Kirsch HE. Effect of Levetiracetam on Cognition in Patients With Alzheimer Disease With and Without Epileptiform Activity: A Randomized Clinical Trial. JAMA Neurol 2021; 78:1345-1354. [PMID: 34570177 DOI: 10.1001/jamaneurol.2021.3310] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Network hyperexcitability may contribute to cognitive dysfunction in patients with Alzheimer disease (AD). Objective To determine the ability of the antiseizure drug levetiracetam to improve cognition in persons with AD. Design, Setting, and Participants The Levetiracetam for Alzheimer's Disease-Associated Network Hyperexcitability (LEV-AD) study was a phase 2a randomized double-blinded placebo-controlled crossover clinical trial of 34 adults with AD that was conducted at the University of California, San Francisco, and the University of Minnesota, Twin Cities, between October 16, 2014, and July 21, 2020. Participants were adults 80 years and younger who had a Mini-Mental State Examination score of 18 points or higher and/or a Clinical Dementia Rating score of less than 2 points. Screening included overnight video electroencephalography and a 1-hour resting magnetoencephalography examination. Interventions Group A received placebo twice daily for 4 weeks followed by a 4-week washout period, then oral levetiracetam, 125 mg, twice daily for 4 weeks. Group B received treatment using the reverse sequence. Main Outcomes and Measures The primary outcome was the ability of levetiracetam treatment to improve executive function (measured by the National Institutes of Health Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research [NIH-EXAMINER] composite score). Secondary outcomes were cognition (measured by the Stroop Color and Word Test [Stroop] interference naming subscale and the Alzheimer's Disease Assessment Scale-Cognitive Subscale) and disability. Exploratory outcomes included performance on a virtual route learning test and scores on cognitive and functional tests among participants with epileptiform activity. Results Of 54 adults assessed for eligibility, 11 did not meet study criteria, and 9 declined to participate. A total of 34 adults (21 women [61.8%]; mean [SD] age, 62.3 [7.7] years) with AD were enrolled and randomized (17 participants to group A and 17 participants to group B). Thirteen participants (38.2%) were categorized as having epileptiform activity. In total, 28 participants (82.4%) completed the study, 10 of whom (35.7%) had epileptiform activity. Overall, treatment with levetiracetam did not change NIH-EXAMINER composite scores (mean difference vs placebo, 0.07 points; 95% CI, -0.18 to 0.32 points; P = .55) or secondary measures. However, among participants with epileptiform activity, levetiracetam treatment improved performance on the Stroop interference naming subscale (net improvement vs placebo, 7.4 points; 95% CI, 0.2-14.7 points; P = .046) and the virtual route learning test (t = 2.36; Cohen f2 = 0.11; P = .02). There were no treatment discontinuations because of adverse events. Conclusions and Relevance In this randomized clinical trial, levetiracetam was well tolerated and, although it did not improve the primary outcome, in prespecified analysis, levetiracetam improved performance on spatial memory and executive function tasks in patients with AD and epileptiform activity. These exploratory findings warrant further assessment of antiseizure approaches in AD. Trial Registration ClinicalTrials.gov Identifier: NCT02002819.
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Affiliation(s)
- Keith Vossel
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco.,N. Bud Grossman Center for Memory Research and Care, Department of Neurology, University of Minnesota, Minneapolis.,Institute for Translational Neuroscience, University of Minnesota, Minneapolis.,Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles.,Gladstone Institute of Neurological Disease, San Francisco, California
| | - Kamalini G Ranasinghe
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Alexander J Beagle
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Alice La
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Kasey Ah Pook
- N. Bud Grossman Center for Memory Research and Care, Department of Neurology, University of Minnesota, Minneapolis
| | - Madelyn Castro
- N. Bud Grossman Center for Memory Research and Care, Department of Neurology, University of Minnesota, Minneapolis
| | - Danielle Mizuiri
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco
| | - Susanne M Honma
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco
| | - Nisha Venkateswaran
- N. Bud Grossman Center for Memory Research and Care, Department of Neurology, University of Minnesota, Minneapolis.,Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles
| | - Mary Koestler
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Wenbo Zhang
- Minnesota Epilepsy Group, St Paul, Minnesota.,Department of Neurology, University of Minnesota, Minneapolis
| | - Lennart Mucke
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco.,Gladstone Institute of Neurological Disease, San Francisco, California
| | | | - Katherine L Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Srikantan S Nagarajan
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco
| | - Heidi E Kirsch
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco.,Epilepsy Center, Department of Neurology, University of California, San Francisco, San Francisco
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6
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Beagle AJ, Tison GH, Aschbacher K, Olgin JE, Marcus GM, Pletcher MJ. Comparison of the Physical Activity Measured by a Consumer Wearable Activity Tracker and That Measured by Self-Report: Cross-Sectional Analysis of the Health eHeart Study. JMIR Mhealth Uhealth 2020; 8:e22090. [PMID: 33372896 PMCID: PMC7803477 DOI: 10.2196/22090] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/20/2020] [Accepted: 11/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background Commercially acquired wearable activity trackers such as the Fitbit provide objective, accurate measurements of physically active time and step counts, but it is unclear whether these measurements are more clinically meaningful than self-reported physical activity. Objective The aim of this study was to compare self-reported physical activity to Fitbit-measured step counts and then determine which is a stronger predictor of BMI by using data collected over the same period reflecting comparable physical activities. Methods We performed a cross-sectional analysis of data collected by the Health eHeart Study, a large mobile health study of cardiovascular health and disease. Adults who linked commercially acquired Fitbits used in free-living conditions with the Health eHeart Study and completed an International Physical Activity Questionnaire (IPAQ) between 2013 and 2019 were enrolled (N=1498). Fitbit step counts were used to quantify time by activity intensity in a manner comparable to the IPAQ classifications of total active time and time spent being sedentary, walking, or doing moderate activities or vigorous activities. Fitbit steps per day were computed as a measure of the overall activity for exploratory comparisons with IPAQ-measured overall activity (metabolic equivalent of task [MET]-h/wk). Measurements of physical activity were directly compared by Spearman rank correlation. Strengths of associations with BMI for Fitbit versus IPAQ measurements were compared using multivariable robust regression in the subset of participants with BMI and covariates measured. Results Correlations between synchronous paired measurements from Fitbits and the IPAQ ranged in strength from weak to moderate (0.09-0.48). In the subset with BMI and covariates measured (n=586), Fitbit-derived predictors were generally stronger predictors of BMI than self-reported predictors. For example, an additional hour of Fitbit-measured vigorous activity per week was associated with nearly a full point reduction in BMI (–0.84 kg/m2, 95% CI –1.35 to –0.32) in adjusted analyses, whereas the association between self-reported vigorous activity measured by IPAQ and BMI was substantially smaller in magnitude (–0.17 kg/m2, 95% CI –0.34 to –0.00; P<.001 versus Fitbit) and was dominated by the Fitbit-derived predictor when compared head-to-head in a single adjusted multivariable model. Similar patterns of associations with BMI, with Fitbit dominating self-report, were seen for moderate activity and total active time and in comparisons between overall Fitbit steps per day and IPAQ MET-h/wk on standardized scales. Conclusions Fitbit-measured physical activity was more strongly associated with BMI than self-reported physical activity, particularly for moderate activity, vigorous activity, and summary measures of total activity. Consumer-marketed wearable activity trackers such as the Fitbit may be useful for measuring health-relevant physical activity in clinical practice and research.
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Affiliation(s)
- Alexander J Beagle
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Geoffrey H Tison
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Kirstin Aschbacher
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
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Ranasinghe KG, Petersen C, Kudo K, Srivatsan S, Beagle AJ, Mizuiri D, Findlay A, Houde JF, Rankin K, Rabinovici GD, Seeley WW, Spina S, Gorno‐Tempini M, Kramer JH, Miller BL, Vossel KA, Grinberg LT, Nagarajan SS. Alpha‐frequency synchronization deficits during life predict postmortem neurofibrillary tangle burden in Alzheimer’s disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.045351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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)
| | - Cathrine Petersen
- Memory and Aging Center UCSF Weill Institute for Neurosciences University of California, San Francisco San Francisco CA USA
| | - Kiwamu Kudo
- University of California San Francisco San Francisco CA USA
| | | | | | | | - Anne Findlay
- University of California San Francisco San Francisco CA USA
| | - John F Houde
- University of California San Francisco San Francisco CA USA
| | - Katherine Rankin
- Memory and Aging Center UCSF Weill Institute for Neurosciences University of California, San Francisco San Francisco CA USA
| | - Gil D Rabinovici
- Memory and Aging Center UCSF Weill Institute for Neurosciences University of California, San Francisco San Francisco CA USA
| | | | | | | | - Joel H Kramer
- UMemory and Aging Center UCSF Weill Institute for Neurosciences University of California, San Francisco San Francisco CA USA
| | - Bruce L Miller
- University of California San Francisco San Francisco CA USA
| | - Keith A Vossel
- University of California San Francisco San Francisco CA USA
- University of Minnesota Minneapolis MN USA
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Ranasinghe KG, Cha J, Iaccarino L, Hinkley LB, Beagle AJ, Pham J, Jagust WJ, Miller BL, Rankin KP, Rabinovici GD, Vossel KA, Nagarajan SS. Neurophysiological signatures in Alzheimer's disease are distinctly associated with TAU, amyloid-β accumulation, and cognitive decline. Sci Transl Med 2020; 12:eaaz4069. [PMID: 32161102 PMCID: PMC7138514 DOI: 10.1126/scitranslmed.aaz4069] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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: 09/09/2019] [Accepted: 02/03/2020] [Indexed: 12/31/2022]
Abstract
Neural synchrony is intricately balanced in the normal resting brain but becomes altered in Alzheimer's disease (AD). To determine the neurophysiological manifestations associated with molecular biomarkers of AD neuropathology, in patients with AD, we used magnetoencephalographic imaging (MEGI) and positron emission tomography with amyloid-beta (Aβ) and TAU tracers. We found that alpha oscillations (8 to 12 Hz) were hyposynchronous in occipital and posterior temporoparietal cortices, whereas delta-theta oscillations (2 to 8 Hz) were hypersynchronous in frontal and anterior temporoparietal cortices, in patients with AD compared to age-matched controls. Regional patterns of alpha hyposynchrony were unique in each neurobehavioral phenotype of AD, whereas the regional patterns of delta-theta hypersynchrony were similar across the phenotypes. Alpha hyposynchrony strongly colocalized with TAU deposition and was modulated by the degree of TAU tracer uptake. In contrast, delta-theta hypersynchrony colocalized with both TAU and Aβ depositions and was modulated by both TAU and Aβ tracer uptake. Furthermore, alpha hyposynchrony but not delta-theta hypersynchrony was correlated with the degree of global cognitive dysfunction in patients with AD. The current study demonstrates frequency-specific neurophysiological signatures of AD pathophysiology and suggests that neurophysiological measures from MEGI are sensitive indices of network disruptions mediated by TAU and Aβ and associated cognitive decline. These findings facilitate the pursuit of novel therapeutic approaches toward normalizing network synchrony in AD.
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Affiliation(s)
- Kamalini G Ranasinghe
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA.
| | - Jungho Cha
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Leighton B Hinkley
- Department Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Alexander J Beagle
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Julie Pham
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - William J Jagust
- Helen Wills Neuroscience Institute, UC Berkeley, Berkeley, CA 94720, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
- Department Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Keith A Vossel
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
- N. Bud Grossman Center for Memory Research and Care, Institute for Translational Neuroscience, and Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Srikantan S Nagarajan
- Department Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143, USA
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9
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Beagle AJ, Zahir A, Borzello M, Kayser AS, Hsu M, Miller BL, Kramer JH, Chiong W. Amount and delay insensitivity during intertemporal choice in three neurodegenerative diseases reflects dorsomedial prefrontal atrophy. Cortex 2019; 124:54-65. [PMID: 31837518 DOI: 10.1016/j.cortex.2019.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/28/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022]
Abstract
Patients with Alzheimer's disease and other dementias often make poor financial decisions, but it remains unclear whether this reflects specific failures in decision-making or more general deficits in episodic and working memory. We investigated how patients with Alzheimer's disease, behavioral variant frontotemporal dementia (bvFTD), and semantic variant primary progressive aphasia (svPPA) apply information in an intertemporal choice task between smaller intermediate and larger delayed rewards, with minimal memory demands. Multilevel modeling estimated subject-level sensitivities to three attributes of choice (the relative difference in reward magnitude, delay length, and absolute reward magnitudes) as well as baseline impulsivity. While baseline impulsivity in patients with Alzheimer's disease did not differ from controls, patients with bvFTD and svPPA were more impulsive than controls overall. Patients with Alzheimer's disease or bvFTD were less sensitive than controls to all three choice attributes, whereas patients with svPPA were less sensitive than controls to two attributes. Attenuated sensitivity to information presented during the choice was associated across all subjects with dorsomedial prefrontal atrophy for all three choice attributes. Given the minimal memory demands of our task, these findings suggest specific mechanisms underlying decision-making failures beyond episodic and working memory deficits in dementia.
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Affiliation(s)
- Alexander J Beagle
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Ali Zahir
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Mia Borzello
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Andrew S Kayser
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Division of Neurology, VA Northern California Health Care System, Martinez, CA, USA
| | - Ming Hsu
- Helen Wills Neuroscience Institute and Haas School of Business, University of California, Berkeley, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Winston Chiong
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
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10
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Ranasinghe KG, Beagle AJ, Mizuiri D, Honma S, Welch AE, Gorno Tempini ML, Vossel KA, Houde JF, Nagarajan SS. P2-396: NEURAL ACTIVITY PATTERNS UNDERLYING ABNORMAL PHONOLOGICAL PROCESSING IN PATIENTS WITH LOGOPENIC VARIANT PRIMARY PROGRESSIVE APHASIA. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2803] [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: 11/29/2022]
Affiliation(s)
| | | | | | | | - Ariane E. Welch
- University of California; San Francisco/Memory and Aging Center; San Francisco CA USA
| | - Maria Luisa Gorno Tempini
- Memory and Aging Center, UCSF Weill Institute for Neurosciences; University of California, San Francisco; San Francisco CA USA
| | - Keith A. Vossel
- UCSF; San Francisco CA USA
- University of Minnesota; Minneapolis MN USA
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11
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Ranasinghe KG, Kothare H, Kort N, Hinkley LB, Beagle AJ, Mizuiri D, Honma SM, Lee R, Miller BL, Gorno-Tempini ML, Vossel KA, Houde JF, Nagarajan SS. Neural correlates of abnormal auditory feedback processing during speech production in Alzheimer's disease. Sci Rep 2019; 9:5686. [PMID: 30952883 PMCID: PMC6450891 DOI: 10.1038/s41598-019-41794-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/13/2019] [Indexed: 11/24/2022] Open
Abstract
Accurate integration of sensory inputs and motor commands is essential to achieve successful behavioral goals. A robust model of sensorimotor integration is the pitch perturbation response, in which speakers respond rapidly to shifts of the pitch in their auditory feedback. In a previous study, we demonstrated abnormal sensorimotor integration in patients with Alzheimer's disease (AD) with an abnormally enhanced behavioral response to pitch perturbation. Here we examine the neural correlates of the abnormal pitch perturbation response in AD patients, using magnetoencephalographic imaging. The participants phonated the vowel /α/ while a real-time signal processor briefly perturbed the pitch (100 cents, 400 ms) of their auditory feedback. We examined the high-gamma band (65-150 Hz) responses during this task. AD patients showed significantly reduced left prefrontal activity during the early phase of perturbation and increased right middle temporal activity during the later phase of perturbation, compared to controls. Activity in these brain regions significantly correlated with the behavioral response. These results demonstrate that impaired prefrontal modulation of speech-motor-control network and additional recruitment of right temporal regions are significant mediators of aberrant sensorimotor integration in patients with AD. The abnormal neural integration mechanisms signify the contribution of cortical network dysfunction to cognitive and behavioral deficits in AD.
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Affiliation(s)
- Kamalini G Ranasinghe
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA.
| | - Hardik Kothare
- Speech Neuroscience Laboratory, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, 94143, USA
- UC Berkeley - UCSF, Graduate Program in Bioengineering, San Francisco, CA, USA
| | - Naomi Kort
- Speech Neuroscience Laboratory, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Leighton B Hinkley
- Speech Neuroscience Laboratory, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Alexander J Beagle
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Danielle Mizuiri
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Susanne M Honma
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Richard Lee
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Keith A Vossel
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
- N. Bud Grossman Center for Memory Research and Care, Institute for Translational Neuroscience, and Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - John F Houde
- Speech Neuroscience Laboratory, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Srikantan S Nagarajan
- Speech Neuroscience Laboratory, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, 94143, USA
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12
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Ranasinghe KG, Cha J, Hinkley LB, Beagle AJ, Mizuiri D, Honma S, Bourakova V, Jagust WJ, Miller BL, Rabinovici GD, Nagarajan SS, Vossel KA. O1‐01‐05: DISTINCT NEURAL OSCILLATION ABNORMALITIES ASSOCIATED WITH AMYLOID‐BETA AND TAU IN ALZHEIMER'S DISEASE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2334] [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: 11/29/2022]
Affiliation(s)
| | - Jungho Cha
- University of California, San FranciscoSan FranciscoCAUSA
| | | | | | | | - Susanne Honma
- University of California San FranciscoSan FranciscoCAUSA
| | | | | | - Bruce L. Miller
- Memory and Aging Center, Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCAUSA
| | - Gil D. Rabinovici
- Memory and Aging Center and Department of Neurology, Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCAUSA
| | | | - Keith A. Vossel
- University of California San FranciscoSan FranciscoCAUSA
- University of MinnesotaMinneapolisMNUSA
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13
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Beagle AJ, Darwish SM, Ranasinghe KG, La AL, Karageorgiou E, Vossel KA. Relative Incidence of Seizures and Myoclonus in Alzheimer's Disease, Dementia with Lewy Bodies, and Frontotemporal Dementia. J Alzheimers Dis 2018; 60:211-223. [PMID: 28826176 DOI: 10.3233/jad-170031] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with Alzheimer's disease (AD) are more prone to seizures and myoclonus, but relative risk of these symptoms among other dementia types is unknown. OBJECTIVE To determine incidence of seizures and myoclonus in the three most common neurodegenerative dementias: AD, dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD). METHODS Our institution's medical records were reviewed for new-onset unprovoked seizures and myoclonus in patients meeting criteria for AD (n = 1,320), DLB (n = 178), and FTD (n = 348). Cumulative probabilities of developing seizures and myoclonus were compared between diagnostic groups, whereas age-stratified incidence rates were determined relative to control populations. RESULTS The cumulative probability of developing seizures after disease onset was 11.5% overall, highest in AD (13.4%) and DLB (14.7%) and lowest in FTD (3.0%). The cumulative probability of developing myoclonus was 42.1% overall, highest in DLB (58.1%). The seizure incidence rates, relative to control populations, were nearly 10-fold in AD and DLB, and 6-fold in FTD. Relative seizure rates increased with earlier age-at-onset in AD (age <50, 127-fold; 50-69, 21-fold; 70+, 2-fold) and FTD (age <50, 53-fold; 50-69, 9-fold), and relative myoclonus rates increased with earlier age-at-onset in all groups. Seizures began an average of 3.9 years after the onset of cognitive or motor decline, and myoclonus began 5.4 years after onset. CONCLUSIONS Seizures and myoclonus occur with greater incidence in patients with AD, DLB, and FTD than in the general population, but rates vary with diagnosis, suggesting varied pathomechanisms of network hyperexcitability. Patients often experience these symptoms early in disease, suggesting hyperexcitability could be an important target for interventions.
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Affiliation(s)
- Alexander J Beagle
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Sonja M Darwish
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Kamalini G Ranasinghe
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Alice L La
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Elissaios Karageorgiou
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA.,Neurological Institute of Athens, Athens, Greece
| | - Keith A Vossel
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA.,N. Bud Grossman Center for Memory Research and Care, Institute for Translational Neuroscience, and Department of Neurology, University of Minnesota, Minneapolis, MN, USA
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14
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Ranasinghe KG, Hinkley LB, Beagle AJ, Mizuiri D, Honma SM, Welch AE, Hubbard I, Mandelli ML, Miller ZA, Garrett C, La A, Boxer AL, Houde JF, Miller BL, Vossel KA, Gorno-Tempini ML, Nagarajan SS. Distinct spatiotemporal patterns of neuronal functional connectivity in primary progressive aphasia variants. Brain 2017; 140:2737-2751. [PMID: 28969381 DOI: 10.1093/brain/awx217] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 07/04/2017] [Indexed: 12/15/2022] Open
Abstract
Primary progressive aphasia is a syndrome characterized by progressive loss of language abilities with three main phenotypic clinical presentations, including logopenic, non-fluent/agrammatic, and semantic variants. Previous imaging studies have shown unique anatomic impacts within language networks in each variant. However, direct measures of spontaneous neuronal activity and functional integrity of these impacted neural networks in primary progressive aphasia are lacking. The aim of this study was to characterize the spatial and temporal patterns of resting state neuronal synchronizations in primary progressive aphasia syndromes. We hypothesized that resting state brain oscillations will show unique deficits within language network in each variant of primary progressive aphasia. We examined 39 patients with primary progressive aphasia including logopenic variant (n = 14, age = 61 ± 9 years), non-fluent/agrammatic variant (n = 12, age = 71 ± 8 years) and semantic variant (n = 13, age = 65 ± 7 years) using magnetoencephalographic imaging, compared to a control group that was matched in age and gender to each primary progressive aphasia subgroup (n = 20, age = 65 ± 5 years). Each patient underwent a complete clinical evaluation including a comprehensive battery of language tests. We examined the whole-brain resting state functional connectivity as measured by imaginary coherence in each patient group compared to the control cohort, in three frequency oscillation bands-delta-theta (2-8 Hz); alpha (8-12 Hz); beta (12-30 Hz). Each variant showed a distinct spatiotemporal pattern of altered functional connectivity compared to age-matched controls. Specifically, we found significant hyposynchrony of alpha and beta frequency within the left posterior temporal and occipital cortices in patients with the logopenic variant, within the left inferior frontal cortex in patients with the non-fluent/agrammatic variant, and within the left temporo-parietal junction in patients with the semantic variant. Patients with logopenic variant primary progressive aphasia also showed significant hypersynchrony of delta-theta frequency within bilateral medial frontal and posterior parietal cortices. Furthermore, region of interest-based analyses comparing the spatiotemporal patterns of variant-specific regions of interest identified in comparison to age-matched controls showed significant differences between primary progressive aphasia variants themselves. We also found distinct patterns of regional spectral power changes in each primary progressive aphasia variant, compared to age-matched controls. Our results demonstrate neurophysiological signatures of network-specific neuronal dysfunction in primary progressive aphasia variants. The unique spatiotemporal patterns of neuronal synchrony signify diverse neurophysiological disruptions and pathological underpinnings of the language network in each variant.
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Affiliation(s)
- Kamalini G Ranasinghe
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Leighton B Hinkley
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco CA 94143, USA
| | - Alexander J Beagle
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Danielle Mizuiri
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco CA 94143, USA
| | - Susanne M Honma
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco CA 94143, USA
| | - Ariane E Welch
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Isabel Hubbard
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Coleman Garrett
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco CA 94143, USA
| | - Alice La
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - John F Houde
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco CA 94143, USA.,Speech Neuroscience Laboratory, Department of Otolaryngology, Head and Neck Surgery, University of California San Francisco, San Francisco CA 94143, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Keith A Vossel
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Srikantan S Nagarajan
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco CA 94143, USA.,Speech Neuroscience Laboratory, Department of Otolaryngology, Head and Neck Surgery, University of California San Francisco, San Francisco CA 94143, USA
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15
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Ranasinghe KG, Gill JS, Kothare H, Beagle AJ, Mizuiri D, Honma SM, Gorno-Tempini ML, Miller BL, Vossel KA, Nagarajan SS, Houde JF. Abnormal vocal behavior predicts executive and memory deficits in Alzheimer's disease. Neurobiol Aging 2017; 52:71-80. [PMID: 28131013 DOI: 10.1016/j.neurobiolaging.2016.12.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/07/2016] [Accepted: 12/23/2016] [Indexed: 02/07/2023]
Abstract
Speakers respond automatically and rapidly to compensate for brief perturbations of pitch in their auditory feedback. The specific adjustments in vocal output require integration of brain regions involved in speech-motor-control in order to detect the sensory-feedback error and implement the motor correction. Cortical regions involved in the pitch reflex phenomenon are highly vulnerable targets of network disruption in Alzheimer's disease (AD). We examined the pitch reflex in AD patients (n = 19) compared to an age-matched control group (n = 16). We measured the degree of behavioral compensation (peak compensation) and the extent of the adaptive response (pitch-response persistence). Healthy-controls reached a peak compensation of 18.7 ± 0.8 cents, and demonstrated a sustained compensation at 8.9 ± 0.69 cents. AD patients, in contrast, demonstrated a significantly elevated peak compensation (22.4 ± 1.2 cents, p < 0.05), and a reduced sustained response (pitch-response persistence, 4.5 ± 0.88 cents, p < 0.001). The degree of increased peak compensation predicted executive dysfunction, while the degree of impaired pitch-response persistence predicted memory dysfunction, in AD patients. The current study demonstrates pitch reflex as a sensitive behavioral index of impaired prefrontal modulation of sensorimotor integration, and compromised plasticity mechanisms of memory, in AD.
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Affiliation(s)
- Kamalini G Ranasinghe
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
| | - Jeevit S Gill
- Speech Neuroscience Laboratory, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Hardik Kothare
- Speech Neuroscience Laboratory, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA; Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Alexander J Beagle
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Danielle Mizuiri
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Susanne M Honma
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Keith A Vossel
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Srikantan S Nagarajan
- Speech Neuroscience Laboratory, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA; Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - John F Houde
- Speech Neuroscience Laboratory, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA; Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
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16
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Vossel KA, Ranasinghe KG, Beagle AJ, Mizuiri D, Honma SM, Dowling AF, Darwish SM, Van Berlo V, Barnes DE, Mantle M, Karydas AM, Coppola G, Roberson ED, Miller BL, Garcia PA, Kirsch HE, Mucke L, Nagarajan SS. Incidence and impact of subclinical epileptiform activity in Alzheimer's disease. Ann Neurol 2016; 80:858-870. [PMID: 27696483 DOI: 10.1002/ana.24794] [Citation(s) in RCA: 313] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Seizures are more frequent in patients with Alzheimer's disease (AD) and can hasten cognitive decline. However, the incidence of subclinical epileptiform activity in AD and its consequences are unknown. Motivated by results from animal studies, we hypothesized higher than expected rates of subclinical epileptiform activity in AD with deleterious effects on cognition. METHODS We prospectively enrolled 33 patients (mean age, 62 years) who met criteria for AD, but had no history of seizures, and 19 age-matched, cognitively normal controls. Subclinical epileptiform activity was assessed, blinded to diagnosis, by overnight long-term video-electroencephalography (EEG) and a 1-hour resting magnetoencephalography exam with simultaneous EEG. Patients also had comprehensive clinical and cognitive evaluations, assessed longitudinally over an average period of 3.3 years. RESULTS Subclinical epileptiform activity was detected in 42.4% of AD patients and 10.5% of controls (p = 0.02). At the time of monitoring, AD patients with epileptiform activity did not differ clinically from those without such activity. However, patients with subclinical epileptiform activity showed faster declines in global cognition, determined by the Mini-Mental State Examination (3.9 points/year in patients with epileptiform activity vs 1.6 points/year in patients without; p = 0.006), and in executive function (p = 0.01). INTERPRETATION Extended monitoring detects subclinical epileptiform activity in a substantial proportion of patients with AD. Patients with this indicator of network hyperexcitability are at risk for accelerated cognitive decline and might benefit from antiepileptic therapies. These data call for more sensitive and comprehensive neurophysiological assessments in AD patient evaluations and impending clinical trials. Ann Neurol 2016;80:858-870.
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Affiliation(s)
- Keith A Vossel
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
- Gladstone Institute of Neurological Disease, San Francisco, CA
| | - Kamalini G Ranasinghe
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Alexander J Beagle
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Danielle Mizuiri
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Susanne M Honma
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Anne F Dowling
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Sonja M Darwish
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Victoria Van Berlo
- Department of Neurology and Semel Institute for Neuroscience and Human Behavior in the Department of Psychiatry, University of California Los Angeles, Los Angeles, CA
| | - Deborah E Barnes
- Departments of Psychiatry and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
- Veterans Affairs Medical Center, San Francisco, CA
| | - Mary Mantle
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
- Epilepsy Center, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Anna M Karydas
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Giovanni Coppola
- Department of Neurology and Semel Institute for Neuroscience and Human Behavior in the Department of Psychiatry, University of California Los Angeles, Los Angeles, CA
| | - Erik D Roberson
- Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology and Neurobiology, University of Alabama at Birmingham, Birmingham, AL
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Paul A Garcia
- Epilepsy Center, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Heidi E Kirsch
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
- Epilepsy Center, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Lennart Mucke
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
- Gladstone Institute of Neurological Disease, San Francisco, CA
| | - Srikantan S Nagarajan
- Biomagnetic Imaging Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
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17
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Chiong W, Wood KA, Beagle AJ, Hsu M, Kayser AS, Miller BL, Kramer JH. Neuroeconomic dissociation of semantic dementia and behavioural variant frontotemporal dementia. Brain 2015; 139:578-87. [PMID: 26667277 DOI: 10.1093/brain/awv344] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 10/06/2015] [Indexed: 11/14/2022] Open
Abstract
Many neuropsychiatric disorders are marked by abnormal behaviour and decision-making, but prevailing diagnostic criteria for such behaviours are typically qualitative and often ambiguous. Behavioural variant frontotemporal dementia and semantic variant primary progressive aphasia (also called semantic dementia) are two clinical variants of frontotemporal dementia with overlapping but distinct anatomical substrates known to cause profound changes in decision-making. We investigated whether abnormal decision-making in these syndromes could be more precisely characterized in terms of dissociable abnormalities in patients' subjective evaluations of valence (positive versus negative outcome) and of time (present versus future outcome). We presented 28 patients with behavioural variant frontotemporal dementia, 14 patients with semantic variant primary progressive aphasia, 25 patients with Alzheimer's disease (as disease controls), and 61 healthy older control subjects with experimental tasks assaying loss aversion and delay discounting. In general linear models controlling for age, gender, education and Mini-Mental State Examination score, patients with behavioural variant frontotemporal dementia were less averse to losses than control subjects (P < 0.001), while patients with semantic variant primary progressive aphasia discounted delayed rewards more steeply than controls (P = 0.019). There was no relationship between loss aversion and delay discounting across the sample, nor in any of the subgroups. These findings suggest that abnormal behaviours in neurodegenerative disease may result from the disruption of either of two dissociable neural processes for evaluating the outcomes of action. More broadly, these findings suggest a role for computational methods to supplement traditional qualitative characterizations in the differential diagnosis of neuropsychiatric disorders.
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Affiliation(s)
- Winston Chiong
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Kristie A Wood
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Alexander J Beagle
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Ming Hsu
- 2 Helen Wills Neuroscience Institute and Haas School of Business, University of California, Berkeley, USA
| | - Andrew S Kayser
- 3 Department of Neurology, University of California, San Francisco, USA 4 Division of Neurology, VA Northern California Health Care System, Martinez, CA, USA
| | - Bruce L Miller
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Joel H Kramer
- 1 Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
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Morris M, Sanchez PE, Verret L, Beagle AJ, Guo W, Dubal D, Ranasinghe KG, Koyama A, Ho K, Yu GQ, Vossel KA, Mucke L. Network dysfunction in α-synuclein transgenic mice and human Lewy body dementia. Ann Clin Transl Neurol 2015; 2:1012-28. [PMID: 26732627 PMCID: PMC4693622 DOI: 10.1002/acn3.257] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 02/13/2015] [Revised: 07/14/2015] [Accepted: 08/25/2015] [Indexed: 12/20/2022] Open
Abstract
Objective Dementia with Lewy bodies (DLB) is associated with the accumulation of wild‐type human α‐synuclein (SYN) in neurons and with prominent slowing of brain oscillations on electroencephalography (EEG). However, it remains uncertain whether the EEG abnormalities are actually caused by SYN. Methods To determine whether SYN can cause neural network abnormalities, we performed EEG recordings and analyzed the expression of neuronal activity‐dependent gene products in SYN transgenic mice. We also carried out comparative analyses in humans with DLB. Results We demonstrate that neuronal expression of SYN in transgenic mice causes a left shift in spectral power that closely resembles the EEG slowing observed in DLB patients. Surprisingly, SYN mice also had seizures and showed molecular hippocampal alterations indicative of aberrant network excitability, including calbindin depletion in the dentate gyrus. In postmortem brain tissues from DLB patients, we found reduced levels of calbindin mRNA in the dentate gyrus. Furthermore, nearly one quarter of DLB patients showed myoclonus, a clinical sign of aberrant network excitability that was associated with an earlier age of onset of cognitive impairments. In SYN mice, partial suppression of epileptiform activity did not alter their shift in spectral power. Furthermore, epileptiform activity in human amyloid precursor protein transgenic mice was not associated with a left shift in spectral power. Interpretation We conclude that neuronal accumulation of SYN slows brain oscillations and, in parallel, causes aberrant network excitability that can escalate into seizure activity. The potential role of aberrant network excitability in DLB merits further investigation.
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Affiliation(s)
- Meaghan Morris
- Gladstone Institute of Neurological Disease San Francisco California 94158; Biochemistry, Cellular and Molecular Biology Graduate Program Department of Biological Chemistry The Johns Hopkins University School of Medicine Baltimore Maryland 21205
| | - Pascal E Sanchez
- Gladstone Institute of Neurological Disease San Francisco California 94158
| | - Laure Verret
- Gladstone Institute of Neurological Disease San Francisco California 94158; Department of Neurology University of California, San Francisco San Francisco California 94158
| | - Alexander J Beagle
- Department of Neurology University of California, San Francisco San Francisco California 94158
| | - Weikun Guo
- Gladstone Institute of Neurological Disease San Francisco California 94158
| | - Dena Dubal
- Department of Neurology University of California, San Francisco San Francisco California 94158
| | - Kamalini G Ranasinghe
- Department of Neurology University of California, San Francisco San Francisco California 94158
| | - Akihiko Koyama
- Gladstone Institute of Neurological Disease San Francisco California 94158
| | - Kaitlyn Ho
- Gladstone Institute of Neurological Disease San Francisco California 94158
| | - Gui-Qiu Yu
- Gladstone Institute of Neurological Disease San Francisco California 94158
| | - Keith A Vossel
- Gladstone Institute of Neurological Disease San Francisco California 94158; Department of Neurology University of California, San Francisco San Francisco California 94158
| | - Lennart Mucke
- Gladstone Institute of Neurological Disease San Francisco California 94158; Department of Neurology University of California, San Francisco San Francisco California 94158
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Ranasinghe KG, Hinkley LB, Beagle AJ, Mizuiri D, Dowling AF, Honma SM, Finucane MM, Scherling C, Miller BL, Nagarajan SS, Vossel KA. Regional functional connectivity predicts distinct cognitive impairments in Alzheimer's disease spectrum. Neuroimage Clin 2014; 5:385-95. [PMID: 25180158 PMCID: PMC4145532 DOI: 10.1016/j.nicl.2014.07.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/27/2014] [Accepted: 07/17/2014] [Indexed: 11/12/2022]
Abstract
Understanding neural network dysfunction in neurodegenerative disease is imperative to effectively develop network-modulating therapies. In Alzheimer’s disease (AD), cognitive decline associates with deficits in resting-state functional connectivity of diffuse brain networks. The goal of the current study was to test whether specific cognitive impairments in AD spectrum correlate with reduced functional connectivity of distinct brain regions. We recorded resting-state functional connectivity of alpha-band activity in 27 patients with AD spectrum − 22 patients with probable AD (5 logopenic variant primary progressive aphasia, 7 posterior cortical atrophy, and 10 early-onset amnestic/dysexecutive AD) and 5 patients with mild cognitive impairment due to AD. We used magnetoencephalographic imaging (MEGI) to perform an unbiased search for regions where patterns of functional connectivity correlated with disease severity and cognitive performance. Functional connectivity measured the strength of coherence between a given region and the rest of the brain. Decreased neural connectivity of multiple brain regions including the right posterior perisylvian region and left middle frontal cortex correlated with a higher degree of disease severity. Deficits in executive control and episodic memory correlated with reduced functional connectivity of the left frontal cortex, whereas visuospatial impairments correlated with reduced functional connectivity of the left inferior parietal cortex. Our findings indicate that reductions in region-specific alpha-band resting-state functional connectivity are strongly correlated with, and might contribute to, specific cognitive deficits in AD spectrum. In the future, MEGI functional connectivity could be an important biomarker to map and follow defective networks in the early stages of AD. Magnetoencephalographic imaging (MEGI) measures brain functional connectivity. We investigated MEGIalpha-band connectivity in a cohort with Alzheimer’s disease spectrum. Decreased connectivity of multiple brain regions correlates with disease severity. Decreased connectivity of focal brain regions correlates with cognitive deficits. MEGI is a novel, unbiased approach to map neural network defects in dementia.
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Affiliation(s)
- Kamalini G Ranasinghe
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Leighton B Hinkley
- Department of Radiology and Biomedical Imaging, Biomagnetic Imaging Laboratory, University of California San Francisco, San Francisco, CA 94143, USA
| | - Alexander J Beagle
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Danielle Mizuiri
- Department of Radiology and Biomedical Imaging, Biomagnetic Imaging Laboratory, University of California San Francisco, San Francisco, CA 94143, USA
| | - Anne F Dowling
- Department of Radiology and Biomedical Imaging, Biomagnetic Imaging Laboratory, University of California San Francisco, San Francisco, CA 94143, USA
| | - Susanne M Honma
- Department of Radiology and Biomedical Imaging, Biomagnetic Imaging Laboratory, University of California San Francisco, San Francisco, CA 94143, USA
| | - Mariel M Finucane
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA
| | - Carole Scherling
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Srikantan S Nagarajan
- Department of Radiology and Biomedical Imaging, Biomagnetic Imaging Laboratory, University of California San Francisco, San Francisco, CA 94143, USA
| | - Keith A Vossel
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA ; Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA
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Vossel KA, Beagle AJ, Rabinovici GD, Shu H, Lee SE, Naasan G, Hegde M, Cornes SB, Henry ML, Nelson AB, Seeley WW, Geschwind MD, Gorno-Tempini ML, Shih T, Kirsch HE, Garcia PA, Miller BL, Mucke L. Seizures and epileptiform activity in the early stages of Alzheimer disease. JAMA Neurol 2013; 70:1158-66. [PMID: 23835471 DOI: 10.1001/jamaneurol.2013.136] [Citation(s) in RCA: 454] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Epileptic activity associated with Alzheimer disease (AD) deserves increased attention because it has a harmful impact on these patients, can easily go unrecognized and untreated, and may reflect pathogenic processes that also contribute to other aspects of the illness. We report key features of AD-related seizures and epileptiform activity that are instructive for clinical practice and highlight similarities between AD and transgenic animal models of the disease. OBJECTIVE To describe common clinical characteristics and treatment outcomes of patients with amnestic mild cognitive impairment (aMCI) or early AD who also have epilepsy or subclinical epileptiform activity. DESIGN Retrospective observational study from 2007 to 2012. SETTING Memory and Aging Center, University of California, San Francisco. PATIENTS We studied 54 patients with a diagnosis of aMCI plus epilepsy (n = 12), AD plus epilepsy (n = 35), and AD plus subclinical epileptiform activity (n = 7). MAIN OUTCOMES AND MEASURES Clinical and demographic data, electroencephalogram (EEG) readings, and treatment responses to antiepileptic medications. RESULTS Patients with aMCI who had epilepsy presented with symptoms of cognitive decline 6.8 years earlier than patients with aMCI who did not have epilepsy (64.3 vs 71.1 years; P = .02). Patients with AD who had epilepsy presented with cognitive decline 5.5 years earlier than patients with AD who did not have epilepsy (64.8 vs 70.3 years; P = .001). Patients with AD who had subclinical epileptiform activity also had an early onset of cognitive decline (58.9 years). The timing of seizure onset in patients with aMCI and AD was nonuniform (P < .001), clustering near the onset of cognitive decline. Epilepsies were most often complex partial seizures (47%) and more than half were nonconvulsive (55%). Serial or extended EEG monitoring appeared to be more effective than routine EEG at detecting interictal and subclinical epileptiform activity. Epileptic foci were predominantly unilateral and temporal. Of the most commonly prescribed antiepileptics, treatment outcomes appeared to be better for lamotrigine and levetiracetam than for phenytoin. CONCLUSIONS AND RELEVANCE Common clinical features of patients with aMCI- or AD-associated epilepsy at our center included early age at onset of cognitive decline, early incidence of seizures in the disease course, unilateral temporal epileptic foci detected by serial/extended EEG, transient cognitive dysfunction, and good seizure control and tolerability with lamotrigine and levetiracetam. Careful identification and treatment of epilepsy in such patients may improve their clinical course.
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Affiliation(s)
- Keith A Vossel
- Gladstone Institute of Neurological Disease, San Francisco, California2Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
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