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Johnson KE, Li H, Zhang M, Springer MV, Galecki AT, Whitney RT, Gottesman RF, Hayward RA, Sidney S, Elkind MSV, Longstreth WT, Heckbert SR, Gerber Y, Sullivan KJ, Levine DA. Cumulative Systolic Blood Pressure and Incident Stroke Type Variation by Race and Ethnicity. JAMA Netw Open 2024; 7:e248502. [PMID: 38700866 PMCID: PMC11069082 DOI: 10.1001/jamanetworkopen.2024.8502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/28/2024] [Indexed: 05/06/2024] Open
Abstract
Importance Stroke risk varies by systolic blood pressure (SBP), race, and ethnicity. The association between cumulative mean SBP and incident stroke type is unclear, and whether this association differs by race and ethnicity remains unknown. Objective To examine the association between cumulative mean SBP and first incident stroke among 3 major stroke types-ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)-and explore how these associations vary by race and ethnicity. Design, Setting, and Participants Individual participant data from 6 US longitudinal cohorts (January 1, 1971, to December 31, 2019) were pooled. The analysis was performed from January 1, 2022, to January 2, 2024. The median follow-up was 21.6 (IQR, 13.6-31.8) years. Exposure Time-dependent cumulative mean SBP. Main Outcomes and Measures The primary outcome was time from baseline visit to first incident stroke. Secondary outcomes consisted of time to first incident IS, ICH, and SAH. Results Among 40 016 participants, 38 167 who were 18 years or older at baseline with no history of stroke and at least 1 SBP measurement before the first incident stroke were included in the analysis. Of these, 54.0% were women; 25.0% were Black, 8.9% were Hispanic of any race, and 66.2% were White. The mean (SD) age at baseline was 53.4 (17.0) years and the mean (SD) SBP at baseline was 136.9 (20.4) mm Hg. A 10-mm Hg higher cumulative mean SBP was associated with a higher risk of overall stroke (hazard ratio [HR], 1.20 [95% CI, 1.18-1.23]), IS (HR, 1.20 [95% CI, 1.17-1.22]), and ICH (HR, 1.31 [95% CI, 1.25-1.38]) but not SAH (HR, 1.13 [95% CI, 0.99-1.29]; P = .06). Compared with White participants, Black participants had a higher risk of IS (HR, 1.20 [95% CI, 1.09-1.33]) and ICH (HR, 1.67 [95% CI, 1.30-2.13]) and Hispanic participants of any race had a higher risk of SAH (HR, 3.81 [95% CI, 1.29-11.22]). There was no consistent evidence that race and ethnicity modified the association of cumulative mean SBP with first incident stroke and stroke type. Conclusions and Relevance The findings of this cohort study suggest that cumulative mean SBP was associated with incident stroke type, but the associations did not differ by race and ethnicity. Culturally informed stroke prevention programs should address modifiable risk factors such as SBP along with social determinants of health and structural inequities in society.
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Affiliation(s)
- Kimson E. Johnson
- Department of Health Management and Policy, University of Michigan, Ann Arbor
- Department of Sociology, University of Michigan, Ann Arbor
| | - Hanyu Li
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Min Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | - Andrzej T. Galecki
- Department of Biostatistics, University of Michigan, Ann Arbor
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
| | - Rachael T. Whitney
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Rodney A. Hayward
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - W. T. Longstreth
- Department of Epidemiology, University of Washington, Seattle
- Department of Neurology, University of Washington, Seattle
| | | | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lilian and Marcel Pollak Chair in Biological Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kevin J. Sullivan
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Deborah A. Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Neurology and Stroke Program, University of Michigan, Ann Arbor
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Bleiweis MS, Sharaf OM, Philip J, Peek GJ, Stukov Y, Janelle GM, Pitkin AD, Sullivan KJ, Nixon CS, Neal D, Jacobs JP. A single-institutional experience with 36 children less than 5 kilograms supported with the Berlin Heart: Comparison of congenital versus acquired heart disease. Cardiol Young 2024:1-8. [PMID: 38362907 DOI: 10.1017/s1047951123004134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVES We reviewed outcomes in all 36 consecutive children <5 kg supported with the Berlin Heart pulsatile ventricular assist device at the University of Florida, comparing those with acquired heart disease (n = 8) to those with congenital heart disease (CHD) (n = 28). METHODS The primary outcome was mortality. The Kaplan-Meier method and log-rank tests were used to assess group differences in long-term survival after ventricular assist device insertion. T-tests using estimated survival proportions were used to compare groups at specific time points. RESULTS Of 82 patients supported with the Berlin Heart at our institution, 49 (49/82 = 59.76%) weighed <10 kg and 36 (36/82 = 43.90%) weighed <5 kg. Of 36 patients <5 kg, 26 (26/36 = 72.22%) were successfully bridged to transplantation. (The duration of support with ventricular assist device for these 36 patients <5 kg was [days]: median = 109, range = 4-305.) Eight out of 36 patients <5 kg had acquired heart disease, and all eight [8/8 = 100%] were successfully bridged to transplantation. (The duration of support with ventricular assist device for these 8 patients <5 kg with acquired heart disease was [days]: median = 50, range = 9-130.) Twenty-eight of 36 patients <5 kg had congenital heart disease. Eighteen of these 28 [64.3%] were successfully bridged to transplantation. (The duration of support with ventricular assist device for these 28 patients <5 kg with congenital heart disease was [days]: median = 136, range = 4-305.) For all 36 patients who weighed <5 kg: 1-year survival estimate after ventricular assist device insertion = 62.7% (95% confidence interval = 48.5-81.2%) and 5-year survival estimate after ventricular assist device insertion = 58.5% (95% confidence interval = 43.8-78.3%). One-year survival after ventricular assist device insertion = 87.5% (95% confidence interval = 67.3-99.9%) in acquired heart disease and 55.6% (95% confidence interval = 39.5-78.2%) in CHD, P = 0.036. Five-year survival after ventricular assist device insertion = 87.5% (95% confidence interval = 67.3-99.9%) in acquired heart disease and 48.6% (95% confidence interval = 31.6-74.8%) in CHD, P = 0.014. CONCLUSION Pulsatile ventricular assist device facilitates bridge to transplantation in neonates and infants weighing <5 kg; however, survival after ventricular assist device insertion in these small patients is less in those with CHD in comparison to those with acquired heart disease.
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Affiliation(s)
- Mark S Bleiweis
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Omar M Sharaf
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Joseph Philip
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Giles J Peek
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Yuriy Stukov
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Gregory M Janelle
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Andrew D Pitkin
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Kevin J Sullivan
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Connie S Nixon
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Dan Neal
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Jeffrey P Jacobs
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
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Skow LF, Sharrett AR, Gottesman RF, Coresh J, Deal JA, Palta P, Sullivan KJ, Griswold ME, Schrack JA, Windham BG. Mid-Life Vascular Risk and Rate of Physical Function Decline Among Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad210. [PMID: 37659100 PMCID: PMC10809050 DOI: 10.1093/gerona/glad210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Physical function and its decline in older age may be connected to treatable vascular risk factors in mid-life. This study aimed to evaluate whether these factors affect the underlying rate of decline. METHODS This prospective cohort included 5 481 older adults aged 67-91 in the Atherosclerosis Risk in Communities Study (mean [standard deviation {SD}] age = 75.8 [5.0], 58% women, 21% Black race) without a history of stroke. The main outcome was the rate of Short Physical Performance Battery (SPPB) decline over a median late-life follow-up of 4.8 years. Primary mid-life (aged 45-64) exposures were Visit 1 hypertension (>140/90 mm Hg or treatment), diabetes (>126 mg/dL or treatment), high cholesterol (>240 mg/dL or treatment), and smoking, and number of decades of vascular risk exposure across Visits 1-4. RESULTS The average adjusted rate of SPPB decline (points per 5 years) for older adults was -0.79 (confidence interval [CI]: -0.87, 0.71) and was accelerated by mid-life hypertension (+57% decline vs normotension: additional decline of -0.47, 95% CI: -0.64, -0.30), diabetes (+73% decline vs no diabetes: additional decline of -0.67, 95% CI: -1.09, -0.24), elevated systolic blood pressure (+17% decline per SD: -0.16, 95% CI: -0.23, -0.10), and elevated fasting blood glucose (+16% decline per SD: -0.015, 95% CI: -0.24, -0.06). Each decade greater mid-life exposure to hypertension (+32% decline: -0.93, 95% CI: -1.25, -0.61) and diabetes (+35% decline: -1.03, 95% CI: -1.68, -0.38) was associated with faster SPPB decline. CONCLUSIONS Mid-life control of blood pressure and diabetes may offset aging-related functional decline.
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Affiliation(s)
- Laura F Skow
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Priya Palta
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin J Sullivan
- Memory Impairment and Neurodegenerative Dementia (MIND) Center, Department of Medicine, Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael E Griswold
- Memory Impairment and Neurodegenerative Dementia (MIND) Center, Department of Medicine, Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - B Gwen Windham
- Memory Impairment and Neurodegenerative Dementia (MIND) Center, Department of Medicine, Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Ma Y, Zhang Y, Coresh J, Viswanathan A, Sullivan KJ, Walker KA, Liu C, Lipsitz LA, Selvin E, Sharrett AR, Gottesman RF, Blacker D, Hofman A, Windham BG, Juraschek SP. Orthostatic Blood Pressure Change, Dizziness, and Risk of Dementia in the ARIC Study. Hypertension 2024; 81:96-106. [PMID: 37869909 PMCID: PMC10843561 DOI: 10.1161/hypertensionaha.123.21438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/14/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Abnormal orthostatic blood pressure (BP) regulation may result in cerebral hypoperfusion and brain ischemia and contribute to dementia. It may also manifest as early symptoms of the neurodegenerative process associated with dementia. The relationship between the magnitude and timing of orthostatic BP responses and dementia risk is not fully understood. METHODS We conducted a prospective cohort analysis of the associations of orthostatic BP changes and self-reported orthostatic dizziness with the risk of dementia in the Atherosclerosis Risk in Communities study (ARIC). We calculated changes in BP from the supine to the standing position at 5 measurements taken within 2 minutes after standing during the baseline visit (1987-1989). The primary outcome was adjudicated dementia ascertained through 2019. RESULTS Among 11 644 participants (mean [SD] age, 54.5 [5.7] years; 54.1% women; 25.9% Black), 2303 dementia cases were identified during a median follow-up of 25.9 years. Large decreases in systolic BP from the supine to standing position measured at the first 2 measurements ≈30 and 50 seconds after standing, but not afterward, were associated with orthostatic dizziness and a higher risk of dementia. Comparing a decrease in systolic BP of ≤-20 or >-20 to -10 mm Hg to stable systolic BP (>-10 to 10 mm Hg) at the first measurement, the adjusted hazard ratios were 1.22 (95% CI, 1.01-1.47) and 1.10 (95% CI, 0.97-1.25), respectively. CONCLUSIONS Abnormal orthostatic BP regulation, especially abrupt drops in BP within the first minute, might be early risk markers for the development of dementia. Transient early orthostatic hypotension warrants more attention in clinical settings.
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Affiliation(s)
- Yuan Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Yiwen Zhang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Josef Coresh
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, USA
| | - Kevin J. Sullivan
- Memory Impairment and Neurogenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS USA
| | - Keenan A. Walker
- Intramural Research Program of the National Institute on Aging, NIH, Baltimore, Maryland, USA
| | - Chelsea Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Lewis A. Lipsitz
- Beth Israel Deaconess Medical Center, Harvard Medical School, and Hebrew Senior Life Hinda and Arthur Marcus Institute for Aging Research, Boston, USA
| | - Elizabeth Selvin
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A. Richey Sharrett
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
| | - Deborah Blacker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - B. Gwen Windham
- Memory Impairment and Neurogenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS USA
| | - Stephen P Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Wang Y, Sharrett AR, Schneider ALC, Knopman D, Hu J, Gottesman R, Sullivan KJ, Coresh J. Timing of Cognitive Test Score Decline Prior to Incident Dementia Diagnosis in Blacks and Whites: The Atherosclerosis Risk in Communities Neurocognitive Study. Neuroepidemiology 2023; 58:23-30. [PMID: 37918374 PMCID: PMC10910615 DOI: 10.1159/000533851] [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: 03/14/2023] [Accepted: 08/10/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Commonly occurring dementias include those of Alzheimer's, vascular, and mixtures of these and other pathologies. They are believed to evolve over many years, but that time interval has been difficult to establish. Our objective was to determine how many years in advance of a dementia diagnosis cognitive scores begin to change. METHODS 14,086 dementia-free ARIC participants underwent a cognitive exam at baseline visit 2 (1990-1992, mean age 57 ± 5.72), and 11,244 at visit 4 (1996-1998), 5,640 at visit 5 (2011-2013), and 3,574 at visit 6 (2016-2017) with surveillance for dementias of all-causes combined. Within 5-year intervals after each visit, we compared performance on the Delayed Word Recall Test (DWRT), the Digit Symbol Substitution Test (DSST), the Word Fluency Test (WFT), and the combined mean of three cognitive tests at baseline in participants who were diagnosed with dementia within each interval versus those who survived the interval without a dementia diagnosis. Z-scores were adjusted for demographics and education in separate regression models for each visit. We plotted adjusted z-score means by time interval following each visit. RESULTS During follow-up 3,334, 2,821, 1,218, and 329 dementia cases were ascertained after visits 2, 4, 5, and 6, respectively. Adjusted DWRT z-scores were significantly lower 20-25 years before dementia than those who did not experience dementia within 25 years. DSST z-scores were significantly lower at 25-30 years and 3-test combination z-scores were significantly lower as early as 30-31 years before onset. The difference between dementia and non-dementia group in the visit 2 3-test combination z-score was -0.20 at 30-31 years prior to dementia diagnosis. As expected, differences between the dementia and non-dementia groups increased closer to the time of dementia occurrence, up to their widest point at 0-5 years prior to dementia diagnosis. The difference between dementia and non-dementia groups in the visit 2 3-test combination z-score at 0-5 years was -0.90. WFT z-score differences were smaller than for the DSST or DWRT and began later. Patterns were similar in Black and White participants. CONCLUSION DWRT, DSST, and combined 3-test z-scores were significantly lower more than 20 years prior to diagnosis in the dementia group versus the non-dementia group. Findings contribute to our knowledge of the long prodromal period in Blacks and Whites.
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Affiliation(s)
- Yunzhi Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea L C Schneider
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jiaqi Hu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
| | - Kevin J Sullivan
- Department of Medicine, The MIND Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Bleiweis MS, Philip J, Stukov Y, Peek GJ, Janelle GM, Pitkin AD, Sullivan KJ, Fudge JC, Vyas HV, Hernandez-Rivera JF, Neal D, Sharaf OM, Jacobs JP. Outcomes of Children Supported With Pulsatile Paracorporeal Ventricular Assist Device: Congenital Versus Acquired Heart Disease. World J Pediatr Congenit Heart Surg 2023; 14:708-715. [PMID: 37609822 DOI: 10.1177/21501351231181105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND We reviewed the outcomes of 82 consecutive pediatric patients (less than 18 years of age) supported with the Berlin Heart ventricular assist device (VAD), comparing those with congenital heart disease (CHD; n = 44) with those with acquired heart disease (AHD; n = 37). METHODS The primary outcome was mortality after VAD insertion. Kaplan-Meier methods and log-rank tests were used to assess group differences in long-term survival. RESULTS Forty-four CHD patients were supported (age: median = 65 days, range = 4 days-13.3 years; weight [kg]: median = 4, range = 2.4-42.3). Ten biventricular CHD patients were supported with eight biventricular assist devices (BiVADs), one left ventricular assist device (LVAD) only, and one LVAD converted to BiVAD, while 34 univentricular CHD patients were supported with single ventricle-ventricular assist devices (sVADs). In CHD patients, duration of VAD support was [days]: median = 134, range = 4-554. Of 44 CHD patients, 28 underwent heart transplantation, 15 died on VAD, and one was still on VAD. Thirty-seven AHD patients were supported (age: median = 1.9 years, range = 27 days-17.7 years; weight [kg]: median = 11, range = 3.1-112), including 34 BiVAD and 3 LVAD. In AHD patients, duration of VAD support was [days]: median = 97, range = 4-315. Of 37 AHD patients, 28 underwent transplantation, three died on VAD, five weaned off VAD (one of whom underwent heart transplantation 334 days after weaning), and one was still on VAD. One-year survival after VAD insertion was 59.9% (95% CI = 46.7%-76.7%) in CHD and 88.6% (95% CI = 78.8%-99.8%) in AHD, P = .0004. Five-year survival after VAD insertion was 55.4% (95% CI = 40.8%-75.2%) in CHD and 85.3% (95% CI = 74.0%-98.2%) in AHD, P = .002. CONCLUSIONS Pulsatile VAD facilitates bridge-to-transplantation in neonates, infants, and children with CHD; however, survival after VAD insertion is worse in patients with CHD than in patients with AHD.
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Affiliation(s)
- Mark S Bleiweis
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Joseph Philip
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Yuriy Stukov
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Giles J Peek
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Gregory M Janelle
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Andrew D Pitkin
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Kevin J Sullivan
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - James C Fudge
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Himesh V Vyas
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Jose F Hernandez-Rivera
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Dan Neal
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Omar M Sharaf
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Jeffrey P Jacobs
- Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA
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Shrestha S, Zhu X, London SJ, Sullivan KJ, Lutsey PL, Windham BG, Griswold ME, Mosley TH. Association of Lung Function With Cognitive Decline and Incident Dementia in the Atherosclerosis Risk in Communities Study. Am J Epidemiol 2023; 192:1637-1646. [PMID: 37392093 DOI: 10.1093/aje/kwad140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023] Open
Abstract
We examined the associations between lung function and incident dementia and cognitive decline in 12,688 participants in the ARIC Study who provided lung function measurements in 1990-1992. Cognitive tests were administered up to 7 times, and dementia was ascertained through 2019. We used shared parameter models to jointly fit proportional hazard models and linear mixed-effect models to estimate lung-function-associated dementia rate and cognitive change, respectively. Higher forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were associated with reduced dementia (n = 2,452 persons developed dementia); hazard ratios per 1-L increase in FEV1 and FVC were 0.79 (95% confidence interval (CI): 0.71, 0.89) and 0.81 (95% CI: 0.74, 0.89), respectively. Each 1-L increase in FEV1 and FVC was associated with a 0.08-standard deviation (SD) (95% CI: 0.05, 0.12) and a 0.05-SD (95% CI: 0.02, 0.07) attenuation of 30-year cognitive decline, respectively. A 1% increase in FEV1/FVC ratio was associated with 0.008-SD (95% CI: 0.004, 0.012) less cognitive decline. We observed statistical interaction between FEV1 and FVC, suggesting that cognitive declines depended on values of specific FEV1 and FVC (as compared with FEV1, FVC, or FEV1/FVC ratio models that suggested linear incremental associations). Our findings may have important implications for reducing the burden of cognitive decline that is attributable to environmental exposures and associated lung function impairment.
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Johnson EL, Sullivan KJ, Schneider ALC, Simino J, Mosley TH, Kucharska-Newton A, Knopman DS, Gottesman RF. Association of Plasma Aβ 42/Aβ 40 Ratio and Late-Onset Epilepsy: Results From the Atherosclerosis Risk in Communities Study. Neurology 2023; 101:e1319-e1327. [PMID: 37541842 PMCID: PMC10558158 DOI: 10.1212/wnl.0000000000207635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/30/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to determine the relationship between plasma β-amyloid (Aβ), specifically the ratio of 2 Aβ peptides (the Aβ42/Aβ40 ratio, which correlates with increased accumulation of Aβ in the CNS), and late-onset epilepsy (LOE). METHODS We used Medicare fee-for-service claims codes from 1991 to 2018 to identify cases of LOE among 1,424 Black and White men and women enrolled in the Atherosclerosis Risk in Communities (ARIC) study cohort. The Aβ42/Aβ40 ratio was calculated from plasma samples collected from ARIC participants in 1993-1995 (age 50-71 years) and 2011-2013 (age 67-90 years). We used survival analysis accounting for the competing risk of death to determine the relationship between late-life plasma Aβ42/Aβ40, and its change from midlife to late life, and the subsequent development of epilepsy. We adjusted for demographics, the apolipoprotein e4 genotype, and comorbidities, including stroke, dementia, and head injury. A low plasma ratio of 2 Aβ peptides, the Aβ42/Aβ40 ratio, correlates with low CSF Aβ42/Aβ40 and with increased accumulation of Aβ in the CNS. RESULTS Decrease in plasma Aβ42/Aβ40 ratio from midlife to late life, but not an isolated measurement of Aβ42/Aβ40, was associated with development of epilepsy in later life. For every 50% reduction in Aβ42/Aβ40, there was a 2-fold increase in risk of epilepsy (adjusted subhazard ratio 2.30, 95% CI 1.27-4.17). DISCUSSION A reduction in plasma Aβ42/Aβ40 is associated with an increased risk of subsequent epilepsy. Our observations provide a further validation of the link between Aβ, hyperexcitable states, and LOE.
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Affiliation(s)
- Emily L Johnson
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD.
| | - Kevin J Sullivan
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
| | - Andrea Lauren Christman Schneider
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
| | - Jeannette Simino
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
| | - Tom H Mosley
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
| | - Anna Kucharska-Newton
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
| | - David S Knopman
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
| | - Rebecca F Gottesman
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
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Shrestha S, Zhu X, Sullivan KJ, Blackshear C, Deal JA, Sharrett AR, Kamath V, Schneider ALC, Jack CR, Huang J, Palta P, Reid RI, Knopman DS, Gottesman RF, Chen H, Windham BG, Griswold ME, Mosley TH. Association of Olfaction and Microstructural Integrity of Brain Tissue in Community-Dwelling Adults: Atherosclerosis Risk in Communities Neurocognitive Study. Neurology 2023; 101:e1328-e1340. [PMID: 37541841 PMCID: PMC10558165 DOI: 10.1212/wnl.0000000000207636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/30/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Research on olfaction and brain neuropathology may help understand brain regions associated with normal olfaction and dementia pathophysiology. To identify early regional brain structures affected in poor olfaction, we examined cross-sectional associations of microstructural integrity of the brain with olfaction in the Atherosclerosis Risk in Communities Neurocognitive Study. METHODS Participants were selected from a prospective cohort study of community-dwelling adults; selection criteria included the following: evidence of cognitive impairment, participation in a previous MRI study, and a random sample of cognitively normal participants. Microstructural integrity was measured by 2 diffusion tensor imaging (DTI) measures, fractional anisotropy (FA) and mean diffusivity (MD), and olfaction by a 12-item odor identification test at the same visit. Higher FA and MD values indicate better and worse microstructural integrity, respectively, and higher odor identification scores indicate better olfaction. We used brain region-specific linear regression models to examine associations between DTI measures and olfaction, adjusting for potential confounders. RESULTS Among 1,418 participants (mean age 76 ± 5 years, 41% male, 21% Black race, 59% with normal cognition), the mean olfaction score was 9 ± 2.3. Relevant to olfaction, higher MD in the medial temporal lobe (MTL) regions, namely the hippocampus (β -0.79 [95% CI -0.94 to -0.65] units lower olfaction score per 1 SD higher MD), amygdala, entorhinal area, and some white matter (WM) tracts connecting to these regions, was associated with olfaction. We also observed associations with MD and WM FA in multiple atlas regions that were not previously implicated in olfaction. The associations between MD and olfaction were particularly stronger in the MTL regions among individuals with mild cognitive impairment (MCI) compared with those with normal cognition (e.g., βhippocampus -0.75 [95% CI -1.02 to -0.49] and -0.44 [95% CI -0.63 to -0.26] for MCI and normal cognition, respectively, p interaction = 0.004). DISCUSSION Neuronal microstructural integrity in multiple brain regions, particularly the MTL (the regions known to be affected in early Alzheimer disease), is associated with odor identification ability. Differential associations in the MTL regions among cognitively normal individuals compared with those with MCI may reflect the earlier vs later effects of the dementia pathogenesis. It is likely that some of the associated regions may not have any functional relevance to olfaction.
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Affiliation(s)
- Srishti Shrestha
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing.
| | - Xiaoqian Zhu
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Kevin J Sullivan
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Chad Blackshear
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Jennifer A Deal
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - A Richey Sharrett
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Vidyulata Kamath
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Andrea L C Schneider
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Clifford R Jack
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Juebin Huang
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Priya Palta
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Robert I Reid
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - David S Knopman
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Rebecca F Gottesman
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Honglei Chen
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - B Gwen Windham
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Michael E Griswold
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Thomas H Mosley
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
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10
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Shrestha S, Zhu X, Kamath V, Sullivan KJ, Deal JA, Sharrett AR, Schneider ALC, Palta P, Gottesman RF, Windham BG, Mosley TH, Griswold ME, Chen H. Factors Associated with Poor Olfaction and Olfactory Decline in Older Adults in the ARIC Neurocognitive Study. Nutrients 2023; 15:3641. [PMID: 37630831 PMCID: PMC10459162 DOI: 10.3390/nu15163641] [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: 07/17/2023] [Revised: 08/13/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Olfactory function has significant implications for human health, but few risk factors for olfactory decline have been identified. We examined the factors associated with olfactory status and decline over five years in the Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study. A 12-item odor identification test was used to assess olfaction in 6053 participants in 2011-2013 (ARIC visit 5, mean age: 75.6, 41% male, 23% Black race) and in 3235 participants in 2016-2017 (visit 6). We used Poisson regression models to examine cross-sectional associations of a range of potential factors with the total odor identification errors (mean errors: 2.8 ± 2.4) in visit 5 participants. We used mixed-effect Poisson regression to examine associations with olfactory decline between visits 5 and 6. We also examined associations with visit 5 anosmia prevalence (847 cases, 14%) and incident anosmia between the two visits (510 cases, 16%) using Poisson models. Older age, male sex, lower education, Black race, APOE ε4 alleles, and diabetes were associated with higher odor identification errors and higher anosmia prevalence, and greater physical activity and hypertension with better olfaction. Age, male sex, lower education, Black race, APOE ε4 allele, and vitamin B12 levels were associated with incident anosmia over 5 years. Older age was associated with faster olfactory decline. Future studies with longer follow-ups are warranted.
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Affiliation(s)
- Srishti Shrestha
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Xiaoqian Zhu
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Kevin J. Sullivan
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Andrea L. C. Schneider
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Priya Palta
- Department of Neurology, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD 20892, USA
| | - B. Gwen Windham
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Thomas H. Mosley
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Michael E. Griswold
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA
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11
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Walker KA, Chen J, Shi L, Yang Y, Fornage M, Zhou L, Schlosser P, Surapaneni A, Grams ME, Duggan MR, Peng Z, Gomez GT, Tin A, Hoogeveen RC, Sullivan KJ, Ganz P, Lindbohm JV, Kivimaki M, Nevado-Holgado AJ, Buckley N, Gottesman RF, Mosley TH, Boerwinkle E, Ballantyne CM, Coresh J. Proteomics analysis of plasma from middle-aged adults identifies protein markers of dementia risk in later life. Sci Transl Med 2023; 15:eadf5681. [PMID: 37467317 PMCID: PMC10665113 DOI: 10.1126/scitranslmed.adf5681] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
A diverse set of biological processes have been implicated in the pathophysiology of Alzheimer's disease (AD) and related dementias. However, there is limited understanding of the peripheral biological mechanisms relevant in the earliest phases of the disease. Here, we used a large-scale proteomics platform to examine the association of 4877 plasma proteins with 25-year dementia risk in 10,981 middle-aged adults. We found 32 dementia-associated plasma proteins that were involved in proteostasis, immunity, synaptic function, and extracellular matrix organization. We then replicated the association between 15 of these proteins and clinically relevant neurocognitive outcomes in two independent cohorts. We demonstrated that 12 of these 32 dementia-associated proteins were associated with cerebrospinal fluid (CSF) biomarkers of AD, neurodegeneration, or neuroinflammation. We found that eight of these candidate protein markers were abnormally expressed in human postmortem brain tissue from patients with AD, although some of the proteins that were most strongly associated with dementia risk, such as GDF15, were not detected in these brain tissue samples. Using network analyses, we found a protein signature for dementia risk that was characterized by dysregulation of specific immune and proteostasis/autophagy pathways in adults in midlife ~20 years before dementia onset, as well as abnormal coagulation and complement signaling ~10 years before dementia onset. Bidirectional two-sample Mendelian randomization genetically validated nine of our candidate proteins as markers of AD in midlife and inferred causality of SERPINA3 in AD pathogenesis. Last, we prioritized a set of candidate markers for AD and dementia risk prediction in midlife.
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Affiliation(s)
- Keenan A. Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, MD 21224, USA
| | - Jingsha Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21210, USA
| | - Liu Shi
- Novo Nordisk Research Centre Oxford (NNRCO), Oxford OX3 7FZ, UK
| | - Yunju Yang
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School and Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School and Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Linda Zhou
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21210, USA
| | - Pascal Schlosser
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21210, USA
| | - Aditya Surapaneni
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21210, USA
| | - Morgan E. Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21210, USA
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21210, USA
| | - Michael R. Duggan
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, MD 21224, USA
| | - Zhongsheng Peng
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, MD 21224, USA
| | - Gabriela T. Gomez
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21210, USA
| | - Adrienne Tin
- MIND Center and Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Ron C. Hoogeveen
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kevin J. Sullivan
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Peter Ganz
- Department of Medicine, University of California-San Francisco, San Francisco, CA 94115, USA
| | - Joni V. Lindbohm
- Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA 02142, USA
| | - Mika Kivimaki
- Department of Mental Health of Older People, Faculty of Brain Sciences, University College London, London WC1E 6BT, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki 00100, Finland
| | | | - Noel Buckley
- Department of Psychiatry, University of Oxford, Oxford OX1 2JD, UK
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke, Intramural Research Program, Bethesda, MD 20892, USA
| | - Thomas H. Mosley
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Christie M. Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21210, USA
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12
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Bleiweis MS, Philip J, Peek GJ, Stukov Y, Janelle GM, Pitkin AD, Sullivan KJ, Nixon CS, Sharaf OM, Neal D, Jacobs JP. A Single-Institutional Experience with 36 Children Smaller Than 5 Kilograms Supported with the Berlin Heart Ventricular Assist Device (VAD) over 12 Years: Comparison of Patients with Biventricular versus Functionally Univentricular Circulation. World J Pediatr Congenit Heart Surg 2023; 14:117-124. [PMID: 36798022 DOI: 10.1177/21501351221146150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVES We reviewed outcomes in all 36 consecutive children <5 kg supported with the Berlin Heart pulsatile ventricular assist device (VAD) at the University of Florida, comparing those with univentricular circulation (n = 23) to those with biventricular circulation (n = 13). METHODS The primary outcome was mortality. Kaplan-Meier methods and log-rank tests were used to assess group differences in long-term survival after VAD insertion. T-tests using estimated survival proportions and standard errors were used to compare groups at specific time points. RESULTS Of all 82 patients ever supported with Berlin Heart at our institution, 49 (49/82 = 59.76%) weighed <10 kg and 36 (36/82 = 43.90%) weighed <5 kg. Of these 36 patients who weighed <5 kg, 26 (26/36 = 72.22%) were successfully bridged to transplantation. Of these 36 patients who weighed <5 kg, 13 (13/36 = 36.1%) had biventricular circulation and were supported with 12 biventricular assist devices (BiVADs) and 1 left ventricular assist device (LVAD) (Age [days]: median = 67, range = 17-212; Weight [kilograms]: median = 4.1, range = 3.1-4.9), while 23 (23/36 = 63.9%) had univentricular circulation and were supported with 23 single ventricle-ventricular assist devices (sVADs) (Age [days]: median = 25, range = 4-215; Weight [kilograms]: median = 3.4, range = 2.4-4.9). Of 13 biventricular patients who weighed <5 kg, 12 (12/23 = 92.3%) were successfully bridged to cardiac transplantation. Of 23 functionally univentricular patients who weighed <5 kg, 14 (14/23 = 60.87%) were successfully bridged to cardiac transplantation. For all 36 patients who weighed <5 kg: 1-year survival estimate after VAD insertion = 62.7% (95% confidence interval [CI] = 48.5%-81.2%) and 5-year survival estimate after VAD insertion = 58.5% (95% CI = 43.8%-78.3%). One-year survival after VAD insertion: 84.6% (95% CI = 67.1%-99.9%) in biventricular patients and 49.7% (95% CI = 32.3%-76.4%) in univentricular patients, P = 0.018. Three-year survival after VAD insertion: 84.6% (95% CI = 67.1%-99.9%) in biventricular patients and 41.4% (95% CI = 23.6%-72.5%) in univentricular patients, P = 0.005. CONCLUSION Pulsatile VAD facilitates bridge to transplantation in neonates and infants weighing <5 kg; however, survival after VAD insertion in these small patients is less in those with univentricular circulation in comparison to those with biventricular circulation.
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Affiliation(s)
- Mark S Bleiweis
- Congenital Heart Center, Departments of Surgery and Pediatrics, 3463University of Florida, Gainesville, FL, USA
| | - Joseph Philip
- Congenital Heart Center, Departments of Surgery and Pediatrics, 3463University of Florida, Gainesville, FL, USA
| | - Giles J Peek
- Congenital Heart Center, Departments of Surgery and Pediatrics, 3463University of Florida, Gainesville, FL, USA
| | - Yuriy Stukov
- Congenital Heart Center, Departments of Surgery and Pediatrics, 3463University of Florida, Gainesville, FL, USA
| | - Gregory M Janelle
- Congenital Heart Center, Departments of Surgery and Pediatrics, 3463University of Florida, Gainesville, FL, USA
| | - Andrew D Pitkin
- Congenital Heart Center, Departments of Surgery and Pediatrics, 3463University of Florida, Gainesville, FL, USA
| | - Kevin J Sullivan
- Congenital Heart Center, Departments of Surgery and Pediatrics, 3463University of Florida, Gainesville, FL, USA
| | - Connie S Nixon
- Congenital Heart Center, Departments of Surgery and Pediatrics, 3463University of Florida, Gainesville, FL, USA
| | - Omar M Sharaf
- Congenital Heart Center, Departments of Surgery and Pediatrics, 3463University of Florida, Gainesville, FL, USA
| | - Dan Neal
- Congenital Heart Center, Departments of Surgery and Pediatrics, 3463University of Florida, Gainesville, FL, USA
| | - Jeffrey P Jacobs
- Congenital Heart Center, Departments of Surgery and Pediatrics, 3463University of Florida, Gainesville, FL, USA
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13
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Full KM, Pusalavidyasagar S, Palta P, Sullivan KJ, Shin JI, Gottesman RF, Spira AP, Pase MP, Lutsey PL. Associations of Late-Life Sleep Medication Use With Incident Dementia in the Atherosclerosis Risk in Communities Study. J Gerontol A Biol Sci Med Sci 2023; 78:438-446. [PMID: 35421897 PMCID: PMC9977227 DOI: 10.1093/gerona/glac088] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sleep medications may contribute to dementia development or indicate sleep disturbances that are markers of or contributors to neurologic disease. The objective of this study was to examine the use of sleep medications and incident dementia in a community-based cohort of older adults. We hypothesize late-life sleep medication use is associated with a greater risk of dementia. METHODS The Atherosclerosis Risk in Communities (ARIC) study is an ongoing community-based cohort study. ARIC participants taking barbiturates, benzodiazepines, antidepressants, non-benzodiazepine receptor agonists (Z-drugs), or other hypnotics in 2011-2013 were categorized as sleep medication users. Participants were followed through 2019 for incident dementia. Logistic regression propensity scores were used to match sleep medication users with nonusers (1:2). Cox proportional hazards regression models were used to estimate hazard ratios (HR) for time to dementia diagnosis with adjustment for demographics, lifestyle characteristics, and cardiovascular risk factors. RESULTS One-quarter of the eligible ARIC participants used sleep medications. In the matched sample (N = 4 197; 69% female; mean age 75.3 + 5.0 years), 632 dementia cases were ascertained over a median follow-up of 6.5 years. In the fully adjusted model, sleep medication use compared to nonuse was associated with a 48% greater risk of dementia (HR: 1.48; 95% confidence interval (CI): 1.26-1.74). CONCLUSION To expand on these findings, studies with longer follow-up and earlier assessment of sleep medication use are needed. Furthermore investigation of the potential dose-response association of multiple sleep medications and the potential causal role of sleep medications in the development of dementia may be clinically meaningful.
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Affiliation(s)
- Kelsie M Full
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Snigdha Pusalavidyasagar
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Priya Palta
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kevin J Sullivan
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jung-Im Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,USA
| | - Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
| | - Adam P Spira
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Center on Aging and Health, Baltimore, Maryland,USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Matthew P Pase
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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14
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Windham BG, Griswold ME, Ranadive R, Sullivan KJ, Mosley TH, Mielke MM, Jack CR, Knopman D, Petersen R, Vemuri P. Relationships of Cerebral Perfusion With Gait Speed Across Systolic Blood Pressure Levels and Age: A Cohort Study. J Gerontol A Biol Sci Med Sci 2023; 78:514-520. [PMID: 35640170 PMCID: PMC9977228 DOI: 10.1093/gerona/glac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study aimed to examine if the association of cerebral perfusion with gait speed differs across systolic blood pressure (SBP) and age. METHODS Cerebral perfusion was measured via arterial spin labeled (ASL)-MRI among community-dwelling adults aged 31-94 years in the population-based Mayo Clinic Study of Aging. Usual gait speed was assessed over 5.6 meters on an electronic mat. Sex- and body mass index (BMI)-adjusted linear regression models estimated cross-sectional gait speed associations with ASL and modifying effects of age and SBP using 3-way and 2-way interaction terms between continuous age, SBP, and ASL. Results report estimated differences in gait speed per standard deviation (SD) lower ASL for exemplar SBPs and ages. RESULTS Among 479 participants (mean age 67.6 years; 44% women; mean gait speed 1.17 m/s), ASL relations to gait speed varied by age (ASL-x-age interaction: p = .001) and SBP (ASL-x-SBP interaction: p = .009). At an SBP of 120 mmHg, each SD lower ASL was associated with a 0.04 m/s (95% confidence interval [CI]: 0.01, 0.07) slower gait speed at 65 years, 0.07 m/s (0.04, 0.10) at 75 years, and 0.09 m/s (0.05, 0.13) at 85 years. At an SBP of 140 mmHg, ASL associations with gait speed were attenuated to 0.01 (-0.01, 0.04), 0.04 (0.02, 0.06), and 0.06 (0.04, 0.09) m/s slower gait speed at ages 65, 75, and 85, respectively. CONCLUSION Poorer cerebral perfusion is associated with clinically meaningful slower gait speeds, particularly with older age, while higher perfusion markedly attenuates age differences in gait speed.
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Affiliation(s)
- B Gwen Windham
- Address correspondence to: B. Gwen Windham, MD, MHS, Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, USA. E-mail:
| | - Michael E Griswold
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Radhikesh Ranadive
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kevin J Sullivan
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Thomas H Mosley
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michelle M Mielke
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dave Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ron Petersen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashanthi Vemuri
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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15
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Bleiweis MS, Philip J, Fudge JC, Vyas HV, Peek GJ, Pitkin AD, Janelle GM, Sullivan KJ, Stukov Y, Nixon CS, Sharaf OM, Neal D, Jacobs JP. Support with Single Ventricle-Ventricular Assist Device (sVAD) in Patients with Functionally Univentricular Circulation Prior to Fontan Operation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 26:26-39. [PMID: 36842796 DOI: 10.1053/j.pcsu.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022]
Abstract
Some patients with functionally univentricular circulation develop cardiac failure refractory to maximal management and are supported with a ventricular assist device (VAD). The purpose of this manuscript is to summarize our previous publications related to single ventricle-ventricular assist device (sVAD) support in patients with functionally univentricular circulation and to describe our current institutional approach at University of Florida to sVAD support in neonates, infants, and children prior to Fontan. Our programmatic philosophy at University of Florida is to strive to identify the minority of neonates with functionally univentricular circulation who are extremely high-risk prior to initiating staged palliation and to stabilize these neonates with primary preemptive sVAD in preparation for cardiac transplantation; our rationale for this approach is related to the challenges associated with failed staged palliation and subsequent bail-out sVAD support and transplantation. A subset of extremely high-risk neonates and infants with functionally univentricular ductal-dependent circulation undergo primary preemptive sVAD insertion and subsequent cardiac transplantation. Support with VAD clearly facilitates survival on the waiting list during prolonged wait times and optimizes outcomes after Norwood (Stage 1) by providing an alternative pathway for extremely high-risk patients. Therefore, the selective utilization of sVAD in extremely high-risk neonates facilitates improved outcomes for all patients with functionally univentricular ductal-dependent circulation. At University of Florida, our programmatic approach to utilizing sVAD support as a bridge to transplantation in the minority of neonates with functionally univentricular circulation who are extremely high-risk for staged palliation is associated with Operative Mortality after Norwood (Stage 1) Operation of 2.9% (2/68) and a one-year survival of 91.1% (82/90) for all neonates presenting with hypoplastic left heart syndrome (HLHS) or HLHS-related malformation with functionally univentricular ductal-dependent systemic circulation. Meanwhile, at University of Florida, for all 82 consecutive neonates, infants, and children supported with pulsatile paracorporeal VAD: Kaplan-Meier survival estimated one year after VAD insertion = 73.3% (95% confidence interval [CI] = 64.1-83.8%), and Kaplan-Meier survival estimated five years after VAD insertion = 68.3% (95% CI = 58.4-79.8%). For all 48 consecutive neonates, infants, and children at University of Florida with biventricular circulation supported with pulsatile paracorporeal VAD: Kaplan-Meier survival estimated one year after VAD insertion = 82.7% (95% CI = 72.4-94.4%), and Kaplan-Meier survival estimated five years after VAD insertion = 79.7% (95% CI = 68.6-92.6%). For all 34 consecutive neonates, infants, and children at University of Florida with functionally univentricular circulation supported with pulsatile paracorporeal sVAD: Kaplan-Meier survival estimated one year after VAD insertion = 59.7% (95% CI = 44.9-79.5%), and Kaplan-Meier survival estimated five years after VAD insertion = 50.5% (95% CI = 35.0-73.0%). These Kaplan-Meier survival estimates for patients supported with pulsatile paracorporeal VAD are better in patients with biventricular circulation in comparison to patients with functionally univentricular circulation both one year after VAD insertion (P=0.026) and five years after VAD insertion (P=0.010). Although outcomes after VAD support in functionally univentricular patients are worse than in patients with biventricular circulation, sVAD provides a reasonable chance for survival. Ongoing research is necessary to improve the outcomes of these challenging patients, with the goal of developing strategies where outcomes after sVAD support in functionally univentricular patients are equivalent to the outcomes achieved after VAD support in patients with biventricular circulation.
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Affiliation(s)
- Mark S Bleiweis
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida.
| | - Joseph Philip
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida
| | - James C Fudge
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida
| | - Himesh V Vyas
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida
| | - Giles J Peek
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida
| | - Andrew D Pitkin
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida
| | - Gregory M Janelle
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida
| | - Kevin J Sullivan
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida
| | - Yuriy Stukov
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida
| | - Connie S Nixon
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida
| | - Omar M Sharaf
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida
| | - Dan Neal
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida
| | - Jeffrey P Jacobs
- Congenital Heart Center, Departments of Anesthesia, Surgery, and Pediatrics, University of Florida, Gainesville, Florida
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Ducca EL, Gomez GT, Palta P, Sullivan KJ, Jack CR, Knopman DS, Gottesman RF, Walston J, Windham BG, Walker KA. Physical Frailty and Brain White Matter Abnormalities: The Atherosclerosis Risk in Communities Study. J Gerontol A Biol Sci Med Sci 2023; 78:357-364. [PMID: 35596270 PMCID: PMC9951053 DOI: 10.1093/gerona/glac111] [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: 01/31/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physical frailty is associated with increased risk for dementia and other neurologic sequelae. However, the neurobiological changes underlying frailty and frailty risk remain unknown. We examined the association of cerebral white matter structure with current and future frailty. METHODS Atherosclerosis Risk in Communities Study Neurocognitive Study participants who underwent 3T brain MRI were included. Frailty status was classified according to the Fried criteria. Cerebral white matter integrity was defined using white matter hyperintensity (WMH) volume and microstructure, measured using diffusion tensor imaging fractional anisotropy (FA) and mean diffusivity (MD). Multivariable linear regression was used to relate baseline frailty to white matter structure; multivariable logistic regression was used to relate baseline white matter to frailty risk among participants nonfrail at baseline. RESULTS In the cross-sectional analysis (N = 1 754; mean age: 76 years), frailty was associated with greater WMH volume, lower FA, and greater MD. These associations remained consistent after excluding participants with a history of stroke or dementia. Among participants nonfrail at baseline who completed follow-up frailty assessment (N = 1 379; 6.6-year follow-up period), each standard deviation increase in WMH volume was associated with 1.46 higher odds of frailty at follow-up. Composite FA and MD measures were not associated with future frailty; however, secondary analyses found several significant white matter tract-specific associations with frailty risk. CONCLUSION The current study demonstrates a robust association of WMH volume with current and future frailty. Although measures of white matter microstructure were altered in frail individuals, these measures were not generally associated with progression from nonfrail to frail status.
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Affiliation(s)
- Emma L Ducca
- Department of Psychology, St. John’s University, Jamaica, New York, USA
| | - Gabriela T Gomez
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Priya Palta
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Kevin J Sullivan
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rebecca F Gottesman
- Stroke Branch, Intramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Center on Aging and Health, and Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - B Gwen Windham
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Keenan A Walker
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
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Sullivan KJ, Griswold ME, Ghelani K, Rajesh A, Shrestha S, Gottesman RF, Knopman D, Mosley TH, Windham BG. Late Midlife Subclinical Infarct Burden and Risk of Dementia: The Atherosclerosis Risk in Communities Neurocognitive Study. J Alzheimers Dis 2023; 91:543-549. [PMID: 36463445 PMCID: PMC10168700 DOI: 10.3233/jad-220746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
At visit 3 (1993-1995) of the ARIC Study, 1.5T brain MRI was completed in 1,881 stroke-free participants (Mean age = 62.9±4.9, 50% Black). Cox regression examined associations between infarct group [infarct-free (referent; n = 1,611), smaller only (<3 mm; n = 50), larger only (≥3 mm but <20 mm; n = 185), both (n = 35)] and up to 25-year incident dementia (n = 539). Participants with both infarcts were over 2.5 times more likely to develop dementia [HR = 2.61; 95% CI = 1.44, 4.72]. Smaller only (HR = 1.22; 95% CI = 0.70, 2.13) and larger only (HR = 1.27; 95% CI = 0.92, 1.74) groups showed associations with wide confidence intervals, unsupported statistically. A late midlife infarct profile including smaller and larger infarcts may represent particular vulnerability to dementia risk.
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Affiliation(s)
- Kevin J Sullivan
- The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS
| | - Michael E Griswold
- The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS
| | - Kunali Ghelani
- The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS
| | - Aishwarya Rajesh
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Srishti Shrestha
- The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD
| | | | - Thomas H Mosley
- The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS
| | - B Gwen Windham
- The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS
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Sedaghat S, Ji Y, Hughes TM, Coresh J, Grams ME, Folsom AR, Sullivan KJ, Murray AM, Gottesman RF, Mosley TH, Lutsey PL. The Association of Kidney Function with Plasma Amyloid-β Levels and Brain Amyloid Deposition. J Alzheimers Dis 2023; 92:229-239. [PMID: 36710673 PMCID: PMC10124796 DOI: 10.3233/jad-220765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Reduced kidney function is related to brain atrophy and higher risk of dementia. It is not known whether kidney impairment is associated with higher levels of circulating amyloid-β and brain amyloid-β deposition, which could contribute to elevated risk of dementia. OBJECTIVE To investigate whether kidney impairment is associated with higher levels of circulating amyloid-β and brain amyloid-β deposition. METHODS This cross-sectional study was performed within the community-based Atherosclerosis Risk in Communities (ARIC) Study cohort. We used estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C levels and urine albumin-to-creatinine ratio (ACR) to assess kidney function. Amyloid positivity was defined as a standardized uptake value ratios > 1.2 measured with florbetapir positron emission tomography (PET) (n = 340). Plasma amyloid-β1 - 40 and amyloid-β1 - 42 were measured using a fluorimetric bead-based immunoassay (n = 2,569). RESULTS Independent of demographic and cardiovascular risk factors, a doubling of ACR was associated with 1.10 (95% CI: 1.01,1.20) higher odds of brain amyloid positivity, but not eGFR (odds ratio per 15 ml/min/1.73 m2 lower eGFR: 1.08; 95% CI: 0.95,1.23). A doubling of ACR was associated with a higher level of plasma amyloid-β1 - 40 (standardized difference: 0.12; 95% CI: 0.09,0.14) and higher plasma amyloid-β1 - 42 (0.08; 95% CI: 0.05,0.10). Lower eGFR was associated with higher plasma amyloid-β1 - 40 (0.36; 95% CI: 0.33,0.39) and higher amyloid-β1 - 42 (0.32; 95% CI: 0.29,0.35). CONCLUSION Low clearance of amyloid-β and elevated brain amyloid positivity may link impaired kidney function with elevated risk of dementia. kidney function should be considered in interpreting amyloid biomarker results in clinical and research setting.
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Affiliation(s)
- Sanaz Sedaghat
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Yuekai Ji
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Timothy M Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Kevin J Sullivan
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Anne M Murray
- Department of Medicine, Geriatrics Division, Hennepin Health Care, and Hennepin Health Care Institute, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, NIH, Bethesda, MD, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Walker KA, Chen J, Shi L, Yang Y, Fornage M, Zhou L, Schlosser P, Surapaneni A, Grams ME, Duggan MR, Peng Z, Gomez G, Tin A, Hoogeveen RC, Sullivan KJ, Ganz P, Lindbohm JV, Kivimaki M, Nevado‐Holgado AJ, Buckley N, Gottesman RF, Mosley TH, Boerwinkle E, Ballantyne CM, Coresh J. Midlife proteome‐wide analysis identifies plasma biomarkers for 25‐year dementia risk linked to diverse pathophysiology. Alzheimers Dement 2022. [DOI: 10.1002/alz.062935] [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)
- Keenan A Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program Baltimore MD USA
| | - Jingsha Chen
- Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Liu Shi
- Department of Psychiatry, University of Oxford Oxford United Kingdom
| | - Yunju Yang
- The University of Texas Health Science Center at Houston Houston TX USA
| | - Myriam Fornage
- The University of Texas Health Science Center at Houston Houston TX USA
| | - Linda Zhou
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Pascal Schlosser
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Aditya Surapaneni
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Morgan E Grams
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of MedicineDivision of Nephrology, Department of Medicine, Johns Hopkins University School of MedicineDivision of Nephrology, Department of Medicine, Johns Hopkins University Baltimore MD USA
| | - Michael R Duggan
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program Baltimore MD USA
| | - Zhongsheng Peng
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program Baltimore MD USA
| | - Gabriela Gomez
- Department of Neurology, Johns Hopkins University School of Medicine Baltimore MD USA
| | - Adrienne Tin
- University of Mississippi Medical Center Jackson MS USA
| | | | | | - Peter Ganz
- UCSF Medical Center San Francisco CA USA
| | - Joni V Lindbohm
- Department of Epidemiology and Public Health, University College London London United Kingdom
| | | | | | - Noel Buckley
- Department of Psychiatry, University of Oxford Oxford United Kingdom
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke, Intramural Research Program Bethesda MD USA
| | - Thomas H Mosley
- MIND Center, University of Mississippi Medical Center Jackson MS USA
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Xie J, Pike JR, Walker KA, Sullivan KJ, Windham BG, Gottesman RF. Association of Spousal Separation and Widowhood with Incident Dementia: The Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study (NCS). Alzheimers Dement 2022. [DOI: 10.1002/alz.062898] [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)
- Jiaxin Xie
- National Institute of Neurological Disorders and Stroke Intramural Research Program Bethesda MD USA
| | | | - Keenan A Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program Baltimore MD USA
| | | | | | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program Bethesda MD USA
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Hu X, Mok Y, Ding N, Sullivan KJ, Lutsey PL, Schrack JA, Palta P, Matsushita K. Physical Function and Subsequent Risk of Cardiovascular Events in Older Adults: The Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2022; 11:e025780. [PMID: 36043511 PMCID: PMC9496416 DOI: 10.1161/jaha.121.025780] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Reduced physical function, a representative phenotype of aging, has been associated with cardiovascular disease (CVD). However, few studies have comprehensively investigated its association with composite and individual CVD outcomes in community‐dwelling older adults and its predictive value for CVD beyond traditional risk factors. Methods and Results We studied 5570 participants (mean age 75 [SD 5] years, female 58%, Black 22%) at visit 5 (2011–2013) of the ARIC (Atherosclerosis Risk in Communities) study. Physical function was evaluated with the Short Physical Performance Battery (SPPB), which incorporates a walk test, chair stands, and balance tests. The SPPB score was modeled categorically (low [0–6], intermediate [7–9], and high [10–12]) and continuously. We assessed the associations of SPPB score with subsequent composite (coronary heart disease, stroke, or heart failure) and individual CVD outcomes (components within composite outcome) using multivariable Cox models adjusting for major CVD risk factors and history of CVD. We also evaluated improvement in C‐statistics by adding SPPB to traditional CVD risk factors in the Pooled Cohort Equation. Among the study participants, 13% had low, 30% intermediate, and 57% high SPPB scores. During a median follow‐up of 7.0 (interquartile interval 5.3–7.8) years, there were 930 composite CVD events (386 coronary heart disease, 251 stroke, and 529 heart failure cases). The hazard ratios of composite CVD in low and intermediate versus high SPPB score were 1.47 (95% CI, 1.20–1.79) and 1.25 (95% CI, 1.07–1.46), respectively, after adjusting for potential confounders. Continuous SPPB score demonstrated independent associations with each CVD outcome. The associations were largely consistent across subgroups (including participants with prevalent CVD at baseline). The addition of SPPB to traditional CVD risk factors significantly improved the C‐statistics of CVD outcomes (eg, ΔC‐statistic 0.019 [95% CI, 0.011–0.027] for composite CVD). Conclusions Reduced physical function was independently associated with the risk of composite and individual CVD outcomes and improved their risk prediction beyond traditional risk factors in community‐dwelling older adults. Although confirmatory studies are needed, our results suggest the potential usefulness of SPPB for classifying CVD risk in older adults.
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Affiliation(s)
- Xiao Hu
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Yejin Mok
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Ning Ding
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Kevin J Sullivan
- Department of Medicine The University of Mississippi Medical Center Jackson MS
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health University of Minnesota School of Public Health Minneapolis MN
| | - Jennifer A Schrack
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Priya Palta
- Department of Medicine Columbia University Medical Center New York NY
| | - Kunihiro Matsushita
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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Tin A, Bressler J, Simino J, Sullivan KJ, Mei H, Windham BG, Griswold M, Gottesman RF, Boerwinkle E, Fornage M, Mosley TH. Genetic Risk, Midlife Life's Simple 7, and Incident Dementia in the Atherosclerosis Risk in Communities Study. Neurology 2022; 99:e154-e163. [PMID: 35613930 PMCID: PMC9280991 DOI: 10.1212/wnl.0000000000200520] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Higher scores in Life's Simple 7 (LS7), a metric for cardiovascular and brain health, have been associated with lower risk of dementia. It is uncertain whether this association holds among those with high genetic risk of dementia. Our objective is to evaluate the extent that LS7 may offset dementia risk across the range of genetic risk. METHODS Participants in the Atherosclerosis Risk in Communities (ARIC) Study were followed from 1987-1989 to 2019. We derived midlife LS7 scores and generated genetic risk scores (GRS) using genome-wide summary statistics of Alzheimer disease, which have been used to study the genetic risk for dementia. Incident dementia was ascertained based on the criteria of the National Institute on Aging-Alzheimer's Association workgroups and Diagnostic and Statistical Manual of Mental Disorders. The associations of the GRS and LS7 with incident dementia were evaluated using Cox regression. RESULTS This study included 8,823 European American (EA) and 2,738 African American (AA) participants (mean age at baseline 54 years). We observed 1,603 cases of dementia among EA participants and 631 among AA participants (median follow-up 26.2 years). Higher GRS were associated with higher risk of dementia (EA, hazard ratio [HR] per SD 1.44, 95% CI 1.37, 1.51; AA, HR 1.26, 95% CI 1.16, 1.36). Among EA participants, higher LS7 scores were consistently associated with lower risk of dementia across quintiles of GRS, including the highest quintile (HR per point 0.91, 95% CI 0.87, 0.96). Among AA participants, the associations between LS7 and incident dementia within stratum of GRS had the same direction as among EA participants, although wide CIs and smaller sample sizes limited reliable inferences. DISCUSSION Across strata of GRS, higher midlife LS7 scores were associated with lower risk of dementia. Larger sample sizes from diverse populations are needed to obtain more reliable estimates of the effects of modifiable health factors on dementia risk within genetic risk strata in each ancestry group.
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Affiliation(s)
- Adrienne Tin
- From the Memory Impairment and Neurodegenerative Dementia (MIND) Center and Department of Medicine (A.T., K.J.S., B.G.W., M.G., T.H.M.) and Department of Data Science (J.S., H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (A.T.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Human Genetics Center, School of Public Health (J.B., E.B., M.F.), and Institute of Molecular Medicine, McGovern Medical School (M.F.), University of Texas Health Science Center at Houston; and Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD.
| | - Jan Bressler
- From the Memory Impairment and Neurodegenerative Dementia (MIND) Center and Department of Medicine (A.T., K.J.S., B.G.W., M.G., T.H.M.) and Department of Data Science (J.S., H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (A.T.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Human Genetics Center, School of Public Health (J.B., E.B., M.F.), and Institute of Molecular Medicine, McGovern Medical School (M.F.), University of Texas Health Science Center at Houston; and Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD
| | - Jeannette Simino
- From the Memory Impairment and Neurodegenerative Dementia (MIND) Center and Department of Medicine (A.T., K.J.S., B.G.W., M.G., T.H.M.) and Department of Data Science (J.S., H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (A.T.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Human Genetics Center, School of Public Health (J.B., E.B., M.F.), and Institute of Molecular Medicine, McGovern Medical School (M.F.), University of Texas Health Science Center at Houston; and Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD
| | - Kevin J Sullivan
- From the Memory Impairment and Neurodegenerative Dementia (MIND) Center and Department of Medicine (A.T., K.J.S., B.G.W., M.G., T.H.M.) and Department of Data Science (J.S., H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (A.T.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Human Genetics Center, School of Public Health (J.B., E.B., M.F.), and Institute of Molecular Medicine, McGovern Medical School (M.F.), University of Texas Health Science Center at Houston; and Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD
| | - Hao Mei
- From the Memory Impairment and Neurodegenerative Dementia (MIND) Center and Department of Medicine (A.T., K.J.S., B.G.W., M.G., T.H.M.) and Department of Data Science (J.S., H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (A.T.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Human Genetics Center, School of Public Health (J.B., E.B., M.F.), and Institute of Molecular Medicine, McGovern Medical School (M.F.), University of Texas Health Science Center at Houston; and Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD
| | - B Gwen Windham
- From the Memory Impairment and Neurodegenerative Dementia (MIND) Center and Department of Medicine (A.T., K.J.S., B.G.W., M.G., T.H.M.) and Department of Data Science (J.S., H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (A.T.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Human Genetics Center, School of Public Health (J.B., E.B., M.F.), and Institute of Molecular Medicine, McGovern Medical School (M.F.), University of Texas Health Science Center at Houston; and Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD
| | - Michael Griswold
- From the Memory Impairment and Neurodegenerative Dementia (MIND) Center and Department of Medicine (A.T., K.J.S., B.G.W., M.G., T.H.M.) and Department of Data Science (J.S., H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (A.T.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Human Genetics Center, School of Public Health (J.B., E.B., M.F.), and Institute of Molecular Medicine, McGovern Medical School (M.F.), University of Texas Health Science Center at Houston; and Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD
| | - Rebecca F Gottesman
- From the Memory Impairment and Neurodegenerative Dementia (MIND) Center and Department of Medicine (A.T., K.J.S., B.G.W., M.G., T.H.M.) and Department of Data Science (J.S., H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (A.T.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Human Genetics Center, School of Public Health (J.B., E.B., M.F.), and Institute of Molecular Medicine, McGovern Medical School (M.F.), University of Texas Health Science Center at Houston; and Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD
| | - Eric Boerwinkle
- From the Memory Impairment and Neurodegenerative Dementia (MIND) Center and Department of Medicine (A.T., K.J.S., B.G.W., M.G., T.H.M.) and Department of Data Science (J.S., H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (A.T.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Human Genetics Center, School of Public Health (J.B., E.B., M.F.), and Institute of Molecular Medicine, McGovern Medical School (M.F.), University of Texas Health Science Center at Houston; and Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD
| | - Myriam Fornage
- From the Memory Impairment and Neurodegenerative Dementia (MIND) Center and Department of Medicine (A.T., K.J.S., B.G.W., M.G., T.H.M.) and Department of Data Science (J.S., H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (A.T.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Human Genetics Center, School of Public Health (J.B., E.B., M.F.), and Institute of Molecular Medicine, McGovern Medical School (M.F.), University of Texas Health Science Center at Houston; and Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD
| | - Thomas H Mosley
- From the Memory Impairment and Neurodegenerative Dementia (MIND) Center and Department of Medicine (A.T., K.J.S., B.G.W., M.G., T.H.M.) and Department of Data Science (J.S., H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (A.T.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Human Genetics Center, School of Public Health (J.B., E.B., M.F.), and Institute of Molecular Medicine, McGovern Medical School (M.F.), University of Texas Health Science Center at Houston; and Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD
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Bleiweis MS, Peek GJ, Philip J, Fudge JC, Sullivan KJ, Co-Vu J, DeGroff C, Vyas HV, Gupta D, Shih R, Pietra BBA, Fricker FJ, Cruz Beltran SC, Arnold MA, Wesley MC, Pitkin AD, Hernandez-Rivera JF, Lopez-Colon D, Barras WE, Stukov Y, Sharaf OM, Neal D, Nixon CS, Jacobs JP. A Comprehensive Approach to the Management of Patients With HLHS and Related Malformations: An Analysis of 83 Patients (2015-2021). World J Pediatr Congenit Heart Surg 2022; 13:664-675. [PMID: 35511494 DOI: 10.1177/21501351221088030] [Citation(s) in RCA: 6] [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] [Indexed: 11/17/2022]
Abstract
Background: Some patients with hypoplastic left heart syndrome (HLHS) and HLHS-related malformations with ductal-dependent systemic circulation are extremely high-risk for Norwood palliation. We report our comprehensive approach to the management of these patients designed to maximize survival and optimize the utilization of donor hearts. Methods: We reviewed our entire current single center experience with 83 neonates and infants with HLHS and HLHS-related malformations (2015-2021). Standard-risk patients (n = 62) underwent initial Norwood (Stage 1) palliation. High-risk patients with risk factors other than major cardiac risk factors (n = 9) underwent initial Hybrid Stage 1 palliation, consisting of application of bilateral pulmonary bands, stent placement in the patent arterial duct, and atrial septectomy if needed. High-risk patients with major cardiac risk factors (n = 9) were bridged to transplantation with initial combined Hybrid Stage 1 palliation and pulsatile ventricular assist device (VAD) insertion (HYBRID + VAD). Three patients were bridged to transplantation with prostaglandin. Results: Overall survival at 1 year = 90.4% (75/83). Operative Mortality for standard-risk patients undergoing initial Norwood (Stage 1) Operation was 2/62 (3.2%). Of 60 survivors: 57 underwent Glenn, 2 underwent biventricular repair, and 1 underwent cardiac transplantation. Operative Mortality for high-risk patients with risk factors other than major cardiac risk factors undergoing initial Hybrid Stage 1 palliation without VAD was 0/9: 4 underwent transplantation, 1 awaits transplantation, 3 underwent Comprehensive Stage 2 (with 1 death), and 1 underwent biventricular repair. Of 9 HYBRID + VAD patients, 6 (67%) underwent successful cardiac transplantation and are alive today and 3 (33%) died while awaiting transplantation on VAD. Median length of VAD support was 134 days (mean = 134, range = 56-226). Conclusion: A comprehensive approach to the management of patients with HLHS or HLHS-related malformations is associated with Operative Mortality after Norwood of 2/62 = 3.2% and a one-year survival of 75/83 = 90.4%. A subset of 9/83 patients (11%) were stabilized with HYBRID + VAD while awaiting transplantation. VAD facilitates survival on the waiting list during prolonged wait times.
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Affiliation(s)
- Mark S Bleiweis
- Department of Surgery, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA.,Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Giles J Peek
- Department of Surgery, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA.,Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Joseph Philip
- Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - James C Fudge
- Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Kevin J Sullivan
- Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA.,Department of Anesthesia, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Jennifer Co-Vu
- Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Curt DeGroff
- Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Himesh V Vyas
- Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Dipankar Gupta
- Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Renata Shih
- Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Biagio Bill A Pietra
- Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Frederick Jay Fricker
- Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Susana C Cruz Beltran
- Department of Anesthesia, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Michael A Arnold
- Department of Anesthesia, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Mark C Wesley
- Department of Anesthesia, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Andrew D Pitkin
- Department of Anesthesia, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Jose F Hernandez-Rivera
- Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Dalia Lopez-Colon
- Department of Surgery, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA.,Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Wendy E Barras
- Department of Surgery, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Yuriy Stukov
- Department of Surgery, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Omar M Sharaf
- Department of Surgery, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA.,Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Dan Neal
- Department of Surgery, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Connie S Nixon
- Department of Surgery, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA.,Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
| | - Jeffrey P Jacobs
- Department of Surgery, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA.,Department of Pediatrics, Congenital Heart Center, 3463University of Florida, Gainesville, FL, USA
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Bleiweis MS, Stukov Y, Philip J, Peek GJ, Pitkin AD, Sullivan KJ, Neal D, Jacobs JP. Analysis of 82 Children Supported with Pulsatile Paracorporeal Ventricular Assist Device: Comparison of Patients with Biventricular versus Univentricular Circulation. Semin Thorac Cardiovasc Surg 2022; 35:367-376. [DOI: 10.1053/j.semtcvs.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/11/2022]
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Wang W, Norby FL, Alonso A, Gottesman RF, Jack CR, Meyer ML, Knopman DS, Sullivan KJ, Hughes TM, Lakshminarayan K, Lutsey PL. Association of Carotid Intima-Media Thickness with Brain MRI Markers in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). J Stroke Cerebrovasc Dis 2022; 31:106388. [PMID: 35193028 PMCID: PMC9018472 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106388] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Elevated carotid intima-media thickness (cIMT) and carotid plaque are markers of arterial injury and may be linked to structural brain injury. We hypothesized cIMT or presence of carotid plaque at midlife are associated with presence of infarcts and cerebral microbleeds, greater white matter hyperintensity (WMH) volume, and smaller regional brain volumes in late-life. METHODS We included 1,795 Atherosclerosis Risk in Communities (ARIC) Study participants (aged 57±6 years, 57% female, 23% Black) with carotid ultrasounds in 1990-1992 and brain MRI scans in 2011-2013. Weighted linear regression was used for brain volume outcomes, while logistic regression was used for infarcts and cerebral microbleeds. RESULTS After multivariable adjustments, the highest cIMT quintile was associated with smaller deep gray matter (β [95% CI]: -0.11 [-0.22, -0.01]) and cortical volume in a temporal-parietal meta region of interest (ROI) (β [95% CI]: -0.10 [-0.20, -0.01]) in late-life. Similarly, those with carotid plaque had smaller regional brain volumes than those without (βs [95% CIs]: -0.05 [-0.12, 0.03] and -0.06 [-0.13, 0.01] for deep gray matter and temporal-parietal meta ROI). No significant relations were observed with WMH volume, infarcts, or cerebral microbleeds. CONCLUSION Over a median follow-up of 21 years, greater midlife cIMT and presence of carotid plaque were associated with smaller deep gray matter volume and cortical volume in a meta ROI involving temporal and parietal lobe regions typically involved in neurodegeneration, including Alzheimer's disease, in later life. Contrary to our hypothesis, associations between measures of arterial injury and markers of vascular brain injury were null.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States.
| | - Faye L Norby
- Center for Cardiac Arrest Prevention, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, United States.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States.
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States.
| | | | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States.
| | - Kevin J Sullivan
- Department of Medicine: The MIND Center, University of Mississippi Medical Center, Jackson, Mississippi, United States.
| | - Timothy M Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States.
| | | | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States.
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Gomez GT, Gottesman RF, Gabriel KP, Palta P, Gross AL, Soldan A, Albert MS, Sullivan KJ, Jack CR, Knopman DS, Windham BG, Walker KA. The association of motoric cognitive risk with incident dementia and neuroimaging characteristics: The Atherosclerosis Risk in Communities Study. Alzheimers Dement 2022; 18:434-444. [PMID: 34786837 PMCID: PMC10064850 DOI: 10.1002/alz.12412] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/05/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Motoric cognitive risk (MCR), a clinical syndrome characterized by slow gait speed and subjective cognitive complaints, has been associated with dementia risk. The neuropathological features underlying MCR remain poorly understood. METHODS The Atherosclerosis Risk in Communities (ARIC) community-based cohort study classified participants using standardized criteria as MCR+/- and mild cognitive impairment (MCI)+/- at study baseline (2011-2013). We examined the 5-year dementia risk and baseline brain structural/molecular abnormalities associated with MCR+ and MCI+ status. RESULTS Of 5023 nondemented participants included, 204 were MCR+ and 1030 were MCI+. Both MCR+ and MCI+ participants demonstrated increased dementia risk. The pattern of structural brain abnormalities associated with MCR+ differed from that of MCI+. Whereas MCI+ was associated with comparatively smaller volumes in brain regions vulnerable to Alzheimer's disease pathology, MCR+ status was associated with smaller volumes in frontoparietal regions and greater white matter abnormalities. DISCUSSION MCR may represent a predementia syndrome characterized by prominent white matter abnormalities and frontoparietal atrophy.
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Affiliation(s)
- Gabriela T. Gomez
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F. Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Priya Palta
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anja Soldan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kevin J. Sullivan
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS
| | | | | | - B. Gwen Windham
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS
| | - Keenan A. Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, MD
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Windham BG, Parker SB, Zhu X, Gabriel KP, Palta P, Sullivan KJ, Parker KG, Knopman DS, Gottesman RF, Griswold ME, Mosley TH. Endurance and gait speed relationships with mild cognitive impairment and dementia. Alzheimers Dement (Amst) 2022; 14:e12281. [PMID: 35155735 PMCID: PMC8828991 DOI: 10.1002/dad2.12281] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/09/2021] [Accepted: 12/08/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Slower mobility is associated with mild cognitive impairment (MCI) and dementia. We examined the interaction of endurance with gait speed on prevalent MCI and dementia. METHODS Cross-sectional multinomial regression in the ARIC cohort (n = 2844 participants; 71 to 94 years; 44% men; 18% Black persons) with cognitive status (normal/MCI/dementia), 4 m gait speed, and endurance (2 minute walk [2MW]). RESULTS Faster gait speed (up to but not above 1 m/s) and better 2MW were separately associated with lower dementia risk. Good performance in both (2MW = 200 m, gait speed = 1.2 m/s) was associated with 99% lower dementia (Relative Prevalence Ratio [RPR] = 0.01 [95% CI: 0.0 to 0.06]) and 73% lower MCI, RPR = 0.27 (0.15 to 0.48) compared to poor performance in both (2MW = 100 m, gait speed = 0.8 m/s). Models incorporating a gait speed-by-2MW interaction term outperformed gait speed-only models (P < .001). DISCUSSION Gait speed relationships with dementia diminish at faster gait speeds. Combining endurance with gait speed may yield more sensitive markers of MCI and dementia than gait speed alone.
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Affiliation(s)
| | - Sara B. Parker
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Xiaoqian Zhu
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Kelley Pettee Gabriel
- Department of EpidemiologyThe University of Alabama at BirminghamBirminghamAlabamaUSA
| | - Priya Palta
- Department of General MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Kevin J. Sullivan
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Kirby G. Parker
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | | | - Rebecca F. Gottesman
- Stroke BranchNational Institute of Neurological Disorders and Stroke Intramural Research ProgramBethesdaMarylandUSA
| | - Michael E. Griswold
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Thomas H. Mosley
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
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28
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Wang W, Gottesman RF, Meyer ML, Hughes TM, Sullivan KJ, Wong DF, Lakshminarayan K, Lutsey PL. Carotid Intima-Media Thickness and Amyloid-β Deposition: The ARIC-PET Study. J Alzheimers Dis 2022; 88:17-22. [PMID: 35527548 PMCID: PMC10167843 DOI: 10.3233/jad-215671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We assessed whether carotid intima-media thickness (cIMT) is prospectively associated with amyloid-β (Aβ). 332 nondemented Atherosclerosis Risk in Communities Study participants with carotid ultrasounds (1990-1992) and PET scans (2012-2014) were studied. Participants in the highest (versus lowest) cIMT tertile had 2.17 times the odds of elevated Aβ (95% CI: 1.15-4.11), after demographic and APOE ɛ4 adjustments. An interaction with APOE ɛ4 was observed (p = 0.02). Greater cIMT was associated with elevated Aβ independent of vascular risk factors among those with ≥1 APOE ɛ4 allele, but not in noncarriers. In this cohort, higher cIMT was associated with Aβ deposition 22 years later, particularly among APOE ɛ4 carriers.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Timothy M. Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kevin J. Sullivan
- Department of Medicine: The MIND Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Dean F. Wong
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
- Department of Neuroscience, Washington University in St. Louis, St. Louis, Missouri
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Sullivan KJ, Ranadive R, Su D, Neyland BR, Hughes TM, Hugenschmidt CE, Lockhart SN, Wong DF, Jack CR, Gottesman RF, Mosley TH, Griswold ME, Windham BG. Imaging-based indices of Neuropathology and gait speed decline in older adults: the atherosclerosis risk in communities study. Brain Imaging Behav 2021; 15:2387-2396. [PMID: 33439369 PMCID: PMC9189901 DOI: 10.1007/s11682-020-00435-y] [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] [Accepted: 12/17/2020] [Indexed: 02/01/2023]
Abstract
Imaging markers of cerebrovascular disease and Alzheimer's disease (AD) are implicated in mobility impairment in older adults, but few studies have examined these relationships longitudinally in a racially-diverse population-based sample. At Visit 5 (2011-13) of the ARIC Study, 1859 participants had usual pace gait speed (cm/s) assessed and brain MRI (mean age = 76.3, 28.5% Black) and PET (n = 343; mean age = 75.9, 42.6% Black) measures including total/regional brain volume (cm3), white matter hyperintensities (WMH; cm3), infarcts (present/absent), microbleeds (count) and global beta-amyloid (Aβ). Participants returned at Visit 6 (n = 1264, 2016-17) and Visit 7 (n = 1108, 2018-19) for follow-up gait speed assessments. We used linear regression to estimate effects of baseline infarct presence, higher microbleed count, and a one interquartile range (IQR) poorer measures of continuous predictors (-1 IQR total brain volume, temporal-parietal lobe meta region of interest(ROI); +1 IQR WMH volume, global Aβ SUVR) on cross-sectional gait speed and change in gait speed adjusting for age, sex, education, study site, APOE e4, estimated intracranial volume, BMI, and cardiovascular risk factors. Cross-sectionally, slower gait speed outcome was associated with higher WMH volume, -3.38 cm/s (95%CI:-4.71, -2.04), infarct presence, -5.60 cm/s (-7.69, -3.51), microbleed count, -2.20 cm/s (-3.20, -0.91), smaller total brain volume, -9.26 cm/s (-12.1, -6.43), and smaller temporal-parietal lobe ROI -6.28 cm/s (-8.28, -4.28). Longitudinally, faster gait speed outcome decline was associated with higher WMH volume, -0.27 cm/s/year, (-0.51, -0.03) and higher global Aβ SUVR, -0.62 cm/s/year (-1.20, -0.03). Both cerebrovascular and AD pathology may contribute to mobility decline commonly seen with aging.
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Affiliation(s)
- Kevin J Sullivan
- Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Radhikesh Ranadive
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Dan Su
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Blake R Neyland
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Timothy M Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Samuel N Lockhart
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dean F Wong
- Department of Radiology, Washington University in St Louis, St Louis, MO, USA
| | | | - Rebecca F Gottesman
- Department of Neurology, The Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, The Johns Hopkins University, Baltimore, MD, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Michael E Griswold
- Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - B Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
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Bleiweis MS, Fudge JC, Peek GJ, Vyas HV, Cruz Beltran S, Pitkin AD, Sullivan KJ, Hernandez-Rivera JF, Philip J, Jacobs JP. Ventricular assist device support in neonates and infants with a failing functionally univentricular circulation. JTCVS Tech 2021; 13:194-204. [PMID: 35711213 PMCID: PMC9195634 DOI: 10.1016/j.xjtc.2021.09.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/10/2021] [Indexed: 11/03/2022] Open
Abstract
Some neonates with functionally univentricular hearts are at extremely high risk for conventional surgical palliation. Primary cardiac transplantation offers the best option for survival of these challenging neonates; however, waitlist mortality must be minimized. We have developed a comprehensive strategy for the management of neonates with functionally univentricular hearts that includes the selective use of conventional neonatal palliation in standard-risk neonates, hybrid approaches in neonates with elevated risk secondary to a noncardiac etiology, and neonatal palliation combined with insertion of a single ventricular assist device (VAD) in neonates with elevated risk secondary to a cardiac etiology. Here we describe our selection criteria, technical details, management strategies, pitfalls, and current outcomes for neonates with functionally univentricular hearts supported with a VAD. Our experience shows that extremely high-risk neonates with functionally univentricular hearts who are poor candidates for conventional palliation can be successfully stabilized with concomitant palliation and pulsatile VAD insertion while awaiting cardiac transplantation.
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Sullivan KJ, Blackshear C, Simino J, Tin A, Walker KA, Sharrett AR, Younkin S, Gottesman RF, Mielke MM, Knopman D, Windham BG, Griswold ME, Mosley TH. Association of Midlife Plasma Amyloid-β Levels With Cognitive Impairment in Late Life: The ARIC Neurocognitive Study. Neurology 2021; 97:e1123-e1131. [PMID: 34349010 DOI: 10.1212/wnl.0000000000012482] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/16/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the association between midlife plasma amyloid-beta (Aβ1-42, Aβ1-40, Aβ42:Aβ40) and risk of MCI and dementia. METHODS Plasma Aβ42 and Aβ40 were retrospectively measured using a fluorimetric bead-based immunoassay in a subsample of the Atherosclerosis Risk in Communities cohort study. We investigated the relationship of plasma Aβ42, Aβ40, and Aβ42:Aβ40 ratio measured in midlife, late-life, and the change from midlife to late-life, to risk of MCI, dementia, and combined MCI/dementia outcomes in late-life (from 2011-19). We used multinomial logistic regressions estimating relative risk ratios (RRR) of these cognitive outcomes vs cognitively normal adjusted for age, sex, education, site-race, APOE, hypertension, diabetes, and body mass index. RESULTS A total of 2284 participants were included (midlife mean age=59.2±5.2, 57% female, 22% Black). Each doubling of midlife Aβ42:Aβ40 was associated with 37% lower risk of MCI/dementia (RRR=0.63, 95% CI: 0.46, 0.87), but only up to approximately the median (spline model threshold 0.20). Every standard deviation increase in plasma Aβ42 (10 pg/mL) was associated with 13% lower risk of MCI/dementia (RRR=0.87, 95% CI: 0.77, 0.98), whereas every standard deviation increase in plasma Aβ40 (67 pg/mL) was associated with 15% higher risk of MCI/dementia (RRR=1.15, 95% CI: 1.01, 1.29). Associations were comparable, but slightly weaker statistically, when repeating models using late-life plasma Aβ predictors. Aβ42 and Aβ40 increased from midlife to late-life, but changes were not associated with cognitive outcomes. CONCLUSION Midlife measurement of plasma Aβ may have utility as a blood-based biomarker indicative of risk for future cognitive impairment.
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Affiliation(s)
- Kevin J Sullivan
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Chad Blackshear
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS
| | - Jeannette Simino
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS
| | - Adrienne Tin
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Keenan A Walker
- Department of Neurology, The Johns Hopkins University, Baltimore, MD
| | - A Richey Sharrett
- Department of Epidemiology, The Johns Hopkins University, Baltimore, MD
| | | | - Rebecca F Gottesman
- Department of Neurology, The Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins University, Baltimore, MD
| | - Michelle M Mielke
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN.,Department of Neurology, Mayo Clinic, Rochester, MN
| | | | - B Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Michael E Griswold
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
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Bleiweis MS, Philip J, Peek GJ, Fudge JC, Sullivan KJ, Co-Vu J, Gupta D, Fricker FJ, Vyas HV, Ebraheem M, Powers ER, Falasa M, Jacobs JP. Combined Hybrid Procedure and VAD insertion in 9 High-Risk Neonates and Infants with HLHS. Ann Thorac Surg 2021; 114:809-816. [PMID: 34186096 DOI: 10.1016/j.athoracsur.2021.05.073] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/13/2021] [Accepted: 05/10/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND We report nine high-risk neonates and infants with HLHS stabilized with a Hybrid Approach + VAD insertion (Hybrid+VAD) in preparation for transplantation. METHODS Nine patients with HLHS (7 neonates, 2 infants) presented with anatomical and/or physiological features associated with increased risk for conventional univentricular palliation with the Norwood Operation (large coronary sinusoids/fistulas, severe tricuspid regurgitation, cardiogenic shock, restrictive atrial septum). These patients underwent combined VAD insertion (Berlin EXCOR) and stage 1 hybrid palliation (application of bilateral pulmonary bands, stent placement in the PDA, and atrial septectomy if needed). During this same era, at our institution, 41 neonates underwent Norwood Operation, three neonates underwent Hybrid Approach "Stage 1" without VAD, and three HLHS patients were supported with prostaglandin while awaiting transplantation. RESULTS At Hybrid+VAD insertion, median age = 20 days (range = 13-143) and median weight = 3.25 kilograms (range = 2.43-4.2). Six patients survive (67%) and three patients died (33%). Five survivors are at home doing well after successful transplantation and one survivor is doing well in the ICU on VAD support awaiting transplantation. Only one of six survivors (16.7%) required intubation more than 10 days after Hybrid+VAD insertion. In eight patients no longer on VAD, median length of VAD support was 119.5 days (range = 56-196 days). CONCLUSIONS High-risk patients with HLHS who are suboptimal candidates for Norwood palliation can be successfully stabilized with pulsatile VAD insertion along with hybrid palliation while awaiting cardiac transplantation; these patients may be extubated and optimized for transplantation while on VAD.
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Affiliation(s)
- Mark S Bleiweis
- Congenital Heart Center, University of Florida, Gainesville, Florida.
| | - Joseph Philip
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Giles J Peek
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - James C Fudge
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Kevin J Sullivan
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Jennifer Co-Vu
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | | | - Himesh V Vyas
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Mohammed Ebraheem
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Emma R Powers
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Matheus Falasa
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Jeffrey P Jacobs
- Congenital Heart Center, University of Florida, Gainesville, Florida
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Johansen MC, Nyquist P, Sullivan KJ, Fornage M, Gottesman RF, Becker DM. Cerebral Small-Vessel Disease in Individuals with a Family History of Coronary Heart Disease: The Atherosclerosis Risk in Communities Study. Neuroepidemiology 2021; 55:316-322. [PMID: 34139692 PMCID: PMC8371924 DOI: 10.1159/000516428] [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: 01/23/2021] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The degree to which a family history of coronary heart disease (FHCHD) is associated with silent cerebral small-vessel disease (cSVD) among healthy adults, independent of prevalent CHD and traditional risk factors, is unknown. METHODS The Atherosclerosis Risk in Communities (ARIC) study is a community-based cohort study with self-reported family history data and brain magnetic resonance imaging (ages 68-88). The association between markers of cSVD (lacunar infarcts and cerebral microbleeds), or log-transformed white matter hyperintensity (WMH) volume, and FHCHD, or the number of affected relatives was examined using separate adjusted logistic or linear regression models, respectively. Race interaction terms were evaluated. RESULTS Of 1,639 participants without prevalent CHD (76 ± 5 years, 62% female, 29% black), 686 (42%) had FHCHD. There were higher odds of lacunar infarct (OR 1.40, 95% CI 1.07-1.84) among those with parental FHCHD and higher odds of microhemorrhages (lobar OR 1.86, 95% CI 1.13-3.06; subcortical OR 1.47, 95% CI 1.01-2.15) among those with sibling FHCHD. A greater number of any relative affected was associated with higher odds of lacunar infarct (OR 1.24, 95% CI 1.04-1.47) and lobar microhemorrhages (OR 1.31, 95% CI 1.05-1.64) but not subcortical microhemorrhages (OR 1.09, 95% CI 0.92-1.28). Odds of having a lacunar infarct were higher among blacks (p-interaction 0.04) with paternal FHCHD (OR 2.20, CI 1.35-3.58) than whites with paternal FHCHD (OR 1.17, CI 0.87-1.56). There was no association with WMH. DISCUSSION/CONCLUSION Markers of cSVD, specifically lacunar infarcts and microhemorrhages, appear to be associated with FHCHD, potentially representing shared mechanisms in different vascular beds, and perhaps a genetic propensity for vascular disease.
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Affiliation(s)
- Michelle C. Johansen
- Johns Hopkins University School of Medicine (JHUSOM) Department of Neurology, Baltimore, MD
| | - Paul Nyquist
- Johns Hopkins University School of Medicine (JHUSOM) Department of Neurology, Baltimore, MD
- JHUSOM Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Kevin J. Sullivan
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Myriam Fornage
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Rebecca F. Gottesman
- Johns Hopkins University School of Medicine (JHUSOM) Department of Neurology, Baltimore, MD
| | - Diane M. Becker
- JHUSOM Department of Medicine, Division of General Internal Medicine, Baltimore, MD
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Martinez-Amezcua P, Powell D, Kuo PL, Reed NS, Sullivan KJ, Palta P, Szklo M, Sharrett R, Schrack JA, Lin FR, Deal JA. Association of Age-Related Hearing Impairment With Physical Functioning Among Community-Dwelling Older Adults in the US. JAMA Netw Open 2021; 4:e2113742. [PMID: 34170305 PMCID: PMC8233700 DOI: 10.1001/jamanetworkopen.2021.13742] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
IMPORTANCE Hearing impairment, a common treatable condition, may contribute to poorer physical function with aging. OBJECTIVE To assess whether hearing impairment is associated with poorer physical function, reduced walking endurance, and faster decline in physical function. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, cross-sectional and longitudinal analyses were performed using data from the 2011 to 2019 period of the Atherosclerosis Risk in Communities study, a population-based study of community-dwelling adults at 4 sites in the US. EXPOSURES Hearing thresholds (per 10 dB) assessed with pure tone audiometry and categorized as normal hearing or mild, moderate, or severe hearing impairment. MAIN OUTCOMES AND MEASURES Physical function was assessed using the short physical performance battery (SPPB), with composite scores ranging from 0 to 12. A composite score of 6 or less and a score for each component (balance, gait speed, and chair stands) of 2 or less indicated poor performance. Walking endurance was assessed using a 2-minute fast-paced walk test. Tobit regression models adjusted for sociodemographic factors and medical history were used to calculate the mean differences in SPPB composite scores; logistic regression models, to estimate the odds ratios (ORs) of low SPPB composite and component scores; and linear mixed-effects models, to estimate the mean rate of change in SPPB composite scores over time. RESULTS Of the 2956 participants (mean [SD] age, 79 [4.6] years) who attended study visit 6 between 2016 and 2017, 1722 (58.3%) were women, and 2356 (79.7%) were White. As determined by pure tone audiometry, 973 (33%) participants had normal hearing, 1170 (40%) had mild hearing impairment, 692 (23%) had moderate hearing impairment, and 121 (4%) had severe hearing impairment. In the Tobit regression model, severe hearing impairment was associated with a lower mean SPPB score (β, -0.82; 95% CI, -0.34 to -1.30) compared with normal hearing. In fully adjusted logistic regression models, hearing impairment was associated with higher odds of low physical performance scores (severe impairment vs normal hearing: OR for composite physical performance, 2.51 [95% CI, 1.47-4.27]; OR for balance, 2.58 [95% CI, 1.62-4.12]; OR for gait speed, 2.11 [95% CI, 1.03-4.33]). Over time (2 to 3 visits; maximum, 8.9 years), participants with hearing impairment had faster declines in SPPB compared with those with normal hearing (moderate hearing impairment × time interaction, -0.34 [-0.52 to -0.16]). In adjusted models for walking endurance, participants with moderate or severe hearing impairment walked a mean distance of -2.81 m (95% CI, -5.45 to -0.17 m) and -5.31 m (95% CI, -10.20 to -0.36 m) than those with normal hearing, respectively, during the 2-minute walk test. CONCLUSIONS AND RELEVANCE In this cohort study, hearing impairment was associated with poorer performance, faster decline in physical function, and reduced walking endurance. The results of the longitudinal analysis suggest that hearing impairment may be associated with poorer physical function with aging. Whether management of hearing impairment could delay decline in physical function requires further investigation.
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Affiliation(s)
- Pablo Martinez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Baltimore, Maryland
| | - Danielle Powell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Baltimore, Maryland
| | - Pei-Lun Kuo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Nicholas S. Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Baltimore, Maryland
| | - Kevin J. Sullivan
- Department of Medicine, University of Mississippi, Medical Center, Jackson
| | - Priya Palta
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
- Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer A. Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Frank R. Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Baltimore, Maryland
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Baltimore, Maryland
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Walker KA, Chen J, Zhang J, Fornage M, Yang Y, Zhou L, Grams ME, Tin A, Daya N, Hoogeveen RC, Wu A, Sullivan KJ, Ganz P, Zeger SL, Gudmundsson EF, Emilsson V, Launer LJ, Jennings LL, Gudnason V, Chatterjee N, Gottesman RF, Mosley TH, Boerwinkle E, Ballantyne CM, Coresh J. Large-scale plasma proteomic analysis identifies proteins and pathways associated with dementia risk. Nat Aging 2021; 1:473-489. [PMID: 37118015 PMCID: PMC10154040 DOI: 10.1038/s43587-021-00064-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/02/2021] [Indexed: 04/30/2023]
Abstract
The plasma proteomic changes that precede the onset of dementia could yield insights into disease biology and highlight new biomarkers and avenues for intervention. We quantified 4,877 plasma proteins in nondemented older adults in the Atherosclerosis Risk in Communities cohort and performed a proteome-wide association study of dementia risk over five years (n = 4,110; 428 incident cases). Thirty-eight proteins were associated with incident dementia after Bonferroni correction. Of these, 16 were also associated with late-life dementia risk when measured in plasma collected nearly 20 years earlier, during mid-life. Two-sample Mendelian randomization causally implicated two dementia-associated proteins (SVEP1 and angiostatin) in Alzheimer's disease. SVEP1, an immunologically relevant cellular adhesion protein, was found to be part of larger dementia-associated protein networks, and circulating levels were associated with atrophy in brain regions vulnerable to Alzheimer's pathology. Pathway analyses for the broader set of dementia-associated proteins implicated immune, lipid, metabolic signaling and hemostasis pathways in dementia pathogenesis.
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Affiliation(s)
- Keenan A Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, MD, USA.
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Jingsha Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jingning Zhang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School and Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yunju Yang
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School and Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Linda Zhou
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adrienne Tin
- MIND Center and Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Natalie Daya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ron C Hoogeveen
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Aozhou Wu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kevin J Sullivan
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Peter Ganz
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - Lori L Jennings
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Nilanjan Chatterjee
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas H Mosley
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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36
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Sullivan KJ, Ran X, Wu F, Chang CCH, Sharma R, Jacobsen E, Berman S, Snitz BE, Sekikawa A, Talbott EO, Ganguli M. Ambient fine particulate matter exposure and incident mild cognitive impairment and dementia. J Am Geriatr Soc 2021; 69:2185-2194. [PMID: 33904156 DOI: 10.1111/jgs.17188] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/14/2021] [Accepted: 04/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVE Poor air quality is implicated as a risk factor for cognitive impairment and dementia. Few studies have examined these associations longitudinally in well-characterized population-based cohorts with standardized annual assessment of both mild cognitive impairment (MCI) and dementia. We investigated the association between estimated ambient fine particulate matter (PM2.5 ) and risk of incident MCI and dementia in a post-industrial region known for historically poor air quality. SETTING/PARTICIPANTS Adults aged 65+ years in a population-based cohort (n = 1572). MEASUREMENTS Census tract level PM2.5 from Environmental Protection Agency (EPA) air quality monitors; Clinical Dementia Rating (CDR)®. DESIGN We estimated ambient PM2.5 exposure (μg/m3 , single-year and 5-year averages) by geocoding participants' residential addresses to census tracts with daily EPA PM2.5 measurements from 2002 to 2014. Using Bayesian spatial regression modeling adjusted for age, sex, education, smoking history, and household income, we examined the association between estimated PM2.5 exposure and risk of incident MCI (CDR = 0.5) and incident dementia (CDR ≥ 1.0). RESULTS Modeling estimated single-year exposure, each 1 μg/m3 higher ambient PM2.5 was associated with 67% higher adjusted risk of incident dementia (hazard ratio [HR] = 1.669, 95% credible interval [CI]: 1.298, 2.136) and 75% higher adjusted risk of incident MCI (HR = 1.746, 95% CI: 1.518, 2.032). Estimates were higher when modeling 5-year ambient PM2.5 exposure for incident dementia (HR = 2.082, 95% CI: 1.528, 3.015) and incident MCI (HR = 3.419, 95% CI: 2.806, 4.164). CONCLUSIONS Higher estimated ambient PM2.5 was associated with higher risk of incident MCI and dementia, particularly when considering longer-term exposure, and independent of demographic characteristics and smoking history. Targeting poor air quality may be a reasonable population-wide intervention to reduce the risk of cognitive impairment in older adults, particularly in regions exceeding current recommendations for safe exposure to PM2.5 .
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Affiliation(s)
- Kevin J Sullivan
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Xinhui Ran
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fan Wu
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chung-Chou H Chang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ravi Sharma
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erin Jacobsen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah Berman
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Beth E Snitz
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Akira Sekikawa
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Evelyn O Talbott
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Ganguli
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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37
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Walker KA, Chen J, Wu A, Tin A, Mosley TH, Fornage M, Ballantyne CM, Boerwinkle E, Sullivan KJ, Zeger SL, Ganz P, Gottesman RF, Coresh J. Large‐scale plasma proteomic analysis identifies proteins and biological pathways associated with incident dementia. Alzheimers Dement 2020. [DOI: 10.1002/alz.038307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Keenan A Walker
- Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jingsha Chen
- Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Aozhou Wu
- Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Adrienne Tin
- Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | | | - Myriam Fornage
- The University of Texas Health Science Center at Houston Houston TX USA
| | | | | | | | - Scott L Zeger
- Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Peter Ganz
- UCSF Medical Center San Francisco CA USA
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Sullivan KJ, Liu A, Chang CCH, Cohen AD, Lopresti BJ, Minhas DS, Laymon CM, Klunk WE, Aizenstein H, Nadkarni NK, Loewenstein D, Kamboh MI, Ganguli M, Snitz BE. Alzheimer's disease pathology in a community-based sample of older adults without dementia: The MYHAT neuroimaging study. Brain Imaging Behav 2020; 15:1355-1363. [PMID: 32748322 DOI: 10.1007/s11682-020-00334-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/07/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022]
Abstract
A true understanding of the distribution and functional correlates of Alzheimer's disease pathology in dementia-free older adults requires a population-based perspective. Here we report initial findings from a sample of 102 cognitively unimpaired participants (average age 77.2 years, 54.9% women, 13.7% APOE*4 carriers) recruited for neuroimaging from a larger representative population-based cohort participating in an ongoing longitudinal study of aging, the Monongahela-Youghiogheny Healthy Aging Team (MYHAT). All participants scored < 1.0 on the Clinical Dementia Rating (CDR) Scale, with 8 participants (7.8%) scoring CDR = 0.5. Participants completed a positron emission tomography scan using the tracers [C-11]Pittsburgh Compound-B (PiB) and [F-18]AV-1451 to estimate amyloid and tau deposition. PiB positivity was defined on a regional basis using established standardized uptake value ratio cutoffs (SUVR; cerebellar gray matter reference), with 39 participants (38.2%) determined to be PiB(+). Health history, lifestyle, and cognitive abilities were assessed cross-sectionally at the nearest annual parent MYHAT study visit. A series of adjusted regression analyses modeled cognitive performance as a function of global PiB SUVR and [F-18]AV-1451 SUVR in Braak associated regions 1, 3/4, and 5/6. In comparison to PiB(-) participants (n = 63), PiB(+) participants were older, less educated, and were more likely to be APOE*4 carriers. Global PiB SUVR was significantly correlated with [F-18]AV-1451 SUVR in all Braak-associated regions (r = .38-0.53, p < .05). In independent models, higher Global PiB SUVR and Braak 1 [F-18]AV-1451 SUVR were associated with worse performance on a semantic interference verbal memory test. Our findings suggest that brain amyloid is common in a community-based setting, and is associated with tau deposition, but both pathologies show few associations with concurrent cognitive performance in a dementia-free sample.
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Affiliation(s)
- Kevin J Sullivan
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Anran Liu
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian J Lopresti
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Davneet S Minhas
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles M Laymon
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William E Klunk
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Neelesh K Nadkarni
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Loewenstein
- Department of Psychiatry and Behavioral Science, University of Miami, FL, Coral Gables, USA
| | - M Ilyas Kamboh
- Department of Human Genetics, University of Pittsburgh, PA, Pittsburgh, USA
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beth E Snitz
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
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Kubala AG, Sullivan KJ, Kline CE, Cauley JA. 0856 Relationship Between A Composite Measure Of Sleep Health And Bone Mineral Density In A Sample Of Older Women From The Study Of Osteoporotic Fractures. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Observational studies suggest poor sleep is related to lower bone mineral density (BMD) and increased osteoporosis risk. Yet, many studies focus on sleep duration and lack inclusion of other sleep characteristics. The sleep health construct simultaneously recognizes multiple dimensions of sleep and is operationalized as a composite score. Thus, we examined whether a composite measure of sleep health was related to BMD in a sample of older women.
Methods
The sample included 1968 older women (mean age: 83.6 ± 3.1 years) from the Study of Osteoporotic Fractures. Six sleep health domains (regularity, duration, satisfaction, timing, efficiency, sleepiness/alertness) were dichotomized into either “good” or “poor” categories. The number of “good” characteristics were summed into a score ranging from 0 (poor) to 6 (good). BMD (g/cm2) was measured at the femoral neck, total hip, and trochanter sites with dual energy x-ray absorptiometry. Multiple linear regression was used to explore the association between sleep health (composite score and the individual domains) with BMD (cross-sectional) and annualized percent change in BMD (longitudinal). All models were adjusted for age, body mass index, alcohol consumption, smoking, physical activity, education, diabetes, hyperthyroidism, fracture history, and cardiovascular disease.
Results
Average sleep health score was 3.8±1.2. Cross-sectionally, better sleep health was associated with higher BMD at the femoral neck (β=.04, p=.04) and trochanter (β=.05, p=.02). Sleep health was not cross-sectionally associated with BMD at the total hip (β=.03, p=.09) or with change in BMD at any region (Each p >.13). The individual domain of sleep regularity was cross-sectionally related to BMD at the total hip and trochanter, respectively (β=.04, P=.04; β=.05, P=.02).
Conclusion
A multi-dimensional measure of sleep health was related to greater BMD cross-sectionally at the femoral neck and trochanter regions in a sample of older women. Future studies should focus on associations between sleep health and osteoporotic-related fractures.
Support
The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576
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Affiliation(s)
- A G Kubala
- Department of Health and Physical Activity, Pittsburgh, PA
| | | | - C E Kline
- Department of Health and Physical Activity, Pittsburgh, PA
| | - J A Cauley
- Department of Epidemiology, Pittsburgh, PA
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Ganguli M, Beer JC, Zmuda JM, Ryan CM, Sullivan KJ, Chang CCH, Rao RH. Aging, Diabetes, Obesity, and Cognitive Decline: A Population-Based Study. J Am Geriatr Soc 2020; 68:991-998. [PMID: 32020605 DOI: 10.1111/jgs.16321] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 08/22/2019] [Revised: 10/26/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES To investigate potential mechanisms underlying the well-established relationship of diabetes and obesity with cognitive decline, among older adults participating in a population-based study. DESIGN/SETTING Ten-year population-based cohort study. PARTICIPANTS A total of 478 individuals aged 65 years and older. MEASUREMENTS We assayed fasting blood for markers of glycemia (glucose and hemoglobin A1c [HbA1c]), insulin resistance (IR) (insulin and homeostatic model assessment of IR), obesity (resistin, adiponectin, and glucagon-like peptide-1), and inflammation (C-reactive protein). We modeled these indices as predictors of the slope of decline in global cognition, adjusting for age, sex, education, APOE*4 genotype, depressive symptoms, waist-hip ratio (WHR), and systolic blood pressure, in multivariable regression analyses of the entire sample and stratified by sex-specific median WHR. We then conducted WHR-stratified machine-learning (Classification and Regression Tree [CART]) analyses of the same variables. RESULTS In multivariable regression analyses, in the entire sample, HbA1c was significantly associated with cognitive decline. After stratifying by median WHR, HbA1c remained associated with cognitive decline in those with higher WHR. No metabolic indices were associated with cognitive decline in those with lower WHR. Cross-validated WHR-stratified CART analyses selected no predictors in participants older than 87 to 88 years. Faster cognitive decline was associated, in lower WHR participants younger than 87 years, with adiponectin of 11 or greater; and in higher WHR participants younger than 88 years, with HbA1c of 6.2% or greater. CONCLUSIONS Our population-based data suggest that, in individuals younger than 88 years with central obesity, even modest degrees of hyperglycemia might independently predispose to faster cognitive decline. In contrast, among those younger than 87 years without central obesity, adiponectin may be a novel independent risk factor for cognitive decline. J Am Geriatr Soc 68:991-998, 2020.
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Affiliation(s)
- Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Joanne C Beer
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph M Zmuda
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Christopher M Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kevin J Sullivan
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Chung-Chou H Chang
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - R Harsha Rao
- Division of Endocrinology, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Sullivan KJ, Liu A, Dodge HH, Andreescu C, Chang CCH, Ganguli M. Depression Symptoms Declining Among Older Adults: Birth Cohort Analyses From the Rust Belt. Am J Geriatr Psychiatry 2020; 28:99-107. [PMID: 31300193 PMCID: PMC6898763 DOI: 10.1016/j.jagp.2019.06.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate potential birth cohort effects in depression symptoms in older adults. DESIGN Population-based prospective cohort. SETTING Small-town communities in Pennsylvania. PARTICIPANTS Three thousand two hundred and twenty seven older adults (average baseline age = 71.6) born between 1902 and 1941. MEASUREMENTS Four decade-long birth cohorts were the primary predictors in this study: 1902-1911, 1912-1921, 1922-1931, and 1932-1941. The outcome was symptoms of depression assessed at baseline and follow-up study visits using a modified Center for Epidemiologic Studies Depression Scale (mCES-D). The depression outcome was operationalized as: 1). A binary outcome of having greater than equal to 5 depression symptoms on the total mCES-D at any study visit, and 2). A continuous outcome of four factor-analyzed component scores of the mCES-D including depressed mood, anergia/hopelessness, withdrawal, and poor self-esteem. All analyses were jointly modeled with attrition and adjusted for age, sex, education, Mini Mental State Examination score, antidepressant medications, and total prescription medications. RESULTS Participants from more recently born cohorts were significantly less likely to have a study visit in which they reported greater than or equal to 5 depression symptoms, controlling for attrition. Specifically, in comparison to the 1902-1911 referent cohort, the 1912-1921 birth cohort was 43% less likely (odds ratio [OR] = 0.566, 95% confidence interval [CI]: 0.341-0.939), the 1922-1931 birth cohort was 63% less likely (OR = 0.0369, 95% CI: 0.215-0.632), and the 1932-1941 cohort was 79% less likely (OR = 0.205, 95% CI: 0.106-0.399). The cohort effect was most evident in the depressed mood and anergia/hopelessness symptom composites. CONCLUSION Reduced rates of depression symptoms observed in successive birth cohorts of older adults may reflect compression of morbidity or other secular trends.
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Affiliation(s)
- Kevin J Sullivan
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
| | - Anran Liu
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Hiroko H Dodge
- Michigan Alzheimer’s Disease Center, Department of Neurology, University of Michigan, Ann Arbor, MI,Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Chung-Chou H Chang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mary Ganguli
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Sullivan KJ, Griswold M, Hughes T, Hugenschmidt CE, Lockhart S, Mosley T, Gottesman R, Windham G. NEUROPATHOLOGY AND GAIT SPEED DECLINE IN OLDER ADULTS: THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY. Innov Aging 2019. [PMCID: PMC6846235 DOI: 10.1093/geroni/igz038.3377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Neuropathological markers including amyloid-beta (Aβ) have been implicated in mobility decline in older adults, but no studies have examined the relationship between these markers and longitudinal change in gait speed in a racially diverse community-based sample. In the multi-site prospective ARIC study, a subsample of participants (n=1,978, mean age=76.3, 28.5% black) underwent brain MRI at Visit 5 (2011-13). Of these, 343 participants (mean age=75.9, 42.6% black) completed PET scans using the tracer florbetapir to estimate global brain Aβ. We investigated the relationship between four neuropathological markers [white matter hyperintensities (WMH; log2cm3), infarcts (present/absent), brain atrophy (log2cm3), and global Aβ (log2SUVR)] with cross-sectional usual pace gait speed (cm/s) over 4 meters, and change in gait speed through Visits 6 (2016-17) and 7 (2018-19). Linear regression models were adjusted for age, site, sex, education, BMI, intracranial volume, and all race interactions. Cross-sectionally, slower gait was associated with higher WMH volume (β=-2.16, 95%CI: -2.92, -1.39), infarcts (β=-5.81, 95%CI: -7.86, -3.76), and brain atrophy (β=-16.39, 95%CI: -21.07, -11.71). Longitudinally, only higher WMH volume was statistically associated with gait speed decline (β=-0.14, 95%CI: -0.28, -0.01). Global Aβ was not statistically associated with gait speed cross-sectionally (β=-.269, 95%CI: -8.11, 7.57) or longitudinally (β=-1.16, 95%CI: -2.94, 0.62). There were no significant interactions with race. Detrimental relations of cerebral small vessel disease to mobility and mobility decline were observed across race in this diverse sample. The magnitude of the Aβ association with gait speed decline was high, although not statistically significant in the smaller PET subsample.
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Affiliation(s)
- Kevin J Sullivan
- University of Mississippi Medical Center MIND Center, Jackson, Mississippi, United States
| | - Michael Griswold
- University of Mississippi Medical Center MIND Center, Jackson, Mississippi, United States
| | - Timothy Hughes
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | | | - Samuel Lockhart
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Thomas Mosley
- University of Mississippi Medical Center MIND Center, Jackson, Mississippi, United States
| | | | - Gwen Windham
- University of Mississippi Medical Center MIND Center, Jackson, Mississippi, United States
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Sullivan KJ, Dodge HH, Hughes TF, Chang CCH, Zhu X, Liu A, Ganguli M. Declining Incident Dementia Rates Across Four Population-Based Birth Cohorts. J Gerontol A Biol Sci Med Sci 2019; 74:1439-1445. [PMID: 30312371 PMCID: PMC6696712 DOI: 10.1093/gerona/gly236] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Incidence rates of dementia appear to be declining in high-income countries according to several large epidemiological studies. We aimed to describe declining incident dementia rates across successive birth cohorts in a U.S. population-based sample and to explore the influences of sex and education on these trends. METHODS We pooled data from two community-sampled prospective cohort studies with similar study aims and contiguous sampling regions: the Monongahela Valley Independent Elders Survey (1987-2001) and the Monongahela-Youghiogheny Healthy Aging Team (2006-Ongoing). We identified four decade-long birth cohorts spanning birth years 1902-1941. In an analysis sample of 3,010 participants (61% women, mean baseline age = 75.7 years, mean follow-up = 7.1 years), we identified 257 cases of incident dementia indicated by a Clinical Dementia Rating of 1.0 or higher. We used Poisson regression to model incident dementia rates by birth cohort, age, sex, education, and interactions of Sex × Cohort and Sex × Education. We further examined whether cohort effects varied by education, testing a Cohort × Education interaction and stratifying the models by education. RESULTS Compared to the earliest birth cohort (1902-1911), each subsequent cohort had a significantly lower incident dementia rate (1912-1921: incidence rate ratio [IRR] = 0.655, 95% confidence interval [95% CI] = 0.477-0.899; 1922-1931: IRR = 0.387, 95% CI = 0.265-0.564; 1932-1941: IRR = 0.233, 95% CI = 0.121-0.449). We observed no significant interactions of either sex or education with birth cohort. CONCLUSIONS A decline in incident dementia rates was observed across successive birth cohorts independent of sex, education, and age.
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Affiliation(s)
| | - Hiroko H Dodge
- Michigan Alzheimer’s Disease Center, Department of Neurology, University of Michigan, Ann Arbor
- Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland
| | - Tiffany F Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Ohio
| | - Chung-Chou H Chang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh, Pennsylvania
| | - Xinmei Zhu
- Department of Medicine, University of Pittsburgh, Pennsylvania
| | - Anran Liu
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Mary Ganguli
- Department of Epidemiology, University of Michigan, Ann Arbor
- Department of Medicine, University of Pittsburgh, Pennsylvania
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pennsylvania
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Sullivan KJ, Liu A, Cohen A, Lopresti BJ, Minhas DS, Laymon CM, Aizenstein HJ, Campbell E, Klunk WE, Ganguli M, Snitz BE. P4-631: ALZHEIMER'S DISEASE PATHOLOGY IN A COMMUNITY-BASED SAMPLE OF OLDER ADULTS WITHOUT DEMENTIA: A POPULATION-NEUROSCIENCE APPROACH. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.08.180] [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: 11/25/2022]
Affiliation(s)
- Kevin J. Sullivan
- University of Pittsburgh Graduate School of Public Health; Pittsburgh PA USA
| | - Anran Liu
- University of Pittsburgh Graduate School of Public Health; Pittsburgh PA USA
| | - Ann Cohen
- University of Pittsburgh School of Medicine; Pittsburgh PA USA
- Alzheimer's Disease Research Center; Pittsburgh PA USA
| | | | | | | | - Howard J. Aizenstein
- University of Pittsburgh School of Medicine; Pittsburgh PA USA
- Alzheimer's Disease Research Center; Pittsburgh PA USA
| | | | - William E. Klunk
- University of Pittsburgh School of Medicine; Pittsburgh PA USA
- Alzheimer's Disease Research Center; Pittsburgh PA USA
| | - Mary Ganguli
- University of Pittsburgh Graduate School of Public Health; Pittsburgh PA USA
- University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Beth E. Snitz
- University of Pittsburgh School of Medicine; Pittsburgh PA USA
- Alzheimer's Disease Research Center; Pittsburgh PA USA
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Ganguli M, Jia Y, Hughes TF, Snitz BE, Chang CCH, Berman SB, Sullivan KJ, Kamboh MI. Mild Cognitive Impairment that Does Not Progress to Dementia: A Population-Based Study. J Am Geriatr Soc 2018; 67:232-238. [PMID: 30444944 DOI: 10.1111/jgs.15642] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVE In population studies, most individuals with mild cognitive impairment (MCI) do not progress to dementia in the near term, but rather remain stable MCI or revert to normal cognition. Here, we characterized MCI subgroups with different outcomes over 5 years. SETTING/PARTICIPANTS A population-based cohort (N=1603). MEASUREMENTS Clinical Dementia Rating (CDR); self-reported medical conditions, subjective cognitive concerns, self-rated health, depressive symptoms, blood pressure, medications, blood pressure, APOE genotype, cognitive domain composite scores. DESIGN We compared 3 MCI subgroups who progressed to dementia (n=86), stabilized at MCI (n=384), or reverted to normal (n=252), to those who remained consistently normal (n=881), defining MCI as CDR = 0.5 and dementia as CDR≥1. Using multinomial logistic regression models adjusted for demographics, we examined the associations of each group with selected baseline characteristics. RESULTS With the normal group for reference, worse subjective cognitive concerns, functional impairments, self-rated health, and depressive symptoms were associated with being in any MCI group. Taking more prescription medications was associated with being in the stable MCI and reverter groups; diabetes and low diastolic blood pressure were associated with stable MCI. The APOE4 genotype was associated with stable and progressive MCI; stroke was associated with progressive MCI. All MCI subgroups were likely to have lower mean composite scores in all cognitive domains and more operationally defined impairments in attention, language, and executive function; reverters were more likely to lack memory and visuospatial impairments. CONCLUSIONS MCI subgroups with different 5-year outcomes had some distinct characteristics suggesting different underlying causes. The progressors, unlike the reverters, had a profile broadly typical of Alzheimer's disease; the stable MCIs had other, including vascular, morbidity. These data shed light on the heterogeneity of MCI in the population. J Am Geriatr Soc 67:232-238, 2019.
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Affiliation(s)
- Mary Ganguli
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yichen Jia
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tiffany F Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Youngstown, Ohio
| | - Beth E Snitz
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chung-Chou H Chang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah B Berman
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kevin J Sullivan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - M Ilyas Kamboh
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Boet S, Larrigan S, Martin L, Liu H, Sullivan KJ, Etherington N. Measuring non-technical skills of anaesthesiologists in the operating room: a systematic review of assessment tools and their measurement properties. Br J Anaesth 2018; 121:1218-1226. [PMID: 30442248 DOI: 10.1016/j.bja.2018.07.028] [Citation(s) in RCA: 17] [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: 05/11/2018] [Revised: 06/25/2018] [Accepted: 07/12/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Non-technical skills, such as communication or leadership, are integral to clinical competence in anaesthesia. There is a need for valid and reliable tools to measure anaesthetists' non-technical performance for both initial and continuing professional development. This systematic review aims to summarise the measurement properties of existing assessment tools to determine which tool is most robust. METHODS Embase (via OVID), Medline and Medline in Process (via OVID), and reference lists of included studies and previously published relevant systematic reviews were searched (through August 2017). Quantitative studies investigating the measurement properties of tools used to assess anaesthetists' intraoperative non-technical skills, either in a clinical or simulated environment, were included. Pairs of independent reviewers determined eligibility and extracted data. Risk of bias was assessed using the COSMIN checklist. RESULTS The search yielded 978 studies, of which 14 studies describing seven tools met the inclusion criteria. Of these, 12 involved simulated crisis settings only. The measurement properties of the Anaesthetists' Non-Technical Skills (ANTS) tool were most commonly assessed (n=9 studies), with studies of two types of validity (content, concurrent) and two types of reliability (internal consistency, interrater). Most of these studies, however, were at serious risk of bias. CONCLUSIONS Though there are seven tools for assessing the non-technical skills of anaesthetists, only ANTS has been extensively investigated with regard to its measurement properties. ANTS appears to have acceptable validity and reliability for assessing non-technical skills of anaesthetists in both simulated and clinical settings. Future research should consider additional clinical contexts and types of measurement properties.
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Affiliation(s)
- S Boet
- Department of Anaesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Innovation in Medical Education, University of Ottawa, ON, Canada.
| | - S Larrigan
- Translational and Molecular Medicine Program, ON
| | | | | | - K J Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - N Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Sullivan KJ, Dodge HH, Hughes TF, Chang CC, Ganguli M. P1‐623: DECLINING DEMENTIA INCIDENCE IN THE MONONGAHELA VALLEY: BIRTH COHORT ANALYSES FROM THE MOVIES AND MYHAT STUDIES. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.636] [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: 11/25/2022]
Affiliation(s)
| | | | | | | | - Mary Ganguli
- University of Pittsburgh School of MedicinePittsburghPAUSA
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Andrioli V, Guerra L, Keays M, Keefe DT, Tang K, Sullivan KJ, Garland K, Rafikov M, Leonard MP. Active surveillance for antenatally detected ureteroceles: Predictors of success. J Pediatr Urol 2018; 14:243.e1-243.e6. [PMID: 29580731 DOI: 10.1016/j.jpurol.2018.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/05/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Historically, ureteroceles were surgically treated, as patients were diagnosed after developing symptoms. However, with the advance of fetal medicine, antenatal detection has provided an opportunity to look at the natural history of ureteroceles. OBJECTIVES With data derived from a retrospective chart review of patients with ureteroceles that were detected antenatally, the current study aimed to determine which group of children would be at risk for failure on active surveillance. It was hypothesized that single system ureteroceles (SSU) and male patients with duplex system ureteroceles (DSU) would be ideal for observation. METHODS Outcomes were assessed by descriptive statistics. Kaplan-Meier curves were utilized to estimate median duration on active surveillance in both single and duplex cohorts. Breakthrough febrile urinary tract infection (fUTI) and surgery were determined by Cox regression in the duplex system cohort. Surgery was considered surveillance failure. RESULTS A total of 102 patients (64 females/38 males) met the criteria: 78 (76.5%) had DSU and 24 (23.5%) SSU. The overall median observation was 1.2 years (range 0.7-3.1). Follow-up ranged from 0.3 to 11.7 years for SSU, and from 0.02 to 17.3 years for DSU. The predictors of failure of active surveillance (AS) in DSU (surgical intervention) were male gender (HR 1.8, 1.0-3.3, P = 0.037), or fUTI (HR 3.1, 1.7-5.8, P = 0.002). Predictors of fUTI were contralateral hydroureter or ipsilateral hydronephrosis ± hydroureter (OR 9.5, 1.2-71.7, P = 0.028). Interestingly, vesicoureteral reflux (VUR) was not a predictor of fUTI. The SSU patients were ideal for AS, while in DSU, surveillance was successful in 30% of patients who were primarily females without contralateral hydroureter or ipsilateral hydronephrosis ± hydroureter. However, in contradiction to the hypothesis, males were at higher risk for surgical intervention in the DSU cohort. CONCLUSION Active surveillance is an option for patients with antenatally detected ureteroceles, but careful long term follow up is mandatory. Parents should be advised that surgical intervention may still be necessary, particularly in males with DSU.
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Affiliation(s)
- V Andrioli
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - L Guerra
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - M Keays
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - D T Keefe
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - K Tang
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - K J Sullivan
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - K Garland
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - M Rafikov
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - M P Leonard
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
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Sullivan KJ, Hunter Z, Andrioli V, Guerra L, Leonard M, Klassen A, Keays MA. Assessing quality of life of patients with hypospadias: A systematic review of validated patient-reported outcome instruments. J Pediatr Urol 2017; 13:19-27. [PMID: 28089292 DOI: 10.1016/j.jpurol.2016.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/08/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patient-reported outcomes have the potential to provide invaluable information for evaluation of hypospadias patients, aid in decision-making, performance assessment, and improvement in quality of care. To appropriately measure patient-relevant outcomes, well-developed and validated patient-reported outcome (PRO) instruments are essential. OBJECTIVE To identify and evaluate existing PRO instruments designed to measure quality of life and/or satisfaction of individuals with hypospadias that have been developed and validated in a hypospadias population. METHODS A systematic search of MEDLINE, EMBASE, PsycINFO, CINAHL and Health and Psychosocial Instruments was conducted in April 2016. Two reviewers independently assessed studies and identified PRO instruments for inclusion. Data were extracted on study characteristics, instrument development and validation, and content domains. RESULTS A total of 32 studies were included that used or described five PRO instruments: Hypospadias Objective Scoring Evaluation (HOSE), Pediatric Penile Perception Score (PPPS), Penile Perception Score (PPS), Genital Perception Scale (GPS) for adults, and GPS for children/adolescents. Instrument development and validation was limited. The majority of identified instruments focused on postoperative cosmetic satisfaction, with only one instrument considering urinary function, and no instruments evaluating sexual function and psychosocial sequelae. CONCLUSIONS While many hypospadias studies have acknowledged the necessity of a patient-reported element, few have used validated PRO instruments developed in a hypospadias population. Existing instruments to measure patient-reported outcomes in hypospadias require improvement in both the breadth of content and in their development and validation methodology.
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Affiliation(s)
- K J Sullivan
- Department of Pediatric Surgery, Division of Urology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada
| | - Z Hunter
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, Canada
| | - V Andrioli
- Department of Pediatric Surgery, Division of Urology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada
| | - L Guerra
- Department of Pediatric Surgery, Division of Urology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, Canada
| | - M Leonard
- Department of Pediatric Surgery, Division of Urology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, Canada
| | - A Klassen
- Department of Pediatrics, McMaster University, 3N27, 1280 Main Street West, Hamilton, ON, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, 3N27, 1280 Main Street West, Hamilton, ON, Canada
| | - M A Keays
- Department of Pediatric Surgery, Division of Urology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, Canada.
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Abstract
Over the last several years, there has been increasing recognition of the potential for central nervous system (CNS) recovery after brain damage. One commonality across the recovery and brain plasticity literature is that practice induces plastic, dynamic changes in the CNS. However, more than simply repetition, it is the manipulation of specific practice variables that appears to drive these dynamic processes in the CNS. The experimental manipulations used in the studies on neuroplasticity largely derive from the concept that in the undamaged or healthy brain neuronal connections and cortical maps are continuously remodeled by experience and by the performance of specific, intensive, and complex movements used to solve motor problems and attain goals. Intervention designed to promote recovery rather than compensation after stroke would then manipulate these same practice variables that have consistently promoted behavioral recovery and neuroplasticity in laboratory settings. Three current intervention strategies that incorporate these practice variables are reviewed. Preliminary results provide evidence that manipulation of task intensity and specificity and the sensorimotor experience of the task training are the necessary ingredients for maximizing the tremendous potential for recovery in patients with stroke.
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Affiliation(s)
- B E Fisher
- Department of Neurology, University of Southern California, Los Angeles, California, USA
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