Pub Date : 2024-04-01Epub Date: 2024-05-15DOI: 10.1097/WAD.0000000000000617
Isabella Wood, Ruopu Song, Yingjin Zhang, Erin Jacobsen, Tiffany Hughes, Chung-Chou H Chang, Mary Ganguli
Background: Identifying potentially modifiable risk factors associated with MCI in different ethnoracial groups could reduce MCI burden and health inequity in the population.
Methods: Among 2845 adults aged 65+ years, we investigated potential risk exposures including education, physical and mental health, lifestyle, and sensory function, and their cross-sectional associations with MCI. We compared proportions of exposures between Black and White participants and explored relationships among race, MCI, and exposures. Logistic regression modeled MCI as a function of each exposure in the overall sample adjusting for age, sex, educational level, and race, and investigating race*exposure interactions.
Results: Compared with White participants, Black participants had greater odds of MCI (OR 1.53; 95% CI, 1.13 to 2.06) and were more likely to report depressive symptoms, diabetes, and stroke, to have high blood pressure and BMI, and to be APOE - 4 carriers. Exposures associated with higher odds of MCI were diabetes, stroke, lifetime smoking, sleep disturbances, social isolation, loneliness, depression and anxiety symptoms, and vision and hearing loss. There were no significant interactions between race and any exposure.
Conclusions: Black participants had 53% higher odds of MCI adjusting for age, sex, and education. The same exposures were associated with MCI in Black and White participants.
{"title":"Ethnoracial Identity and Cognitive Impairment: A Community Study.","authors":"Isabella Wood, Ruopu Song, Yingjin Zhang, Erin Jacobsen, Tiffany Hughes, Chung-Chou H Chang, Mary Ganguli","doi":"10.1097/WAD.0000000000000617","DOIUrl":"10.1097/WAD.0000000000000617","url":null,"abstract":"<p><strong>Background: </strong>Identifying potentially modifiable risk factors associated with MCI in different ethnoracial groups could reduce MCI burden and health inequity in the population.</p><p><strong>Methods: </strong>Among 2845 adults aged 65+ years, we investigated potential risk exposures including education, physical and mental health, lifestyle, and sensory function, and their cross-sectional associations with MCI. We compared proportions of exposures between Black and White participants and explored relationships among race, MCI, and exposures. Logistic regression modeled MCI as a function of each exposure in the overall sample adjusting for age, sex, educational level, and race, and investigating race*exposure interactions.</p><p><strong>Results: </strong>Compared with White participants, Black participants had greater odds of MCI (OR 1.53; 95% CI, 1.13 to 2.06) and were more likely to report depressive symptoms, diabetes, and stroke, to have high blood pressure and BMI, and to be APOE - 4 carriers. Exposures associated with higher odds of MCI were diabetes, stroke, lifetime smoking, sleep disturbances, social isolation, loneliness, depression and anxiety symptoms, and vision and hearing loss. There were no significant interactions between race and any exposure.</p><p><strong>Conclusions: </strong>Black participants had 53% higher odds of MCI adjusting for age, sex, and education. The same exposures were associated with MCI in Black and White participants.</p>","PeriodicalId":7679,"journal":{"name":"Alzheimer Disease & Associated Disorders","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140943495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-03-27DOI: 10.1097/WAD.0000000000000612
Mariana L Almeida, Anna M Pederson, Scott C Zimmerman, Ruijia Chen, Sarah Ackley, Alicia Riley, Chloe W Eng, Rachel A Whitmer, Kristen M George, Rachel L Peterson, Elizabeth Rose Mayeda, Paola Gilsanz, Dan M Mungas, Sarah Tomaszewski Farias, M Maria Glymour
Objective: Most prior research on physical activity (PA) and cognition is based on predominantly white cohorts and focused on associations of PA with mean (average) cognition versus the distribution of cognition. Quantile regression offers a novel way to quantify how PA affects cognition across the entire distribution.
Methods: The Kaiser Healthy Aging and Diverse Life Experiences study includes 30% white, 19% black, 25% Asian, and 26% Latinx adults age 65+ living in Northern California (n = 1600). The frequency of light or heavy PA was summarized as 2 continuous variables. Outcomes were z-scored executive function, semantic memory, and verbal episodic memory. We tested associations of PA with mean cognition using linear regression and used quantile regression to estimate the association of PA with the 10th-90th percentiles of cognitive scores.
Results: Higher levels of PA were associated with higher mean semantic memory (b = 0.10; 95% CI: 0.06, 0.14) and executive function (b = 0.05; 95% CI: 0.01, 0.09). Associations of PA across all 3 cognitive domains were stronger at low quantiles of cognition.
Conclusion: PA is associated with cognition in this racially/ethnically diverse sample and may have larger benefits for individuals with low cognitive scores, who are most vulnerable to dementia.
{"title":"The Association Between Physical Activity and Cognition in a Racially/Ethnically Diverse Cohort of Older Adults: Results From the Kaiser Healthy Aging and Diverse Life Experiences Study.","authors":"Mariana L Almeida, Anna M Pederson, Scott C Zimmerman, Ruijia Chen, Sarah Ackley, Alicia Riley, Chloe W Eng, Rachel A Whitmer, Kristen M George, Rachel L Peterson, Elizabeth Rose Mayeda, Paola Gilsanz, Dan M Mungas, Sarah Tomaszewski Farias, M Maria Glymour","doi":"10.1097/WAD.0000000000000612","DOIUrl":"10.1097/WAD.0000000000000612","url":null,"abstract":"<p><strong>Objective: </strong>Most prior research on physical activity (PA) and cognition is based on predominantly white cohorts and focused on associations of PA with mean (average) cognition versus the distribution of cognition. Quantile regression offers a novel way to quantify how PA affects cognition across the entire distribution.</p><p><strong>Methods: </strong>The Kaiser Healthy Aging and Diverse Life Experiences study includes 30% white, 19% black, 25% Asian, and 26% Latinx adults age 65+ living in Northern California (n = 1600). The frequency of light or heavy PA was summarized as 2 continuous variables. Outcomes were z-scored executive function, semantic memory, and verbal episodic memory. We tested associations of PA with mean cognition using linear regression and used quantile regression to estimate the association of PA with the 10th-90th percentiles of cognitive scores.</p><p><strong>Results: </strong>Higher levels of PA were associated with higher mean semantic memory (b = 0.10; 95% CI: 0.06, 0.14) and executive function (b = 0.05; 95% CI: 0.01, 0.09). Associations of PA across all 3 cognitive domains were stronger at low quantiles of cognition.</p><p><strong>Conclusion: </strong>PA is associated with cognition in this racially/ethnically diverse sample and may have larger benefits for individuals with low cognitive scores, who are most vulnerable to dementia.</p>","PeriodicalId":7679,"journal":{"name":"Alzheimer Disease & Associated Disorders","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11141342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140292515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-04-11DOI: 10.1097/WAD.0000000000000613
Emilia Brandt, Anne Koivisto, Pedro Pereira, Ella Mustanoja, Petri Auvinen, Toni Saari, Juha-Matti Lehtola, Sanna Hannonen, Minna Rusanen, Ville Leinonen, Filip Scheperjans, Virve Kärkkäinen
Background: The gut microbiome is a complex system within the human gastrointestinal tract. The bacteria play a significant role in human health, and some can promote inflammation and pathologic processes through chemical interactions or metabolites. Gut microbiome dysbiosis has been linked to some neurological and other diseases. Here we aimed to examine microbiome differences between patients with a progressive neurological disorder, idiopathic normal pressure hydrocephalus (iNPH), compared with healthy controls (CO).
Methods: We recruited 37 neurologically healthy CO and 10 patients with shunted iNPH. We evaluated these participants' cognition using the CERAD-NB test battery and CDR test, and collected a variety of information, including about dietary habits and health. We also collected fecal samples, which were subjected to 16S amplicon sequencing to analyze differences in gut microbiome composition.
Results: We found that the iNPH group exhibited significantly different abundances of 10 bacterial genera compared with the CO group. The Escherichia/Shigella and Anaeromassilibacillus genera were most remarkably increased. Other increased genera were Butyrivibrio , Duncaniella , and an unidentified genus. The decreased genera were Agathobaculum , Paramuribaculum , Catenibacterium , and 2 unidentified genera.
Conclusions: Here we report the first identified microbiome differences in iNPH patients compared with healthy controls.
{"title":"Gut Microbiome Changes in Patients With Idiopathic Normal Pressure Hydrocephalus.","authors":"Emilia Brandt, Anne Koivisto, Pedro Pereira, Ella Mustanoja, Petri Auvinen, Toni Saari, Juha-Matti Lehtola, Sanna Hannonen, Minna Rusanen, Ville Leinonen, Filip Scheperjans, Virve Kärkkäinen","doi":"10.1097/WAD.0000000000000613","DOIUrl":"10.1097/WAD.0000000000000613","url":null,"abstract":"<p><strong>Background: </strong>The gut microbiome is a complex system within the human gastrointestinal tract. The bacteria play a significant role in human health, and some can promote inflammation and pathologic processes through chemical interactions or metabolites. Gut microbiome dysbiosis has been linked to some neurological and other diseases. Here we aimed to examine microbiome differences between patients with a progressive neurological disorder, idiopathic normal pressure hydrocephalus (iNPH), compared with healthy controls (CO).</p><p><strong>Methods: </strong>We recruited 37 neurologically healthy CO and 10 patients with shunted iNPH. We evaluated these participants' cognition using the CERAD-NB test battery and CDR test, and collected a variety of information, including about dietary habits and health. We also collected fecal samples, which were subjected to 16S amplicon sequencing to analyze differences in gut microbiome composition.</p><p><strong>Results: </strong>We found that the iNPH group exhibited significantly different abundances of 10 bacterial genera compared with the CO group. The Escherichia/Shigella and Anaeromassilibacillus genera were most remarkably increased. Other increased genera were Butyrivibrio , Duncaniella , and an unidentified genus. The decreased genera were Agathobaculum , Paramuribaculum , Catenibacterium , and 2 unidentified genera.</p><p><strong>Conclusions: </strong>Here we report the first identified microbiome differences in iNPH patients compared with healthy controls.</p>","PeriodicalId":7679,"journal":{"name":"Alzheimer Disease & Associated Disorders","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Enrolling individuals from underrepresented ethnoracial groups in aging research is often a challenge.
Methods: We sought a diverse sample of older adults from a small-town area for a longitudinal aging study. We employed an intensive community engagement approach encompassing a range of recruitment strategies.
Results: Over 4 years a steady trickle of individuals, 66% self-identifying as Black, signed up for study information; the proportion of those who eventually enroll in the study has been rising each year, from 68% to 94%. Community events, word-of-mouth referrals, and mailed postcards brought in the most contacts. The highest percentage of contacts who ultimately enrolled were from postcards, flyers, and word-of-mouth. Significantly more word-of-mouth referrals were endorsed by Black individuals than White and by Black men than other race/sex groups.
Conclusions: We have had some success in building relationships and trust with the local community, enrolling Black study participants in a proportion equal to their representation in the target community using a variety of recruitment methods. Patience, immersion in the community, and partnerships with key community members alongside traditional advertisements, and the utilization of study participants as recruiters are critical to designing optimal, targeted, recruitment strategies.
{"title":"Recruitment of a Diverse Community-based Older Adult Cohort for a Longitudinal Aging Study: The 15104 Seniors Project.","authors":"Erin Jacobsen, Heather Lucas, Catherine Moran, Reverend Gloria Dixon, Mary Ganguli","doi":"10.1097/WAD.0000000000000618","DOIUrl":"10.1097/WAD.0000000000000618","url":null,"abstract":"<p><strong>Introduction: </strong>Enrolling individuals from underrepresented ethnoracial groups in aging research is often a challenge.</p><p><strong>Methods: </strong>We sought a diverse sample of older adults from a small-town area for a longitudinal aging study. We employed an intensive community engagement approach encompassing a range of recruitment strategies.</p><p><strong>Results: </strong>Over 4 years a steady trickle of individuals, 66% self-identifying as Black, signed up for study information; the proportion of those who eventually enroll in the study has been rising each year, from 68% to 94%. Community events, word-of-mouth referrals, and mailed postcards brought in the most contacts. The highest percentage of contacts who ultimately enrolled were from postcards, flyers, and word-of-mouth. Significantly more word-of-mouth referrals were endorsed by Black individuals than White and by Black men than other race/sex groups.</p><p><strong>Conclusions: </strong>We have had some success in building relationships and trust with the local community, enrolling Black study participants in a proportion equal to their representation in the target community using a variety of recruitment methods. Patience, immersion in the community, and partnerships with key community members alongside traditional advertisements, and the utilization of study participants as recruiters are critical to designing optimal, targeted, recruitment strategies.</p>","PeriodicalId":7679,"journal":{"name":"Alzheimer Disease & Associated Disorders","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11178142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140943599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-04-23DOI: 10.1097/WAD.0000000000000616
Liza L Behrens, Hannah L Anderson, Kaléi H Kowalchik, Jacqueline Mogle, Joanne Roman Jones, Kimberly Van Haitsma, Nancy Hodgson, Marie Boltz
Background: Persons living with Alzheimer disease and related dementia (ADRD) in nursing homes (NH) are often excluded from conversations about their health/safety. These omissions impinge on personhood and the rights to have care preferences heard and honored. While persons with ADRD maintain the ability to communicate their preferences long after their decision-making abilities are affected, little is known about how persons with ADRD understand the risks associated with their preferences.
Methods: As part of a larger focused ethnography, in-depth interviews and an adapted risk propensity questionnaire explored the risk perceptions of NH residents with ADRD (N=7) associated with their preferences for care and activities of daily living.
Results: Residents generally self-identified as risk avoiders ( M =3.2±1.84) on the risk propensity scale and were able to rate risk associated with preferences described within 5 thematic categories: 1) participation in decision-making, 2) risk awareness, 3) paying attention to safety, 4) reliance on nursing home staff and family, and 5) impacts on quality of life and quality of care.
Discussion: Results suggest NH residents with ADRD can express risk surrounding their preferences and should be encouraged to participate in discussions about their health and safety.
{"title":"\" I'm not a risk taker \" : Risk Perceptions of Nursing Home Residents With Dementia.","authors":"Liza L Behrens, Hannah L Anderson, Kaléi H Kowalchik, Jacqueline Mogle, Joanne Roman Jones, Kimberly Van Haitsma, Nancy Hodgson, Marie Boltz","doi":"10.1097/WAD.0000000000000616","DOIUrl":"10.1097/WAD.0000000000000616","url":null,"abstract":"<p><strong>Background: </strong>Persons living with Alzheimer disease and related dementia (ADRD) in nursing homes (NH) are often excluded from conversations about their health/safety. These omissions impinge on personhood and the rights to have care preferences heard and honored. While persons with ADRD maintain the ability to communicate their preferences long after their decision-making abilities are affected, little is known about how persons with ADRD understand the risks associated with their preferences.</p><p><strong>Methods: </strong>As part of a larger focused ethnography, in-depth interviews and an adapted risk propensity questionnaire explored the risk perceptions of NH residents with ADRD (N=7) associated with their preferences for care and activities of daily living.</p><p><strong>Results: </strong>Residents generally self-identified as risk avoiders ( M =3.2±1.84) on the risk propensity scale and were able to rate risk associated with preferences described within 5 thematic categories: 1) participation in decision-making, 2) risk awareness, 3) paying attention to safety, 4) reliance on nursing home staff and family, and 5) impacts on quality of life and quality of care.</p><p><strong>Discussion: </strong>Results suggest NH residents with ADRD can express risk surrounding their preferences and should be encouraged to participate in discussions about their health and safety.</p>","PeriodicalId":7679,"journal":{"name":"Alzheimer Disease & Associated Disorders","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11141213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140846860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-05-16DOI: 10.1097/WAD.0000000000000624
Daphna Shefet, Ido Lurie
Objective: The aim of this study was to test whether patients are better oriented to the day on the first working day following the weekend (in Israel-Sunday), compared with other weekdays, on the Mini-Mental Score Examination (MMSE).
Methods: All MMSE scores from November 2016 until December 2022 in our mental health center's computerized system were collected. The proportion of correct answers to orientation to the day was compared between weekdays.
Results: The cohort consisted of 2049 MMSEs taken by 1376 patients [average age 80.3 (SD=9.3), 56.4% female]. The difference between the proportion of correct and incorrect answers was statistically significant between the days, of which Sundays showed a larger difference (53.4%) compared with the other days (χ 2 =20.77, P <0.001, Cramer V =0.104). A statistically significant odds ratio (OR) for providing a correct response was found for Sundays (OR=1.55, P =0.001) and, to a lesser extent, on Thursdays (OR=1.29, P =0.01). The difference between Sundays and other weekdays disappears as the total MMSE decreases.
Conclusion: Day orientation on the MMSE may be better on the first day following the weekend, especially in early cognitive decline.
Clinical implications: The weekday in which the MMSE is performed may influence its results.
{"title":"Not All Days Were Created Equal-Better Day Orientation Following the Weekend on Mini-Mental State Examination (MMSE).","authors":"Daphna Shefet, Ido Lurie","doi":"10.1097/WAD.0000000000000624","DOIUrl":"10.1097/WAD.0000000000000624","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to test whether patients are better oriented to the day on the first working day following the weekend (in Israel-Sunday), compared with other weekdays, on the Mini-Mental Score Examination (MMSE).</p><p><strong>Methods: </strong>All MMSE scores from November 2016 until December 2022 in our mental health center's computerized system were collected. The proportion of correct answers to orientation to the day was compared between weekdays.</p><p><strong>Results: </strong>The cohort consisted of 2049 MMSEs taken by 1376 patients [average age 80.3 (SD=9.3), 56.4% female]. The difference between the proportion of correct and incorrect answers was statistically significant between the days, of which Sundays showed a larger difference (53.4%) compared with the other days (χ 2 =20.77, P <0.001, Cramer V =0.104). A statistically significant odds ratio (OR) for providing a correct response was found for Sundays (OR=1.55, P =0.001) and, to a lesser extent, on Thursdays (OR=1.29, P =0.01). The difference between Sundays and other weekdays disappears as the total MMSE decreases.</p><p><strong>Conclusion: </strong>Day orientation on the MMSE may be better on the first day following the weekend, especially in early cognitive decline.</p><p><strong>Clinical implications: </strong>The weekday in which the MMSE is performed may influence its results.</p>","PeriodicalId":7679,"journal":{"name":"Alzheimer Disease & Associated Disorders","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140943595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-04-02DOI: 10.1097/WAD.0000000000000614
Na-Yeon Jung, Yuri Je, Hong-Gi Ham, Yu Hyun Park, Tae-Yun Kim, Min-Su Go, Hye-In Lee, Da Eun Kim, Myung Jun Lee, Sang Won Seo, Eun-Joo Kim
We examined whether there were differences in the presence of centrum semiovale-enlarged perivascular spaces (CSO-ePVS) and basal ganglia-ePVS (BG-ePVS) among patients with Alzheimer disease-related cognitive impairment (ADCI) based on their age of onset. Out of a total of 239 patients with cognitive impairment, 155 with positive amyloid-PET results were included. Among these, 43 had early-onset ADCI (EOADCI) and 112 had late-onset ADCI (LOADCI). Patients with LOADCI exhibited a higher prevalence of hypertension, lacunes, white matter hyperintensities, and BG-ePVS than those with EOADCI. BG-ePVS showed a significant correlation with age at the onset and the number of lacunes, whereas CSO-ePVS did not exhibit any association. The higher prevalence of BG-ePVS in patients with LOADCI might be attributable to vascular risk factors (hypertension) and cerebral small vessel disease (CSVD). These findings support the hypothesis that BG-ePVS is associated with CSVD and vascular risk factors, whereas CSO-ePVS is associated with cerebral amyloid angiopathy.
{"title":"Comparison of Enlarged Perivascular Spaces in Early-Onset and Late-Onset Alzheimer Disease-related Cognitive Impairment: A Single Clinic-based Study in South Korea.","authors":"Na-Yeon Jung, Yuri Je, Hong-Gi Ham, Yu Hyun Park, Tae-Yun Kim, Min-Su Go, Hye-In Lee, Da Eun Kim, Myung Jun Lee, Sang Won Seo, Eun-Joo Kim","doi":"10.1097/WAD.0000000000000614","DOIUrl":"10.1097/WAD.0000000000000614","url":null,"abstract":"<p><p>We examined whether there were differences in the presence of centrum semiovale-enlarged perivascular spaces (CSO-ePVS) and basal ganglia-ePVS (BG-ePVS) among patients with Alzheimer disease-related cognitive impairment (ADCI) based on their age of onset. Out of a total of 239 patients with cognitive impairment, 155 with positive amyloid-PET results were included. Among these, 43 had early-onset ADCI (EOADCI) and 112 had late-onset ADCI (LOADCI). Patients with LOADCI exhibited a higher prevalence of hypertension, lacunes, white matter hyperintensities, and BG-ePVS than those with EOADCI. BG-ePVS showed a significant correlation with age at the onset and the number of lacunes, whereas CSO-ePVS did not exhibit any association. The higher prevalence of BG-ePVS in patients with LOADCI might be attributable to vascular risk factors (hypertension) and cerebral small vessel disease (CSVD). These findings support the hypothesis that BG-ePVS is associated with CSVD and vascular risk factors, whereas CSO-ePVS is associated with cerebral amyloid angiopathy.</p>","PeriodicalId":7679,"journal":{"name":"Alzheimer Disease & Associated Disorders","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-05-17DOI: 10.1097/WAD.0000000000000621
Lauren R Bangerter, Joan M Griffin, Kyungmin Kim, Dawn M Finnie, Maria I Lapid, Joseph E Gaugler, Virginia S Biggar, Theresa Frangiosa
Purpose: Lucid episodes (LEs: unexpected episodes of spontaneous, meaningful, and relevant communication or behavior) in Alzheimer disease and related dementias are a new area of scientific inquiry that lacks clinical consensus and require more conceptual attention.
Methods: We aimed to measure consensus from an expert group on: (1) potential medical or clinical explanations for LEs; (2) necessary medical and clinical context to LEs; and (3) interpretation of LEs.
Patients: We convened 13 experts from different disciplines (neurology, psychiatry, psychology, pharmacy, palliative care, hospice, nursing, social work, primary care, geriatrics, and professional home caregivers) to identify elements of LEs.
Results: Experts provided a range of opinions on medical and clinical explanations and questions to understand LEs. Consensus on LEs when presented with clinical vignettes was not reached. Panelists highlighted key medical and contextual factors needed to make a definitive judgement about LEs.
Conclusion: There is variability in how LEs are interpreted by clinical experts, which complicates the identification of LEs in Alzheimer disease and related dementias.
目的:阿尔茨海默病和相关痴呆症的 "朦胧发作"(LEs:自发的、有意义的、相关的交流或行为的意外发作)是科学研究的一个新领域,但缺乏临床共识,需要在概念上给予更多关注:我们旨在衡量专家组在以下方面的共识:(1)LEs 的潜在医学或临床解释;(2)LEs 的必要医学和临床背景;以及(3)LEs 的解释:我们召集了来自不同学科(神经病学、精神病学、心理学、药学、姑息治疗、临终关怀、护理、社会工作、初级保健、老年病学和专业家庭护理人员)的 13 位专家,以确定 LEs 的要素:结果:专家们就医学和临床解释以及理解LEs的问题提出了各种意见。在展示临床案例时,专家们未能就低风险因素达成共识。专家组成员强调了对 LE 做出明确判断所需的关键医学和背景因素:结论:临床专家对LE的解释存在差异,这使得阿尔茨海默病和相关痴呆症中LE的识别变得复杂。
{"title":"A Delphi Approach to Define Lucid Episodes in People Living With Dementia.","authors":"Lauren R Bangerter, Joan M Griffin, Kyungmin Kim, Dawn M Finnie, Maria I Lapid, Joseph E Gaugler, Virginia S Biggar, Theresa Frangiosa","doi":"10.1097/WAD.0000000000000621","DOIUrl":"10.1097/WAD.0000000000000621","url":null,"abstract":"<p><strong>Purpose: </strong>Lucid episodes (LEs: unexpected episodes of spontaneous, meaningful, and relevant communication or behavior) in Alzheimer disease and related dementias are a new area of scientific inquiry that lacks clinical consensus and require more conceptual attention.</p><p><strong>Methods: </strong>We aimed to measure consensus from an expert group on: (1) potential medical or clinical explanations for LEs; (2) necessary medical and clinical context to LEs; and (3) interpretation of LEs.</p><p><strong>Patients: </strong>We convened 13 experts from different disciplines (neurology, psychiatry, psychology, pharmacy, palliative care, hospice, nursing, social work, primary care, geriatrics, and professional home caregivers) to identify elements of LEs.</p><p><strong>Results: </strong>Experts provided a range of opinions on medical and clinical explanations and questions to understand LEs. Consensus on LEs when presented with clinical vignettes was not reached. Panelists highlighted key medical and contextual factors needed to make a definitive judgement about LEs.</p><p><strong>Conclusion: </strong>There is variability in how LEs are interpreted by clinical experts, which complicates the identification of LEs in Alzheimer disease and related dementias.</p>","PeriodicalId":7679,"journal":{"name":"Alzheimer Disease & Associated Disorders","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-05-17DOI: 10.1097/WAD.0000000000000619
Houjun Liu, Alyssa M Weakley, Jiawei Zhang, Xin Liu
Introduction: Early classification and prediction of Alzheimer disease (AD) and amnestic mild cognitive impairment (aMCI) with noninvasive approaches is a long-standing challenge. This challenge is further exacerbated by the sparsity of data needed for modeling. Deep learning methods offer a novel method to help address these challenging multiclass classification and prediction problems.
Methods: We analyzed 3 target feature-sets from the National Alzheimer Coordinating Center (NACC) dataset: (1) neuropsychological (cognitive) data; (2) patient health history data; and (3) the combination of both sets. We used a masked Transformer-encoder without further feature selection to classify the samples on cognitive status (no cognitive impairment, aMCI, AD)-dynamically ignoring unavailable features. We then fine-tuned the model to predict the participants' future diagnosis in 1 to 3 years. We analyzed the sensitivity of the model to input features via Feature Permutation Importance.
Results: We demonstrated (1) the masked Transformer-encoder was able to perform prediction with sparse input data; (2) high multiclass current cognitive status classification accuracy (87% control, 79% aMCI, 89% AD); (3) acceptable results for 1- to 3-year multiclass future cognitive status prediction (83% control, 77% aMCI, 91% AD).
Conclusion: The flexibility of our methods in handling inconsistent data provides a new venue for the analysis of cognitive status data.
{"title":"A Transformer Approach for Cognitive Impairment Classification and Prediction.","authors":"Houjun Liu, Alyssa M Weakley, Jiawei Zhang, Xin Liu","doi":"10.1097/WAD.0000000000000619","DOIUrl":"10.1097/WAD.0000000000000619","url":null,"abstract":"<p><strong>Introduction: </strong>Early classification and prediction of Alzheimer disease (AD) and amnestic mild cognitive impairment (aMCI) with noninvasive approaches is a long-standing challenge. This challenge is further exacerbated by the sparsity of data needed for modeling. Deep learning methods offer a novel method to help address these challenging multiclass classification and prediction problems.</p><p><strong>Methods: </strong>We analyzed 3 target feature-sets from the National Alzheimer Coordinating Center (NACC) dataset: (1) neuropsychological (cognitive) data; (2) patient health history data; and (3) the combination of both sets. We used a masked Transformer-encoder without further feature selection to classify the samples on cognitive status (no cognitive impairment, aMCI, AD)-dynamically ignoring unavailable features. We then fine-tuned the model to predict the participants' future diagnosis in 1 to 3 years. We analyzed the sensitivity of the model to input features via Feature Permutation Importance.</p><p><strong>Results: </strong>We demonstrated (1) the masked Transformer-encoder was able to perform prediction with sparse input data; (2) high multiclass current cognitive status classification accuracy (87% control, 79% aMCI, 89% AD); (3) acceptable results for 1- to 3-year multiclass future cognitive status prediction (83% control, 77% aMCI, 91% AD).</p><p><strong>Conclusion: </strong>The flexibility of our methods in handling inconsistent data provides a new venue for the analysis of cognitive status data.</p>","PeriodicalId":7679,"journal":{"name":"Alzheimer Disease & Associated Disorders","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-04-15DOI: 10.1097/WAD.0000000000000611
Jane Stocks, Erin Gibson, Karteek Popuri, Mirza F Beg, Howard Rosen, Lei Wang
Purpose: Individuals with behavioral-variant frontotemporal dementia (bvFTD) show changes in brain structure as assessed by MRI and brain function assessed by 18FDG-PET hypometabolism. However, current understanding of the spatial and temporal interplay between these measures remains limited.
Methods: Here, we examined longitudinal atrophy and hypometabolism relationships in 15 bvFTD subjects with 2 to 4 follow-up MRI and PET scans (56 visits total). Subject-specific slopes of atrophy and hypometabolism over time were extracted across brain regions and correlated with baseline measures both locally, via Pearson correlations, and nonlocally, via sparse canonical correlation analyses (SCCA).
Results: Notably, we identified a robust link between initial hypometabolism and subsequent cortical atrophy rate changes in bvFTD subjects. Network-level exploration unveiled alignment between baseline hypometabolism and ensuing atrophy rates in the dorsal attention, language, and default mode networks. SCCA identified 2 significant and highly localized components depicting the connection between baseline hypometabolism and atrophy slope over time. The first centered around bilateral orbitofrontal, frontopolar, and medial prefrontal lobes, whereas the second concentrated in the left temporal lobe and precuneus.
Conclusions: This study highlights 18FDG-PET as a dependable predictor of forthcoming atrophy in spatially adjacent brain regions for individuals with bvFTD.
{"title":"Spatial and Temporal Relationships Between Atrophy and Hypometabolism in Behavioral-Variant Frontotemporal Dementia.","authors":"Jane Stocks, Erin Gibson, Karteek Popuri, Mirza F Beg, Howard Rosen, Lei Wang","doi":"10.1097/WAD.0000000000000611","DOIUrl":"10.1097/WAD.0000000000000611","url":null,"abstract":"<p><strong>Purpose: </strong>Individuals with behavioral-variant frontotemporal dementia (bvFTD) show changes in brain structure as assessed by MRI and brain function assessed by 18FDG-PET hypometabolism. However, current understanding of the spatial and temporal interplay between these measures remains limited.</p><p><strong>Methods: </strong>Here, we examined longitudinal atrophy and hypometabolism relationships in 15 bvFTD subjects with 2 to 4 follow-up MRI and PET scans (56 visits total). Subject-specific slopes of atrophy and hypometabolism over time were extracted across brain regions and correlated with baseline measures both locally, via Pearson correlations, and nonlocally, via sparse canonical correlation analyses (SCCA).</p><p><strong>Results: </strong>Notably, we identified a robust link between initial hypometabolism and subsequent cortical atrophy rate changes in bvFTD subjects. Network-level exploration unveiled alignment between baseline hypometabolism and ensuing atrophy rates in the dorsal attention, language, and default mode networks. SCCA identified 2 significant and highly localized components depicting the connection between baseline hypometabolism and atrophy slope over time. The first centered around bilateral orbitofrontal, frontopolar, and medial prefrontal lobes, whereas the second concentrated in the left temporal lobe and precuneus.</p><p><strong>Conclusions: </strong>This study highlights 18FDG-PET as a dependable predictor of forthcoming atrophy in spatially adjacent brain regions for individuals with bvFTD.</p>","PeriodicalId":7679,"journal":{"name":"Alzheimer Disease & Associated Disorders","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11141524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}