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1.
Alzheimers Dement ; 19(1): 261-273, 2023 01.
Article in English | MEDLINE | ID: mdl-35357079

ABSTRACT

HYPOTHESIS: We hypothesized that Lomecel-B, an allogeneic medicinal signaling cell (MSC) therapeutic candidate for Alzheimer's disease (AD), is safe and potentially disease-modifying via pleiotropic mechanisms of action. KEY PREDICTIONS: We prospectively tested the predictions that Lomecel-B administration to mild AD patients is safe (primary endpoint) and would provide multiple exploratory indications of potential efficacy in clinical and biomarker domains (prespecified secondary/exploratory endpoints). STRATEGY AND KEY RESULTS: Mild AD patient received a single infusion of low- or high-dose Lomecel-B, or placebo, in a double-blind, randomized, phase I trial. The primary safety endpoint was met. Fluid-based and imaging biomarkers indicated significant improvement in the Lomecel-B arms versus placebo. The low-dose Lomecel-B arm showed significant improvements versus placebo on neurocognitive and other assessments. INTERPRETATION: Our results support the safety of Lomecel-B for AD, suggest clinical potential, and provide mechanistic insights. This early-stage study provides important exploratory information for larger efficacy-powered clinical trials.


Subject(s)
Alzheimer Disease , Humans , Alzheimer Disease/drug therapy , Treatment Outcome , Double-Blind Method , Biomarkers
2.
Int J Psychiatry Clin Pract ; 27(1): 69-81, 2023 Mar.
Article in English | MEDLINE | ID: mdl-35574992

ABSTRACT

Dementia due to Parkinson's disease and Alzheimer's disease are associated with behavioural and psychological symptoms, including psychosis. Long-term management presents a challenge for health care providers and caregivers. Symptoms of psychosis include hallucinations and delusions; if untreated, these can lead to institutionalisation, decreased quality of life, and significant patient and caregiver distress. A critical step in the effective management of dementia-related psychosis (DRP) is the identification and diagnosis of affected patients. The lack of a standardised diagnostic approach presents a barrier to treatment and there are no consensus guidelines for DRP. Furthermore, there are no approved therapies for the treatment of DRP. Antipsychotic medications are often prescribed off-label, even though some are associated with an increased risk of adverse events or mortality. We present currently available screening tools and guidelines for the diagnosis and treatment of Parkinson's disease psychosis and DRP in the context of what is needed for effective management of psychosis.KEY POINTSWe present currently available screening tools and guidelines for Parkinson's disease psychosis and dementia-related psychosis, and discuss the unmet need for simple clinical diagnostic tools and treatment guidelines.The identification of psychosis is variable across different settings and specialties, without a unified approach to screening, definition, or diagnosis.Currently used tools for defining and assessing psychosis in a research setting are usually too cumbersome for everyday clinical practice.The development of a standardised set of diagnostic criteria would provide clinicians the opportunity to improve the detection, treatment, and quality of life of patients and their caregivers.


Subject(s)
Alzheimer Disease , Antipsychotic Agents , Parkinson Disease , Psychotic Disorders , Humans , Parkinson Disease/complications , Parkinson Disease/diagnosis , Parkinson Disease/therapy , Quality of Life , Piperidines/adverse effects , Urea/adverse effects , Psychotic Disorders/diagnosis , Psychotic Disorders/etiology , Psychotic Disorders/therapy , Alzheimer Disease/drug therapy , Antipsychotic Agents/adverse effects
3.
Analyst ; 147(22): 5018-5027, 2022 Nov 07.
Article in English | MEDLINE | ID: mdl-36156609

ABSTRACT

Pattern recognition methodology was developed for the automated detection of marine oil spills in passive infrared multispectral remote sensing images. The images employed in this work were collected from the Deepwater Horizon oil spill accident in 2010. The imaging instrument for data collection was a downward-looking infrared line scanner equipped with eight optical bandpass filters in the spectral range of 8-12 µm on a fixed-wing aircraft. Oil slicks may show either positive or negative thermal contrast against the surrounding sea water, depending on the sun glint conditions or the oil thickness. Classifiers were developed separately to detect oil with different contrasts by the application of backpropagation neural networks to the preprocessed radiances. Preprocessing strategies included: (1) assembly of training data through k-means clustering analysis; (2) elimination of variation in radiance magnitudes by a customized temperature correction method; (3) removal of sun glint artifacts in images by polynomial correction; and (4) extraction of the most representative features as inputs for the neural networks by a subset selection approach. The classifiers designed to detect oil with positive and negative thermal contrast relative to water achieved overall classification accuracies of 88.7 and 92.2%, respectively. Composite classification images were generated by integrating classification scores produced by the two classifiers. The prediction performance of the classification system was demonstrated through its application to images not involved during the training of the networks.


Subject(s)
Petroleum Pollution , Petroleum Pollution/analysis , Remote Sensing Technology/methods , Environmental Monitoring/methods , Algorithms , Neural Networks, Computer
4.
Int Psychogeriatr ; 33(7): 703-713, 2021 07.
Article in English | MEDLINE | ID: mdl-32985406

ABSTRACT

OBJECTIVE: Because of inconsistent findings regarding the relationship between sleep quality and cognitive function in people with age-related memory complaints, we examined how self-reports of sleep quality were related to multiple domains of both objective and subjective cognitive function in middle-aged and older adults. DESIGN: A cross-sectional study involving analysis of baseline data, collected as part of a clinical trial. MEASUREMENTS: Two hundred and three participants (mean age = 60.4 [6.5] years, 69.0% female) with mild memory complaints were asked to rate their sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and their memory performance using the Memory Functioning Questionnaire (MFQ), which measures self-awareness of memory ability. Neurocognitive performance was evaluated using the Continuous Performance Test (CPT), Trail Making Test, Buschke Selective Reminding Test, and the Brief Visuospatial Test - Revised (BVMT-R). RESULTS: Total PSQI scores were significantly associated with objective measures of sustained attention (CPT hit reaction time by block and standard error by block) and subjective memory loss (MFQ frequency and seriousness of forgetting). The PSQI components of (poorer) sleep quality and (greater) sleep disturbance were related to (worse) sustained attention scores while increased sleep latency and daytime sleepiness were associated with greater frequency and seriousness of forgetting. CONCLUSIONS: Sleep quality is related to both objective measures of sustained attention and self-awareness of memory decline. These findings suggest that interventions for improving sleep quality may contribute not only to improving the ability to focus on a particular task but also in reducing memory complaints in middle-aged and older adults.


Subject(s)
Cognitive Aging/psychology , Diagnostic Self Evaluation , Memory Disorders/diagnosis , Memory Disorders/psychology , Memory , Sleep Wake Disorders/psychology , Sleep , Attention , Clinical Trials as Topic , Cross-Sectional Studies , Female , Humans , Male , Mental Status and Dementia Tests , Middle Aged , Reaction Time , Self Report , Sleep Wake Disorders/diagnosis
5.
Exp Aging Res ; 47(2): 131-144, 2021.
Article in English | MEDLINE | ID: mdl-33357089

ABSTRACT

Objective: To study whether memory control beliefs predict response to memory training, or change as a result of participating in memory training. Methods: Eighty community based participants with subjective memory complaints Community-based study at UCLA were randomized to one of three conditions: Memory Training, the program consisted of weekly 120-minute classes featuring instruction in three specific strategies: Method of Loci; Chunking Technique; and Face-Name Association, Health Education or Wait-List over seven weeks. All participants underwent pre- and 1-week post-intervention follow-up memory testing for recalling word lists (in serial order and any order) and face-name pairs. Memory control beliefs were assessed at baseline and follow-up using the Memory Controllability Inventory, which consists of four subscales; Present Ability; Potential Improvement; Effort Utility; and Inevitable Decrement. Results: Sixty-three participants (mean age [SD] 68.3 [6.7] years) were included in the analysis. ANCOVA revealed significant group differences in the Present Ability subscale, F2,58 = 4.93, p =.01. Participants in the Memory Training group significantly improved on the Present Ability subscale compared to the Health Education group (mean difference =.96, SE =.31, p =.003, effect size = 0.93). From regression analyses, baseline Memory Controllability Inventory subscales did not significantly predict memory performance after memory training. Conclusions: Baseline memory control beliefs did not predict memory performance following the intervention, but participating in memory training enhanced memory control beliefs about current memory function. These results suggest that participating in memory training can enhance confidence in one's memory ability.


Subject(s)
Aging , Memory , Aged , Cognition , Humans , Learning , Memory Disorders/therapy
6.
Anal Chem ; 91(3): 1855-1862, 2019 02 05.
Article in English | MEDLINE | ID: mdl-30605302

ABSTRACT

A noninvasive method for detecting episodes of nocturnal hypoglycemia is demonstrated with in vivo measurements made with a rat animal model. Employing spectra collected from the near-infrared combination region of 4000-5000 cm-1, piecewise linear discriminant analysis (PLDA) is used to classify spectra into alarm and nonalarm data classes on the basis of whether or not they correspond to glucose concentrations below a user-defined hypoglycemic threshold. A reference spectrum and corresponding glucose concentration are acquired at the start of the monitoring period, and spectra are then collected continuously and converted to absorbance units relative to the initial reference spectrum. The resulting differential spectra correspond to differential glucose concentrations that reflect the differences in concentration between each spectrum and the reference. Given an alarm threshold (e.g., 3.0 mM), a database of calibration differential spectra can be partitioned into two groups containing spectra above and below the threshold. A classification model is then computed with PLDA. The resulting model can be applied to the differential spectra collected during the monitoring period in order to identify spectra whose corresponding glucose concentrations lie in the hypoglycemic range. In this work, the alarm algorithm was tested in two single-day studies performed with anesthetized rats. Glucose concentrations spanned the range of 1.6 to 13.5 mM (29 to 244 mg/dL). For both rats, the alarm algorithm performed well. On average, 87.5% of alarm events were correctly detected, and the occurrence of false alarms was 7.2%. False alarms were restricted to times when the glucose concentrations were very close to the alarm threshold rather than at random times, thus demonstrating the potential of the approach for practical use.


Subject(s)
Disease Models, Animal , Hypoglycemia/drug therapy , Hypoglycemic Agents/therapeutic use , Algorithms , Animals , Discriminant Analysis , Hypoglycemic Agents/chemistry , Rats , Rats, Sprague-Dawley , Spectroscopy, Near-Infrared
7.
Am J Geriatr Psychiatry ; 27(3): 213-236, 2019 03.
Article in English | MEDLINE | ID: mdl-30686664

ABSTRACT

As the world's population ages and people live longer, the changes in the aging brain present substantial challenges to our health and society. With greater longevity come age-related diseases, many of which have direct and indirect influences on the health of the brain. Although there is some degree of predictable decline in brain functioning with aging, meaningful cognitive decline is not inevitable and is perhaps preventable. In this review, we present the case that the course of aging-related brain disease and dysfunction can be modified. We present the evidence for conditions and risk factors that may contribute to cognitive decline and dementia and for interventions that may mitigate their impact on cognitive functioning later in life, or even prevent them and their cognitive sequelae from developing. Although much work remains to be done to meet the challenges of the aging brain, strategies to promote its health have been demonstrated and offer much promise, which can only be realized if we mount a vigorous public health effort to implement these strategies.


Subject(s)
Brain/physiology , Cognitive Aging , Cognitive Dysfunction/prevention & control , Health Promotion/methods , Aged , Cognition , Dementia/prevention & control , Dementia/psychology , Humans , Life Style
8.
Alzheimer Dis Assoc Disord ; 33(4): 327-330, 2019.
Article in English | MEDLINE | ID: mdl-31513029

ABSTRACT

OBJECTIVE: A rare variant in TREM2 (p.R47H, rs75932628) has been consistently reported to increase the risk for Alzheimer disease (AD), while mixed evidence has been reported for association of the variant with other neurodegenerative diseases. Here, we investigated the frequency of the R47H variant in a diverse and well-characterized multicenter neurodegenerative disease cohort. METHODS: We examined the frequency of the R47H variant in a diverse neurodegenerative disease cohort, including a total of 3058 patients clinically diagnosed with AD, frontotemporal dementia spectrum syndromes, mild cognitive impairment, progressive supranuclear palsy syndrome, corticobasal syndrome, or amyotrophic lateral sclerosis and 5089 control subjects. RESULTS: We observed a significant association between the R47H variant and AD, while no association was observed with any other neurodegenerative disease included in this study. CONCLUSIONS: Our results support the consensus that the R47H variant is significantly associated with AD. However, we did not find evidence for association of the R47H variant with other neurodegenerative diseases.


Subject(s)
Genetic Predisposition to Disease , Genetic Variation , Genotype , Membrane Glycoproteins/genetics , Neurodegenerative Diseases/genetics , Receptors, Immunologic/genetics , Aged , Alzheimer Disease/genetics , Amyotrophic Lateral Sclerosis/genetics , Cognitive Dysfunction/genetics , Cohort Studies , Female , Frontotemporal Dementia/genetics , Humans , Internationality , Male
9.
Am J Geriatr Psychiatry ; 26(1): 13-22, 2018 01.
Article in English | MEDLINE | ID: mdl-29111133

ABSTRACT

OBJECTIVE: Growing evidence supports an association between increased blood pressure and: (a) poor cognitive performance in older adults, and (b) various biomarkers of increased Alzheimer's disease (AD) neuropathology. The objective of this study was to determine whether systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly associated with cognitive functioning in non-demented adults, and to examine in vivo AD pathology as a possible mediator of this association. METHODS: Positron emission tomography (PET) scans with 2-(1-{6-[(2-[F-18]fluoroethyl)(methyl)amino]-2-naphthyl}ethylidene)malononitrile (FDDNP) provide in vivo measurements of plaque and tangle burden. A total of 101 non-demented older subjects with blood pressure data and FDDNP-PET scans were drawn from a larger study of predictors of cognitive decline. A neuropsychological test battery was used to compute "global cognitive scores" (averaged across five key domains), which served as an index of general cognitive functioning. RESULTS: Higher DBP (but not SBP) was significantly associated with lower cognitive scores, controlling for age, sex, antihypertensive medication use, and ApoE genotype (η2 = 0.06). However, this relationship was no longer significant after introducing FDDNP-PET binding as an additional covariate in the statistical models. In vivo plaque and tangle burden accounted for over 30% of the observed association between higher DBP and poorer cognitive performance. CONCLUSIONS: By suggesting a mediation of the relationship between DBP and cognitive functioning by FDDNP-PET binding, this study advances our understanding of some potential predictors of cognitive decline in non-demented adults, and underscores the importance of devising early multimodal interventions to more effectively combat degenerative brain disorders.


Subject(s)
Blood Pressure/physiology , Cognitive Dysfunction/diagnosis , Hypertension/physiopathology , Neurofibrillary Tangles/metabolism , Nitriles , Plaque, Amyloid/diagnostic imaging , Positron-Emission Tomography/methods , Adult , Aged , Aged, 80 and over , Cognitive Dysfunction/diagnostic imaging , Cognitive Dysfunction/physiopathology , Female , Humans , Male , Middle Aged
10.
Am J Geriatr Psychiatry ; 26(3): 266-277, 2018 03.
Article in English | MEDLINE | ID: mdl-29246725

ABSTRACT

OBJECTIVE: Because curcumin's anti-inflammatory properties may protect the brain from neurodegeneration, we studied its effect on memory in non-demented adults and explored its impact on brain amyloid and tau accumulation using 2-(1-{6-[(2-[F-18]fluoroethyl)(methyl)amino]-2-naphthyl}ethylidene)malononitrile positron emission tomography (FDDNP-PET). METHODS: Forty subjects (age 51-84 years) were randomized to a bioavailable form of curcumin (Theracurmin® containing 90 mg of curcumin twice daily [N = 21]) or placebo (N = 19) for 18 months. Primary outcomes were verbal (Buschke Selective Reminding Test [SRT]) and visual (Brief Visual Memory Test-Revised [BVMT-R]) memory, and attention (Trail Making A) was a secondary outcome. FDDNP-PET signals (15 curcumin, 15 placebo) were determined in amygdala, hypothalamus, medial and lateral temporal, posterior cingulate, parietal, frontal, and motor (reference) regions. Mixed effects general linear models controlling for age and education, and effect sizes (ES; Cohen's d) were estimated. RESULTS: SRT Consistent Long-Term Retrieval improved with curcumin (ES = 0.63, p = 0.002) but not with placebo (ES = 0.06, p = 0.8; between-group: ES = 0.68, p = 0.05). Curcumin also improved SRT Total (ES = 0.53, p = 0.002), visual memory (BVMT-R Recall: ES = 0.50, p = 0.01; BVMT-R Delay: ES = 0.51, p = 0.006), and attention (ES = 0.96, p < 0.0001) compared with placebo (ES = 0.28, p = 0.1; between-group: ES = 0.67, p = 0.04). FDDNP binding decreased significantly in the amygdala with curcumin (ES = -0.41, p = 0.04) compared with placebo (ES = 0.08, p = 0.6; between-group: ES = 0.48, p = 0.07). In the hypothalamus, FDDNP binding did not change with curcumin (ES = -0.30, p = 0.2), but increased with placebo (ES = 0.26, p = 0.05; between-group: ES = 0.55, p = 0.02). CONCLUSIONS: Daily oral Theracurmin may lead to improved memory and attention in non-demented adults. The FDDNP-PET findings suggest that symptom benefits are associated with decreases in amyloid and tau accumulation in brain regions modulating mood and memory.


Subject(s)
Aging/drug effects , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Attention/drug effects , Brain/drug effects , Curcumin/pharmacology , Memory/drug effects , Plaque, Amyloid/drug therapy , tau Proteins/drug effects , Aged , Aged, 80 and over , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Brain/diagnostic imaging , Curcumin/administration & dosage , Double-Blind Method , Female , Humans , Male , Middle Aged , Placebos , Positron-Emission Tomography , Treatment Outcome
11.
Proc Natl Acad Sci U S A ; 112(16): E2039-47, 2015 Apr 21.
Article in English | MEDLINE | ID: mdl-25848027

ABSTRACT

Chronic traumatic encephalopathy (CTE) is an acquired primary tauopathy with a variety of cognitive, behavioral, and motor symptoms linked to cumulative brain damage sustained from single, episodic, or repetitive traumatic brain injury (TBI). No definitive clinical diagnosis for this condition exists. In this work, we used [F-18]FDDNP PET to detect brain patterns of neuropathology distribution in retired professional American football players with suspected CTE (n = 14) and compared results with those of cognitively intact controls (n = 28) and patients with Alzheimer's dementia (AD) (n = 24), a disease that has been cognitively associated with CTE. [F-18]FDDNP PET imaging results in the retired players suggested the presence of neuropathological patterns consistent with models of concussion wherein brainstem white matter tracts undergo early axonal damage and cumulative axonal injuries along subcortical, limbic, and cortical brain circuitries supporting mood, emotions, and behavior. This deposition pattern is distinctively different from the progressive pattern of neuropathology [paired helical filament (PHF)-tau and amyloid-ß] in AD, which typically begins in the medial temporal lobe progressing along the cortical default mode network, with no or minimal involvement of subcortical structures. This particular [F-18]FDDNP PET imaging pattern in cases of suspected CTE also is primarily consistent with PHF-tau distribution observed at autopsy in subjects with a history of mild TBI and autopsy-confirmed diagnosis of CTE.


Subject(s)
Brain Injury, Chronic/diagnostic imaging , Brain/diagnostic imaging , Brain/pathology , Nitriles , Positron-Emission Tomography , Adult , Aged , Aged, 80 and over , Alzheimer Disease/diagnostic imaging , Amygdala/microbiology , Amygdala/pathology , Autopsy , Case-Control Studies , Demography , Humans , Male , Mesencephalon/microbiology , Mesencephalon/pathology , Middle Aged
12.
Alzheimers Dement ; 13(7): 739-748, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28183529

ABSTRACT

INTRODUCTION: The translocase of outer mitochondrial membrane 40 (TOMM40), which lies in linkage disequilibrium with apolipoprotein E (APOE), has received attention more recently as a promising gene in Alzheimer's disease (AD) risk. TOMM40 influences AD pathology through mitochondrial neurotoxicity, and the medial temporal lobe (MTL) is the most likely brain region for identifying early manifestations of AD-related morphology changes. METHODS: In this study, we examined the effects of TOMM40 using high-resolution magnetic resonance imaging in 65 healthy, older subjects with and without the APOE ε4 AD-risk variant. RESULTS: Examining individual subregions within the MTL, we found a significant relationship between increasing poly-T lengths of the TOMM40 variant and thickness of the entorhinal cortex only in subjects who did not carry the APOE ε4 allele. DISCUSSION: Our data provide support for TOMM40 variant repeat length as an important contributor to AD-like MTL pathology in the absence of APOE ε4.


Subject(s)
Apolipoprotein E4/genetics , Hippocampus/pathology , Membrane Transport Proteins/genetics , Aged , Alzheimer Disease/genetics , Entorhinal Cortex/pathology , Female , Genotype , Healthy Volunteers , Humans , Linkage Disequilibrium , Magnetic Resonance Imaging , Male , Middle Aged , Mitochondrial Precursor Protein Import Complex Proteins , Temporal Lobe/pathology
13.
Psychogeriatrics ; 17(3): 186-193, 2017 May.
Article in English | MEDLINE | ID: mdl-28130887

ABSTRACT

BACKGROUND: Neurotoxicity associated with amyloid and tau protein aggregation could represent a pathophysiological cascade that, along with vascular compromise, may predispose individuals to late-life depression (LLD). In LLD, apathy is common, leads to worsening of functioning, and responds poorly to antidepressant treatment. Better understanding of the pathophysiological mechanisms of apathy in LLD would facilitate development of more effective diagnostic and treatment approaches. In this cross-sectional pilot study, we performed positron emission tomography scans after injection of 2-(1-{6-[(2-[18 F]fluoroethyl)(methyl)-amino]-2-naphthyl}ethylidene) malononitrile ([18 F]FDDNP), an in vivo amyloid and tau neuroimaging study, in patients with LLD to explore neural correlates of apathy. METHODS: Sixteen depressed elderly volunteers received clinical assessments and [18 F]FDDNP positron emission tomography scans. The cross-sectional relationship of [18 F]FDDNP binding levels with depression (Hamilton Depression Rating Scale) and apathy (Apathy Evaluation Scale) were studied using Spearman's correlation analyses because of the relatively small sample size. Age, sex, and years of education were partialed out. Significance levels were set at P ≤ 0.05. RESULTS: [18 F]FDDNP binding in the anterior cingulate cortex was negatively associated with the Apathy Evaluation Scale total (r = -0.62, P = 0.02; where low Apathy Evaluation Scale score equals greater severity of apathy). This suggests that apathy in LLD is associated with higher amyloid and/or tau levels in the anterior cingulate cortex. None of the regional [18 F]FDDNP binding levels was significantly associated with the Hamilton Depression Rating Scale total. CONCLUSION: This pilot study suggests that increased apathy in subjects with LLD may be associated with greater amyloid and/or tau burden in certain brain regions. Future studies in larger samples would elucidate the generalizability of these results, which eventually could lead to improved diagnostic and treatment methods in LLD.


Subject(s)
Amyloid beta-Peptides/metabolism , Depression/diagnostic imaging , Plaque, Amyloid/diagnostic imaging , Positron-Emission Tomography , tau Proteins/metabolism , Aged , Aged, 80 and over , Apathy , Brain/diagnostic imaging , Brain/metabolism , Cross-Sectional Studies , Depression/physiopathology , Female , Humans , Male , Middle Aged , Nitriles , Pilot Projects , Positron-Emission Tomography/methods , Radiopharmaceuticals
14.
Hum Brain Mapp ; 37(1): 366-80, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26503161

ABSTRACT

The hippocampal complex is affected early in Alzheimer's disease (AD). Increasingly, altered functional connectivity of the hippocampus is recognized as an important feature of preclinical AD. Carriers of the APOEɛ4 allele are at an increased risk for AD, which could lead to altered hippocampal connectivity even in healthy older adults. To test this hypothesis, we used a paired-associates memory task to examine differences in task-dependent functional connectivity of the anterior and posterior hippocampus in nondemented APOEɛ4 carriers (n = 34, 18F) and noncarriers (n = 46, 31F). We examined anterior and posterior portions of the hippocampus separately to test the theory that APOEɛ4-mediated differences would be more pronounced in the anterior region, which is affected earlier in the AD course. This study is the first to use a psychophysiological interaction approach to query the context-dependent connectivity of subregions of the hippocampus during a memory task in adults at increased genetic risk for AD. During encoding, APOEɛ4 carriers had lower functional connectivity change compared to baseline between the anterior hippocampus and right precuneus, anterior insula and cingulate cortex. During retrieval, bilateral supramarginal gyrus and right precuneus showed lower functional connectivity change with anterior hippocampus in carriers. Also during retrieval, carriers showed lower connectivity change in the posterior hippocampus with auditory cortex. In each case, APOEɛ4 carriers showed strong negative connectivity changes compared to noncarriers where positive connectivity change was measured. These differences may represent prodromal functional changes mediated in part by APOEɛ4 and are consistent with the anterior-to-posterior theory of AD progression in the hippocampus.


Subject(s)
Alzheimer Disease , Apolipoproteins E/genetics , Auditory Cortex/pathology , Hippocampus/pathology , Memory Disorders/etiology , Polymorphism, Single Nucleotide/genetics , Aged , Alzheimer Disease/complications , Alzheimer Disease/genetics , Alzheimer Disease/pathology , Brain Mapping , Disease Progression , Female , Genotype , Humans , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Male , Mental Recall/physiology , Models, Neurological , Neural Pathways/pathology , Neuropsychological Tests , Psychiatric Status Rating Scales , Risk Factors , Verbal Learning
15.
Am J Geriatr Psychiatry ; 24(12): 1142-1150, 2016 12.
Article in English | MEDLINE | ID: mdl-27745823

ABSTRACT

Current diagnostic and treatment strategies for cognitive decline can help patients maintain cognitive ability and higher levels of function longer. Despite advances in detection and early treatment strategies, many patients do not receive proper assessments and available therapies. A systematic assessment strategy will increase the likelihood of an accurate diagnosis, which can facilitate pharmacologic and non-pharmacologic treatment plans that can have a meaningful impact on prognosis. Available data support the integration of healthy lifestyle strategies in the treatment plan to help to stabilize symptoms and potentially delay future cognitive decline. While investigators continue to pursue more effective detection, treatment, and prevention strategies, the scientific data support the use of symptomatic drug treatments and recommendations for healthy lifestyle behaviors to improve quality of life and potentially stave off future cognitive decline. Success of such healthy lifestyle programs involves educating participants on the connection between lifestyle and disease prevention, offering enjoyable exercises that target the patient's skill level, and providing feedback that motivates participants to continue their healthy behaviors so they become habits.


Subject(s)
Cognitive Dysfunction/diagnosis , Aged , Biomarkers , Cognitive Dysfunction/drug therapy , Cognitive Dysfunction/genetics , Cognitive Dysfunction/prevention & control , Dementia/diagnosis , Dementia/prevention & control , Humans , Nootropic Agents/therapeutic use , Prognosis , Risk Reduction Behavior
16.
Am J Geriatr Psychiatry ; 24(10): 784-90, 2016 10.
Article in English | MEDLINE | ID: mdl-27567184

ABSTRACT

Here a case is presented of a 51-year-old former high school football player with multiple concussions, including one episode with loss of consciousness. The patient experienced 6 years of cognitive and mood decline, and his wife corroborated increasing memory loss, attentional difficulties, and depressed mood without suicidal ideation. He had been unable to maintain full-time employment because of progressive decline. Based on his presentation, he had been previously diagnosed with attention deficit hyperactivity disorder and bipolar disorder, type II. Neuropsychological tests indicated domain-specific cognitive impairment, and longitudinal volumetric magnetic resonance imaging (MRI) of the brain showed progressive brainstem, diencephalic, and frontal lobe atrophy. This regional volume loss correlated with the increased signal seen on tau and amyloid imaging (FDDNP-PET scan) of a separate case of suspected chronic traumatic encephalopathy (CTE). Visual assessment of the MRI also showed evidence of old petechial hemorrhages in the frontal and temporal-parietal lobe white matter. This case raises the possibility of distinct quantitative and visual brain MRI findings in suspected CTE.


Subject(s)
Brain/diagnostic imaging , Chronic Traumatic Encephalopathy/diagnostic imaging , Football/injuries , Amyloid/metabolism , Atrophy , Brain/metabolism , Brain/pathology , Brain Stem/diagnostic imaging , Brain Stem/metabolism , Brain Stem/pathology , Cerebral Hemorrhage/diagnostic imaging , Chronic Traumatic Encephalopathy/metabolism , Chronic Traumatic Encephalopathy/pathology , Chronic Traumatic Encephalopathy/psychology , Cognitive Dysfunction/psychology , Depressive Disorder/psychology , Diencephalon/diagnostic imaging , Diencephalon/metabolism , Diencephalon/pathology , Disease Progression , Frontal Lobe/diagnostic imaging , Frontal Lobe/metabolism , Frontal Lobe/pathology , Gray Matter/diagnostic imaging , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Organ Size , Positron-Emission Tomography , White Matter/diagnostic imaging , tau Proteins/metabolism
17.
Am J Geriatr Psychiatry ; 24(9): 729-37, 2016 09.
Article in English | MEDLINE | ID: mdl-27421618

ABSTRACT

OBJECTIVE: Exercise and diet impact body composition, but their age-related brain effects are unclear at the molecular imaging level. To address these issues, the authors determined whether body mass index (BMI), physical activity, and diet relate to brain positron emission tomography (PET) of amyloid plaques and tau tangles using 2-(1-(6-[(2-[F-18]fluoroethyl)(methyl)amino]-2-naphthyl)ethylidene)malononitrile (FDDNP). METHODS: Volunteers (N = 44; mean age: 62.6 ± 10.7 years) with subjective memory impairment (N = 24) or mild cognitive impairment (MCI; N = 20) were recruited by soliciting for memory complaints. Levels of physical activity and extent of following a Mediterranean-type diet were self-reported. FDDNP-PET scans assessed plaque/tangle binding in Alzheimer disease-associated regions (frontal, parietal, medial and lateral temporal, posterior cingulate). Mixed models controlling for known covariates examined BMI, physical activity, and diet in relation to FDDNP-PET. RESULTS: MCI subjects with above normal BMI (>25) had higher FDDNP-PET binding compared with those with normal BMI (1.11(0.03) versus 1.08(0.03), ES = 1.04, t(35) = 3.3, p = 0.002). Greater physical activity was associated with lower FDDNP-PET binding in MCI subjects (1.07(0.03) versus 1.11(0.03), ES = 1.13, t(35) = -3.1, p = 0.004) but not in subjects with subjective memory impairment (1.07(0.03) versus 1.07(0.03), ES = 0.02, t(35) = -0.1, p = 0.9). Healthier diet related to lower FDDNP-PET binding, regardless of cognitive status (1.07(0.03) versus 1.09(0.02), ES = 0.72, t(35) = -2.1, p = 0.04). CONCLUSION: These preliminary findings are consistent with a relationship between risk modifiersand brain plaque/tangle deposition in nondemented individuals and supports maintenance of normal body weight, regular physical activity, and healthy diet to protect the brain during aging. (clinicaltrials.gov; NCT00355498).


Subject(s)
Aging , Brain , Cognitive Dysfunction , Diet, Mediterranean/psychology , Exercise , Memory Disorders , Self-Assessment , Aged , Aging/physiology , Aging/psychology , Brain/diagnostic imaging , Brain/metabolism , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/psychology , Exercise/physiology , Exercise/psychology , Female , Humans , Male , Memory Disorders/diagnosis , Memory Disorders/psychology , Middle Aged , Neurofibrillary Tangles/pathology , Plaque, Amyloid/diagnostic imaging , Positron-Emission Tomography/methods , Protective Factors
19.
Analyst ; 140(3): 786-96, 2015 Feb 07.
Article in English | MEDLINE | ID: mdl-25473807

ABSTRACT

A diagnostic and updating strategy is explored for multivariate calibrations based on near-infrared spectroscopy. For use with calibration models derived from spectral fitting or decomposition techniques, the proposed method constructs models that relate the residual concentrations remaining after a prediction to the residual spectra remaining after the information associated with the calibration model has been extracted. This residual modeling approach is evaluated for use with partial least-squares (PLS) models for predicting physiological levels of glucose in a simulated biological matrix. Residual models are constructed with both PLS and a hybrid technique based on the use of PLS scores as inputs to support vector regression. Calibration and residual models are built with both absorbance and single-beam data collected over 416 days. Effective models for the spectral residuals are built with both types of data and demonstrate the ability to diagnose and correct deviations in performance of the calibration model with time.

20.
Analyst ; 140(12): 3981-8, 2015 Jun 21.
Article in English | MEDLINE | ID: mdl-25894331

ABSTRACT

Near-infrared (near-IR) spectroscopy has been investigated for use in direct measurements of human tissue for the purpose of quantifying clinically relevant analytes such as glucose. Spectra collected by transmitting near-IR light through human tissue reveal the presence of both aqueous components and solid structures within the optical path of the measurement. Developing technology for use in making these measurements requires either the availability of human subjects or an in vitro experimental platform that can effectively simulate the spectroscopic properties of tissue. This paper describes the preparation and testing of films of collagen and keratin, the two proteins that comprise the bulk of the solid material in the human epidermis and dermis. By placing these films in the optical path of a near-IR spectrometer together with an aqueous sample cell, a phantom can be constructed that allows experiments to be performed that simulate noninvasive measurements of tissue. In this work, both constant and variable thickness films are prepared and evaluated by use of a regression fit to spectra of human tissue. The stability and spectral reproducibility of the prepared films are also assessed. The regression fits to the human subject spectra yield values of R(2) ranging from 0.97 to 0.99 and the films are found to yield spectra that vary by less than a 2% relative standard deviation under three different reproducibility tests.


Subject(s)
Collagen/chemistry , Keratins/chemistry , Phantoms, Imaging , Spectroscopy, Near-Infrared , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Skin/chemistry , Skin/cytology , Young Adult
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