دورية أكاديمية
Investigation of frailty as a moderator of the relationship between neuropathology and dementia in Alzheimer's disease: a cross-sectional analysis of data from the Rush Memory and Aging Project.
| العنوان: | Investigation of frailty as a moderator of the relationship between neuropathology and dementia in Alzheimer's disease: a cross-sectional analysis of data from the Rush Memory and Aging Project. |
|---|---|
| المؤلفون: | Wallace LMK; Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada., Theou O; Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada., Godin J; Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada., Andrew MK; Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada., Bennett DA; Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA., Rockwood K; Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada. Electronic address: kenneth.rockwood@dal.ca. |
| المصدر: | The Lancet. Neurology [Lancet Neurol] 2019 Feb; Vol. 18 (2), pp. 177-184. |
| نوع المنشور: | Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lancet Pub. Group Country of Publication: England NLM ID: 101139309 Publication Model: Print Cited Medium: Internet ISSN: 1474-4465 (Electronic) Linking ISSN: 14744422 NLM ISO Abbreviation: Lancet Neurol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: London, UK ; New York, NY : Lancet Pub. Group, 2002- |
| مواضيع طبية MeSH: | Alzheimer Disease/*complications , Alzheimer Disease/*pathology , Dementia/*epidemiology , Frailty/*complications, Aged ; Aged, 80 and over ; Aging/pathology ; Cross-Sectional Studies ; Dementia/etiology ; Female ; Frail Elderly/statistics & numerical data ; Frailty/epidemiology ; Humans ; Male |
| مستخلص: | Background: Some people with substantial Alzheimer's disease pathology at autopsy had shown few characteristic clinical symptoms or signs of the disease, whereas others with little Alzheimer's disease pathology have been diagnosed with Alzheimer's dementia. We aimed to examine whether frailty, which is associated with both age and dementia, moderates the relationship between Alzheimer's disease pathology and Alzheimer's dementia. Methods: We did a cross-sectional analysis of data from participants of the Rush Memory and Aging Project, a clinical-pathological cohort study of older adults (older than 59 years) without known dementia at baseline, living in Illinois, USA. Participants in the cohort study underwent annual neuropsychological and clinical evaluations. In the present cross-sectional analysis, we included those participants who did not have any form of dementia or who had Alzheimer's dementia at the time of their last clinical assessment and who had died and for whom complete autopsy data were available. Alzheimer's disease pathology was quantified by a summary measure of neurofibrillary tangles and neuritic and diffuse plaques. Clinical diagnosis of Alzheimer's dementia was based on clinician consensus. Frailty was operationalised retrospectively using health variable information obtained at each clincial evaluation using the deficit accumulation approach (41-item frailty index). Logistic regression and moderation modelling were used to assess relationships between Alzheimer's disease pathology, frailty, and Alzheimer's dementia. All analyses were adjusted for age, sex, and education. Findings: Up to data cutoff (Jan 20, 2017), we included 456 participants (mean age at death 89·7 years [SD 6·1]; 316 [69%] women). 242 (53%) had a diagnosis of possible or probable Alzheimer's dementia at their last clinical assessment. Frailty (odds ratio 1·76, 95% CI 1·54-2·02; p<0·0001) and Alzheimer's disease pathology (4·81, 3·31-7·01; p<0·0001) were independently associated with Alzheimer's dementia, after adjusting for age, sex, and education. When frailty was added to the model for the relationship between Alzheimer's disease pathology and Alzheimer's dementia, model fit improved (p<0·0001). There was a significant interaction between frailty and Alzheimer's disease pathology (odds ratio 0·73, 95% CI 0·57-0·94; p Interpretation: The degree of frailty among people of the same age modifies the association between Alzheimer's disease pathology and Alzheimer's dementia. That frailty is related to both odds of Alzheimer's dementia and disease expression has implications for clinical management, since individuals with even a low level of Alzheimer's disease pathology might be at risk for dementia if they have high amounts of frailty. Further research should assess how frailty and cognition change over time to better elucidate this complex relationship. Funding: None. (Copyright © 2019 Elsevier Ltd. All rights reserved.) |
| التعليقات: | Comment in: Lancet Neurol. 2019 Feb;18(2):133-134. (PMID: 30663601) Erratum in: Lancet Neurol. 2019 Mar;18(3):e2. (PMID: 30784561) Comment in: Nat Med. 2019 Mar;25(3):358. (PMID: 30842666) |
| References: | Lancet. 2013 Mar 2;381(9868):752-62. (PMID: 23395245) Health Rep. 2013 Sep;24(9):10-7. (PMID: 24258362) Neurology. 2008 Aug 12;71(7):499-504. (PMID: 18695161) J Gerontol A Biol Sci Med Sci. 2014 Dec;69(12):1536-44. (PMID: 25136002) Ann Neurol. 2018 Jan;83(1):74-83. (PMID: 29244218) Neurology. 2017 Feb 14;88(7):661-668. (PMID: 28108637) Ageing Res Rev. 2013 Sep;12(4):840-51. (PMID: 23831959) Alzheimers Dement. 2011 May;7(3):280-92. (PMID: 21514248) Alzheimers Res Ther. 2015 Aug 03;7(1):54. (PMID: 26240611) Acta Neuropathol. 1991;82(4):239-59. (PMID: 1759558) Sci Rep. 2017 Mar 14;7:44336. (PMID: 28290548) Front Neurol. 2017 Nov 27;8:628. (PMID: 29230192) BMJ. 2010 Oct 12;341:c4670. (PMID: 20940218) Lancet Neurol. 2013 Feb;12(2):207-16. (PMID: 23332364) Curr Alzheimer Res. 2012 Jul;9(6):646-63. (PMID: 22471867) ScientificWorldJournal. 2001 Aug 08;1:323-36. (PMID: 12806071) Lancet Neurol. 2006 May;5(5):406-12. (PMID: 16632311) Neurology. 2011 Jul 19;77(3):227-34. (PMID: 21753161) Neurology. 1984 Jul;34(7):939-44. (PMID: 6610841) J Neuropathol Exp Neurol. 2006 Aug;65(8):740-57. (PMID: 16896308) J Alzheimers Dis. 2018;62(3):993-1012. (PMID: 29562543) J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56. (PMID: 11253156) Alzheimers Res Ther. 2014 Sep 18;6(5-8):54. (PMID: 25356088) Neuroepidemiology. 2006;27(3):169-76. (PMID: 17035694) Curr Opin Clin Nutr Metab Care. 2015 Jan;18(1):43-50. (PMID: 25405314) J Alzheimers Dis. 2016 Jun 15;53(3):1003-13. (PMID: 27314525) Psychosom Med. 2007 Jun;69(5):483-9. (PMID: 17556640) N Engl J Med. 2009 May 28;360(22):2302-9. (PMID: 19474427) BMC Geriatr. 2008 Sep 30;8:24. (PMID: 18826625) Alzheimers Dement (Amst). 2018 May 30;10:394-401. (PMID: 30094326) Neurology. 2003 Jan 28;60(2):246-52. (PMID: 12552039) |
| معلومات مُعتمدة: | R01 AG017917 United States AG NIA NIH HHS |
| تواريخ الأحداث: | Date Created: 20190122 Date Completed: 20200608 Latest Revision: 20240502 |
| رمز التحديث: | 20240502 |
| مُعرف محوري في PubMed: | PMC11062500 |
| DOI: | 10.1016/S1474-4422(18)30371-5 |
| PMID: | 30663607 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1474-4465 |
|---|---|
| DOI: | 10.1016/S1474-4422(18)30371-5 |