Bichun Ouyang’s research while affiliated with Rush University Medical Center and other places

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Publications (165)


Health Status of Lewy Body Dementia Caregivers Predicts Psychological Response to Peer Mentoring Intervention
  • Article

February 2025

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3 Reads

Alzheimer Disease & Associated Disorders

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Bichun Ouyang

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Individuals with Lewy body dementia (LBD) rely on family caregivers. Caregiving demands limit caregivers’ ability to attend to their own health needs, increasing their vulnerability to the psychological effects of caregiving. We previously piloted a peer mentoring intervention with experienced (mentor) and less experienced (mentee) LBD caregivers. Matched mentor-mentee dyads spoke weekly for 16 weeks, guided by an intervention handbook. LBD knowledge and attitudes towards dementia improved postintervention. We hypothesized that caregiver health status moderates response to peer mentoring. Post hoc analyses (N = 30 dyads) showed that 75% of mentees and 66% of mentors endorsed ≥1 comorbidity. Mentees and mentors with comorbidities showed greater improvement in LBD knowledge postintervention ( P = 0.039) and dementia attitudes post-training ( P = 0.016), respectively. Caregivers with comorbidities and thus greater exposure to health care may derive excess benefit from an effective LBD caregiver intervention than healthier counterparts, enhancing both the objective knowledge and their confidence in caring for their loved ones.




Higher state average nighttime light intensity is associated with higher state AD prevalence (2012–2018 average). (A) AD prevalence by state. (B) Average nighttime light intensity by state. (C) Average nighttime light intensity state rankings. 1/5 = darkest average nighttime light intensity through 5/5 = brightest average nighttime light intensity. (D) State AD prevalence by average state nighttime light intensity rankings. ANOVA revealed a statistically significant difference in AD prevalence between groups [F(4, 43) = 13.50, p < 0.0001]. Multiple comparisons testing found that the states with the lowest average light intensity had significantly different AD prevalence than states with higher average nighttime light intensity: 1/5 vs. 2/5 (p = 0.031), 1/5 vs. 3/5 (p < 0.001), 1/5 vs. 4/5 (p < 0.001), 1/5 vs. 5/5 (p < 0.001), and 2/5 vs. 5/5 (p = 0.010). *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001. (E) Pearson correlation analysis between state AD prevalence and state nighttime light intensity revealed a positive relationship [r(46) = 0.557. p < 0.001]. Circle size reflects state population.
Higher average county nighttime light intensity is associated with higher county AD prevalence (2012–2018 average). (A) Average county nighttime light intensity rankings. 1/4 = darkest average nighttime light intensity through 4/4 = brightest average nighttime light intensity. (B) County AD prevalence by average county nighttime light intensity rankings. ANOVA revealed a statistically significant difference in AD prevalence between groups [F(3, 42) = 10.750, p < 0.001]. Multiple comparisons testing found that the counties with the lowest average light intensity had significantly different AD prevalence than counties with higher average nighttime light intensity: 1/4 vs. 3/4 (p = 0.003), 1/4 vs. 4/4 (p < 0.001), 2/4 vs. 4/4 (p = 0.002). **p < 0.01, ****p < 0.0001. (C) Pearson correlation analysis between county AD prevalence and average county nighttime light intensity revealed a positive relationship [r(44) = 0.599, p < 0.001]. Circle size reflects county population.
Outdoor nighttime light exposure (light pollution) is associated with Alzheimer’s disease
  • Article
  • Full-text available

September 2024

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33 Reads

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4 Citations

Introduction Alzheimer’s disease (AD) prevalence has increased in the last century which can be attributed to increased lifespan, but environment is also important. Exposure to artificial light at night is one environmental factor that may influence AD. Methods This study evaluated the relationship between outdoor nighttime light exposure and AD prevalence in the United States using satellite acquired outdoor nighttime light intensity and Medicare data. Results Higher outdoor nighttime light was associated with higher prevalence of AD. While atrial fibrillation, diabetes, hyperlipidemia, hypertension, and stroke were associated more strongly with AD prevalence than nighttime light intensity, nighttime light was more strongly associated with AD prevalence than alcohol abuse, chronic kidney disease, depression, heart failure, and obesity. Startlingly, nighttime light exposure more strongly associated with AD prevalence in those under the age of 65 than any other disease factor examined. Discussion These data suggest light exposure at night may influence AD, but additional studies are needed.

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FIG. 1. Study schematic. At the 1-and 6-month visits two separate assessors completed a mono-polar survey at the previously established optimal electrode level in each subject, comparing four monopolar stimulation conditions: ring mode, segment A, segment B, and segment C.
Demographic data (n = 20)
Inter-rater and intra-rater agreement
Difference in TW% between the two best electrodes
Directional Deep Brain Stimulation Programming: Is the Segment Clearly Identifiable and Stable Over Time?

June 2024

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24 Reads

Movement Disorders Clinical Practice

Background: In our early experience programming directional deep brain stimulation (d-DBS) in PD, we found the optimal directional segment changed over time in some patients. To determine the frequency/reasons for this we examined whether (1) different programmers would identify the same segment as "optimal"; and (2) the same programmer would select the same "optimal" segment over time. We hypothesized there would be a moderately high level of agreement on optimal electrode selection between different assessors and repeated assessments by the same evaluator. Methods: This was a prospective, double-blind investigation evaluating the reliability and stability of programming d-DBS. Each patient underwent a mono-polar survey four times (2 time points by 2 separate assessors). The primary aim was the inter-rater agreement of selecting the optimal electrode at 1 and 6 months. The secondary aim was to determine the intra-rater agreement of selecting the optimal electrode from 1 to 6 months. Results: Twenty-one patients were enrolled. There was fair inter-rater agreement at 1 month and moderate at 6 months. There was minimal intra-rater agreement between 1 and 6 months. Discussion: The data refuted our hypothesis. Potential reasons for low agreement include (1) the arduous/subjective nature of identifying the optimal electrode in d-DBS systems, especially in well-placed electrodes; and/or (2) acute changes to the location of stimulation delivery offering temporary improvement in symptoms. Key takeaways gathered were it may, (1) behoove the programmer to explore different electrode montages after a period of time; and (2) be more efficient to review the directional electrode montage only when dictated by clinical symptoms/disease progression.


Postural sway comparisons among the controls, PMCs without FXTAS (no FXTAS), and PMCs with FXTAS.
Dual-task costs while balancing in the control, no FXTAS, and FXTAS groups.
Cont.
Potential Prodromal Digital Postural Sway Markers for Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS) Detected via Dual-Tasking and Sensory Manipulation

April 2024

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32 Reads

Sensors

FXTAS is a neurodegenerative disorder occurring in some Fragile X Messenger Ribonucleoprotein 1 (FMR1) gene premutation carriers (PMCs) and is characterized by cerebellar ataxia, tremor, and cognitive deficits that negatively impact balance and gait and increase fall risk. Dual-tasking (DT) cognitive-motor paradigms and challenging balance conditions may have the capacity to reveal markers of FXTAS onset. Our objectives were to determine the impact of dual-tasking and sensory and stance manipulation on balance in FXTAS and potentially detect subtle postural sway deficits in FMR1 PMCs who are asymptomatic for signs of FXTAS on clinical exam. Participants with FXTAS, PMCs without FXTAS, and controls underwent balance testing using an inertial sensor system. Stance, vision, surface stability, and cognitive demand were manipulated in 30 s trials. FXTAS participants had significantly greater total sway area, jerk, and RMS sway than controls under almost all balance conditions but were most impaired in those requiring vestibular control. PMCs without FXTAS had significantly greater RMS sway compared with controls in the feet apart, firm, single task conditions both with eyes open and closed (EC) and the feet together, firm, EC, DT condition. Postural sway deficits in the RMS postural sway variability domain in asymptomatic PMCs might represent prodromal signs of FXTAS. This information may be useful in providing sensitive biomarkers of FXTAS onset and as quantitative balance measures in future interventional trials and longitudinal natural history studies.



Table 1 .
Fig. S1: Higher state average nighttime light intensity is associated with higher state AD prevalence (2012-2018) in those over the age of 65 and those under the age of 65. (a) AD prevalence by state average nighttime light intensity rankings in individuals over the age of 65. ANOVA: F(4,43)=14.560, p<0.001. Multiple comparisons testing revealed differences between groups with lower average light intensity and groups with higher average light intensity: 1/5 vs. 3/5 (p<0.001), 1/5 vs. 4/5 (p<0.001), 1/5 vs. 5/5 (p<0.001), 2/5 vs. 3/5 (p=0.031), 2/5 vs. 4/5 (p=0.009), 2/5 vs. 5/5 (p=0.013). (b) Pearson correlation analysis between AD prevalence and nighttime light intensity in those over the age of 65: r(46)=0.490, p<0.001. (c) AD prevalence by state average nighttime light intensity rankings in individuals under the age of 65. ANOVA: F(4,43)=6.950, p<0.001. Multiple comparisons testing revealed differences between groups with lower average light intensity and groups with higher average light intensity: 1/5 vs. 5/5 (p<0.001), 3/5 vs. 5/5 (p=0.048), 4/5 vs 5/5 (p=0.018). (d) Pearson correlation analysis between AD prevalence and nighttime light intensity in those over the age of 65: r(46)=0.550, p<0.001. *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001. Circle size reflects state population.
Fig. S3: Changes in nighttime light from 2012-2022 at the state level. Nighttime light in 2012 (for each state) was set as 100% and changes in light across years 2013-2022 was calculated.
Regression coefficient, SE, p-value
Outdoor Nighttime Light Exposure (Light Pollution) is Associated with Alzheimer Disease

February 2024

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82 Reads

Alzheimer’s disease (AD) prevalence has increased in the last century which can be attributed to increased lifespan, but environment is also important. This study evaluated the relationship between outdoor nighttime light exposure and AD prevalence in the United States. Higher outdoor nighttime light was associated with higher prevalence of AD. While atrial fibrillation, diabetes, hyperlipidemia, hypertension, and stroke were associated more strongly with AD prevalence than nighttime light intensity, nighttime light was more strongly associated with AD prevalence than alcohol abuse, chronic kidney disease, depression, heart failure, and obesity. Startlingly, nighttime light exposure more strongly associated with AD prevalence in those under the age of 65 than any other disease factor examined. These data indicate a need to investigate how nighttime light exposure influences AD pathogenesis. One-Sentence Summary There is a positive association between Alzheimer’s disease prevalence and average outdoor nighttime light intensity in the United States.


Gait parameters under self-selected (SS) speed two-minute walk test (2MWT). Significantly different gait parameters among FXTAS, PD, and ET participants: (A) stride velocity variability, (B) cadence variability, (C) stride length, and (D) arm symmetry index. C o V coefficient of variation = S D mean × 100 . All data reported as mean ± SEM. *p ≤ 0.05, **p ≤ 0.01.
Gait parameters under fast as possible (FP) two-minute walk test (2MWT). Significantly different gait and movement transition parameters among FXTAS, PD, and ET participants: (A) stride length, and (B) turn duration. All data reported as mean ± SEM. *p ≤ 0.05, **p ≤ 0.01.
Dual task costs for gait parameters. Significantly different gait parameters among FXTAS, PD, and ET participants: (A) stride length, and (B) stride velocity. DTC was calculated using the formula D T − S S S S × 100 . All data reported as mean ± SEM. *p ≤ 0.05.
Movement transition parameters in the Instrumented Timed Up and Go test (i-TUG). Significantly different parameter among FXTAS, PD, and ET participants: sit-to-stand peak velocity. All data reported as mean ± SEM. *p ≤ 0.05, **p ≤ 0.01.
Significant multinomial regression results. Significantly different gait parameters among FXTAS, PD, and ET participants during the dual task (DT) condition: (A) stride length, and (B) arm symmetry index. All data reported as mean ± SEM. *p ≤ 0.05.
Digital gait markers to potentially distinguish fragile X-associated tremor/ataxia syndrome, Parkinson’s disease, and essential tremor

December 2023

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37 Reads

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1 Citation

Background Fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disease that affects carriers of a 55-200 CGG repeat expansion in the fragile X messenger ribonucleoprotein 1 (FMR1) gene, may be given an incorrect initial diagnosis of Parkinson’s disease (PD) or essential tremor (ET) due to overlapping motor symptoms. It is critical to characterize distinct phenotypes in FXTAS compared to PD and ET to improve diagnostic accuracy. Fast as possible (FP) speed and dual-task (DT) paradigms have the potential to distinguish differences in gait performance between the three movement disorders. Therefore, we sought to compare FXTAS, PD, and ET patients using quantitative measures of functional mobility and gait under self-selected (SS) speed, FP, and DT conditions. Methods Participants with FXTAS (n = 22), PD (n = 23), ET (n = 20), and controls (n = 20) underwent gait testing with an inertial sensor system (APDM™). An instrumented Timed Up and Go test (i-TUG) was used to measure movement transitions, and a 2-min walk test (2MWT) was used to measure gait and turn variables under SS, FP, and DT conditions, and dual-task costs (DTC) were calculated. ANOVA and multinomial logistic regression analyses were performed. Results PD participants had reduced stride lengths compared to FXTAS and ET participants under SS and DT conditions, longer turn duration than ET participants during the FP task, and less arm symmetry than ET participants in SS gait. They also had greater DTC for stride length and velocity compared to FXTAS participants. On the i-TUG, PD participants had reduced sit-to-stand peak velocity compared to FXTAS and ET participants. Stride length and arm symmetry index during the DT 2MWT was able to distinguish FXTAS and ET from PD, such that participants with shorter stride lengths were more likely to have a diagnosis of PD and those with greater arm asymmetry were more likely to be diagnosed with PD. No gait or i-TUG parameters distinguished FXTAS from ET participants in the regression model. Conclusion This is the first quantitative study demonstrating distinct gait and functional mobility profiles in FXTAS, PD, and ET which may assist in more accurate and timely diagnosis.



Citations (52)


... It also reduces self-efficacy, confidence, and motivation, affecting psychological frustration, annoyance, and physical stress responses [24,25]. Artificial light exposure disrupts sleep-wake cycles, gene expression, neuronal reorganization, brain electrical activity, blood flow, metabolite turnover, and gut bacteria, potentially contributing to neurodegeneration and AD development [26,27]. ...

Reference:

Foreign Contaminants Target Brain Health
Outdoor nighttime light exposure (light pollution) is associated with Alzheimer’s disease

... It was found that economic cost-benefit differential analysis showed implementation costs were financed by savings on outbreak costs within an average of 14 months at facilities using integrated technological solutions (Singh et al., 2024). Also, actual facilities incorporating peer-mentor programs along with conventional training and development demonstrated enhanced staff self-efficiency by 52% and decreased protocol deviation episodes by 38% (Fleisher et al., 2023). Although strict visiting hour limitations were prescribed to lower the risks of transmissions significantly, compassionate but flexibly monitored visitors' technologies provided similar safety results while at the same time recording much superior resident satisfaction scores (Hugelius et al., 2021). ...

Learning to PERSEVERE: A pilot study of peer mentor support and caregiver education in Lewy body dementia
  • Citing Article
  • June 2023

Parkinsonism & Related Disorders

... Persons with PD have depleted concentrations of SCFA in stool [129,164,165]. High-fiber dietary interventions provide benefits to enrich depleted taxa in people living with PD and improve GI motility and markers of inflammation [166]. Further, in an ⍺-syn-overexpression mouse model, high-fiber diet limits ⍺-syn accumulation and motor deficits [167]. ...

An open label, non-randomized study assessing a prebiotic fiber intervention in a small cohort of Parkinson’s disease participants

... A few articles included studies with an intervention (n = 5), of which four were focused on reducing psychiatric symptoms of either the PwP, their caregiver, or both. Interventions focused on music therapy [36], mindfulness [27,39], mentorship [41], and education [30], with music therapy being found effective in reducing apathy in PwP and mindfulness effective in improving the reported relaxation of caregivers. Of the interventions that did not demonstrate significant differences among groups, satisfaction with the intervention was still high [30,41]. ...

IN-HOME-PD Caregivers: The effects of a combined home visit and peer mentoring intervention for caregivers of homebound individuals with advanced Parkinson's disease
  • Citing Article
  • November 2022

Parkinsonism & Related Disorders

... The literature search revealed that educational components are central to digital interventions for PD management, aiming to empower patients through home-based exercises available via videos, audios, and digital information sheets. [26][27][28][29][30][31]65,67,68 These elements represent a pedagogical strategy embraced by many systems to disseminate PD knowledge, promoting self-learning and condition management. Included literature also highlights systems integrating self-reporting of symptoms with biomechanical data collection, offering a comprehensive self-management approach. ...

IN-HOME-PD: The effects of longitudinal telehealth-enhanced interdisciplinary home visits on care and quality of life for homebound individuals with Parkinson's disease
  • Citing Article
  • August 2022

Parkinsonism & Related Disorders

... 13 15 18 21 24-26 Six studies provide 12-18 month follow-up data (mean 14.1 months) with 56% of dLeads on a directional setting (n=234/426). 18 22 24 25 27 28 Only one study 25 reported >2-year follow-up data. Although the use of directional stimulation increased from 27% at 2 years to 60% at 3 years, missing data increased drastically over the length of follow-up (n=91 on inclusion, 26 at 2 years, 7 at 3 years), making it difficult to reach any meaningful conclusion. ...

Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming: A Retrospective Review

Neurology and Therapy

... Of the 31 articles, age was the most common reported caregiver demographic or characteristic (n = 27), followed by gender (n = 24), race and/or ethnicity (n = 21), and relationship to the PwP (n = 18). Of the 24 articles that included gender, nearly all reported a large majority of female participants (average 76.1% female), with one study reporting the same number of male and female subjects (50% female, 50% male) [34], and a separate study reporting a slight male majority of 51.43% [42]. Of the 21 articles that reported race, all reported a majority of participants as white (average 93.1% white), with eight articles including 100% white participants [18,24,26,27,32,[34][35][36]. ...

Soluble urokinase-type plasminogen activator receptor (suPAR) is elevated in caregivers of patients with parkinsonism
  • Citing Article
  • June 2022

Parkinsonism & Related Disorders

... Anishchuk and colleagues [45], for instance, developed a module on clinical empathy that focused on recognizing and understanding patients' feelings and experiences, as well as effectively communicating this understanding to patients. Likewise, Hess and colleagues [40] proposed interventions for Parkinson's disease that encompassed lectures, breakout sessions, and immersive virtual reality experiences, aimed at enhancing empathetic interactions with patients. Beyond cognitive and emotional empathy, certain programs explore alternative dimensions of empathy. ...

The impact and feasibility of a brief, virtual, educational intervention for home healthcare professionals on Parkinson’s Disease and Related Disorders: pilot study of I SEE PD Home

... However, Weill and colleagues (Weill et al. 2022), while generally sharing the concern, pointed out that the un-operated control group in this study was taken from the large longitudinal observational PPMI study, which may introduce a bias for milder disease courses. So, no clear conclusion is possible at this time and further longitudinal well-designed studies on the cognitive outcome depending on treatment strategies in genetically characterized sub-cohorts with different GBA mutations are necessary (Pal et al. 2022b). ...

Reply to: Cognitive Effects of Deep Brain Stimulation in GBA‐Related Parkinson's Disease
  • Citing Article
  • June 2022

Annals of Neurology

... In an analysis of initial readings of radiological images that resulted in delayed diagnosis, approximately 42% of the errors were attributed to "underreading" or missing the finding, and 82% of the examined cases had an instance of underreading (Kim & Mansfield, 2014). A prospective study using MRI scans of 60 patients with known lesions (Garg et al., 2022) showed that neuroradiologists performing a routine read missed the presence of lesions in 21 patients (including 6 patients with multiple lesions). On average, the two radiologists who were instructed to Page 2 of 17 Hults et al. ...

Inattentional blindness to DWI lesions in spontaneous intracerebral hemorrhage
  • Citing Article
  • March 2022

Neurological Sciences