Journal of Alzheimer's Disease - Volume 82, issue 2

Authors: Zilli, Eduardo Marques | O’Donnell, Adrienne | Salinas, Joel | Aparicio, Hugo J. | Gonzales, Mitzi Michelle | Jacob, Mini | Beiser, Alexa | Seshadri, Sudha

Article Type: Research Article

Abstract: Background: An association between chronic infectious diseases and development of dementia has been suspected for decades, based on the finding of pathogens in postmortem brain tissue and on serological evidence. However, questions remain regarding confounders, reverse causality, and how accurate, reproducible and generalizable those findings are. Objective: Investigate whether exposure to Herpes simplex (manifested as herpes labialis), Chlamydophila pneumoniae (C. pneumoniae), Helicobacter pylori (H. pylori) , and cytomegalovirus (CMV) modifies the risk of dementia in a populational cohort. Methods: Questionnaires regarding incidence of herpes infections were administered to Original Framingham Study participants (n  = 2,632). Serologies …for C. pneumoniae, H. pylori , and CMV were obtained in Original (n  = 2,351) and Offspring cohort (n  = 3,687) participants. Participants are under continuous dementia surveillance. Brain MRI and neuropsychological batteries were administered to Offspring participants from 1999–2005. The association between each infection and incident dementia was tested with Cox models. Linear models were used to investigate associations between MRI or neuropsychological parameters and serologies. Results: There was no association between infection serologies and dementia incidence, total brain volume, and white matter hyperintensities. Herpes labialis was associated with reduced 10-year dementia risk (HR 0.66, CI 0.46–0.97), but not for the duration of follow-up. H. pylori antibodies were associated with worse global cognition (β –0.14, CI –0.22, –0.05). Conclusion: We found no association between measures of chronic infection and incident dementia, except for a reduction in 10-year dementia risk for patients with herpes labialis. This unexpected result requires confirmation and further characterization, concerning antiviral treatment effects and capture of episodes. Show more

Keywords: Alzheimer’s disease, dementia, Framingham, herpes labialis, viral infections

DOI: 10.3233/JAD-200957

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 593-605, 2021

Authors: Rasu, Rafia S. | Shrestha, Nistha | Karpes Matusevich, Aliza R. | Zalmai, Rana | Large, Stephanie | Johnson, Leigh | O’Bryant, Sid E.

Article Type: Research Article

Abstract: Background: Polypharmacy (using≥5 medications) is associated with poor health outcomes. Mixed results from past studies surrounding chronic medication use, control of chronic conditions, and their effects on cognitive performance warrant further attention. Objective: Investigate a link between polypharmacy and cognition function in rural-dwelling adults in Texas, USA. Methods: Project FRONTIER (Facing Rural Obstacles to Healthcare Now Through Intervention, Education & Research) is a cross-sectional epidemiological study using community-based participatory research in three counties of Texas. Residents age > 40 were eligible for inclusion. The primary outcome is cognitive impairment, and exposures of interest are polypharmacy; comorbidities; and diabetes, …hypertension, and depression medication. Logistic regression was used to assess association. Results: Six hundred eighty-nine individuals participated; the mean age was 61, and the majority were female (68.7%).The median number of medications taken by participants was 3.3 (IQR: 0–5); the rate of polypharmacy was 29.6%. Anti-hypertensive agents were the most common medications (15%) used. Polypharmacy users were 2.84 times more likely to have cognitive impairment [OR: 2.84, 95%CI (1.32–6.09)] than those using < 5 medications. Participants on hypertensive medications had 1.85 times higher odds [OR: 1.85, 95%CI (1.14–3.01)] of having cognitive impairment than those who did not have cognitive impairment. Conclusion: Polypharmacy increases the odds of cognitive impairment. The odds of presenting with cognitive impairment increased as the number of medications increased. Additionally, we identified a large, concerning number of participants with pharmacotherapy and poor chronic disease management. A larger study should examine medication adherence among rural elders to manage chronic disease and any healthcare barriers to adherence. Show more

Keywords: Antidepressants, antidiabetics, antihypertensive, cognitive impairment, cognition performance, dementia, medications, polypharmacy

DOI: 10.3233/JAD-200951

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 607-619, 2021

Authors: Xiao, Tian | Wijnant, Sara R.A. | Licher, Silvan | Terzikhan, Natalie | Lahousse, Lies | Ikram, M. Kamran | Brusselle, Guy G. | Ikram, M. Arfan

Article Type: Research Article

Abstract: Background: The etiology of dementia may partly be underpinned by impaired lung function via systemic inflammation and hypoxia. Objective: To prospectively examine the association between chronic obstructive pulmonary disease (COPD) and subclinical impairments in lung function and the risk of dementia. Methods: In the Rotterdam Study, we assessed the risk of incident dementia in participants with Preserved Ratio Impaired Spirometry (PRISm; FEV1 /FVC≥0.7, FEV1  < 80% predicted) and in participants with COPD (FEV1 /FVC < 0.7) compared to those with normal spirometry (controls; FEV1 /FVC≥0.7, FEV1 ≥80% predicted). Hazard ratios (HRs) with 95% confidence intervals (CI) for dementia were …adjusted for age, sex, education attainment, smoking status, systolic blood pressure, body mass index, triglycerides, comorbidities and Apolipoprotein E (APOE) genotype. Results: Of 4,765 participants, 110 (2.3%) developed dementia after 3.3 years. Compared to controls, participants with PRISm, but not COPD, had an increased risk for all-type dementia (adjusted HRPRISm 2.70; 95% CI, 1.53–4.75; adjusted HRCOPD 1.03; 95% CI, 0.61–1.74). These findings were primarily driven by men and smokers. Similarly, participants with FVC% predicted values in the lowest quartile compared to those in the highest quartile were at increased risk of all-type dementia (adjusted HR 2.28; 95% CI, 1.31–3.98), as well as Alzheimer’s disease (AD; adjusted HR 2.13; 95% CI, 1.13–4.02). Conclusion: Participants with PRISm or a low FVC% predicted lung function were at increased risk of dementia, compared to those with normal spirometry or a higher FVC% predicted, respectively. Further research is needed to elucidate whether this association is causal and how PRISm might contribute to dementia pathogenesis. Show more

Keywords: Alzheimer’s disease, chronic obstructive pulmonary disease, dementia, forced vital capacity (FVC), preserved ratio impaired spirometry

DOI: 10.3233/JAD-210162

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 621-630, 2021

Authors: Wei, Wei | Liu, Yinghua | Dai, Chun-Ling | Baazaoui, Narjes | Tung, Yunn Chyn | Liu, Fei | Iqbal, Khalid

Article Type: Research Article

Abstract: Background: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by impairments in synaptic plasticity and cognitive performance. Cognitive dysfunction and loss of neuronal plasticity are known to begin decades before the clinical diagnosis of the disease. The important influence of congenital genetic mutations on the early development of AD provides a novel opportunity to initiate treatment during early development to prevent the Alzheimer-like behavior and synaptic dysfunction. Objective: To explore strategies for early intervention to prevent Alzheimer’s disease. Methods: In the present study, we investigated the effect of treatment during early development with a ciliary …neurotrophic factor (CNTF) derived peptidergic compound, P021 (Ac-DGGLA G-NH2) on cognitive function and synaptic plasticity in 3xTg-AD transgenic mouse model of AD. 3xTg-AD and genetic background-matched wild type female mice were treated from birth to postnatal day 120 with P021 in diet or as a control with vehicle diet, and cognitive function and molecular markers of neuroplasticity were evaluated. Results: P021 treatment during early development prevented cognitive impairment and increased expressions of pCREB and BDNF that activated downstream various signaling cascades such as PLC/PKC, MEK/ERK and PI3K/Akt, and ameliorated synaptic protein deficit in 4-month-old 3xTg-AD mice. Conclusion: These findings indicate that treatment with the neurotrophic peptide mimetic such as P021 during early development can be an effective therapeutic strategy to rescue synaptic deficit and cognitive impairment in familial AD and related tauopathies. Show more

Keywords: Alzheimer’s disease, brain-derived neurotrophic factor, ciliary neurotrophic factor, cognition, neurotrophin, synaptic plasticity

DOI: 10.3233/JAD-201599

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 631-646, 2021

Authors: Karanth, Shama D. | Schmitt, Frederick A. | Nelson, Peter T. | Katsumata, Yuriko | Kryscio, Richard J. | Fardo, David W. | Harp, Jordan P. | Abner, Erin L.

Article Type: Research Article

Abstract: Background: Late-life cognitive function is heterogeneous, ranging from no decline to severe dementia. Prior studies of cognitive trajectories have tended to focus on a single measure of global cognition or individual tests scores, rather than considering longitudinal performance on multiple tests simultaneously. Objective: The current study aimed to examine cognitive trajectories from two independent datasets to assess whether similar patterns might describe longitudinal cognition in the decade preceding death, as well as what participant characteristics were associated with trajectory membership. Methods: Data were drawn from autopsied longitudinally followed participants of two cohorts (total N  = 1,346), community-based …cohort at the University of Kentucky Alzheimer’s Disease Research Center (n  = 365) and National Alzheimer’s Coordinating Center (n  = 981). We used group-based multi-trajectory models (GBMTM) to identify cognitive trajectories over the decade before death using Mini-Mental State Exam, Logical Memory-Immediate, and Animal Naming performance. Multinomial logistic and Random Forest analyses assessed characteristics associated with trajectory groups. Results: GBMTM identified four similar cognitive trajectories in each dataset. In multinomial models, death age, Braak neurofibrillary tangles (NFT) stage, TDP-43, and α-synuclein were associated with declining trajectories. Random Forest results suggested the most important trajectory predictors were Braak NFT stage, cerebral atrophy, death age, and brain weight. Multiple pathologies were most common in trajectories with moderate or accelerated decline. Conclusion: Cognitive trajectories associated strongly with neuropathology, particularly Braak NFT stage. High frequency of multiple pathologies in trajectories with cognitive decline suggests dementia treatment and prevention efforts must consider multiple diseases simultaneously. Show more

Keywords: Cognitive decline, dementia, neurodegenerative disorders, neuropsychological tests, trajectories

DOI: 10.3233/JAD-210293

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 647-659, 2021

Authors: Babić Leko, Mirjana | Jurasović, Jasna | Nikolac Perković, Matea | Španić, Ena | Sekovanić, Ankica | Orct, Tatjana | Lukinović Škudar, Vesna | Bačić Baronica, Koraljka | Kiđemet-Piskač, Spomenka | Vogrinc, Željka | Pivac, Nela | Borovečki, Fran | Hof, Patrick R. | Šimić, Goran

Article Type: Research Article

Abstract: Background: The major confirmed genetic risk factor for late-onset, sporadic Alzheimer’s disease (AD) is variant ɛ4 of apolipoprotein E gene (APOE ). It is proposed that ApoE, a protein involved in transport of cholesterol to neurons can cause neurodegeneration in AD through interaction with metals. Previous studies mostly associated copper, iron, zinc, and calcium with ApoE4-mediated toxicity. Objective: To test the association of essential metals with APOE genotype. Methods: We compared plasma and cerebrospinal fluid (CSF) levels of copper, zinc, iron, sodium, magnesium, calcium, cobalt, molybdenum, manganese, boron, and chromium, and CSF ferritin levels among …AD, mild cognitive impairment (MCI) patients, and healthy controls (HC) with different APOE genotype. Results: Sodium, copper, and magnesium levels were increased in carriers of ɛ4 allele. Additionally, the increase in sodium, calcium and cobalt plasma levels was observed in carriers of ɛ4/ɛx genotype. The decrease in boron plasma levels was observed in carriers of ɛ4 allele and ɛ4/ɛ4 genotype. Additionally, CSF zinc levels as well as plasma sodium levels were increased in AD patients compared to HC. Conclusion: These results indicate that the molecular underpinnings of association of essential metals and metalloids with APOE should be further tested and clarified in vivo and in vitro . Show more

Keywords: Alzheimer’s disease, apolipoprotein E, copper, metals, mild cognitive impairment, zinc

DOI: 10.3233/JAD-210158

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 661-672, 2021

Authors: Ponvel, Pavapriya | Shahar, Suzana | Singh, Devinder Kaur Ajit | Ludin, Arimi Fitri Mat | Rajikan, Roslee | Rajab, Nor Fadilah | Ai-Vyrn, Chin | Din, Normah Che | Ibrahim, Norhayati | Subramaniam, Ponnusamy | Haron, Hasnah | Ismail, Aniza | Sharif, Razinah | Ramasamy, Kalavathy | Majeed, Abu Bakar Abdul | Ali, Nazlena Mohamad | Mohamad, Mazlyfarina | Noah, Shahrul Azman Mohd | Ibrahim, Azianah Mohd | Safien, Aisyah Mohd | Khalid, Norhayati Mustafa | Fadzil, Nurul Hidayah Md | Mangialasche, Francesca | Kivipelto, Miia

Article Type: Research Article

Abstract: Background: Cognitive frailty (CF) is identified as one of the main precursors of dementia. Multidomain intervention has been found to delay or prevent the onset of CF. Objective: The aim of our present study is to determine the effectiveness of a comprehensive, multidomain intervention on CF; to evaluate its cost effectiveness and the factors influencing adherence toward this intensive intervention. Methods: A total of 1,000 community dwelling older adults, aged 60 years and above will be screened for CF. This randomized controlled trial involves recruitment of 330 older adults with CF from urban, semi-urban, and rural …areas in Malaysia. Multidomain intervention comprised of physical, nutritional, cognitive, and psychosocial aspects will be provided to participants in the experimental group (n  = 165). The control group (n  = 165) will continue their usual care with their physician. Primary outcomes include CF status, physical function, psychosocial and nutritional status as well as cognitive performance. Vascular health and gut microbiome will be assessed using blood and stool samples. A 24-month intensive intervention will be prescribed to the participants and its sustainability will be assessed for the following 12 months. The effective intervention strategies will be integrated as a personalized telerehabilitation package for the reversal of CF for future use. Results: The multidomain intervention developed from this trial is expected to be cost effective compared to usual care as well as able is to reverse CF. Conclusion: This project will be part of the World-Wide FINGERS (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) Network, of which common identifiable data will be shared and harmonized among the consortia. Show more

Keywords: Cognitive frailty, multidomain intervention, older adults, randomized control trial, reversal

DOI: 10.3233/JAD-201607

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 673-687, 2021

Authors: Sun, Xiaoyan | Dong, Chuanhui | Levin, Bonnie E. | Caunca, Michelle | Zeki Al Hazzourie, Adina | DeRosa, Janet T. | Stern, Yaakov | Cheung, Ying Kuen | Elkind, Mitchell S.V. | Rundek, Tatjana | Wright, Clinton B. | Sacco, Ralph L.

Article Type: Research Article

Abstract: Background: Increasing evidence suggests that hypertension is a risk factor for cognitive impairment and dementia. The relationship between blood pressure and cognition in a racially and ethnically diverse population remains unclear. Objective: To study association of blood pressure with cognition cross-sectionally and longitudinally in the elderly. Methods: Participants are stroke-free individuals from the racially and ethnically diverse Northern Manhattan Study (NOMAS) (n  = 1215). General linear models are constructed to examine blood pressure in relation to cognition cross-sectionally and longitudinally at a five-year follow-up. Results: We found a cross-sectional association of systolic blood pressure (SBP) …with word fluency/semantic memory, executive function, and processing speed/visual motor integration (VMI) function. This association was independent of demographics, vascular risk factors, white matter hyperintensity volume (WMHV), and carotid intima-media thickness (cIMT). The cross-sectional association of SBP with processing speed/VMI and executive function was attenuated after adjusting anti-hypertension medications in the models. Baseline SBP was associated with the change of processing speed/VMI function after adjusting vascular risk factors, WMHV, and cIMT at a 5-year follow-up. This longitudinal association was not found after adjusting anti-hypertension medications in the models. Further analyses revealed that individuals with category SBP from < 120 mmHg to≥140 mmHg had a linear decline in processing speed/VMI function at a 5-year follow-up. Conclusion: We show that SBP is negatively associated with cognition cross-sectionally and longitudinally in the elderly. Anti-hypertension treatment eliminates the negative association of SBP with processing speed/VMI function longitudinally. Our findings support the treatment of stage 1 systolic hypertension in the elderly. Show more

Keywords: Cognition, northern manhattan study (NOMAS), race/ethnicity, systolic blood pressure

DOI: 10.3233/JAD-210252

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 689-699, 2021

Authors: Makino, Taeko | Umegaki, Hiroyuki | Ando, Masahiko | Cheng, Xian Wu | Ishida, Koji | Akima, Hiroshi | Oshida, Yoshiharu | Yoshida, Yasuko | Uemura, Kazuki | Shimada, Hiroyuki | Kuzuya, Masafumi

Article Type: Research Article

Abstract: Background: Physical exercise is suggested to be effective for preventing cognitive decline in older adults, but the relative efficacy of different types of exercise have yet to be clarified. Objective: This single-blinded randomized controlled trial was designed to investigate the differential effects of aerobic exercise training (AT), resistance exercise training (RT), and combined exercise training (CT) on cognition in older adults with subjective memory complaints (SMC). Methods: Community-dwelling older adults with SMC (n  = 415; mean age = 72.3 years old) were randomly assigned to one of the four groups: AT, RT, CT, or control group. The study consisted …of two phases: a 26-week intervention and a 26-week follow-up. The participants were evaluated at baseline, 26 weeks (postintervention), and 52 weeks (follow-up). The primary outcome of this study was memory function, which was assessed using the Logical Memory II subtest of the Wechsler Memory Scale-Revised (WMS-R) score. The secondary outcomes included global cognitive function, verbal fluency, working memory, processing speed, and executive functions. Results: Intention-to-treat analysis by a mixed-effect model repeated measure showed that the AT group had significantly improved performance on the WMS-R Logical Memory II test (2.74 [1.82–3.66] points) than the control group (1.36 [0.44–2.28] points) at the postintervention assessment (p  = 0.037). The effect was more pronounced in those without amnesia than those with amnesia. No significant improvement was observed in the RT and CT groups. Conclusion: This study suggests that AT intervention can improve delayed memory in community-dwelling older adults, particularly in individuals without objective memory decline. Show more

Keywords: Amnesia, cognition, cognitive dysfunction, executive function, exercise, memory, physical activity, randomized controlled trial, resistance training, wechsler memory scale

DOI: 10.3233/JAD-210047

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 701-717, 2021

Authors: Shinohara, Mitsuru | Suzuki, Kaoru | Bu, Guojun | Sato, Naoyuki

Article Type: Research Article

Abstract: Background: While both apolipoprotein E (APOE ) genotype and diabetes affect longevity as well as Alzheimer’s disease, their relationship remains to be elucidated. Objective: The current study investigated the potential interaction between diabetes and APOE for lifespan and their relationship with cognitive status. Methods: We reviewed the National Alzheimer’s Coordinating Center (NACC) dataset, which documents longitudinally clinical records of 24,967 individuals with APOE genotype and diabetic status. Results: Diabetes was associated with shorter lifespan in APOE3 carriers (n  = 12,415, HR = 1.29, 95%CI = 1.17–1.42, p  < 0.001) and APOE2 carriers (n  = 2,390, HR = 1.37, 95%CI = 1.10–1.69, …p  = 0.016), while such associations were weaker and not significant in APOE4 carriers (n  = 9,490, HR = 1.11, 95%CI = 0.99–1.24, p  = 0.162). As there is a significant interactive effect of cognitive status and diabetes on lifespan (p  < 0.001), we stratified subjects by cognitive status and observed persistent APOE -dependent harmful effects of diabetes in nondemented individuals but not demented individuals. Notably, questionnaire-based activity status, with which we previously observed an association between APOE genotype and longevity, was also significantly affected by diabetes only in non-APOE4 carriers. Conclusion: The effects of diabetes on longevity vary among APOE genotype. These effects are observed in nondemented individuals and are potentially associated with activity status during their lifespan. Show more

Keywords: Apolipoprotein E, dementia, diabetes, longevity

DOI: 10.3233/JAD-210125

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 719-726, 2021

Authors: Delazer, Margarete | Zamarian, Laura | Djamshidian, Atbin

Article Type: Research Article

Abstract: Background: Agraphia is a typical feature in the clinical course of Alzheimer’s disease (AD). Objective: Assess the differences between AD and normal aging as regards kinematographic features of handwriting and elucidate writing deficits in AD. Methods: The study included 23 patients with AD (78.09 years/SD = 7.12; MMSE 21.39/SD = 3.61) and 34 healthy controls (75.56 years/SD = 5.85; MMSE 29.06/SD = 0.78). Both groups performed alphabetical and non-alphabetical writing tasks. The kinematographic assessment included the average number of inversions per stroke (NIV; number of peaks in the velocity profile in a single up or down stroke), percentage of automated segments, frequency (average number …of strokes per second), writing pressure, and writing velocity on paper. Results: A total of 14 patients showed overt writing difficulties reflected by omissions or substitutions of letters. AD patients showed less automated movements (as measured by NIV), lower writing velocity, and lower frequency of up-and-down strokes in non-alphabetical as well as in alphabetical writing. In the patient group, Spearman correlation analysis between overt writing performance and NIV was significant. That means patients who had less errors in writing a sentence showed a higher automaticity in handwriting. The correctness of alphabetical writing and some kinematographic measures in writing non-alphabetical material reached excellent diagnostic values in ROC analyses. There was no difference in the application of pressure on the pen between patients and controls. Conclusion: Writing disorders are multi-componential in AD and not strictly limited to one processing level. The slow and poorly automated execution of motor programs is not bound to alphabetical material. Show more

Keywords: Agraphia, dementia, inversions, kinematographic analysis, writing velocity

DOI: 10.3233/JAD-210279

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 727-735, 2021

Authors: Callahan, Brandy L. | McLaren-Gradinaru, Michael | Burles, Ford | Iaria, Giuseppe

Article Type: Research Article

Abstract: Background: Older adults with bipolar disorder (BD) have increased dementia risk, but signs of dementia are difficult to detect in the context of pre-existing deficits inherent to BD. Objective: To identify the emergence of indicators of early dementia in BD. Methods: One hundred and fifty-nine non-demented adults with BD from the National Alzheimer’s Coordinating Center (NACC) data repository underwent annual neuropsychological assessment up to 14 years (54.0 months average follow-up). Cognitive performance was examined longitudinally with linear mixed-effects models, and yearly differences between incident dementia cases and controls were examined in the six years prior to …diagnosis. Results: Forty participants (25.2%) developed dementia over the follow-up period (‘incident dementia cases’). Alzheimer’s disease was the most common presumed etiology, though this was likely a result of sampling biases within NACC. Incident dementia cases showed declining trajectories in memory, language, and speeded attention two years prior to dementia onset. Conclusion: In a sample of BD patients enriched for Alzheimer’s type dementia, prodromal dementia in BD can be detected up to two years before onset using the same cognitive tests used in psychiatrically-healthy older adults (i.e., measures of verbal recall and fluency). Cognition in the natural course of BD is generally stable, and impairment or marked decline on measures of verbal episodic memory or semantic retrieval may indicate an early neurodegenerative process. Show more

Keywords: Aging, cognitive dysfunction, neuropsychology, psychiatry

DOI: 10.3233/JAD-201240

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 737-748, 2021

Authors: Ben Ayed, Ines | Castor-Guyonvarch, Naomie | Amimour, Souad | Naija, Salma | Aouichaoui, Chirine | Ben Omor, Sana | Tabka, Zouhair | El Massioui, Farid

Article Type: Research Article

Abstract: Background: Many studies have shown the impact of acute aerobic exercises (AAE) on cognition in healthy adults or at a pre-dementia stage. Few studies, however, have explored the positive effects of AAE in moderate Alzheimer’s disease (ADM) patients. Objective: Evaluating the effect of AAE on cognitive functions in ADM patients. Methods: Overall, 79 (age: 69.62±0.99) ADM patients were recruited. Participants were divided into three groups according to the task: aerobic exercises done alone or combined with cognitive games presented on a screen, and a control group who performed a reading task. The aerobic exercise protocol consisted …of a 20-min cycling exercise of moderate intensity, corresponding to 60%of the individual target maximal heart rate recorded in a 6-minute walking test. The participants’ cognition was monitored before and after the intervention using the Tower of Hanoi, Digit Span, and Stroop tasks. Results: After the exercise, the participants’ attention in both the physical and combined groups improved for the Stroop, the forward and backward Digit Span tasks, as well as the time taken to solve the Tower of Hanoi, although no significant differences were found in the number of moves taken in the latter. By contrast, the control group did not show any significant improvement for most of the cognitive tasks after the reading session. Conclusion: Current evidence suggests that AAE may help to improve cognitive functions in ADM patients. This improvement is enhanced when the exercise is combined with cognitive games. Safe and progressive types of exercises should be promoted among ADM patients. Show more

Keywords: Aerobic exercises, Alzheimer disease, attention, solving problem, working memory

DOI: 10.3233/JAD-201317

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 749-760, 2021

Authors: Korpioja, Anita | Krüger, Johanna | Koivuluoma, Susanna | Pylkäs, Katri | Moilanen, Virpi | Helisalmi, Seppo | Hiltunen, Mikko | Remes, Anne M.

Article Type: Research Article

Abstract: Background: Rare variants of SORL1 have been associated with an increased risk of early-onset or late-onset Alzheimer’s disease (AD). However, a lot remains to be clarified about their significance in the pathogenesis of the disease. Objective: To evaluate the role of SORL1 variants among Finnish patients with early-onset AD (EOAD). Methods: The rare SORL1 variants were screened in a cohort of 115 Finnish EOAD patients (mean age at onset 58.3 years, range 46–65 years) by using the whole-exome sequencing. Results: We found one novel nonsense variant (p.Gln290* ) and eight missense variants …in SORL1 . This is the first study reporting the SORL1 variants p.Lys80Arg, p.Ala789Val and p.Arg866Gln in EOAD patients. Furthermore, two of these three missense variants were overrepresented in EOAD patients compared to gnomAD non-neuro Finnish samples. Conclusion: This study strengthens the earlier findings, that the rare variants in SORL1 are associated with EOAD. Show more

Keywords: Dementia, early onset Alzheimer’s disease, gene, human, mutation, neurodegenerative disease, single nucleotide polymorphism, SORL1

DOI: 10.3233/JAD-210207

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 761-770, 2021

Authors: Sewell, Margaret C. | Neugroschl, Judith | Umpierre, Mari | Chin, Shehan | Zhu, Carolyn W. | Velasco, Nelly | Gonzalez, Sabrina | Acabá-Berrocal, Alexandra | Bianchetti, Luca | Silva, Gabriela | Collazo, Alma | Sano, Mary

Article Type: Research Article

Abstract: Background: Latinx elders are underrepresented in dementia research. In a previous study we assessed research attitudes in urban minority elders and found a significant minority expressed neutral to negative attitudes relating to trust, safety, and personal responsibility to help research. Objective: To assess the impact of a composite intervention on attitudes toward research and research participation among elderly Latinx. The intervention was a collaboratively produced research participation video shown during presentations with our elderly community advisory board (CAB) as co-presenters. Methods: The video was created by the ADRC and CAB. All senior center attendees were eligible …to participate. Afterwards, the Research Attitudes Questionnaire (RAQ) and a brief questionnaire on the impact of the video were administered. Using Wilcoxon Rank Sum Tests, Chi Square, and OLS regressions, RAQ responses were compared to those from a historical cohort from similar centers. Results: 74 in the “Historical Cohort 1” and 104 in “Intervention Cohort 2” were included. RAQ total score was higher in Cohort 2 than Cohort 1 (28.5 versus 26.1, p  < 0.05) after controlling for age, education, and country of origin. In response to the question “Has the video influenced your willingness and interest to participate in research”, 88.7%of the participants in Cohort 2 reported being “more” or “much more” interested in research. Conclusion: Tailoring community research recruitment programs to include relatable peers using novel recruitment techniques may have positive implications for improving enrollment of diverse elderly individuals in research. Show more

Keywords: Attitudes towards research, diversity, elder minorities, minorities in research, research participation

DOI: 10.3233/JAD-210027

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 771-779, 2021

Authors: Svensson, Johan | Blomqvist, Maria | Kettunen, Petronella | Eckerström, Carl | Henricsson, Marcus | Jonsson, Michael | Bjerke, Maria | Månsson, Jan-Eric | Wallin, Anders

Article Type: Research Article

Abstract: Background: Sulfatides (STs) in cerebrospinal fluid (CSF), as well as magnetic resonance imaging (MRI)-detected white matter hyperintensities (WMHs), may reflect demyelination. Here, we investigated the diagnostic utility of CSF ST levels in the subcortical small vessel type of dementia (SSVD), which is characterized by the presence of brain WMHs. Objective: To study the diagnostic utility of CSF ST levels in SSVD. Methods: This was a mono-center, cross-sectional study of SSVD (n  = 16), Alzheimer’s disease (n  = 40), mixed dementia (n  = 27), and healthy controls (n  = 33). Totally, 20 ST species were measured in CSF by liquid chromatography-mass …spectrometry (LC-MS/MS). Results: CSF total ST levels, as well as CSF levels of hydroxylated and nonhydroxylated ST species, did not differ across the study groups. In contrast, CSF neurofilament light chain (NFL) levels separated the patient groups from the controls. CSF total ST level correlated with CSF/serum albumin ratio in the total study population (r  = 0.64, p  < 0.001) and in all individual study groups. Furthermore, CSF total ST level correlated positively with MRI-estimated WMH volume in the total study population (r  = 0.30, p  < 0.05), but it did not correlate with CSF NFL level. Conclusion: Although there was some relation between CSF total ST level and WMH volume, CSF ST levels were unaltered in all dementia groups compared to the controls. This suggests that CSF total ST level is a poor biomarker of demyelination in SSVD. Further studies are needed to investigate the mechanisms underlying the marked correlation between CSF total ST level and CSF/serum albumin ratio. Show more

Keywords: Alzheimer’s disease, cerebrospinal fluid, mixed dementia, sulfatide species, sulfatides, subcortical small vessel type of dementia, white matter hyperintensities

DOI: 10.3233/JAD-201552

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 781-790, 2021

Authors: Greco, Frank A. | McKee, Ann C. | Kowall, Neil W. | Hanlon, Eugene B.

Article Type: Research Article

Abstract: Background: Medical imaging methods such as PET and MRI aid clinical assessment of Alzheimer’s disease (AD). Less expensive, less technically demanding, and more widely deployable technologies are needed to expand objective screening for diagnosis, treatment, and research. We previously reported brain tissue near-infrared optical spectroscopy (NIR) in vitro indicating the potential to meet this need. Objective: To determine whether completely non-invasive, clinical, NIR in vivo can distinguish AD patients from age-matched controls and to show the potential of NIR as a clinical screen and monitor of therapeutic efficacy. Methods: NIR spectra were acquired in …vivo . Three groups were studied: autopsy-confirmed AD, control and mild cognitive impairment (MCI). A feature selection approach using the first derivative of the intensity normalized spectra was used to discover spectral regions that best distinguished “AD-alone” (i.e., without other significant neuropathology) from controls. The approach was then applied to other autopsy-confirmed AD cases and to clinically diagnosed MCI cases. Results: Two regions about 860 and 895 nm completely separate AD patients from controls and differentiate MCI subjects according to the degree of impairment. The 895 nm feature is more important in separating MCI subjects from controls (ratio-of-weights: 1.3); the 860 nm feature is more important for distinguishing MCI from AD (ratio-of-weights: 8.2). Conclusion: These results form a proof of the concept that near-infrared spectroscopy can detect and classify diseased and normal human brain in vivo . A clinical trial is needed to determine whether the two features can track disease progression and monitor potential therapeutic interventions. Show more

Keywords: Alzheimer’s disease, cognitive dysfunction, data analysis, mild cognitive impairment, near-infrared spectroscopy

DOI: 10.3233/JAD-201021

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 791-802, 2021

Authors: Zhao, Xuan | Li, Cancan | Ding, Guoyong | Heng, Yuanyuan | Li, An | Wang, Wei | Hou, Haifeng | Wen, Jun | Zhang, Yanbo

Article Type: Research Article

Abstract: Background: The increasing prevalence of Alzheimer’s disease (AD), along with the associated burden on healthcare systems, presents a substantial public health challenge. Objective: This study aimed to investigate trends in AD mortality and the relevant burden across the United States (U.S.) from 1999 to 2018 and to predict mortality trends between 2019 and 2023. Methods: Data on AD-related deaths between 1999 and 2018 were collected from the WONDER database administered by the U.S. Centers for Disease Control and Prevention (CDC). The Joinpoint Regression Program was used to analyze mortality trends due to AD. Years of life …lost (YLL) were calculated to explore the burden of AD deaths. An autoregressive integrated moving average (ARIMA) model was employed to forecast mortality trends from 2019 to 2023. Results: Over a recent 20-year period, the number of AD deaths in the U.S. increased from 44,536 (31,145 females and 13,391 males) to 122,019 (84,062 females and 37,957 males). The overall age-adjusted mortality rate increased from 16.5/100,000 in 1999 to 30.5/100,000 in 2018. AD mortality is projected to reach 42.40/100000 within the year 2023. Overall, AD resulted in 322,773.00 YLL (2.33 per 1000 population) in 1999 and 658,501.87 YLL (3.68 per 1000 population) in 2018. Conclusion: Our findings demonstrate an increase in AD mortality in the U.S. from 1999 to 2018 as well as a rapid increase from 2019 to 2023. The high burden of AD deaths emphasizes the need for targeted prevention, early diagnosis, and hierarchical management. Show more

Keywords: Alzheimer’s disease, mortality, time series analysis, years of life lost

DOI: 10.3233/JAD-210225

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 803-813, 2021

Authors: Paradela, Regina Silva | Ferreira, Naomi Vidal | Nucci, Mariana Penteado | Cabella, Brenno | Martino, Luiza Menoni | Torres, Laura Aló | Costa, Danielle Irigoyen da | Consolim-Colombo, Fernanda Marciano | Suemoto, Claudia Kimie | Irigoyen, Maria Claudia

Article Type: Research Article

Abstract: Background: Socioeconomic factors are important contributors to brain health. However, data from developing countries (where social inequalities are the most prominent) are still scarce, particularly about hypertensive individuals. Objective: To evaluate the relationship between socioeconomic index, cognitive function, and cortical brain volume, as well as determine whether white matter hyperintensities are mediators of the association of the socioeconomic index with cognitive function in hypertensive individuals. Methods: We assessed 92 hypertensive participants (mean age = 58±8.6 years, 65.2%female). Cognitive evaluation and neuroimaging were performed and clinical and sociodemographic data were collected using questionnaires. A socioeconomic index was created using …education, income, occupation (manual or non-manual work), and race. The associations of the socioeconomic index with cognitive performance and brain volume were investigated using linear regression models adjusted for age, sex, time of hypertension since diagnosis, and comorbidities. A causal mediation analysis was also conducted. Results: Better socioeconomic status was associated with better visuospatial ability, executive function, and global cognition. We found associations between a better socioeconomic index and a higher parietal lobe volume. White matter hyperintensities were also not mediators in the relationship between the socioeconomic index and cognitive performance. Conclusion: Socioeconomic disadvantages are associated with worse cognitive performance and brain volume in individuals with hypertension. Show more

Keywords: Brain volume, cognitive dysfunction, executive function, hypertension, neuroimaging, social determinants of health, white matter hyperintensities

DOI: 10.3233/JAD-210143

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 815-826, 2021

Authors: Melo van Lent, Debora | O’Donnell, Adrienne | Beiser, Alexa S. | Vasan, Ramachandran S. | DeCarli, Charles S. | Scarmeas, Nikolaos | Wagner, Michael | Jacques, Paul F. | Seshadri, Sudha | Himali, Jayandra J. | Pase, Matthew P.

Article Type: Research Article

Abstract: Background: Adherence to the Mediterranean-DASH for Neurodegenerative Delay (MIND) diet has previously been associated with cognitive decline and dementia. To our knowledge, no prior study has investigated the association between the MIND diet and measures of brain volume, silent brain infarcts (SBIs), or brain atrophy. Objective: We evaluated whether adherence to the MIND diet associated with superior cognitive function, larger brain volumes, fewer SBIs, and less cognitive decline in the community-based Framingham Heart Study. Methods: 2,092 participants (mean±SD, age 61±9) completed Food Frequency Questionnaires, averaged across a maximum of 3-time points (examination cycles 5, 6, and …7), cognitive testing at examination cycle 7 (present study baseline: 1998–2001) and after a mean±SD of 6.6±1.1 years from baseline (n  = 1,584). A subset of participants also completed brain magnetic resonance imaging (MRI) at examination cycle 7 (n  = 1,904). In addition, participants with dementia, stroke, and other relevant neurological diseases such as significant head trauma, subdural hematoma, or multiple sclerosis were excluded from the analyses. Results: Higher MIND diet scores were associated with better global cognitive function (β±SE,+0.03SD±0.01; p  = 0.004), verbal memory, visual memory, processing speed, verbal comprehension/reasoning, and with larger total brain volume (TBV) following adjustments for clinical, lifestyle and demographic covariates, but not with other brain MRI measures (i.e., hippocampal volume, lateral ventricular volume, white matter hyperintensity volume, and SBIs) or cognitive decline. Conclusion: Higher MIND diet scores associated with better cognitive performance and larger TBV at baseline, but not with cognitive decline. Clinical trials are needed to ascertain whether adopting the MIND diet affects trajectories of cognitive decline. Show more

Keywords: Apolipoprotein ɛ4, brain volume, cognition, dietary pattern, framingham heart study, MIND diet, silent brain infarcts

DOI: 10.3233/JAD-201238

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 827-839, 2021

Authors: Schoemaker, Dorothee | Velilla-Jimenez, Lina | Zuluaga, Yesica | Baena, Ana | Ospina, Carolina | Bocanegra, Yamile | Alvarez, Sergio | Ochoa-Escudero, Martin | Guzmán-Vélez, Edmarie | Martinez, Jairo | Lopera, Francisco | Arboleda-Velasquez, Joseph F. | Quiroz, Yakeel T.

Article Type: Research Article

Abstract: Background: Cardiovascular risk factors increase the risk of developing dementia, including Alzheimer’s disease and vascular dementia. Objective: Studying individuals with autosomal dominant mutations leading to the early onset of dementia, this study examines the effect of the global cardiovascular risk profile on early cognitive and neuroimaging features of Alzheimer’s disease and vascular dementia. Methods: We studied 85 non-demented and stroke-free individuals, including 20 subjects with Presenilin1 (PSEN1) E280A mutation leading to the early onset of autosomal dominant Alzheimer’s disease (ADAD), 20 subjects with NOTCH3 mutations leading to cerebral autosomal dominant arteriopathy with subcortical infarcts …and leukoencephalopathy (CADASIL) and to the early onset of vascular dementia, and 45 non-affected family members (non-carriers). All subjects underwent clinical and neuropsychological evaluations and an MRI. The global cardiovascular risk profile was estimated using the office-based Framingham Cardiovascular Risk Profile (FCRP) score. Results: In individuals with CADASIL, a higher FCRP score was associated with a reduced hippocampal volume (B = –0.06, p  < 0.05) and an increased severity of cerebral microbleeds (B = 0.13, p  < 0.001), lacunes (B = 0.30, p  < 0.001), and perivascular space enlargement in the basal ganglia (B = 0.50, p  < 0.05). There was no significant association between the FCRP score and neuroimaging measures in ADAD or non-carrier subjects. While the FCRP score was related to performance in executive function in non-carrier subjects (B = 0.06, p  < 0.05), it was not significantly associated with cognitive performance in individuals with CADASIL or ADAD. Conclusion: Our results suggest that individuals with CADASIL and other forms of vascular cognitive impairment might particularly benefit from early interventions aimed at controlling cardiovascular risks. Show more

Keywords: Autosomal dominant Alzheimer’s disease, CADASIL, cardiovascular risk factors, cerebral small vessel disease, cognition, magnetic resonance imaging

DOI: 10.3233/JAD-210313

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 841-853, 2021

Authors: Niu, Jiahui | Iqbal, Khalid | Liu, Fei | Hu, Wen

Article Type: Research Article

Abstract: Background: Women have a two-fold higher risk than men to Alzheimer’s disease (AD) at midlife. Larger brain tau burden was consistently shown in older women than age-matched men. The biological basis for this gender disparity remains elusive. Objective: We sought to know whether tau expression and phosphorylation physiologically differ between males and females. Methods: We used western blots and immunohistochemistry to compare the levels of total tau and phosphorylated tau in the hippocampus and entorhinal cortex (EC) between sexes in Wistar rats at 40 days, and 8 and 20 months of age. Results: We …detected no statistically significant difference in total tau, 3R-tau, and 4R-tau between sexes. However, female rats exhibited lower levels of tau unphosphorylated at the Tau-1 site at 40 days of age. At 8 months of age, females showed higher levels of tau phosphorylated at Ser190 , Ser387 , and Ser395 (Ser199 , Ser396 , and Ser404 of human tau, respectively) than males in EC. At 20 months of age, both brain regions of female rats consistently showed higher levels than males of tau phosphorylated at Ser253 , Ser387 , PHF-1 (Ser387/395 ), and Ser413 sites, which correspond to Ser262 , Ser396 , Ser396/404 , and Ser422 of human tau, respectively. Conclusion: Rats of both sexes have comparable levels of total tau, 3R-tau, and 4R-tau, whereas females exhibit higher levels of tau phosphorylated at multiple sites that are implicated in AD tau pathology, indicating a sexual dimorphism of tau phosphorylation that may potentially underlie the disparity in brain tau burden and risk for AD between sexes. Show more

Keywords: Alzheimer’s disease, entorhinal cortex, gender, hippocampus, protein phosphorylation, tau expression, tau isoforms

DOI: 10.3233/JAD-210341

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 855-869, 2021

Authors: Vecchio, Fabrizio | Miraglia, Francesca | Alú, Francesca | Orticoni, Alessandro | Judica, Elda | Cotelli, Maria | Rossini, Paolo Maria

Article Type: Research Article

Abstract: Background: Most common progressive brain diseases in the elderly are Alzheimer’s disease (AD) and vascular dementia (VaD). They present with relatively similar clinical symptoms of cognitive decline, but the underlying pathophysiological mechanisms are different. Objective: The aim is to explore the brain connectivity differences between AD and VaD patients compared to mild cognitive impairment (MCI) and normal elderly (Nold) subjects applying graph theory, in particular the Small World (SW) analysis. Methods: 274 resting state EEGs were analyzed in 100 AD, 80 MCI, 40 VaD, and 54 Nold subjects. Graph theory analyses were applied to undirected and …weighted networks obtained by lagged linear coherence evaluated by eLORETA tool. Results: VaD and AD patients presented more ordered low frequency structure (lower value of SW) than Nold and MCI subjects, and more random organization (higher value of SW) in low and high frequency alpha rhythms. Differences between patients have been found in high frequency alpha rhythms in VaD (higher value of SW) with respect to AD, and in theta band with a trend which is more similar to MCI and Nold than to AD. MCI subjects presented a network organization which is intermediate, in low frequency bands, between Nold and patients. Conclusion: Graph theory applied to EEG data has proved very useful in identifying differences in brain network patterns in subjects with dementia, proving to be a valid tool for differential diagnosis. Future studies will aim to validate this method to diagnose especially in the early stages of the disease and at single subject level. Show more

Keywords: Brain networks, EEG, functional coupling, LORETA, Small World

DOI: 10.3233/JAD-210394

Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 871-879, 2021