Using magnetic resonance imaging to measure head muscles: An innovative method to opportunistically determine muscle mass and detect sarcopenia

Background Sarcopenia is associated with multiple adverse outcomes. Traditional methods to determine low muscle mass for the diagnosis of sarcopenia are mainly based on dual-energy X-ray absorptiometry (DXA), whole-body magnetic resonance imaging (MRI) and bioelectrical impedance analysis. These tests are not always available and are rather time consuming and expensive. However, many brain and head diseases require a head MRI. In this study, we aim to provide a more accessible way to detect sarcopenia by comparing the traditional method of DXA lean mass estimation versus the tongue and masseter muscle mass assessed in a standard brain MRI. Methods The H70 study is a longitudinal study of older people living in Gothenburg, Sweden. In this cross-sectional analysis, from 1203 participants aged 70 years at baseline, we included 495 with clinical data and MRI images available. We used the appendicular lean soft tissue index (ALSTI) in DXA images as our reference measure of lean mass. Images from the masseter and tongue were analysed and segmented using 3D Slicer. For the statistical analysis, the Spearman correlation coefficient was used, and concordance was estimated with the Kappa coefficient. Results The final sample consisted of 495 participants, of which 52.3% were females. We found a significant correlation coefficient between both tongue (0.26) and masseter (0.33) with ALSTI (P < 0.001). The sarcopenia prevalence confirmed using the alternative muscle measure in MRI was calculated using the ALSTI (tongue = 2.0%, masseter = 2.2%, ALSTI = 2.4%). Concordance between sarcopenia with masseter and tongue versus sarcopenia with ALSTI as reference has a Kappa of 0.989 (P < 0.001) for masseter and a Kappa of 1 for the tongue muscle (P < 0.001). Comorbidities evaluated with the Cumulative Illness Rating Scale were significantly associated with all the muscle measurements: ALSTI (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.07–1.26, P < 0.001), masseter (OR 1.16, 95% CI 1.07–1.26, P < 0.001) and tongue (OR 1.13, 95% CI 1.04–1.22, P = 0.002); the higher the comorbidities, the higher the probability of having abnormal muscle mass. Conclusions ALSTI was significantly correlated with tongue and masseter muscle mass. When performing the sarcopenia diagnostic algorithm, the prevalence of sarcopenia calculated with head muscles did not differ from sarcopenia calculated using DXA, and almost all participants were correctly classified using both methods.publishedVersio

Biomarkers of Alzheimer’s disease and cerebrovascular disease in relation to depressive symptomatology in individuals with subjective cognitive decline

Background: Subjective cognitive decline (SCD) has gained recent interest as a potential harbinger of neurodegenerative diseases such as Alzheimer’s disease (AD) and cerebrovascular disease (CVD). In addition, SCD can be related to depressive symptomatology. However, the association between AD and CVD biomarkers, depressive symptomatology, and SCD is still unclear. We investigated the association of AD and CVD biomarkers and depressive symptomatology with SCD in individuals with subjective memory complaints (SCD-memory group) and individuals with subjective concentration complaints (SCD-concentration group).// Methods: We recruited a population-based cohort of 217 individuals (all aged 70 years, 53% female, 119 SCD-memory individuals, 23 SCD-concentration individuals, 89 controls). AD and CVD were assessed through cerebrospinal fluid levels of the Aβ42/40 ratio and phosphorylated tau, and white matter signal abnormalities on magnetic resonance imaging, respectively. Associations between biomarkers, depressive symptomatology, and SCD were tested via logistic regression and correlation analyses.// Results: We found a significant association of depressive symptomatology with SCD-memory and SCD-concentration. Depressive symptomatology was not associated with AD and CVD biomarkers. Both the phosphorylated tau biomarker and depressive symptomatology predicted SCD-memory, and the Aβ42/40 ratio and depressive symptomatology predicted SCD-concentration.// Conclusions: The role of depressive symptomatology in SCD may differ depending on the stage within the spectrum of preclinical AD (as determined by amyloid-beta and tau positivity), and does not seem to reflect AD pathology. Our findings contribute to the emerging field of subclinical depressive symptomatology in SCD, and clarify the association of different types of subjective complaints with distinct syndromic and biomarker profiles

Buffering of Segmental and Chromosomal Aneuploidies in Drosophila melanogaster

Chromosomal instability, which involves the deletion and duplication of chromosomes or chromosome parts, is a common feature of cancers, and deficiency screens are commonly used to detect genes involved in various biological pathways. However, despite their importance, the effects of deficiencies, duplications, and chromosome losses on the regulation of whole chromosomes and large chromosome domains are largely unknown. Therefore, to explore these effects, we examined expression patterns of genes in several Drosophila deficiency hemizygotes and a duplication hemizygote using microarrays. The results indicate that genes expressed in deficiency hemizygotes are significantly buffered, and that the buffering effect is general rather than being mainly mediated by feedback regulation of individual genes. In addition, differentially expressed genes in haploid condition appear to be generally more strongly buffered than ubiquitously expressed genes in haploid condition, but, among genes present in triploid condition, ubiquitously expressed genes are generally more strongly buffered than differentially expressed genes. Furthermore, we show that the 4th chromosome is compensated in response to dose differences. Our results suggest general mechanisms have evolved that stimulate or repress gene expression of aneuploid regions as appropriate, and on the 4th chromosome of Drosophila this compensation is mediated by Painting of Fourth (POF)

Atrial fibrillation in aging; methodological aspects and the relation to dementia and cerebral vascular disease

Emerging evidence suggest an increased risk of dementia in individuals with atrial fibrillation (AF). However, until recently, few studies have investigated the relation between AF and dementia taking both prevalent and incident stroke into account. Therefore, this thesis aims to examine if AF increase the risk of dementia in a sample free from a history of stroke at baseline and incident stroke during follow-up. Further, the mechanisms behind an association between AF and dementia in the absence of symptomatic stroke is not elucidated. Therefore, this thesis also aims to examine if AF is associated to silent brain infarcts (SBIs) and small vessel disease on brain MRI. Since epidemiological studies often are accompanied with biases, we also analyzed differential attrition during follow-up and agreement between self- and proxy-reported diagnoses. Data were obtained from the Gothenburg H70 Birth Cohort (H70) studies and the Prospective Population Study of Women (PPSW) in Gothenburg. The samples used in this thesis include the cohorts born 1930 (followed from age 70 to 88) and 1944 (examined at age 70). The H70 and PPSW studies are comprehensive population-based studies aiming to be representative of older adults living in Gothenburg, Sweden. We found that a history of AF at age 70 increased the risk of dementia during follow-up in the 1930 cohort. Further, we found that AF was cross-sectionally associated to symptomatic stroke, SBIs, and lacunes among 70-year-olds in the 1944 cohort. There were no associations between AF and global white matter hyperintensity (WMH) volumes or the presence of any cerebral microbleed. However, among participants with symptomatic stroke, AF was associated with larger WMH volumes. In the 1930 cohort, both AF and dementia were associated with attrition due to death. Further, agreement between self- and proxy-reported diagnoses was substantial for AF, myocardial infarction, angina pectoris, hypertension, and diabetes mellitus, but only fair for heart failure and intermittent claudication. Further research is needed to investigate the mechanism(s) behind the association between AF and dementia, the optimal treatment regimens for AF in relation to dementia prevention, and possibilities to include brain MRI in treatment guidelines to further personalize anticoagulation treatment in AF patients. In addition, analyzing differential attrition and diagnostic accuracy in epidemiologic research is necessary to evaluate and generalize results

Patienters upplevelser av tvångsvård inom psykiatrisk slutenvård

Bakgrund:  Ibland kräver psykisk ohälsa psykiatrisk tvångsvård. Under 2019 vårdades 12 300 personer i Sverige mot sin vilja. Sjuksköterskan ska jobba personcentrerat och med respekt mot människors autonomi och integritet. Genom ökad kunskap angående patienters upplevelser av tvångsvård kan medvetenheten hos sjuksköterskor och andra yrkesverksamma förbättras och utvecklas. Syfte: Syftet var att belysa patienters upplevelser av tvångsvård inom psykiatrisk slutenvård. Metod: Litteraturstudie med kvalitativ ansats, 10 artiklar har analyserats enligt Forsberg &amp; Wengströms (2015) innehållsanalys. Artiklarna är hämtade från databaserna Cinahl och PubMed. Resultat: I resultatet framkom fyra kategorier: tvångsvård som nödvändigt, tvångsvård som skadande, socialt samspel och information och delaktighet samt 8 underkategorier: en nödvändighet, förlorande av integritet och autonomi, tvångsåtgärder som hot och straff, medicinering och biverkan, bemötande från personalen, mänsklig kontakt, brist på information och delaktighet i sin egen vård. Slutsats: De flesta patienterna hade en negativ upplevelse av tvångsvården men de fanns också de som tyckte att den var nödvändig och hjälpande. Det fanns även en önskan om mer delaktighet och information angående sin egen vård. Vårdpersonalen hade en stor roll i patientens upplevelse av tvångsvården.

Pancreatic perfusion and its response to glucose as measured by simultaneous PET/MRI

AIMS: Perfusion of the pancreas and the islets of Langerhans is sensitive to physiological stimuli and is dysregulated in metabolic disease. Pancreatic perfusion can be assessed by both positron emission tomography (PET) and magnetic resonance imaging (MRI), but the methods have not been directly compared or benchmarked against the gold-standard microsphere technique. METHODS: Pigs (n = 4) were examined by [15O]H2O PET and intravoxel incoherent motion (IVIM) MRI technique simultaneously using a hybrid PET/MRI scanner. The pancreatic perfusion was measured both at basal conditions and after intravenous (IV) administration of up to 0.5 g/kg glucose. RESULTS: Pancreatic perfusion increased by 35%, 157%, and 29% after IV 0.5 g/kg glucose compared to during basal conditions, as assessed by [15O]H2O PET, IVIM MRI, and microspheres, respectively. There was a correlation between pancreatic perfusion as assessed by [15O]H2O PET and IVIM MRI (r = 0.81, R2 = 0.65, p &lt; 0.01). The absolute quantification of pancreatic perfusion (ml/min/g) by [15O]H2O PET was within a 15% error of margin of the microsphere technique. CONCLUSION: Pancreatic perfusion by [15O]H2O PET was in agreement with the microsphere technique assessment. The IVIM MRI method has the potential to replace [15O]H2O PET if the pancreatic perfusion is sufficiently large, but not when absolute quantitation is required

Comparison of the 2010 and 2019 diagnostic criteria for sarcopenia by the European Working Group on Sarcopenia in Older People (EWGSOP) in two cohorts of Swedish older adults

Background The operational definition of sarcopenia has been updated (EWGSOP2) and apply different cut-off points compared to previous criteria (EWGSOP1). Therefore, we aim to compare the sarcopenia prevalence and the association with mortality and dependence in activities of daily living using the 2010 (EWGSOP1 and 2019 (EWGSOP2 operational definition, applying cut-offs at two levels using T-scores. Methods Two birth cohorts, 70 and 85-years-old (n = 884 and n = 157, respectively), were assessed cross-sectionally (57% women). Low grip strength, low muscle mass and slow gait speed were defined below − 2.0 and − 2.5 SD from a young reference population (T-score). Muscle mass was defined as appendicular lean soft tissue index by DXA. The EWGSOP1 and EWGSOP2 were applied and compared with McNemar tests and Cohen’s kappa. All-cause mortality was analyzed with the Cox-proportional hazard model. Results Sarcopenia prevalence was 1.4–7.8% in 70-year-olds and 42–62% in 85 years-old’s, depending on diagnostic criteria. Overall, the prevalence of sarcopenia was 0.9–1.0 percentage points lower using the EWGSOP2 compared to EWGSOP1 when applying uniform T-score cut-offs (P &lt;  0.005). The prevalence was doubled (15.0 vs. 7.5%) using the − 2.0 vs. -2.5 T-scores with EWGSOP2 in the whole sample. The increase in prevalence when changing the cut-offs was 5.7% (P &lt;  0.001) in the 70-year-olds and 17.8% (P &lt;  0.001) in the 85-year-olds (EWGSP2). Sarcopenia with cut-offs at − 2.5 T-score was associated with increased mortality (hazard ratio 2.4–2.8, P &lt;  0.05) but not at T-score − 2.0. Conclusions The prevalence of sarcopenia was higher in 85-year-olds compared to 70-year-olds. Overall, the differences between the EWGSOP1 and EWGSOP2 classifications are small. Meaningful differences between EWGSOP1 and 2 in the 85-year-olds could not be ruled out. Prevalence was more dependent on cut-offs than on the operational definition.The 1944 study on 70-year-olds was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALF 716681) [...]The 1930 study on 85-year-olds was fnanced by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALF 716681, 722441) [...] The Alzheimer’s Association Zenith Award (ZEN-01-3151), The Alzheimer’s Association (IIRG-09-131338). Open access funding provided by University of Gothenburg.</p

Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease : A Population-based MRI Study

Background and ObjectivesAtrial fibrillation (AF) has been associated with cognitive decline and dementia. However, the mechanisms behind these associations are not clear. Examination of cerebrovascular pathology on MRI may shed light on how AF affects the brain. This study aimed to determine whether AF is associated with a broad range of cerebrovascular diseases beyond the well-known association with symptomatic stroke, including silent infarcts and markers of small vessel disease, i.e., cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and lacunes, in a population-based sample of 70-year-olds.MethodsData were obtained from the Gothenburg H70 Birth Cohort Studies, in which individuals are invited based on birthdate. This study has a cross-sectional design and includes individuals born in 1944 who underwent structural brain MRI in 2014 to 2017. AF diagnoses were based on self-report, ECG, and register data. Symptomatic stroke was based on self-report, proxy interviews, and register data. Brain infarcts and CMBs were assessed by a radiologist. WMH volumes were measured on fluid-attenuated inversion recovery images with the Lesion Segmentation Tool. Multivariable logistic regression was used to study the association between AF and infarcts/CMBs, and multivariable linear regression was used to study the association between AF and WMHs.ResultsA total of 776 individuals were included, and 65 (8.4%) had AF. AF was associated with symptomatic stroke (odds ratio [OR] 4.5, 95% confidence interval [CI] 2.1-9.5) and MRI findings of large infarcts (OR 5.0, 95% CI 1.5-15.9), lacunes (OR 2.7, 95% CI 1.2-5.6), and silent brain infarcts (OR 3.5; 95% CI 1.6-7.4). Among those with symptomatic stroke, individuals with AF had larger WMH volumes (0.0137 mL/total intracranial volume [TIV], 95% CI 0.0074-0.0252) compared to those without AF (0.0043 mL/TIV, 95% CI 0.0029-0.0064). There was no association between AF and WMH volumes among those without symptomatic stroke. In addition, AF was associated to CMBs in the frontal lobe.DiscussionAF was associated with a broad range of cerebrovascular pathologies. Further research is needed to establish whether cerebrovascular MRI markers can be added to current treatment guidelines to further personalize anticoagulant treatment in patients with AF and to further characterize the pathogenetic processes underlying the associations between AF and cerebrovascular diseases, as well as dementia