Journal of Alzheimer's Disease - Volume 84, issue 2

Authors: Bagheri, Nasser | Mavoa, Suzanne | Tabatabaei-Jafari, Hossein | Knibbs, Luke D. | Coffee, Neil T. | Salvador-Carulla, Luis | Anstey, Kaarin J.

Article Type: Research Article

Abstract: Background: Dementia is a major global health challenge and the impact of built and social environments’ characteristics on dementia risk have not yet been fully evaluated. Objective: To investigate associations between built and social environmental characteristics and diagnosed dementia cases and estimated dementia risk. Methods: We recruited 25,511 patients aged 65 and older from family physicians’ practices. We calculated a dementia risk score based on risk and protective factors for patients not diagnosed with dementia. Our exposure variables were estimated for each statistical area level 1: social fragmentation, nitrogen dioxide, public open spaces, walkability, socio-economic status, …and the length of main roads. We performed a multilevel mixed effect linear regression analysis to allow for the hierarchical nature of the data. Results: We found that a one standard deviation (1-SD) increase in NO2 and walkability score was associated with 10% higher odds of any versus no dementia (95% CI: 1%, 21% for NO2 and 0%, 22% for walkability score). For estimated future risk of dementia, a 1-SD increase in social fragmentation and NO2 was associated with a 1% increase in dementia risk (95% CI: 0, 1%). 1-SD increases in public open space and socioeconomic status were associated with 3% (95% CI: 0.95, 0.98) and 1% decreases (95% CI: 0.98, 0.99) in dementia risk, respectively. There was spatial heterogeneity in the pattern of diagnosed dementia and the estimated future risk of dementia. Conclusion: Associations of neighborhood NO2 level, walkability, public open space, and social fragmentation with diagnosed dementia cases and estimated future risk of dementia were statistically significant, indicating the potential to reduce the risk through changes in built and social environments. Show more

Keywords: Dementia, green spaces, social fragmentation, spatial analysis, walkability

DOI: 10.3233/JAD-210208

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 621-632, 2021

Authors: Kang, Sung Hoon | Cho, Hanna | Shin, Jiho | Kim, Hang-Rai | Noh, Young | Kim, Eun-Joo | Lyoo, Chul Hyoung | Jang, Hyemin | Kim, Hee Jin | Koh, Seong-Beom | Na, Duk L. | Suh, Mee Kyung | Seo, Sang Won

Article Type: Research Article

Abstract: Background: Primary progressive aphasia (PPA) is associated with amyloid-β (Aβ) pathology. However, clinical feature of PPA based on Aβ positivity remains unclear. Objective: We aimed to assess the prevalence of Aβ positivity in patients with PPA and compare the clinical characteristics of patients with Aβ-positive (A+) and Aβ-negative (A–) PPA. Further, we applied Aβ and tau classification system (AT system) in patients with PPA for whom additional information of in vivo tau biomarker was available. Methods: We recruited 110 patients with PPA (41 semantic [svPPA], 27 non-fluent [nfvPPA], 32 logopenic [lvPPA], and 10 unclassified [ucPPA]) …who underwent Aβ-PET imaging at multi centers. The extent of language impairment and cortical atrophy were compared between the A+ and A–PPA subgroups using general linear models. Results: The prevalence of Aβ positivity was highest in patients with lvPPA (81.3%), followed by ucPPA (60.0%), nfvPPA (18.5%), and svPPA (9.8%). The A+ PPA subgroup manifested cortical atrophy mainly in the left superior temporal/inferior parietal regions and had lower repetition scores compared to the A–PPA subgroup. Further, we observed that more than 90% (13/14) of the patients with A+ PPA had tau deposition. Conclusion: Our findings will help clinicians understand the patterns of language impairment and cortical atrophy in patients with PPA based on Aβ deposition. Considering that most of the A+ PPA patents are tau positive, understanding the influence of Alzheimer’s disease biomarkers on PPA might provide an opportunity for these patients to participate in clinical trials aimed for treating atypical Alzheimer’s disease. Show more

Keywords: Amyloid-β, biomarker, language, primary progressive aphasia, tau

DOI: 10.3233/JAD-210392

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 633-645, 2021

Authors: Culibrk, Robert A. | Arabiyat, Ahmad S. | DeKalb, Carisa A. | Hahn, Mariah S.

Article Type: Research Article

Abstract: Background: A significant subset of patients with Alzheimer’s disease (AD) exhibit low bone mineral density and are therefore more fracture-prone, relative to their similarly aged neurotypical counterparts. In addition to chronic immune hyperactivity, behavioral dysregulation of effector peripheral sympathetic neurons—which densely innervate bone and potently modulate bone remodeling—is implicated in this pathological bone reformation. Objective: Thus, there exists a pressing need for a robust in vitro model which allows interrogation of the paracrine interactions between the putative mediators of AD-related osteopenia: sympathetic neurons (SNs) and mesenchymal stem cells (MSCs). Methods: Toward this end, activated SN-like …PC12 cells and bone marrow derived MSCs were cultured in poly(ethylene glycol) diacrylate (PEGDA) hydrogels in the presence or absence of the AD-relevant inflammatory cytokine tumor necrosis factor alpha (TNF-α) under mono- and co-culture conditions. Results: PC12s and MSCs exposed separately to TNF-α displayed increased expression of pro-inflammatory mediators and decreased osteopontin (OPN), respectively. These data indicate that TNF-α was capable of inducing a dysregulated state in both cell types consistent with AD. Co-culture of TNF-α-activated PC12s and MSCs further exacerbated pathological behaviors in both cell types. Specifically, PC12s displayed increased secretion of interleukin 6 relative to TNF-α stimulated monoculture controls. Similarly, MSCs demonstrated a further reduction in osteogenic capacity relative to TNF-α stimulated monoculture controls, as illustrated by a significant decrease in OPN and collagen type I alpha I chain. Conclusion: Taken together, these data may indicate that dysregulated sympathetic activity may contribute to AD-related bone loss. Show more

Keywords: Alzheimer’s disease, inflammation, mesenchymal stem cells, osteopenia

DOI: 10.3233/JAD-215007

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 647-658, 2021

Authors: Wei, Qiang | Cao, Shanshan | Ji, Yang | Zhang, Jun | Chen, Chen | Wang, Xiaojing | Tian, Yanghua | Qiu, Bensheng | Wang, Kai

Article Type: Research Article

Abstract: Background: The white matter hyperintensities (WMHs) are considered as one of the core neuroimaging findings of cerebral small vessel disease and independently associated with cognitive deficit. The parietal lobe is a heterogeneous area containing many subregions and play an important role in the processes of neurocognition. Objective: To explore the relationship between parietal subregions alterations and cognitive impairments in WHMs. Methods: Resting-state functional connectivity (rs-FC) analyses of parietal subregions were performed in 104 right-handed WMHs patients divided into mild (n  = 39), moderate (n  = 37), and severe WMHs (n  = 28) groups according to the Fazekas scale and …36 healthy controls. Parietal subregions were defined using tractographic Human Brainnetome Atlas and included five subregions for superior parietal lobe, six subregions for inferior parietal lobe (IPL), and three subregions for precuneus. All participants underwent a neuropsychological test battery to evaluate emotional and general cognitive functions. Results: Differences existed between the rs-FC strength of IPL_R_6_2 with the left anterior cingulate gyrus, IPL_R_6_3 with the right dorsolateral superior frontal gyrus, and the IPL_R_6_5 with the left anterior cingulate gyrus. The connectivity strength between IPL_R_6_3 and the left anterior cingulate gyrus were correlated with AVLT-immediate and AVLT-recognition test in WMHs. Conclusion: We explored the roles of parietal subregions in WMHs using rs-FC. The functional connectivity of parietal subregions with the cortex regions showed significant differences between the patients with WMHs and healthy controls which may be associated with cognitive deficits in WMHs. Show more

DOI: 10.3233/JAD-210315

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 659-669, 2021

Authors: Lazarova, Maria | Tancheva, Lyubka | Alexandrova, Albena | Tsvetanova, Elina | Georgieva, Almira | Stefanova, Miroslava | Tsekova, Daniela | Vezenkov, Lyubomir | Kalfin, Reni | Uzunova, Diamara | Petkova-Kirova, Polina

Article Type: Research Article

Abstract: Alzheimer’s disease (AD), a progressive neurodegenerative disorder characterized by memory loss and cognitive functions decline, is a leading cause for dementia and currently ranked as the sixth foremost cause of death. As of present, treatment of AD is symptomatic without convincing therapeutic benefits and new, effective, therapeutic agents are pursued. Due to massive loss of cholinergic neurons and decreased acetylcholine levels, cholinesterase inhibitors like galantamine, remain the backbone of pharmacological treatment of the disease. In the present study, using behavioral and biochemical methods, four newly synthesized galantamine derivatives, Gal 34, Gal 43, Gal 44, and Gal 46, were evaluated for …a beneficial effect in a scopolamine model of dementia in mice. They were designed to have all the advantages of galantamine and additionally to inhibit β-secretase and exert favorable effects on plasma lipids. Behavioral tests included step-through inhibitory avoidance, T-maze, and the hole-board test, whereas biochemical evaluations involved assessment of acetylcholinesterase activity, brain monoamines levels, lipid peroxidation, catalase, glutathione peroxidase, and superoxide dismutase activities along with measurement of total glutathione. Results show that Gal 43, Gal 44, and, in particular, Gal 46 are especially effective in improving both short- and long-term memory and in the case of Gal 46 having a significant effect on exploratory activity as well. Although Gal 34 did not show behavioral effects as convincing as those of the other three galantamine derivatives, it demonstrated persuasive antioxidant and restorative capacities, making all four galantamine derivatives promising AD treatment agents and prompting further research, especially that in many of our studies they performed better than galantamine. Show more

Keywords: Alzheimer’s disease, cholinesterase inhibitors, dementia, galantamine, scopolamine

DOI: 10.3233/JAD-215165

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 671-690, 2021

Authors: Lazris, David | Perkins, Molly M. | Bay, Allison A. | Hackney, Madeleine E.

Article Type: Research Article

Abstract: Background: 10%to 20%of Americans aged 65 and older have mild cognitive impairment (MCI) with 10%progressing to Alzheimer’s disease (AD) each year. Underserved groups, including African Americans (AAs), are among the most vulnerable to MCI and AD. Although evidence continues to amass, the benefits of exercise and movement for AD is still understudied in AD. Objective: Understanding the attitudes, perceptions, and beliefs about motor-cognitive integration and examining the physical activity of a sample of predominantly Black women community members with self-reported memory problems will allow improved recruitment and refinement of multimodal interventions designed to improve motor-cognitive and cognitive function. …Methods: We conducted focus groups with older adults who reported subjective memory complaints (n  = 15; Black: n  = 12, White: n  = 3, mean age 71.7±5.8). Results: Findings from thematic analysis showed most participants knew of benefits of exercise. However, most participants reported not getting adequate exercise due to factors such as pain, increased responsibilities, and fear of injury. Despite barriers, participants expressed enthusiasm for multimodal interventions designed to target body and brain health and provided several suggestions to improve or enhance the proposed interventions. Conclusion: Results provide useful insights regarding improving participation among historically under-represented groups in clinical movement-based research. Participants’ discussion focused primarily on the way motor-cognitive integration prevents falls, maintains memory, and provides a social benefit. The reported perceived benefits and limitations of exercise, as this population understands it, can help researchers and physicians better engage the community for lifestyle changes that will support greater motor-cognitive health. Show more

Keywords: Alzheimer’s disease, cognitive impairment, exercise, motor cognition, older adults, patient engagement, patient’s perspective

DOI: 10.3233/JAD-210617

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 691-703, 2021

Authors: Read, Sanna | Hu, Bo | Wittenberg, Raphael | Brimblecombe, Nicola | Robinson, Louise | Banerjee, Sube

Article Type: Research Article

Abstract: Background: Understanding the changes of unmet need in dementia may enable effective targeting of help and allow people to stay in their homes longer. Objective: We investigated changes in unmet need and functioning over a 4-year period and the role of socio-demographic factors in these changes among people with dementia. Methods: 234 community-dwelling people with dementia at baseline were studied in three consecutive waves (four years) of the English Longitudinal Study of Ageing (ELSA). Unmet needs (self/informant-reported limitations for which no help was received) and functional limitations (self/informant-reported difficulties in activities/instrumental activities of daily living and …mobility) were modelled with latent growth curves. Sex, age, partnership, and socioeconomic status at baseline were used as predictors. Admission to a care home was an additional outcome. Results: Unmet needs increased over time, especially among those who initially had more functional limitations. Unmet needs contributed to faster decline in functional capability, except among those with many limitations initially. The major driver of increased unmet needs was not having a partner (direct effect). Age, sex, and wealth contributed indirectly via the initial level of functional limitations and/or unmet need. Those with several functional limitations but few unmet needs were most likely to move to a care home. Conclusion: Unmet need increases over time in those with dementia with mitigating effects of having a partner and initial levels of functioning. Meeting needs at early stages of dementia, especially for those living alone and when functional limitations are low may help slow functional decline. Show more

Keywords: Dementia, functional status, longitudinal survey, needs, social inequalities

DOI: 10.3233/JAD-210724

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 705-716, 2021

Authors: Katz, Joseph | Gao, Hanzhi

Article Type: Research Article

Abstract: Background: Alzheimer’s disease (AD) is a neurodegenerative disease with unclear etiology. Recent studies have demonstrated a potential role for gut microbiome. There is, however, a significant dearth in epidemiological correlation between gut bacteria and AD. Objective: To investigate the association between Escherichia coli (E. coli ) infection and AD. Methods: Counts of patients with ICD 10 diagnoses of AD, E. coli , urinary tract infection, and comorbidities were retrieved from the electronic health records at the University of Florida Health Center. Results: The relative risk for AD with a previous event of E. …coli was 5.17 (95%CI 4.0786 to 6.5446, p  < 0.0001). In the unadjusted association, patients with E. coli infection had odds ratio (OR) of 20.83 to have AD (95%CI, 17.7–24.34; p  < 0.0001); after adjusting for gender (OR = 12.71; 95%CI, 10.82–14.83; p  < 0.0001), race (OR = 13.97; 95%CI, 11.84–16.36; p  < 0.0001), age group (OR = 11.51; 95%CI, 9.73–13.54; p  < 0.0001), diabetes (OR = 9.23; 95%CI, 7.79–10.87; p  < 0.0001), stroke (OR = 5.31; 95%CI, 4.47–6.28; p  < 0.0001), and hypertension (OR = 4.55; 95%CI, 3.86–5.32; p  < 0.0001). Conclusion: These results should be taken cautiously. This retrospective cross-sectional study cannot infer causality and had used aggregate data that did not allow simultaneous adjustments of covariates. Future studies are warranted to investigate the link between gut bacteria and AD. Show more

Keywords: Alzheimer’s disease, association, E. coli, infection

DOI: 10.3233/JAD-215004

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 717-721, 2021

Authors: Galvin, James E. | Kleiman, Michael J. | Walker, Marcia

Article Type: Research Article

Abstract: Background: Screening for Alzheimer’s disease and related disorders (ADRD) and mild cognitive impairment (MCI) could increase case identification, enhance clinical trial enrollment, and enable early intervention. MCI and ADRD screening would be most beneficial if detection measures reflect neurodegenerative changes. Optical coherence tomography (OCT) could be a marker of neurodegeneration (part of the amyloid-tau-neurodegeneration (ATN) framework). Objective: To determine whether OCT measurements can be used as a screening measure to detect individuals with MCI and ADRD. Methods: A retrospective cross-sectional study was performed on 136 participants with comprehensive clinical, cognitive, functional, and behavioral evaluations including OCT …with a subset (n  = 76) completing volumetric MRI. Pearson correlation coefficients tested strength of association between OCT and outcome measures. Receiver operator characteristic curves assessed the ability of OCT, patient-reported outcomes, and cognitive performance measures to discriminate between individuals with and without cognitive impairment. Results: After controlling for age, of the 6 OCT measurements collected, granular cell layer-inner plexiform layer (GCL + IPL) thickness best correlated with memory, global cognitive performance, Clinical Dementia Rating, and hippocampal atrophy. GCL + IPL thickness provided good discrimination in cognitive status with a cut-off score of 75μm. Combining GCL + IPL thickness as a proxy marker for hippocampal atrophy with a brief patient-reported outcome and performance measure correctly classified 87%of MCI and ADRD participants. Conclusion: Multimodal approaches may improve recognition of MCI and ADRD. OCT has the potential to be a practical, non-invasive biomarker for ADRD providing a screening platform to quickly identify at-risk individuals for further clinical evaluation or research enrollment. Show more

Keywords: Alzheimer’s disease, dementia, granular cell layer, internal plexiform layer, mild cognitive impairment, optical coherence tomography

DOI: 10.3233/JAD-210328

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 723-736, 2021

Authors: Capuano, Ana W. | Wilson, Robert S. | Leurgans, Sue E. | Sampaio, Carolina | Farfel, Jose M. | Barnes, Lisa L. | Bennett, David A.

Article Type: Research Article

Abstract: Background: Literacy is more consistently reported than education as protective against dementia in developing regions. Objective: To study the association of verbal literacy, numeracy, and music literacy with dementia in older Black and White Brazilians with a broad spectrum of education. Methods: We studied 1,818 Black, Mixed-race, and White deceased Brazilians 65 years or older at death (mean = 79.64). Data were retrospectively obtained within 36 hours after death in a face-to-face interview with an informant, usually a family member. Dementia was classified using the Clinical Dementia Rating (CDR) scale. Three forms of literacy were ascertained: verbal literacy …(10 questions: reading and writing), numeracy (3 questions: multiplication, percentages, and use of a calculator), and music literacy (1 question: reading music). Black (11%) and Mixed-race (23%) older adults were combined in analyses. Models adjusted for age and sex. Results: Dementia was identified in 531 people. Participants had 0 to 25 years of education (median = 4). More literacy was associated with lower odds of dementia (all p ≤0.039). Participants that read music had about half the odds of having dementia. Participants in the highest quartile of numeracy and verbal literacy had respectively 27%and 15%lower odds of having dementia compared to the lowest quartile. Literacy was lower in Blacks (p  < 0.001, except music p  = 0.894) but the effect of literacy on dementia was similar (interaction p  > 0.237). In secondary analyses, playing instruments without reading music was not associated with dementia (p  = 0.887). Conclusion: In a large sample of Brazilians, verbal literacy, numeracy, and music literacy were associated with lower odds of dementia. The effect was similar across races. Show more

Keywords: African American, Brazil, education, latinos, race

DOI: 10.3233/JAD-210601

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 737-744, 2021

Authors: Dutzi, Ilona | Schwenk, Michael | Kirchner, Marietta | Jooss, Eva | Bauer, Jürgen M. | Hauer, Klaus

Article Type: Research Article

Abstract: Background: Cognitive impairment (CI) has been reported to negatively impact rehabilitation outcomes. Knowledge about differences in rehabilitation received in dependence of CI as a potential mediating factor is limited. Objective: To analyze whether CI affects amount and frequency of rehabilitation received and if associations between CI and rehabilitation outcome are mediated by the provided amount of therapy. Methods: Observational cohort study in ward-based geriatric rehabilitation consecutively including 373 patients (mean age 82.0±6.69 years, mean MMSE 23.66±5.31). Outcome measures were amount, frequency, and type of multi-professional therapy sessions and rehabilitation outcome assessed with the Barthel Index (BI). …Cognitive status was measured with the Mini-Mental-State Examination (MMSE) classifying three patient subgroups according to cognitive status. Results: Patients with more severe CI received least total therapy hours (TTH) (MMSE < 17, 13.67±6.58 versus MMSE 17–26, 16.12±7.19 and MMSE > 26, 17.79±8.88 h, p  = 0.014) and were less often included in occupational therapy (MMSE < 17, 48.9%versus MMSE 17–26, 65.5%and MMSE > 26, 71.4%, p  = 0.019) and group-based physiotherapy (MMSE < 17, 73.3%versus MMSE 17–26, 88.5%and MMSE > 26, 81.2%, p  = 0.027). Regression models showed that CI negatively impacted TTH (β= 0.24, p  = 0.003) and rehabilitation outcome (β= 0.41, p  = 0.008). In the mediation model, TTH accounted for 23.18%(p  < 0.001) of the relationship between CI and rehabilitation outcome. Conclusion: Cognitive impairment negatively impacted rehabilitation received. The lower TTH partly mediated the negative association between CI and rehabilitation outcome. Future research should identify specific barriers to therapy provision and optimal length, intensity, and dosage of rehabilitation programs to optimize rehabilitation outcomes in CI. Show more

Keywords: Cognitive impairment, functional outcome, rehabilitation, therapy provision

DOI: 10.3233/JAD-210620

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 745-756, 2021

Authors: Palermo, Giovanni | Belli, Elisabetta | Tommasini, Luca | Morganti, Riccardo | Frosini, Daniela | Nicoletti, Valentina | Tognoni, Gloria | Siciliano, Gabriele | Bonuccelli, Ubaldo | Baldacci, Filippo | Ceravolo, Roberto

Article Type: Research Article

Abstract: Background: Dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) are differentiated by the time of onset of cognitive and motor symptoms (‘1-year rule’). We explored the neuropsychological continuum of DLB and PDD subjects with different timing of dementia onset. Objective: Our aim was to compare the neuropsychological profile of DLB and PDD patients with different timing of dementia onset. Methods: Neuropsychological findings at the diagnosis of dementia of 66 PDD and 42 DLB patients were retrospectively compared. Patients with PDD were divided into three tertile subgroups according to the time interval between the onset …of parkinsonism and dementia (N  = 24, 2–4 years; N  = 17, 5–7 years; N  = 25 ≥8 years, respectively). Results: DLB patients performed worse on the Stroop and semantic fluency tests than PDD, even in comparison to PD with early dementia onset. No significant differences among PDD subgroups were reported. Conclusion: Executive and semantic language tests could differentiate DLB and PD patients with earlier development of dementia relative to parkinsonism. Show more

Keywords: Cognitive testing, dementia with Lewy bodies, Parkinson’s disease, ‘1-year rule’

DOI: 10.3233/JAD-210006

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 757-766, 2021

Authors: Heggy, Alaa | Masoumi, Aisha | Al-Yafei, Maryam | Al-Bader, Fatima | Al-Abdi, Tamara | Shi, Zumin

Article Type: Research Article

Abstract: Background: Tea and coffee consumption is associated with cognitive function in some studies. Objective: We aimed to identify tea and coffee drinking patterns and their association with mean reaction time among Qatari adults. Method: The study included 1,000 adults aged 20 years and above attending the Qatar Biobank Study (QBB). Habitual tea and coffee consumption during the previous year was assessed by questionnaire. Tea and coffee drinking patterns were identified using factor analysis. In a computer-based self-administered touch screens test, mean reaction time (MRT) was used as an indicator of cognitive function. Results: The …mean age of the participants was 35.8 (SD 10.3) years. Herbal tea and regular coffee consumption was inversely associated with MRT. In the multivariable model, compared with non-consumers, the regression coefficients for MRT were –34.3 (–65.4, –3.3) and –37.9 (–71.0, –4.7) for daily consumers of herbal tea and regular coffee, respectively. Of the two tea and coffee drinking patterns identified, pattern 1 (high consumption of tea, Arabic coffee, and herbal tea) was not associated with MRT but pattern 2 (high loadings of instant coffee, regular coffee, and Karak) was inversely associated with MRT in the unadjusted model. There was a significant interaction between pattern 2 and low-density lipoprotein (LDL) in relation to MRT. Pattern 2 was inversely associated with MRT among those with a low LDL. Conclusion: There was an inverse association between regular coffee and herbal tea consumption with mean reaction time. There was an interaction between Western coffee pattern and LDL. Show more

Keywords: Coffee, cognition, mean reaction time, Qatar biobank, tea

DOI: 10.3233/JAD-215130

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 767-776, 2021

Authors: Lan, Yu-Tung | Blacker, Deborah | Yuan, Changzheng | Chibnik, Lori B. | Hofman, Albert | Ma, Yuan

Article Type: Research Article

Abstract: Background: The evidence regarding dementia and late-life weight change is inconsistent, and data on body weight fluctuation and dementia are limited. Objective: To test the hypothesis that weight loss and substantial weight fluctuation predict cognitive decline independent of body weight and traditional risk factors of dementia. Methods: This study utilized longitudinal data from the National Alzheimer’s Coordinating Center for 10,639 stroke- and dementia-free older adults (60.9%female, mean age 71.6 years, median follow-up 5.5 years). Trends in weight change and weight fluctuation were estimated for each individual by regressing repeated body weight measurements on time. Cognitive decline …was examined as diagnostic progression from normal to mild cognitive impairment (MCI) or dementia and from MCI to dementia. Results: Compared to participants with stable weight, those with weight loss had increased odds of diagnostic progression (adjusted OR = 1.35, 95%CI [1.21, 1.51 ]). Also, large weight fluctuation was associated with increased odds of diagnostic progression (OR comparing the extreme quartiles = 1.20, 95%CI [1.04, 1.39 ]) after adjusting for traditional risk factors for dementia and body weight change. The magnitude of the association appeared larger among those older than 80 and those with 3 or more cardiometabolic risk factors at baseline (both p for interaction < 0.05). Conclusion: Weight loss and substantial weight fluctuation during late-life were associated with increased odds of cognitive decline independent of body weight and traditional risk factors of dementia. Our results suggested the linkage between late-life body weight instability and cognitive decline especially among those with greater age or higher cardiometabolic risk. Show more

Keywords: Alzheimer’s disease, body weight, dementia, epidemiology

DOI: 10.3233/JAD-210625

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 777-786, 2021

Authors: Matsuzono, Kosuke | Suzuki, Masayuki | Miura, Kumiko | Ozawa, Tadashi | Mashiko, Takafumi | Koide, Reiji | Tanaka, Ryota | Fujimoto, Shigeru

Article Type: Research Article

Abstract: Background: Many issues persist in the today’s Alzheimer’s disease (AD) screening and the breakthrough method is desired. Objective: We aim to validate the association between venous reflux and AD, and to develop a new method for AD screening. Methods: We examined spontaneous echo contrast, area, diameter, retrograde velocity, and anterograde velocity of the bilateral cervical internal jugular vein (IJV) using carotid ultrasonography. Results: A total of 112 patients participated in this study, with 26 diagnosed as AD. The proportion of both or either IJV spontaneous echo contrast (+) occupied 25 …of total 26 AD patients, which showed 96.2%of sensitivity and 98.5%negative predictive value. The IJV velocities also showed significant correlation with AD diagnosis, although the IJV area or diameter did not. Conclusion: Our results indicate that the validation of the spontaneous echo contrast or velocities of the IJV are convenient AD diagnosis screening methods and that the venous reflux disturbance correlates with AD development. Show more

Keywords: Alzheimer’s disease, atrial fibrillation, carotid ultrasonography, screening, venous reflux

DOI: 10.3233/JAD-210490

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 787-796, 2021

Authors: Fink, Anne | Doblhammer, Gabriele | Tamgüney, Gültekin

Article Type: Research Article

Abstract: Background: Gastrointestinal infections cause significant health problems, including those affecting the immune, musculoskeletal, and nervous system, and are one of the leading causes for death worldwide. Recent findings suggest that microbiota of the gastrointestinal tract contribute to dementia. Objective: In this nested case-control study we investigated the role of common gastrointestinal infections on the subsequent risk of dementia. Methods: We used a longitudinal sample of 202,806 individuals from health claims data of the largest German health insurer and applied a nested case-control design with 23,354 initial dementia cases between 2006 and 2014 and …23,354 matched controls. We used conditional logistic regression to compute odds ratios (ORs) for dementia and corresponding 95%confidence intervals (CIs), adjusting for potential confounders. Results: The risk of dementia was increased in patients with recurring incidences of quarters with diagnosed gastrointestinal infections when compared to the unexposed population (one quarter: OR = 1.49, 95%CI = 1.40–1.58; two quarters: OR = 1.70, 95%CI = 1.51–1.91; three or more quarters: OR = 1.64, 95%CI = 1.40–1.93), adjusted for potential confounders. Conclusion: Our findings suggest that recurring gastrointestinal infections are associated with an increased risk of subsequent dementia. Show more

Keywords: Alzheimer’s disease, dementia, gastrointestinal microbiome, risk

DOI: 10.3233/JAD-210316

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 797-806, 2021

Authors: Fukuda, Haruhisa | Ono, Rei | Maeda, Megumi | Murata, Fumiko

Article Type: Research Article

Abstract: Background: Alzheimer’s disease (AD) can increase both medical care and long-term care (LTC) costs, but the latter are frequently neglected in estimates of AD’s economic burden. Objective: To elucidate the economic burden of new AD cases in Japan by estimating patient-level medical care and LTC expenditures over 3 years using a longitudinal database. Methods: The study was performed using monthly claims data from residents of 6 municipalities in Japan. We identified patients with new AD diagnoses between April 2015 and March 2016 with 3 years of follow-up data. Medical care and LTC expenditures were estimated from …1 year before onset until 3 years after onset. To quantify the additional AD-attributable expenditures, AD patients were matched with non-AD controls using propensity scores, and their differences in expenditures were calculated. Results: After propensity score matching, the AD group and non-AD group each comprised 1748 individuals for analysis (AD group: mean age±standard deviation, 81.9±7.6 years; women, 66.0%). The total additional expenditures peaked at $1398 in the first month, followed by $1192 and $1031 in the second and third months, respectively. The additional LTC expenditures increased substantially 3 months after AD onset ($227), and gradually increased thereafter. These additional LTC expenditures eventually exceeded the additional medical care expenditures in the second year after AD onset. Conclusion: Although total AD-attributable expenditures peaked just after disease onset, the impact of LTC on these expenditures rose over time. Failure to include LTC expenditures would severely underestimate the economic burden of AD. Show more

Keywords: Alzheimer’s disease, dementia, health expenditures, healthcare administrative claims, long-term care

DOI: 10.3233/JAD-201508

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 807-817, 2021

Authors: Fischer, Corinne E. | Churchill, Nathan | Leggieri, Melissa | Vuong, Veronica | Tau, Michael | Fornazzari, Luis R. | Thaut, Michael H. | Schweizer, Tom A.

Article Type: Research Article

Abstract: Background: Repeated exposure to long-known music has been shown to have a beneficial effect on cognitive performance in patients with AD. However, the brain mechanisms underlying improvement in cognitive performance are not yet clear. Objective: In this pilot study we propose to examine the effect of repeated long-known music exposure on imaging indices and corresponding changes in cognitive function in patients with early-stage cognitive decline. Methods: Participants with early-stage cognitive decline were assigned to three weeks of daily long-known music listening, lasting one hour in duration. A cognitive battery was administered, and brain activity was measured …before and after intervention. Paired-measures tests evaluated the longitudinal changes in brain structure, function, and cognition associated with the intervention. Results: Fourteen participants completed the music-based intervention, including 6 musicians and 8 non-musicians. Post-baseline there was a reduction in brain activity in key nodes of a music-related network, including the bilateral basal ganglia and right inferior frontal gyrus, and declines in fronto-temporal functional connectivity and radial diffusivity of dorsal white matter. Musician status also significantly modified longitudinal changes in functional and structural brain measures. There was also a significant improvement in the memory subdomain of the Montreal Cognitive Assessment. Conclusion: These preliminary results suggest that neuroplastic mechanisms may mediate improvements in cognitive functioning associated with exposure to long-known music listening and that these mechanisms may be different in musicians compared to non-musicians. Show more

Keywords: Alzheimer’s disease, cognitive reserve, functional MRI, imaging, MRI, music

DOI: 10.3233/JAD-210610

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 819-833, 2021

Authors: Hao, Jing | Qiao, Yuchen | Li, Tingting | Yang, Jianwei | Song, Yang | Jia, Longfei | Jia, Jianping

Article Type: Research Article

Abstract: Background: Serum levels of inflammatory factors, such as C3, C4, C-reactive protein (CRP), immunoglobulin (Ig) G, IgA, and IgM, in patients with Alzheimer’s disease (AD) and their correlation with cognitive function remain unexplored. Objective: To investigate the expression of serum inflammatory factors in patients with AD and its correlation with cognitive function. Methods: Serum levels of C3, C4, CRP, IgG, IgA, and IgM in 200 patients with AD (mild, moderate, and severe) and those in 174 normal controls were assessed. Spearman’s rank correlation analysis was used to explore the relationships among biomarker levels, cognitive function, and …activities of daily living (ADL). Results: Among these inflammatory factors, C3 and CRP levels were significantly lower, and IgG and IgA levels were significantly higher in the AD group than in the control group (p  < 0.05). There were no significant differences in C4 and IgM levels between the two groups (p  > 0.05). In all participants, CRP level was positively correlated with the Mini-Mental State Examination and Montreal Cognitive Assessment scores (p  < 0.05). In the AD group, IgA level was negatively associated with ADL scores (p  < 0.05). No significant correlation was detected between the other factors and different cognitive scores (p  > 0.05). Conclusion: Inflammatory factors C3, CRP, IgG, and IgA have the potential to serve as biomarkers for AD. Furthermore, serum IgA was not only correlated with AD but also with ADL. These results support the hypothesis that inflammation is involved in the occurrence and development of AD. Show more

Keywords: Alzheimer’s disease, cognitive function, inflammatory factors, serum

DOI: 10.3233/JAD-210552

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 835-842, 2021

Authors: Russin, Kate J. | Nair, K. Sreekumaran | Montine, Thomas J. | Baker, Laura D. | Craft, Suzanne

Article Type: Research Article

Abstract: Background: Exploration of cerebrospinal fluid (CSF) amino acids and the impact of dietary intake on central levels may provide a comprehensive understanding of the metabolic component of Alzheimer’s disease. Objective: The objective of this exploratory study was to investigate the effects of two diets with varied nutrient compositions on change in CSF amino acids levels in adults with mild cognitive impairment (MCI) and normal cognition (NC). Secondary objectives were to assess the correlations between the change in CSF amino acids and change in Alzheimer’s disease biomarkers. Methods: In a randomized, parallel, controlled feeding trial, adults (NC, …n  = 20; MCI, n  = 29) consumed a high saturated fat (SFA)/glycemic index (GI) diet [HIGH] or a low SFA/GI diet [LOW] for 4 weeks. Lumbar punctures were performed at baseline and 4 weeks. Results: CSF valine increased and arginine decreased after the HIGH compared to the LOW diet in MCI (ps = 0.03 and 0.04). This pattern was more prominent in MCI versus NC (diet by diagnosis interaction ps = 0.05 and 0.09), as was an increase in isoleucine after the HIGH diet (p  = 0.05). Changes in CSF amino acids were correlated with changes in Alzheimer’s disease CSF biomarkers Aβ42 , total tau, and p-Tau 181, with distinct patterns in the relationships by diet intervention and cognitive status. Conclusion: Dietary intake affects CSF amino acid levels and the response to diet is differentially affected by cognitive status. Show more

Keywords: Alzheimer’s disease, amino acids, cerebrospinal fluid, diet intervention, mild cognitive impairment

DOI: 10.3233/JAD-210471

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 843-853, 2021

Authors: Wawrziczny, Emilie | Antoine, Pascal | Doba, Karyn

Article Type: Research Article

Abstract: Background: The increased tasks and responsibilities involved in supporting a parent with dementia (PWD) can induce distress in adult-child caregivers. Previous studies have shown that distress can be influenced by PWD and caregiver determinants, but few studies have considered the associations between these variables. Objective: This study tested a complex model of adult-child caregiver distress in which PWD and caregiver determinants and their associations are considered. Methods: 159 adult-child caregivers participated in this online study. PWD and caregiver determinants were assessed using questionnaires and their associations were investigated using the partial least squares path method. …Results: The model showed a significant partial mediation through self-efficacy (confidence in one’s ability to organize and manage caregiving situations) between poor self-rated health and distress. Self-efficacy was a significant mediator of the relationship between informal social support and distress, and between preparedness and distress. The direct path between parental overprotection and distress was significant. The association between care and distress was significantly stronger for adult-child caregivers not living with their PWD. Conclusion: The model revealed the important mediating role of self-efficacy. Clinical interventions should improve the preparedness of adult-child caregivers and the quality of social support. The positive perception of their self-rated health may thus be promoted. Show more

Keywords: Adult-child, caregivers, dementia, model

DOI: 10.3233/JAD-210624

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 855-867, 2021

Authors: Dai, Songyang | Zhou, Fanlin | Sun, Jieyun | Li, Yu

Article Type: Research Article

Abstract: Background: The most prevalent kind of dementia, Alzheimer’s disease (AD), is a neurodegenerative disease. Previous research has shown that glycogen synthase kinase-3β (GSK-3β) is involved in the etiology and progression of AD, including amyloid-β (Aβ), phosphorylated tau, and mitochondrial dysfunction. NPD1 has been shown to serve a neuroprotective function in AD, although the mechanism is unclear. Objective: The effects of NPD1 on Aβ expression levels, tau protein phosphorylation, apoptosis ratio, autophagy activity, and GSK-3β activity in N2a/APP695swe cells (AD cell model) were studied, as well as the mechanism behind such effects. Methods: N2a/APP695swe cells were treated …with NPD1, SB216763, or wortmannin as an AD cell model. The associated proteins of hyperphosphorylated tau and autophagy, as well as the activation of GSK3β, were detected using western blot and RT-PCR. Flow cytometry was utilized to analyze apoptosis and ELISA was employed to observe Aβ42 . Images of autophagy in cells are captured using transmission electron microscopy. Results: In N2a/APP695swe cells, NPD1 decreased Aβ42 and hyperphosphorylated tau while suppressing cell death. NPD1 also promoted autophagy while suppressing GSK-3β activation in N2a/APP695swe cells. The outcome of inhibiting GSK-3β is comparable to that of NPD1 therapy. However, after activating GSK-3β, the opposite experimental results were achieved. Conclusion: NPD1 might minimize cell apoptosis, downregulate Aβ expression, control tau hyperphosphorylation, and enhance autophagy activity in AD cell models to promote neuronal survival. NPD1’s neuroprotective effects may be mediated via decreasing GSK-3β. Show more

Keywords: Alzheimer’s disease, autophagy, glycogen synthase kinase 3, Neuroprotectin D1

DOI: 10.3233/JAD-210729

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 869-881, 2021

Authors: Sultana, Munira | Campbell, Karen | Jennings, Morgan | Montero-Odasso, Manuel | Orange, J.B. | Knowlton, Jill | St. George, Armin | Bryant, Dianne

Article Type: Research Article

Abstract: Background: People with advanced dementia often exhibit responsive behaviors such as apathy, depression, agitation, aggression, and psychosis. Non-pharmacological approaches (e.g., listening to music, watching television, doing arts and crafts) are now considered as a first-line strategy to manage responsive behaviors in clinical practice due to the potential risks associated with the antipsychotic medications. To date, no evaluations of immersive non-head mounted virtual reality (VR) experience as a non-pharmacologic approach for people with advanced dementia living in nursing homes have been reported. Objective: To evaluate the feasibility (acceptance and safety) of VR experience. Methods: A single site …case series (nonrandomized and unblinded) with a convenience sample (N = 24; age = 85.8±8.6 years; Cognitive Performance Scale score = 3.4±0.6) measuring depression and agitation before and after the intervention. The intervention was a 30-min long research coordinator– facilitated VR experience for two weeks (10 sessions). Results: The intervention was feasible (attrition rate = 0% ; adverse events = 0). A reduction in depression and in agitation was observed after the intervention. However, we suggest extreme caution in interpreting this result considering the study design and small sample size. Conclusion: This study provides the basis for conducting a randomized controlled trial to evaluate the effect of VR experience on responsive behaviors in nursing homes. Since our intervention uses a smart remote-controlled projector without a headset, infectious exposure can be avoided following the COVID-19 pandemic-induced physical distancing policy in care homes. Show more

Keywords: Dementia, nursing home, responsive behaviors, virtual reality experience intervention

DOI: 10.3233/JAD-210010

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 883-893, 2021

Authors: Yin, Xiaomin | Zhou, Zheng | Qiu, Yanyan | Fan, Xing | Zhao, Chenhao | Bao, Junze | Liu, Chenxu | Liu, Fei | Qian, Wei

Article Type: Research Article

Abstract: Background: Amyloid plaques and neurofibrillary tangles are two pathological hallmarks of Alzheimer’s disease (AD). However, synaptic deficits occur much earlier and correlate stronger with cognitive decline than amyloid plaques and neurofibrillary tangles. Mislocalization of tau is an early hallmark of neurodegeneration and precedes aggregations. Sirtuin type 1 (SIRT1) is a deacetylase which acts on proteins including transcriptional factors and associates closely with AD. Objective: The present study investigated the association between SIRT1 and tau expression/tau localization in cells and in mice brains. Methods: Western blot was performed to detected tau, SIRT1, C/EBPα , and GAPDH protein …levels. Immunological fluorescence assay was used to assess tau localization in primary cortical neuronal cells. Golgi staining was performed to evaluated dendritic spine morphology in mice brains. Results: In the present study, we found that SIRT1 negatively regulates expression of tau at the transcriptional level through transcriptional factor C/EBPα . Inhibition of the activity of SIRT1 limits the distribution of tau to the neurites. In the meantime, the alteration of dendritic spine morphology is also observed in the brains of SIRT1+/– mice. Conclusion: SIRT1 may be a potential drug target for early intervention in AD. Show more

Keywords: Alzheimer’s disease, post-synapse, SIRT1, tau

DOI: 10.3233/JAD-215118

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 895-904, 2021

Authors: Aso, Yasuhiro | Kimura, Noriyuki | Matsubara, Etsuro

Article Type: Research Article

Abstract: Background: Whether blood biomarkers of neurovascular unit are associated with cortical amyloid deposition on positron emission tomography (PET) imaging remains unclear. Objective: To investigate the association between novel serum biomarkers of neurovascular unit, such as protein tyrosine phosphatase receptor type B (PTPRB), gap junction protein alpha-5 (GJA5), adenosine triphosphate-sensitive inward rectifier potassium channel-8 (KCNJ8), and von Willebrand factor (vWF), and cortical amyloid deposition. Methods: Between 2012 and 2018, 68 elderly individuals with amnestic mild cognitive impairment (32 men and 36 women; mean age 75.2 years) were enrolled. All participants underwent 11 C-Pittsburgh compound-B (PiB)-PET, 18 F-fluorodeoxyglucose-PET, …and measurement of serum PTPRB, GJA5, KCNJ8, and vWF levels using commercially available human enzyme-linked immunosorbent assay kits. Based on the mean cortical standardized uptake value ratio, the participants were divided into two groups: PiB-negative group and PiB-positive group. Serum levels of PTPRB, GJA5, KCNJ8, and vWF were compared between the two groups. Multiple linear regression analysis was performed to investigate the relationship between serum PTPRB, GJA5, KCNJ8, and vWF levels and cortical amyloid deposition. Results: PTPRB and GJA5 levels were significantly lower and KCNJ8 and vWF levels were significantly higher in the PiB-positive group than in the PiB-negative group. PTPRB and GJA5 levels inversely correlated with mean PiB uptake, whereas KCNJ8 and vWF levels positively correlated with mean PiB uptake. Conclusion: Serum levels of PTPRB, GJA5, KCNJ8, and vWF correlate with cortical amyloid deposition. These novel blood biomarkers of neurovascular unit are useful for identifying elderly individuals at risk of developing Alzheimer’s disease. Show more

Keywords: Alzheimer’s disease, amyloid deposits, blood–brain barrier, cerebrovascular disease, mild cognitive impairment, positron emission tomography

DOI: 10.3233/JAD-215135

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 905-914, 2021

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

Article Type: Correction

DOI: 10.3233/JAD-219015

Citation: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 915-915, 2021