TY - JOUR
T1 - Lower Left Ventricular Ejection Fraction Relates to Cerebrospinal Fluid Biomarker Evidence of Neurodegeneration in Older Adults
AU - Kresge, Hailey A.
AU - Liu, Dandan
AU - Gupta, Deepak K.
AU - Moore, Elizabeth E.
AU - Osborn, Katie E.
AU - Acosta, Lealani Mae Y.
AU - Bell, Susan P.
AU - Pechman, Kimberly R.
AU - Gifford, Katherine A.
AU - Mendes, Lisa A.
AU - Wang, Thomas J.
AU - Blennow, Kaj
AU - Zetterberg, Henrik
AU - Hohman, Timothy J.
AU - Jefferson, Angela L.
N1 - Funding Information:
The authors would like to thank the dedicated Vanderbilt Memory & Aging Project participants, their loved ones, and our devoted staff and trainees who contributed to recruitment, screening, and enrollment of the cohort. We also thank our skilled laboratory technicians at the Clinical Neurochemistry Laboratory in Mölndal, Sweden. This research was supported by Alzheimer’s Association IIRG-08-88733 (ALJ), R01-AG034962 (ALJ), R01-AG056534 (ALJ), R01-NS100980 (ALJ), K24-AG046373 (ALJ), Paul B. Beeson Career Development Award in Aging K23-AG045966 (KAG), Paul B. Beeson Career Development Award in Aging K23-AG048347 (SPB), K01-AG049164 (TJH), K12-HL109019 (DKG), T32-GM007347 (EEM), F30-AG064847 (EEM), F32-AG058395 (KEO), UL1-TR000445 (Vanderbilt Clinical Translational Science Award), S10-OD023680 (Vanderbilt’s High-Performance Computer Cluster for Biomedical Research), the Vanderbilt Memory & Alzheimer’s Center, the Torsten Söderberg Foundation, Stockholm, Sweden, the Swedish Research Council (#2017-00915), the Swedish Alzheimer Foundation (#AF-742881), Hjärnfonden, Sweden (#FO2017-0243), and a grant (#ALFGBG-715986) from the Swedish state under the agreement between the Swedish government and the County Councils, the ALF-agreement.
Publisher Copyright:
© 2020-IOS Press and the authors. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Background: Subclinical cardiac dysfunction is associated with decreased cerebral blood flow, placing the aging brain at risk for Alzheimer's disease (AD) pathology and neurodegeneration. Objective: This study investigates the association between subclinical cardiac dysfunction, measured by left ventricular ejection fraction (LVEF), and cerebrospinal fluid (CSF) biomarkers of AD and neurodegeneration. Methods: Vanderbilt Memory Aging Project participants free of dementia, stroke, and heart failure (n = 152, 72±6 years, 68% male) underwent echocardiogram to quantify LVEF and lumbar puncture to measure CSF levels of amyloid-β42 (Aβ42), phosphorylated tau (p-tau), and total tau (t-tau). Linear regressions related LVEF to CSF biomarkers, adjusting for age, sex, race/ethnicity, education, Framingham Stroke Risk Profile, cognitive diagnosis, and apolipoprotein E ϵ4 status. Secondary models tested an LVEF x cognitive diagnosis interaction and then stratified by diagnosis (normal cognition (NC), mild cognitive impairment (MCI)). Results: Higher LVEF related to decreased CSF Aβ42 levels (β=-6.50, p = 0.04) reflecting greater cerebral amyloid accumulation, but this counterintuitive result was attenuated after excluding participants with cardiovascular disease and atrial fibrillation (p = 0.07). We observed an interaction between LVEF and cognitive diagnosis on CSF t-tau (p = 0.004) and p-tau levels (p = 0.002), whereas lower LVEF was associated with increased CSF t-tau (β=-9.74, p = 0.01) and p-tau in the NC (β=-1.41, p = 0.003) but not MCI participants (p-values>0.13). Conclusions: Among cognitively normal older adults, subclinically lower LVEF relates to greater molecular evidence of tau phosphorylation and neurodegeneration. Modest age-related changes in cardiovascular function may have implications for pathophysiological changes in the brain later in life.
AB - Background: Subclinical cardiac dysfunction is associated with decreased cerebral blood flow, placing the aging brain at risk for Alzheimer's disease (AD) pathology and neurodegeneration. Objective: This study investigates the association between subclinical cardiac dysfunction, measured by left ventricular ejection fraction (LVEF), and cerebrospinal fluid (CSF) biomarkers of AD and neurodegeneration. Methods: Vanderbilt Memory Aging Project participants free of dementia, stroke, and heart failure (n = 152, 72±6 years, 68% male) underwent echocardiogram to quantify LVEF and lumbar puncture to measure CSF levels of amyloid-β42 (Aβ42), phosphorylated tau (p-tau), and total tau (t-tau). Linear regressions related LVEF to CSF biomarkers, adjusting for age, sex, race/ethnicity, education, Framingham Stroke Risk Profile, cognitive diagnosis, and apolipoprotein E ϵ4 status. Secondary models tested an LVEF x cognitive diagnosis interaction and then stratified by diagnosis (normal cognition (NC), mild cognitive impairment (MCI)). Results: Higher LVEF related to decreased CSF Aβ42 levels (β=-6.50, p = 0.04) reflecting greater cerebral amyloid accumulation, but this counterintuitive result was attenuated after excluding participants with cardiovascular disease and atrial fibrillation (p = 0.07). We observed an interaction between LVEF and cognitive diagnosis on CSF t-tau (p = 0.004) and p-tau levels (p = 0.002), whereas lower LVEF was associated with increased CSF t-tau (β=-9.74, p = 0.01) and p-tau in the NC (β=-1.41, p = 0.003) but not MCI participants (p-values>0.13). Conclusions: Among cognitively normal older adults, subclinically lower LVEF relates to greater molecular evidence of tau phosphorylation and neurodegeneration. Modest age-related changes in cardiovascular function may have implications for pathophysiological changes in the brain later in life.
KW - Aging
KW - Alzheimer's disease
KW - atrophy
KW - cerebrospinal fluid proteins
KW - echocardiography
KW - tau proteins
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U2 - 10.3233/JAD-190813
DO - 10.3233/JAD-190813
M3 - Article
C2 - 32144980
AN - SCOPUS:85083328734
SN - 1387-2877
VL - 74
SP - 965
EP - 974
JO - Journal of Alzheimer's Disease
JF - Journal of Alzheimer's Disease
IS - 3
ER -