Can a Data-Driven Measure of Neuroanatomic Dementia Risk be Considered a Measure of Brain Aging?

Abstract There is an increasing interest in identifying aging-related factors which may be permissive of Alzheimer’s Disease (AD) emergence. We previously used machine learning to derive an index of neuroanatomic risk of dementia called AD pattern similarity (AD-PS) score using MRIs obtained in the Atherosclerosis Risk in Communities (ARIC) study. Here, we investigate the potential of the AD-PS scores as a brain-focused measure of biologic age. Among 1970 ARIC participants with MRI collected at ARIC Visit 5, we related AD-PS scores to three measures of aging: mortality (n=356) over 8 years of follow-up; an a priori panel of 32 proteins related to aging (N=1647); and a deficit accumulation index (DAI) based on 38 health-related measures. We found lower AD-PS scores associated with significantly lower mortality (HR=0.58, CI-95%, [0.45 - 0.75], p < 0.001) after adjusting for age, race, smoking and hypertension. Among the 32 proteins, nine were significantly associated to AD-PS scores (p < 0.05) with 4 remaining significant adjusting for multiple comparisons (Growth/differentiation factor 15, Tumor necrosis factor receptor superfamily member 1A and 1B and Collagen alpha-1(XVIII) chain). Finally, in a linear regression model after adjusting for age, race, sex, hypertension and smoking, AD-PS scores were associated with the DAI (p < 0.001). The consistent patterns of associations suggest that a data-driven measure of AD neuroanatomic risk may be capturing aspects of biologic age in older adults.

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Faculty Opinions recommendation of Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726644717.793523230 ◽

2016 ◽

Author(s):

Gretchen Kimmick

Keyword(s):

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Older Patients ◽

Deficit Accumulation ◽

Patients With Cancer ◽

Accumulation Index

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Incorporating radiomics into clinical trials: expert consensus on considerations for data-driven compared to biologically driven quantitative biomarkers

European Radiology ◽

10.1007/s00330-020-07598-8 ◽

2021 ◽

Author(s):

Laure Fournier ◽

Lena Costaridou ◽

Luc Bidaut ◽

Nicolas Michoux ◽

Frederic E. Lecouvet ◽

...

Keyword(s):

Clinical Trials ◽

Quantitative Imaging ◽

A Priori ◽

External Validation ◽

Data Driven ◽

Imaging Biomarkers ◽

Clinical Validation ◽

Biological Processes ◽

Imaging Data ◽

Selection Of

Abstract Existing quantitative imaging biomarkers (QIBs) are associated with known biological tissue characteristics and follow a well-understood path of technical, biological and clinical validation before incorporation into clinical trials. In radiomics, novel data-driven processes extract numerous visually imperceptible statistical features from the imaging data with no a priori assumptions on their correlation with biological processes. The selection of relevant features (radiomic signature) and incorporation into clinical trials therefore requires additional considerations to ensure meaningful imaging endpoints. Also, the number of radiomic features tested means that power calculations would result in sample sizes impossible to achieve within clinical trials. This article examines how the process of standardising and validating data-driven imaging biomarkers differs from those based on biological associations. Radiomic signatures are best developed initially on datasets that represent diversity of acquisition protocols as well as diversity of disease and of normal findings, rather than within clinical trials with standardised and optimised protocols as this would risk the selection of radiomic features being linked to the imaging process rather than the pathology. Normalisation through discretisation and feature harmonisation are essential pre-processing steps. Biological correlation may be performed after the technical and clinical validity of a radiomic signature is established, but is not mandatory. Feature selection may be part of discovery within a radiomics-specific trial or represent exploratory endpoints within an established trial; a previously validated radiomic signature may even be used as a primary/secondary endpoint, particularly if associations are demonstrated with specific biological processes and pathways being targeted within clinical trials. Key Points • Data-driven processes like radiomics risk false discoveries due to high-dimensionality of the dataset compared to sample size, making adequate diversity of the data, cross-validation and external validation essential to mitigate the risks of spurious associations and overfitting. • Use of radiomic signatures within clinical trials requires multistep standardisation of image acquisition, image analysis and data mining processes. • Biological correlation may be established after clinical validation but is not mandatory.

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Frailty Phenotype and Healthcare Costs in Women in Late Life: The SOF study

Innovation in Aging ◽

10.1093/geroni/igaa057.2814 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 778-778

Author(s):

Lisa Langsetmo ◽

Allyson Kats ◽

John Schousboe ◽

Tien Vo ◽

Brent Taylor ◽

...

Keyword(s):

Healthcare Costs ◽

Functional Limitations ◽

Late Life ◽

Cost Ratio ◽

Deficit Accumulation ◽

Frailty Phenotype ◽

Medicare Claims ◽

Accumulation Index ◽

Direct Healthcare Costs ◽

Frailty Indicator

Abstract We used data from 1324 women (mean age 83) at the 2002-2004 exam linked with their Medicare claims to determine the association of the frailty phenotype with healthcare costs. The frailty phenotype was categorized as robust, pre-frail or frail. Multimorbidity and a frailty indicator (approximating the deficit accumulation index) were derived from claims. Functional limitations were assessed by asking about difficulty performing IADL. Total direct healthcare costs were ascertained during 36 months following the exam. Compared with robust, pre-frailty and frailty were associated with higher costs after accounting for demographics, multimorbidity, functional limitations and the frailty indicator (cost ratio 1.37 [1.10-1.71] among pre-frail and 1.63 [1.28-2.08] among frail). Discrimination of high-cost (top decile) women was improved by adding the phenotype and functional limitations to a model containing demographics and the claims-based measures. Findings suggest that assessment of the phenotype may improve identification of individuals at higher risk of costly care.

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Avoidance of Healthcare Utilization in South Korea during the Coronavirus Disease 2019 (COVID-19) Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084363 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4363

Author(s):

Minjung Lee ◽

Myoungsoon You

Keyword(s):

General Population ◽

South Korea ◽

Healthcare Utilization ◽

Online Survey ◽

Negative Impact ◽

Sociodemographic Characteristics ◽

Related Factors ◽

First Case ◽

Significant Difference ◽

Health Related

Avoidance of healthcare utilization among the general population during pandemic outbreaks has been observed and it can lead to a negative impact on population health. The object of this study is to examine the influence of socio-demographic and health-related factors on the avoidance of healthcare utilization during the global outbreak of a novel coronavirus (COVID-19) in 2020. Data were collected through an online survey four weeks after the Korea Centers for Disease Control and Prevention (KCDC) confirmed the first case in South Korea; 1000 subjects were included in the analysis. The logit model for regression was used to analyze the associations between sociodemographic and health-related factors regarding the avoidance of healthcare utilization. Among the participants, 73.2% avoided healthcare utilization, and there was no significant difference in the prevalence of healthcare avoidance between groups with (72.0%) and without (74.9%) an underlying disease. Sociodemographic characteristics (e.g., gender, age, income level, and residential area) were related to healthcare avoidance. Among the investigated influencing factors, residential areas highly affected by COVID-19 (i.e., Daegu/Gyeoungbuk region) had the most significant effect on healthcare avoidance. This study found a high prevalence of healthcare avoidance among the general population who under-utilized healthcare resources during the COVID-19 outbreak. However, the results reveal that not all societal groups share the burden of healthcare avoidance equally, with it disproportionately affecting those with certain sociodemographic characteristics. This study can inform healthcare under-utilization patterns during emerging infectious disease outbreaks and provide information to public health emergency management for implementing strategies necessary to improve the preparedness of the healthcare system.

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Health-Related Quality of Life and Related Factors in Persons with Preserved Ratio Impaired Spirometry: Data from the Korea National Health and Nutrition Examination Surve

Medicina ◽

10.3390/medicina57010004 ◽

2020 ◽

Vol 57 (1) ◽

pp. 4

Author(s):

I Re Heo ◽

Ho Cheol Kim ◽

Tae Hoon Kim

Keyword(s):

Quality Of Life ◽

Low Income ◽

Control Group ◽

Poor Hrqol ◽

Related Factors ◽

Health And Nutrition ◽

Prism Group ◽

Related Quality ◽

Health Related

Background and Objectives: preserved ratio impaired spirometry (PRISm) is a common spirometric pattern that causes respiratory symptoms, systemic inflammation, and mortality. However, its impact on health-related quality of life (HRQOL) and its associated factors remain unclear. We aimed to identify these HRQOL-related factors and investigate the differences in HROOL between persons with PRISm and those with normal lung function. Materials and Methods: we reviewed the Korea National Health and Nutrition Examination Survey data from 2008 to 2013 to evaluate the HRQOL of persons with PRISm, as measured while using the Euro Quality of Life-5D (EQ-5D) and identify any influencing factors. PRISm was defined as pre-bronchodilator forced expiratory volume in 1 s (FEV1) <80% predicted and FEV1 to forced vital capacity (FVC) ratio (FEV1/FVC) ≥0.7. Individuals with FEV1 ≥80% predicted and FEV1/FVC ≥0.7 were considered as Controls. Results: of the 27,824 participants over the age of 40 years, 1875 had PRISm. The age- and sex-adjusted EQ-5D index was lower in the PRISm group than in the control group (PRISm, 0.930; control, 0.941; p = 0.005). The participants with PRISm showed a significantly higher prevalence of hypertension (p < 0.001), diabetes (p < 0.001), obesity (p < 0.001), low physical activity (p = 0.001), ever-smoker (p < 0.001), and low income (p = 0.034) than those in the control group. In participants with PRISm, lower EQ-5D index scores were independently associated with old age (p = 0.002), low income (p < 0.001), low education level (p < 0.001), and no economic activity (p < 0.001). Three out of five EQ-5D dimensions (mobility, self-care, and usual activity) indicated a higher proportion of dissatisfied participants in the PRISm group than the control group. Conclusions: the participants with PRISm were identified to have poor HRQOL when compared to those without PRISm. Old age and low socioeconomic status play important roles in HRQOL deterioration in patients with PRISm. By analyzing risk factors that are associated with poor HRQOL, early detection and intervention of PRISm can be done in order to preserve patients’ quality of life.

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Quantifying the Impact of a Tsunami on Data-Driven Earthquake Relief Zone Planning in Los Angeles County via Multivariate Spatial Optimization

Geosciences ◽

10.3390/geosciences11020099 ◽

2021 ◽

Vol 11 (2) ◽

pp. 99 ◽

Cited By ~ 1

Author(s):

Yueqi Gu ◽

Orhun Aydin ◽

Jacqueline Sosa

Keyword(s):

Los Angeles ◽

A Priori ◽

Safety Data ◽

Spatial Optimization ◽

Optimal Number ◽

Multidisciplinary Optimization ◽

Data Driven ◽

Fault System ◽

Design Data ◽

The Impact

Post-earthquake relief zone planning is a multidisciplinary optimization problem, which required delineating zones that seek to minimize the loss of life and property. In this study, we offer an end-to-end workflow to define relief zone suitability and equitable relief service zones for Los Angeles (LA) County. In particular, we address the impact of a tsunami in the study due to LA’s high spatial complexities in terms of clustering of population along the coastline, and a complicated inland fault system. We design data-driven earthquake relief zones with a wide variety of inputs, including geological features, population, and public safety. Data-driven zones were generated by solving the p-median problem with the Teitz–Bart algorithm without any a priori knowledge of optimal relief zones. We define the metrics to determine the optimal number of relief zones as a part of the proposed workflow. Finally, we measure the impacts of a tsunami in LA County by comparing data-driven relief zone maps for a case with a tsunami and a case without a tsunami. Our results show that the impact of the tsunami on the relief zones can extend up to 160 km inland from the study area.

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Frailty and Autonomy among the Oldest Old: Evidence from the Multicenter Prospective AgeCoDe-AgeQualiDe Study

Gerontology ◽

10.1159/000514170 ◽

2021 ◽

pp. 1-8

Author(s):

André Hajek ◽

Christian Brettschneider ◽

Tina Mallon ◽

Hanna Kaduszkiewicz ◽

Birgitt Wiese ◽

...

Keyword(s):

Old Age ◽

Service Use ◽

Oldest Old ◽

Strong Association ◽

Total Sample ◽

Sociodemographic Factors ◽

Related Factors ◽

Clinical Frailty Scale ◽

Related Quality ◽

Health Related

Introduction: There is a lack of studies examining the link between perceived autonomy and frailty among the oldest old. Therefore, our objective was to fill this gap. Methods: Data were used from the multicenter prospective cohort study “Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)” (AgeQualiDe; follow-up [FU] wave 9; n = 510 observations in the analytical sample). The average age was 90.3 years (SD: 2.7 years). The Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) was used to assess frailty. Socioeconomic and health-related covariates were included in our regression model. The autonomy scale developed by Schwarzer was used to assess perceived autonomy in old age. Results: Adjusting for various confounders, multiple linear regressions showed that lower perceived autonomy was associated with increased levels of frailty (total sample: β = −0.13, p < 0.001; women: β = −0.14, p < 0.001; and men: β = −0.12, p < 0.001). Furthermore, lower perceived autonomy was associated with more depressive symptoms, higher cognitive impairment, and being institutionalized (except for men) in the total sample and in both sexes, but it was not significantly associated with age, sex, marital status, educational level, and social support. Conclusion: Findings indicate that frailty is associated with lower autonomy among the oldest old. More generally, while health-related factors were consistently associated with autonomy, sociodemographic factors (except for being institutionalized) were not associated with autonomy among the oldest old. We should be aware of the strong association between autonomy and physical as well as mental health in very old age.

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Impact of flooding on health-related quality of life in England: results from the National Study of Flooding and Health

European Journal of Public Health ◽

10.1093/eurpub/ckaa049 ◽

2020 ◽

Vol 30 (5) ◽

pp. 942-948

Author(s):

Charlotte Robin ◽

Charles Beck ◽

Ben Armstrong ◽

Thomas David Waite ◽

G James Rubin ◽

...

Keyword(s):

Quality Of Life ◽

A Priori ◽

National Study ◽

Health Related Quality ◽

Euroqol Group ◽

Related Quality ◽

Health Related ◽

Anxiety Depression ◽

The Impact

Abstract Background Flooding can have extensive effects on the health and wellbeing of affected communities. The impact of flooding on psychological morbidity has been established; however, the wider impacts of flooding exposure, including on health-related quality of life (HRQoL), have not been described. Methods Using data from the English National Study of Flooding and Health cohort, HRQoL 2 and 3 years post-flooding was assessed with the EuroQol Group EQ-5D-5L tool. Associations between exposure groups (flooding and disruption from flooding) and HRQoL were assessed, using ordinal and linear regression, adjusting for a priori confounders. Results For both 2 and 3 years post-flooding, the median HRQoL scores were lower in the flooded and disrupted groups, compared with unaffected respondents. A higher proportion of flooded and disrupted respondents reported HRQoL problems in most dimensions of the EQ-5D-5L, compared with unaffected respondents. In year 2, independent associations between exposure to flooding and experiencing anxiety/depression [adjusted odds ratio (aOR) 7.7; 95% CI 4.6–13.5], problems with usual activities (aOR 5.3; 95% CI 2.5–11.9) and pain/discomfort (aOR 2.4; 95% CI 1.5–3.9) were identified. These problems persisted 3 years post-flooding; associations between exposure to flooding and experiencing anxiety/depression (aOR 4.3; 95% CI 2.5–7.7), problems with usual activities (aOR 2.9; 95% CI 1.5–6.1) and pain/discomfort (aOR 2.5; 95% CI 1.5–4.2) were identified. Conclusions Exposure to flooding and disruption from flooding significantly reduces HRQoL. These findings extend our knowledge of the impacts of flooding on health, with implications for multi-agency emergency response and recovery plans.

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Experimental Evaluations of a Model of Mental Workload

Proceedings of the Human Factors Society Annual Meeting ◽

10.1177/154193128903301814 ◽

1989 ◽

Vol 33 (18) ◽

pp. 1233-1237 ◽

Cited By ~ 5

Author(s):

P. A. Hancock ◽

M. H. Chignell ◽

M. Vercruyssen ◽

M. Denhoff

Keyword(s):

Path Length ◽

Mental Workload ◽

Movement Time ◽

A Priori ◽

Independent Effect ◽

Subjective Perception ◽

Performance Task ◽

Related Factors ◽

Task Goal ◽

Systematic Effects

The present experiments were designed to test predictions from a model of mental workload. The model predicts non-linear increases in mental workload as perceived distance from a task goal grows and effective time for action is reduced. Diminution of mental workload is achieved by application of effort which brings the task goal into the region of acceptable time/distance constraints for successful resolution. Two experiments are reported which tested these assertions using the timepools performance task. Timepools is unique as a performance task in that it generates a spatial representation of a shrinking temporal target. The independent effects of path length, i.e., the number of sequential targets to be acquired, and shrink rate, i.e., the collapse time during which the circle is halved in area, may be assessed using performance variables such as reaction time (RT), movement time (MT), error rate (E), and the subjective perception of workload. Data from Experiment 1, indicate systematic effects for task related factors across performance and workload measures, although such a pattern was not isomorphically mapped to the a priori assumed difficulty of the task. In Experiment 2, shrink rate and path length had independent effect on RT and MT respectively, which were reflected in components of the individual workload scales. The ramifications with respect to the model are elaborated.

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