Yi Guan1, Seyed Amir Ebrahimzadeh1, Chia-Hsin Cheng1, Weifan Chen1, Tiffany Leung1, Sherman Bigornia1, Natalia Palacios1, Mahdi O Garelnabi1, Tammy Scott1, Rafeeque Bhadelia1, Katherine L Tucker1, Bang-Bon Koo1. 1. From the Department of Anatomy and Neurobiology (Y.G., C.-h.C., W.C., T.L., B.-B.K.), Boston University School of Medicine; Department of Radiology (S.A.E., R.B.), Neuroradiology Section, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Agriculture, Nutrition, and Food Systems (S.B.), College of Life Sciences and Agriculture, University of New Hampshire, Durham; Departments of Public Health (N.P., M.O.G.) and Biomedical and Nutritional Sciences (K.L.T.), Zuckerberg College of Health Sciences, and Center for Population Health (N.P., K.L.T.), University of Massachusetts Lowell; and School of Medicine (T.S.), Tufts University, Boston, MA.
Abstract
BACKGROUND AND OBJECTIVES: The Boston Puerto Rican Health Study (BPRHS) is a longitudinal study following self-identified Puerto Rican older adults living in the Greater Boston area. Studies have shown higher prevalence of hypertension (HTN) and type 2 diabetes (T2D) within this ethnic group compared to age-matched non-Hispanic White adults. In this study, we investigated the associations of HTN and T2D comorbidity on brain structural integrity and cognitive capacity in community-dwelling Puerto Rican adults and compared these measures with older adult participants (non-Hispanic White and Hispanic) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and National Alzheimer's Coordinating Center (NACC) databases. METHODS: BPRHS participants who underwent brain MRI and cognitive testing were divided into 4 groups based on their HTN and T2D status: HTN-/T2D-, HTN+/T2D-, HTN-/T2D+, and HTN+/T2D+. We assessed microstructural integrity of white matter (WM) pathways using diffusion MRI, brain macrostructural integrity using hippocampal volumes, and brain age using T1-weighted MRI and cognitive test scores. BPRHS results were then compared with results from non-Hispanic White and Hispanic participants from the ADNI and NACC databases. RESULTS: The prevalence of HTN was almost 2 times (66.7% vs 38.7%) and of T2D was 5 times (31.8% vs 6.6.%) higher in BPRHS than in ADNI non-Hispanic White participants. Diffusion MRI showed clear deterioration patterns in major WM tracts in the HTN+/T2D+ group and, to a lesser extent, in the HTN+/T2D- group compared to the HTN-/T2D- group. HTN+/T2D+ participants also had the smallest hippocampal volume and larger brain aging deviations. Trends toward lower executive function and global cognitive scores were observed in HTN+/T2D+ relative to HTN-/T2D- individuals. MRI measures and the Mini-Mental State Examination (MMSE) scores from the HTN+/T2D+ BPRHS group resembled those of ADNI White participants with progressive mild cognitive impairment (MCI), while the BPRHS HTN-/T2D- participants resembled participants with stable MCI. The BPRHS was not significantly different from the ADNI + NACC Hispanic cohort on imaging or MMSE measures. DISCUSSION: The effects of T2D and HTN comorbidity led to greater brain structural disruptions than HTN alone. The high prevalence of HTN and T2D in the Puerto Rican population may be a key factor contributing to health disparities in cognitive impairment in this group compared to non-Hispanic White adults in the same age range. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov identifier: NCT01231958.
BACKGROUND AND OBJECTIVES: The Boston Puerto Rican Health Study (BPRHS) is a longitudinal study following self-identified Puerto Rican older adults living in the Greater Boston area. Studies have shown higher prevalence of hypertension (HTN) and type 2 diabetes (T2D) within this ethnic group compared to age-matched non-Hispanic White adults. In this study, we investigated the associations of HTN and T2D comorbidity on brain structural integrity and cognitive capacity in community-dwelling Puerto Rican adults and compared these measures with older adult participants (non-Hispanic White and Hispanic) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and National Alzheimer's Coordinating Center (NACC) databases. METHODS: BPRHS participants who underwent brain MRI and cognitive testing were divided into 4 groups based on their HTN and T2D status: HTN-/T2D-, HTN+/T2D-, HTN-/T2D+, and HTN+/T2D+. We assessed microstructural integrity of white matter (WM) pathways using diffusion MRI, brain macrostructural integrity using hippocampal volumes, and brain age using T1-weighted MRI and cognitive test scores. BPRHS results were then compared with results from non-Hispanic White and Hispanic participants from the ADNI and NACC databases. RESULTS: The prevalence of HTN was almost 2 times (66.7% vs 38.7%) and of T2D was 5 times (31.8% vs 6.6.%) higher in BPRHS than in ADNI non-Hispanic White participants. Diffusion MRI showed clear deterioration patterns in major WM tracts in the HTN+/T2D+ group and, to a lesser extent, in the HTN+/T2D- group compared to the HTN-/T2D- group. HTN+/T2D+ participants also had the smallest hippocampal volume and larger brain aging deviations. Trends toward lower executive function and global cognitive scores were observed in HTN+/T2D+ relative to HTN-/T2D- individuals. MRI measures and the Mini-Mental State Examination (MMSE) scores from the HTN+/T2D+ BPRHS group resembled those of ADNI White participants with progressive mild cognitive impairment (MCI), while the BPRHS HTN-/T2D- participants resembled participants with stable MCI. The BPRHS was not significantly different from the ADNI + NACC Hispanic cohort on imaging or MMSE measures. DISCUSSION: The effects of T2D and HTN comorbidity led to greater brain structural disruptions than HTN alone. The high prevalence of HTN and T2D in the Puerto Rican population may be a key factor contributing to health disparities in cognitive impairment in this group compared to non-Hispanic White adults in the same age range. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov identifier: NCT01231958.
Authors: Katherine L Tucker; Josiemer Mattei; Sabrina E Noel; Bridgette M Collado; Jackie Mendez; Jason Nelson; John Griffith; Jose M Ordovas; Luis M Falcon Journal: BMC Public Health Date: 2010-03-01 Impact factor: 3.295
Authors: Clifford R Jack; Matt A Bernstein; Nick C Fox; Paul Thompson; Gene Alexander; Danielle Harvey; Bret Borowski; Paula J Britson; Jennifer L Whitwell; Chadwick Ward; Anders M Dale; Joel P Felmlee; Jeffrey L Gunter; Derek L G Hill; Ron Killiany; Norbert Schuff; Sabrina Fox-Bosetti; Chen Lin; Colin Studholme; Charles S DeCarli; Gunnar Krueger; Heidi A Ward; Gregory J Metzger; Katherine T Scott; Richard Mallozzi; Daniel Blezek; Joshua Levy; Josef P Debbins; Adam S Fleisher; Marilyn Albert; Robert Green; George Bartzokis; Gary Glover; John Mugler; Michael W Weiner Journal: J Magn Reson Imaging Date: 2008-04 Impact factor: 4.813
Authors: Martha L Daviglus; Gregory A Talavera; M Larissa Avilés-Santa; Matthew Allison; Jianwen Cai; Michael H Criqui; Marc Gellman; Aida L Giachello; Natalia Gouskova; Robert C Kaplan; Lisa LaVange; Frank Penedo; Krista Perreira; Amber Pirzada; Neil Schneiderman; Sylvia Wassertheil-Smoller; Paul D Sorlie; Jeremiah Stamler Journal: JAMA Date: 2012-11-07 Impact factor: 56.272