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Kang S, Kim SW, Seong JK. Disentangling brain atrophy heterogeneity in Alzheimer's disease: A deep self-supervised approach with interpretable latent space. Neuroimage 2024; 297:120737. [PMID: 39004409 DOI: 10.1016/j.neuroimage.2024.120737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/03/2024] [Accepted: 07/11/2024] [Indexed: 07/16/2024] Open
Abstract
Alzheimer's disease (AD) is heterogeneous, but existing methods for capturing this heterogeneity through dimensionality reduction and unsupervised clustering have limitations when it comes to extracting intricate atrophy patterns. In this study, we propose a deep learning based self-supervised framework that characterizes complex atrophy features using latent space representation. It integrates feature engineering, classification, and clustering to synergistically disentangle heterogeneity in Alzheimer's disease. Through this representation learning, we trained a clustered latent space with distinct atrophy patterns and clinical characteristics in AD, and replicated the findings in prodromal Alzheimer's disease. Moreover, we discovered that these clusters are not solely attributed to subtypes but also reflect disease progression in the latent space, representing the core dimensions of heterogeneity, namely progression and subtypes. Furthermore, longitudinal latent space analysis revealed two distinct disease progression pathways: medial temporal and parietotemporal pathways. The proposed approach enables effective latent representations that can be integrated with individual-level cognitive profiles, thereby facilitating a comprehensive understanding of AD heterogeneity.
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Affiliation(s)
- Sohyun Kang
- Department of Artificial Intelligence, College of Informatics, Korea University, Seoul, 02841, South Korea
| | - Sung-Woo Kim
- School of Biomedical Engineering, College of Health Science, Korea University, Seoul, 02841, South Korea; Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, 26426, South Korea; Research Institute of Metabolism and Inflammation, Yonsei University Wonju College of Medicine, Wonju, 26426, South Korea
| | - Joon-Kyung Seong
- Department of Artificial Intelligence, College of Informatics, Korea University, Seoul, 02841, South Korea; School of Biomedical Engineering, College of Health Science, Korea University, Seoul, 02841, South Korea; Interdisciplinary Program in Precision Public Health, College of Health Science, Korea University, Seoul, 02841, South Korea.
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Na HK, Shin JH, Kim SW, Seo S, Kim WR, Kang JM, Lee SY, Cho J, Byun J, Okamura N, Seong JK, Noh Y. Diverging Relationships among Amyloid, Tau, and Brain Atrophy in Early-Onset and Late-Onset Alzheimer's Disease. Yonsei Med J 2024; 65:434-447. [PMID: 39048319 PMCID: PMC11284308 DOI: 10.3349/ymj.2023.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE Alzheimer's disease (AD) dementia may not be a single disease entity. Early-onset AD (EOAD) and late-onset AD (LOAD) have been united under the same eponym of AD until now, but disentangling the heterogeneity according to the age of sonset has been a major tenet in the field of AD research. MATERIALS AND METHODS Ninety-nine patients with AD (EOAD, n=54; LOAD, n=45) and 66 cognitively normal controls completed both [18F]THK5351 and [18F]flutemetamol (FLUTE) positron emission tomography scans along with structural magnetic resonance imaging and detailed neuropsychological tests. RESULTS EOAD patients had higher THK retention in the precuneus, parietal, and frontal lobe, while LOAD patients had higher THK retention in the medial temporal lobe. Intravoxel correlation analyses revealed that EOAD presented narrower territory of local FLUTE-THK correlation, while LOAD presented broader territory of correlation extending to overall parieto-occipito-temporal regions. EOAD patients had broader brain areas which showed significant negative correlations between cortical thickness and THK retention, whereas in LOAD, only limited brain areas showed significant correlation with THK retention. In EOAD, most of the cognitive test results were correlated with THK retention. However, a few cognitive test results were correlated with THK retention in LOAD. CONCLUSION LOAD seemed to show gradual increase in tau and amyloid, and those two pathologies have association to each other. On the other hand, in EOAD, tau and amyloid may develop more abruptly and independently. These findings suggest LOAD and EOAD may have different courses of pathomechanism.
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Affiliation(s)
- Han Kyu Na
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Hyeon Shin
- Bio Medical Research Center, Bio Medical & Health Division, Korea Testing Laboratory, Daegu, Korea
| | - Sung-Woo Kim
- School of Biomedical Engineering, Korea University, Seoul, Korea
| | - Seongho Seo
- Neuroscience Research Institute, Gachon University, Incheon, Korea
- Department of Electronic Engineering, Pai Chai University, Daejeon, Korea
| | - Woo-Ram Kim
- Neuroscience Research Institute, Gachon University, Incheon, Korea
| | - Jae Myeong Kang
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Korea
| | - Sang-Yoon Lee
- Department of Neuroscience, College of Medicine, Gachon University, Incheon, Korea
| | - Jaelim Cho
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Justin Byun
- Department of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nobuyuki Okamura
- Division of Pharmacology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, Seoul, Korea
- Department of Artificial Intelligence, Korea University, Seoul, Korea.
| | - Young Noh
- Neuroscience Research Institute, Gachon University, Incheon, Korea
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
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3
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Baumeister H, Vogel JW, Insel PS, Kleineidam L, Wolfsgruber S, Stark M, Gellersen HM, Yakupov R, Schmid MC, Lüsebrink F, Brosseron F, Ziegler G, Freiesleben SD, Preis L, Schneider LS, Spruth EJ, Altenstein S, Lohse A, Fliessbach K, Vogt IR, Bartels C, Schott BH, Rostamzadeh A, Glanz W, Incesoy EI, Butryn M, Janowitz D, Rauchmann BS, Kilimann I, Goerss D, Munk MH, Hetzer S, Dechent P, Ewers M, Scheffler K, Wuestefeld A, Strandberg O, van Westen D, Mattsson-Carlgren N, Janelidze S, Stomrud E, Palmqvist S, Spottke A, Laske C, Teipel S, Perneczky R, Buerger K, Schneider A, Priller J, Peters O, Ramirez A, Wiltfang J, Heneka MT, Wagner M, Düzel E, Jessen F, Hansson O, Berron D. A generalizable data-driven model of atrophy heterogeneity and progression in memory clinic settings. Brain 2024; 147:2400-2413. [PMID: 38654513 PMCID: PMC11224599 DOI: 10.1093/brain/awae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/02/2024] [Accepted: 03/03/2024] [Indexed: 04/26/2024] Open
Abstract
Memory clinic patients are a heterogeneous population representing various aetiologies of pathological ageing. It is not known whether divergent spatiotemporal progression patterns of brain atrophy, as previously described in Alzheimer's disease patients, are prevalent and clinically meaningful in this group of older adults. To uncover distinct atrophy subtypes, we applied the Subtype and Stage Inference (SuStaIn) algorithm to baseline structural MRI data from 813 participants enrolled in the DELCODE cohort (mean ± standard deviation, age = 70.67 ± 6.07 years, 52% females). Participants were cognitively unimpaired (n = 285) or fulfilled diagnostic criteria for subjective cognitive decline (n = 342), mild cognitive impairment (n = 118) or dementia of the Alzheimer's type (n = 68). Atrophy subtypes were compared in baseline demographics, fluid Alzheimer's disease biomarker levels, the Preclinical Alzheimer Cognitive Composite (PACC-5) as well as episodic memory and executive functioning. PACC-5 trajectories over up to 240 weeks were examined. To test whether baseline atrophy subtype and stage predicted clinical trajectories before manifest cognitive impairment, we analysed PACC-5 trajectories and mild cognitive impairment conversion rates of cognitively unimpaired participants and those with subjective cognitive decline. Limbic-predominant and hippocampal-sparing atrophy subtypes were identified. Limbic-predominant atrophy initially affected the medial temporal lobes, followed by further temporal regions and, finally, the remaining cortical regions. At baseline, this subtype was related to older age, more pathological Alzheimer's disease biomarker levels, APOE ε4 carriership and an amnestic cognitive impairment. Hippocampal-sparing atrophy initially occurred outside the temporal lobe, with the medial temporal lobe spared up to advanced atrophy stages. This atrophy pattern also affected individuals with positive Alzheimer's disease biomarkers and was associated with more generalized cognitive impairment. Limbic-predominant atrophy, in all participants and in only unimpaired participants, was linked to more negative longitudinal PACC-5 slopes than observed in participants without or with hippocampal-sparing atrophy and increased the risk of mild cognitive impairment conversion. SuStaIn modelling was repeated in a sample from the Swedish BioFINDER-2 cohort. Highly similar atrophy progression patterns and associated cognitive profiles were identified. Cross-cohort model generalizability, at both the subject and the group level, was excellent, indicating reliable performance in previously unseen data. The proposed model is a promising tool for capturing heterogeneity among older adults at early at-risk states for Alzheimer's disease in applied settings. The implementation of atrophy subtype- and stage-specific end points might increase the statistical power of pharmacological trials targeting early Alzheimer's disease.
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Affiliation(s)
- Hannah Baumeister
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
| | - Jacob W Vogel
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, 222 42 Lund, Sweden
| | - Philip S Insel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Luca Kleineidam
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University of Bonn Medical Center, 53127 Bonn, Germany
| | - Steffen Wolfsgruber
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University of Bonn Medical Center, 53127 Bonn, Germany
| | - Melina Stark
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University of Bonn Medical Center, 53127 Bonn, Germany
| | - Helena M Gellersen
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
| | - Renat Yakupov
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Matthias C Schmid
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Institute for Medical Biometry, University Hospital Bonn, 53127 Bonn, Germany
| | - Falk Lüsebrink
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
| | - Frederic Brosseron
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Gabriel Ziegler
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Silka D Freiesleben
- German Center for Neurodegenerative Diseases (DZNE), 10117 Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Lukas Preis
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Luisa-Sophie Schneider
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Eike J Spruth
- German Center for Neurodegenerative Diseases (DZNE), 10117 Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Slawek Altenstein
- German Center for Neurodegenerative Diseases (DZNE), 10117 Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Andrea Lohse
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Klaus Fliessbach
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University of Bonn Medical Center, 53127 Bonn, Germany
| | - Ina R Vogt
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Björn H Schott
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), 37075 Göttingen, Germany
- Leibniz Institute for Neurobiology, 39118 Magdeburg, Germany
| | - Ayda Rostamzadeh
- Department of Psychiatry, Medical Faculty, University of Cologne, 50937 Cologne, Germany
| | - Wenzel Glanz
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
| | - Enise I Incesoy
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, 39120 Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Michaela Butryn
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research (ISD), Ludwig-Maximilians-Universität, 81377 Munich, Germany
| | - Boris-Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, 80336 Munich, Germany
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield S10 2HQ, UK
- Department of Neuroradiology, Ludwig-Maximilians-Universität, 81377 Munich, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), 18147 Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, 18147 Rostock, Germany
| | - Doreen Goerss
- German Center for Neurodegenerative Diseases (DZNE), 18147 Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, 18147 Rostock, Germany
| | - Matthias H Munk
- German Center for Neurodegenerative Diseases (DZNE), 72076 Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany
| | - Stefan Hetzer
- Berlin Center for Advanced Neuroimaging, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Peter Dechent
- MR-Research in Neurosciences, Department of Cognitive Neurology, Georg-August-University Göttingen, 37075 Göttingen, Germany
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), Ludwig-Maximilians-Universität, 81377 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany
| | - Klaus Scheffler
- Department for Biomedical Magnetic Resonance, University of Tübingen, 72076 Tübingen, Germany
| | - Anika Wuestefeld
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, 222 42 Lund, Sweden
| | - Olof Strandberg
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, 222 42 Lund, Sweden
| | - Danielle van Westen
- Diagnostic Radiology, Institution of Clinical Sciences Lund, Lund University, 211 84 Lund, Sweden
- Image and Function, Skåne University Hospital, 211 84 Lund, Sweden
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, 222 42 Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund University, 211 84 Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, 22184 Lund, Sweden
| | - Shorena Janelidze
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, 222 42 Lund, Sweden
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, 222 42 Lund, Sweden
- Memory Clinic, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, 222 42 Lund, Sweden
- Memory Clinic, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Annika Spottke
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Neurology, University of Bonn, 53127 Bonn, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE), 72076 Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany
- Section for Dementia Research, Hertie Institute for Clinical Brain Research, 72076 Tübingen, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), 18147 Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, 18147 Rostock, Germany
| | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, 80336 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - Katharina Buerger
- Institute for Stroke and Dementia Research (ISD), Ludwig-Maximilians-Universität, 81377 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University of Bonn Medical Center, 53127 Bonn, Germany
| | - Josef Priller
- German Center for Neurodegenerative Diseases (DZNE), 10117 Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Psychiatry and Psychotherapy, Technical University of Munich, 81675 Munich, Germany
- Centre for Clinical Brain Sciences, University of Edinburgh and UK DRI, Edinburgh EH16 4SB, UK
| | - Oliver Peters
- German Center for Neurodegenerative Diseases (DZNE), 10117 Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Alfredo Ramirez
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University of Bonn Medical Center, 53127 Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, University of Cologne, 50931 Cologne, Germany
- Department of Psychiatry & Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, The University of Texas at San Antonio, San Antonio, TX 78229, USA
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), 37075 Göttingen, Germany
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Michael T Heneka
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 4362, Belvaux, Luxembourg
| | - Michael Wagner
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University of Bonn Medical Center, 53127 Bonn, Germany
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany
| | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Psychiatry, Medical Faculty, University of Cologne, 50937 Cologne, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, 222 42 Lund, Sweden
- Memory Clinic, Skåne University Hospital, 205 02 Malmö, Sweden
| | - David Berron
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, 222 42 Lund, Sweden
- Center for Behavioral Brain Sciences (CBBS), Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany
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Mohanty R, Ferreira D, Westman E. Multi-pathological contributions toward atrophy patterns in the Alzheimer's disease continuum. Front Neurosci 2024; 18:1355695. [PMID: 38655107 PMCID: PMC11036869 DOI: 10.3389/fnins.2024.1355695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Heterogeneity in downstream atrophy in Alzheimer's disease (AD) is predominantly investigated in relation to pathological hallmarks (Aβ, tau) and co-pathologies (cerebrovascular burden) independently. However, the proportional contribution of each pathology in determining atrophy pattern remains unclear. We assessed heterogeneity in atrophy using two recently conceptualized dimensions: typicality (typical AD atrophy at the center and deviant atypical atrophy on either extreme including limbic predominant to hippocampal sparing patterns) and severity (overall neurodegeneration spanning minimal atrophy to diffuse typical AD atrophy) in relation to Aβ, tau, and cerebrovascular burden. Methods We included 149 Aβ + individuals on the AD continuum (cognitively normal, prodromal AD, AD dementia) and 163 Aβ- cognitively normal individuals from the ADNI. We modeled heterogeneity in MRI-based atrophy with continuous-scales of typicality (ratio of hippocampus to cortical volume) and severity (total gray matter volume). Partial correlation models investigated the association of typicality/severity with (a) Aβ (global Aβ PET centiloid), tau (global tau PET SUVR), cerebrovascular (total white matter hypointensity volume) burden (b) four cognitive domains (memory, executive function, language, visuospatial composites). Using multiple regression, we assessed the association of each pathological burden and typicality/severity with cognition. Results (a) In the AD continuum, typicality (r = -0.31, p < 0.001) and severity (r = -0.37, p < 0.001) were associated with tau burden after controlling for Aβ, cerebrovascular burden and age. Findings imply greater tau pathology in limbic predominant atrophy and diffuse atrophy. (b) Typicality was associated with memory (r = 0.49, p < 0.001) and language scores (r = 0.19, p = 0.02). Severity was associated with memory (r = 0.26, p < 0.001), executive function (r = 0.24, p = 0.003) and language scores (r = 0.29, p < 0.001). Findings imply better cognitive performance in hippocampal sparing and minimal atrophy patterns. Beyond typicality/severity, tau burden but not Aβ and cerebrovascular burden explained cognition. Conclusion In the AD continuum, atrophy-based severity was more strongly associated with tau burden than typicality after accounting for Aβ and cerebrovascular burden. Cognitive performance in memory, executive function and language domains was explained by typicality and/or severity and additionally tau pathology. Typicality and severity may differentially reflect burden arising from tau pathology but not Aβ or cerebrovascular pathologies which need to be accounted for when investigating AD heterogeneity.
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Affiliation(s)
- Rosaleena Mohanty
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Karolinska Institutet, Huddinge, Sweden
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Karolinska Institutet, Huddinge, Sweden
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Las Palmas, Spain
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Karolinska Institutet, Huddinge, Sweden
- Department of Neuroimaging, Center for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
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Liu L, Sun S, Kang W, Wu S, Lin L. A review of neuroimaging-based data-driven approach for Alzheimer's disease heterogeneity analysis. Rev Neurosci 2024; 35:121-139. [PMID: 37419866 DOI: 10.1515/revneuro-2023-0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/18/2023] [Indexed: 07/09/2023]
Abstract
Alzheimer's disease (AD) is a complex form of dementia and due to its high phenotypic variability, its diagnosis and monitoring can be quite challenging. Biomarkers play a crucial role in AD diagnosis and monitoring, but interpreting these biomarkers can be problematic due to their spatial and temporal heterogeneity. Therefore, researchers are increasingly turning to imaging-based biomarkers that employ data-driven computational approaches to examine the heterogeneity of AD. In this comprehensive review article, we aim to provide health professionals with a comprehensive view of past applications of data-driven computational approaches in studying AD heterogeneity and planning future research directions. We first define and offer basic insights into different categories of heterogeneity analysis, including spatial heterogeneity, temporal heterogeneity, and spatial-temporal heterogeneity. Then, we scrutinize 22 articles relating to spatial heterogeneity, 14 articles relating to temporal heterogeneity, and five articles relating to spatial-temporal heterogeneity, highlighting the strengths and limitations of these strategies. Furthermore, we discuss the importance of understanding spatial heterogeneity in AD subtypes and their clinical manifestations, biomarkers for abnormal orderings and AD stages, the recent advancements in spatial-temporal heterogeneity analysis for AD, and the emerging role of omics data integration in advancing personalized diagnosis and treatment for AD patients. By emphasizing the significance of understanding AD heterogeneity, we hope to stimulate further research in this field to facilitate the development of personalized interventions for AD patients.
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Affiliation(s)
- Lingyu Liu
- Intelligent Physiological Measurement and Clinical Translation, Beijing International Platform for Scientific and Technological Cooperation, Department of Biomedical Engineering, Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing, 100124, China
| | - Shen Sun
- Intelligent Physiological Measurement and Clinical Translation, Beijing International Platform for Scientific and Technological Cooperation, Department of Biomedical Engineering, Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing, 100124, China
| | - Wenjie Kang
- Intelligent Physiological Measurement and Clinical Translation, Beijing International Platform for Scientific and Technological Cooperation, Department of Biomedical Engineering, Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing, 100124, China
| | - Shuicai Wu
- Intelligent Physiological Measurement and Clinical Translation, Beijing International Platform for Scientific and Technological Cooperation, Department of Biomedical Engineering, Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing, 100124, China
| | - Lan Lin
- Intelligent Physiological Measurement and Clinical Translation, Beijing International Platform for Scientific and Technological Cooperation, Department of Biomedical Engineering, Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing, 100124, China
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Chen P, Zhang S, Zhao K, Kang X, Rittman T, Liu Y. Robustly uncovering the heterogeneity of neurodegenerative disease by using data-driven subtyping in neuroimaging: A review. Brain Res 2024; 1823:148675. [PMID: 37979603 DOI: 10.1016/j.brainres.2023.148675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023]
Abstract
Neurodegenerative diseases are associated with heterogeneity in genetics, pathology, and clinical manifestation. Understanding this heterogeneity is particularly relevant for clinical prognosis and stratifying patients for disease modifying treatments. Recently, data-driven methods based on neuroimaging have been applied to investigate the subtyping of neurodegenerative disease, helping to disentangle this heterogeneity. We reviewed brain-based subtyping studies in aging and representative neurodegenerative diseases, including Alzheimer's disease, mild cognitive impairment, frontotemporal dementia, and Lewy body dementia, from January 2000 to November 2022. We summarized clustering methods, validation, robustness, reproducibility, and clinical relevance of 71 eligible studies in the present study. We found vast variations in approaches between studies, including ten neuroimaging modalities, 24 cluster algorithms, and 41 methods of cluster number determination. The clinical relevance of subtyping studies was evaluated by summarizing the analysis method of clinical measurements, showing a relatively low clinical utility in the current studies. Finally, we conclude that future studies of heterogeneity in neurodegenerative disease should focus on validation, comparison between subtyping approaches, and prioritise clinical utility.
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Affiliation(s)
- Pindong Chen
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China; Department of Clinical Neurosciences, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Shirui Zhang
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Kun Zhao
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Xiaopeng Kang
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Yong Liu
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China.
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7
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Poulakis K, Westman E. Clustering and disease subtyping in Neuroscience, toward better methodological adaptations. Front Comput Neurosci 2023; 17:1243092. [PMID: 37927546 PMCID: PMC10620518 DOI: 10.3389/fncom.2023.1243092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Konstantinos Poulakis
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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8
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Song L, Huang CR, Pan SZ, Zhu JG, Cheng ZQ, Yu X, Xue L, Xia F, Zhang JY, Wu DP, Miao LY. A model based on machine learning for the prediction of cyclosporin A trough concentration in Chinese allo-HSCT patients. Expert Rev Clin Pharmacol 2023; 16:83-91. [PMID: 36373407 DOI: 10.1080/17512433.2023.2142561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cyclosporin A is a calcineurin inhibitor which has a narrow therapeutic window and high interindividual variability. Various population pharmacokinetic models have been reported; however, professional software and technical personnel were needed and the variables of the models were limited. Therefore, the aim of this study was to establish a model based on machine learning to predict CsA trough concentrations in Chinese allo-HSCT patients. METHODS A total of 7874 cases of CsA therapeutic drug monitoring data from 2069 allo-HSCT patients were retrospectively included. Sequential forward selection was used to select variable subsets, and eight different algorithms were applied to establish the prediction model. RESULTS XGBoost exhibited the highest prediction ability. Except for the variables that were identified by previous studies, some rarely reported variables were found, such as norethindrone, WBC, PAB, and hCRP. The prediction accuracy within ±30% of the actual trough concentration was above 0.80, and the predictive ability of the models was demonstrated to be effective in external validation. CONCLUSION In this study, models based on machine learning technology were established to predict CsA levels 3-4 days in advance during the early inpatient phase after HSCT. A new perspective for CsA clinical application is provided.
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Affiliation(s)
- Lin Song
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou, China.,College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | - Chen-Rong Huang
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shi-Zheng Pan
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou, China.,College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | - Jian-Guo Zhu
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zong-Qi Cheng
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xun Yu
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ling Xue
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fan Xia
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou, China
| | | | - De-Pei Wu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li-Yan Miao
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou, China.,College of Pharmaceutical Sciences, Soochow University, Suzhou, China.,National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
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9
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Giraldo DL, Smith RE, Struyfs H, Niemantsverdriet E, De Roeck E, Bjerke M, Engelborghs S, Romero E, Sijbers J, Jeurissen B. Investigating Tissue-Specific Abnormalities in Alzheimer's Disease with Multi-Shell Diffusion MRI. J Alzheimers Dis 2022; 90:1771-1791. [PMID: 36336929 PMCID: PMC9789487 DOI: 10.3233/jad-220551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Most studies using diffusion-weighted MRI (DW-MRI) in Alzheimer's disease (AD) have focused their analyses on white matter (WM) microstructural changes using the diffusion (kurtosis) tensor model. Although recent works have addressed some limitations of the tensor model, such as the representation of crossing fibers and partial volume effects with cerebrospinal fluid (CSF), the focus remains in modeling and analyzing the WM. OBJECTIVE In this work, we present a brain analysis approach for DW-MRI that disentangles multiple tissue compartments as well as micro- and macroscopic effects to investigate differences between groups of subjects in the AD continuum and controls. METHODS By means of the multi-tissue constrained spherical deconvolution of multi-shell DW-MRI, underlying brain tissue is modeled with a WM fiber orientation distribution function along with the contributions of gray matter (GM) and CSF to the diffusion signal. From this multi-tissue model, a set of measures capturing tissue diffusivity properties and morphology are extracted. Group differences were interrogated following fixel-, voxel-, and tensor-based morphometry approaches while including strong FWE control across multiple comparisons. RESULTS Abnormalities related to AD stages were detected in WM tracts including the splenium, cingulum, longitudinal fasciculi, and corticospinal tract. Changes in tissue composition were identified, particularly in the medial temporal lobe and superior longitudinal fasciculus. CONCLUSION This analysis framework constitutes a comprehensive approach allowing simultaneous macro and microscopic assessment of WM, GM, and CSF, from a single DW-MRI dataset.
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Affiliation(s)
- Diana L. Giraldo
- Computer Imaging and Medical Applications Laboratory - Cim@Lab, Universidad Nacional de Colombia, Bogotá, Colombia,imec-Vision Lab, Department of Physics, University of Antwerp, Antwerp, Belgium,μNEURO Research Center of Excellence, University of Antwerp, Antwerp, Belgium
| | - Robert E. Smith
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia,The Florey Department of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Hanne Struyfs
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Ellis Niemantsverdriet
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Ellen De Roeck
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Maria Bjerke
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium,Laboratory of Neurochemistry, Department of Clinical Chemistry, and Center for Neurosciences (C4N), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium,Department of Neurology, and Center for Neurosciences (C4N), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Eduardo Romero
- Computer Imaging and Medical Applications Laboratory - Cim@Lab, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jan Sijbers
- imec-Vision Lab, Department of Physics, University of Antwerp, Antwerp, Belgium,μNEURO Research Center of Excellence, University of Antwerp, Antwerp, Belgium
| | - Ben Jeurissen
- imec-Vision Lab, Department of Physics, University of Antwerp, Antwerp, Belgium,μNEURO Research Center of Excellence, University of Antwerp, Antwerp, Belgium,Lab for Equilibrium Investigations and Aerospace, Department of Physics, University of Antwerp, Antwerp, Belgium,Correspondence to: Ben Jeurissen, PhD, imec - Vision Lab, Department of Physics, University of Antwerp (CDE), Universiteitsplein 1, Building N, 2610 Antwerp, Belgium. Tel.: +32 3 265 24 77; E-mail:
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10
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Hanyu H, Koyama Y, Horita H, Aoki T, Sato T, Takenoshita N, Kanetaka H, Shimizu S, Hirao K, Watanabe S. Characterization of Alzheimer’s Disease Subtypes Based on Magnetic Resonance Imaging and Perfusion Single-Photon Emission Computed Tomography. J Alzheimers Dis 2022; 87:781-789. [DOI: 10.3233/jad-215674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Alzheimer’s disease (AD) is a biologically heterogenous disease. Previous studies have reported the existence of various AD subtypes, and the various clinical features of the subtypes. However, inconsistent results have been obtained. Objective: To clarify the clinical characteristics of the various AD subtypes, by classifying probable AD into subtypes based on magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) findings. Methods: A total of 245 patients with probable AD were classified into the typical AD (TAD) subtype, limbic-predominant (LP) subtype, hippocampal-sparing (HS) subtype, and minimal-change (MC) subtype, based on the presence of medial temporal lobe atrophy on MRI and posterior cerebral hypoperfusion on SPECT. Demographics, including age, sex, body mass index, disease duration, education years, comorbidities, frailty, leisure activity, and neuropsychological findings were compared between the AD subtypes. Results: he frequency of TAD, LP, HS, and MC subtypes was 49%, 20%, 18%, and 13%, respectively. Patients with the LP subtype were older and characterized by fewer major comorbidities, higher frailty, and slower progression of disease. Patients with the HS subtype were younger and characterized by shorter disease duration, lower frailty, and preserved memory, but had prominent constructional dysfunction. Patients of the MC subtype were characterized by shorter disease duration, lower education level, less leisure activity, less impaired memory and orientation, and slower progression. Conclusion: Patients with different AD subtypes differed in their demographic and clinical features. The characterization of patients’ AD subtypes may provide effective support for the diagnosis, treatment, and care of AD patients.
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Affiliation(s)
- Haruo Hanyu
- Dementia Research Center, Tokyo General Hospital, Tokyo, Japan
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yumi Koyama
- Department of Rehabilitation, Tokyo General Hospital, Tokyo, Japan
| | - Haruka Horita
- Department of Rehabilitation, Tokyo General Hospital, Tokyo, Japan
| | - Toshinori Aoki
- Department of Radiology, Tokyo General Hospital, Tokyo, Japan
| | - Tomohiko Sato
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Naoto Takenoshita
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Kanetaka
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Soichiro Shimizu
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Kentaro Hirao
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
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11
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Sadiq MU, Kwak K, Dayan E. Model-based stratification of progression along the Alzheimer disease continuum highlights the centrality of biomarker synergies. Alzheimers Res Ther 2022; 14:16. [PMID: 35073974 PMCID: PMC8787915 DOI: 10.1186/s13195-021-00941-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/23/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The progression rates of Alzheimer's disease (AD) are variable and dynamic, yet the mechanisms that contribute to heterogeneity in progression rates remain ill-understood. Particularly, the role of synergies in pathological processes reflected by biomarkers for amyloid-beta ('A'), tau ('T'), and neurodegeneration ('N') in progression along the AD continuum is not fully understood. METHODS Here, we used a combination of model and data-driven approaches to address this question. Working with a large dataset (N = 321 across the training and testing cohorts), we first applied unsupervised clustering on longitudinal cognitive assessments to divide individuals on the AD continuum into those showing fast vs. moderate decline. Next, we developed a deep learning model that differentiated fast vs. moderate decline using baseline AT(N) biomarkers. RESULTS Training the model with AT(N) biomarker combination revealed more prognostic utility than any individual biomarkers alone. We additionally found little overlap between the model-driven progression phenotypes and established atrophy-based AD subtypes. Our model showed that the combination of all AT(N) biomarkers had the most prognostic utility in predicting progression along the AD continuum. A comprehensive AT(N) model showed better predictive performance than biomarker pairs (A(N) and T(N)) and individual biomarkers (A, T, or N). CONCLUSIONS This study combined data and model-driven methods to uncover the role of AT(N) biomarker synergies in the progression of cognitive decline along the AD continuum. The results suggest a synergistic relationship between AT(N) biomarkers in determining this progression, extending previous evidence of A-T synergistic mechanisms.
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Affiliation(s)
- Muhammad Usman Sadiq
- Biomedical Research Imaging Center (BRIC), UNC-Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kichang Kwak
- Biomedical Research Imaging Center (BRIC), UNC-Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Eran Dayan
- Biomedical Research Imaging Center (BRIC), UNC-Chapel Hill, Chapel Hill, NC, 27599, USA.
- Department of Radiology, UNC-Chapel Hill, Chapel Hill, NC, 27599, USA.
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12
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Imaging Clinical Subtypes and Associated Brain Networks in Alzheimer’s Disease. Brain Sci 2022; 12:brainsci12020146. [PMID: 35203910 PMCID: PMC8869882 DOI: 10.3390/brainsci12020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
Alzheimer’s disease (AD) does not present uniform symptoms or a uniform rate of progression in all cases. The classification of subtypes can be based on clinical symptoms or patterns of pathological brain alterations. Imaging techniques may allow for the identification of AD subtypes and their differentiation from other neurodegenerative diseases already at an early stage. In this review, the strengths and weaknesses of current clinical imaging methods are described. These include positron emission tomography (PET) to image cerebral glucose metabolism and pathological amyloid or tau deposits. Magnetic resonance imaging (MRI) is more widely available than PET. It provides information on structural or functional changes in brain networks and their relation to AD subtypes. Amyloid PET provides a very early marker of AD but does not distinguish between AD subtypes. Regional patterns of pathology related to AD subtypes are observed with tau and glucose PET, and eventually as atrophy patterns on MRI. Structural and functional network changes occur early in AD but have not yet provided diagnostic specificity.
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13
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Wen J, Varol E, Sotiras A, Yang Z, Chand GB, Erus G, Shou H, Abdulkadir A, Hwang G, Dwyer DB, Pigoni A, Dazzan P, Kahn RS, Schnack HG, Zanetti MV, Meisenzahl E, Busatto GF, Crespo-Facorro B, Rafael RG, Pantelis C, Wood SJ, Zhuo C, Shinohara RT, Fan Y, Gur RC, Gur RE, Satterthwaite TD, Koutsouleris N, Wolf DH, Davatzikos C. Multi-scale semi-supervised clustering of brain images: Deriving disease subtypes. Med Image Anal 2022; 75:102304. [PMID: 34818611 PMCID: PMC8678373 DOI: 10.1016/j.media.2021.102304] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/09/2021] [Accepted: 11/08/2021] [Indexed: 01/03/2023]
Abstract
Disease heterogeneity is a significant obstacle to understanding pathological processes and delivering precision diagnostics and treatment. Clustering methods have gained popularity for stratifying patients into subpopulations (i.e., subtypes) of brain diseases using imaging data. However, unsupervised clustering approaches are often confounded by anatomical and functional variations not related to a disease or pathology of interest. Semi-supervised clustering techniques have been proposed to overcome this and, therefore, capture disease-specific patterns more effectively. An additional limitation of both unsupervised and semi-supervised conventional machine learning methods is that they typically model, learn and infer from data using a basis of feature sets pre-defined at a fixed anatomical or functional scale (e.g., atlas-based regions of interest). Herein we propose a novel method, "Multi-scAle heteroGeneity analysIs and Clustering" (MAGIC), to depict the multi-scale presentation of disease heterogeneity, which builds on a previously proposed semi-supervised clustering method, HYDRA. It derives multi-scale and clinically interpretable feature representations and exploits a double-cyclic optimization procedure to effectively drive identification of inter-scale-consistent disease subtypes. More importantly, to understand the conditions under which the clustering model can estimate true heterogeneity related to diseases, we conducted extensive and systematic semi-simulated experiments to evaluate the proposed method on a sizeable healthy control sample from the UK Biobank (N = 4403). We then applied MAGIC to imaging data from Alzheimer's disease (ADNI, N = 1728) and schizophrenia (PHENOM, N = 1166) patients to demonstrate its potential and challenges in dissecting the neuroanatomical heterogeneity of common brain diseases. Taken together, we aim to provide guidance regarding when such analyses can succeed or should be taken with caution. The code of the proposed method is publicly available at https://github.com/anbai106/MAGIC.
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Affiliation(s)
- Junhao Wen
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | - Erdem Varol
- Department of Statistics, Center for Theoretical Neuroscience, Zuckerman Institute, Columbia University, New York, USA
| | - Aristeidis Sotiras
- Department of Radiology and Institute for Informatics, Washington University School of Medicine, St. Louis, USA
| | - Zhijian Yang
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ganesh B Chand
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, USA
| | - Guray Erus
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Haochang Shou
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ahmed Abdulkadir
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Gyujoon Hwang
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Dazzan
- Institute of Psychiatry, King's College London, London, UK
| | - Rene S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Hugo G Schnack
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcus V Zanetti
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Eva Meisenzahl
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Geraldo F Busatto
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Benedicto Crespo-Facorro
- Hospital Universitario Virgen del Rocio, University of Sevilla-IBIS; IDIVAL-CIBERSAM, Cantabria, Spain
| | - Romero-Garcia Rafael
- Department of Medical Physiology and Biophysics, University of Seville, Instituto de Investigación Sanitaria de Sevilla, IBiS, CIBERSAM, Sevilla, Spain
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia
| | - Stephen J Wood
- Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia
| | - Chuanjun Zhuo
- key Laboratory of Real Tine Tracing of Brain Circuits in Psychiatry and Neurology(RTBCPN-Lab), Nankai University Affiliated Tianjin Fourth Center Hospital; Department of Psychiatry, Tianjin Medical University, Tianjin, China
| | - Russell T Shinohara
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Yong Fan
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Theodore D Satterthwaite
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Daniel H Wolf
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
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14
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Jellinger KA. Recent update on the heterogeneity of the Alzheimer’s disease spectrum. J Neural Transm (Vienna) 2021; 129:1-24. [DOI: 10.1007/s00702-021-02449-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/25/2021] [Indexed: 02/03/2023]
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15
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Verdi S, Marquand AF, Schott JM, Cole JH. Beyond the average patient: how neuroimaging models can address heterogeneity in dementia. Brain 2021; 144:2946-2953. [PMID: 33892488 PMCID: PMC8634113 DOI: 10.1093/brain/awab165] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/24/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Dementia is a highly heterogeneous condition, with pronounced individual differences in age of onset, clinical presentation, progression rates and neuropathological hallmarks, even within a specific diagnostic group. However, the most common statistical designs used in dementia research studies and clinical trials overlook this heterogeneity, instead relying on comparisons of group average differences (e.g. patient versus control or treatment versus placebo), implicitly assuming within-group homogeneity. This one-size-fits-all approach potentially limits our understanding of dementia aetiology, hindering the identification of effective treatments. Neuroimaging has enabled the characterization of the average neuroanatomical substrates of dementias; however, the increasing availability of large open neuroimaging datasets provides the opportunity to examine patterns of neuroanatomical variability in individual patients. In this update, we outline the causes and consequences of heterogeneity in dementia and discuss recent research that aims to tackle heterogeneity directly, rather than assuming that dementia affects everyone in the same way. We introduce spatial normative modelling as an emerging data-driven technique, which can be applied to dementia data to model neuroanatomical variation, capturing individualized neurobiological 'fingerprints'. Such methods have the potential to detect clinically relevant subtypes, track an individual's disease progression or evaluate treatment responses, with the goal of moving towards precision medicine for dementia.
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Affiliation(s)
- Serena Verdi
- Centre for Medical Image Computing, Medical Physics and Biomedical Engineering, University College London, London WC1V 6LJ, UK
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Andre F Marquand
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, 6525EN, The Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, 6525EN, The Netherlands
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - James H Cole
- Centre for Medical Image Computing, Medical Physics and Biomedical Engineering, University College London, London WC1V 6LJ, UK
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
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16
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Pursuit of precision medicine: Systems biology approaches in Alzheimer's disease mouse models. Neurobiol Dis 2021; 161:105558. [PMID: 34767943 PMCID: PMC10112395 DOI: 10.1016/j.nbd.2021.105558] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 12/12/2022] Open
Abstract
Alzheimer's disease (AD) is a complex disease that is mediated by numerous factors and manifests in various forms. A systems biology approach to studying AD involves analyses of various body systems, biological scales, environmental elements, and clinical outcomes to understand the genotype to phenotype relationship that potentially drives AD development. Currently, there are many research investigations probing how modifiable and nonmodifiable factors impact AD symptom presentation. This review specifically focuses on how imaging modalities can be integrated into systems biology approaches using model mouse populations to link brain level functional and structural changes to disease onset and progression. Combining imaging and omics data promotes the classification of AD into subtypes and paves the way for precision medicine solutions to prevent and treat AD.
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17
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Lenhart L, Seiler S, Pirpamer L, Goebel G, Potrusil T, Wagner M, Dal Bianco P, Ransmayr G, Schmidt R, Benke T, Scherfler C. Anatomically Standardized Detection of MRI Atrophy Patterns in Early-Stage Alzheimer's Disease. Brain Sci 2021; 11:brainsci11111491. [PMID: 34827490 PMCID: PMC8615991 DOI: 10.3390/brainsci11111491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022] Open
Abstract
MRI studies have consistently identified atrophy patterns in Alzheimer’s disease (AD) through a whole-brain voxel-based analysis, but efforts to investigate morphometric profiles using anatomically standardized and automated whole-brain ROI analyses, performed at the individual subject space, are still lacking. In this study we aimed (i) to utilize atlas-derived measurements of cortical thickness and subcortical volumes, including of the hippocampal subfields, to identify atrophy patterns in early-stage AD, and (ii) to compare cognitive profiles at baseline and during a one-year follow-up of those previously identified morphometric AD subtypes to predict disease progression. Through a prospectively recruited multi-center study, conducted at four Austrian sites, 120 patients were included with probable AD, a disease onset beyond 60 years and a clinical dementia rating of ≤1. Morphometric measures of T1-weighted images were obtained using FreeSurfer. A principal component and subsequent cluster analysis identified four morphometric subtypes, including (i) hippocampal predominant (30.8%), (ii) hippocampal-temporo-parietal (29.2%), (iii) parieto-temporal (hippocampal sparing, 20.8%) and (iv) hippocampal-temporal (19.2%) atrophy patterns that were associated with phenotypes differing predominately in the presentation and progression of verbal memory and visuospatial impairments. These morphologically distinct subtypes are based on standardized brain regions, which are anatomically defined and freely accessible so as to validate its diagnostic accuracy and enhance the prediction of disease progression.
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Affiliation(s)
- Lukas Lenhart
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.L.); (T.P.); (T.B.)
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Stephan Seiler
- Center for Neurosciences, Department of Neurology, University of California, Davis, CA 95616, USA;
- Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA 95616, USA
- Department of Neurology, Medical University of Graz, 8036 Graz, Austria; (L.P.); (R.S.)
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, 8036 Graz, Austria; (L.P.); (R.S.)
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Müllerstraße 44, 6020 Innsbruck, Austria;
| | - Thomas Potrusil
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.L.); (T.P.); (T.B.)
| | - Michaela Wagner
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Peter Dal Bianco
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Gerhard Ransmayr
- Department of Neurology, Kepler University Hospital, 4021 Linz, Austria;
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, 8036 Graz, Austria; (L.P.); (R.S.)
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.L.); (T.P.); (T.B.)
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.L.); (T.P.); (T.B.)
- Correspondence: ; Tel.: +43-512-504-26276
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18
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Zeiler FA, Iturria-Medina Y, Thelin EP, Gomez A, Shankar JJ, Ko JH, Figley CR, Wright GEB, Anderson CM. Integrative Neuroinformatics for Precision Prognostication and Personalized Therapeutics in Moderate and Severe Traumatic Brain Injury. Front Neurol 2021; 12:729184. [PMID: 34557154 PMCID: PMC8452858 DOI: 10.3389/fneur.2021.729184] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/09/2021] [Indexed: 01/13/2023] Open
Abstract
Despite changes in guideline-based management of moderate/severe traumatic brain injury (TBI) over the preceding decades, little impact on mortality and morbidity have been seen. This argues against the "one-treatment fits all" approach to such management strategies. With this, some preliminary advances in the area of personalized medicine in TBI care have displayed promising results. However, to continue transitioning toward individually-tailored care, we require integration of complex "-omics" data sets. The past few decades have seen dramatic increases in the volume of complex multi-modal data in moderate and severe TBI care. Such data includes serial high-fidelity multi-modal characterization of the cerebral physiome, serum/cerebrospinal fluid proteomics, admission genetic profiles, and serial advanced neuroimaging modalities. Integrating these complex and serially obtained data sets, with patient baseline demographics, treatment information and clinical outcomes over time, can be a daunting task for the treating clinician. Within this review, we highlight the current status of such multi-modal omics data sets in moderate/severe TBI, current limitations to the utilization of such data, and a potential path forward through employing integrative neuroinformatic approaches, which are applied in other neuropathologies. Such advances are positioned to facilitate the transition to precision prognostication and inform a top-down approach to the development of personalized therapeutics in moderate/severe TBI.
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Affiliation(s)
- Frederick A. Zeiler
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
- Centre on Aging, University of Manitoba, Winnipeg, MB, Canada
- Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Yasser Iturria-Medina
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Montreal, QC, Canada
| | - Eric P. Thelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Alwyn Gomez
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jai J. Shankar
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ji Hyun Ko
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg, MB, Canada
| | - Chase R. Figley
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg, MB, Canada
| | - Galen E. B. Wright
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg, MB, Canada
- Department of Pharmacology and Therapeutics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Chris M. Anderson
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg, MB, Canada
- Department of Pharmacology and Therapeutics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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19
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Rauchmann BS, Ersoezlue E, Stoecklein S, Keeser D, Brosseron F, Buerger K, Dechent P, Dobisch L, Ertl-Wagner B, Fliessbach K, Haynes JD, Heneka MT, Incesoy EI, Janowitz D, Kilimann I, Laske C, Metzger CD, Munk MH, Peters O, Priller J, Ramirez A, Roeske S, Roy N, Scheffler K, Schneider A, Spottke A, Spruth EJ, Teipel S, Tscheuschler M, Vukovich R, Wagner M, Wiltfang J, Yakupov R, Duezel E, Jessen F, Perneczky R. Resting-State Network Alterations Differ between Alzheimer's Disease Atrophy Subtypes. Cereb Cortex 2021; 31:4901-4915. [PMID: 34080613 DOI: 10.1093/cercor/bhab130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/14/2022] Open
Abstract
Several Alzheimer's disease (AD) atrophy subtypes were identified, but their brain network properties are unclear. We analyzed data from two independent datasets, including 166 participants (103 AD/63 controls) from the DZNE-longitudinal cognitive impairment and dementia study and 151 participants (121 AD/30 controls) from the AD neuroimaging initiative cohorts, aiming to identify differences between AD atrophy subtypes in resting-state functional magnetic resonance imaging intra-network connectivity (INC) and global and nodal network properties. Using a data-driven clustering approach, we identified four AD atrophy subtypes with differences in functional connectivity, accompanied by clinical and biomarker alterations, including a medio-temporal-predominant (S-MT), a limbic-predominant (S-L), a diffuse (S-D), and a mild-atrophy (S-MA) subtype. S-MT and S-D showed INC reduction in the default mode, dorsal attention, visual and limbic network, and a pronounced reduction of "global efficiency" and decrease of the "clustering coefficient" in parietal and temporal lobes. Despite severe atrophy in limbic areas, the S-L exhibited only marginal global network but substantial nodal network failure. S-MA, in contrast, showed limited impairment in clinical and cognitive scores but pronounced global network failure. Our results contribute toward a better understanding of heterogeneity in AD with the detection of distinct differences in functional connectivity networks accompanied by CSF biomarker and cognitive differences in AD subtypes.
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Affiliation(s)
- Boris-Stephan Rauchmann
- Department of Radiology, University Hospital, LMU, Munich 81377, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU, Munich 80336, Germany
| | - Ersin Ersoezlue
- Department of Psychiatry and Psychotherapy, University Hospital, LMU, Munich 80336, Germany
| | - Sophia Stoecklein
- Department of Radiology, University Hospital, LMU, Munich 81377, Germany
| | - Daniel Keeser
- Department of Radiology, University Hospital, LMU, Munich 81377, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU, Munich 80336, Germany
| | - Frederic Brosseron
- German Center for Neurodegenerative Diseases (DZNE), Bonn 53127, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn 53127, Germany
| | - Katharina Buerger
- German Center for Neurodegenerative Diseases (DZNE), Munich 81377, Germany.,Institute for Stroke and Dementia Research (ISD), University Hospital, LMU, Munich 81377, Germany
| | - Peter Dechent
- MR-Research in Neurology and Psychiatry, Georg-August-University Goettingen, Göttingen 37077, Germany
| | - Laura Dobisch
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg 39120, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital, LMU, Munich 81377, Germany.,Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario M5T 1W7, Canada
| | - Klaus Fliessbach
- German Center for Neurodegenerative Diseases (DZNE), Bonn 53127, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn 53127, Germany
| | - John Dylan Haynes
- Bernstein Center for Computational Neuroscience, Charité, Berlin 10115, Germany
| | - Michael T Heneka
- German Center for Neurodegenerative Diseases (DZNE), Bonn 53127, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn 53127, Germany
| | - Enise I Incesoy
- German Center for Neurodegenerative Diseases (DZNE), Berlin 10117, Germany.,Charité - Universitaetsmedizin Berlin, Institute of Psychiatry and Psychotherapy, Berlin 10117, Germany
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU, Munich 81377, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock 18147, Germany.,Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock 18147
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen 72076, Germany.,Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen 72076, Germany
| | - Coraline D Metzger
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg 39120, Germany.,Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg 39120, Germany.,Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg 39120, Germany
| | - Matthias H Munk
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen 72076, Germany.,Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen 72076, Germany
| | - Oliver Peters
- German Center for Neurodegenerative Diseases (DZNE), Berlin 10117, Germany.,Charité - Universitaetsmedizin Berlin, Institute of Psychiatry and Psychotherapy, Berlin 10117, Germany
| | - Josef Priller
- German Center for Neurodegenerative Diseases (DZNE), Berlin 10117, Germany.,Department of Psychiatry and Psychotherapy, Charité, Berlin 10117, Germany
| | - Alfredo Ramirez
- German Center for Neurodegenerative Diseases (DZNE), Bonn 53127, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn 53127, Germany.,Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry, University of Cologne, Medical Faculty, Cologne 50937, Germany
| | - Sandra Roeske
- German Center for Neurodegenerative Diseases (DZNE), Bonn 53127, Germany
| | - Nina Roy
- German Center for Neurodegenerative Diseases (DZNE), Bonn 53127, Germany
| | - Klaus Scheffler
- Department for Biomedical Magnetic Resonance, University of Tuebingen, Tuebingen 72076, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn 53127, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn 53127, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases (DZNE), Bonn 53127, Germany.,Department of Neurology, University of Bonn, Bonn 53127, Germany
| | - Eike Jakob Spruth
- German Center for Neurodegenerative Diseases (DZNE), Berlin 10117, Germany.,Department of Psychiatry and Psychotherapy, Charité, Berlin 10117, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock 18147, Germany.,Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock 18147
| | - Maike Tscheuschler
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne 50924, Germany
| | - Ruth Vukovich
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Goettingen 37075, Germany
| | - Michael Wagner
- German Center for Neurodegenerative Diseases (DZNE), Bonn 53127, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn 53127, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Goettingen 37075, Germany.,German Center for Neurodegenerative Diseases (DZNE), Goettingen 37075, Germany.,Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro 3810-193, Portugal
| | - Renat Yakupov
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg 39120, Germany
| | - Emrah Duezel
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg 39120, Germany.,Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg 39120, Germany
| | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), Bonn 53127, Germany.,Department of Psychiatry, University of Cologne, Medical Faculty, Cologne 50924, Germany.,Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne 50931, Germany
| | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, University Hospital, LMU, Munich 80336, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich 81377, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich 81377, Germany.,Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College, London W6 8RP, UK
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20
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Integrating molecular, histopathological, neuroimaging and clinical neuroscience data with NeuroPM-box. Commun Biol 2021; 4:614. [PMID: 34021244 PMCID: PMC8140107 DOI: 10.1038/s42003-021-02133-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/22/2021] [Indexed: 02/04/2023] Open
Abstract
Understanding and treating heterogeneous brain disorders requires specialized techniques spanning genetics, proteomics, and neuroimaging. Designed to meet this need, NeuroPM-box is a user-friendly, open-access, multi-tool cross-platform software capable of characterizing multiscale and multifactorial neuropathological mechanisms. Using advanced analytical modeling for molecular, histopathological, brain-imaging and/or clinical evaluations, this framework has multiple applications, validated here with synthetic (N > 2900), in-vivo (N = 911) and post-mortem (N = 736) neurodegenerative data, and including the ability to characterize: (i) the series of sequential states (genetic, histopathological, imaging or clinical alterations) covering decades of disease progression, (ii) concurrent intra-brain spreading of pathological factors (e.g., amyloid, tau and alpha-synuclein proteins), (iii) synergistic interactions between multiple biological factors (e.g., toxic tau effects on brain atrophy), and (iv) biologically-defined patient stratification based on disease heterogeneity and/or therapeutic needs. This freely available toolbox ( neuropm-lab.com/neuropm-box.html ) could contribute significantly to a better understanding of complex brain processes and accelerating the implementation of Precision Medicine in Neurology.
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21
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Li HT, Yuan SX, Wu JS, Gu Y, Sun X. Predicting Conversion from MCI to AD Combining Multi-Modality Data and Based on Molecular Subtype. Brain Sci 2021; 11:brainsci11060674. [PMID: 34064186 PMCID: PMC8224289 DOI: 10.3390/brainsci11060674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/15/2021] [Accepted: 05/19/2021] [Indexed: 12/20/2022] Open
Abstract
Alzheimer’s disease (AD) is a neurodegenerative brain disease in the elderly. Identifying patients with mild cognitive impairment (MCI) who are more likely to progress to AD is a key step in AD prevention. Recent studies have shown that AD is a heterogeneous disease. In this study, we propose a subtyping-based prediction strategy to predict the conversion from MCI to AD in three years according to MCI patient subtypes. Structural magnetic resonance imaging (sMRI) data and multi-omics data, including genotype data and gene expression profiling derived from peripheral blood samples, from 125 MCI patients were used in the Alzheimer’s Disease Neuroimaging Initiative (ADNI)-1 dataset and from 98 MCI patients in the ADNI-GO/2 dataset. A variational Bayes approximation model based on the multiple kernel learning method was constructed to predict whether an MCI patient will progress to AD within three years. In internal fivefold cross-validation within ADNI-1, we achieved an overall AUC of 0.83 (79.20% accuracy, 81.25% sensitivity, 77.92% specificity) compared to the model without subtyping, which achieved an AUC of 0.78 (76.00% accuracy, 77.08% sensitivity, 75.32% specificity). In external validation using ADNI-1 as a training set and ADNI-GO/2 as an independent test set, we attained an AUC of 0.78 (74.49% accuracy, 74.19% sensitivity, 74.63% specificity). Identifying MCI patient subtypes with omics data would improve the accuracy of predicting the conversion from MCI to AD. In addition to evaluating statistics, obtaining the significant sMRI, single nucleotide polymorphism (SNP) and mRNA expression data from peripheral blood of MCI patients is noninvasive and cost-effective for predicting conversion from MCI to AD.
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Affiliation(s)
- Hai-Tao Li
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China; (H.-T.L.); (S.-X.Y.); (Y.G.)
| | - Shao-Xun Yuan
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China; (H.-T.L.); (S.-X.Y.); (Y.G.)
| | - Jian-Sheng Wu
- School of Geography and Biological Information, Nanjing University of Posts and Telecommunications, Nanjing 210023, China;
| | - Yu Gu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China; (H.-T.L.); (S.-X.Y.); (Y.G.)
| | - Xiao Sun
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China; (H.-T.L.); (S.-X.Y.); (Y.G.)
- Correspondence:
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22
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Zhang B, Lin L, Wu S. A Review of Brain Atrophy Subtypes Definition and Analysis for Alzheimer’s Disease Heterogeneity Studies. J Alzheimers Dis 2021; 80:1339-1352. [DOI: 10.3233/jad-201274] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Alzheimer’s disease (AD) is a heterogeneous disease with different subtypes. Studying AD subtypes from brain structure, neuropathology, and cognition are of great importance for AD heterogeneity research. Starting from the study of constructing AD subtypes based on the features of T1-weighted structural magnetic resonance imaging, this paper introduces the major connections between the subtype definition and analysis strategies, including brain region-based subtype definition, and their demographic, neuropathological, and neuropsychological characteristics. The advantages and existing problems are analyzed, and reasonable improvement schemes are prospected. Overall, this review offers a more comprehensive view in the field of atrophy subtype in AD, along with their advantages, challenges, and future prospects, and provide a basis for improving individualized AD diagnosis.
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Affiliation(s)
- Baiwen Zhang
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Lan Lin
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Shuicai Wu
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
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23
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Planche V, Bouteloup V, Mangin JF, Dubois B, Delrieu J, Pasquier F, Blanc F, Paquet C, Hanon O, Gabelle A, Ceccaldi M, Annweiler C, Krolak-Salmon P, Habert MO, Fischer C, Chupin M, Béjot Y, Godefroy O, Wallon D, Sauvée M, Bourdel-Marchasson I, Jalenques I, Tison F, Chêne G, Dufouil C. Clinical relevance of brain atrophy subtypes categorization in memory clinics. Alzheimers Dement 2020; 17:641-652. [PMID: 33325121 DOI: 10.1002/alz.12231] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The clinical relevance of brain atrophy subtypes categorization in non-demented persons without a priori knowledge regarding their amyloid status or clinical presentation is unknown. METHODS A total of 2083 outpatients with either subjective cognitive complaint or mild cognitive impairment at study entry were followed during 4 years (MEMENTO cohort). Atrophy subtypes were defined using baseline magnetic resonance imaging (MRI) and previously described algorithms. RESULTS Typical/diffuse atrophy was associated with faster cognitive decline and the highest risk of developing dementia and Alzheimer's disease (AD) over time, both in the whole analytic sample and in amyloid-positive participants. Hippocampal-sparing and limbic-predominant atrophy were also associated with incident dementia, with faster cognitive decline in the limbic predominant atrophy group. Lewy body dementia was more frequent in the hippocampal-sparing and minimal/no atrophy groups. DISCUSSION Atrophy subtypes categorization predicted different subsequent patterns of cognitive decline and rates of conversion to distinct etiologies of dementia in persons attending memory clinics.
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Affiliation(s)
- Vincent Planche
- Univ. Bordeaux, CNRS UMR 5293, Institut des Maladies Neurodégénératives, Centre Mémoire de Ressources et de Recherches, Pôle de Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
| | - Vincent Bouteloup
- Univ. Bordeaux, Inserm U1219, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux, France
| | - Jean-François Mangin
- Univ. Paris-Saclay, CEA, CNRS, Baobab, Neurospin, CATI multicenter neuroimaging platform, Gif-sur-Yvette, France
| | - Bruno Dubois
- Sorbonne-Université, Service des maladies cognitives et comportementales et Institut de la mémoire et de la maladie d'Alzheimer (IM2A), Hôpital de la Salpêtrière, AP-PH, Paris, France
| | - Julien Delrieu
- Departement de Gériatrie, Univ. Toulouse, Inserm U1027, Gérontopôle, CHU Purpan, Toulouse, France
| | - Florence Pasquier
- Univ. Lille, Inserm U1171, Centre Mémoire de Ressources et de Recherches, CHU Lille, DISTAlz, Lille, France
| | - Frédéric Blanc
- ICube laboratory, Departement de Gériatrie, Univ. Strasbourg, CNRS, UMR 7357, Fédération de Médecine Translationnelle de Strasbourg, Centre Mémoire de Ressources et de Recherches, Strasbourg, France
| | - Claire Paquet
- Univ. Paris, Inserm U1144, Groupe Hospitalier Lariboisière Fernand-Widal, AP-HP, Paris, France
| | - Olivier Hanon
- Univ. Paris Descartes Sorbonne Paris Cité, EA 4468, Service de Gériatrie, AP-HP, Hôpital Broca, Paris, France
| | - Audrey Gabelle
- Département de Neurologie, Univ. Montpellier, i-site MUSE, Inserm U1061, Centre Mémoire de Ressources et de Recherches, Pôle de Neurosciences, CHU de Montpellier, Montpellier, France
| | - Matthieu Ceccaldi
- Département de Neurologie et de Neuropsychologie, Univ. Aix Marseille, Inserm UMR 1106, Institut de Neurosciences des Systèmes, Centre Mémoire de Ressources et de Recherches, AP-HM, Marseille, France
| | - Cédric Annweiler
- Département de Gériatrie, CHU d'Angers, Univ. Angers, UPRES EA 4638, Centre Mémoire de Ressources et de Recherches, Angers, France
| | - Pierre Krolak-Salmon
- Univ. Lyon, Inserm U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France
| | - Marie-Odile Habert
- Laboratoire d'Imagerie Biomédicale, Sorbonne-Université, CNRS, Inserm, CATI multicenter neuroimaging platform, AP-HP, Hôpital Pitié-Salpêtrière, Médecine Nucléaire, Paris, France
| | - Clara Fischer
- Univ. Paris-Saclay, CEA, CNRS, Baobab, Neurospin, CATI multicenter neuroimaging platform, Gif-sur-Yvette, France
| | - Marie Chupin
- Sorbonne-Université, Inserm U1127, CNRS UMR 7225, CATI multicenter neuroimaging platform, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Yannick Béjot
- Univ. Bourgogne, EA7460, Centre Mémoire de Ressources et de Recherches, CHU Dijon Bourgogne, Dijon, France
| | - Olivier Godefroy
- Laboratoire de Neurosciences Fonctionnelles et Pathologies, Univ. Picardie, UR UPJV4559, Service de Neurologie, CHU Amiens, Amiens, France
| | - David Wallon
- Departement de Neurologie, Univ. Normandie, UNIROUEN, Inserm U1245, CNR-MAJ, CHU de Rouen, Rouen, France
| | - Mathilde Sauvée
- Centre Mémoire de Ressources et de Recherches Grenoble Arc Alpin, Pôle de Psychiatrie et Neurologie, CHU Grenoble, Grenoble, France
| | - Isabelle Bourdel-Marchasson
- Univ. Bordeaux, Inserm U1219, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux, France
- Univ. Bordeaux, CNRS UMR 5536, Centre de Résonance Magnétique des Systèmes Biologiques, Pole de gérontologie clinique, CHU de Bordeaux, Bordeaux, France
| | - Isabelle Jalenques
- Univ. Clermont Auvergne, Centre Mémoire de Ressources et de Recherches, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - François Tison
- Univ. Bordeaux, CNRS UMR 5293, Institut des Maladies Neurodégénératives, Centre Mémoire de Ressources et de Recherches, Pôle de Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
| | - Geneviève Chêne
- Univ. Bordeaux, Inserm U1219, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Pôle de Sante Publique, CHU de Bordeaux, Bordeaux, France
| | - Carole Dufouil
- Univ. Bordeaux, Inserm U1219, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Pôle de Sante Publique, CHU de Bordeaux, Bordeaux, France
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24
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Mohanty R, Mårtensson G, Poulakis K, Muehlboeck JS, Rodriguez-Vieitez E, Chiotis K, Grothe MJ, Nordberg A, Ferreira D, Westman E. Comparison of subtyping methods for neuroimaging studies in Alzheimer's disease: a call for harmonization. Brain Commun 2020; 2:fcaa192. [PMID: 33305264 PMCID: PMC7713995 DOI: 10.1093/braincomms/fcaa192] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023] Open
Abstract
Biological subtypes in Alzheimer's disease, originally identified on neuropathological data, have been translated to in vivo biomarkers such as structural magnetic resonance imaging and positron emission tomography, to disentangle the heterogeneity within Alzheimer's disease. Although there is methodological variability across studies, comparable characteristics of subtypes are reported at the group level. In this study, we investigated whether group-level similarities translate to individual-level agreement across subtyping methods, in a head-to-head context. We compared five previously published subtyping methods. Firstly, we validated the subtyping methods in 89 amyloid-beta positive Alzheimer's disease dementia patients (reference group: 70 amyloid-beta negative healthy individuals) using structural magnetic resonance imaging. Secondly, we extended and applied the subtyping methods to 53 amyloid-beta positive prodromal Alzheimer's disease and 30 amyloid-beta positive Alzheimer's disease dementia patients (reference group: 200 amyloid-beta negative healthy individuals) using structural magnetic resonance imaging and tau positron emission tomography. Subtyping methods were implemented as outlined in each original study. Group-level and individual-level comparisons across methods were performed. Each individual subtyping method was replicated, and the proof-of-concept was established. At the group level, all methods captured subtypes with similar patterns of demographic and clinical characteristics, and with similar cortical thinning and tau positron emission tomography uptake patterns. However, at the individual level, large disagreements were found in subtype assignments. Although characteristics of subtypes are comparable at the group level, there is a large disagreement at the individual level across subtyping methods. Therefore, there is an urgent need for consensus and harmonization across subtyping methods. We call for the establishment of an open benchmarking framework to overcome this problem.
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Affiliation(s)
- Rosaleena Mohanty
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Mårtensson
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Konstantinos Poulakis
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - J-Sebastian Muehlboeck
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Elena Rodriguez-Vieitez
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Konstantinos Chiotis
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Michel J Grothe
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Clinical Dementia Research Section, German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Agneta Nordberg
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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25
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Poulakis K, Ferreira D, Pereira JB, Smedby Ö, Vemuri P, Westman E. Fully bayesian longitudinal unsupervised learning for the assessment and visualization of AD heterogeneity and progression. Aging (Albany NY) 2020; 12:12622-12647. [PMID: 32644944 PMCID: PMC7377879 DOI: 10.18632/aging.103623] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/19/2020] [Indexed: 11/25/2022]
Abstract
Tau pathology and brain atrophy are the closest correlate of cognitive decline in Alzheimer's disease (AD). Understanding heterogeneity and longitudinal progression of atrophy during the disease course will play a key role in understanding AD pathogenesis. We propose a framework for longitudinal clustering that simultaneously: 1) incorporates whole brain data, 2) leverages unequal visits per individual, 3) compares clusters with a control group, 4) allows for study confounding effects, 5) provides cluster visualization, 6) measures clustering uncertainty. We used amyloid-β positive AD and negative healthy subjects, three longitudinal structural magnetic resonance imaging scans (cortical thickness and subcortical volume) over two years. We found three distinct longitudinal AD brain atrophy patterns: one typical diffuse pattern (n=34, 47.2%), and two atypical patterns: minimal atrophy (n=23 31.9%) and hippocampal sparing (n=9, 12.5%). We also identified outliers (n=3, 4.2%) and observations with uncertain classification (n=3, 4.2%). The clusters differed not only in regional distributions of atrophy at baseline, but also longitudinal atrophy progression, age at AD onset, and cognitive decline. A framework for the longitudinal assessment of variability in cohorts with several neuroimaging measures was successfully developed. We believe this framework may aid in disentangling distinct subtypes of AD from disease staging.
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Affiliation(s)
- Konstantinos Poulakis
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Joana B. Pereira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Örjan Smedby
- Department of Biomedical Engineering and Health Systems (MTH), KTH Royal Institute of Technology, Stockholm, Sweden
| | | | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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26
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Habes M, Grothe MJ, Tunc B, McMillan C, Wolk DA, Davatzikos C. Disentangling Heterogeneity in Alzheimer's Disease and Related Dementias Using Data-Driven Methods. Biol Psychiatry 2020; 88:70-82. [PMID: 32201044 PMCID: PMC7305953 DOI: 10.1016/j.biopsych.2020.01.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/30/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
Brain aging is a complex process that includes atrophy, vascular injury, and a variety of age-associated neurodegenerative pathologies, together determining an individual's course of cognitive decline. While Alzheimer's disease and related dementias contribute to the heterogeneity of brain aging, these conditions themselves are also heterogeneous in their clinical presentation, progression, and pattern of neural injury. We reviewed studies that leveraged data-driven approaches to examining heterogeneity in Alzheimer's disease and related dementias, with a principal focus on neuroimaging studies exploring subtypes of regional neurodegeneration patterns. Over the past decade, the steadily increasing wealth of clinical, neuroimaging, and molecular biomarker information collected within large-scale observational cohort studies has allowed for a richer understanding of the variability of disease expression within the aging and Alzheimer's disease and related dementias continuum. Moreover, the availability of these large-scale datasets has supported the development and increasing application of clustering techniques for studying disease heterogeneity in a data-driven manner. In particular, data-driven studies have led to new discoveries of previously unappreciated disease subtypes characterized by distinct neuroimaging patterns of regional neurodegeneration, which are paralleled by heterogeneous profiles of pathological, clinical, and molecular biomarker characteristics. Incorporating these findings into novel frameworks for more differentiated disease stratification holds great promise for improving individualized diagnosis and prognosis of expected clinical progression, and provides opportunities for development of precision medicine approaches for therapeutic intervention. We conclude with an account of the principal challenges associated with data-driven heterogeneity analyses and outline avenues for future developments in the field.
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Affiliation(s)
- Mohamad Habes
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Memory Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Biggs Institute Neuroimaging Core, Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Michel J. Grothe
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany,Wallenberg Center for Molecular and Translational Medicine and the Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Birkan Tunc
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Corey McMillan
- Department of Neurology and Penn FTD Center, University of Pennsylvania, Philadelphia, USA
| | - David A. Wolk
- Department of Neurology and Penn Memory Center, University of Pennsylvania, Philadelphia, USA
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics and Department of Radiology, University of Pennsylvania, Philadelphia, USA
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27
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Badhwar A, McFall GP, Sapkota S, Black SE, Chertkow H, Duchesne S, Masellis M, Li L, Dixon RA, Bellec P. A multiomics approach to heterogeneity in Alzheimer's disease: focused review and roadmap. Brain 2020; 143:1315-1331. [PMID: 31891371 PMCID: PMC7241959 DOI: 10.1093/brain/awz384] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 11/14/2022] Open
Abstract
Aetiological and clinical heterogeneity is increasingly recognized as a common characteristic of Alzheimer's disease and related dementias. This heterogeneity complicates diagnosis, treatment, and the design and testing of new drugs. An important line of research is discovery of multimodal biomarkers that will facilitate the targeting of subpopulations with homogeneous pathophysiological signatures. High-throughput 'omics' are unbiased data-driven techniques that probe the complex aetiology of Alzheimer's disease from multiple levels (e.g. network, cellular, and molecular) and thereby account for pathophysiological heterogeneity in clinical populations. This review focuses on data reduction analyses that identify complementary disease-relevant perturbations for three omics techniques: neuroimaging-based subtypes, metabolomics-derived metabolite panels, and genomics-related polygenic risk scores. Neuroimaging can track accrued neurodegeneration and other sources of network impairments, metabolomics provides a global small-molecule snapshot that is sensitive to ongoing pathological processes, and genomics characterizes relatively invariant genetic risk factors representing key pathways associated with Alzheimer's disease. Following this focused review, we present a roadmap for assembling these multiomics measurements into a diagnostic tool highly predictive of individual clinical trajectories, to further the goal of personalized medicine in Alzheimer's disease.
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Affiliation(s)
- AmanPreet Badhwar
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
- Université de Montréal, Montreal, Canada
| | - G Peggy McFall
- Department of Psychology, University of Alberta, Edmonton, Canada
| | - Shraddha Sapkota
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Howard Chertkow
- Baycrest Health Sciences and the Rotman Research Institute, University of Toronto, Toronto, Canada
| | - Simon Duchesne
- Centre CERVO, Quebec City Mental Health Institute, Quebec, Quebec City, Canada
- Department of Radiology, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Mario Masellis
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Liang Li
- Department of Chemistry, University of Alberta, Edmonton, Canada
| | - Roger A Dixon
- Department of Psychology, University of Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Pierre Bellec
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
- Université de Montréal, Montreal, Canada
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28
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Liang KJ, Carlson ES. Resistance, vulnerability and resilience: A review of the cognitive cerebellum in aging and neurodegenerative diseases. Neurobiol Learn Mem 2020; 170:106981. [PMID: 30630042 PMCID: PMC6612482 DOI: 10.1016/j.nlm.2019.01.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/14/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022]
Abstract
In the context of neurodegeneration and aging, the cerebellum is an enigma. Genetic markers of cellular aging in cerebellum accumulate more slowly than in the rest of the brain, and it generates unknown factors that may slow or even reverse neurodegenerative pathology in animal models of Alzheimer's Disease (AD). Cerebellum shows increased activity in early AD and Parkinson's disease (PD), suggesting a compensatory function that may mitigate early symptoms of neurodegenerative pathophysiology. Perhaps most notably, different parts of the brain accumulate neuropathological markers of AD in a recognized progression and generally, cerebellum is the last brain region to do so. Taken together, these data suggest that cerebellum may be resistant to certain neurodegenerative mechanisms. On the other hand, in some contexts of accelerated neurodegeneration, such as that seen in chronic traumatic encephalopathy (CTE) following repeated traumatic brain injury (TBI), the cerebellum appears to be one of the most susceptible brain regions to injury and one of the first to exhibit signs of pathology. Cerebellar pathology in neurodegenerative disorders is strongly associated with cognitive dysfunction. In neurodegenerative or neurological disorders associated with cerebellar pathology, such as spinocerebellar ataxia, cerebellar cortical atrophy, and essential tremor, rates of cognitive dysfunction, dementia and neuropsychiatric symptoms increase. When the cerebellum shows AD pathology, such as in familial AD, it is associated with earlier onset and greater severity of disease. These data suggest that when neurodegenerative processes are active in the cerebellum, it may contribute to pathological behavioral outcomes. The cerebellum is well known for comparing internal representations of information with observed outcomes and providing real-time feedback to cortical regions, a critical function that is disturbed in neuropsychiatric disorders such as intellectual disability, schizophrenia, dementia, and autism, and required for cognitive domains such as working memory. While cerebellum has reciprocal connections with non-motor brain regions and likely plays a role in complex, goal-directed behaviors, it has proven difficult to establish what it does mechanistically to modulate these behaviors. Due to this lack of understanding, it's not surprising to see the cerebellum reflexively dismissed or even ignored in basic and translational neuropsychiatric literature. The overarching goals of this review are to answer the following questions from primary literature: When the cerebellum is affected by pathology, is it associated with decreased cognitive function? When it is intact, does it play a compensatory or protective role in maintaining cognitive function? Are there theoretical frameworks for understanding the role of cerebellum in cognition, and perhaps, illnesses characterized by cognitive dysfunction? Understanding the role of the cognitive cerebellum in neurodegenerative diseases has the potential to offer insight into origins of cognitive deficits in other neuropsychiatric disorders, which are often underappreciated, poorly understood, and not often treated.
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Affiliation(s)
- Katharine J Liang
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA, United States
| | - Erik S Carlson
- University of Washington School of Medicine, Seattle, WA, United States.
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29
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Kim Y, Jiang X, Giancardo L, Pena D, Bukhbinder AS, Amran AY, Schulz PE. Multimodal Phenotyping of Alzheimer's Disease with Longitudinal Magnetic Resonance Imaging and Cognitive Function Data. Sci Rep 2020; 10:5527. [PMID: 32218482 PMCID: PMC7099007 DOI: 10.1038/s41598-020-62263-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/06/2020] [Indexed: 01/26/2023] Open
Abstract
Alzheimer's disease (AD) varies a great deal cognitively regarding symptoms, test findings, the rate of progression, and neuroradiologically in terms of atrophy on magnetic resonance imaging (MRI). We hypothesized that an unbiased analysis of the progression of AD, regarding clinical and MRI features, will reveal a number of AD phenotypes. Our objective is to develop and use a computational method for multi-modal analysis of changes in cognitive scores and MRI volumes to test for there being multiple AD phenotypes. In this retrospective cohort study with a total of 857 subjects from the AD (n = 213), MCI (n = 322), and control (CN, n = 322) groups, we used structural MRI data and neuropsychological assessments to develop a novel computational phenotyping method that groups brain regions from MRI and subsets of neuropsychological assessments in a non-biased fashion. The phenotyping method was built based on coupled nonnegative matrix factorization (C-NMF). As a result, the computational phenotyping method found four phenotypes with different combination and progression of neuropsychologic and neuroradiologic features. Identifying distinct AD phenotypes here could help explain why only a subset of AD patients typically respond to any single treatment. This, in turn, will help us target treatments more specifically to certain responsive phenotypes.
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Affiliation(s)
- Yejin Kim
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA.
| | - Xiaoqian Jiang
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Luca Giancardo
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Diagnostic and Interventional Imaging, the McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Danilo Pena
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Avram S Bukhbinder
- Department of Neurology, the McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Albert Y Amran
- Department of Neurology, the McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Paul E Schulz
- Department of Neurology, the McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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30
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Ferreira D, Nordberg A, Westman E. Biological subtypes of Alzheimer disease: A systematic review and meta-analysis. Neurology 2020; 94:436-448. [PMID: 32047067 PMCID: PMC7238917 DOI: 10.1212/wnl.0000000000009058] [Citation(s) in RCA: 209] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To test the hypothesis that distinct subtypes of Alzheimer disease (AD) exist and underlie the heterogeneity within AD, we conducted a systematic review and meta-analysis on AD subtype studies based on postmortem and neuroimaging data. METHODS EMBASE, PubMed, and Web of Science databases were consulted until July 2019. RESULTS Neuropathology and neuroimaging studies have consistently identified 3 subtypes of AD based on the distribution of tau-related pathology and regional brain atrophy: typical, limbic-predominant, and hippocampal-sparing AD. A fourth subtype, minimal atrophy AD, has been identified in several neuroimaging studies. Typical AD displays tau-related pathology and atrophy both in hippocampus and association cortex and has a pooled frequency of 55%. Limbic-predominant, hippocampal-sparing, and minimal atrophy AD had a pooled frequency of 21%, 17%, and 15%, respectively. Between-subtype differences were found in age at onset, age at assessment, sex distribution, years of education, global cognitive status, disease duration, APOE ε4 genotype, and CSF biomarker levels. CONCLUSION We identified 2 core dimensions of heterogeneity: typicality and severity. We propose that these 2 dimensions determine individuals' belonging to one of the AD subtypes based on the combination of protective factors, risk factors, and concomitant non-AD brain pathologies. This model is envisioned to aid with framing hypotheses, study design, interpretation of results, and understanding mechanisms in future subtype studies. Our model can be used along the A/T/N classification scheme for AD biomarkers. Unraveling the heterogeneity within AD is critical for implementing precision medicine approaches and for ultimately developing successful disease-modifying drugs for AD.
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Affiliation(s)
- Daniel Ferreira
- From the Division of Clinical Geriatrics (D.F., A.N., E.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Theme Aging (A.N.), Karolinska University Hospital, Huddinge, Sweden; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Agneta Nordberg
- From the Division of Clinical Geriatrics (D.F., A.N., E.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Theme Aging (A.N.), Karolinska University Hospital, Huddinge, Sweden; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Eric Westman
- From the Division of Clinical Geriatrics (D.F., A.N., E.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Theme Aging (A.N.), Karolinska University Hospital, Huddinge, Sweden; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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31
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Ossenkoppele R, Lyoo CH, Sudre CH, van Westen D, Cho H, Ryu YH, Choi JY, Smith R, Strandberg O, Palmqvist S, Westman E, Tsai R, Kramer J, Boxer AL, Gorno-Tempini ML, La Joie R, Miller BL, Rabinovici GD, Hansson O. Distinct tau PET patterns in atrophy-defined subtypes of Alzheimer's disease. Alzheimers Dement 2020; 16:335-344. [PMID: 31672482 PMCID: PMC7012375 DOI: 10.1016/j.jalz.2019.08.201] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Differential patterns of brain atrophy on structural magnetic resonance imaging (MRI) revealed four reproducible subtypes of Alzheimer’s disease (AD): (1) “typical”, (2) “limbic-predominant”, (3) “hippocampal-sparing”, and (4) “mild atrophy”. We examined the neurobiological characteristics and clinical progression of these atrophy-defined subtypes. Methods: The four subtypes were replicated using a clustering method on MRI data in 260 amyloid-β-positive patients with mild cognitive impairment or AD dementia, and we subsequently tested whether the subtypes differed on [18F]flortaucipir (tau) positron emission tomography, white matter hyperintensity burden, and rate of global cognitive decline. Results: Voxel-wise and region-of-interest analyses revealed the greatest neocortical tau load in hippocampal-sparing (frontoparietal-predominant) and typical (temporal-predominant) patients, while limbic-predominant patients showed particularly high entorhinal tau. Typical patients with AD had the most pronounced white matter hyperintensity load, and hippocampal-sparing patients showed the most rapid global cognitive decline. Discussion: Our data suggest that structural MRI can be used to identify biologically and clinically meaningful subtypes of AD.
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Affiliation(s)
- Rik Ossenkoppele
- Lund University, Clinical Memory Research Unit, Lund, Sweden.,Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences King's College London, London, United Kingdom.,Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,Centre for Medical Image Computing, Department of Medical Physics, University College London, United Kingdom
| | | | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Jae Yong Choi
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Division of RI-Convergence Research, Korea Institute Radiological and Medical Sciences, Seoul, South Korea
| | - Ruben Smith
- Lund University, Clinical Memory Research Unit, Lund, Sweden
| | - Olof Strandberg
- Lund University, Clinical Memory Research Unit, Lund, Sweden
| | | | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Karolinska Institute, Care Sciences and Society, Stockholm, Sweden
| | - Richard Tsai
- Department of Neurology, University of California San Francisco, Memory and Aging Center, San Francisco, USA
| | - Joel Kramer
- Department of Neurology, University of California San Francisco, Memory and Aging Center, San Francisco, USA
| | - Adam L Boxer
- Division of Clinical Geriatrics, Department of Neurobiology, Karolinska Institute, Care Sciences and Society, Stockholm, Sweden
| | - Maria L Gorno-Tempini
- Department of Neurology, University of California San Francisco, Memory and Aging Center, San Francisco, USA
| | - Renaud La Joie
- Department of Neurology, University of California San Francisco, Memory and Aging Center, San Francisco, USA
| | - Bruce L Miller
- Department of Neurology, University of California San Francisco, Memory and Aging Center, San Francisco, USA
| | - Gil D Rabinovici
- Department of Neurology, University of California San Francisco, Memory and Aging Center, San Francisco, USA
| | - Oskar Hansson
- Lund University, Clinical Memory Research Unit, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
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32
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Wada-Isoe K, Kikuchi T, Umeda-Kameyama Y, Mori T, Akishita M, Nakamura Y. ABC Dementia Scale Classifies Alzheimer's Disease Patients into Subgroups Characterized by Activities of Daily Living, Behavioral and Psychological Symptoms of Dementia, and Cognitive Function. J Alzheimers Dis 2020; 73:383-392. [PMID: 31771061 PMCID: PMC7029317 DOI: 10.3233/jad-190767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/27/2022]
Abstract
The course of Alzheimer's disease (AD) varies between individuals, and the relationship between cognitive and functional decline and the deterioration of behavioral and psychological symptoms of dementia (BPSD) is still poorly understood. Until recently, it was challenging to monitor subsequent changes in these symptoms because there was no single composite scale available that could simultaneously evaluate activities of daily living (ADL), BPSD, and cognitive function (CF) states. The present authors developed a new, brief assessment scale, the "ABC Dementia Scale" (ABC-DS), which is based on item response theory and facilitates concurrent measurement of ADL, BPSD, and CF states. We previously presented the reliability, construct validity, concurrent validity, and responsiveness of the ABC-DS. We obtained the evidence through three clinical trials featuring 1,400 subjects in total. In the present study, we performed a secondary analysis of the data obtained in the previous study. We conducted hierarchical cluster analyses that allowed us to classify 197 AD patients in terms of similarities regarding ADL, BPSD, and CF domain scores, as measured by the ABC-DS. Consequently, the scale identified subgroups of patients with global clinical dementia ratings of 1, 2, and 3. Considering our results in conjunction with the clinical experiences of the AD expert among the present authors regarding longitudinal changes in ADL, BPSD, and CF, we were able to propose potential progression pathways of AD in the form of a hypothetical roadmap.
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Affiliation(s)
- Kenji Wada-Isoe
- Department of Dementia Research, Kawasaki Medical School, Kita-ku, Okayama, Japan
| | - Takashi Kikuchi
- Translational Research Informatics Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Chuo-ku Kobe, Hyogo, Japan
| | - Yumi Umeda-Kameyama
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Mori
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yu Nakamura
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - on behalf of the ABC Dementia Scale Research Group
- Department of Dementia Research, Kawasaki Medical School, Kita-ku, Okayama, Japan
- Translational Research Informatics Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Chuo-ku Kobe, Hyogo, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
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33
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Krajcovicova L, Klobusiakova P, Rektorova I. Gray Matter Changes in Parkinson's and Alzheimer's Disease and Relation to Cognition. Curr Neurol Neurosci Rep 2019; 19:85. [PMID: 31720859 PMCID: PMC6854046 DOI: 10.1007/s11910-019-1006-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW We summarize structural (s)MRI findings of gray matter (GM) atrophy related to cognitive impairment in Alzheimer's disease (AD) and Parkinson's disease (PD) in light of new analytical approaches and recent longitudinal studies results. RECENT FINDINGS The hippocampus-to-cortex ratio seems to be the best sMRI biomarker to discriminate between various AD subtypes, following the spatial distribution of tau pathology, and predict rate of cognitive decline. PD is clinically far more variable than AD, with heterogeneous underlying brain pathology. Novel multivariate approaches have been used to describe patterns of early subcortical and cortical changes that relate to more malignant courses of PD. New emerging analytical approaches that combine structural MRI data with clinical and other biomarker outcomes hold promise for detecting specific GM changes in the early stages of PD and preclinical AD that may predict mild cognitive impairment and dementia conversion.
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Affiliation(s)
- Lenka Krajcovicova
- Applied Neuroscience Research Group, CEITEC, Masaryk University, Kamenice 5, Brno, Czech Republic
- First Department of Neurology, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Pekarska 53, Brno, Czech Republic
| | - Patricia Klobusiakova
- Applied Neuroscience Research Group, CEITEC, Masaryk University, Kamenice 5, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Irena Rektorova
- Applied Neuroscience Research Group, CEITEC, Masaryk University, Kamenice 5, Brno, Czech Republic.
- First Department of Neurology, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Pekarska 53, Brno, Czech Republic.
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Böhle M, Eitel F, Weygandt M, Ritter K. Layer-Wise Relevance Propagation for Explaining Deep Neural Network Decisions in MRI-Based Alzheimer's Disease Classification. Front Aging Neurosci 2019; 11:194. [PMID: 31417397 PMCID: PMC6685087 DOI: 10.3389/fnagi.2019.00194] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022] Open
Abstract
Deep neural networks have led to state-of-the-art results in many medical imaging tasks including Alzheimer's disease (AD) detection based on structural magnetic resonance imaging (MRI) data. However, the network decisions are often perceived as being highly non-transparent, making it difficult to apply these algorithms in clinical routine. In this study, we propose using layer-wise relevance propagation (LRP) to visualize convolutional neural network decisions for AD based on MRI data. Similarly to other visualization methods, LRP produces a heatmap in the input space indicating the importance/relevance of each voxel contributing to the final classification outcome. In contrast to susceptibility maps produced by guided backpropagation ("Which change in voxels would change the outcome most?"), the LRP method is able to directly highlight positive contributions to the network classification in the input space. In particular, we show that (1) the LRP method is very specific for individuals ("Why does this person have AD?") with high inter-patient variability, (2) there is very little relevance for AD in healthy controls and (3) areas that exhibit a lot of relevance correlate well with what is known from literature. To quantify the latter, we compute size-corrected metrics of the summed relevance per brain area, e.g., relevance density or relevance gain. Although these metrics produce very individual "fingerprints" of relevance patterns for AD patients, a lot of importance is put on areas in the temporal lobe including the hippocampus. After discussing several limitations such as sensitivity toward the underlying model and computation parameters, we conclude that LRP might have a high potential to assist clinicians in explaining neural network decisions for diagnosing AD (and potentially other diseases) based on structural MRI data.
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Affiliation(s)
- Moritz Böhle
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Bernstein Center for Computational Neuroscience, Berlin, Germany
| | - Fabian Eitel
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Bernstein Center for Computational Neuroscience, Berlin, Germany
| | - Martin Weygandt
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Excellence Cluster NeuroCure Berlin, Berlin, Germany
| | - Kerstin Ritter
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Bernstein Center for Computational Neuroscience, Berlin, Germany
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35
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Ten Kate M, Dicks E, Visser PJ, van der Flier WM, Teunissen CE, Barkhof F, Scheltens P, Tijms BM. Atrophy subtypes in prodromal Alzheimer's disease are associated with cognitive decline. Brain 2019; 141:3443-3456. [PMID: 30351346 DOI: 10.1093/brain/awy264] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/05/2018] [Indexed: 01/09/2023] Open
Abstract
Alzheimer's disease is a heterogeneous disorder. Understanding the biological basis for this heterogeneity is key for developing personalized medicine. We identified atrophy subtypes in Alzheimer's disease dementia and tested whether these subtypes are already present in prodromal Alzheimer's disease and could explain interindividual differences in cognitive decline. First we retrospectively identified atrophy subtypes from structural MRI with a data-driven cluster analysis in three datasets of patients with Alzheimer's disease dementia: discovery data (dataset 1: n = 299, age = 67 ± 8, 50% female), and two independent external validation datasets (dataset 2: n = 181, age = 66 ± 7, 52% female; dataset 3: n = 227, age = 74 ± 8, 44% female). Subtypes were compared on clinical, cognitive and biological characteristics. Next, we classified prodromal Alzheimer's disease participants (n = 603, age = 72 ± 8, 43% female) according to the best matching subtype to their atrophy pattern, and we tested whether subtypes showed cognitive decline in specific domains. In all Alzheimer's disease dementia datasets we consistently identified four atrophy subtypes: (i) medial-temporal predominant atrophy with worst memory and language function, older age, lowest CSF tau levels and highest amount of vascular lesions; (ii) parieto-occipital atrophy with poor executive/attention and visuospatial functioning and high CSF tau; (iii) mild atrophy with best cognitive performance, young age, but highest CSF tau levels; and (iv) diffuse cortical atrophy with intermediate clinical, cognitive and biological features. Prodromal Alzheimer's disease participants classified into one of these subtypes showed similar subtype characteristics at baseline as Alzheimer's disease dementia subtypes. Compared across subtypes in prodromal Alzheimer's disease, the medial-temporal subtype showed fastest decline in memory and language over time; the parieto-occipital subtype declined fastest on executive/attention domain; the diffuse subtype in visuospatial functioning; and the mild subtype showed intermediate decline in all domains. Robust atrophy subtypes exist in Alzheimer's disease with distinct clinical and biological disease expression. Here we observe that these subtypes can already be detected in prodromal Alzheimer's disease, and that these may inform on expected trajectories of cognitive decline.
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Affiliation(s)
- Mara Ten Kate
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Ellen Dicks
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, VU University Medical Center, Neuroscience Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Betty M Tijms
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Torok J, Maia PD, Powell F, Pandya S, Raj A. A method for inferring regional origins of neurodegeneration. Brain 2019; 141:863-876. [PMID: 29409009 DOI: 10.1093/brain/awx371] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 11/08/2017] [Indexed: 01/20/2023] Open
Abstract
Alzheimer's disease, the most common form of dementia, is characterized by the emergence and spread of senile plaques and neurofibrillary tangles, causing widespread neurodegeneration. Though the progression of Alzheimer's disease is considered to be stereotyped, the significant variability within clinical populations obscures this interpretation on the individual level. Of particular clinical importance is understanding where exactly pathology, e.g. tau, emerges in each patient and how the incipient atrophy pattern relates to future spread of disease. Here we demonstrate a newly developed graph theoretical method of inferring prior disease states in patients with Alzheimer's disease and mild cognitive impairment using an established network diffusion model and an L1-penalized optimization algorithm. Although the 'seeds' of origin using our inference method successfully reproduce known trends in Alzheimer's disease staging on a population level, we observed that the high degree of heterogeneity between patients at baseline is also reflected in their seeds. Additionally, the individualized seeds are significantly more predictive of future atrophy than a single seed placed at the hippocampus. Our findings illustrate that understanding where disease originates in individuals is critical to determining how it progresses and that our method allows us to infer early stages of disease from atrophy patterns observed at diagnosis.
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Affiliation(s)
- Justin Torok
- Department of Radiology, Weill Cornell Medical College of Cornell University, 407 E. 61 Street, RR106, New York, NY 10065, USA
| | - Pedro D Maia
- Department of Radiology, Weill Cornell Medical College of Cornell University, 407 E. 61 Street, RR106, New York, NY 10065, USA
| | - Fon Powell
- Department of Radiology, Weill Cornell Medical College of Cornell University, 407 E. 61 Street, RR106, New York, NY 10065, USA
| | - Sneha Pandya
- Department of Radiology, Weill Cornell Medical College of Cornell University, 407 E. 61 Street, RR106, New York, NY 10065, USA
| | - Ashish Raj
- Department of Radiology, Weill Cornell Medical College of Cornell University, 407 E. 61 Street, RR106, New York, NY 10065, USA
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Meyer F, Wehenkel M, Phillips C, Geurts P, Hustinx R, Bernard C, Bastin C, Salmon E. Characterization of a temporoparietal junction subtype of Alzheimer's disease. Hum Brain Mapp 2019; 40:4279-4286. [PMID: 31243829 DOI: 10.1002/hbm.24701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 01/01/2023] Open
Abstract
Alzheimer's disease (AD) subtypes have been described according to genetics, neuropsychology, neuropathology, and neuroimaging. Thirty-one patients with clinically probable AD were selected based on perisylvian metabolic decrease on FDG-PET. They were compared to 25 patients with a typical pattern of decreased posterior metabolism. Tree-based machine learning was used on those 56 images to create a classifier that was subsequently applied to 207 Alzheimer's Disease Neuroimaging Initiative (ADNI) patients with AD. Machine learning was also used to discriminate between the two ADNI groups based on neuropsychological scores. Compared to AD patients with a typical precuneus metabolic decrease, the new subtype showed stronger hypometabolism in the temporoparietal junction. The classifier was able to distinguish the two groups in the ADNI population. Both groups could only be distinguished cognitively by Trail Making Test-A scores. This study further confirms that there is more than a typical metabolic pattern in probable AD with amnestic presentation.
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Affiliation(s)
- François Meyer
- GIGA-Cyclotron Research Centre in vivo imaging, University of Liège, Liège, Belgium
| | - Marie Wehenkel
- GIGA-Cyclotron Research Centre in vivo imaging, University of Liège, Liège, Belgium.,Department of Electrical Engineering and Computer Science, University of Liège, Liège, Belgium
| | - Christophe Phillips
- GIGA-Cyclotron Research Centre in vivo imaging, University of Liège, Liège, Belgium
| | - Pierre Geurts
- Department of Electrical Engineering and Computer Science, University of Liège, Liège, Belgium
| | - Roland Hustinx
- Nuclear Medecine Department, CHU of Liège, University of Liège, Liège, Belgium
| | - Claire Bernard
- Nuclear Medecine Department, CHU of Liège, University of Liège, Liège, Belgium
| | - Christine Bastin
- GIGA-Cyclotron Research Centre in vivo imaging, University of Liège, Liège, Belgium
| | - Eric Salmon
- GIGA-Cyclotron Research Centre in vivo imaging, University of Liège, Liège, Belgium
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Garcia-Gorro C, Llera A, Martinez-Horta S, Perez-Perez J, Kulisevsky J, Rodriguez-Dechicha N, Vaquer I, Subira S, Calopa M, Muñoz E, Santacruz P, Ruiz-Idiago J, Mareca C, Beckmann CF, de Diego-Balaguer R, Camara E. Specific patterns of brain alterations underlie distinct clinical profiles in Huntington's disease. Neuroimage Clin 2019; 23:101900. [PMID: 31255947 PMCID: PMC6606833 DOI: 10.1016/j.nicl.2019.101900] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
Huntington's disease (HD) is a genetic neurodegenerative disease which involves a triad of motor, cognitive and psychiatric disturbances. However, there is great variability in the prominence of each type of symptom across individuals. The neurobiological basis of such variability remains poorly understood but would be crucial for better tailored treatments. Multivariate multimodal neuroimaging approaches have been successful in disentangling these profiles in other disorders. Thus we applied for the first time such approach to HD. We studied the relationship between HD symptom domains and multimodal measures sensitive to grey and white matter structural alterations. Forty-three HD gene carriers (23 manifest and 20 premanifest individuals) were scanned and underwent behavioural assessments evaluating motor, cognitive and psychiatric domains. We conducted a multimodal analysis integrating different structural neuroimaging modalities measuring grey matter volume, cortical thickness and white matter diffusion indices - fractional anisotropy and radial diffusivity. All neuroimaging measures were entered into a linked independent component analysis in order to obtain multimodal components reflecting common inter-subject variation across imaging modalities. The relationship between multimodal neuroimaging independent components and behavioural measures was analysed using multiple linear regression. We found that cognitive and motor symptoms shared a common neurobiological basis, whereas the psychiatric domain presented a differentiated neural signature. Behavioural measures of different symptom domains correlated with different neuroimaging components, both the brain regions involved and the neuroimaging modalities most prominently associated with each type of symptom showing differences. More severe cognitive and motor signs together were associated with a multimodal component consisting in a pattern of reduced grey matter, cortical thickness and white matter integrity in cognitive and motor related networks. In contrast, depressive symptoms were associated with a component mainly characterised by reduced cortical thickness pattern in limbic and paralimbic regions. In conclusion, using a multivariate multimodal approach we were able to disentangle the neurobiological substrates of two distinct symptom profiles in HD: one characterised by cognitive and motor features dissociated from a psychiatric profile. These results open a new view on a disease classically considered as a uniform entity and initiates a new avenue for further research considering these qualitative individual differences.
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Affiliation(s)
- Clara Garcia-Gorro
- Cognition and Brain Plasticity Unit, L'Hospitalet de Llobregat (Barcelona), IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Alberto Llera
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
| | - Saul Martinez-Horta
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
| | - Jesus Perez-Perez
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
- Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Irene Vaquer
- Hestia Duran i Reynals, Hospital Duran i Reynals, Hospitalet de Llobregat (Barcelona), Spain
| | - Susana Subira
- Hestia Duran i Reynals, Hospital Duran i Reynals, Hospitalet de Llobregat (Barcelona), Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matilde Calopa
- Movement Disorders Unit, Neurology Service, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Esteban Muñoz
- Movement Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
| | - Pilar Santacruz
- Movement Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - Jesus Ruiz-Idiago
- Hospital Mare de Deu de la Mercè, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Celia Mareca
- Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Christian F. Beckmann
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruth de Diego-Balaguer
- Cognition and Brain Plasticity Unit, L'Hospitalet de Llobregat (Barcelona), IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
- The Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- ICREA (Catalan Institute for Research and Advanced Studies), Barcelona, Spain
| | - Estela Camara
- Cognition and Brain Plasticity Unit, L'Hospitalet de Llobregat (Barcelona), IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), Spain
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Ferreira D, Pereira JB, Volpe G, Westman E. Subtypes of Alzheimer's Disease Display Distinct Network Abnormalities Extending Beyond Their Pattern of Brain Atrophy. Front Neurol 2019; 10:524. [PMID: 31191430 PMCID: PMC6547836 DOI: 10.3389/fneur.2019.00524] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 05/01/2019] [Indexed: 01/08/2023] Open
Abstract
Different subtypes of Alzheimer's disease (AD) with characteristic distributions of neurofibrillary tangles and corresponding brain atrophy patterns have been identified using structural magnetic resonance imaging (MRI). However, the underlying biological mechanisms that determine this differential expression of neurofibrillary tangles are still unknown. Here, we applied graph theoretical analysis to structural MRI data to test the hypothesis that differential network disruption is at the basis of the emergence of these AD subtypes. We studied a total of 175 AD patients and 81 controls. Subtyping was done using the Scheltens' scale for medial temporal lobe atrophy, the Koedam's scale for posterior atrophy, and the Pasquier's global cortical atrophy scale for frontal atrophy. A total of 89 AD patients showed a brain atrophy pattern consistent with typical AD; 30 patients showed a limbic-predominant pattern; 29 patients showed a hippocampal-sparing pattern; and 27 showed minimal atrophy. We built brain structural networks from 68 cortical regions and 14 subcortical gray matter structures for each AD subtype and for the controls, and we compared between-group measures of integration, segregation, and modular organization. At the global level, modularity was increased and differential modular reorganization was detected in the four subtypes. We also found a decrease of transitivity in the typical and hippocampal-sparing subtypes, as well as an increase of average local efficiency in the minimal atrophy and hippocampal-sparing subtypes. We conclude that the AD subtypes have a distinct signature of network disruption associated with their atrophy patterns and further extending to other brain regions, presumably reflecting the differential spread of neurofibrillary tangles. We discuss the hypothetical emergence of these subtypes and possible clinical implications.
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Affiliation(s)
- Daniel Ferreira
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Joana B Pereira
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Giovanni Volpe
- Department of Physics, University of Gothenburg, Gothenburg, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
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40
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Tam A, Dansereau C, Iturria-Medina Y, Urchs S, Orban P, Sharmarke H, Breitner J, Bellec P. A highly predictive signature of cognition and brain atrophy for progression to Alzheimer's dementia. Gigascience 2019; 8:giz055. [PMID: 31077314 PMCID: PMC6511068 DOI: 10.1093/gigascience/giz055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/07/2019] [Accepted: 04/21/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Clinical trials in Alzheimer's disease need to enroll patients whose cognition will decline over time, if left untreated, in order to demonstrate the efficacy of an intervention. Machine learning models used to screen for patients at risk of progression to dementia should therefore favor specificity (detecting only progressors) over sensitivity (detecting all progressors), especially when the prevalence of progressors is low. Here, we explore whether such high-risk patients can be identified using cognitive assessments and structural neuroimaging by training machine learning tools in a high-specificity regime. RESULTS A multimodal signature of Alzheimer's dementia was first extracted from the ADNI1 dataset. We then validated the predictive value of this signature on ADNI1 patients with mild cognitive impairment (N = 235). The signature was optimized to predict progression to dementia over 3 years with low sensitivity (55.1%) but high specificity (95.6%), resulting in only moderate accuracy (69.3%) but high positive predictive value (80.4%, adjusted for a "typical" 33% prevalence rate of true progressors). These results were replicated in ADNI2 (N = 235), with 87.8% adjusted positive predictive value (96.7% specificity, 47.3% sensitivity, 85.1% accuracy). CONCLUSIONS We found that cognitive measures alone could identify high-risk individuals, with structural measurements providing a slight improvement. The signature had comparable receiver operating characteristics to standard machine learning tools, yet a marked improvement in positive predictive value was achieved over the literature by selecting a high-specificity operating point. The multimodal signature can be readily applied for the enrichment of clinical trials.
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Affiliation(s)
- Angela Tam
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, QC, H3W 1W4, Canada
- Centre for the Studies on Prevention of Alzheimer's Disease, Douglas Mental Health University Institute Research Centre, 6875 Lasalle Boulevard, Montréal, QC, H4H 1R3, Canada
| | - Christian Dansereau
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, QC, H3W 1W4, Canada
- Département d'informatique et de recherche opérationnelle, Université de Montréal, 2920 chemin de la Tour, Montréal, QC, H3T 1J4, Canada
| | - Yasser Iturria-Medina
- Montreal Neurological Institute, McGill University, 3801 University Street, Montréal, QC, H3A 2B4, Canada
| | - Sebastian Urchs
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, QC, H3W 1W4, Canada
- Montreal Neurological Institute, McGill University, 3801 University Street, Montréal, QC, H3A 2B4, Canada
| | - Pierre Orban
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, QC, H3W 1W4, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, 7331 rue Hochelaga, Montréal, QC, H1N 3V2, Canada
- Département de psychiatrie, Université de Montréal, 2900 boulevard Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada
| | - Hanad Sharmarke
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, QC, H3W 1W4, Canada
| | - John Breitner
- Centre for the Studies on Prevention of Alzheimer's Disease, Douglas Mental Health University Institute Research Centre, 6875 Lasalle Boulevard, Montréal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC, H3A 1A1, Canada
| | - Pierre Bellec
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, QC, H3W 1W4, Canada
- Département de psychologie, Université de Montréal, 90 avenue Vincent d'Indy, Montréal, QC, H3C 3J7, Canada
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Abstract
PURPOSE OF REVIEW The aim of this study was to discuss the contribution of neuroimaging studies to our understanding of Alzheimer's disease. We now have the capability of measuring both tau and beta-amyloid (Aβ) proteins in the brain, which together with more traditional neuroimaging modalities, has led the field to focus on using neuroimaging to better characterize disease mechanisms underlying Alzheimer's disease. RECENT FINDINGS Studies have utilized tau and Aβ PET, as well as [18F]fluorodeoxyglucose PET, and structural and functional MRI, to investigate the following topics: phenotypic variability in Alzheimer's disease , including how neuroimaging findings are related to clinical phenotype and age; multimodality analyses to investigate the relationships between different neuroimaging modalities and what that teaches us about disease mechanisms; disease staging by assessing neuroimaging changes in the very earliest phases of the disease in cognitively normal individuals and individuals carrying an autosomal dominant Alzheimer's disease mutation; and influence of other comorbidities and proteins to the disease process. SUMMARY The findings shed light on the role of tau and Aβ, as well as age and other comorbidities, in the neurodegenerative process in Alzheimer's disease. This knowledge will be crucial in the development of better disease biomarkers and targeted therapeutic approaches.
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Jang H, Park JY, Jang YK, Kim HJ, Lee JS, Na DL, Noh Y, Lockhart SN, Seong JK, Seo SW. Distinct amyloid distribution patterns in amyloid positive subcortical vascular cognitive impairment. Sci Rep 2018; 8:16178. [PMID: 30385819 PMCID: PMC6212495 DOI: 10.1038/s41598-018-34032-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/25/2018] [Indexed: 11/09/2022] Open
Abstract
Amyloid-β (Aβ) and cerebral small vessel disease (CSVD) commonly coexist. They can occur independently by chance, or may interact with each other. We aimed to determine whether the distribution of Aβ in subcortical vascular cognitive impairments (SVCI) patients can be classified by the underlying pathobiologies. A total of 45 11C-Pittsburgh compound B PET positive (PiB(+)) SVCI patients were included in this study. They were classified using a new cluster analysis method which adopted the Louvain method, which finds optimal decomposition of the participants based on similarity of relative Aβ deposition pattern. We measured atherosclerotic cerebral small vessel disease (CSVD) markers and cerebral amyloid angiopathy (CAA) markers. Forty-five PiB(+) SVCI patients were classified into two groups: 17 patients with the characteristic Alzheimer's disease like Aβ uptake with sparing of occipital region (OccSp) and 28 patients with occipital predominant Aβ uptake (OccP). Compared to OccSp group, OccP group had more postive association of atherosclerotic CSVD score (p for interaction = 0.044), but not CAA score with occipital/global ratio of PiB uptake. Our findings suggested that Aβ positive SVCI patients might consist of heterogeneous groups with combined CSVD and Aβ resulting from various pathobiologies. Furthermore, atherosclerotic CSVD might explain increased occipital Aβ uptakes.
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Affiliation(s)
- Hyemin Jang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jong-Yun Park
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea
| | - Young Kyoung Jang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Hee Jin Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jin San Lee
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea
| | - Duk L Na
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Korea
- Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Young Noh
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, Korea
| | - Samuel N Lockhart
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea.
| | - Sang Won Seo
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Neuroscience Center, Samsung Medical Center, Seoul, Korea.
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.
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Sui X, Rajapakse JC. Profiling heterogeneity of Alzheimer's disease using white-matter impairment factors. NEUROIMAGE-CLINICAL 2018; 20:1222-1232. [PMID: 30412925 PMCID: PMC6226553 DOI: 10.1016/j.nicl.2018.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/28/2018] [Accepted: 10/23/2018] [Indexed: 01/09/2023]
Abstract
The clinical presentation of Alzheimer's disease (AD) is not unitary as heterogeneity exists in the disease's clinical and anatomical characteristics. MRI studies have revealed that heterogeneous gray matter atrophy patterns are associated with specific traits of cognitive decline. Although white matter (WM) impairment also contributes to AD pathology, its heterogeneity remains unclear. The Latent Dirichlet Allocation (LDA) method is a suitable framework to study heterogeneity and allows to identify latent impairment factors of AD instead of simply mapping an overall disease effect. By exploring whole brain WM skeleton images by using LDA, three latent factors were revealed in AD: a temporal-frontal impairment factor (temporal and frontal lobes, especially hippocampus and para-hippocampus), a parietal factor (parietal lobe, especially precuneus), and a long fibre bundle factor (corpus callosum and superior longitudinal fasciculus). As revealed by longitudinal analysis, the latent factors have distinct impact on cognitive decline: for executive function (EF), the temporal-frontal factor was more strongly associated with baseline EF compared with the parietal factor, while the long-fibre bundle factor was most associated with decline rate of EF; for memory, the three factors showed almost equal effect on the baseline memory and decline rate. For each participant, LDA estimates his/her composition profile of latent impairment factors, which indicates disease subtype. We also found that the APOE genotype affects the AD subtype. Specifically, APOE ε4 was more associated with the long fibre bundle factor and APOE ε2 was more associated with temporal-frontal factor. By investigating heterogeneity and subtypes of AD through white matter impairment factors, our study could facilitate precision medicine. LDA revealed three latent white matter impairment factors in Alzheimer’s disease. Latent factors associate with executive function and memory decline differently. Individual factor composition indicates disease subtype. The APOE genotype is associated with the factor composition.
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Affiliation(s)
- Xiuchao Sui
- School of Computer Science and Engineering, Nanyang Technological University, 639798, Singapore
| | - Jagath C Rajapakse
- School of Computer Science and Engineering, Nanyang Technological University, 639798, Singapore.
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- School of Computer Science and Engineering, Nanyang Technological University, 639798, Singapore
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Veitch DP, Weiner MW, Aisen PS, Beckett LA, Cairns NJ, Green RC, Harvey D, Jack CR, Jagust W, Morris JC, Petersen RC, Saykin AJ, Shaw LM, Toga AW, Trojanowski JQ. Understanding disease progression and improving Alzheimer's disease clinical trials: Recent highlights from the Alzheimer's Disease Neuroimaging Initiative. Alzheimers Dement 2018; 15:106-152. [PMID: 30321505 DOI: 10.1016/j.jalz.2018.08.005] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The overall goal of the Alzheimer's Disease Neuroimaging Initiative (ADNI) is to validate biomarkers for Alzheimer's disease (AD) clinical trials. ADNI is a multisite, longitudinal, observational study that has collected many biomarkers since 2004. Recent publications highlight the multifactorial nature of late-onset AD. We discuss selected topics that provide insights into AD progression and outline how this knowledge may improve clinical trials. METHODS We used standard methods to identify nearly 600 publications using ADNI data from 2016 and 2017 (listed in Supplementary Material and searchable at http://adni.loni.usc.edu/news-publications/publications/). RESULTS (1) Data-driven AD progression models supported multifactorial interactions rather than a linear cascade of events. (2) β-Amyloid (Aβ) deposition occurred concurrently with functional connectivity changes within the default mode network in preclinical subjects and was followed by specific and progressive disconnection of functional and anatomical networks. (3) Changes in functional connectivity, volumetric measures, regional hypometabolism, and cognition were detectable at subthreshold levels of Aβ deposition. 4. Tau positron emission tomography imaging studies detailed a specific temporal and spatial pattern of tau pathology dependent on prior Aβ deposition, and related to subsequent cognitive decline. 5. Clustering studies using a wide range of modalities consistently identified a "typical AD" subgroup and a second subgroup characterized by executive impairment and widespread cortical atrophy in preclinical and prodromal subjects. 6. Vascular pathology burden may act through both Aβ dependent and independent mechanisms to exacerbate AD progression. 7. The APOE ε4 allele interacted with cerebrovascular disease to impede Aβ clearance mechanisms. 8. Genetic approaches identified novel genetic risk factors involving a wide range of processes, and demonstrated shared genetic risk for AD and vascular disorders, as well as the temporal and regional pathological associations of established AD risk alleles. 9. Knowledge of early pathological changes guided the development of novel prognostic biomarkers for preclinical subjects. 10. Placebo populations of randomized controlled clinical trials had highly variable trajectories of cognitive change, underscoring the importance of subject selection and monitoring. 11. Selection criteria based on Aβ positivity, hippocampal volume, baseline cognitive/functional measures, and APOE ε4 status in combination with improved cognitive outcome measures were projected to decrease clinical trial duration and cost. 12. Multiple concurrent therapies targeting vascular health and other AD pathology in addition to Aβ may be more effective than single therapies. DISCUSSION ADNI publications from 2016 and 2017 supported the idea of AD as a multifactorial disease and provided insights into the complexities of AD disease progression. These findings guided the development of novel biomarkers and suggested that subject selection on the basis of multiple factors may lower AD clinical trial costs and duration. The use of multiple concurrent therapies in these trials may prove more effective in reversing AD disease progression.
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Affiliation(s)
- Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA.
| | - Paul S Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Laurel A Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Nigel J Cairns
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA; Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - William Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - John C Morris
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Alzheimer's Disease Core Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Udall Parkinson's Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kim HJ, Park JY, Seo SW, Jung YH, Kim Y, Jang H, Kim ST, Seong JK, Na DL. Cortical atrophy pattern-based subtyping predicts prognosis of amnestic MCI: an individual-level analysis. Neurobiol Aging 2018; 74:38-45. [PMID: 30415126 DOI: 10.1016/j.neurobiolaging.2018.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/19/2018] [Accepted: 10/05/2018] [Indexed: 01/18/2023]
Abstract
We categorized patients with amnestic mild cognitive impairment (aMCI) based on cortical atrophy patterns and evaluated whether the prognosis differed across the subtypes. Furthermore, we developed a classifier that learns the cortical atrophy pattern and predicts subtypes at an individual level. A total of 662 patients with aMCI were clustered into 3 subtypes based on cortical atrophy patterns. Of these, 467 patients were followed up for more than 12 months, and the median follow-up duration was 43 months. To predict individual-level subtype, we used a machine learning-based classifier with a 10-fold cross-validation scheme. Patients with aMCI were clustered into 3 subtypes: medial temporal atrophy, minimal atrophy (Min), and parietotemporal atrophy (PT) subtypes. The PT subtype had higher prevalence of APOE ε4 carriers, amyloid PET positivity, and greater risk of dementia conversion than the Min subtype. The accuracy for binary classification was 89.3% (MT vs. Rest), 92.6% (PT vs. Rest), and 86.6% (Min vs. Rest). When we used ensemble model of 3 binary classifiers, the accuracy for predicting the aMCI subtype at an individual level was 89.6%. Patients with aMCI with the PT subtype were more likely to have underlying Alzheimer's disease pathology and showed the worst prognosis. Our classifier may be useful for predicting the prognosis of individual aMCI patients.
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Affiliation(s)
- Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jong-Yun Park
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Young Hee Jung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Yeshin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea.
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
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Goyal D, Tjandra D, Migrino RQ, Giordani B, Syed Z, Wiens J. Characterizing heterogeneity in the progression of Alzheimer's disease using longitudinal clinical and neuroimaging biomarkers. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2018; 10:629-637. [PMID: 30456290 PMCID: PMC6234900 DOI: 10.1016/j.dadm.2018.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Models characterizing intermediate disease stages of Alzheimer's disease (AD) are needed to inform clinical care and prognosis. Current models, however, use only a small subset of available biomarkers, capturing only coarse changes along the complete spectrum of disease progression. We propose the use of machine learning techniques and clinical, biochemical, and neuroimaging biomarkers to characterize progression to AD. METHODS We used a large multimodal longitudinal data set of biomarkers and demographic and genotype information from 1624 participants from the Alzheimer's Disease Neuroimaging Initiative. Using hidden Markov models, we characterized intermediate disease stages. We validated inferred disease trajectories by comparing time to first clinical AD diagnosis. We trained an L2-regularized logistic regression model to predict disease trajectory and evaluated its discriminative performance on a test set. RESULTS We identified 12 distinct disease states. Progression to AD occurred most often through one of two possible paths through these states. Paths differed in terms of rate of disease progression (by 5.44 years on average), amyloid and total-tau (t-tau) burden (by 10% and 69%, respectively), and hippocampal neurodegeneration (P < .001). On the test set, the predictive model achieved an area under the receiver operating characteristic curve of 0.85. DISCUSSION Progression to AD, in terms of biomarker trajectories, can be predicted based on participant-specific factors. Such disease staging tools could help in targeting high-risk patients for therapeutic intervention trials. As longitudinal data with richer features are collected, such models will help increase our understanding of the factors that drive the different trajectories of AD.
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Affiliation(s)
- Devendra Goyal
- Computer Science and Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Donna Tjandra
- Computer Science and Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | - Bruno Giordani
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Zeeshan Syed
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Jenna Wiens
- Computer Science and Engineering, University of Michigan, Ann Arbor, MI, USA
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Kim J, Na HK, Byun J, Shin J, Kim S, Lee BH, Na DL. Tracking Cognitive Decline in Amnestic Mild Cognitive Impairment and Early-Stage Alzheimer Dementia: Mini-Mental State Examination versus Neuropsychological Battery. Dement Geriatr Cogn Disord 2018; 44:105-117. [PMID: 28768247 DOI: 10.1159/000478520] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Although the Mini-Mental State Examination (MMSE), Clinical Dementia Rating-Sum of Boxes (CDR-SOB), and neuropsychological batteries are widely used for evaluating cognitive function, it remains elusive which instrument best reflects the longitudinal disease progression in amnestic mild cognitive impairment (aMCI) and probable Alzheimer disease (AD). We investigated whether changes in these three instruments over time correlate with loss of cortical gray matter volume (cGMV). METHODS We retrospectively investigated 204 patients (aMCI, n = 114; AD, n = 90) who had undergone MMSE, CDR-SOB, the dementia version of the Seoul Neuropsychological Screening Battery (SNSB-D), and 3-dimensional T1-weighted magnetic resonance images at least twice. We investigated the partial correlation between annual decline in test scores and percent change of cGMV. RESULTS In aMCI patients, changes in the SNSB-D total score (r = 0.340, p < 0.001) and CDR-SOB (r = 0.222, p = 0.020), but not MMSE, showed a correlation with cGMV loss, with the SNSB-D total score showing the strongest correlation. In AD patients, decline in all three test scores correlated significantly with cGMV loss, with MMSE exhibiting the strongest correlation (r = 0.464, p < 0.001). CONCLUSION In aMCI patients, neuropsychological battery, though time-consuming, was the most adequate tool in tracking disease progression. In AD patients, however, MMSE may be the most effective longitudinal monitoring tool when considering cost-effectiveness.
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Affiliation(s)
- Joonho Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
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Ferreira D, Shams S, Cavallin L, Viitanen M, Martola J, Granberg T, Shams M, Aspelin P, Kristoffersen-Wiberg M, Nordberg A, Wahlund LO, Westman E. The contribution of small vessel disease to subtypes of Alzheimer's disease: a study on cerebrospinal fluid and imaging biomarkers. Neurobiol Aging 2018; 70:18-29. [PMID: 29935417 DOI: 10.1016/j.neurobiolaging.2018.05.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/10/2018] [Accepted: 05/22/2018] [Indexed: 01/19/2023]
Abstract
We investigated whether subtypes of Alzheimer's disease (AD), that is, typical, limbic-predominant, hippocampal-sparing, and minimal atrophy AD, had a specific signature of small vessel disease and neurodegeneration. Four hundred twenty-three clinically diagnosed AD patients were included (161 typical, 121 limbic-predominant, 70 hippocampal-sparing, 71 minimal atrophy). One hundred fifty-six fulfilled a biomarkers-based AD diagnosis. White matter hyperintensities and cerebral microbleeds (CMB) had the highest prevalence in limbic-predominant AD, and the lowest prevalence in minimal atrophy AD. CMB existed evenly in lobar and deep brain areas in limbic-predominant, typical, and hippocampal-sparing AD. In minimal atrophy AD, CMB were mainly located in brain lobar areas. Perivascular spaces in the centrum semiovale were more prevalent in typical AD. Small vessel disease contributed to the prediction of Mini-Mental State Examination. Minimal atrophy AD showed highly pathological levels of cerebrospinal fluid Aß1-42, total tau, and phosphorylated tau, in the absence of overt brain atrophy. Cerebral amyloid angiopathy seems to have a stronger contribution to hippocampal-sparing and minimal atrophy AD, whereas hypertensive arteriopathy may have a stronger contribution to typical and limbic-predominant AD.
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Affiliation(s)
- Daniel Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Centre for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
| | - Sara Shams
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Cavallin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Matti Viitanen
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Centre for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Juha Martola
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tobias Granberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mana Shams
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Aspelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Kristoffersen-Wiberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences, and Society, Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm, Sweden; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Centre for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Centre for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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Lee WJ, Han CE, Aganj I, Seo SW, Seong JK. Distinct Patterns of Rich Club Organization in Alzheimer’s Disease and Subcortical Vascular Dementia: A White Matter Network Study. J Alzheimers Dis 2018; 63:977-987. [DOI: 10.3233/jad-180027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Wha Jin Lee
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea
| | - Cheol E. Han
- Department of Electronics and Information Engineering, Korea University, Sejong, Republic of Korea
| | - Iman Aganj
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea
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Poulakis K, Pereira JB, Mecocci P, Vellas B, Tsolaki M, Kłoszewska I, Soininen H, Lovestone S, Simmons A, Wahlund LO, Westman E. Heterogeneous patterns of brain atrophy in Alzheimer's disease. Neurobiol Aging 2018; 65:98-108. [DOI: 10.1016/j.neurobiolaging.2018.01.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 12/17/2022]
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