{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T22:39:19Z","timestamp":1793054359356,"version":"4.5.0"},"reference-count":69,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:sec id=\"ab-noi250097-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Ventricle-brain volume ratio (VBR), a marker of cerebral atrophy, is a robust correlate of cognition and a predictor of Alzheimer disease (AD) progression. Higher circulating concentrations of the longevity protein klotho have been linked to better cognition, but whether klotho modifies the known association between age-related brain atrophy and cognitive decline is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250097-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine whether serum klotho moderates the association between VBR and cognition and whether this association differs in younger adults (age \u226461.6 years; median split) compared with older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250097-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This was a cross-sectional study using data from the Wisconsin Alzheimer Disease Research Center and the Wisconsin Registry for Alzheimer Prevention, collected from 2009 to 2023. This was a community-based, longitudinal study at a research center. Included in the analysis were middle-aged and older adults without cognitive impairment, most with a parental history of AD, who underwent neuropsychological testing, magnetic resonance image, and venipuncture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250097-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Serum soluble \u03b1-klotho concentration, measured via enzyme-linked immunosorbent assay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250097-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>\n                      Outcome measures included composite\n                      <jats:italic toggle=\"yes\">z<\/jats:italic>\n                      scores for global cognition, executive function, delayed recall, and immediate learning. VBR was calculated as total ventricular volume divided by total brain volume \u00d7100.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250097-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across the entire sample (308 participants; mean [SD] age, 61.3 [6.5] years; 246 female [80%]; parental history of AD, 227 [74%]), the VBR\u2009\u00d7\u2009klotho interaction was significant, whereby those with higher serum klotho levels performed better on tests assessing global cognition (mean [SE], 0.35 [0.14]; 95% CI, 0.08-0.62;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.01) and executive function (mean [SE], 0.41 [0.15]; 95% CI, 0.11-0.71;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.01) but not delayed recall or immediate learning, despite having more brain atrophy. VBR\u2009\u00d7\u2009klotho interactions were not significant in the younger group. In the older group, the VBR\u2009\u00d7\u2009klotho interaction was significant, whereby those with higher circulating klotho levels performed better on tests of global cognition (mean [SE], 0.59 [0.24]; 95% CI, 0.12-1.06;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.01), executive function (mean [SE], 0.71 [0.27]; 95% CI, 0.19-1.24;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.01), and immediate learning (mean [SE], 0.59 [0.27]; 95% CI, 0.06-1.20;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.03) but not delayed recall, despite having more brain atrophy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250097-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>Results suggest that circulating serum klotho levels modified the known adverse association between age-related brain atrophy and cognition in older, but not younger, adults at risk for AD, suggesting that the neuroprotective effects of klotho may be age dependent.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaneurol.2025.5581","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T16:00:23Z","timestamp":1770048023000},"page":"259","source":"Crossref","is-referenced-by-count":3,"title":["Serum Klotho Levels, Brain Structure, and Cognitive Performance"],"prefix":"10.1001","volume":"83","author":[{"given":"Alec M.","family":"Czaplicki","sequence":"first","affiliation":[{"name":"Wisconsin Alzheimer\u2019s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ira","family":"Frahmand Driscoll","sequence":"additional","affiliation":[{"name":"Wisconsin Alzheimer\u2019s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Ma","sequence":"additional","affiliation":[{"name":"Wisconsin Alzheimer\u2019s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Max","family":"Gait\u00e1n","sequence":"additional","affiliation":[{"name":"Wisconsin Alzheimer\u2019s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara B.","family":"Bendlin","sequence":"additional","affiliation":[{"name":"Wisconsin Alzheimer\u2019s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison"},{"name":"Wisconsin Alzheimer\u2019s Institute, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison"},{"name":"Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sterling C.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Wisconsin Alzheimer\u2019s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison"},{"name":"Wisconsin Alzheimer\u2019s Institute, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Asthana","sequence":"additional","affiliation":[{"name":"Wisconsin Alzheimer\u2019s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison"},{"name":"Wisconsin Alzheimer\u2019s Institute, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison"},{"name":"Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dena B.","family":"Dubal","sequence":"additional","affiliation":[{"name":"Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco"},{"name":"Associate Editor, JAMA Neurology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozioma C.","family":"Okonkwo","sequence":"additional","affiliation":[{"name":"Wisconsin Alzheimer\u2019s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison"},{"name":"Wisconsin Alzheimer\u2019s Institute, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, 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