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Abstract

Background and Objectives

Mounting evidence indicates that hypertension leads to a higher risk of dementia. Hypertension is a highly heritable trait, and a higher polygenic susceptibility to hypertension (PSH) is known to associate with a higher risk of dementia. We tested the hypothesis that a higher PSH leads to worse cognitive performance in middle-aged persons without dementia. Confirming this hypothesis would support follow-up research focused on using hypertension-related genomic information to risk-stratify middle-aged adults before hypertension develops.

Methods

We conducted a nested cross-sectional genetic study within the UK Biobank (UKB). Study participants with a history of dementia or stroke were excluded. We categorized participants as having low (≤20th percentile), intermediate, or high (≥80th percentile) PSH according to results of 2 polygenic risk scores for systolic and diastolic blood pressure (BP) generated with data on 732 genetic risk variants. A general cognitive ability score was calculated as the first component of an analysis that included the results of 5 cognitive tests. Primary analyses focused on Europeans, and secondary analyses included all race/ethnic groups.

Results

Of the 502,422 participants enrolled in the UKB, 48,118 (9.6%) completed the cognitive evaluation, including 42,011 (8.4%) of European ancestry. Multivariable regression models using systolic BP–related genetic variants indicated that compared with study participants with a low PSH, those with intermediate and high PSH had reductions of 3.9% (β −0.039, SE 0.012) and 6.6% (β −0.066, SE 0.014), respectively, in their general cognitive ability score (p < 0.001). Secondary analyses including all race/ethnic groups and using diastolic BP–related genetic variants yielded similar results (p < 0.05 for all tests). Analyses evaluating each cognitive test separately indicated that reaction time, numeric memory, and fluid intelligence drove the association between PSH and general cognitive ability score (all individual tests, p < 0.05).

Discussion

Among nondemented, community-dwelling, middle-aged Britons, a higher PSH is associated with worse cognitive performance. These findings suggest that genetic predisposition to hypertension influences brain health in persons who have not yet developed dementia. Because information on genetic risk variants for elevated BP is available long before the development of hypertension, these results lay the foundation for further research focused on using genomic data for the early identification of high-risk middle-aged adults.

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Information & Authors

Information

Published In

Neurology®
Volume 101Number 5August 1, 2023
Pages: e512-e521
PubMed: 37295956

Publication History

Received: November 1, 2022
Accepted: April 4, 2023
Published online: June 9, 2023
Published in print: August 1, 2023

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Disclosure

The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Study Funding

T.M. Gill is supported by the NIH P30AG021342. K.N. Sheth is supported by the NIH (R03NS112859, R01NS110721, R01NS075209, U01NS113445, U01NS106513, R01NR01833, U24NS107215, and U24NS107136) and the American Heart Association (17CSA33550004, 817874) and reports grants from Hyperfine, Biogen, and Astrocyte unrelated to this work. G.J. Falcone is supported by the NIH (P30AG021342), the American Heart Association (817874), and the Yale Pepper Pilot Award (P30AG021342).

Authors

Affiliations & Disclosures

Cyprien A. Rivier, MD, MSc https://orcid.org/0000-0002-1148-1829
From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
1) Pyxis Partners, All of Us Research Ambassador stipend. More than 1,000$ but less than 5,000$.2) Speaker honorarium for the DREF (1 time). Less than 1,000$
Editorial Boards:
1.
NONE
Patents:
1.
1) Algorithm for post-stroke motor recovery prediction. Patent pending in Switzerland.
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
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NONE
Other Activities:
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NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
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1.
None
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1.
NONE
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NONE
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1.
NONE
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Natalia Szejko, MD, PhD, ScD https://orcid.org/0000-0001-6160-9221
From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
1. Healthcare, Guest Editor, 2022-20232. Intechopen, Academic Editor, 2021-2023
Patents:
1.
NONE
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1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
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NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
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Daniela Renedo, MD
From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
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Rommell B. Noche, MSc
From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
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1.
NONE
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From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
1) Rad AI Inc, Clinical Data Scientist, 1 year (not related to the submitted work)
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
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1.
NONE
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Cameron P. Both, BS
From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
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1.
NONE
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Richa Sharma, MD, MPH
From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
National Institutes of Health, K23NS121634, PI, 2022-2027.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
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Victor M. Torres-Lopez, MA
From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
AJNRFrontiers Oncology
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NINDS K23 NS118056
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Doris Duke Foundation 2020097
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
1) Commercial, Novo Nordisk
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
1) Blood pressure for secondary stroke prevention, UptoDate
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
1) Commercial, Integra2) Commercial, NovoNordisk
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
1) American Academy of Neurology
Research Support, Government Entities:
1.
1) NIH/NINDS, K23NS105924, Primary Investigator, 2019-20241) NIH/NINDS, R01NS130189, Primary Investigator, 2023-2028
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
1) Certus Critical Care2) TitinKM
Legal Proceedings:
1.
NONE
Kevin N. Sheth, MD
From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
(1) DSMB for Zoll sponsored study(2) DSMB for Sense(3) Cerevasc(4) Astrocyte(5) Rhaeos(6) CSL
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
Editorial Board, StrokeEditorial Board, Annals of Neurology
Patents:
1.
Patent Stroke detection technologyPatent for nanoparticle technology
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Astrocyte
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Bard, Biogen, Hyperfine
Research Support, Government Entities:
1.
(1) NIH U24NS107136, U24NS107215, U01NS106513, RO1NR018335, R01EB031114, R01MD016178, R01NS110721
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
American Heart Association
Stock/stock Options/board of Directors Compensation:
1.
Astrocyte
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
Astrocyte, Alva, AbbieVie
Legal Proceedings:
1.
Legal consultant
From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
Editorial board: Journal of the American Geriatrics Society, Journal of Gerontology Medical Sciences
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
National Institute on Aging (P30AG021342)*Claude D. Pepper Older Americans Independence Center, Principal Investigator, 7/18 - 6/23.National Institute on Minority Health and Health Disparities (R01MD017298)*A Multifactorial Approach to Evaluating Disparities in Outcomes after Major Surgery in Disadvantaged Older Persons, Multiple Principal Investigator, 5/22 - 1/26.National Institute on Aging (R01AG017560)*Distressing Symptoms and Disability Before and After Sentinel Health Events among Community-living Older Persons, Principal Investigator, 9/22 - 5/25.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH (grant #P30AG021342)
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
American Heart Association (grant #817874, principal investigator, 2020-2024).
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Falcone [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Previously published at medRxiv doi: 2022.09.27.22280434.
Submitted and externally peer reviewed. The handling editors were Deputy Editor Bradford Worrall, MD, MSc, FAAN and Assistant Editor Andrea Schneider, MD, PhD.

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