%0 Journal Article %J J Alzheimers Dis %D 2023 %T The Potential Role of Selection Bias in the Association Between Coronary Atherosclerosis and Cognitive Impairment. %A Yahagi-Estevam, Maristella %A Farias-Itao, Daniela Souza %A Leite, Renata Elaine Paraizo %A Rodriguez, Roberta Diehl %A Pasqualucci, Carlos Augusto %A Nitrini, Ricardo %A Jacob-Filho, Wilson %A Power, Melinda C %A Suemoto, Claudia Kimie %X

BACKGROUND: Coronary atherosclerosis assessed in vivo was associated with cognitive impairment; however, conflicting findings have been reported in autopsy samples.

OBJECTIVE: Our aims were to assess the association between atherosclerotic stenosis in the coronary arteries and cognitive impairment and to investigate the possibility of selection bias in an autopsy study.

METHODS: Coronary arteries were collected, and the largest luminal stenosis was measured. Sociodemographic, clinical, and cognitive information were reported by a reliable next-of-kin. The association was tested using logistic and linear regressions adjusted for sociodemographic and clinical variables. We restricted the sample to individuals that were born in 1935 or earlier and stratified the analysis by cause of death to investigate the role of selection bias.

RESULTS: In 253 participants (mean age = 78.0±8.5 years old, 48% male), stenosis was not associated with cognitive impairment (OR = 0.85, 95% CI = 0.69; 1.06, p = 0.15). In individuals who were born before 1936 in the absence of cardiovascular disease as the cause of death, greater stenosis was associated with cognitive impairment (OR = 4.02, 95% CI = 1.39; 11.6, p = 0.01). On the other hand, this association was not present among those born in 1935 or earlier who died of cardiovascular diseases (OR = 0.83, 95% CI = 0.60; 1.16, p = 0.28).

CONCLUSION: We found that higher coronary stenosis was associated with cognitive impairment only in individuals born in 1935 or earlier and who had not died from cardiovascular diseases. Selection bias may be an important issue when investigating risk factors for chronic degenerative diseases in older individuals using autopsy samples.

%B J Alzheimers Dis %V 93 %P 1307-1316 %8 2023 Jun 13 %G eng %N 4 %R 10.3233/JAD-220820 %0 Journal Article %J J Alzheimers Dis %D 2018 %T Neuropathologic Correlates of Psychiatric Symptoms in Alzheimer's Disease. %A Ehrenberg, Alexander J %A Suemoto, Claudia K %A França Resende, Elisa de Paula %A Petersen, Cathrine %A Leite, Renata Elaine Paraizo %A Rodriguez, Roberta Diehl %A Ferretti-Rebustini, Renata Eloah de Lucena %A You, Michelle %A Oh, Jun %A Nitrini, Ricardo %A Pasqualucci, Carlos Augusto %A Jacob-Filho, Wilson %A Kramer, Joel H %A Gatchel, Jennifer R %A Grinberg, Lea T %X

Clarifying the relationships between neuropsychiatric symptoms and Alzheimer's disease (AD)-related pathology may open avenues for effective treatments. Here, we investigate the odds of developing neuropsychiatric symptoms across increasing burdens of neurofibrillary tangle and amyloid-β pathology. Participants who passed away between 2004 and 2014 underwent comprehensive neuropathologic evaluation at the Biobank for Aging Studies from the Faculty of Medicine at the University of São Paulo. Postmortem interviews with reliable informants were used to collect information regarding neuropsychiatric and cognitive status. Of 1,092 cases collected, those with any non-Alzheimer pathology were excluded, bringing the cohort to 455 cases. Braak staging was used to evaluate neurofibrillary tangle burden, and the CERAD neuropathology score was used to evaluate amyloid-β burden. The 12-item neuropsychiatric inventory was used to evaluate neuropsychiatric symptoms and CDR-SOB score was used to evaluate dementia status. In Braak I/II, significantly increased odds were detected for agitation, anxiety, appetite changes, depression, and sleep disturbances, compared to controls. Increased odds of agitation continue into Braak III/IV. Braak V/VI is associated with higher odds for delusions. No increased odds for neuropsychiatric symptoms were found to correlate with amyloid-β pathology. Increased odds of neuropsychiatric symptoms are associated with early neurofibrillary tangle pathology, suggesting that subcortical neurofibrillary tangle accumulation with minimal cortical pathology is sufficient to impact quality of life and that neuropsychiatric symptoms are a manifestation of AD biological processes.

%B J Alzheimers Dis %V 66 %P 115-126 %8 2018 Oct 16 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/30223398?dopt=Abstract %R 10.3233/JAD-180688 %0 Journal Article %J J Alzheimers Dis %D 2017 %T Diabetes is Not Associated with Alzheimer's Disease Neuropathology. %A Dos Santos Matioli, Maria Niures Pimentel %A Suemoto, Claudia Kimie %A Rodriguez, Roberta Diehl %A Farias, Daniela Souza %A da Silva, Magnólia Moreira %A Leite, Renata Elaine Paraizo %A Ferretti-Rebustini, Renata Eloah Lucena %A Farfel, José Marcelo %A Pasqualucci, Carlos Augusto %A Jacob Filho, Wilson %A Arvanitakis, Zoe %A Naslavsky, Michel Satya %A Zatz, Mayana %A Grinberg, Lea Tenenholz %A Nitrini, Ricardo %X

BACKGROUND: Previous evidence linking diabetes to Alzheimer's disease (AD) neuropathology is mixed and scant data are available from low- and middle-income countries.

OBJECTIVE: To investigate the association between diabetes and AD neuropathology in a large autopsy study of older Brazilian adults.

METHODS: In this cross-sectional study, diabetes was defined by diagnosis during life or use of antidiabetic medication. A standardized neuropathological examination was performed using immunohistochemistry. The associations of diabetes with Consortium to Establish and Registry for Alzheimer Disease (CERAD) scores for neuritic plaques and Braak-Braak (BB) scores for neurofibrillary tangles were investigated using multivariable ordinal logistic regression. We investigated effect modification of education, race, and APOE on these associations.

RESULTS: Among 1,037 subjects (mean age = 74.4±11.5 y; mean education = 4.0±3.7 y; 48% male, 61% White), diabetes was present in 279 subjects. Diabetes was not associated with BB (OR = 1.12, 95% CI = 0.81-1.54, p = 0.48) or with CERAD (OR = 0.97, 95% CI = 0.68-1.38, p = 0.86) scores on analyses adjusted for sociodemographic and clinical variables. We observed effect modification by the APOE allele ɛ4 on the association between diabetes mellitus and BB scores.

CONCLUSION: No evidence of an association between diabetes and AD neuropathology was found in a large sample of Brazilians; however, certain subgroups, such as APOE allele ɛ4 carriers, had higher odds of accumulation of neurofibrillary tangles.

%B J Alzheimers Dis %V 60 %P 1035-1043 %8 2017 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/28984587?dopt=Abstract %R 10.3233/JAD-170179