Adler, Charles

AbstractBackgroundMild Cognitive Impairment (MCI) is a pre‐dementia state where impaired cognitive domains (memory, executive, visuospatial processing, language) may predict underlying pathology, e.g. Alzheimer’s disease(AD), Lewy body (LB), and other. Delineating neuropathological heterogeneity in MCI and their associations with neuropsychological profiles are important in identifying individuals at risk of further deterioration. We aimed to characterize the neuropathological heterogeneity in cases with a diagnosis of MCI.MethodCases with a final consensus cognitive diagnosis of MCI (n = 128) prior to death were selected from the Arizona Study of Aging and Neurodegenerative disorders (AZSAND). Groups were divided into amnestic (aMCI) and non‐amnestic MCI (naMCI), single and multi‐domain impairment, and specific domain impairment (executive, language, visuospatial) was explored. Presence and severity of neuropathology including AD, LB, cerebral white matter rarefaction (CWMR), cerebral amyloid angiopathy (CAA), cerebral infarcts and microinfarcts (cortical and subcortical), TAR DNA‐binding protein 43 (TDP‐43), and apolipoprotein E (ApoE) status were compared between MCI subtypes.ResultThe number of cases meeting neuropathological criteria for AD was not different between aMCI (36.4%) and naMCI (22.6%) while co‐existent PD was less frequent in aMCI (19.5% vs 38.7%). When compared to naMCI (n = 31), the aMCI (n = 85) group had an older age of death (p = 0.001), less educational years (p = 0.04), a higher number of subcortical infarcts (p = 0.012), a higher regional density of neurofibrillary tangles (p = 0.027) and a lower density of LB (p = 0.015) in the temporal lobe, and CWMR in tended to be more severe in the frontal lobe (p = 0.052). Those with single domain aMCI had less CWMR (p = 0.001) compared to the multidomain. Within the naMCI group, those with single domain MCI had higher proportions of CAA (p = 0.042), and lower LB density (p = 0.019) compared to multidomain. CWMR was more severe (p = 0.026) inConclusionA high heterogeneity was observed between MCI subtypes. While AD pathology was similar between groups, regional anatomical differences were observed. Vascular pathology including subcortical infarcts, CWMR and CAA appear to be commonly associated with both aMCI and naMCI respectively while CWMR was associated with executive dysfunctions. CWMR, CAA and LBs appear to be more frequent in multidomain aMCI and naMCI respectively.

AbstractBackgroundLittle is known about sleep in those with a history of contact sports, who are at increased risk for neurodegenerative disease(s). Sleep disruption and disorders are increasingly recognized as having a bidirectional relationship with Alzheimer’s disease neuropathology. Here, we investigated self‐reported sleep disruption and disorders in male former college and professional American football players.Method116 former National Football League (NFL) players, 60 former college football players, and 60 asymptomatic men without a history of traumatic brain injury or repetitive head impacts (controls), all between 45‐74 years, completed the Mayo Sleep Questionnaire (MSQ) which includes the Epworth Sleepiness Scale (ESS). Former American football players were enrolled across the spectrum of symptom severity (asymptomatic to mild dementia). Using binary logistic regression or analysis of covariance, comparisons (controlling for age, racial identity, body mass index, APOE e4 status) on each of the MSQ items and the ESS were made between each of the study groups.ResultCompared to controls, former NFL players were more likely to restless legs (OR = 7.32, 95% CI = 1.63‐32.97*), sleepwalking (OR = 8.65, 95% CI = 1.08‐69.22*), observed apnea (OR = 2.25, 95% CI = 1.04‐4.85*), lower alertness levels (marginal mean diff. = 0.90**) and had higher ESS (marginal mean diff. = 2.37**). Former college football players reported greater sleep disturbances compared with controls: restless legs (OR = 10.82, 95% CI = 1.86‐62.89**), sleepwalking (OR = 10.45, 95% CI = 1.12‐97.58*), alertness levels (marginal mean diff. = 1.48**) and ESS (marginal mean diff. = 2.76*). There were no college vs control differences for observed apnea. There were no differences between former NFL players and former college football players on any sleep metric. **p<.005, *p<.05.ConclusionSleep disturbances may be an important factor to investigate in those with a history of participation in American football.