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Stickel AM, Tarraf W, Kuwayama S, Wu B, Sundermann EE, Gallo LC, Lamar M, Daviglus M, Zeng D, Thyagarajan B, Isasi CR, Lipton RB, Cordero C, Perreira KM, Gonzalez HM, Banks SJ. Connections between reproductive health and cognitive aging among women enrolled in the HCHS/SOL and SOL-INCA. Alzheimers Dement 2024; 20:1944-1957. [PMID: 38160447 PMCID: PMC10947951 DOI: 10.1002/alz.13575] [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: 07/16/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Reproductive health history may contribute to cognitive aging and risk for Alzheimer's disease, but this is understudied among Hispanic/Latina women. METHODS Participants included 2126 Hispanic/Latina postmenopausal women (44 to 75 years) from the Study of Latinos-Investigation of Neurocognitive Aging. Survey linear regressions separately modeled the associations between reproductive health measures (age at menarche, history of oral contraceptive use, number of pregnancies, number of live births, age at menopause, female hormone use at Visit 1, and reproductive span) with cognitive outcomes at Visit 2 (performance, 7-year change, and mild cognitive impairment [MCI] prevalence). RESULTS Younger age at menarche, oral contraceptive use, lower pregnancies, lower live births, and older age at menopause were associated with better cognitive performance. Older age at menarche was protective against cognitive change. Hormone use was linked to lower MCI prevalence. DISCUSSION Several aspects of reproductive health appear to impact cognitive aging among Hispanic/Latina women.
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Affiliation(s)
- Ariana M. Stickel
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Wassim Tarraf
- Institute of Gerontology & Department of Healthcare SciencesWayne State UniversityDetroitMichiganUSA
| | - Sayaka Kuwayama
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Benson Wu
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Erin E. Sundermann
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Linda C. Gallo
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Melissa Lamar
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoCollege of MedicineChicagoIllinoisUSA
- Rush Alzheimer's Disease Research Center and the Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Martha Daviglus
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoCollege of MedicineChicagoIllinoisUSA
| | - Donglin Zeng
- Department of BiostatisticsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Carmen R. Isasi
- Department of Epidemiology & Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Richard B. Lipton
- Department of Epidemiology & Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | | | - Krista M. Perreira
- Department of Social MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Hector M. Gonzalez
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Sarah J. Banks
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
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Sundermann EE, Dastgheyb R, Moore DJ, Buchholz AS, Bondi MW, Ellis RJ, Letendre SL, Heaton RK, Rubin LH. Identifying and distinguishing cognitive profiles among virally suppressed people with HIV. Neuropsychology 2024; 38:169-183. [PMID: 37971860 DOI: 10.1037/neu0000935] [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] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Cognitive deficits are common among people with HIV (PWH), even when virally suppressed. We identified cognitive profiles among virally suppressed PWH and determined how sociodemographic, clinical/behavioral, and HIV disease characteristics distinguish profile membership. METHOD Participants included 704 virally suppressed PWH (Mage = 43.9 [SD = 10.2], 88% male, 58.9% non-Hispanic White) from the HIV Neurobehavioral Research Program. Demographically adjusted T scores were derived from a neuropsychological evaluation comprised of 13 tests. We implemented a pipeline involving dimension reduction and clustering to identify profiles of cognitive performance. Random forest models on a 70/30 training/testing set with internal cross-validation were used to identify sociodemographic, clinical/behavioral, and HIV disease correlates of profile membership. RESULTS Six cognitive profiles were identified: (a) "unimpaired" (19.9%); (b) weakness in verbal learning and memory (15.5%); (c) weakness in executive function and learning (25.8%); (d) weakness in motor, processing speed, and executive function (8.1%); (e) impaired learning and recall with weak-to-impaired motor, processing speed, and executive function (13.1%); (f) global deficits (17.6%). The most discriminative sociodemographic, clinical/behavioral, and HIV disease characteristics varied by profile with self-reported mood symptoms and cognitive/functional difficulties (e.g., language/communication, memory, and overall everyday function complaints) most consistently associated with profile membership. CONCLUSIONS Cognitive profiles and their associated factors among PWH are heterogeneous, but learning/memory deficits were most common and self-reported mood, and cognitive/functional difficulties were most consistently related to profile membership. This heterogeneity in cognitive profiles and their correlates in PWH suggests that differing mechanisms contribute to cognitive deficits and, thus, underscores the need for personalized risk reduction and therapeutic strategies among PWH. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | - David J Moore
- Department of Psychiatry, University of California, San Diego
| | | | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego
| | - Ronald J Ellis
- Department of Psychiatry, University of California, San Diego
| | | | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University
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Wang X, Sundermann EE, Buckley RF, Banks SJ. Sex differences in the association between tau PET and cognitive performance in a non-Hispanic White cohort with preclinical AD. Alzheimers Dement 2024; 20:25-33. [PMID: 37641484 PMCID: PMC10916995 DOI: 10.1002/alz.13432] [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: 03/03/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION We investigated how the associations between tau and cognitive measures differ by sex in the preclinical Alzheimer's disease (AD) stage. METHODS A total of 343 cognitively unimpaired, amyloid-positive individuals (205 women, 138 men) who self-identified as non-Hispanic White from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's (A4) Study were included. We assessed sex-stratified associations between 18 F-flortaucipir positron emission tomography (PET) standardized uptake value ratio (SUVR) in the meta-temporal region and Preclinical Alzheimer's Cognitive Composite (PACC) and Computerized Cognitive Composite (C3) components. RESULTS We observed that higher tau level was significantly associated with worse cognitive performance only in women: PACC and its components except for Mini-Mental State Examination (MMSE) and C3 components: First Letter Name Recall (FNLT) and One-Card Learning Reaction Time (OCL RT). These associations except for FNLT were apolipoprotein E (APOE) ε4 independent. DISCUSSION Women show stronger associations between tau PET and cognitive outcomes in preclinical AD. These findings have important implications for sex-specific tau-targeted preventive AD clinical trials. HIGHLIGHTS The tau positron emission tomography (PET) signal in the meta-temporal region was associated with poor cognitive performance in preclinical Alzheimer's disease (AD). After sex stratification, the associations between regional tau PET and cognitive outcomes were observed only in women. The associations between tau PET and some cognitive outcomes were independent of apolipoprotein E (APOE) ε4.
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Affiliation(s)
- Xin Wang
- Department of NeurosciencesUniversity of CaliforniaSan DiegoCaliforniaUSA
| | | | - Rachel F. Buckley
- Department of NeurologyMassachusetts General Hospital/Harvard Medical SchoolBostonMassachusettsUSA
| | - Sarah J. Banks
- Department of NeurosciencesUniversity of CaliforniaSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
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Harvey PD, Strassnig A, Strassnig M, Heaton A, Kuehn K, Torre P, Sundermann EE, Pinkham A, Depp CA, Black G, Wharton W, Waldrop D, Anderson AM, Moore RC. Mild Cognitive Impairment, But Not HIV Status, is Related to Reduced Awareness of Level of Cognitive Performance Among Older Adults. Am J Geriatr Psychiatry 2023; 31:1117-1128. [PMID: 37544836 PMCID: PMC10732243 DOI: 10.1016/j.jagp.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Self-assessment of cognitive abilities can be an important predictor of clinical outcomes. This study examined impairments in self-assessments of cognitive performance, assessed with traditional neuropsychological assessments and novel virtual reality tests among older persons with and without human immunodeficiency virus (HIV) and mild cognitive impairment (MCI). METHODS One hundred twenty-two participants (82 persons with HIV; 79 MCI+) completed a traditional neuropsychological battery, DETECT virtual reality cognitive battery, and self-reported their general cognitive complaints, depressive symptoms, and perceptions of DETECT performance. Relationships between DETECT performance and self-assessments of performance were examined as were the correlations between general cognitive complaints and performance. These relations were evaluated across HIV and MCI status, considering the associations of depressive symptoms, performance, and self-assessment. RESULTS We found no effect of HIV status on objective performance or self-assessment of DETECT performance. However, MCI+ participants performed worse on DETECT and traditional cognitive tests, while also showing a directional bias towards overestimation of their performance. MCI- participants showed a bias toward underestimation. Cognitive complaints were reduced compared to objective performance in MCI+ participants. Correlations between self-reported depressive symptoms and cognitive performance or self-assessment of performance were nonsignificant. CONCLUSIONS MCI+ participants underperformed on neuropsychological testing, while overestimating performance. Interestingly, MCI- participants underestimated performance to approximately the same extent as MCI+ participants overestimated. Practical implications include providing support for persons with MCI regarding awareness of limitations and consideration that self-assessments of cognitive performance may be overestimated. Similarly, supporting older persons without MCI to realistically appraise their abilities may have clinical importance.
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry and Behavioral Sciences (PDH, MS), Miller School of Medicine, University of Miami, Miami, FL; Research Service (PDH), Miami VA Healthcare System, Miami, FL
| | | | - Martin Strassnig
- Department of Psychiatry and Behavioral Sciences (PDH, MS), Miller School of Medicine, University of Miami, Miami, FL
| | - Anne Heaton
- Department of Psychiatry (AH, ESS, CAD, RCM), University of California San Diego, San Diego, CA
| | - Kevin Kuehn
- Department of Medicine (KK), University of California San Diego, San Diego, CA
| | - Peter Torre
- School of Speech, Language, and Hearing Sciences (PT), San Diego State University, San Diego, CA
| | - Erin E Sundermann
- Department of Psychiatry (AH, ESS, CAD, RCM), University of California San Diego, San Diego, CA
| | - Amy Pinkham
- School of Behavioral and Brain Sciences (AP), The University of Texas at Dallas, Richardson, TX
| | - Colin A Depp
- Department of Psychiatry (AH, ESS, CAD, RCM), University of California San Diego, San Diego, CA; VA San Diego Healthcare System (CAD), San Diego, CA
| | | | | | | | | | - Raeanne C Moore
- Department of Psychiatry (AH, ESS, CAD, RCM), University of California San Diego, San Diego, CA.
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Fisher A, Moore DJ, Levine AJ, Masliah E, Gouaux B, Soontornniyomkij V, Letendre S, Sundermann EE. The relationship between synaptodendritic neuropathology and HIV-associated neurocognitive disorders is moderated by cognitive reserve. J Neurovirol 2023; 29:713-722. [PMID: 37943478 DOI: 10.1007/s13365-023-01177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/23/2023] [Accepted: 09/21/2023] [Indexed: 11/10/2023]
Abstract
We examined whether cognitive reserve moderated the relationship between neurodegeneration and cognition in 67 postmortem persons with HIV (PWH) who were cognitively assessed within 1 year of death. Cognitive reserve was measured via the Wide Range Achievement Test-4 reading subtest (WRAT4). Synaptodendritic neurodegeneration was based on densities of synaptophysin and microtubule-associated protein 2 immunohistochemical reactivity in frontal cortex, and categorized as minimal, moderate, or severe (tertile-split). T-Scores from 15 cognitive tests were averaged into a global cognitive T-score. Among those with low cognitive reserve (based on WRAT4 median split), the moderate neurodegeneration group showed cognition that was poorer than the minimal neurodegeneration group and comparable to the severe neurodegeneration group. Among those with high cognitive reserve, the moderate neurodegeneration group showed cognition comparable to the minimal neurodegeneration group and better than the severe neurodegeneration group. High cognitive reserve may buffer against cognitive impairment among PWH with moderate, but not severe, neurodegeneration.
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Affiliation(s)
- Arin Fisher
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92037, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92037, USA
| | - Andrew J Levine
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Ben Gouaux
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92037, USA
| | | | - Scott Letendre
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Erin E Sundermann
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92037, USA.
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Moore RC, Kuehn KS, Heaton A, Sundermann EE, Campbell LM, Torre P, Umlauf A, Moore DJ, Kosoris N, Wright DW, LaPlaca MC, Waldrop D, Anderson AM. An Automated Virtual Reality Program Accurately Diagnoses HIV-Associated Neurocognitive Disorders in Older People With HIV. Open Forum Infect Dis 2023; 10:ofad592. [PMID: 38149107 PMCID: PMC10750141 DOI: 10.1093/ofid/ofad592] [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: 07/20/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023] Open
Abstract
Background HIV-associated neurocognitive disorders (HANDs) remain prevalent despite antiretroviral therapy, particularly among older people with HIV (PWH). However, the diagnosis of HAND is labor intensive and requires expertise to administer neuropsychological tests. Our prior pilot work established the feasibility and accuracy of a computerized self-administered virtual reality program (DETECT; Display Enhanced Testing for Cognitive Impairment and Traumatic Brain Injury) to measure cognition in younger PWH. The present study expands this to a larger sample of older PWH. Methods We enrolled PWH who were ≥60 years old, were undergoing antiretroviral therapy, had undetectable plasma viral loads, and were without significant neuropsychological confounds. HAND status was determined via Frascati criteria. Regression models that controlled for demographic differences (age, sex, education, race/ethnicity) examined the association between DETECT's cognition module and both HAND status and Global Deficit Score (GDS) derived via traditional neuropsychological tests. Results Seventy-nine PWH (mean age, 66 years; 28% women) completed a comprehensive neuropsychological battery and DETECT's cognition module. Twenty-five (32%) had HAND based on the comprehensive battery. A significant correlation was found between the DETECT cognition module and the neuropsychological battery (r = 0.45, P < .001). Furthermore, in two separate regression models, HAND status (b = -0.79, P < .001) and GDS impairment status (b = -0.83, P < .001) significantly predicted DETECT performance. Areas under the curve for DETECT were 0.78 for differentiating participants by HAND status (HAND vs no HAND) and 0.85 for detecting GDS impairment. Conclusions The DETECT cognition module provides a novel means to identify cognitive impairment in older PWH. As DETECT is fully immersive and self-administered, this virtual reality tool holds promise as a scalable cognitive screening battery.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Kevin S Kuehn
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Anne Heaton
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Erin E Sundermann
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Laura M Campbell
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
- University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, California, USA
| | - Peter Torre
- San Diego State University, San Diego, California, USA
| | - Anya Umlauf
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - David J Moore
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | | | - David W Wright
- Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Michelle C LaPlaca
- Department of Biomedical Engineering, Georgia Tech and Emory University, Atlanta, Georgia, USA
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Albert M Anderson
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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Abstract
OBJECTIVES To evaluate the peripheral hearing sensitivity and central auditory processing in persons with HIV (PWH) and persons without HIV (PWoH); and the association between cognitive function and central auditory processing in PWH and PWoH. DESIGN Cross-sectional, observational study. METHODS Participants included 67 PWH {70.2% men; mean age = 66.6 years [standard deviation (SD) = 4.7 years]} and 35 PWoH [51.4% men; mean age = 72.9 years (SD = 7.0 years)]. Participants completed a hearing assessment and a central auditory processing assessment that included dichotic digits testing (DDT). Pure-tone air-conduction thresholds were obtained at octave frequencies from 0.25 through 8 kHz. A pure-tone average (PTA) was calculated from 0.5, 1, 2, and 4 kHz thresholds for each ear. Participants also completed a neuropsychological battery assessing cognition in seven domains. RESULTS PWH had slightly lower (i.e. better) PTAs compared with PWoH, but this was not statistically significant. Conversely, PWH and PWoH had similar DDT results for both ears. Poorer verbal fluency, learning, and working memory performance was significantly related to lower DDT scores, and those defined as having verbal fluency, learning, and working memory impairment had significantly poorer DDT scores (8-18% lower) in both ears. CONCLUSION Hearing and DDT results were similar in PWH and PWoH. The relationship between verbal fluency, learning, and working memory impairment and poorer DDT results did not differ by HIV serostatus. Clinicians, particularly audiologists, should be mindful of cognitive functioning abilities when evaluating central auditory processing.
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Affiliation(s)
- Peter Torre
- San Diego State University, School of Speech, Language, and Hearing Sciences, San Diego
| | - Erin E Sundermann
- University of California San Diego, Department of Psychiatry, La Jolla, California
| | | | - Anne Heaton
- University of California San Diego, Department of Psychiatry, La Jolla, California
| | - Julia Devore
- San Diego State University, School of Speech, Language, and Hearing Sciences, San Diego
| | | | - Raeanne C Moore
- University of California San Diego, Department of Psychiatry, La Jolla, California
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Sundermann EE, Tang B, Kim M, Paolillo EW, Heaton RK, Moore RC. Neuropsychiatric predictors of cognitive functioning over a one-year follow-up period in HIV. J Affect Disord 2023; 336:92-96. [PMID: 37211052 PMCID: PMC10766340 DOI: 10.1016/j.jad.2023.05.030] [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: 12/05/2022] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) and cognitive impairment are highly prevalent among persons with HIV (PWH). We examined the effect of the most common NPS, depression and anxiety, on cognitive change among PWH and compared these associations to those among persons without HIV (PWoH). METHODS Participants included 168 PWH and 91 PWoH who completed baseline self-report measures of depression (Beck Depression Inventory-II) and anxiety (Profile of Mood States [POMS] - Tension-anxiety subscale) and completed a comprehensive neurocognitive evaluation at baseline and at 1-year follow-up. Demographically-corrected scores from 15 neurocognitive tests were used to calculate global and domain-specific T-scores. Linear mixed-effects models examined the effect of depression and anxiety and their interaction with HIV-serostatus and time on global T-scores. RESULTS There were significant depression-by-HIV and anxiety-by-HIV interactions on global T-scores such that, among PWH only, greater depressive and anxiety symptoms at baseline related to worse global T-scores across visits. Non-significant interactions with time suggest stability in these relationships across visits. Follow-up analyses examining cognitive domains revealed that both the depression-by-HIV and the anxiety-by-HIV interactions were driven by learning and recall. LIMITATIONS Follow-up was limited to one-year and there were fewer PWoH than PWH, creating a differential in statistical power. CONCLUSION Findings suggest that anxiety and depression have stronger links to worse cognitive functioning in PWH than PWoH, particularly learning and memory, and that these associations seem to persist for at least one-year.
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Affiliation(s)
- Erin E Sundermann
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Bin Tang
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Michelle Kim
- Department of Medicine, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Emily W Paolillo
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA
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Sundermann EE, Campbell LM, Villers O, Bondi MW, Gouaux B, Salmon DP, Galasko D, Soontornniyomkij V, Ellis RJ, Moore DJ. Alzheimer's Disease Pathology in Middle Aged and Older People with HIV: Comparisons with Non-HIV Controls on a Healthy Aging and Alzheimer's Disease Trajectory and Relationships with Cognitive Function. Viruses 2023; 15:1319. [PMID: 37376619 PMCID: PMC10305373 DOI: 10.3390/v15061319] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
We determined the prevalence of Alzheimer's disease (AD) pathological hallmarks, amyloid-β and phosphorylated-Tau, in autopsied brains of 49 people with HIV (PWH) (ages: 50-68; mean age = 57.0) from the National NeuroAIDS Tissue Consortium and in a comparative cohort of 55 people without HIV (PWoH) from the UC San Diego Alzheimer's Disease Research Center (17 controls, 14 mild cognitive impairment, 24 AD; ages: 70-102, mean age = 88.7). We examined how AD pathology relates to domain-specific cognitive functions in PWH overall and in sex-stratified samples. Amyloid-β and phosphorylated-Tau positivity (presence of pathology of any type/density) was determined via immunohistochemistry in AD-sensitive brain regions. Among PWH, amyloid-β positivity ranged from 19% (hippocampus) to 41% (frontal neocortex), and phosphorylated-Tau positivity ranged from 47% (entorhinal cortex) to 73% (transentorhinal cortex). Generally, AD pathology was significantly less prevalent, and less severe when present, in PWH versus PWoH regardless of cognitive status. Among PWH, positivity for AD pathology related most consistently to memory-related domains. Positivity for p-Tau pathology related to memory-related domains in women with HIV only, although the sample size of women with HIV was small (n = 10). Results indicate that AD pathology is present in a sizable portion of middle aged and older PWH, although not to the extent in older PWoH. Studies with better age-matched PWoH are needed to examine the effect of HIV status on AD pathology.
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Affiliation(s)
- Erin E. Sundermann
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| | - Laura M. Campbell
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Olivia Villers
- School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA
| | - Ben Gouaux
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| | - David P. Salmon
- Department of Neurosciences, University of California San Diego, 9375 Gilman Dr., La Jolla, CA 92161, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California San Diego, 9375 Gilman Dr., La Jolla, CA 92161, USA
| | - Virawudh Soontornniyomkij
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| | - Ronald J. Ellis
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
- Department of Neurosciences, University of California San Diego, 9375 Gilman Dr., La Jolla, CA 92161, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
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Wang X, Sundermann EE, Buckley RF, Reas ET, McEvoy LK, Banks SJ. Sex Differences in the Associations of Obesity with Tau, Amyloid PET, and Cognitive Outcomes in Preclinical Alzheimer's Disease: Cross-Sectional A4 Study. J Alzheimers Dis 2023; 95:615-624. [PMID: 37574737 DOI: 10.3233/jad-230466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND The association between obesity and Alzheimer's disease (AD) is complex. Recent studies indicated the relationships between obesity and AD may differ by sex, and women may benefit from being overweight in terms of AD risk. OBJECTIVE We investigated whether sex modifies the associations of obesity with tau positron emission tomography (PET), amyloid PET, and cognition in preclinical AD. METHODS We included 387 cognitively-unimpaired amyloid-positive participants (221 women, 166 men, 87.6% non-Hispanic White) with available 18F-flortaucipir PET, 18F-florbetapir PET, and completed the Preclinical Alzheimer Cognitive Composite (PACC) tests from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) study. Participants were categorized based on body mass index (BMI: kg/m2): normal-weight (BMI: 18.5-25), overweight (BMI: 25-30), and obese (BMI≥30). RESULTS Significant sex by BMI category interactions on PACC and its components: Mini-Mental State Examination (MMSE) and Reminding Test-Free+Total Recall (FCSRT96) revealed that overweight and obese women outperformed normal-weight women on FCSRT96, while obese men showed poorer MMSE performance than normal-weight men. These interactions were independent of APOE4. There were no significant interactions of sex by BMI category on tau and amyloid PET. However, sex-stratified analyses observed obesity was associated with less regional tau and mean cortical amyloid in women, not in men. CONCLUSION This study found that in preclinical AD, overweight and obesity were associated with better verbal memory in women, whereas obesity was associated with worse global cognition among men. Future studies focusing on the mechanism for this relationship may inform sex-specific interventions for AD prevention.
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Affiliation(s)
- Xin Wang
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Rachel F Buckley
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Emilie T Reas
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Linda K McEvoy
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Sarah J Banks
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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11
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Araujo-Menendez CE, Saelzler UG, Stickel AM, Sundermann EE, Banks SJ, Paipilla A, Barnes ML, Panizzon MS. Associations Between Parity and Cognition: Race/Ethnic Differences. J Alzheimers Dis 2023; 94:1157-1168. [PMID: 37393496 PMCID: PMC10473123 DOI: 10.3233/jad-221210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Race/ethnicity is associated with differences in reproductive history and cognition individually, yet it remains an understudied factor in the relationship between parity and later-life cognition. OBJECTIVE To evaluate if the association between parity and cognition differs between racial/ethnic groups. METHODS Participants included 778 older, postmenopausal women from the Health and Nutrition Examination Survey (Latina: n = 178, Non-Latino Black [NLB]: n = 169, Non-Latino White [NLW]: n = 431) who self-reported at least one birth. Cognitive outcomes included working memory, learning memory, and verbal fluency. Covariates included age, education, cardiovascular and other reproductive health factors, adult socioeconomic status (SES) and depressive symptoms. We fit a series of linear models to examine a) whether parity was associated with cognitive functioning, b) if this association varied by race/ethnicity through parity by race/ethnicity interactions, and c) individual parity with cognition associations stratified by race/ethnicity. RESULTS In the full sample, parity was significantly negatively associated with Digit Symbol Substitution Test (DSST) performance (b = -0.70, p = 0.024) but not Animal Fluency or word-list learning and memory. Tests of race/ethnicity-by-parity interactions were not statistically significant (ps > 0.05). However, stratified analyses by race/ethnicity showed a differential effect of parity on DSST performance, such that parity was significantly negatively associated with DSST performance (b = -1.66, p = 0.007) among Latinas but not in NLWs (b = -0.16, p = 0.74) or NLBs (b = -0.81, p = 0.191). CONCLUSION Among Latina, but not NLB or NLW women, greater parity was associated with worse processing speed/executive functioning later in life. Further research is needed to understand the mechanisms driving racial/ethnic differences.
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Affiliation(s)
| | - Ursula G. Saelzler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Ariana M. Stickel
- Department of Psychology, San Diego State University, La Jolla, CA, USA
| | - Erin E. Sundermann
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Sarah J. Banks
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Andrea Paipilla
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - McKinna L. Barnes
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Matthew S. Panizzon
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, CA, USA
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12
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Stickel AM, Tarraf W, Wu B, Sundermann EE, Gallo LC, Lamar M, Daviglus ML, Zeng D, Thyagarajan B, Isasi CR, Lipton RB, Cordero C, Perreira KM, González HM, Banks SJ. Connections between reproductive health and cognitive aging among women enrolled in the HCHS/SOL and SOL‐INCA. Alzheimers Dement 2022. [DOI: 10.1002/alz.064686] [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)
| | | | - Benson Wu
- University of California, San Diego La Jolla CA USA
| | | | | | - Melissa Lamar
- Rush Alzheimer’s Disease Center Chicago IL USA
- University of Illinois at Chicago, College of Medicine Chicago IL USA
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13
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Shepherd AL, Wang X, Bernier RA, Lui KK, Deters KD, Chowdhury T, Edland SD, Sundermann EE, Banks SJ. Tau and memory performance in women: Advantages of visuospatial over standard verbal memory tests. Alzheimers Dement 2022. [DOI: 10.1002/alz.069387] [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)
| | - Xin Wang
- University of California, San Diego La Jolla CA USA
| | | | - Kitty K Lui
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
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14
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Saelzler UG, Sundermann EE, Karlsson I, Gatz M, Pedersen NL, Panizzon MS. Examination of associations between female natural reproductive span and dementia risk. Alzheimers Dement 2022. [DOI: 10.1002/alz.068026] [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)
| | | | | | - Margaret Gatz
- University of Southern California Los Angeles CA USA
| | - Nancy L. Pedersen
- Department of Molecular Epidemiology and Biostatistics, Karolinska Institutet Stockholm Sweden
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15
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Lui KK, Shepherd AL, Wang X, Bernier RA, Bosompra N, DeYoung PN, Malhotra A, Sundermann EE, Banks SJ. Apnea‐associated hypoxemia is linked to greater tau deposition in women with Alzheimer’s disease risk. Alzheimers Dement 2022. [DOI: 10.1002/alz.068218] [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)
- Kitty K Lui
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | | | - Xin Wang
- University of California, San Diego La Jolla CA USA
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16
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Tsiknia AA, Sundermann EE, Edland SD, Reas ET, Brewer JB, Galasko DR, Banks SJ. The relationship between plasma matrix metalloproteinase‐9 and cerebrospinal fluid biomarkers of tau is sex‐dependent. Alzheimers Dement 2022. [DOI: 10.1002/alz.064323] [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)
| | | | | | | | - James B. Brewer
- University of California San Diego La Jolla CA USA
- Shiley‐Marcos Alzheimer's Disease Research Center La Jolla CA USA
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17
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Sundermann EE, Saelzler UG, Shadyab AH, Banks SJ, Jacobs EG, Rapp SR, Wactawski‐Wende J, Casanova R, Panizzon MS. Natural premature menopause relates to higher risk of mild cognitive impairment and Alzheimer’s disease and related dementias in APOE‐ε4 carriers only. Alzheimers Dement 2022. [DOI: 10.1002/alz.068132] [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)
| | | | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego La Jolla CA USA
| | | | | | | | - Jean Wactawski‐Wende
- University at Buffalo School of Public Health and Health Professions Buffalo NY USA
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18
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Wang X, Edland SD, Sundermann EE, Banks SJ. Sex Differences in Mild Cognitive Impairment Risk by APOE Genotype. Alzheimers Dement 2022. [DOI: 10.1002/alz.064996] [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)
- Xinran Wang
- University of California, San Diego La Jolla CA USA
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19
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Tsiknia AA, Sundermann EE, Reas ET, Edland SD, Brewer JB, Galasko D, Banks SJ. Sex differences in Alzheimer's disease: plasma MMP-9 and markers of disease severity. Alzheimers Res Ther 2022; 14:160. [PMID: 36324151 PMCID: PMC9628176 DOI: 10.1186/s13195-022-01106-4] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/16/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Studies have reported higher plasma matrix metalloproteinase-9 (MMP-9) levels in mild cognitive impairment (MCI) and Alzheimer's disease (AD). Despite evidence that MMP-9 activity and its influence on AD pathophysiology may be modulated by sex hormones, sex differences in the association between MMP-9 and AD biomarkers and cognition have not been explored. METHODS Our sample included 238 amyloid-β (Aβ)-positive participants with MCI or AD dementia from the Alzheimer's Disease Neuroimaging Initiative (37.4% women, 74.6 ± 7.3 years). We used linear regression models to examine whether sex modified free and total plasma MMP-9 associations with CSF t-tau, p-tau181, and Aβ42. We used linear mixed effects models to examine whether sex modified total and free plasma MMP-9 associations with cognition, using longitudinal Mini-Mental Status Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog) data. RESULTS Total and free MMP-9 levels did not differ by sex, but AD dementia patients had higher total MMP-9 levels than participants with MCI (β = 0.06 [-0.11 to -0.01], p = 0.031). Sex modified the association of CSF t-tau with total (β = 128.68 [55.37 to 201.99], p < 0.001) and free MMP-9 (β = 98.61 [33.61 to 163.62], p = 0.003), whereby higher total and free MMP-9 correlated with higher CSF t-tau in women and lower CSF t-tau in men. Higher free MMP-9 correlated with lower CSF p-tau181 among men (β = -14.98 [-27.37 to -2.58], p = 0.018), but not women. In participants with MCI, higher free MMP-9 levels were associated with higher CSF Aβ42 among men (β = 26.88 [4.03 to 49.73], p = 0.022) but not women. In the overall sample, higher free and total MMP-9 at baseline predicted worsening MMSE scores in women (β = -2.10 [-3.97 to -0.27], p = 0.027 and β = -2.24 [-4.32 to -0.18], p = 0.035) but not men. Higher free MMP-9 correlated with worse ADAS-cog scores (β = 12.34 [3.02 to 21.65], p = 0.011) in women (β = 12.34 [3.02 to 21.65], p = 0.011) but not men with AD dementia cross-sectionally but correlated with worsening ADAS-cog scores longitudinally only in men (β = 8.98 [0.27 to 17.68], p = 0.042). CONCLUSIONS MMP-9 may have more detrimental effects on AD-related pathological and cognitive changes in women. If replicated, our findings could help uncover potential mechanisms contributing to women's elevated susceptibility to AD.
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Affiliation(s)
- Amaryllis A. Tsiknia
- Department of Neurosciences, School of Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093 USA
| | - Erin E. Sundermann
- grid.410371.00000 0004 0419 2708Research Service, VA San Diego Healthcare System, San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093 USA
| | - Emilie T. Reas
- Department of Neurosciences, School of Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093 USA
| | - Steven D. Edland
- Department of Neurosciences, School of Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093 USA ,grid.266100.30000 0001 2107 4242Division of Biostatistics, School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA 92093 USA
| | - James B. Brewer
- Department of Neurosciences, School of Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093 USA
| | - Douglas Galasko
- Department of Neurosciences, School of Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093 USA
| | - Sarah J. Banks
- Department of Neurosciences, School of Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093 USA
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20
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Fields JA, Swinton M, Sundermann EE, Scrivens N, Vallee KAJ, Moore DJ. Complement component 3 and complement factor H protein levels are altered in brain tissues from people with human immunodeficiency virus: A pilot study. Front Aging Neurosci 2022; 14:981937. [PMID: 36118688 PMCID: PMC9472593 DOI: 10.3389/fnagi.2022.981937] [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: 06/29/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
People with HIV (PWH) continue to suffer from dysfunction of the central nervous system, as evidenced by HIV-associated neurocognitive disorder (HAND), despite antiretroviral therapy and suppressed viral loads. As PWH live longer they may also be at risk of age-related neurodegenerative diseases such Alzheimer’s disease (AD) and its precursor, amnestic mild cognitive impairment (aMCI). The complement system is associated with deposition of AD-related proteins such as beta amyloid (Aβ), neuroinflammation, and neurological dysfunction in PWH. Complement component 3 (C3) is a key protagonist in the complement cascade and complement factor H (CFH) is an antagonist of C3 activity. We investigated the relationship between C3 and CFH levels in the brain and Aβ plaques and neurological dysfunction in 22 PWH. We analyzed by immunoblot C3 and CFH protein levels in frontal cortex (FC) and cerebellum (CB) brain specimens from PWH previously characterized for Aβ plaque deposition. C3 and CFH protein levels were then correlated with specific cognitive domains. C3 protein levels in the FC were significantly increased in brains with Aβ plaques and in brains with HAND compared to controls. In the CB, C3 levels trended higher in brains with Aβ plaques. Overall C3 protein levels were significantly higher in the FC compared to the CB, but the opposite was true for CFH, having significantly higher levels of CFH protein in the CB compared to the FC. However, only CFH in the FC showed significant correlations with specific domains, executive function and motor performance. These findings corroborate previous results showing that complement system proteins are associated with HAND and AD neuropathogenesis.
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21
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Bernier RA, Banks SJ, Panizzon MS, Andrews MJ, Jacobs EG, Galasko DR, Shepherd AL, Akassoglou K, Sundermann EE. The neuroinflammatory marker sTNFR2 relates to worse cognition and tau in women across the Alzheimer's disease spectrum. Alzheimers Dement (Amst) 2022; 14:e12284. [PMID: 35386474 PMCID: PMC8973901 DOI: 10.1002/dad2.12284] [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] [Received: 10/12/2021] [Revised: 11/19/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
Introduction Despite women showing greater Alzheimer's disease (AD) prevalence, tau burden, and immune/neuroinflammatory response, whether neuroinflammation impacts cognition differently in women versus men and the biological basis of this impact remain unknown. We examined sex differences in how cerebrospinal fluid (CSF) neuroinflammation relates to cognition across the aging-mild cognitive impairment (MCI)-AD continuum and the mediating role of phosphorylated tau (p-tau) versus other AD biomarkers. Methods Participants included 284 individuals from the Alzheimer's Disease Neuroimaging Initiative study. CSF neuroinflammatory markers included interleukin-6, tumor necrosis factor α, soluble tumor necrosis factor receptor 2 (sTNFR2), and chitinase-3-like protein 1. AD biomarkers were CSF p-tau181 and amyloid beta1-42 levels and magnetic resonance imaging measures of hippocampal and white matter hyperintensity volumes. Results We found a sex-by-sTNFR2 interaction on Mini-Mental State Examination and Clinical Dementia Rating-Sum of Boxes. Higher levels of sTNFR2 related to poorer cognition in women only. Among biomarkers, only p-tau181 eliminated the female-specific relationships between neuroinflammation and cognition. Discussion Women may be more susceptible than men to the adverse effects of sTNFR2 on cognition with a potential etiological link with tau to these effects.
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Affiliation(s)
- Rachel A. Bernier
- Department of NeuroscienceUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Sarah J. Banks
- Department of NeuroscienceUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Matthew S. Panizzon
- Department of PsychiatryUniversity of California, San DiegoSan DiegoCaliforniaUSA
- Center for Behavior Genetics of AgingUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Murray J. Andrews
- Department of NeuroscienceUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Emily G. Jacobs
- Department of Psychological and Brain SciencesUniversity of California, Santa BarbaraSanta BarbaraCaliforniaUSA
| | - Douglas R. Galasko
- Department of NeuroscienceUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Alyx L. Shepherd
- Department of NeuroscienceUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Katerina Akassoglou
- Gladstone UCSF Center for Neurovascular Brain ImmunologySan FranciscoCaliforniaUSA
- Gladstone Institute of Neurological DiseaseSan FranciscoCaliforniaUSA
- Department of NeurologyWeill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Erin E. Sundermann
- Department of PsychiatryUniversity of California, San DiegoSan DiegoCaliforniaUSA
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22
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Tsiknia AA, Reas E, Bangen KJ, Sundermann EE, McEvoy L, Brewer JB, Edland SD, Banks SJ. Sex and APOE ε4 modify the effect of cardiovascular risk on tau in cognitively normal older adults. Brain Commun 2022; 4:fcac035. [PMID: 35233525 PMCID: PMC8882003 DOI: 10.1093/braincomms/fcac035] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/12/2021] [Accepted: 02/15/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
The interaction between APOE ε4 and vascular risk factors on cognitive function is stronger in women than in men. These effects may be mediated by the amount of tau pathology in the brain. Therefore, we examined whether APOE ε4 and sex modify cross-sectional associations between cardiovascular risk and tau deposition in cognitively normal older adults from the Alzheimer’s Disease Neuroimaging Initiative. We calculated the Framingham Heart Study cardiovascular disease risk score for 141 participants (74 women, 47 APOE ε4 carriers) with complete medical history data, processed tau PET data and a Clinical Dementia Rating global score of 0.0 at the time of the tau PET scan, implying no significant cognitive or functional impairment. We used linear regression models to examine the effects of sex, APOE ε4, cardiovascular risk and their interactions on tau deposition in the entorhinal cortex, inferior temporal cortex and a composite meta-region of interest of temporal lobe areas. We found a significant three-way interaction among sex, APOE ε4 status, and cardiovascular disease risk on tau deposition in the entorhinal cortex (β = 0.04; 95% CI, 0.01 to 0.07; P =0.008), inferior temporal cortex (β = 0.02; 95% CI, 0.0 to 0.05; P =0.029) and meta-region (β = 0.02; 95% CI, 0.0–0.04; P = 0.042). After stratifying by APOE ε4 status to examine interactions between sex and cardiovascular disease risk on tau in APOE ε4 carriers and non-carriers, we found a significant two-way interaction between sex and cardiovascular disease risk on tau in the entorhinal cortex (β = 0.05; 95% CI, 0.02 to 0.08; P =0.001), inferior temporal cortex (β = 0.03; 95% CI, 0.01 to 0.05; P =0.009) and meta-region (β = 0.02; 95% CI, 0.01 to 0.04; P =0.008) only among APOE ε4 carriers. In analyses stratified by sex, higher cardiovascular risk scores were associated with higher levels of tau in the entorhinal cortex (β = 0.05; 95% CI, 0.02 to 0.08; P =0.002), inferior temporal cortex (β = 0.02; 95% CI, 0.0 to 0.05; P =0.023) and meta-region (β = 0.02; 95% CI, 0.01 to 0.04; P =0.013) in female APOE ε4 carriers but not in male carriers. Our findings suggest that cognitively normal older women carrying at least one APOE ε4 allele, may be particularly vulnerable to the effects of cardiovascular disease risk on early tau deposition.
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Affiliation(s)
- Amaryllis A. Tsiknia
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Emilie Reas
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Erin E. Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Linda McEvoy
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - James B. Brewer
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Steven D. Edland
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Sarah J. Banks
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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23
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Tsiknia AA, Edland SD, Sundermann EE, Reas ET, Brewer JB, Galasko D, Banks SJ. Sex differences in plasma p-tau181 associations with Alzheimer's disease biomarkers, cognitive decline, and clinical progression. Mol Psychiatry 2022; 27:4314-4322. [PMID: 35768637 PMCID: PMC9718670 DOI: 10.1038/s41380-022-01675-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 02/07/2023]
Abstract
Studies have shown that women on the Alzheimer's disease (AD) continuum have more pathological tau in the brain and cerebrospinal fluid (CSF), than men. Some studies have found that higher levels of tau biomarkers are more strongly associated with clinical AD, cognitive decline and neurodegeneration in women than in men. Despite major developments in the use of plasma tau phosphorylated at threonine 181 (p-tau181) as an AD biomarker, it is unknown whether these sex differences apply to plasma p-tau181. In 1060 Alzheimer's Disease Neuroimaging Initiative (ADNI) participants (47% women, 73.8 ± 7.6 years old), we examined sex differences in plasma p-tau181 levels and their association with other biomarkers, cognitive decline and incident AD. Linear regressions tested for an effect of sex on plasma p-tau181 levels and for plasma p-tau181 × sex interactions on CSF p-tau181, as well as entorhinal cortex tau, cortical amyloid-β (Aβ) deposition, and brain glucose metabolism, quantified using PET imaging. Linear mixed effects models tested for a sex × baseline plasma p-tau181 interaction on change in cognition over time. Finally, Cox models tested for a sex × plasma p-tau181 interaction on the risk of AD dementia in participants who were free of dementia at baseline. Despite similar plasma p-tau181 levels between sexes, women had lower brain glucose metabolism, greater brain Aβ and entorhinal cortex tau deposition, higher CSF p-tau181 and faster cognitive decline in relation to higher baseline plasma p-tau181 levels compared with men. Among Aβ positive, dementia-free participants, women had higher rates of incident AD dementia associated with increasing baseline plasma p-tau181 levels, relative to men. Our results suggest that sex may impact the clinical interpretation of plasma p-tau181 concentrations. If replicated, these findings could have important implications for the use of plasma p-tau181 as an accessible AD biomarker and screening tool for preventive and therapeutic clinical trials.
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Affiliation(s)
- Amaryllis A. Tsiknia
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093 USA
| | - Steven D. Edland
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093 USA ,grid.266100.30000 0001 2107 4242Division of Biostatistics, School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA 92093 USA
| | - Erin E. Sundermann
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093 USA ,grid.410371.00000 0004 0419 2708Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161 USA
| | - Emilie T. Reas
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093 USA
| | - James B. Brewer
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093 USA
| | - Douglas Galasko
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093 USA
| | - Sarah J. Banks
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093 USA
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Sundermann EE, Saelzler UG, Jacobs EG, Banks SJ, Shadyab AH, Taylor CM, Gleason CE, James TT, Jonaitis EM, Panizzon MS. Age at menopause relates to later‐life hippocampal volume in an APOE4‐specific manner. Alzheimers Dement 2021. [DOI: 10.1002/alz.056666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego La Jolla CA USA
| | | | - Carey E Gleason
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Taryn T James
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Erin M Jonaitis
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
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Bernier RA, Banks SJ, Clark AL, Shepherd AL, Sundermann EE. Exercise: Just what the doctor ordered, but why? Elucidating mechanisms for women’s increased HDL benefit from exercise. Alzheimers Dement 2021. [DOI: 10.1002/alz.055025] [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)
| | | | - Alexandra L. Clark
- Research and Psychology Services VA San Diego Healthcare System (VASDHS) San Diego CA USA
- University of California School of Medicine San Diego San Diego CA USA
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Serrano VB, Montoya JL, Campbell LM, Sundermann EE, Iudicello J, Letendre S, Heaton RK, Moore DJ. The relationship between vascular endothelial growth factor (VEGF) and amnestic mild cognitive impairment among older adults living with HIV. J Neurovirol 2021; 27:885-894. [PMID: 34735690 PMCID: PMC8901513 DOI: 10.1007/s13365-021-01001-y] [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] [Received: 03/04/2021] [Revised: 06/03/2021] [Accepted: 07/13/2021] [Indexed: 10/27/2022]
Abstract
Older people with HIV (PWH) experience increased risk of age-related neurodegenerative disorders and cognitive decline, such as amnestic mild cognitive impairment (aMCI). The objective of this study was to examine the relationship between aMCI and plasma VEGF biomarkers among older PWH. Data were collected at a university-based research center from 2011 to 2013. Participants were 67 antiretroviral therapy-treated, virally suppressed PWH. Participants completed comprehensive neurobehavioral and neuromedical evaluations. aMCI status was determined using adapted Jak/Bondi criteria, classifying participants as aMCI + if their performance was > 1 SD below the normative mean on at least two of four memory assessments. VEGF family plasma biomarkers (i.e., VEGF, VEGF-C, VEGF-D, and PIGF) were measured by immunoassay. Logistic regression models were conducted to determine whether VEGF biomarkers were associated with aMCI status. Participants were mostly non-Hispanic white (79%) men (85%) with a mean age of 57.7 years. Eighteen (26.9%) participants met criteria for aMCI. Among potential covariates, only antidepressant drug use differed by aMCI status, and was included as a covariate. VEGF-D was significantly lower in the aMCI + group compared to the aMCI - group. No other VEGF levels (VEGF, VEGF-C, PIGF) differed by aMCI classification (ps > .05). In a sample of antiretroviral therapy-treated, virally suppressed PWH, lower levels of VEGF-D were associated with aMCI status. Longitudinal analyses in a larger and more diverse sample are needed to support VEGF-D as a putative biological marker of aMCI in HIV.
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Affiliation(s)
- Vanessa B Serrano
- Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, La Jolla, CA, USA
| | - Jessica L Montoya
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Laura M Campbell
- Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, La Jolla, CA, USA
| | - Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Jennifer Iudicello
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Scott Letendre
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
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27
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Tsiknia AA, Sundermann EE, Galasko DR, Andrews M, Banks SJ. Sex differences in the association between plasma and CSF p‐tau. Alzheimers Dement 2021. [DOI: 10.1002/alz.056504] [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]
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Sundermann EE, Barnes LL, Bondi MW, Bennett DA, Salmon DP, Maki PM. Improving Detection of Amnestic Mild Cognitive Impairment with Sex-Specific Cognitive Norms. J Alzheimers Dis 2021; 84:1763-1770. [PMID: 34719502 DOI: 10.3233/jad-215260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BackgroundDespite a female advantage in verbal memory, normative data for verbal memory tests used to diagnose Alzheimer's disease (AD) dementia and amnestic mild cognitive impairment (aMCI) often are not sex-adjusted.ObjectiveTo determine whether sex-adjusted norms improve aMCI diagnostic accuracy when accuracy was evaluated by progression to AD dementia over time.MethodsNon-sex-specific and sex-specific verbal memory test norms were incorporated into Jak/Bondi aMCI criteria and applied to older (age 65-90) non-demented women (N = 1,036) and men (N = 355) from the Rush Memory and Aging Project. Using sex-specific aMCI diagnosis as the "true" condition versus non-sex-specific aMCI diagnosis as the "predicted" condition, we identified True Positives, False Positives, True Negatives, and False Negatives and compared AD dementia risk over 10 years among groups.ResultsRates of aMCI were higher in men versus women (χ2 = 15.39, p < 0.001) when determined based on typical diagnostic criteria, but this difference reversed when using sex-specific diagnostic criteria (χ2 = 8.38, p = 0.004). We identified 8%of women as False Negatives and 12%of men as False Positives. Risk of incident AD dementia in False Positive men was significantly lower than in True Positive men (HR = 0.26, 95%CI = 0.12-0.58, p = 0.001). Risk of incident AD dementia in False Negative women was substantially higher than in True Negative women (HR = 3.11, 95%CI = 2.09-4.63, p < 0.001).ConclusionResults suggest that previous reports of higher aMCI rates in men versus women may be an artifact of non-sex-adjusted norms/cut-scores. Incorporation of sex-specific norms/cut-scores for verbal memory impairment into aMCI diagnostic criteria may improve diagnostic accuracy and avoid diagnostic errors in approximately 20%.
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Affiliation(s)
- Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David P Salmon
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Pauline M Maki
- Department of Psychiatry, Psychology and OBGYN, University of Illinois at Chicago, Chicago, IL, USA
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Werhane ML, Thomas KR, Bangen KJ, Weigand AJ, Edmonds EC, Nation DA, Sundermann EE, Bondi MW, Delano-Wood L. Arterial Stiffening Moderates the Relationship Between Type-2 Diabetes Mellitus and White Matter Hyperintensity Burden in Older Adults With Mild Cognitive Impairment. Front Aging Neurosci 2021; 13:716638. [PMID: 34759811 PMCID: PMC8574966 DOI: 10.3389/fnagi.2021.716638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cerebrovascular dysfunction has been proposed as a possible mechanism underlying cognitive impairment in the context of type 2 diabetes mellitus (DM). Although magnetic resonance imaging (MRI) evidence of cerebrovascular disease, such as white matter hyperintensities (WMH), is often observed in DM, the vascular dynamics underlying this pathology remain unclear. Thus, we assessed the independent and combined effects of DM status and different vascular hemodynamic measures (i.e., systolic, diastolic, and mean arterial blood pressure and pulse pressure index [PPi]) on WMH burden in cognitively unimpaired (CU) older adults and those with mild cognitive impairment (MCI). Methods: 559 older adults (mean age: 72.4 years) from the Alzheimer's Disease Neuroimaging Initiative were categorized into those with diabetes (DM+; CU = 43, MCI = 34) or without diabetes (DM-; CU = 279; MCI = 203). Participants underwent BP assessment, from which all vascular hemodynamic measures were derived. T2-FLAIR MRI was used to quantify WMH burden. Hierarchical linear regression, adjusting for age, sex, BMI, intracranial volume, CSF amyloid, and APOE ε4 status, examined the independent and interactive effects of DM status and each vascular hemodynamic measure on total WMH burden. Results: The presence of DM (p = 0.046), but not PPi values (p = 0.299), was independently associated with greater WMH burden overall after adjusting for covariates. Analyses stratified by cognitive status revealed a significant DM status x PPi interaction within the MCI group (p = 0.001) such that higher PPi values predicted greater WMH burden in the DM + but not DM- group. No significant interactions were observed in the CU group (all ps > 0.05). Discussion: Results indicate that higher PPi values are positively associated with WMH burden in diabetic older adults with MCI, but not their non-diabetic or CU counterparts. Our findings suggest that arterial stiffening and reduced vascular compliance may have a role in development of cerebrovascular pathology within the context of DM in individuals at risk for future cognitive decline. Given the specificity of these findings to MCI, future exploration of the sensitivity of earlier brain markers of vascular insufficiency (i.e., prior to macrostructural white matter changes) to the effects of DM and arterial stiffness/reduced vascular compliance in CU individuals is warranted.
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Affiliation(s)
- Madeleine L. Werhane
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Kelsey R. Thomas
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Katherine J. Bangen
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Alexandra J. Weigand
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, United States
| | - Emily C. Edmonds
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Daniel A. Nation
- Department of Psychological Sciences, University of California, Irvine, Irvine, CA, United States
| | - Erin E. Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Mark W. Bondi
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Lisa Delano-Wood
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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30
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Swinton MK, Sundermann EE, Pedersen L, Nguyen JD, Grelotti DJ, Taffe MA, Iudicello JE, Fields JA. Alterations in Brain Cannabinoid Receptor Levels Are Associated with HIV-Associated Neurocognitive Disorders in the ART Era: Implications for Therapeutic Strategies Targeting the Endocannabinoid System. Viruses 2021; 13:v13091742. [PMID: 34578323 PMCID: PMC8473156 DOI: 10.3390/v13091742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 01/02/2023] Open
Abstract
HIV-associated neurocognitive disorders (HAND) persist despite the advent of antiretroviral therapy (ART), suggesting underlying systemic and central nervous system (CNS) inflammatory mechanisms. The endogenous cannabinoid receptors 1 and 2 (CB1 and CB2) modulate inflammatory gene expression and play an important role in maintaining neuronal homeostasis. Cannabis use is disproportionately high among people with HIV (PWH) and may provide a neuroprotective effect for those on ART due to its anti-inflammatory properties. However, expression profiles of CB1 and CB2 in the brains of PWH on ART with HAND have not been reported. In this study, biochemical and immunohistochemical analyses were performed to determine CB1 and CB2 expression in the brain specimens of HAND donors. Immunoblot revealed that CB1 and CB2 were differentially expressed in the frontal cortices of HAND brains compared to neurocognitively unimpaired (NUI) brains of PWH. CB1 expression levels negatively correlated with memory and information processing speed. CB1 was primarily localized to neuronal soma in HAND brains versus a more punctate distribution of neuronal processes in NUI brains. CB1 expression was increased in cells with glial morphology and showed increased colocalization with an astroglial marker. These results suggest that targeting the endocannabinoid system may be a potential therapeutic strategy for HAND.
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Clark AL, Weigand AJ, Thomas KR, Solders SK, Delano-Wood L, Bondi MW, Bernier RA, Sundermann EE, Banks SJ, Bangen KJ. Elevated Inflammatory Markers and Arterial Stiffening Exacerbate Tau but Not Amyloid Pathology in Older Adults with Mild Cognitive Impairment. J Alzheimers Dis 2021; 80:1451-1463. [PMID: 33682714 DOI: 10.3233/jad-201382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Age-related cerebrovascular and neuroinflammatory processes have been independently identified as key mechanisms of Alzheimer's disease (AD), although their interactive effects have yet to be fully examined. OBJECTIVE The current study examined 1) the influence of pulse pressure (PP) and inflammatory markers on AD protein levels and 2) links between protein biomarkers and cognitive function in older adults with and without mild cognitive impairment (MCI). METHODS This study included 218 ADNI (81 cognitively normal [CN], 137 MCI) participants who underwent lumbar punctures, apolipoprotein E (APOE) genotyping, and cognitive testing. Cerebrospinal (CSF) levels of eight pro-inflammatory markers were used to create an inflammation composite, and amyloid-beta 1-42 (Aβ42), phosphorylated tau (p-tau), and total tau (t-tau) were quantified. RESULTS Multiple regression analyses controlling for age, education, and APOE ɛ4 genotype revealed significant PP x inflammation interactions for t-tau (B = 0.88, p = 0.01) and p-tau (B = 0.84, p = 0.02); higher inflammation was associated with higher levels of tau within the MCI group. However, within the CN group, analyses revealed a significant PP x inflammation interaction for Aβ42 (B = -1.01, p = 0.02); greater inflammation was associated with higher levels of Aβ42 (indicative of lower cerebral amyloid burden) in those with lower PP. Finally, higher levels of tau were associated with poorer memory performance within the MCI group only (p s < 0.05). CONCLUSION PP and inflammation exert differential effects on AD CSF proteins and provide evidence that vascular risk is associated with greater AD pathology across our sample of CN and MCI older adults.
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Affiliation(s)
- Alexandra L Clark
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Alexandra J Weigand
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,San Diego State University/University of California, San Diego (SDSU/UCSD), La Jolla, CA, USA
| | - Kelsey R Thomas
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Seraphina K Solders
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Lisa Delano-Wood
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Mark W Bondi
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Rachel A Bernier
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Erin E Sundermann
- University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Sarah J Banks
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J Bangen
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
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Moore RC, Paolillo EW, Sundermann EE, Campbell LM, Delgadillo J, Heaton A, Swendsen J, Depp CA. Validation of the mobile verbal learning test: Illustration of its use for age and disease-related cognitive deficits. Int J Methods Psychiatr Res 2021; 30:e1859. [PMID: 33159488 PMCID: PMC7992286 DOI: 10.1002/mpr.1859] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE We developed a mobile cognitive test of verbal learning and memory, the mobile verbal learning test (mVLT), to allow for brief, repeated and portable delivery of a 12-item list learning test through a smartphone. This study examined the psychometric properties of the mVLT among older persons with and without human immunodeficiency virus (HIV). METHODS Sixty-eight persons with HIV and 36 HIV-negative individuals (aged 50-74) completed three trials of the mVLT on a smartphone once daily for 14 days. A different word list was administered each day. RESULTS Participants completed 80% of the 14 mVLT administrations, equating to 1166 valid and complete mVLTs. Neither adherence nor mean mVLT total score (number correct in 3 recall trials) differed by HIV status. No practice effects from repeated mVLT administration were observed, and there were moderately strong correlations of mVLT performance with performance on the in-lab version of the task and with traditional cognitive assessments of cognitive processes contributing to memory. We found evidence of within-person learning across mVLT trials, with persons with HIV demonstrating less learning from trials 1 to 3 compared to HIV-negative participants. CONCLUSIONS The mVLT is a valid method to assess learning in the real world in older adults with and without HIV.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Emily W Paolillo
- Department of Psychiatry, University of California San Diego, San Diego, California, USA.,SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Erin E Sundermann
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Laura M Campbell
- Department of Psychiatry, University of California San Diego, San Diego, California, USA.,SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Jeremy Delgadillo
- Advancing Diversity in Aging Research (ADAR) Program, San Diego State University, San Diego, California, USA
| | - Anne Heaton
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Joel Swendsen
- National Center for Scientific Research, University of Bordeaux, EPHE PSL Research University, Bordeaux, France
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, California, USA.,VA San Diego Healthcare System, San Diego, California, USA
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Sundermann EE, Fields A, Saloner R, Gouaux B, Bharti A, Murphy C, Moore DJ. The utility of olfactory function in distinguishing early-stage Alzheimer's disease from HIV-associated neurocognitive disorders. AIDS 2021; 35:429-437. [PMID: 33252483 PMCID: PMC7856221 DOI: 10.1097/qad.0000000000002761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Given the rising number of older people with HIV (PWH) and the overlap in cognitive dysfunction profiles in HIV-associated neurocognitive disorders (HAND) and Alzheimer's disease and its precursor, amnestic mild cognitive impairment (aMCI), methods are needed to distinguish aMCI/Alzheimer's disease from HAND. As an early indicator of Alzheimer's disease, we examined whether olfactory dysfunction could help to distinguish between aMCI/Alzheimer's disease and HAND among PWH. DESIGN An observational cohort study. METHODS Eighty-one older (≥50 years) PWH (83% men, 65% white) from the California NeuroAIDS Tissue Consortium completed the University of Pennsylvania Smell Identification Test (UPSIT; higher scores = better smell identification) and a comprehensive seven-domain neuropsychological test battery and neuromedical evaluation. HAND was classified via Frascati criteria. High aMCI risk was defined as impairment (>1.0 SD below normative mean) on two of four delayed recall or recognition outcomes (at least one recognition impairment required) from the Hopkins Verbal Learning Test-Revised and the Brief Visuospatial Memory Test-Revised. We examined UPSIT scores in relation to aMCI risk and HAND status, and continuous memory scores considering adjustments for demographics and relevant clinical or HIV disease characteristics. RESULTS Fifty-seven participants were classified with HAND (70%) and 35 participants were classified as high aMCI risk (43%). UPSIT scores were lower (worse) in the high versus low aMCI risk group [F (1,76) = 10.04, P = 0.002], but did not differ by HAND status [F (1,76) = 0.62, P = 0.43]. UPSIT scores positively correlated with all memory outcomes (Ps < 0.05). CONCLUSION Olfactory assessments may help in detecting early aMCI/Alzheimer's disease among PWH and allow for appropriate and early disease intervention.
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Affiliation(s)
| | | | | | | | - Ajay Bharti
- Department of Medicine, University of California
| | - Claire Murphy
- Department of Psychiatry
- Department of Psychology, San Diego State University, San Diego, California, USA
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34
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Sundermann EE, Thomas KR, Bangen KJ, Weigand AJ, Eppig JS, Edmonds EC, Wong CG, Bondi MW, Delano-Wood L. Prediabetes Is Associated With Brain Hypometabolism and Cognitive Decline in a Sex-Dependent Manner: A Longitudinal Study of Nondemented Older Adults. Front Neurol 2021; 12:551975. [PMID: 33679574 PMCID: PMC7933503 DOI: 10.3389/fneur.2021.551975] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Although type 2 diabetes is a well-known risk factor for Alzheimer's disease (AD), little is known about how its precursor-prediabetes-impacts neuropsychological function and brain health. Thus, we examined the relationship between prediabetes and AD-related biological and cognitive/clinical markers in a well-characterized sample drawn from the Alzheimer's Disease Neuroimaging Initiative. Additionally, because women show higher rates of AD and generally more atherogenic lipid profiles than men, particularly in the context of diabetes, we examined whether sex moderates any observed associations. The total sample of 911 nondemented and non-diabetic participants [normal control = 540; mild cognitive impairment (MCI) = 371] included 391 prediabetic (fasting blood glucose: 100-125 mg/dL) and 520 normoglycemic individuals (age range: 55-91). Linear mixed effects models, adjusted for demographics and vascular and AD risk factors, examined the independent and interactive effects of prediabetes and sex on 2-6 year trajectories of FDG-PET measured cerebral metabolic glucose rate (CMRglu), hippocampal/intracranial volume ratio (HV/IV), cerebrospinal fluid phosphorylated tau-181/amyloid-β1-42 ratio (p-tau181/Aβ1-42), cognitive function (executive function, language, and episodic memory) and the development of dementia. Analyses were repeated in the MCI subsample. In the total sample, prediabetic status had an adverse effect on CMRglu across time regardless of sex, whereas prediabetes had an adverse effect on executive function across time in women only. Within the MCI subsample, prediabetic status was associated with lower CMRglu and poorer executive function and language performance across time within women, whereas these associations were not seen within men. In the total sample and MCI subsample, prediabetes did not relate to HV/IV, p-tau181/Aβ1-42, memory function or dementia risk regardless of sex; however, among incident dementia cases, prediabetic status related to earlier age of dementia onset in women but not in men. Results suggest that prediabetes may affect cognition through altered brain metabolism, and that women may be more vulnerable to the negative effects of glucose intolerance.
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Affiliation(s)
- Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Kelsey R Thomas
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Katherine J Bangen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Joel S Eppig
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Emily C Edmonds
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Christina G Wong
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
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Rubin LH, Sundermann EE, Dastgheyb R, Buchholz AS, Pasipanodya E, Heaton RK, Grant I, Ellis R, Moore DJ. Sex Differences in the Patterns and Predictors of Cognitive Function in HIV. Front Neurol 2020; 11:551921. [PMID: 33329301 PMCID: PMC7732436 DOI: 10.3389/fneur.2020.551921] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
Despite advancements in antiretroviral therapy, mild cognitive deficits persist in nearly half of people with HIV (PWH). The profile of impairment in HIV is highly variable with deficits observed in a range of cognitive domains. Despite evidence of greater cognitive impairment among women with HIV (WWH) vs. men with HIV (MWH), it is unclear how MWH and WWH differ in the type of cognitive impairment and in risk factors associated with cognitive impairment profiles. In a large and well-characterized sample of PWH, we used machine learning to identify profiles of cognitive functioning and their associated factors overall and within sex. Participants included 1,666 PWH (201 WWH; 1,465 MMH) from the HIV Neurobehavioral Research Program who completed a neuropsychological test battery at their baseline visits. Using demographically-adjusted T-scores from 13 test outcomes assessing motor skills, executive functioning, attention/working memory, episodic learning and memory, verbal fluency, and processing speed, we used Kohonen self-organizing maps to identify patterns of high-dimensional data by mapping participants to similar nodes based on T-scores (MCLUST R package). Random forest models were used to determine how sociodemographic (e.g., age, education), clinical (e.g., depressive symptoms, substance use disorder), and biological (e.g., HIV disease characteristics) factors differentially related to membership within a cognitive profile. All analyses were repeated within sex. Three cognitive profiles were identified overall and within each sex. Overall and within MWH, there were unimpaired and global weakness profiles. The third profile in the total sample demonstrated relatively weak auditory attention whereas in MWH showed relative strengths in attention and processing speed. Conversely, there was no unimpaired profile among WWH. Rather, WWH demonstrated separate profiles reflecting weakness in motor skills, a relative weakness in learning and delayed recall, and global weaknesses with spared recognition memory. Despite different cognitive profiles by sex, the most discriminative factors were similar between men and women and included reading level (cognitive reserve), current and nadir CD4 count, plasma HIV viral load, duration of HIV disease, age, depressive symptoms, and race/ethnicity. Findings fill a knowledge gap concerning sex differences in cognitive impairment in PWH and inform personalized risk reduction and therapeutic strategies.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States.,Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Alison S Buchholz
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States
| | - Elizabeth Pasipanodya
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Ronald Ellis
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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Sundermann EE, Bondi MW, Campbell LM, Gouaux B, Moore RC, Soontornniyomkij V, Moore DJ. Distinguishing Amnestic Mild Cognitive Impairment From HIV-Associated Neurocognitive Disorders. J Infect Dis 2020; 224:435-442. [PMID: 33319235 DOI: 10.1093/infdis/jiaa760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/09/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Memory impairment occurs in human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) and amnestic mild cognitive impairment (aMCI), the precursor to Alzheimer disease (AD). Methods are needed to distinguish aMCI-associated from HAND-associated impairment in people with HIV (PWH). We developed a neuropsychological method of identifying aMCI in PWH and tested this by relating AD neuropathology (β-amyloid, phospho-Tau) to aMCI versus HAND classification. METHODS Seventy-four HIV-positive cases (aged 50-68 years) from the National NeuroAIDS Tissue Consortium had neurocognitive data within 1 year of death and data on β-amyloid and phospho-Tau pathology in frontal brain tissue. High aMCI risk was defined as impairment (<1.0 SD below normative mean) on 2 of 4 delayed recall or recognition outcomes from a verbal and nonverbal memory test (at least 1 recognition impairment required). Differences in β-amyloid and phospho-Tau by aMCI and HAND classification were examined. RESULTS High aMCI risk was more common in HAND (69.0%) versus no HAND (37.5%) group. β-amyloid pathology was 4.75 times more likely in high versus low aMCI risk group. Phospho-Tau pathology did not differ between aMCI groups. Neither neuropathological feature differed by HAND status. CONCLUSIONS Amnestic mild cognitive impairment criteria that include recognition impairment may help to detect AD-like cognitive/biomarker profiles among PWH.
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Affiliation(s)
- Erin E Sundermann
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Laura M Campbell
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Ben Gouaux
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | | | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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Panizzon MS, Sundermann EE, Jacobs EG, Karlsson I, Pedersen NL, Gatz M. Lifetime endogenous estrogen exposure in women influences risk of dementia. Alzheimers Dement 2020. [DOI: 10.1002/alz.044173] [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]
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38
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Sundermann EE, Maki PM, Reddy S, Bondi MW, Biegon A. Doing more with less: Women’s higher brain metabolic rate compensates for early Alzheimer’s pathological changes. Alzheimers Dement 2020. [DOI: 10.1002/alz.037933] [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)
| | | | | | - Mark W Bondi
- University of California, San Diego School of Medicine San Diego CA USA
| | - Anat Biegon
- Stony Brook University School of Medicine Stony Brook NY USA
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Banks SJ, Andrews MJ, Digma LA, Caldwell JZK, Sundermann EE, Brewer JB. Sex and cognition: Relationships with tau PET across the Alzheimer’s disease spectrum. Alzheimers Dement 2020. [DOI: 10.1002/alz.046683] [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: 11/09/2022]
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40
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Sundermann EE, Bondi MW, Umlauf AE, Vaida F, Moore DJ. Detecting amnestic MCI among persons with HIV with high rates of HIV‐associated neurocognitive disorder. Alzheimers Dement 2020. [DOI: 10.1002/alz.046737] [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)
| | - Mark W. Bondi
- University of California, San Diego, School of Medicine San Diego CA USA
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS) San Diego CA USA
| | | | - Florin Vaida
- University of California San Diego La Jolla CA USA
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Sundermann EE, Maki PM, Reddy S, Bondi MW, Biegon A. Women's higher brain metabolic rate compensates for early Alzheimer's pathology. Alzheimers Dement (Amst) 2020; 12:e12121. [PMID: 33251322 PMCID: PMC7678742 DOI: 10.1002/dad2.12121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The female advantage in brain metabolic function may confer cognitive resilience against Alzheimer's disease (AD). METHODS A total of 1259 participants (44% women; 52% mild cognitive impairment; 18% AD) aged 55 to 90 from the Alzheimer's Disease Neuroimaging Initiative (ANDI) completed tests of global cognition, verbal memory, and executive function, and neuroimaging assessments of regional glucose metabolism, hippocampal volume (HV), and amyloid beta (Aβ). We examined sex differences in brain metabolism and cognition by AD biomarker quartiles (Aβ, HV). We then examined if metabolism mediates sex differences in cognition. RESULTS Metabolism was higher in women versus men when pathology was mild-to-moderate (quartiles 2 to 3). Women outperformed men on all cognitive outcomes at ≥1 biomarker quartile, reflecting minimal-to-moderate pathology; however, these differences were eliminated/attenuated after adjusting for metabolism. The female advantage in verbal memory was also observed at minimal pathology quartiles but was unchanged after metabolism adjustment. DISCUSSION Women's greater brain metabolism may confer cognitive resilience against early AD.
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Affiliation(s)
- Erin E. Sundermann
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Pauline M. Maki
- Departments of PsychiatryPsychology and Obstetrics & GynecologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Sarah Reddy
- Departments of Radiology and NeurologyState University of New York at Stony BrookNew YorkUSA
| | - Mark W. Bondi
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
- Veterans Affairs San Diego Healthcare SystemLa JollaCaliforniaUSA
| | - Anat Biegon
- Departments of Radiology and NeurologyState University of New York at Stony BrookNew YorkUSA
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Ellis RJ, Moore DJ, Sundermann EE, Heaton RK, Mehta S, Hulgan T, Samuels D, Fields JA, Letendre SL. Nucleic acid oxidation is associated with biomarkers of neurodegeneration in CSF in people with HIV. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/6/e902. [PMID: 33055205 PMCID: PMC7577534 DOI: 10.1212/nxi.0000000000000902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether oxidative stress in virologically suppressed people with HIV (PWH) may contribute to or result from neurodegeneration, we measured 7,8-dihydro-8-oxoguanine (8-oxo-dG), a marker of DNA damage due to oxidative stress, and markers of age-related neurodegeneration, specifically, reduced levels of CSF Aβ-42, and elevated CSF total tau and neurofilament light (NFL). METHODS This cross-sectional study prospectively enrolled participants at 6 US centers in the CNS HIV Antiretroviral Effects Research study. Inclusion criteria included HIV+ with a plasma level of HIV RNA ≤50 copies/mL. Exclusions included significant CNS confounding conditions. Measurements of total tau and Aβ-42 were performed by bead suspension array. NFL and 8-oxo-dG were measured using ELISA. RESULTS Participants were 53 PWH, mean age 55 (±9.3) years, 19% women, and 48% non-Hispanic White. Higher 8-oxo-dG correlated with markers of AD-related neurodegeneration including lower CSF Aβ-42 (r = -0.34; p = 0.012) and higher CSF NFL (r = 0.39; p = 0.0091) and total tau (r = 0.6696; p < 0.0001). Relationships remained after adjusting for demographic variables. Levels of protein carbonyls, a marker of protein oxidation, were not related to neurodegeneration markers. CONCLUSIONS Among virologically suppressed PWH, nucleic acid oxidation was associated with standard CSF biomarkers of neurodegeneration. Potential sources of oxidative stress in PWH include low-level HIV replication, inflammation, mitochondrial dysfunction, and specific antiretroviral drugs. Results suggest that the higher levels of oxidative stress among PWH may play a role in neurodegeneration. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that among virologically suppressed PWH, nucleic acid oxidation is associated with standard CSF biomarkers of neurodegeneration.
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Affiliation(s)
- Ronald J Ellis
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego.
| | - David J Moore
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - Erin E Sundermann
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - Robert K Heaton
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - Sanjay Mehta
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - Todd Hulgan
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - David Samuels
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - Jerel A Fields
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
| | - Scott L Letendre
- From the Departments of Neurosciences and Psychiatry, University of California (R.J.E.), San Diego; Department of Psychiatry, University of California (D.J.M., E.E.S., R.K.H.), San Diego; Department of Medicine, University of California (S.M., T.H.), San Diego; Vanderbilt University (D.S., J.A.F.), Nashville, Tennessee; and Departments of Medicine and Psychiatry, University of California (S.L.L.), San Diego
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Moore RC, Campbell LM, Delgadillo JD, Paolillo EW, Sundermann EE, Holden J, Schweitzer P, Heaton RK, Swendsen J. Smartphone-Based Measurement of Executive Function in Older Adults with and without HIV. Arch Clin Neuropsychol 2020; 35:347-357. [PMID: 31942632 DOI: 10.1093/arclin/acz084] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/05/2019] [Accepted: 12/17/2019] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To examine feasibility, convergent validity and biases associated with a mobile color-word interference test (mCWIT) among older persons living with HIV (PLHIV). METHOD Over a 14-day period, 58 PLHIV and 32 HIV-uninfected individuals (aged 50-74) completed the mCWIT on smartphones once per day in real-world settings. Participants also completed a comprehensive laboratory-based neuropsychological evaluation. RESULTS A high rate of compliance was observed (86%) in the repeated administration of the mCWIT. A practice effect was observed in the overall sample concerning mCWIT subscores, and these learning effects were greater for PLHIV. Stabilization of performance was observed after 6 (HIV+) and 7 days (HIV-) for completion time and after 2 (HIV-) and 3 days (HIV+) for mCWIT errors. A minor fatigue effect was observed in the overall sample which was unassociated with group status. Moderate to strong correlations were found between mCWIT completion time and mCWIT errors with global neurocognition and with all of the individual neurocognitive domains. The strongest associations were with mCWIT completion time and laboratory-based global neurocognition, executive function, and working memory scores. CONCLUSIONS Cognitive testing administered within the context of a person's daily life provides qualitatively different data than neuropsychological testing completed in clinical settings, and it may constitute a more ecologically valid indicator of cognitive performance than traditional methods. Mobile cognitive testing has potential to help characterize real-time cognitive performance and serve as a complementary assessment tool to traditional methods.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Street, San Diego, CA 92103, USA
| | - Laura M Campbell
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, 6363 Alvarado Court, San Diego, CA 92120, USA
| | - Jeremy D Delgadillo
- Advancing Diversity in Aging Research (ADAR) Program, San Diego State University, 6505 Alvarado Road, Suite 110, San Diego, CA 92120, USA
| | - Emily W Paolillo
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, 6363 Alvarado Court, San Diego, CA 92120, USA
| | - Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Street, San Diego, CA 92103, USA
| | - Jason Holden
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Street, San Diego, CA 92103, USA
| | | | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Street, San Diego, CA 92103, USA
| | - Joel Swendsen
- University of Bordeaux, CNRS UMR, Bordeaux 5287, France.,National Center for Scientific Research, Ecole Pratique des Hautes Etudes, PSL Research University, Paris, France
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Saloner R, Cherner M, Sundermann EE, Watson CWM, Iudicello JE, Letendre SL, Kumar A, Ellis RJ. COMT val158met genotype alters the effects of methamphetamine dependence on dopamine and dopamine-related executive function: preliminary findings. Psychiatry Res 2020; 292:113269. [PMID: 32739643 PMCID: PMC7530039 DOI: 10.1016/j.psychres.2020.113269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022]
Abstract
The Met-allele of the COMT Val158Met polymorphism slows metabolism and increases bioavailability of dopamine (DA) in the prefrontal cortex compared to the Val-allele. Healthy Met-carriers outperform Val-carriers on executive function (EF) tests, yet this 'advantage' disappears in methamphetamine (METH) dependence. Met-carriers may be disproportionately vulnerable to METH-related perturbations of DA, yet it is unknown whether COMT modulates METH effects on CSF DA biomarkers. Participants were 75 METH+ and 47 METH- men who underwent neurocognitive testing, COMT genotyping, and lumbar puncture. CSF was assayed for DA and its metabolite, homovanillic acid (HVA). Separate linear models regressed DA, HVA, and HVA/DA ratios on COMT, METH and their interaction. Pearson correlations examined associations between DA and EF. Significant interactions indicated that METH+ had lower DA and higher HVA/DA ratios among Met/Met, but not Val/Met-or Val/Val. Met/Met-exhibited the highest DA levels among METH-, whereas DA levels were comparable between Met/Met-and Val-carriers among METH+. Higher DA correlated with better EF in METH- Met/Met, but did not predict EF in the entire sample. DA was expectedly higher in METH- Met/Met, yet a discordant genotype-phenotype profile emerged in METH+ Met/Met, consistent with the notion that slow DA clearance exacerbates METH-associated DA dysregulation.
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Affiliation(s)
- Rowan Saloner
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA, USA.
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Caitlin Wei-Ming Watson
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Jennifer E Iudicello
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Scott L Letendre
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Adarsh Kumar
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA
| | - Ronald J Ellis
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA, USA; Department of Neurosciences, University of California, San Diego, San Diego, CA, USA
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Sundermann EE, Panizzon MS, Chen X, Andrews M, Galasko D, Banks SJ. Sex differences in Alzheimer's-related Tau biomarkers and a mediating effect of testosterone. Biol Sex Differ 2020; 11:33. [PMID: 32560743 PMCID: PMC7304096 DOI: 10.1186/s13293-020-00310-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023] Open
Abstract
Women show greater pathological Tau biomarkers than men along the Alzheimer's disease (AD) continuum, particularly among apolipoprotein ε-E4 (APOE4) carriers; however, the reason for this sex difference in unknown. Sex differences often indicate an underlying role of sex hormones. We examined whether testosterone levels might influence this sex difference and the modifying role of APOE4 status. Analyses included 172 participants (25 cognitively normal, 97 mild cognitive impairment, 50 AD participants) from the Alzheimer's Disease Neuroimaging Initiative (34% female, 54% APOE4 carriers, aged 55-90). We examined the separate and interactive effects of plasma testosterone levels and APOE4 on cerebrospinal fluid phosphorylated-tau181 (p-Tau) levels in the overall sample and the sex difference in p-Tau levels before and after adjusting for testosterone. A significant APOE4-by-testosterone interaction revealed that lower testosterone levels related to higher p-Tau levels among APOE4 carriers regardless of sex. As expected, women had higher p-Tau levels than men among APOE4 carriers only, yet this difference was eliminated upon adjustment for testosterone. Results suggest that testosterone is protective against p-Tau particularly among APOE4 carriers. The lower testosterone levels that typically characterize women may predispose them to pathological Tau, particularly among female APOE4 carriers.
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Affiliation(s)
- Erin E. Sundermann
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093 USA
| | - Matthew S. Panizzon
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093 USA
| | - Xu Chen
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093 USA
| | - Murray Andrews
- Department of Neuroscience, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093 USA
| | - Douglas Galasko
- Department of Neuroscience, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093 USA
| | - Sarah J. Banks
- Department of Neuroscience, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093 USA
| | - for the Alzheimer’s Disease Neuroimaging Initiative
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093 USA
- Department of Neuroscience, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093 USA
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Umlauf A, Soontornniyomkij B, Sundermann EE, Gouaux B, Ellis RJ, Levine AJ, Moore DJ, Soontornniyomkij V. Risk of developing cerebral β-amyloid plaques with posttranslational modification among HIV-infected adults. AIDS 2019; 33:2157-2166. [PMID: 31688040 PMCID: PMC6852888 DOI: 10.1097/qad.0000000000002336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Evidence of accelerated brain aging among HIV-infected adults argues for the increased risk of developing cerebral β-amyloid (Aβ) plaques. We compared the frequency of Aβ plaque-bearing cases in our HIV cohort with that in a general cohort reported by Braak et al. We explored posttranslationally modified Aβ forms (N3pE, E22P, phospho-Ser8) in plaques and E22P-Aβ in the postmortem cerebrospinal fluid (CSF) in the HIV cohort. DESIGN Clinicopathological study of HIV-infected adults. METHODS To assess frontal Aβ plaque deposition, we conducted immunohistochemistry for generic Aβ (4G8) and three modified Aβ forms. We determined CSF E22P-Aβ levels by ELISA. RESULTS We found 4G8-Aβ plaques in 29% of 279 HIV-infected cases. Within the age range of 31-70 years, the frequency of 4G8-Aβ plaque-bearing cases was higher in our HIV cohort (n = 273) compared with the general cohort (n = 1110) overall (29.3 vs. 25.8%) and across four age groups by decade (odds ratio 2.35, P < 0.0001). In HIV-infected cases with (n = 37) and without (n = 12) 4G8-Aβ plaques, modified Aβ forms occurred in order: N3pE, E22P, and phospho-Ser8. In CSF assays of HIV-infected cases with (n = 27; 17 focal, 10 widespread) and without (n = 11) 4G8-Aβ plaques, the median E22P-Aβ/Aβ40 ratio was higher among cases with widespread plaques than in cases with focal or absent plaques (P = 0.047). CONCLUSION Our findings suggest HIV-infected adults are at increased risk of developing cerebral Aβ plaques. The occurrence of modified Aβ forms in order suggests the progression stages of Aβ plaque deposition. The potential for E22P-Aβ as a CSF biomarker of cerebral Aβ plaques should be investigated.
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Affiliation(s)
- Anya Umlauf
- aDepartment of Psychiatry bDepartment of Neurosciences, School of Medicine, University of California San Diego, La Jolla cDepartment of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Sundermann EE, Maki P, Biegon A, Lipton RB, Mielke MM, Machulda M, Bondi MW. Sex-specific norms for verbal memory tests may improve diagnostic accuracy of amnestic MCI. Neurology 2019; 93:e1881-e1889. [PMID: 31597708 DOI: 10.1212/wnl.0000000000008467] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/05/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To examine whether the use of sex-specific norms and cut scores to identify memory impairment improves diagnostic accuracy of amnestic mild cognitive impairment (aMCI) compared to non-sex-specific (typical) norms/cut scores given the female advantage in verbal memory. METHODS We calculated sex-specific and typical norms/cut scores (age and education specific) for impairment on the Rey Auditory Verbal Learning Test in the Mayo Clinic Study of Aging. Norms/cut scores were applied to 453 women and 532 men from the Alzheimer's Disease Neuroimaging Initiative. We compared sex differences in rates of aMCI (Jak/Bondi criteria) for sex-specific vs typical norms/cut scores. Using sex-specific cut scores as the true condition and typical cut scores as the predicted condition, we categorized participants as true positives (TPs), false positives (FPs), true negative (TNs), or false negative (FNs). In cross-sectional analyses within sex, we compared positivity rates of CSF hyperphosphorylated tau/β-amyloid (Aβ) and cortical Aβ deposition ([18F]AV45 PET) and APOE ε4 frequency among diagnostic comparison groups. RESULTS The frequency of aMCI was higher in men when using typical norms/cut scores. Using sex-adjusted norms/cut scores led to the identification of 10% FNs (missed aMCI cases) among women and 10% FPs among men. Biomarker analyses supported the hypothesis that sex-specific diagnostic criteria improves diagnostic accuracy. Biomarkers rates were higher in FNs vs TNs and similar in FNs and TPs. Biomarker rates were lower in FPs vs TPs and similar between FPs and TNs. CONCLUSION Results suggest that non-sex-specific aMCI diagnostic criteria led to a 20% diagnostic error rate. Accounting for sex differences in verbal memory performance may improve aMCI classification.
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Affiliation(s)
- Erin E Sundermann
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA.
| | - Pauline Maki
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA
| | - Anat Biegon
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA
| | - Richard B Lipton
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA
| | - Michelle M Mielke
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA
| | - Mary Machulda
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA
| | - Mark W Bondi
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA
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Rubin LH, Neigh GN, Sundermann EE, Xu Y, Scully EP, Maki PM. Sex Differences in Neurocognitive Function in Adults with HIV: Patterns, Predictors, and Mechanisms. Curr Psychiatry Rep 2019; 21:94. [PMID: 31522330 PMCID: PMC7673651 DOI: 10.1007/s11920-019-1089-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Sex differences in cognitive function are well documented yet few studies had adequate numbers of women and men living with HIV (WLWH; MLWH) to identify sex differences in neurocognitive impairment (NCI) and the factors contributing to NCI. Here, we review evidence that WLWH may be at greater risk for NCI. RECENT FINDINGS We conducted a systematic review of recent studies of NCI in WLWH versus MLWH. A power analysis showed that few HIV studies have sufficient power to address male/female differences in NCI but studies with adequate power find evidence of greater NCI in WLWH, particularly in the domains of memory, speed of information processing, and motor function. Sex is an important determinant of NCI in HIV, and may relate to male/female differences in cognitive reserve, comorbidities (mental health and substance use disorders), and biological factors (e.g., inflammation, hormonal, genetic).
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Affiliation(s)
- Leah H. Rubin
- Department of Neurology and Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Gretchen N. Neigh
- Department of Anatomy and Neurobiology, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | | | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD,Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eileen P. Scully
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Pauline M. Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL,Department of Psychology, University of Illinois at Chicago, Chicago, IL
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Sundermann EE, Erlandson KM, Pope CN, Rubtsova A, Montoya J, Moore AA, Marzolini C, O'Brien KK, Pahwa S, Payne BA, Rubin LH, Walmsley S, Haughey NJ, Montano M, Karris MY, Margolick JB, Moore DJ. Current Challenges and Solutions in Research and Clinical Care of Older Persons Living with HIV: Findings Presented at the 9th International Workshop on HIV and Aging. AIDS Res Hum Retroviruses 2019; 35:985-998. [PMID: 31373216 PMCID: PMC6862962 DOI: 10.1089/aid.2019.0100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/29/2022] Open
Abstract
In the era of effective antiretroviral therapy, the number of older people with HIV (PWH) is increasing, and those aging with HIV are experiencing an increasing burden of age-associated comorbidities. Life expectancy among older PWH is approaching that of demographically comparable HIV-uninfected (HIV-) adults. With this changing demographic of PWH come new challenges for researchers and clinicians in how to identify, address, and manage the complex interplay of treated HIV infection and aging-associated factors. In response to these challenges, the annual International Workshop on HIV and Aging was initiated in 2009 as a multidisciplinary platform for scientific discourse on the research and clinical complications arising from the aging population of PWH. The multidisciplinary nature of the workshop has resulted in a wide range of topics addressed over the past 9 years, from basic mechanisms in aging and HIV pathogenesis, to epidemiology of aging within large cohorts, interventions, and implementation of clinical programs. Herein, we summarize the key topics discussed at the 9th Annual International Workshop on HIV and Aging 2018, including "inflammaging," mitochondrial dysfunction, exercise interventions, HIV-associated neurocognitive impairment, metabolic dysfunction, menopause, and polypharmacy. In addition to recent developments in research and clinical care, we discuss open questions and future research directions required to better understand the interaction of HIV and aging.
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Affiliation(s)
- Erin E. Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Kristine M. Erlandson
- Department of Medicine, University of Colorado-Anschutz Medical Center, Aurora, Colorado
- Department of Epidemiology, School of Public Health, University of Colorado-Anschutz Medical Center, Aurora, Colorado
| | - Caitlin N. Pope
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Anna Rubtsova
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Jessica Montoya
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Alison A. Moore
- Division of Geriatrics and Gerontology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- The Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Kelly K. O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- The Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Savita Pahwa
- Department of Microbiology and Immunology and the Miami CFAR, University of Miami Miller School of Medicine, Miami, Florida
| | - Brendan A.I. Payne
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sharon Walmsley
- Toronto General Hospital, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Norman J. Haughey
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Monty Montano
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Maile Y. Karris
- Division of Infectious Diseases and Global Public Health, Department of Medicine, Unviersity of California San Diego, San Diego, California
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Environmental Health and Engineering, and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California
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Sundermann EE, Hussain MA, Moore DJ, Horvath S, Lin DTS, Kobor MS, Levine A. Inflammation-related genes are associated with epigenetic aging in HIV. J Neurovirol 2019; 25:853-865. [PMID: 31286441 DOI: 10.1007/s13365-019-00777-4] [Citation(s) in RCA: 15] [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: 01/11/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 12/14/2022]
Abstract
Chronic inflammation is characteristic of both HIV and aging ("inflammaging") and may contribute to the accelerated aging observed in people living with HIV (PLWH). We examined whether three inflammation-related single-nucleotide polymorphisms (SNPs) were risk factors for accelerated aging and HIV-associated, non-AIDS (HANA) conditions among PLWH. We examined 155 postmortem cases with HIV (mean age = 47.3, 81% male, 68% self-reported White) from the National NeuroAIDS Tissue Consortium who had pre-mortem neurobehavioral/medical/virologic data and epigenomic data from occipital cortex tissue. Accelerated aging was measured according to the Epigenetic Clock; an aging biomarker based on DNA methylation levels. Past or current age-associated HANA conditions including cerebrovascular, liver and kidney disease, chronic obstructive pulmonary disease, cancer, and diabetes were determined via self-report. Epigenetic Aging Z-scores and likelihood of past/current HANA conditions were compared between major allele homozygotes and minor allele carriers for each SNP (IL-6 - 174G>C, IL-10 - 592C>A, TNF-α - 308 G>A) separately. Analyses were adjusted for relevant demographic/clinical factors. Epigenetic aging (e.g., higher Z-scores) was significantly greater in IL-6 C allele carriers (p = .002) and IL-10 CC homozygotes (p = .02) compared to other genotype groups. The likelihood of any past/current HANA condition did not differ by IL-10 genotype but was 3.36 times greater in IL-6 C allele carriers versus others (OR = 3.36, 95%CI = 1.09-10.34, p = .03). TNF-α genotype was not associated with epigenetic aging or HANA conditions. IL-6 and IL-10 SNPs may help to identify PLWH who are at high risk for accelerated aging. These insights into pathophysiological pathways may inform interventional approaches to treat rapid aging among PLWH.
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Affiliation(s)
- Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Mariam A Hussain
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct, San Diego, CA, 92120, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Steven Horvath
- Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA.,Biostatistics, School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - David T S Lin
- The Centre for Molecular Medicine and Therapeutics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, V5Z 4H4, Canada
| | - Michael S Kobor
- The Centre for Molecular Medicine and Therapeutics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, V5Z 4H4, Canada
| | - Andrew Levine
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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