About

Alexa S. Beiser, PhD, is a Professor of Biostatistics at Boston University School of Public Health. She has been on the faculty since 1985, engaging in teaching and collaborative public health research. Dr. Beiser co-developed the doctoral program in biostatistics, co-directed the biostatistics program from 2000 to 2004, and served as Associate Chair for Education from 2015 to 2018. She formerly taught and coordinated sections of Introduction to Statistical Computing. Her research primarily focuses on neurological outcomes and brain aging, with over twenty-five years of experience serving as the lead biostatistician for the Framingham Heart Study neurology group. Her work involves examining risk factors and prevalence of clinical and subclinical neurological conditions, including dementia, Alzheimer’s disease, stroke, Parkinson’s disease, and epilepsy, often utilizing MRI and PET measures of brain structure. Dr. Beiser leads the FHS neurology group data management team, overseeing surveillance, participant recruitment, and data analysis. Her research has explored various risk factors such as vascular health, plasma biomarkers, environmental exposures like air pollution, and genetic influences, relating them to measures of brain aging and neurological disease. She plays a key role in project conceptualization, supervision of data management, analysis, interpretation, and manuscript preparation.

Research topics

• Biology
• Medicine
• Genetics
• Internal medicine
• Bioinformatics
• Immunology
• Evolutionary biology
• Cancer research
• Neuroscience
• Demography
• Cell biology
• Pathology
• Radiology
• Cardiology

Selected publications

• Association Between Nerve Growth Factor and Clinical Stroke and Covert Brain Infarcts: The FHS

  Journal of the American Heart Association · 2026-04-20

  articleOpen access

  Background Nerve growth factor (NGF) is associated with neuroprotection and neural repair. However, whether NGF is associated with future stroke in humans is unknown. We determined the association between late midlife serum NGF and subsequent risk of clinical stroke, covert brain infarcts, and white matter hyperintensity volume on magnetic resonance imaging. Methods A total of 1709 stroke‐free participants from the FHS (Framingham Heart Study) Offspring and Omni 1 cohorts who attended Offspring examination 7/Omni 1 examination 2, respectively (1998–2001), with baseline serum NGF were included. The primary outcomes were incident all‐cause and ischemic stroke. Secondary outcomes included covert brain infarct and white matter hyperintensity volume on magnetic resonance imaging. Serum NGF was analyzed continuously and by tertiles, adjusting for age, sex, and vascular risk factors. Cox proportional hazards regression models were used to assess the association between serum NGF and all‐cause and ischemic stroke risk. Linear and logistic regression models were used to evaluate the association between serum NGF levels and white matter hyperintensity volume and covert brain infarct. Results Mean age was 60.6±9.6 years, and 47.6% were men. The median follow‐up for incident stroke was 19.2 (interquartile range, 14.7–21.3) years. The highest tertile (tertile 3) of NGF, compared with the bottom tertile (tertile 1), was associated with a reduced risk of incident all‐cause stroke (hazard ratio [HR], 0.59 [95% CI, 0.37–0.94]; P =0.03) and ischemic stroke (HR, 0.50 [95% CI, 0.27–0.77]; P =0.003). Tertile 3 versus tertile 1 of NGF was also associated with a reduced risk of covert brain infarct (odds ratio, 0.57 [95% CI, 0.34–0.97]; P =0.04). Conclusions Higher serum NGF in late midlife demonstrates a protective association with future risk of silent and clinically overt stroke.

  PublisherDOI

• Associations of Left Atrial Dimension and Ventricular Mass With Long-Term Health Outcomes

  JACC Advances · 2026-03-11

  articleOpen access

  BACKGROUND: Higher left atrial end-systolic dimension (LASD) and left ventricular mass (LVM) are associated with higher risk of cardiovascular disease (CVD) over short-term follow-up (<10 years). However, data on long-term associations are limited. OBJECTIVES: The objective of the study was to evaluate associations of echocardiography-derived LASD and LVM with risk of mortality, CVD, dementia, hypertension, diabetes, and chronic kidney disease over long-term follow-up among Framingham participants. METHODS: Clinical covariates and up to 3 serial echocardiographic observations were collected from 1991 to 2008 (median follow-up 17 years; range: 0-29 years). Analyses of incident outcomes excluded those with prevalent disease or missing outcomes. RESULTS: Among 8,192 participants (mean age 48 ± 13 years, 54.3% women), we observed 1,245 deaths, 946 CVD, 290 dementia, 1,565 hypertension, 463 diabetes, and 583 chronic kidney disease events. Higher LASD and LVM were associated with higher risk of all outcomes (modeled separately; all P < 0.05), except for coronary heart disease. Participants with higher LASD and LVM (modeled jointly) had higher death and CVD risk, including hard and atherosclerotic CVD (HR per-SD ranged from 1.18-1.28; all P < 0.001). Higher LASD (HR: 1.39; 95% CI: 1.06-1.84) and LVM (HR: 1.37, 95% CI: 1.08-1.74) were associated with higher risk of HF with preserved ejection fraction, whereas higher LVM was associated with higher risk of HF with reduced ejection fraction (HR: 2.13; 95% CI: 1.63-2.78), per-SD increase. CONCLUSIONS: In our large community-based sample, we observed associations of LASD and LVM with risk of multiple health outcomes over long-term follow-up. These findings underscore the importance of maintaining optimal LASD and LVM values over the life course.

  PublisherDOI

• Sex-specific trends in incident stroke: The Framingham Heart Study

  medRxiv · 2026-04-24

  articleOpen access

  Sex specific differences in stroke are recognized. Whether differences in incident stroke risk persists in recent periods needs further elucidation to aid public health preventive efforts. Aim: To determine long-term sex specific trends in stroke and stroke risk factors at different epochs among Framingham Heart Study participants. Methods: We examined age-adjusted 10-year stroke incidence using Cox regression in women and men in five epochs: 1962-1969 (epoch 1, reference), 1971-1976 (epoch 2), 1987-1991 (epoch 3), 1998-2005 (epoch 4), 2015-2021 (epoch 5). We compared stroke incidence by sex across epochs, estimated decade-wise linear trends overall and by sex. We compared risk factors in successive epochs to the first, and estimated sex-specific trends in risk factors. Interactions between baseline risk factors with epoch and trends were assessed by sex. Secondary analyses were repeated in participants <60 years old. Results: Incident stroke occurred in 4.5% (178/3996) in epoch 1, 3.9% (227/5786) in epoch 2, 3.9% (199/5137) in epoch 3, 2.7% (207/7642) in epoch 4, 2.2% (119/5534) in epoch 5. Men had higher risk of incident stroke in each epoch with significant difference in epochs 2 (HR 1.41, 95% CI [1.08, 1.84]) and 4 (HR 1.46, 95% CI [1.11, 1.91]) overall, and in epoch 4 (HR 2.13, 95% CI [1.17, 3.87]) among those <60 years. Stroke incidence declined by 16% per decade in men (HR 0.84, 95% CI [0.79, 0.89]) and 19% per decade in women (HR 0.81, 95% CI [0.76, 0.86]). Among those <60 years, stroke incidence declined by 22% per decade in women (HR 0.78, 95% CI [0.67, 0.95]). Hypertension declined by 8% per decade in women only ([OR] 0.92, 95% CI [0.90, 0.94]), while Atrial fibrillation and diabetes increased in both. Conclusion: Stroke incidence continues to decline in recent periods for women and men. Among participants <60 years, decline was observed only in women, possibly related to decline in hypertension in women.

  PublisherOA PDFDOI

• Self-Reported Hearing Aid Use and Risk of Incident Dementia

  JAMA Neurology · 2025-08-18 · 5 citations

  articleOpen accessSenior author

  This cohort study compares the risk of incident all-cause dementia among people with hearing loss who use vs do not use hearing aids.

  PublisherOA PDFDOI

• Association of MRI-Visible Perivascular Spaces and Incident Depression in the Framingham Heart Study

  Neurology Open Access · 2025-06-26 · 1 citations

  articleOpen access

  Enlarged perivascular spaces (EPVSs), a MRI marker of cerebral small vessel disease, have rarely been investigated in depression. The aim of this study was to determine the association of EPVS with incident depression in community dwelling individuals.

  PublisherOA PDFDOI

• Selected social and lifestyle correlates of brain health markers: the Cross‐Cohort Collaboration Consortium

  Alzheimer s & Dementia · 2025-04-01 · 7 citations

  reviewOpen access

  INTRODUCTION: To investigate the associations of education level, marital status, and physical activity with dementia risk and brain MRI markers. METHODS: Data from six community-based samples from the Cross-Cohort Collaboration Consortium were analyzed. Self-reported education level, marital status, and physical activity at age 60 to 75 years were harmonized. Subsamples of participants with brain MRI markers at time of exposure were selected. Associations with dementia risk and cross-sectional MRI markers were meta-analyzed. RESULTS: Higher education level was associated with lower dementia risk (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.59; 0.72 vs low level) but not significantly with brain MRI markers. Compared with being unmarried, being married was only associated with higher total brain and hippocampal volumes. Being physically active was associated with lower dementia risk (HR = 0.73, 95% CI = 0.52; 1.04), as well as larger total brain volume and smaller white matter hyperintensity volume. DISCUSSION: This study provides further evidence regarding the contribution of education level and physical activity to dementia resilience. HIGHLIGHTS: Education level, marital status, and physical activity are thought to contribute to resilience against ADRD. We used random-effects meta-analysis to summarize results from six community-based samples from the CCC. In this cross-cohort meta-analysis, higher education level and being physically active were associated with lower risk of dementia. In cross-sectional analyses, being married was associated with larger TBV and HV, while being physically active was associated with larger TBV and lower WMHV.

  PublisherOA PDFDOI

• Association of Platelet Aggregation With Markers of Alzheimer Disease Pathology in Middle-Aged Participants of the Framingham Heart Study

  Neurology · 2025-11-04 · 1 citations

  articleOpen access

  BACKGROUND AND OBJECTIVES: Vascular dysfunction contributes to Alzheimer disease (AD) and related dementias (ADRDs), but the underlying mechanisms remain unclear. Previous studies link midlife hemostasis and platelet aggregation measures to late-life dementia risk. We aimed to determine whether platelet aggregation in midlife is associated with imaging markers of AD pathology. METHODS: F-flortaucipir) PET uptake in dementia-free, middle-aged adults from the Framingham Heart Study. Co-primary outcomes included amyloid and tau uptake in AD-vulnerable regions. We also examined an MRI-based cortical thickness signature of AD risk as a secondary outcome. We used multivariable regression models adjusted for demographic and clinical factors, considering potential nonlinear associations. RESULTS: < 0.035), consistent with a neurodegenerative pattern. DISCUSSION: Our findings indicate that platelet aggregation is linked to PET and MRI markers of AD pathology as early as midlife. These findings support further investigation of platelet-mediated mechanisms in AD pathogenesis.

  PublisherOA PDFDOI

• Multimarker Cerebral Small Vessel Disease Score and Risk of Incident Dementia in the Framingham Heart Study

  Neurology · 2025-09-15 · 5 citations

  articleOpen access

  BACKGROUND AND OBJECTIVES: Individual MRI markers of cerebral small vessel disease (CSVD) are associated with impaired cognition and dementia but may not reflect the overall burden of CSVD. In addition, it is unclear whether these markers provide additional value in dementia risk assessment beyond vascular risk factors alone. Thus, we studied the association between the additive burden of multiple CSVD markers and incident dementia and determined whether this relationship remains independent of the Framingham Stroke Risk Profile (FSRP), a tool used commonly used for stroke risk prediction. METHODS: A total of 1,152 MRI scans from participants in the Original and Offspring cohorts of the Framingham Heart Study, a large observational cohort study, were included. Participants were older than 55 years and free of prevalent dementia, stroke, or other neurologic conditions at the time of MRI. A multimarker score capturing CSVD burden was defined as the sum of CSVD features detected in the MRI: cerebral microbleeds, covert brain infarcts, extensive white matter hyperintensities, high-burden perivascular spaces, and cortical superficial siderosis. Multivariate Cox regression models examined the association between the multimarker CSVD score and incident all-cause dementia, Alzheimer dementia (AD), and vascular dementia. RESULTS: -statistics 0.82-0.83). DISCUSSION: We found a significant association between all-cause dementia and multimarker CSVD scores, which was independent of the FSRP as well as its individual components. Our results support the use of a multimarker CSVD score as an indicator for incident all-cause dementia risk and suggest that it may be as robust as the FSRP. Further studies are necessary to validate the use of a multimarker CSVD score in dementia risk prediction.

  PublisherOA PDFDOI

• Genetic Variation of Aquaporin‐4 Associates with Cognition, Brain Volume, and Dementia Risk in a Large Community Cohort

  Alzheimer s & Dementia · 2025-12-01

  articleOpen access

  BACKGROUND: The aquaporin-4 (AQP4) water channel plays an integral role in removing waste from the brain, including β-amyloid and tau proteins. Currently, little is known about whether genetic differences in the AQP4 gene are involved in the development of dementia. We aimed to study the association between genetic variation at an AQP4 haplotype with cognition, brain volumes, and incident dementia. METHOD: Participants were from the community-based Framingham Heart Study (FHS) first, second, and third-generation cohorts. All participants were dementia-free at the time of cognitive assessment, brain MRI, and the commencement of dementia follow-up. Linear regression models were conducted to examine the relationship between genetic variation of AQP4 with cognition and brain volumes for participants aged 45 years and older. Cox proportional hazards regression models were conducted to examine the association between genetic variation of AQP4 with incident dementia beginning from age 65 ± 2.5, 70 ± 2.5, and 75 ± 2.5 years at baseline, with a maximum of a 20-year follow-up. Analyses were adjusted for age, sex, cohort, APOE (ε4 carrier), age squared (for cognitive and MRI outcomes), and education (for cognitive outcomes). RESULTS: 3847 participants had a cognitive assessment; 3332 had MRI. Carriage of the minor allele at the AQP4 haplotype was associated with better verbal episodic memory (β[95% CI], 0.325 [0.10, 0.55], p = 0.004) and larger hippocampal volumes (β[95% CI], 0.004 [0.001, 0.007], p = 0.009) compared to homozygotes for the major allele. Carrying at least one copy of the minor allele was associated with lower incident dementia risk across each age band. This reached borderline significance from age 75 onwards, with heterozygotes displaying a 32% lower risk of incident AD dementia compared to homozygotes for the major allele (HR = 0.68, 95% CI [0.47, 1.00], p = 0.049, n = 551, incident cases = 35). CONCLUSION: Carrying the minor allele at the AQP4 haplotype was associated with better episodic memory, larger hippocampal volumes, and trends for lower dementia risk. Further research exploring the role of AQP4 may identify additional mechanism contributing to dementia onset and progression.

  PublisherOA PDFDOI

• Signature White Matter Hyperintensity Locations Associated With Vascular Risk Factors Derived From 15 653 Individuals

  Stroke · 2025-08-20 · 4 citations

  articleOpen access

  BACKGROUND: White matter hyperintensities (WMHs) of presumed vascular origin are common in the elderly and are associated with vascular risk factors. There is evidence that vascular risk factors, in particular hypertension, are associated with WMH in particular locations of the white matter. However, it remains unclear whether this is true for all risk factors and whether signature WMH locations differ between risk factors. We aimed to identify WMH locations associated with vascular risk factors in community-dwelling individuals. METHODS: We pooled cross-sectional data from 16 population-based cohorts (15 653 individuals; mean age, 64.2±11.8 years; 52.2% female) through the Meta VCI Map Consortium. We quantified associations between WMH volumes in 50 white matter regions and 6 vascular risk factors using linear mixed models. Analyses were corrected for age, sex, study site, and total WMH volume. RESULTS: =0.531) were not. After correcting for total WMH volume, hypertension was associated with WMH volume in 10 regions (ie, bilateral external capsule, superior longitudinal fasciculus, superior corona radiata, anterior limb of the internal capsule, left anterior corona radiata, and left superior fronto-occipital fasciculus), smoking (body corpus callosum), diabetes (genu corpus callosum), and obesity (left inferior fronto-occipital fasciculus), each with one region. CONCLUSIONS: Hypertension has a signature WMH pattern, whereas associations between other vascular risk factors and regional WMH volumes seem to be mainly explained by a global increase in WMH rather than region-specific effects.

  PublisherOA PDFDOI

Frequent coauthors

• Sudha Seshadri

  Framingham Heart Study

  3237 shared

• Jayandra J. Himali

  The University of Texas Health Science Center at San Antonio

  1604 shared

• Ramachandran S. Vasan

  National Heart Lung and Blood Institute

  1527 shared

• Charles DeCarli

  University of California, San Diego

  1258 shared

• Philip A. Wolf

  1189 shared

• Claudia L. Satizábal

  Institute for Neurodegenerative Disorders

  1030 shared

• Rhoda Au

  Boston University

  804 shared

• Matthew P. Pase

  Monash University

  714 shared

Labs

• Admissions TeamPI