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- Payton, Nicola Maria
(författare)
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Understanding preclinical dementia : early detection of dementia through cognitive and biological markers
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dementia is becoming a growing healthcare crisis, therefore identifying individuals at risk or in the earliest stages of dementia is essential if prevention or disease modification is to be achieved. The objective of this thesis was to examine cognitive performance and decline during the preclinical phase and explore the ability of cognitive and biological markers to identify those at risk of future dementia. Data from a population-based longitudinal study, SNAC-K, were used to investigate this aim. Study I examined the ability of neuropsychological tests, genetics, and structural MRI volumes to predict dementia six years later. Models were systematically created to identify the best combinations for prediction. A model containing all three modalities: hippocampal volume, a task of category fluency, presence of an APOE ɛ4 allele, white-matter hyperintensities volume, and a task of general knowledge, displayed the most predictive value (AUC=.924; C.I=.883–.965). However, this model did not significantly improve predictive value over one containing only cognitive and genetic markers, suggesting that minor increases in predictivity should be weighed against the costs of additional tests. Study II investigated the benefit of DTI, alongside neuropsychological tests, genetics, and brain volume markers in predicting future dementia. MD values for tracts CHC, CS, FMAJ, and IFOF (AUC=.837– .862) and the FA IFOF latent factor (AUC=.839) were significantly associated with dementia at six years. A final model consisting of a measure of perceptual speed, hippocampal volume, and MD of the FMAJ tract was created with the highest predictive value (AUC=.911). Assessment of microstructural white matter integrity via DTI was associated with future dementia but the additional benefit when combined with other markers was relatively small. Study III narrowed its focus to the ability of cognitive markers alone and the effect of modifying factors (age, sex, education, the presence of an ɛ4 allele, AD–only dementia, and time to diagnosis) on identifying those at risk of dementia. The most predictive model, consisting of category fluency, word recall, and pattern comparison, achieved good prediction values (AUC=.913) for dementia six years later. Tests in the domains of category fluency, episodic memory, and perceptual speed were, in general, good predictors across all subgroups and up to 6 years before a dementia diagnosis. However, cognitive tests became increasingly unreliable at predicting dementia beyond that time. Study IV explored the trajectories of cognitive decline over a 12-year period during the preclinical stage of dementia, before examining the ability of early cognitive decline in identifying those with increased likelihood of future dementia. Persons in the preclinical phase showed increased rate of decline in all cognitive domains compared to those who did not develop dementia (β:-.07 to -.11), this difference was particularly noticeable closer to diagnosis. Those classified as fast decliners for 3 or more cognitive tests demonstrated the highest risk of dementia (HR: 3.38, CI: 1.91-6.01). Although, changes in early rates of decline were small and rates of decline may be more predictive closer to diagnosis. Collectively, these studies confirm a long preclinical period in dementia development, which allows for the use of a wide range of markers (cognitive, genetic, MRI, and DTI) capable of identifying those at high risk of dementia. The ability of these markers to predict future dementia is increased through combining within and between modalities.
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| 2. |
- Smith, Jennifer A, et al.
(författare)
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Genome-wide association study identifies 74 loci associated with educational attainment
- 2016
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Ingår i: Nature (London). - : Springer Science and Business Media LLC. - 1476-4687 .- 0028-0836. ; 533:7604, s. 539-542
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Tidskriftsartikel (refereegranskat)abstract
- Educational attainment is strongly influenced by social and other environmental factors, but genetic factors are estimated to account for at least 20% of the variation across individuals. Here we report the results of a genome-wide association study (GWAS) for educational attainment that extends our earlier discovery sample of 101,069 individuals to 293,723 individuals, and a replication study in an independent sample of 111,349 individuals from the UK Biobank. We identify 74 genome-wide significant loci associated with the number of years of schooling completed. Single-nucleotide polymorphisms associated with educational attainment are disproportionately found in genomic regions regulating gene expression in the fetal brain. Candidate genes are preferentially expressed in neural tissue, especially during the prenatal period, and enriched for biological pathways involved in neural development. Our findings demonstrate that, even for a behavioural phenotype that is mostly environmentally determined, a well-powered GWAS identifies replicable associated genetic variants that suggest biologically relevant pathways. Because educational attainment is measured in large numbers of individuals, it will continue to be useful as a proxy phenotype in efforts to characterize the genetic influences of related phenotypes, including cognition and neuropsychiatric diseases.
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| 3. |
- Speh, Andreja, et al.
(författare)
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Cardiovascular Health and Rate of Cognitive Decline in Preclinical Dementia : A 12-Year Population-Based Study
- 2024
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Ingår i: Neuropsychology. - 0894-4105 .- 1931-1559. ; 38:3, s. 211-222
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We investigated whether vascular risk factors (VRFs), assessed with Life’s Simple 7 (LS7), are associated with the rate of cognitive decline in the years preceding a dementia diagnosis. Method: This study included 1,449 stroke-free participants aged ≥60 years from the Swedish National Study on Aging and Care in Kungsholmen, who underwent repeated neuropsychological testing (episodic memory, semantic memory, verbal fluency, perceptual speed) across 12 years. The LS7 score, assessed at baseline, included smoking, diet, physical activity, body mass index, plasma glucose, total cholesterol, and blood pressure. Preclinical dementia was defined as being dementia-free at baseline and diagnosed with dementia during follow-up. Level and change in cognitive performance as a function of LS7 category (poor vs. intermediate to optimal) and future dementia status were estimated using linear mixed-effect models. Results: Participants who later developed dementia had, on average, a poorer LS7 score compared to those who remained dementia-free. For individuals aged 60–72 years, poor diet was associated with accelerated decline in perceptual speed (β = −0.05, 95% CI [−0.08, −0.02]), and a poor glucose score was associated with faster rates of verbal fluency (β = −0.019, 95% CI [−0.09, −0.01]) and global cognitive (β = −0.028, 95% CI [−0.06, 0.00]) decline in the preclinical dementia group. Conclusions: VRFs exacerbate rate of cognitive decline in the years preceding a dementia diagnosis. This effect was most pronounced in young–old age and primarily driven by diet and glucose. The effect of VRFs may be especially detrimental for cognitive decline trajectories of individuals with impending dementia.
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