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Prakash M, Abdelaziz M, Zhang L, Strange BA, Tohka J. Quantitative Longitudinal Predictions of Alzheimer's Disease by Multi-Modal Predictive Learning. J Alzheimers Dis 2021; 79:1533-1546. [PMID: 33459714 DOI: 10.3233/jad-200906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Quantitatively predicting the progression of Alzheimer's disease (AD) in an individual on a continuous scale, such as the Alzheimer's Disease Assessment Scale-cognitive (ADAS-cog) scores, is informative for a personalized approach as opposed to qualitatively classifying the individual into a broad disease category. OBJECTIVE To evaluate the hypothesis that the multi-modal data and predictive learning models can be employed for future predicting ADAS-cog scores. METHODS Unimodal and multi-modal regression models were trained on baseline data comprised of demographics, neuroimaging, and cerebrospinal fluid based markers, and genetic factors to predict future ADAS-cog scores for 12, 24, and 36 months. We subjected the prediction models to repeated cross-validation and assessed the resulting mean absolute error (MAE) and cross-validated correlation (ρ) of the model. RESULTS Prediction models trained on multi-modal data outperformed the models trained on single modal data in predicting future ADAS-cog scores (MAE12, 24 & 36 months= 4.1, 4.5, and 5.0, ρ12, 24 & 36 months= 0.88, 0.82, and 0.75). Including baseline ADAS-cog scores to prediction models improved predictive performance (MAE12, 24 & 36 months= 3.5, 3.7, and 4.6, ρ12, 24 & 36 months= 0.89, 0.87, and 0.80). CONCLUSION Future ADAS-cog scores were predicted which could aid clinicians in identifying those at greater risk of decline and apply interventions at an earlier disease stage and inform likely future disease progression in individuals enrolled in AD clinical trials.
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Affiliation(s)
- Mithilesh Prakash
- University of Eastern Finland, A.I. Virtanen Institute for Molecular Sciences, Kuopio, Finland
| | | | - Linda Zhang
- Department of Neuroimaging, Alzheimer's Disease Research Centre, Reina Sofia-CIEN Foundation, Madrid, Spain
| | - Bryan A Strange
- Department of Neuroimaging, Alzheimer's Disease Research Centre, Reina Sofia-CIEN Foundation, Madrid, Spain.,Laboratory for Clinical Neuroscience, CTB, Universidad Politécnica de Madrid, Madrid, Spain
| | - Jussi Tohka
- University of Eastern Finland, A.I. Virtanen Institute for Molecular Sciences, Kuopio, Finland
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Slayday RE, Gustavson DE, Elman JA, Beck A, McEvoy LK, Tu XM, Fang B, Hauger RL, Lyons MJ, McKenzie RE, Sanderson-Cimino ME, Xian H, Kremen WS, Franz CE. Interaction between Alcohol Consumption and Apolipoprotein E (ApoE) Genotype with Cognition in Middle-Aged Men. J Int Neuropsychol Soc 2021; 27:56-68. [PMID: 32662384 PMCID: PMC7856052 DOI: 10.1017/s1355617720000570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Heavy alcohol consumption is associated with poorer cognitive function in older adults. Although understudied in middle-aged adults, the relationship between alcohol and cognition may also be influenced by genetics such as the apolipoprotein (ApoE) ε4 allele, a risk factor for Alzheimer's disease. We examined the relationship between alcohol consumption, ApoE genotype, and cognition in middle-aged adults and hypothesized that light and/or moderate drinkers (≤2 drinks per day) would show better cognitive performance than heavy drinkers or non-drinkers. Additionally, we hypothesized that the association between alcohol use and cognitive function would differ by ApoE genotype (ε4+ vs. ε4-). METHOD Participants were 1266 men from the Vietnam Era Twin Study of Aging (VETSA; M age = 56; range 51-60) who completed a neuropsychological battery assessing seven cognitive abilities: general cognitive ability (GCA), episodic memory, processing speed, executive function, abstract reasoning, verbal fluency, and visuospatial ability. Alcohol consumption was categorized into five groups: never, former, light, moderate, and heavy. RESULTS In fully adjusted models, there was no significant main effect of alcohol consumption on cognitive functions. However, there was a significant interaction between alcohol consumption and ApoE ε4 status for GCA and episodic memory, such that the relationship of alcohol consumption and cognition was stronger in ε4 carriers. The ε4+ heavy drinking subgroup had the poorest GCA and episodic memory. CONCLUSIONS Presence of the ε4 allele may increase vulnerability to the deleterious effects of heavy alcohol consumption. Beneficial effects of light or moderate alcohol consumption were not observed.
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Affiliation(s)
- Riki E. Slayday
- Department of Psychology, San Diego State University, San
Diego, CA, USA
| | - Daniel E. Gustavson
- Department of Psychiatry, University of California San
Diego, La Jolla CA, USA
| | - Jeremy A. Elman
- Department of Psychiatry, University of California San
Diego, La Jolla CA, USA
| | - Asad Beck
- University of Washington, Graduate Program in Neuroscience,
Seattle, WA, USA
| | - Linda K. McEvoy
- Department of Radiology, University of California San
Diego, La Jolla, CA, USA
| | - Xin M. Tu
- Department of Family Medicine, University of California San
Diego, La Jolla, CA, USA
| | - Bin Fang
- Department of Psychiatry, University of California San
Diego, La Jolla CA, USA
| | - Richard L. Hauger
- Department of Psychiatry, University of California San
Diego, La Jolla CA, USA
- Center of Excellence for Stress and Mental Health, VA San
Diego Healthcare System, San Diego, CA, USA
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston
University, Boston, MA, USA
| | - Ruth E. McKenzie
- Department of Psychological and Brain Sciences, Boston
University, Boston, MA, USA
| | - Mark E. Sanderson-Cimino
- Department of Psychology, San Diego State University, San
Diego, CA, USA
- Department of Psychiatry, University of California San
Diego, La Jolla CA, USA
| | - Hong Xian
- Department of Biostatistics, St Louis University, St.
Louis, MO, USA
| | - William S. Kremen
- Department of Psychiatry, University of California San
Diego, La Jolla CA, USA
- Center of Excellence for Stress and Mental Health, VA San
Diego Healthcare System, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of
California San Diego, La Jolla CA, USA
| | - Carol E. Franz
- Department of Psychiatry, University of California San
Diego, La Jolla CA, USA
- Center for Behavior Genetics of Aging, University of
California San Diego, La Jolla CA, USA
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53
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Hannestad J, Koborsi K, Klutzaritz V, Chao W, Ray R, Páez A, Jackson S, Lohr S, Cummings JL, Kay G, Nikolich K, Braithwaite S. Safety and tolerability of GRF6019 in mild-to-moderate Alzheimer's disease dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12115. [PMID: 33344754 PMCID: PMC7744029 DOI: 10.1002/trc2.12115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/30/2020] [Accepted: 10/26/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This phase 2 trial evaluated the safety, tolerability, and feasibility of repeated infusions of the plasma fraction GRF6019 in mild-to-moderate Alzheimer's disease. METHODS In this randomized, double-blind, dose-comparison trial, 47 patients were randomized 1:1 to receive daily infusions of 100 mL (n = 24) or 250 mL (n = 23) of GRF6019 for 5 consecutive days over two dosing periods separated by a treatment-free interval of 3 months. RESULTS The mean (standard deviation [SD]) age of the enrolled patients was 74.3 (6.9), and 62% were women. Most adverse events (55%) were mild, with no clinically significant differences in safety or tolerability between the two dose levels. The mean (SD) baseline Mini-Mental State Examination score was 20.6 (3.7) in the 100 mL group and 19.6 (3.7) in the 250 mL group; at 24 weeks, the within-patient mean change from baseline was -1.0 points (95% confidence interval [CI], -3.1 to 1.1) in the 100 mL group and +1.5 points (95% CI, -0.4 to 3.3) in the 250 mL group. The within-patient mean change from baseline on the Alzheimer's Disease Assessment Scale-Cognitive subscale was -0.4 points (95% CI, -2.9 to 2.2) in the 100 mL group, while in the 250 mL group it was -0.9 points (95% CI, -3.0 to 1.2). The within-patient mean change from baseline on the Alzheimer's Disease Cooperative Study-Activities of Daily Living was -0.7 points in the 100 mL group (95% CI, -4.3 to 3.0) and -1.3 points (95% CI, -3.4 to 0.7) in the 250 mL group. The mean change from baseline on the Category Fluency Test, Clinical Dementia Rating Scale-Sum of Boxes, Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change, and Neuropsychiatric Inventory Questionnaire was similar for both treatment groups and did not show any worsening. DISCUSSION GRF6019 was safe and well tolerated, and patients experienced no cognitive decline and minimal functional decline. These results support further development of GRF6019.
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Affiliation(s)
| | | | | | | | - Rebecca Ray
- Alkahest Inc.San CarlosCaliforniaUSA
- Arcus Biosciences (present affiliation)HaywardCaliforniaUSA
| | - Antonio Páez
- Bioscience DivisionGrifols, S.A., Parque Empresarial Can Sant Joan, Avinguda de la GeneralitatBarcelonaSpain
| | - Sam Jackson
- Alkahest Inc.San CarlosCaliforniaUSA
- Alector, Inc. (present affiliation)South San FranciscoCaliforniaUSA
| | | | - Jeffrey L. Cummings
- Chambers‐Grundy Center for Transformative NeuroscienceDepartment of Brain HealthSchool of Integrated Health SciencesUniversity of Nevada Las VegasLas VegasNevadaUSA
- Lou Ruvo Center for Brain HealthCleveland ClinicLas VegasNevadaUSA
| | - Gary Kay
- Cognitive Research CorporationSt. PetersburgFloridaUSA
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Crocco E, Curiel-Cid RE, Kitaigorodsky M, González-Jiménez CJ, Zheng D, Duara R, Loewenstein DA. A Brief Version of the LASSI-L Detects Prodromal Alzheimer's Disease States. J Alzheimers Dis 2020; 78:789-799. [PMID: 33074233 DOI: 10.3233/jad-200790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) is an increasingly utilized cognitive stress test designed to identify early cognitive changes associated with incipient neurodegenerative disease. OBJECTIVE To examine previously derived cut-points for cognitively unimpaired older adults that were suggestive of performance impairment on multiple subscales of the LASSI-L. These cut-points were applied to a new sample of older adults who were cognitive healthy controls (HC: n = 26) and those on the Alzheimer's disease (AD) continuum from early stage mild cognitive impairment (EMCI: n = 28), late stage MCI (LMCI: n = 18) to mild AD (AD: n = 27). METHODS All participants were administered the LASSI-L. All cognitively impaired participants were PET amyloid positive which likely reflects underlying AD neuropathology, while cognitively normal counterparts were deemed to have amyloid negative scans. RESULTS There was a monotonic relationship between the number of deficits on LASSI-L subscales and independent classification of study groups with greater severity of cognitive impairment. Importantly, taken together, impairment on maximum learning ability and measures of proactive semantic interference (both reflected by cued recall and intrusion errors) correctly classified 74.1% of EMCI, 94.4% of LMCI, and 96.3% of AD. Only 7.7% of HC were incorrectly classified as having impairments. CONCLUSION A modest number of LASSI-L subscales taking approximately 8 minutes to administer, had excellent discriminative ability using established cut-offs among individuals with presumptive stages of AD. This has potential implications for both clinical practice and clinical research settings targeting AD during early prodromal stages.
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Affiliation(s)
- Elizabeth Crocco
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,1Florida Alzheimer's Disease Research Center, Miami, FL, USA
| | - Rosie E Curiel-Cid
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,1Florida Alzheimer's Disease Research Center, Miami, FL, USA
| | - Marcela Kitaigorodsky
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christian J González-Jiménez
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diane Zheng
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjan Duara
- 1Florida Alzheimer's Disease Research Center, Miami, FL, USA.,Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami, FL, USA
| | - David A Loewenstein
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,1Florida Alzheimer's Disease Research Center, Miami, FL, USA
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Kueper JK, Lizotte DJ, Montero-Odasso M, Speechley M. Cognition and motor function: The gait and cognition pooled index. PLoS One 2020; 15:e0238690. [PMID: 32915845 PMCID: PMC7485843 DOI: 10.1371/journal.pone.0238690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 08/21/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is a need for outcome measures with improved responsiveness to changes in pre-dementia populations. Both cognitive and motor function play important roles in neurodegeneration; motor function decline is detectable at early stages of cognitive decline. This proof of principle study used a Pooled Index approach to evaluate improved responsiveness of the predominant outcome measure (ADAS-Cog: Alzheimer's Disease Assessment Scale-Cognitive Subscale) when assessment of motor function is added. METHODS Candidate Pooled Index variables were selected based on theoretical importance and pairwise correlation coefficients. Kruskal-Wallis and Mann-Whitney U tests assessed baseline discrimination. Standardized response means assessed responsiveness to longitudinal change. RESULTS Final selected variables for the Pooled Index include gait velocity, dual-task cost of gait velocity, and an ADAS-Cog-Proxy (statistical approximation of the ADAS-Cog using similar cognitive tests). The Pooled Index and ADAS-Cog-Proxy scores had similar ability to discriminate between pre-dementia syndromes. The Pooled Index demonstrated trends of similar or greater responsiveness to longitudinal decline than ADAS-Cog-Proxy scores. CONCLUSION Adding motor function assessments to the ADAS-Cog may improve responsiveness in pre-dementia populations.
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Affiliation(s)
- Jacqueline K Kueper
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Daniel J Lizotte
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Computer Science, Faculty of Science, University of Western Ontario, London, Ontario, Canada
- Department of Statistical and Actuarial Sciences, Faculty of Science, University of Western Ontario, London, Ontario, Canada
- Master of Public Health Program, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Manuel Montero-Odasso
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
- Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Mark Speechley
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
- Master of Public Health Program, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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56
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McMaster M, Kim S, Clare L, Torres SJ, Cherbuin N, DʼEste C, Anstey KJ. Lifestyle Risk Factors and Cognitive Outcomes from the Multidomain Dementia Risk Reduction Randomized Controlled Trial, Body Brain Life for Cognitive Decline (BBL-CD). J Am Geriatr Soc 2020; 68:2629-2637. [PMID: 32909259 DOI: 10.1111/jgs.16762] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/28/2020] [Accepted: 07/08/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES To evaluate the efficacy of a multidomain intervention to reduce lifestyle risk factors for Alzheimer's disease (AD) and improve cognition in individuals with subjective cognitive decline (SCD) or mild cognitive impairment (MCI). DESIGN The study was an 8-week two-arm single-blind proof-of-concept randomized controlled trial. SETTING Community-dwelling individuals living in Canberra, Australia, and surrounding areas. PARTICIPANTS Participants were 119 individuals (intervention n = 57; control n = 62) experiencing SCD or MCI. INTERVENTION The control condition involved four educational modules covering dementia and lifestyle risk factors, Mediterranean diet, physical activity, and cognitive engagement. Participants were instructed to implement this information into their own lifestyle. The intervention condition included the same educational modules and additional active components to assist with the implementation of this information into participants' lifestyles: dietitian sessions, an exercise physiologist session, and online brain training. MEASUREMENTS Lifestyle risk factors for AD were assessed using the Australian National University-Alzheimer's Disease Risk Index (ANU-ADRI), and cognition was assessed using Alzheimer's Disease Assessment Scale-Cognitive subscale, Pfeffer Functional Activities Questionnaire, Symbol Digit Modalities Test (SDMT), Trail Making Test-B, and Category Fluency. RESULTS The primary analysis showed that the intervention group had a significantly lower ANU-ADRI score (χ2 = 10.84; df = 3; P = .013) and a significantly higher cognition score (χ2 = 7.28; df = 2; P = .026) than the control group. A secondary analysis demonstrated that the changes in lifestyle were driven by increases in protective lifestyle factors (χ2 = 12.02; df = 3; P = .007), rather than a reduction in risk factors (χ2 = 2.93; df = 3; P = .403), and cognitive changes were only apparent for the SDMT (χ2 = 6.46; df = 2; P = .040). Results were robust to intention-to-treat analysis controlling for missing data. CONCLUSION Results support the hypothesis that improvements in lifestyle risk factors for dementia can lead to improvements in cognition over a short time frame with a population experiencing cognitive decline. Outcomes from this trial support the conduct of a larger and longer trial with this participant group.
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Affiliation(s)
- Mitchell McMaster
- Centre for Research on Ageing, Health and Wellbeing (CRAHW), The Australian National University, Canberra, Australia
| | - Sarang Kim
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health (REACH), University of Exeter, Exeter, UK
| | - Susan J Torres
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing (CRAHW), The Australian National University, Canberra, Australia
| | - Catherine DʼEste
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Canberra, Australia.,School of Medicine and Population Health, The University of Newcastle, Newcastle, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia (NeuRA), Sydney, Australia.,School of Psychology, University of New South Wales, Randwick, NSW, Australia
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Jacobs DM, Thomas RG, Salmon DP, Jin S, Feldman HH, Cotman CW, Baker LD. Development of a novel cognitive composite outcome to assess therapeutic effects of exercise in the EXERT trial for adults with MCI: The ADAS-Cog-Exec. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12059. [PMID: 32995469 PMCID: PMC7507362 DOI: 10.1002/trc2.12059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Use of cognitive composites as primary outcome measures is increasingly common in clinical trials of preclinical and prodromal Alzheimer's disease (AD). Composite outcomes can decrease intra-individual variability, resulting in improved sensitivity to detect longitudinal change and increased statistical power. We developed a novel composite outcome, the ADAS-Cog-Exec, for use in the EXERT trial-a Phase 3 randomized, controlled, 12-month exercise intervention in mild cognitive impairment (MCI). METHODS Three combinations of cognitive measures selected from the Alzheimer's Disease Assessment Scale-Cognitive Subscale version 13 (ADAS-Cog13), tests of executive function, and the Clinical Dementia Rating (CDR) were created based on previously documented sensitivity to longitudinal change in MCI and to the effects of exercise. Optimally weighted composites of each combination were modeled using data from the ADNI-1 MCI cohort. Ten-fold cross-validation was performed to obtain a bias-corrected mean to standard deviation ratio (MSDR). The cognitive composites were assessed for their sensitivity to detect 12-month change in MCI. RESULTS The MSDR of 12-month change for each of the composite outcomes tested exceeded that of the ADAS-Cog13 total score. The composite with the highest MSDR (MSDR = 0.48) and associated statistical power included scores on ADAS-Cog13 Word Recall, Delayed Word Recall, Orientation, and Number Cancellation subtests; Trail-Making Tests A & B, Digit Symbol Substitution and Category Fluency; and cognitive components of the CDR (Memory, Orientation, Judgement & Problem Solving). DISCUSSION An optimally weighted cognitive composite measure was identified and validated for use in EXERT. This composite contained selected subtests from the ADAS-Cog13, additional measures of executive function, and box scores for cognitive components of the CDR. Because this composite score demonstrated high sensitivity to longitudinal change in MCI it will be used as the primary outcome measure for the EXERT trial.
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Affiliation(s)
- Diane M Jacobs
- Department of Neurosciences University of California San Diego La Jolla California USA
- Alzheimer's Disease Cooperative Study University of California San Diego La Jolla California
- Shiley-Marcos Alzheimer's Disease Research Center University of California San Diego La Jolla California USA
| | - Ronald G Thomas
- Alzheimer's Disease Cooperative Study University of California San Diego La Jolla California
- Division of Biostatistics Department of Family Medicine & Public Health University of California San Diego La Jolla California USA
| | - David P Salmon
- Department of Neurosciences University of California San Diego La Jolla California USA
- Alzheimer's Disease Cooperative Study University of California San Diego La Jolla California
- Shiley-Marcos Alzheimer's Disease Research Center University of California San Diego La Jolla California USA
| | - Shelia Jin
- Alzheimer's Disease Cooperative Study University of California San Diego La Jolla California
- Division of Biostatistics Department of Family Medicine & Public Health University of California San Diego La Jolla California USA
| | - Howard H Feldman
- Department of Neurosciences University of California San Diego La Jolla California USA
- Alzheimer's Disease Cooperative Study University of California San Diego La Jolla California
- Shiley-Marcos Alzheimer's Disease Research Center University of California San Diego La Jolla California USA
| | - Carl W Cotman
- Institute for Memory Impairments and Neurological Disorders University of California Irvine Irvine California USA
| | - Laura D Baker
- Department of Internal Medicine-Geriatrics Wake Forest School of Medicine Winston-Salem North Carolina USA
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Zhang Z, Wei F, Shen XN, Ma YH, Chen KL, Dong Q, Tan L, Yu JT. Associations of Subsyndromal Symptomatic Depression with Cognitive Decline and Brain Atrophy in Elderly Individuals without Dementia: A Longitudinal Study. J Affect Disord 2020; 274:262-268. [PMID: 32469814 DOI: 10.1016/j.jad.2020.05.097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/09/2020] [Accepted: 05/15/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Subsyndromal symptomatic depression (SSD) is prevalent in older adults. However, it remains unclear whether there are effects of SSD on brain aging outcomes (cognition and brain structures), especially in the presence of Alzheimer's Disease (AD) pathology. METHODS A total of 1,188 adults without dementia were recruited from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Participants with SSD were measured using the 15-item Geriatric Depression Scale (GDS-15). In multivariable models, the cross-sectional and longitudinal associations of SSD with brain aging outcomes were explored. We further evaluated whether baseline amyloid-β (Aβ) load modifies the relations between SSD and brain aging outcomes. RESULTS SSD at baseline was associated with significantly longitudinal decline in cognition and displayed significantly accelerated atrophy in hippocampus (β = -29.53, p = 0.001) and middle temporal gyrus (β = - 77.82, p = 0.006) among all participants and Aβ-Positive individuals. SSD interacted with baseline Aβ load in predicting longitudinal decline in Mini Mental State Examination (MMSE) (β = - 0.327, p = 0.023), episodic memory (β = -0.065, p = 0.004) and increase in Alzheimer's Disease Assessment Scale Cognition 13-item scale (ADAS-cog13) (β = 0.754, p = 0.026). LIMITATIONS Our study didn't look at AD diagnosis but Aβ status. CONCLUSIONS Our findings suggested that older people without dementia with both SSD and a high level of Aβ load may have higher risk of cognitive deterioration and brain atrophy. Therapeutic mitigation of depressive symptoms, especially in those with abnormal Aβ levels, may help delay progressive decline in cognition.
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Affiliation(s)
- Zhao Zhang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Feng Wei
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xue-Ning Shen
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ke-Liang Chen
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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Boada M, López OL, Olazarán J, Núñez L, Pfeffer M, Paricio M, Lorites J, Piñol-Ripoll G, Gámez JE, Anaya F, Kiprov D, Lima J, Grifols C, Torres M, Costa M, Bozzo J, Szczepiorkowski ZM, Hendrix S, Páez A. A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study. Alzheimers Dement 2020; 16:1412-1425. [PMID: 32715623 PMCID: PMC7984263 DOI: 10.1002/alz.12137] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 12/19/2022]
Abstract
Introduction This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild‐to‐moderate Alzheimer's disease (AD). Methods Three hundred forty‐seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6‐week period of weekly conventional PE followed by a 12‐month period of monthly low‐volume PE), and placebo (sham). Results PE‐treated patients performed significantly better than placebo for the co‐primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study–Activities of Daily Living (ADCS‐ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale–Cognitive Subscale (ADAS‐Cog; P = .06; 66% less decline) scores at month 14. Moderate‐AD patients (baseline Mini‐Mental State Examination [MMSE] 18‐21) scored better on ADCS‐ADL (P = .002) and ADAS‐Cog (P = .05), 61% less decline both. There were no changes in mild‐AD patients (MMSE 22‐26). PE‐treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR‐sb) (P = .002; 71% less decline) and Alzheimer's Disease Cooperative Study‐Clinical Global Impression of Change (ADCS‐CGIC) (P < .0001; 100% less decline) scales. Discussion This trial suggests that PE with albumin replacement could slow cognitive and functional decline in AD, although further studies are warranted.
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Affiliation(s)
- Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Oscar L López
- Departments of Neurology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Javier Olazarán
- Neurology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Memory Disorders Unit - HM Hospitals, Madrid, Spain
| | - Laura Núñez
- Alzheimer's Research Group, Grifols, Barcelona, Spain
| | - Michael Pfeffer
- Medical Services, Allied Biomedical Research Institute, Inc., Miami, Florida, USA
| | - María Paricio
- Center for Prevention of Alzheimer´s Disease, Miami Dade Medical Research Institute, Miami, Florida, USA
| | - Jesús Lorites
- Medical Services, L&L Research Choices, Inc., Miami, Florida, USA
| | - Gerard Piñol-Ripoll
- Seizure Disorders Unit, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria, Lleida, Spain
| | - José E Gámez
- Psychiatry Department, Galiz Research, Hialeah, Florida, USA
| | - Fernando Anaya
- Nephrology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Dobri Kiprov
- Apheresis Care Group and Fresenius Medical Care, San Francisco, California, USA
| | - José Lima
- American Red Cross Southern Blood Services Region, Atlanta, Georgia, USA
| | | | - Mireia Torres
- Alzheimer's Research Group, Grifols, Barcelona, Spain
| | | | - Jordi Bozzo
- Alzheimer's Research Group, Grifols, Barcelona, Spain
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - Antonio Páez
- Alzheimer's Research Group, Grifols, Barcelona, Spain
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60
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Longitudinal survival analysis and two-group comparison for predicting the progression of mild cognitive impairment to Alzheimer's disease. J Neurosci Methods 2020; 341:108698. [PMID: 32534272 DOI: 10.1016/j.jneumeth.2020.108698] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/30/2020] [Accepted: 03/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Longitudinal studies using structural magnetic resonance imaging (MRI) and neuropsychological measurements (NMs) allow a noninvasive means of following the subtle anatomical changes occurring during the evolution of AD. NEW METHOD This paper compared two approaches for the construction of longitudinal predictive models: a) two-group comparison between converter and nonconverter MCI subjects and b) longitudinal survival analysis. Predictive models combined MRI-based markers with NMs and included demographic and clinical information as covariates. Both approaches employed linear mixed effects modeling to capture the longitudinal trajectories of the markers. The two-group comparison approaches used linear discriminant analysis and the survival analysis used risk ratios obtained from the extended Cox model and logistic regression. RESULTS The proposed approaches were developed and evaluated using the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset with a total of 1330 visits from 321 subjects. With both approaches, a very small number of features were selected. These markers are easily interpretable, generating robust, verifiable and reliable predictive models. Our best models predicted conversion with 78% accuracy at baseline (AUC = 0.860, 79% sensitivity, 76% specificity). As more visits were made, longitudinal predictive models improved their predictions with 85% accuracy (AUC = 0.944, 86% sensitivity, 85% specificity). COMPARISON WITH EXISTING METHOD Unlike the recently published models, there was also an improvement in the prediction accuracy of the conversion to AD when considering the longitudinal trajectory of the patients. CONCLUSIONS The survival-based predictive models showed a better balance between sensitivity and specificity with respect to the models based on the two-group comparison approach.
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Soheili-Nezhad S, Jahanshad N, Guelfi S, Khosrowabadi R, Saykin AJ, Thompson PM, Beckmann CF, Sprooten E, Zarei M. Imaging genomics discovery of a new risk variant for Alzheimer's disease in the postsynaptic SHARPIN gene. Hum Brain Mapp 2020; 41:3737-3748. [PMID: 32558014 PMCID: PMC7416020 DOI: 10.1002/hbm.25083] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/29/2020] [Accepted: 05/14/2020] [Indexed: 12/26/2022] Open
Abstract
Molecular mechanisms underlying Alzheimer's disease (AD) are difficult to investigate, partly because diagnosis lags behind the insidious pathological processes. Therefore, identifying AD neuroimaging markers and their genetic modifiers may help study early mechanisms of neurodegeneration. We aimed to identify brain regions of the highest vulnerability to AD using a data-driven search in the AD Neuroimaging Initiative (ADNI, n = 1,100 subjects), and further explored genetic variants affecting this critical brain trait using both ADNI and the younger UK Biobank cohort (n = 8,428 subjects). Tensor-Based Morphometry (TBM) and Independent Component Analysis (ICA) identified the limbic system and its interconnecting white-matter as the most AD-vulnerable brain feature. Whole-genome analysis revealed a common variant in SHARPIN that was associated with this imaging feature (rs34173062, p = 2.1 × 10-10 ). This genetic association was validated in the UK Biobank, where it was correlated with entorhinal cortical thickness bilaterally (p = .002 left and p = 8.6 × 10-4 right), and with parental history of AD (p = 2.3 × 10-6 ). Our findings suggest that neuroanatomical variation in the limbic system and AD risk are associated with a novel variant in SHARPIN. The role of this postsynaptic density gene product in β1-integrin adhesion is in line with the amyloid precursor protein (APP) intracellular signaling pathway and the recent genome-wide evidence.
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Affiliation(s)
- Sourena Soheili-Nezhad
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran.,Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands.,Donders Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
| | - Neda Jahanshad
- Imaging Genetics Center, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Marina del Rey, California, USA
| | - Sebastian Guelfi
- Reta Lila Weston Research Laboratories, Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology, London, UK
| | - Reza Khosrowabadi
- Institute for Cognitive and Brain Science, Shahid Beheshti University, Tehran, Iran
| | - Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Paul M Thompson
- Imaging Genetics Center, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Marina del Rey, California, USA
| | - Christian F Beckmann
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands.,Donders Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands.,Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Emma Sprooten
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mojtaba Zarei
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
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Cerbone B, Massman PJ, Kulesz PA, Woods SP, York MK. Predictors of rate of cognitive decline in patients with amnestic mild cognitive impairment. Clin Neuropsychol 2020; 36:138-164. [DOI: 10.1080/13854046.2020.1773933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Brittany Cerbone
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Paul J. Massman
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Steven P. Woods
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michele K. York
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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63
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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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64
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Yang H, Cheng Z, Li Z, Jiang Y, Zhao J, Wu Y, Gu S, Xu H. Validation study of the Alzheimer's Disease Assessment Scale-Cognitive Subscale for people with mild cognitive impairment and Alzheimer's disease in Chinese communities. Int J Geriatr Psychiatry 2019; 34:1658-1666. [PMID: 31347192 DOI: 10.1002/gps.5179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/17/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Our study aimed to verify the validity of the Chinese version of Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) for the community-dwelling older people in China. METHODS A total of 1276 individuals composed by 628 normal controls (NCs), 572 people living with mild cognitive impairment (MCI), and 76 people living with Alzheimer's disease (AD) were recruited for the current study. All of the participants underwent ADAS-Cog, clinical interview and examination, Quick Cognitive Screening Scale for the Elderly, and Activities of Daily Living Scale. The sensitivity and specificity of ADAS-Cog were calculated, and a receiver operating characteristic curve (ROC curve) was drawn to decide the optimal cutoff points of ADAS-Cog for screening MCI and AD. RESULTS Statistically significant differences were observed among the three groups (P <. 001, NC < MCI <AD), in terms of the total and subtask scores of ADAS-Cog. The optimal cutoff value for MCI was 10 points with an area under the curve (AUC) of 0.824, sensitivity of 61.4%, and specificity of 93.2%. Comparatively, the best cutoff value for AD was 15 points with an AUC of 0.905, sensitivity of 73.7%, and specificity of 92.4%. The overall accuracy was 70.5%, and the accuracy of diagnosing cognitively healthy older people, MCI patients, and AD patients was 81.7%, 58.0%, and 71.1%, respectively. CONCLUSION The present study illustrates that the Chinese version of the ADAS-Cog total score is able to detect cognitive impairment of AD patients in Chinese communities but has a lower efficacy for MCI.
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Affiliation(s)
- Hongyu Yang
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Zaohuo Cheng
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Zemei Li
- School of humanities and management, Graduate School of Wannan Medical College, Wuhu, China
| | - Yan Jiang
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Jinfa Zhao
- School of humanities and management, Graduate School of Wannan Medical College, Wuhu, China
| | - Yue Wu
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Shouquan Gu
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Hong Xu
- Beijing Anding Hospital, Capital Medical University, Beijing, China
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Vipin A, Foo HJL, Lim JKW, Chander RJ, Yong TT, Ng ASL, Hameed S, Ting SKS, Zhou J, Kandiah N. Regional White Matter Hyperintensity Influences Grey Matter Atrophy in Mild Cognitive Impairment. J Alzheimers Dis 2019; 66:533-549. [PMID: 30320575 DOI: 10.3233/jad-180280] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The association between cerebrovascular disease pathology (measured by white matter hyperintensities, WMH) and brain atrophy in early Alzheimer's disease (AD) remain to be elucidated. Thus, we investigated how WMH influence neurodegeneration and cognition in prodromal and clinical AD. We examined 51 healthy controls, 35 subjects with mild cognitive impairment (MCI), and 30 AD patients. We tested how total and regional WMH is related to specific grey matter volume (GMV) reductions in MCI and AD compared to controls. Stepwise regression analysis was further performed to investigate the association of GMV and regional WMH volume with global cognition. We found that total WMH volume was highest in AD but showed the strongest association with lower GMV in MCI. Frontal and parietal WMH had the most extensive influence on GMV loss in MCI. Additionally, parietal lobe WMH volume (but not hippocampal atrophy) was significantly associated with global cognition in MCI while smaller hippocampal volume (but not WMH volume) was associated with lower global cognition in AD. Thus, although WMH volume was highest in AD subjects, it had a more pervasive influence on brain structure and cognitive impairment in MCI. Our study thus highlights the importance of early detection of cerebrovascular disease, as its intervention at the MCI stage might potentially slow down neurodegeneration.
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Affiliation(s)
- Ashwati Vipin
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore
| | - Heidi Jing Ling Foo
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Joseph Kai Wei Lim
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore
| | - Russell Jude Chander
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Ting Ting Yong
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Adeline Su Lyn Ng
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Shahul Hameed
- Department of Neurology, Singapore General Hospital, Singapore
| | | | - Juan Zhou
- Center for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore.,Clinical Imaging Research Centre, The Agency for Science, Technology and Research and National University of Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
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Bucholc M, Ding X, Wang H, Glass DH, Wang H, Prasad G, Maguire LP, Bjourson AJ, McClean PL, Todd S, Finn DP, Wong-Lin K. A practical computerized decision support system for predicting the severity of Alzheimer's disease of an individual. EXPERT SYSTEMS WITH APPLICATIONS 2019; 130:157-171. [PMID: 31402810 PMCID: PMC6688646 DOI: 10.1016/j.eswa.2019.04.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Computerized clinical decision support systems can help to provide objective, standardized, and timely dementia diagnosis. However, current computerized systems are mainly based on group analysis, discrete classification of disease stages, or expensive and not readily accessible biomarkers, while current clinical practice relies relatively heavily on cognitive and functional assessments (CFA). In this study, we developed a computational framework using a suite of machine learning tools for identifying key markers in predicting the severity of Alzheimer's disease (AD) from a large set of biological and clinical measures. Six machine learning approaches, namely Kernel Ridge Regression (KRR), Support Vector Regression, and k-Nearest Neighbor for regression and Support Vector Machine (SVM), Random Forest, and k-Nearest Neighbor for classification, were used for the development of predictive models. We demonstrated high predictive power of CFA. Predictive performance of models incorporating CFA was shown to consistently have higher accuracy than those based solely on biomarker modalities. We found that KRR and SVM were the best performing regression and classification methods respectively. The optimal SVM performance was observed for a set of four CFA test scores (FAQ, ADAS13, MoCA, MMSE) with multi-class classification accuracy of 83.0%, 95%CI = (72.1%, 93.8%) while the best performance of the KRR model was reported with combined CFA and MRI neuroimaging data, i.e., R 2 = 0.874, 95%CI = (0.827, 0.922). Given the high predictive power of CFA and their widespread use in clinical practice, we then designed a data-driven and self-adaptive computerized clinical decision support system (CDSS) prototype for evaluating the severity of AD of an individual on a continuous spectrum. The system implemented an automated computational approach for data pre-processing, modelling, and validation and used exclusively the scores of selected cognitive measures as data entries. Taken together, we have developed an objective and practical CDSS to aid AD diagnosis.
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Affiliation(s)
- Magda Bucholc
- Intelligent Systems Research Centre, School of Computing, Engineering & Intelligent Systems, Ulster University, Magee campus, Northern Ireland, United Kingdom
| | - Xuemei Ding
- Cognitive Analytics Research Lab, School of Computing, Engineering & Intelligent Systems, Ulster University, Magee campus, Northern Ireland, United Kingdom
- Fujian Provincial Engineering Technology Research Centre for Public Service Big Data Mining and Application, College of Mathematics and Informatics, Fujian Normal University, Fuzhou, Fujian, 350108, China
| | - Haiying Wang
- School of Computing and Mathematics, Ulster University, Jordanstown campus, Northern Ireland, United Kingdom
| | - David H. Glass
- School of Computing and Mathematics, Ulster University, Jordanstown campus, Northern Ireland, United Kingdom
| | - Hui Wang
- School of Computing and Mathematics, Ulster University, Jordanstown campus, Northern Ireland, United Kingdom
| | - Girijesh Prasad
- Intelligent Systems Research Centre, School of Computing, Engineering & Intelligent Systems, Ulster University, Magee campus, Northern Ireland, United Kingdom
| | - Liam P. Maguire
- Intelligent Systems Research Centre, School of Computing, Engineering & Intelligent Systems, Ulster University, Magee campus, Northern Ireland, United Kingdom
| | - Anthony J. Bjourson
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, Ulster University, Northern Ireland, United Kingdom
| | - Paula L. McClean
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, Ulster University, Northern Ireland, United Kingdom
| | - Stephen Todd
- Altnagelvin Area Hospital, Western Health and Social Care Trust, Northern Ireland, United Kingdom
| | - David P. Finn
- Pharmacology and Therapeutics, School of Medicine, and NCBES Galway Neuroscience Centre, National University of Ireland, Galway, Republic of Ireland
| | - KongFatt Wong-Lin
- Intelligent Systems Research Centre, School of Computing, Engineering & Intelligent Systems, Ulster University, Magee campus, Northern Ireland, United Kingdom
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Ewers M, Franzmeier N, Suárez-Calvet M, Morenas-Rodriguez E, Caballero MAA, Kleinberger G, Piccio L, Cruchaga C, Deming Y, Dichgans M, Trojanowski JQ, Shaw LM, Weiner MW, Haass C. Increased soluble TREM2 in cerebrospinal fluid is associated with reduced cognitive and clinical decline in Alzheimer's disease. Sci Transl Med 2019; 11:11/507/eaav6221. [PMID: 31462511 PMCID: PMC7050285 DOI: 10.1126/scitranslmed.aav6221] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/24/2018] [Accepted: 04/27/2019] [Indexed: 01/05/2023]
Abstract
Loss of function of TREM2, a key receptor selectively expressed by microglia in the brain, contributes to the development of Alzheimer's disease (AD). We therefore examined whether soluble TREM2 (sTREM2) concentrations in cerebrospinal fluid (CSF) were associated with reduced rates of cognitive decline and clinical progression in subjects with AD or mild cognitive impairment (MCI). We measured sTREM2 in CSF samples from 385 elderly subjects, including cognitively normal controls, individuals with MCI, and subjects with AD dementia (follow-up period: mean, 4 years; range 1.5 to 11.5 years). In subjects with AD defined by evidence of CSF Aβ1-42 (amyloid β-peptide 1 to 42; A+) and CSF p-tau181 (tau phosphorylated on amino acid residue 181; T+), higher sTREM2 concentrations in CSF at baseline were associated with attenuated decline in memory and cognition. When analyzed in clinical subgroups, an association between higher CSF sTREM2 concentrations and subsequent reduced memory decline was consistently observed in individuals with MCI or AD dementia, who were positive for CSF Aβ1-42 and CSF p-tau181 (A+T+). Regarding clinical progression, a higher ratio of CSF sTREM2 to CSF p-tau181 concentrations predicted slower conversion from cognitively normal to symptomatic stages or from MCI to AD dementia in the subjects who were positive for CSF Aβ1-42 and CSF p-tau181. These results suggest that sTREM2 is associated with attenuated cognitive and clinical decline, a finding with important implications for future clinical trials targeting the innate immune response in AD.
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Affiliation(s)
- Michael Ewers
- Institute for Stroke and Dementia Research, University Hospital Munich, LMU, Munich, Germany,Corresponding author. (M.E.); (C.H.)
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research, University Hospital Munich, LMU, Munich, Germany
| | - Marc Suárez-Calvet
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany,German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany,Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation. Barcelona, Catalonia, Spain,Department of Neurology, Hospital del Mar, Barcelona, Catalonia, Spain
| | - Estrella Morenas-Rodriguez
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany,Department of Neurology, Institut d’Investigacions Biomèdiques, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Gernot Kleinberger
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany,ISAR Bioscience GmbH, 82152 Planegg, Germany
| | - Laura Piccio
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA,Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA,Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Carlos Cruchaga
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Yuetiva Deming
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital Munich, LMU, Munich, Germany,German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Leslie M. Shaw
- Center for Neurodegenerative Disease Research, Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Christian Haass
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany,German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany,Corresponding author. (M.E.); (C.H.)
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68
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van Loenhoud AC, van der Flier WM, Wink AM, Dicks E, Groot C, Twisk J, Barkhof F, Scheltens P, Ossenkoppele R. Cognitive reserve and clinical progression in Alzheimer disease: A paradoxical relationship. Neurology 2019; 93:e334-e346. [PMID: 31266904 PMCID: PMC6669930 DOI: 10.1212/wnl.0000000000007821] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/08/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the relationship between cognitive reserve (CR) and clinical progression across the Alzheimer disease (AD) spectrum. METHODS We selected 839 β-amyloid (Aβ)-positive participants with normal cognition (NC, n = 175), mild cognitive impairment (MCI, n = 437), or AD dementia (n = 227) from the Alzheimer's Disease Neuroimaging Initiative (ADNI). CR was quantified using standardized residuals (W scores) from a (covariate-adjusted) linear regression with global cognition (13-item Alzheimer's Disease Assessment Scale-cognitive subscale) as an independent variable of interest, and either gray matter volumes or white matter hyperintensity volume as dependent variables. These W scores, reflecting whether an individual's degree of cerebral damage is lower or higher than clinically expected, were tested as predictors of diagnostic conversion (i.e., NC to MCI/AD dementia, or MCI to AD dementia) and longitudinal changes in memory (ADNI-MEM) and executive functions (ADNI-EF). RESULTS The median follow-up period was 24 months (interquartile range 6-42). Corrected for age, sex, APOE4 status, and baseline cerebral damage, higher gray matter volume-based W scores (i.e., greater CR) were associated with a lower diagnostic conversion risk (hazard ratio [HR] 0.22, p < 0.001) and slower decline in memory (β = 0.48, p < 0.001) and executive function (β = 0.67, p < 0.001). Stratified by disease stage, we found similar results for NC (diagnostic conversion: HR 0.30, p = 0.038; ADNI-MEM: β = 0.52, p = 0.028; ADNI-EF: β = 0.42, p = 0.077) and MCI (diagnostic conversion: HR 0.21, p < 0.001; ADNI-MEM: β = 0.43, p = 0.003; ADNI-EF: β = 0.59, p < 0.001), but opposite findings (i.e., more rapid decline) for AD dementia (ADNI-MEM: β = -0.91, p = 0.002; ADNI-EF: β = -0.77, p = 0.081). CONCLUSIONS Among Aβ-positive individuals, greater CR related to attenuated clinical progression in predementia stages of AD, but accelerated cognitive decline after the onset of dementia.
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Affiliation(s)
- Anna Catharina van Loenhoud
- From Alzheimer Center Amsterdam, Department of Neurology (A.C.v.L., W.M.v.d.F., E.D., C.G., P.S., R.O.), and Department of Radiology and Nuclear Medicine (A.M.W., F.B., R.O.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (W.M.v.d.F., J.T.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Clinical Memory Research Unit (R.O.), Lund University, Sweden.
| | - Wiesje Maria van der Flier
- From Alzheimer Center Amsterdam, Department of Neurology (A.C.v.L., W.M.v.d.F., E.D., C.G., P.S., R.O.), and Department of Radiology and Nuclear Medicine (A.M.W., F.B., R.O.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (W.M.v.d.F., J.T.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Clinical Memory Research Unit (R.O.), Lund University, Sweden
| | - Alle Meije Wink
- From Alzheimer Center Amsterdam, Department of Neurology (A.C.v.L., W.M.v.d.F., E.D., C.G., P.S., R.O.), and Department of Radiology and Nuclear Medicine (A.M.W., F.B., R.O.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (W.M.v.d.F., J.T.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Clinical Memory Research Unit (R.O.), Lund University, Sweden
| | - Ellen Dicks
- From Alzheimer Center Amsterdam, Department of Neurology (A.C.v.L., W.M.v.d.F., E.D., C.G., P.S., R.O.), and Department of Radiology and Nuclear Medicine (A.M.W., F.B., R.O.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (W.M.v.d.F., J.T.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Clinical Memory Research Unit (R.O.), Lund University, Sweden
| | - Colin Groot
- From Alzheimer Center Amsterdam, Department of Neurology (A.C.v.L., W.M.v.d.F., E.D., C.G., P.S., R.O.), and Department of Radiology and Nuclear Medicine (A.M.W., F.B., R.O.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (W.M.v.d.F., J.T.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Clinical Memory Research Unit (R.O.), Lund University, Sweden
| | - Jos Twisk
- From Alzheimer Center Amsterdam, Department of Neurology (A.C.v.L., W.M.v.d.F., E.D., C.G., P.S., R.O.), and Department of Radiology and Nuclear Medicine (A.M.W., F.B., R.O.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (W.M.v.d.F., J.T.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Clinical Memory Research Unit (R.O.), Lund University, Sweden
| | - Frederik Barkhof
- From Alzheimer Center Amsterdam, Department of Neurology (A.C.v.L., W.M.v.d.F., E.D., C.G., P.S., R.O.), and Department of Radiology and Nuclear Medicine (A.M.W., F.B., R.O.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (W.M.v.d.F., J.T.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Clinical Memory Research Unit (R.O.), Lund University, Sweden
| | - Philip Scheltens
- From Alzheimer Center Amsterdam, Department of Neurology (A.C.v.L., W.M.v.d.F., E.D., C.G., P.S., R.O.), and Department of Radiology and Nuclear Medicine (A.M.W., F.B., R.O.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (W.M.v.d.F., J.T.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Clinical Memory Research Unit (R.O.), Lund University, Sweden
| | - Rik Ossenkoppele
- From Alzheimer Center Amsterdam, Department of Neurology (A.C.v.L., W.M.v.d.F., E.D., C.G., P.S., R.O.), and Department of Radiology and Nuclear Medicine (A.M.W., F.B., R.O.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (W.M.v.d.F., J.T.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Clinical Memory Research Unit (R.O.), Lund University, Sweden
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Kueper JK, Speechley M, Montero-Odasso M. The Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog): Modifications and Responsiveness in Pre-Dementia Populations. A Narrative Review. J Alzheimers Dis 2019; 63:423-444. [PMID: 29660938 PMCID: PMC5929311 DOI: 10.3233/jad-170991] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog) was developed in the 1980s to assess the level of cognitive dysfunction in Alzheimer’s disease. Advancements in the research field have shifted focus toward pre-dementia populations, and use of the ADAS-Cog has extended into these pre-dementia studies despite concerns about its ability to detect important changes at these milder stages of disease progression. If the ADAS-Cog cannot detect important changes, our understanding of pre-dementia disease progression may be compromised and trials may incorrectly conclude that a novel treatment approach is not beneficial. The purpose of this review was to assess the performance of the ADAS-Cog in pre-dementia populations, and to review all modifications that have been made to the ADAS-Cog to improve its measurement performance in dementia or pre-dementia populations. The contents of this review are based on bibliographic searches of electronic databases to locate all studies using the ADAS-Cog in pre-dementia samples or subsamples, and to locate all modified versions. Citations from relevant articles were also consulted. Overall, our results suggest the original ADAS-Cog is not an optimal outcome measure for pre-dementia studies; however, given the prominence of the ADAS-Cog, care must be taken when considering the use of alternative outcome measures. Thirty-one modified versions of the ADAS-Cog were found. Modification approaches that appear most beneficial include altering scoring methodology or adding tests of memory, executive function, and/or daily functioning. Although modifications improve the performance of the ADAS-Cog, this is at the cost of introducing heterogeneity that may limit between-study comparison.
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Affiliation(s)
- Jacqueline K Kueper
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada.,Schulich Interfaculty Program in Public Health, The University of Western Ontario, London, ON, Canada
| | - Manuel Montero-Odasso
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada.,Department of Medicine, Division of Geriatric Medicine, The University of Western Ontario, London, ON, Canada.,Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
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70
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Falck RS, Best JR, Davis JC, Liu-Ambrose T. The Independent Associations of Physical Activity and Sleep with Cognitive Function in Older Adults. J Alzheimers Dis 2019; 63:1469-1484. [PMID: 29782311 DOI: 10.3233/jad-170936] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Current evidence suggests physical activity (PA) and sleep are important for cognitive health; however, few studies examining the role of PA and sleep for cognitive health have measured these behaviors objectively. OBJECTIVE We cross-sectionally examined whether 1) higher PA is associated with better cognitive performance independently of sleep quality; 2) higher sleep quality is associated with better cognitive performance independently of PA; and 3) whether higher PA is associated with better sleep quality. METHODS We measured PA, subjective sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and objective sleep quality (i.e., fragmentation, efficiency, duration, and latency) using the MotionWatch8© in community-dwelling adults (N = 137; aged 55+). Cognitive function was indexed using the Alzheimer's Disease Assessment Scale-Plus. Correlation analyses were performed to determine relationships between PA, sleep quality, and cognitive function. We then used latent variable modelling to examine the relationships of PA with cognitive function independently of sleep quality, sleep quality with cognitive function independently of PA, and PA with sleep quality. RESULTS We found greater PA was associated with better cognitive performance independently of 1) PSQI (β= -0.03; p < 0.01); 2) sleep fragmentation (β= -0.02; p < 0.01); 3) sleep duration (β= -0.02; p < 0.01); and 4) sleep latency (β= -0.02; p < 0.01). In addition, better sleep efficiency was associated with better cognitive performance independently of PA (β= -0.01; p = 0.04). We did not find any associations between PA and sleep quality. CONCLUSIONS PA is associated with better cognitive performance independently of sleep quality, and sleep efficiency is associated with better cognitive performance independently of PA. However, PA is not associated with sleep quality and thus PA and sleep quality may be related to cognitive performance through independent mechanisms.
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Affiliation(s)
- Ryan S Falck
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - John R Best
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Jennifer C Davis
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Teresa Liu-Ambrose
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute and University of British Columbia, Vancouver, BC, Canada
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71
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Burke SL, Naseh M, Rodriguez MJ, Burgess A, Loewenstein D. Dementia-Related Neuropsychological Testing Considerations in Non-Hispanic White and Latino/Hispanic Populations. PSYCHOLOGY & NEUROSCIENCE 2019; 12:144-168. [PMID: 31649798 PMCID: PMC6812579 DOI: 10.1037/pne0000163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hispanic individuals are at greater risk for health disparities, less than optimal health care, and are diagnosed at later stages of cognitive impairment than white non-Hispanics. Acculturation and different attitudes toward test-taking may result in decrements in performance, especially on unfamiliar measures that emphasize speed and accuracy. Non-Hispanic individuals often outperform Hispanic individuals on cognitive and neuropsychological measures in community and clinical populations. Current neuropsychological testing may not provide accurate data related to monolingual and bilingual individuals of Hispanic descent. Testing instruments were identified by searching academic databases using combinations of relevant search terms. Neuropsychological instruments were included if they were designed to detect cognitive impairment, had an administration time of less than 45 minutes, and were available in English. Validity studies were required to employ gold standard comparison diagnostic criteria. Twenty-nine instruments were evaluated in dementia staging, global cognition, memory, memory and visual abilities, working memory and attention, verbal learning and memory, recall, language, premorbid intelligence, literacy/cognitive reserve, visuospatial, attention, problem-solving, problem solving and perception, functional assessment, and mood/daily functioning domains. Spanish-language neuropsychological instruments need to be made widely available and existing instruments to be normed in Spanish to best serve and assess diverse populations. Psychometric data were reported for neuropsychological instruments, which may be administered to Hispanic older adults presenting for evaluation related to dementia-spectrum disorders. This is one of the few reviews to provide an overview of the sensitivity and specificity of available Spanish translated neuropsychological instruments.
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Affiliation(s)
- Shanna L Burke
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | - Mitra Naseh
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | | | - Aaron Burgess
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | - David Loewenstein
- Center on Aging as the Center for Cognitive Neuroscience and Aging and Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami
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72
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McMaster M, Kim S, Clare L, Torres SJ, D'Este C, Anstey KJ. Body, Brain, Life for Cognitive Decline (BBL-CD): protocol for a multidomain dementia risk reduction randomized controlled trial for subjective cognitive decline and mild cognitive impairment. Clin Interv Aging 2018; 13:2397-2406. [PMID: 30538436 PMCID: PMC6254686 DOI: 10.2147/cia.s182046] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background With no cure for dementia and the number of people living with the condition predicted to rapidly rise, there is an urgent need for dementia risk reduction and prevention interventions. Modifiable lifestyle risk factors have been identified as playing a major role in the development of dementia; hence, interventions addressing these risk factors represent a significant opportunity to reduce the number of people developing dementia. Relatively few interventions have been trialed in older participants with cognitive decline (secondary prevention). Objectives This study evaluates the efficacy and feasibility of a multidomain lifestyle risk reduction intervention for people with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). Methods This study is an 8-week, two-arm, single-blind, randomized controlled trial (RCT) of a lifestyle modification program to reduce dementia risk. The active control group receives the following four online educational modules: dementia literacy and lifestyle risk, Mediterranean diet (MeDi), cognitive engagement and physical activity. The intervention group also completes the same educational modules but receives additional practical components including sessions with a dietitian, online brain training and sessions with an exercise physiologist to assist with lifestyle modification. Results Primary outcome measures are cognition (The Alzheimer’s Disease Assessment Scale-Cognitive-Plus [ADAS-Cog-Plus]) and a composite lifestyle risk factor score for Alzheimer’s disease (Australian National University – Alzheimer’s Disease Risk Index [ANU-ADRI]). Secondary outcome measures are motivation to change lifestyle (Motivation to Change Lifestyle and Health Behaviour for Dementia Risk Reduction [MCLHB-DRR]) and health-related quality of life (36-item Short Form Health Survey [SF-36]). Feasibility will be determined through adherence to diet (Mediterranean Diet Adherence Screener [MEDAS] and Australian Recommended Food Score [ARFS]), cognitive engagement (BrainHQ-derived statistics) and physical activity interventions (physical activity calendars). Outcomes are measured at baseline, immediately post-intervention and at 3- and 6-month follow-up by researchers blind to group allocation. Discussion If successful and feasible, secondary prevention lifestyle interventions could provide a targeted, cost-effective way to reduce the number of people with cognitive decline going on to develop Alzheimer’s disease (AD) and other dementias.
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Affiliation(s)
- Mitchell McMaster
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, ACT, Australia,
| | - Sarang Kim
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, ACT, Australia,
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Susan J Torres
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Kaarin J Anstey
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, ACT, Australia, .,Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Sydney, NSW, Australia
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73
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Utsumil Y, Rudovicl OO, Petersonl K, Guerrero R, Picardl RW. Personalized Gaussian Processes for Forecasting of Alzheimer's Disease Assessment Scale-Cognition Sub-Scale (ADAS-Cog13). ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:4007-4011. [PMID: 30441237 DOI: 10.1109/embc.2018.8513253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this paper, we introduce the use of a personalized Gaussian Process pGP model to predict per-patient changes in ADAS-Cog13-a significant predictor of Alzheimer's Disease (AD) in the cognitive domain - using data from each patient's previous visits, and testing on future (held-out) data. We start by learning a population-level model using multi- modal data from previously seen patients using a base Gaussian Process (GP) regression. The pGP is then formed by adapting the base GP sequentially over time to a new (target) patient using domain adaptive GPs [1]. We extend this personalized approach to predict the values of ADAS-Cog13 over the future 6, 12, 18, and 24 months. We compare this approach to a GP model trained only on past data of the target patients tGP, as well as to a new approach that combines pGP with tGP. We find that this new approach (pGP+tGP) leads to significant improvements in accurately forecasting future ADAS-Cog13 scores.
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74
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Mohamed AZ, Cumming P, Srour H, Gunasena T, Uchida A, Haller CN, Nasrallah F. Amyloid pathology fingerprint differentiates post-traumatic stress disorder and traumatic brain injury. Neuroimage Clin 2018; 19:716-726. [PMID: 30009128 PMCID: PMC6041560 DOI: 10.1016/j.nicl.2018.05.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 05/01/2018] [Accepted: 05/13/2018] [Indexed: 11/29/2022]
Abstract
Introduction Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are risk factors for early onset of Alzheimer's disease (AD) and may accelerate the progression rate of AD pathology. As amyloid-beta (Aβ) plaques are a hallmark of AD pathology, we hypothesized that TBI and PTSD might increase Aβ accumulation in the brain. Methods We examined PET and neuropsychological data from Vietnam War veterans compiled by the US Department of Defense Alzheimer's Disease Neuroimaging Initiative, to examine the spatial distribution of Aβ in male veterans' who had experienced a TBI and/or developed PTSD. Subjects were classified into controls, TBI only, PTSD only, and TBI with PTSD (TBI_PTSD) groups and data were analyzed using both voxel-based and ROI-based approaches. Results Compared to controls, all three clinical groups showed a pattern of mainly increased referenced standard uptake values (SUVR) for the amyloid tracer [18F]-AV45 PET, with rank order PTSD > TBI_PTSD > TBI > Control, and same rank order was seen in the deficits of cognitive functions. SUVR increase was observed in widespread cortical regions of the PTSD group; in white matter of the TBI_PTSD group; and cerebellum and precuneus area of the TBI group, in contrast with controls. The [18F]-AV45 SUVR correlated negatively with cerebrospinal fluid (CSF) amyloid levels and positively with the CSF tau concentrations. Conclusion These results suggest that both TBI and PTSD are substantial risk factors for cognition decline and increased Aβ deposition resembling that in AD. In addition, both PTSD and TBI_PTSD have a different pathways of Aβ accumulation.
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Affiliation(s)
- Abdalla Z Mohamed
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Paul Cumming
- School of Psychology and Counselling and IHBI, Queensland University of Technology, Brisbane, QLD 4059, Australia; QIMR-Berghofer Institute, Brisbane, QLD 4006, Australia
| | - Hussein Srour
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Tamara Gunasena
- School of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Aya Uchida
- School of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia
| | | | - Fatima Nasrallah
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia.
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75
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Montero-Odasso M, Almeida QJ, Burhan AM, Camicioli R, Doyon J, Fraser S, Li K, Liu-Ambrose T, Middleton L, Muir-Hunter S, McIlroy W, Morais JA, Pieruccini-Faria F, Shoemaker K, Speechley M, Vasudev A, Zou GY, Berryman N, Lussier M, Vanderhaeghe L, Bherer L. SYNERGIC TRIAL (SYNchronizing Exercises, Remedies in Gait and Cognition) a multi-Centre randomized controlled double blind trial to improve gait and cognition in mild cognitive impairment. BMC Geriatr 2018; 18:93. [PMID: 29661156 PMCID: PMC5902955 DOI: 10.1186/s12877-018-0782-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Physical exercise, cognitive training, and vitamin D are low cost interventions that have the potential to enhance cognitive function and mobility in older adults, especially in pre-dementia states such as Mild Cognitive Impairment (MCI). Aerobic and progressive resistance exercises have benefits to cognitive performance, though evidence is somewhat inconsistent. We postulate that combined aerobic exercise (AE) and progressive resistance training (RT) (combined exercise) will have a better effect on cognition than a balance and toning control (BAT) intervention in older adults with MCI. We also expect that adding cognitive training and vitamin D supplementation to the combined exercise, as a multimodal intervention, will have synergistic efficacy. Methods The SYNERGIC trial (SYNchronizing Exercises, Remedies in GaIt and Cognition) is a multi-site, double-blinded, five-arm, controlled trial that assesses the potential synergic effect of combined AE and RT on cognition and mobility, with and without cognitive training and vitamin D supplementation in older adults with MCI. Two-hundred participants with MCI aged 60 to 85 years old will be randomized to one of five arms, four of which include combined exercise plus combinations of dual-task cognitive training (real vs. sham) and vitamin D supplementation (3 × 10,000 IU/wk. vs. placebo) in a quasi-factorial design, and one arm which receives all control interventions. The primary outcome measure is the ADAS-Cog (13 and plus modalities) measured at baseline and at 6 months of follow-up. Secondary outcomes include neuroimaging, neuro-cognitive performance, gait and mobility performance, and serum biomarkers of inflammation (C reactive protein and interleukin 6), neuroplasticity (brain-derived neurotropic factor), endothelial markers (vascular endothelial growth factor 1), and vitamin D serum levels. Discussion The SYNERGIC Trial will establish the efficacy and feasibility of a multimodal intervention to improve cognitive performance and mobility outcomes in MCI. These interventions may contribute to new approaches to stabilize and reverse cognitive-mobility decline in older individuals with MCI. Trial Registration Identifier: NCT02808676. https://www.clinicaltrials.gov/ct2/show/NCT02808676. Electronic supplementary material The online version of this article (10.1186/s12877-018-0782-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manuel Montero-Odasso
- Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada. .,Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Canada.
| | - Quincy J Almeida
- Sun Life Financial Movement Disorders Research Centre, Wilfrid Laurier University, Waterloo, Canada
| | - Amer M Burhan
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Richard Camicioli
- Geriatric and Cognitive Neurology, University of Alberta, Edmonton, Canada
| | - Julien Doyon
- Functional Neuroimaging Unit, University of Montreal, Montreal, Canada
| | - Sarah Fraser
- Department of Psychology-University of Ottawa, Ottawa, Canada
| | - Karen Li
- Department of Psychology and PERFORM Centre, Concordia University, Montreal, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Centre for Hip Health and Mobility, and Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Research Institute, University of British Columbia, Vancouver, Canada
| | - Laura Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Susan Muir-Hunter
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - William McIlroy
- Division of Neurology and Department of Medicine, University of Toronto. Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - José A Morais
- Division of Geriatrics and Centre of Excellence in Aging and Chronic Disease, McGill University, Montreal, Canada
| | - Frederico Pieruccini-Faria
- Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.,Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Canada
| | - Kevin Shoemaker
- Department of Kinesiology, University of Western Ontario, London, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Akshya Vasudev
- Department of Psychiatry, Division of Geriatric Psychiatry and Department of Medicine, Division of Clinical Pharmacology, University of Western Ontario, London, Canada
| | - G Y Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.,Robarts Clinical Trials Inc, London, Canada
| | - Nicolas Berryman
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada.,Department of Sports Studies, Bishop's University, Sherbrooke, Canada
| | - Maxime Lussier
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada.,Faculty of Medicine, University of Montreal, Montréal, Canada
| | | | - Louis Bherer
- Department of Psychology and PERFORM Centre, Concordia University, Montreal, Canada.,Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada.,Faculty of Medicine, University of Montreal, Montréal, Canada.,Montreal Heart Institute, Research Centre, Montreal, Canada
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76
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Lin Q, Rosenberg MD, Yoo K, Hsu TW, O'Connell TP, Chun MM. Resting-State Functional Connectivity Predicts Cognitive Impairment Related to Alzheimer's Disease. Front Aging Neurosci 2018; 10:94. [PMID: 29706883 PMCID: PMC5908906 DOI: 10.3389/fnagi.2018.00094] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/19/2018] [Indexed: 01/11/2023] Open
Abstract
Resting-state functional connectivity (rs-FC) is a promising neuromarker for cognitive decline in aging population, based on its ability to reveal functional differences associated with cognitive impairment across individuals, and because rs-fMRI may be less taxing for participants than task-based fMRI or neuropsychological tests. Here, we employ an approach that uses rs-FC to predict the Alzheimer's Disease Assessment Scale (11 items; ADAS11) scores, which measure overall cognitive functioning, in novel individuals. We applied this technique, connectome-based predictive modeling, to a heterogeneous sample of 59 subjects from the Alzheimer's Disease Neuroimaging Initiative, including normal aging, mild cognitive impairment, and AD subjects. First, we built linear regression models to predict ADAS11 scores from rs-FC measured with Pearson's r correlation. The positive network model tested with leave-one-out cross validation (LOOCV) significantly predicted individual differences in cognitive function from rs-FC. In a second analysis, we considered other functional connectivity features, accordance and discordance, which disentangle the correlation and anticorrelation components of activity timecourses between brain areas. Using partial least square regression and LOOCV, we again built models to successfully predict ADAS11 scores in novel individuals. Our study provides promising evidence that rs-FC can reveal cognitive impairment in an aging population, although more development is needed for clinical application.
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Affiliation(s)
- Qi Lin
- Department of Psychology, Yale University, New Haven, CT, United States
| | | | - Kwangsun Yoo
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Tiffany W Hsu
- Department of Psychology, Yale University, New Haven, CT, United States
| | | | - Marvin M Chun
- Department of Psychology, Yale University, New Haven, CT, United States.,Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, United States.,Department of Neuroscience, Yale School of Medicine, New Haven, CT, United States
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Nogueira J, Freitas S, Duro D, Almeida J, Santana I. Validation study of the Alzheimer's disease assessment scale-cognitive subscale (ADAS-Cog) for the Portuguese patients with mild cognitive impairment and Alzheimer's disease. Clin Neuropsychol 2018; 32:46-59. [PMID: 29566598 DOI: 10.1080/13854046.2018.1454511] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The Alzheimer's disease assessment scale-Cognitive Subscale (ADAS-Cog) is a battery to assess cognitive performance in Alzheimer's disease (AD) and was developed according to the core characteristics of cognitive decline in AD: memory, language, praxis, constructive ability, and orientation. The aim of this study was to explore the diagnostic accuracy and discriminative capacity of the ADAS-Cog for Mild Cognitive Impairment (MCI) and AD, using cut-off points for the Portuguese population. METHOD The European Portuguese version of the ADAS-Cog was administrated to 650 participants, divided into a control group (n = 210), an MCI group (n = 240), and an AD group (n = 200). The clinical groups fulfilled standard international diagnostic criteria. Controls were healthy cognitive participants actively integrated in the community. The neuropsychological assessment protocol included the ADAS-Cog, the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Adults and Older Adults Functional Assessment Inventory (IAFAI). RESULTS The ADAS-Cog revealed good psychometric indicators, and the total scores were significantly different between the three groups (p < .001: Control < MCI < AD). The optimal cut-off points established were: MCI > 9 points (AUC = .835; sensitivity = 58% and specificity = 91%) and AD > 12 points (AUC = .996; sensitivity = 94% and specificity = 98%). CONCLUSIONS Our findings confirmed the capacity of the ADAS-Cog total score to identify cognitive impairment in AD patients, with poor sensitivity for MCI, in a Portuguese cohort.
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Affiliation(s)
- Joana Nogueira
- a Faculty of Psychology and Educational Sciences , University of Coimbra (FPCEUC) , Coimbra , Portugal.,b Centro de Investigação em Neuropsicologia e Intervenção Cognitivo Comportamental (CINEICC) , University of Coimbra , Coimbra , Portugal.,c Psychological Assessment Lab , FPCEUC , Coimbra , Portugal.,d Proaction Laboratory (Perception and Recognition of Objects and Actions Laboratory) , FPCEUC , Coimbra , Portugal
| | - Sandra Freitas
- a Faculty of Psychology and Educational Sciences , University of Coimbra (FPCEUC) , Coimbra , Portugal.,b Centro de Investigação em Neuropsicologia e Intervenção Cognitivo Comportamental (CINEICC) , University of Coimbra , Coimbra , Portugal.,c Psychological Assessment Lab , FPCEUC , Coimbra , Portugal.,e Centre for Neuroscience and Cell Biology (CNC) , University of Coimbra , Coimbra , Portugal
| | - Diana Duro
- b Centro de Investigação em Neuropsicologia e Intervenção Cognitivo Comportamental (CINEICC) , University of Coimbra , Coimbra , Portugal.,e Centre for Neuroscience and Cell Biology (CNC) , University of Coimbra , Coimbra , Portugal.,f Faculty of Medicine , University of Coimbra , Coimbra , Portugal
| | - Jorge Almeida
- a Faculty of Psychology and Educational Sciences , University of Coimbra (FPCEUC) , Coimbra , Portugal.,b Centro de Investigação em Neuropsicologia e Intervenção Cognitivo Comportamental (CINEICC) , University of Coimbra , Coimbra , Portugal.,d Proaction Laboratory (Perception and Recognition of Objects and Actions Laboratory) , FPCEUC , Coimbra , Portugal
| | - Isabel Santana
- e Centre for Neuroscience and Cell Biology (CNC) , University of Coimbra , Coimbra , Portugal.,f Faculty of Medicine , University of Coimbra , Coimbra , Portugal.,g Neurology Department and Dementia Clinic , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
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78
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Evans S, McRae-McKee K, Wong MM, Hadjichrysanthou C, De Wolf F, Anderson R. The importance of endpoint selection: How effective does a drug need to be for success in a clinical trial of a possible Alzheimer's disease treatment? Eur J Epidemiol 2018; 33:635-644. [PMID: 29572656 PMCID: PMC6061129 DOI: 10.1007/s10654-018-0381-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/16/2018] [Indexed: 12/23/2022]
Abstract
To date, Alzheimer’s disease (AD) clinical trials have been largely unsuccessful. Failures have been attributed to a number of factors including ineffective drugs, inadequate targets, and poor trial design, of which the choice of endpoint is crucial. Using data from the Alzheimer’s Disease Neuroimaging Initiative, we have calculated the minimum detectable effect size (MDES) in change from baseline of a range of measures over time, and in different diagnostic groups along the AD development trajectory. The Functional Activities Questionnaire score had the smallest MDES for a single endpoint where an effect of 27% could be detected within 3 years in participants with Late Mild Cognitive Impairment (LMCI) at baseline, closely followed by the Clinical Dementia Rating Sum of Boxes (CDRSB) score at 28% after 2 years in the same group. Composite measures were even more successful than single endpoints with an MDES of 21% in 3 years. Using alternative cognitive, imaging, functional, or composite endpoints, and recruiting patients that have LMCI could improve the success rate of AD clinical trials.
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Affiliation(s)
- Stephanie Evans
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
| | - Kevin McRae-McKee
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Mei Mei Wong
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | | | - Frank De Wolf
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.,Janssen Prevention Center, Leiden, The Netherlands
| | - Roy Anderson
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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79
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Wilkins JM, Trushina E. Application of Metabolomics in Alzheimer's Disease. Front Neurol 2018; 8:719. [PMID: 29375465 PMCID: PMC5770363 DOI: 10.3389/fneur.2017.00719] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/13/2017] [Indexed: 12/22/2022] Open
Abstract
Progress toward the development of efficacious therapies for Alzheimer’s disease (AD) is halted by a lack of understanding early underlying pathological mechanisms. Systems biology encompasses several techniques including genomics, epigenomics, transcriptomics, proteomics, and metabolomics. Metabolomics is the newest omics platform that offers great potential for the diagnosis and prognosis of neurodegenerative diseases as an individual’s metabolome reflects alterations in genetic, transcript, and protein profiles and influences from the environment. Advancements in the field of metabolomics have demonstrated the complexity of dynamic changes associated with AD progression underscoring challenges with the development of efficacious therapeutic interventions. Defining systems-level alterations in AD could provide insights into disease mechanisms, reveal sex-specific changes, advance the development of biomarker panels, and aid in monitoring therapeutic efficacy, which should advance individualized medicine. Since metabolic pathways are largely conserved between species, metabolomics could improve the translation of preclinical research conducted in animal models of AD into humans. A summary of recent developments in the application of metabolomics to advance the AD field is provided below.
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Affiliation(s)
- Jordan Maximillian Wilkins
- Mitochondrial Neurobiology and Therapeutics Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Eugenia Trushina
- Mitochondrial Neurobiology and Therapeutics Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
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80
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Ciudin A, Simó-Servat O, Hernández C, Arcos G, Diego S, Sanabria Á, Sotolongo Ó, Hernández I, Boada M, Simó R. Retinal Microperimetry: A New Tool for Identifying Patients With Type 2 Diabetes at Risk for Developing Alzheimer Disease. Diabetes 2017; 66:3098-3104. [PMID: 28951388 DOI: 10.2337/db17-0382] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/21/2017] [Indexed: 11/13/2022]
Abstract
Type 2 diabetes is associated with a high risk of cognitive impairment and dementia. Therefore, strategies are needed to identify patients who are at risk for dementia. Given that the retina is a brain-derived tissue, it may provide a noninvasive way to examine brain pathology. The aims of this study were to evaluate whether retinal sensitivity 1) correlates with the specific parameters of brain imaging related to cognitive impairment and 2) discriminates patients with diabetes with mild cognitive impairment (MCI) from those with normal cognition and those with Alzheimer disease (AD). For this purpose, a prospective, nested case-control study was performed and included 35 patients with type 2 diabetes without cognitive impairment, 35 with MCI, and 35 with AD. Retinal sensitivity was assessed by Macular Integrity Assessment microperimetry, and a neuropsychological evaluation was performed. Brain neurodegeneration was assessed by MRI and fludeoxyglucose-18 positron emission tomography (18FDG-PET). A significant correlation was found between retinal sensitivity and the MRI and 18FDG-PET parameters related to brain neurodegeneration. Retinal sensitivity was related to cognitive status (normocognitive > MCI > AD; P < 0.0001). Our results suggest that retinal sensitivity assessed by microperimetry is related to brain neurodegeneration and could be a useful biomarker for identifying patients with type 2 diabetes who are at risk for developing AD.
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Affiliation(s)
- Andreea Ciudin
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
| | - Olga Simó-Servat
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Hernández
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
| | - Gabriel Arcos
- Department of Ophthalmology, Hospital San Rafael, Barcelona, Spain
| | - Susana Diego
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Ángela Sanabria
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Óscar Sotolongo
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Isabel Hernández
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Mercè Boada
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Rafael Simó
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
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81
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Anderson RM, Hadjichrysanthou C, Evans S, Wong MM. Why do so many clinical trials of therapies for Alzheimer's disease fail? Lancet 2017; 390:2327-2329. [PMID: 29185425 DOI: 10.1016/s0140-6736(17)32399-1] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Roy M Anderson
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London W2 1PG, UK.
| | - Christoforos Hadjichrysanthou
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London W2 1PG, UK
| | - Stephanie Evans
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London W2 1PG, UK
| | - Mei Mei Wong
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London W2 1PG, UK
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82
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Falck RS, Landry GJ, Best JR, Davis JC, Chiu BK, Liu-Ambrose T. Cross-Sectional Relationships of Physical Activity and Sedentary Behavior With Cognitive Function in Older Adults With Probable Mild Cognitive Impairment. Phys Ther 2017; 97:975-984. [PMID: 29029554 PMCID: PMC5803762 DOI: 10.1093/ptj/pzx074] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 07/17/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) represents a transition between normal cognitive aging and dementia and may represent a critical time frame for promoting cognitive health through behavioral strategies. Current evidence suggests that physical activity (PA) and sedentary behavior are important for cognition. However, it is unclear whether there are differences in PA and sedentary behavior between people with probable MCI and people without MCI or whether the relationships of PA and sedentary behavior with cognitive function differ by MCI status. OBJECTIVE The aims of this study were to examine differences in PA and sedentary behavior between people with probable MCI and people without MCI and whether associations of PA and sedentary behavior with cognitive function differed by MCI status. DESIGN This was a cross-sectional study. METHODS Physical activity and sedentary behavior in adults dwelling in the community (N = 151; at least 55 years old) were measured using a wrist-worn actigraphy unit. The Montreal Cognitive Assessment was used to categorize participants with probable MCI (scores of <26/30) and participants without MCI (scores of ≥26/30). Cognitive function was indexed using the Alzheimer Disease Assessment Scale-Cognitive-Plus (ADAS-Cog Plus). Physical activity and sedentary behavior were compared based on probable MCI status, and relationships of ADAS-Cog Plus with PA and sedentary behavior were examined by probable MCI status. RESULTS Participants with probable MCI (n = 82) had lower PA and higher sedentary behavior than participants without MCI (n = 69). Higher PA and lower sedentary behavior were associated with better ADAS-Cog Plus performance in participants without MCI (β = -.022 and β = .012, respectively) but not in participants with probable MCI (β < .001 for both). LIMITATIONS This study was cross-sectional and therefore could not establish whether conversion to MCI attenuated the relationships of PA and sedentary behavior with cognitive function. The diagnosis of MCI was not confirmed with a physician; therefore, this study could not conclude how many of the participants categorized as having probable MCI would actually have been diagnosed with MCI by a physician. CONCLUSIONS Participants with probable MCI were less active and more sedentary. The relationships of these behaviors with cognitive function differed by MCI status; associations were found only in participants without MCI.
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Affiliation(s)
- Ryan S. Falck
- R.S. Falck, MSc, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenn J. Landry
- G.J. Landry, PhD, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - John R. Best
- J.R. Best, PhD, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C. Davis
- J.C. Davis, PhD, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bryan K. Chiu
- B.K. Chiu, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- T. Liu-Ambrose, PhD, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia and Centre for Hip Health and Mobility, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada.,Address all correspondence to Dr Liu-Ambrose at:
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83
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Guekht A, Skoog I, Edmundson S, Zakharov V, Korczyn AD. ARTEMIDA Trial (A Randomized Trial of Efficacy, 12 Months International Double-Blind Actovegin): A Randomized Controlled Trial to Assess the Efficacy of Actovegin in Poststroke Cognitive Impairment. Stroke 2017; 48:1262-1270. [PMID: 28432265 PMCID: PMC5404405 DOI: 10.1161/strokeaha.116.014321] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 02/08/2017] [Accepted: 02/10/2017] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Poststroke cognitive impairment is a debilitating consequence of stroke. The aim of this study was to assess whether Actovegin confers cognitive benefit in patients who have had an ischemic stroke. Methods— This was a 12-month, parallel-group, randomized, multicenter, double-blind, placebo-controlled study. Eligible patients were ≥60 years of age with a Montreal Cognitive Assessment test score of ≤25 points. Patients were randomized into 2 groups within 1 week of acute supratentorial ischemic stroke in a 1:1 ratio: Actovegin (a deproteinized hemoderivative of calf blood, 2000 mg/d for ≤20 intravenous infusions followed by 1200 mg/d orally) or placebo for 6 months. Patients were treated in accordance with standard clinical practice for a further 6 months. The primary end point was the change from baseline in Alzheimer’s Disease Assessment Scale, cognitive subscale, extended version at 6 months. Results— Two-hundred forty-eight patients were randomized to Actovegin and 255 patients to placebo. At month 6, the least squares mean change from baseline in Alzheimer’s Disease Assessment Scale, cognitive subscale, extended version was −6.8 for Actovegin and −4.6 for placebo; the estimated treatment difference was −2.3 (95% confidence interval, −3.9, −0.7; P=0.005). Recurrent ischemic stroke was the most frequently reported serious adverse event, with a nonsignificantly higher number for Actovegin versus placebo. Conclusions— Actovegin had a beneficial effect on cognitive outcomes in patients with poststroke cognitive impairment. The safety experience was consistent with the known safety and tolerability profile of the drug. These results warrant confirmation in additional robustly designed studies. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01582854.
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Affiliation(s)
- Alla Guekht
- From the Department of Neurology, Neurosurgery and Genetics, Russian National Research Medical University Moscow and Clinical Center for Neuropsychiatry, Russia (A.G.); Sahlgrenska Academy, University of Gothenburg, Sweden (I.S.); Takeda Development Centre Europe, London, United Kingdom (S.E.); Department of Neurology, First Moscow State Medical University, Russia (V.Z.); and Department of Neurology, Tel Aviv University, Israel (A.D.K.).
| | - Ingmar Skoog
- From the Department of Neurology, Neurosurgery and Genetics, Russian National Research Medical University Moscow and Clinical Center for Neuropsychiatry, Russia (A.G.); Sahlgrenska Academy, University of Gothenburg, Sweden (I.S.); Takeda Development Centre Europe, London, United Kingdom (S.E.); Department of Neurology, First Moscow State Medical University, Russia (V.Z.); and Department of Neurology, Tel Aviv University, Israel (A.D.K.)
| | - Sally Edmundson
- From the Department of Neurology, Neurosurgery and Genetics, Russian National Research Medical University Moscow and Clinical Center for Neuropsychiatry, Russia (A.G.); Sahlgrenska Academy, University of Gothenburg, Sweden (I.S.); Takeda Development Centre Europe, London, United Kingdom (S.E.); Department of Neurology, First Moscow State Medical University, Russia (V.Z.); and Department of Neurology, Tel Aviv University, Israel (A.D.K.)
| | - Vladimir Zakharov
- From the Department of Neurology, Neurosurgery and Genetics, Russian National Research Medical University Moscow and Clinical Center for Neuropsychiatry, Russia (A.G.); Sahlgrenska Academy, University of Gothenburg, Sweden (I.S.); Takeda Development Centre Europe, London, United Kingdom (S.E.); Department of Neurology, First Moscow State Medical University, Russia (V.Z.); and Department of Neurology, Tel Aviv University, Israel (A.D.K.)
| | - Amos D Korczyn
- From the Department of Neurology, Neurosurgery and Genetics, Russian National Research Medical University Moscow and Clinical Center for Neuropsychiatry, Russia (A.G.); Sahlgrenska Academy, University of Gothenburg, Sweden (I.S.); Takeda Development Centre Europe, London, United Kingdom (S.E.); Department of Neurology, First Moscow State Medical University, Russia (V.Z.); and Department of Neurology, Tel Aviv University, Israel (A.D.K.)
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84
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Webster L, Groskreutz D, Grinbergs-Saull A, Howard R, O’Brien JT, Mountain G, Banerjee S, Woods B, Perneczky R, Lafortune L, Roberts C, McCleery J, Pickett J, Bunn F, Challis D, Charlesworth G, Featherstone K, Fox C, Goodman C, Jones R, Lamb S, Moniz-Cook E, Schneider J, Shepperd S, Surr C, Thompson-Coon J, Ballard C, Brayne C, Burns A, Clare L, Garrard P, Kehoe P, Passmore P, Holmes C, Maidment I, Robinson L, Livingston G. Core outcome measures for interventions to prevent or slow the progress of dementia for people living with mild to moderate dementia: Systematic review and consensus recommendations. PLoS One 2017; 12:e0179521. [PMID: 28662127 PMCID: PMC5491018 DOI: 10.1371/journal.pone.0179521] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/31/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There are no disease-modifying treatments for dementia. There is also no consensus on disease modifying outcomes. We aimed to produce the first evidence-based consensus on core outcome measures for trials of disease modification in mild-to-moderate dementia. METHODS AND FINDINGS We defined disease-modification interventions as those aiming to change the underlying pathology. We systematically searched electronic databases and previous systematic reviews for published and ongoing trials of disease-modifying treatments in mild-to-moderate dementia. We included 149/22,918 of the references found; with 81 outcome measures from 125 trials. Trials involved participants with Alzheimer's disease (AD) alone (n = 111), or AD and mild cognitive impairment (n = 8) and three vascular dementia. We divided outcomes by the domain measured (cognition, activities of daily living, biological markers, neuropsychiatric symptoms, quality of life, global). We calculated the number of trials and of participants using each outcome. We detailed psychometric properties of each outcome. We sought the views of people living with dementia and family carers in three cities through Alzheimer's society focus groups. Attendees at a consensus conference (experts in dementia research, disease-modification and harmonisation measures) decided on the core set of outcomes using these results. Recommended core outcomes were cognition as the fundamental deficit in dementia and to indicate disease modification, serial structural MRIs. Cognition should be measured by Mini Mental State Examination or Alzheimer's Disease Assessment Scale-Cognitive Subscale. MRIs would be optional for patients. We also made recommendations for measuring important, but non-core domains which may not change despite disease modification. LIMITATIONS Most trials were about AD. Specific instruments may be superseded. We searched one database for psychometric properties. INTERPRETATION This is the first review to identify the 81 outcome measures the research community uses for disease-modifying trials in mild-to-moderate dementia. Our recommendations will facilitate designing, comparing and meta-analysing disease modification trials in mild-to-moderate dementia, increasing their value. TRIAL REGISTRATION PROSPERO no. CRD42015027346.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, University College London, London, United Kingdom
| | - Derek Groskreutz
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | | | - Rob Howard
- Division of Psychiatry, University College London, London, United Kingdom
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Gail Mountain
- ScHARR, University of Sheffield, Sheffield, United Kingdom
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, United Kingdom
| | - Robert Perneczky
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Louise Lafortune
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Charlotte Roberts
- International Consortium for Health Outcomes Measurement, London, United Kingdom
| | - Jenny McCleery
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | | | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, United Kingdom
| | - Georgina Charlesworth
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Katie Featherstone
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - Roy Jones
- Research Institute for the Care of Older People (RICE), University of Bath, Bath, United Kingdom
| | - Sarah Lamb
- Warwick Clinical Trials Research Unit, University of Warwick, Warwick, United Kingdom
| | - Esme Moniz-Cook
- Faculty of Health and Social Care, University of Hull, Hull, United Kingdom
| | - Justine Schneider
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Claire Surr
- School of Health & Community Studies, Leeds Beckett University, Leeds, United Kingdom
| | - Jo Thompson-Coon
- PenCLAHRC, University of Exeter Medical School, Exeter, United Kingdom
| | - Clive Ballard
- Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Alistair Burns
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Linda Clare
- PenCLAHRC, University of Exeter Medical School, Exeter, United Kingdom
- School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Peter Garrard
- Neuroscience Research Centre, St. George's, University of London, London, United Kingdom
| | - Patrick Kehoe
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Clive Holmes
- School of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ian Maidment
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, United Kingdom
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
- North Thames CLAHRC, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
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Posner H, Curiel R, Edgar C, Hendrix S, Liu E, Loewenstein DA, Morrison G, Shinobu L, Wesnes K, Harvey PD. Outcomes Assessment in Clinical Trials of Alzheimer's Disease and its Precursors: Readying for Short-term and Long-term Clinical Trial Needs. INNOVATIONS IN CLINICAL NEUROSCIENCE 2017; 14:22-29. [PMID: 28386518 PMCID: PMC5373792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An evolving paradigm shift in the diagnostic conceptualization of Alzheimer's disease is reflected in its recently updated diagnostic criteria from the National Institute on Aging-Alzheimer's Association and the International Working Group. Additionally, it is reflected in the increased focus in this field on conducting prevention trials in addition to improving cognition and function in people with dementia. These developments are making key contributions towards defining new regulatory thinking around Alzheimer's disease treatment earlier in the disease continuum. As a result, the field as a whole is now concentrated on exploring the next-generation of cognitive and functional outcome measures that will support clinical trials focused on treating the slow slide into cognitive and functional impairment. With this backdrop, the International Society for CNS Clinical Trials and Methodology convened semi-annual working group meetings which began in spring of 2012 to address methodological issues in this area. This report presents the most critical issues around primary outcome assessments in Alzheimer's disease clinical trials, and summarizes the presentations, discussions, and recommendations of those meetings, within the context of the evolving landscape of Alzheimer's disease clinical trials.
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Affiliation(s)
- Holly Posner
- Dr. Posner is with Pfizer Inc., New York, New York; Drs. Curiel, Loewenstein, and Harvey are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Edgar is with Roche, Roche Products Ltd, Hertfordshire, United Kingdom; Dr. Hendrix is with Pentara Corporation, Salt Lake City, Utah; Dr. Liu is with Prothena Biosciences, Inc., South San Francisco, California; Dr. Morrison is with Lumos Labs, Inc., San Francisco, California; Dr. Shinobu is with Decibel, Therapeutics, Inc., Cambridge, Massachussetts; and Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames and Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Rosie Curiel
- Dr. Posner is with Pfizer Inc., New York, New York; Drs. Curiel, Loewenstein, and Harvey are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Edgar is with Roche, Roche Products Ltd, Hertfordshire, United Kingdom; Dr. Hendrix is with Pentara Corporation, Salt Lake City, Utah; Dr. Liu is with Prothena Biosciences, Inc., South San Francisco, California; Dr. Morrison is with Lumos Labs, Inc., San Francisco, California; Dr. Shinobu is with Decibel, Therapeutics, Inc., Cambridge, Massachussetts; and Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames and Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Chris Edgar
- Dr. Posner is with Pfizer Inc., New York, New York; Drs. Curiel, Loewenstein, and Harvey are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Edgar is with Roche, Roche Products Ltd, Hertfordshire, United Kingdom; Dr. Hendrix is with Pentara Corporation, Salt Lake City, Utah; Dr. Liu is with Prothena Biosciences, Inc., South San Francisco, California; Dr. Morrison is with Lumos Labs, Inc., San Francisco, California; Dr. Shinobu is with Decibel, Therapeutics, Inc., Cambridge, Massachussetts; and Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames and Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Suzanne Hendrix
- Dr. Posner is with Pfizer Inc., New York, New York; Drs. Curiel, Loewenstein, and Harvey are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Edgar is with Roche, Roche Products Ltd, Hertfordshire, United Kingdom; Dr. Hendrix is with Pentara Corporation, Salt Lake City, Utah; Dr. Liu is with Prothena Biosciences, Inc., South San Francisco, California; Dr. Morrison is with Lumos Labs, Inc., San Francisco, California; Dr. Shinobu is with Decibel, Therapeutics, Inc., Cambridge, Massachussetts; and Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames and Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Enchi Liu
- Dr. Posner is with Pfizer Inc., New York, New York; Drs. Curiel, Loewenstein, and Harvey are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Edgar is with Roche, Roche Products Ltd, Hertfordshire, United Kingdom; Dr. Hendrix is with Pentara Corporation, Salt Lake City, Utah; Dr. Liu is with Prothena Biosciences, Inc., South San Francisco, California; Dr. Morrison is with Lumos Labs, Inc., San Francisco, California; Dr. Shinobu is with Decibel, Therapeutics, Inc., Cambridge, Massachussetts; and Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames and Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - David A Loewenstein
- Dr. Posner is with Pfizer Inc., New York, New York; Drs. Curiel, Loewenstein, and Harvey are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Edgar is with Roche, Roche Products Ltd, Hertfordshire, United Kingdom; Dr. Hendrix is with Pentara Corporation, Salt Lake City, Utah; Dr. Liu is with Prothena Biosciences, Inc., South San Francisco, California; Dr. Morrison is with Lumos Labs, Inc., San Francisco, California; Dr. Shinobu is with Decibel, Therapeutics, Inc., Cambridge, Massachussetts; and Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames and Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Glenn Morrison
- Dr. Posner is with Pfizer Inc., New York, New York; Drs. Curiel, Loewenstein, and Harvey are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Edgar is with Roche, Roche Products Ltd, Hertfordshire, United Kingdom; Dr. Hendrix is with Pentara Corporation, Salt Lake City, Utah; Dr. Liu is with Prothena Biosciences, Inc., South San Francisco, California; Dr. Morrison is with Lumos Labs, Inc., San Francisco, California; Dr. Shinobu is with Decibel, Therapeutics, Inc., Cambridge, Massachussetts; and Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames and Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Leslie Shinobu
- Dr. Posner is with Pfizer Inc., New York, New York; Drs. Curiel, Loewenstein, and Harvey are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Edgar is with Roche, Roche Products Ltd, Hertfordshire, United Kingdom; Dr. Hendrix is with Pentara Corporation, Salt Lake City, Utah; Dr. Liu is with Prothena Biosciences, Inc., South San Francisco, California; Dr. Morrison is with Lumos Labs, Inc., San Francisco, California; Dr. Shinobu is with Decibel, Therapeutics, Inc., Cambridge, Massachussetts; and Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames and Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Keith Wesnes
- Dr. Posner is with Pfizer Inc., New York, New York; Drs. Curiel, Loewenstein, and Harvey are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Edgar is with Roche, Roche Products Ltd, Hertfordshire, United Kingdom; Dr. Hendrix is with Pentara Corporation, Salt Lake City, Utah; Dr. Liu is with Prothena Biosciences, Inc., South San Francisco, California; Dr. Morrison is with Lumos Labs, Inc., San Francisco, California; Dr. Shinobu is with Decibel, Therapeutics, Inc., Cambridge, Massachussetts; and Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames and Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Philip D Harvey
- Dr. Posner is with Pfizer Inc., New York, New York; Drs. Curiel, Loewenstein, and Harvey are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Edgar is with Roche, Roche Products Ltd, Hertfordshire, United Kingdom; Dr. Hendrix is with Pentara Corporation, Salt Lake City, Utah; Dr. Liu is with Prothena Biosciences, Inc., South San Francisco, California; Dr. Morrison is with Lumos Labs, Inc., San Francisco, California; Dr. Shinobu is with Decibel, Therapeutics, Inc., Cambridge, Massachussetts; and Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames and Department of Psychology, Northumbria University, Newcastle, United Kingdom
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86
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Zhang DM, Ye JX, Mu JS, Cui XP. Efficacy of Vitamin B Supplementation on Cognition in Elderly Patients With Cognitive-Related Diseases. J Geriatr Psychiatry Neurol 2017; 30:50-59. [PMID: 28248558 DOI: 10.1177/0891988716673466] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Increase in serum homocysteine is shown to be a potential risk factor for cognitive impairment. Evidence suggests that vitamin B supplementation may reduce cognitive decline by lowering the homocysteine levels. The current meta-analysis evaluated the efficacy of folic acid along with vitamin B12 and/or B6 in lowering homocysteine, thereby attenuating cognitive decline in elderly patients with Alzheimer disease or dementia. Randomized controlled trials (RCTs) comparing the efficacy of folate and B vitamin supplementation in patients with cognitive decline secondary to Alzheimer disease or dementia were identified using the keywords, "homocysteine, hyper-homocysteinemia, B vitamin, vitamin B6, B12, folic acid, cognitive, Alzheimer's disease, and dementia." The outcome measures analyzed were the Mini-Mental State Examination (MMSE) score and serum homocysteine. Of the 77 studies identified, 4 RCTs were included in the current meta-analysis. The baseline characteristics, age, and gender distribution of patients among the 2 groups (supplement vs placebo) were comparable. The results reveal that the intervention group achieved significantly greater reduction in homocysteine levels than the control (pooled difference in means = -3.625, 95% confidence interval [CI] = -5.642 to -1.608, P < .001). However, no significant difference in MMSE (pooled difference in means = 0.027, 95% CI = -0.518 to 0.573, P = 0.921) was observed between the groups. Taken together, vitamin B supplementation was effective in reducing serum homocysteine levels. However, it did not translate into cognitive improvement, indicating that the existing data on vitamin B-induced improvement in cognition by lowering homocysteine levels are conflicting.
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Affiliation(s)
- Dong-Mei Zhang
- 1 Department of Geriatrics, Fuzhou General Hospital of Nanjing Command, PLA and Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jian-Xin Ye
- 2 Department of Neurology, Fuzhou General Hospital of Nanjing Command, PLA and Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jun-Shan Mu
- 2 Department of Neurology, Fuzhou General Hospital of Nanjing Command, PLA and Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xiao-Ping Cui
- 2 Department of Neurology, Fuzhou General Hospital of Nanjing Command, PLA and Clinical Medical College of Fujian Medical University, Fuzhou, China
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87
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Degradation in intrinsic connectivity networks across the Alzheimer's disease spectrum. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 5:35-42. [PMID: 28054026 PMCID: PMC5198881 DOI: 10.1016/j.dadm.2016.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Changes in intrinsic functional connectivity (iFC) have been reported at various stages of the Alzheimer's disease (AD) spectrum. We aimed to investigate such alterations over a variety of large-scale intrinsic brain networks (iBNs) across the spectrum of amyloid β positivity and uncover their relation to cognitive impairment. Methods Eight iBNs were defined from resting-state functional magnetic resonance imaging data. In amyloid β–positive healthy subjects, prodromal, and AD patients (N = 70), within-network iFC (intra-iFC) and between-network iFC (inter-iFC) were correlated with scores of cognitive impairment. Results Across all iBNs, a general degradation in intra-iFC along the scale of cognitive impairment severity was found. Only subtle changes in inter-iFC were identified. Discussion Across the AD spectrum, changes in iFC that are strongly related to cognitive impairment occur within an extensive variety of networks.
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88
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Koppara A, Wolfsgruber S, Kleineidam L, Schmidtke K, Frölich L, Kurz A, Schulz S, Hampel H, Heuser I, Peters O, Reischies FM, Jahn H, Luckhaus C, Hüll M, Gertz HJ, Schröder J, Pantel J, Rienhoff O, Rüther E, Henn F, Wiltfang J, Maier W, Jessen F, Kornhuber J, Wagner M. The Latent Dementia Phenotype δ is Associated with Cerebrospinal Fluid Biomarkers of Alzheimer's Disease and Predicts Conversion to Dementia in Subjects with Mild Cognitive Impairment. J Alzheimers Dis 2016; 49:547-60. [PMID: 26484902 DOI: 10.3233/jad-150257] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The recently proposed latent variable δ is a new tool for dementia case finding. It is built in a structural equation modeling framework of cognitive and functional data and constitutes a novel endophenotype for Alzheimer's disease (AD) research and clinical trials. OBJECTIVE To investigate the association of δ with AD biomarkers and to compare the prediction of δ with established scales for conversion to dementia in patients with mild cognitive impairment (MCI). METHODS Using data from a multicenter memory clinic study, we examined the external associations of the latent variable δ and compared δ with well-established cognitive and functional scales and cognitive-functional composite scores. For that purpose, logistic regressions with cerebrospinal fluid (CSF) biomarkers and conversion to dementia as dependent variables were performed with the investigated scores. The models were tested for significant differences. RESULTS In patients with MCI, δ based on a broad range of cognitive scales (including the ADAS-cog, the MMSE, and the CERAD neuropsychological battery) predicted an abnormal CSF Aβ42/tau ratio indicative of AD (n = 340, AUC = 0.78, p < 0.001), and predicted incident dementia within 1-3 years of follow-up (n = 525, AUC = 0.84, p < 0.001). These associations were generally stronger than for any other scale or cognitive-functional composite examined. Homologs of δ based on reduced test batteries yielded somewhat lower effects. CONCLUSION These findings support the interpretation of δ as a construct capturing the disease-related "essence" of cognitive and functional impairments in patients with MCI and dementia, and suggest that δ might become an analytical tool for dementia research.
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Affiliation(s)
- Alexander Koppara
- Department of Psychiatry, University of Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Steffen Wolfsgruber
- Department of Psychiatry, University of Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Luca Kleineidam
- Department of Psychiatry, University of Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Klaus Schmidtke
- Center for Geriatric Medicine, Ortenau Klinikum, Offenburg-Gengenbach, Germany
| | - Lutz Frölich
- Department of Gerontopsychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Alexander Kurz
- Department of Psychiatry, Technical University of Munich, Germany
| | | | - Harald Hampel
- Department of Neurology, Université Pierre et Marie Curie (Sorbonne), and AXA Research Fund & UPMC Chair, Paris, France
| | - Isabella Heuser
- Department of Psychiatry, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Oliver Peters
- Department of Psychiatry, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Friedel M Reischies
- Department of Psychiatry, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Holger Jahn
- Department of Psychiatry, University of Hamburg, Germany
| | | | - Michael Hüll
- Center for Psychiatry, Clinic for Geronto- and Neuropsychiatry Emmendingen and Dep. of Psychiatry, University of Freiburg, Germany
| | | | - Johannes Schröder
- Section for Geriatric Psychiatry/Institute of Gerontology, University of Heidelberg, Germany
| | - Johannes Pantel
- Institute of General Medicine University of Frankfurt, Frankfurt am Main, Germany
| | - Otto Rienhoff
- Department of Medical Informatics, University of Göttingen, Germany
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
| | - Fritz Henn
- Ichan School of Medicine at Mt. Sinai, New York, USA
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Frank Jessen
- Department of Psychiatry, University of Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Psychiatry, Medical Faculty University of Cologne, Germany
| | - Johannes Kornhuber
- Department of Psychiatry, Friedrich-Alexander-University Erlangen, Germany
| | - Michael Wagner
- Department of Psychiatry, University of Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany
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89
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Dowling NM, Bolt DM, Deng S. An approach for estimating item sensitivity to within-person change over time: An illustration using the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog). Psychol Assess 2016; 28:1576-1585. [PMID: 27046272 DOI: 10.1037/pas0000285] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
When assessments are primarily used to measure change over time, it is important to evaluate items according to their sensitivity to change, specifically. Items that demonstrate good sensitivity to between-person differences at baseline may not show good sensitivity to change over time, and vice versa. In this study, we applied a longitudinal factor model of change to a widely used cognitive test designed to assess global cognitive status in dementia, and contrasted the relative sensitivity of items to change. Statistically nested models were estimated introducing distinct latent factors related to initial status differences between test-takers and within-person latent change across successive time points of measurement. Models were estimated using all available longitudinal item-level data from the Alzheimer's Disease Assessment Scale-Cognitive subscale, including participants representing the full-spectrum of disease status who were enrolled in the multisite Alzheimer's Disease Neuroimaging Initiative. Five of the 13 Alzheimer's Disease Assessment Scale-Cognitive items demonstrated noticeably higher loadings with respect to sensitivity to change. Attending to performance change on only these 5 items yielded a clearer picture of cognitive decline more consistent with theoretical expectations in comparison to the full 13-item scale. Items that show good psychometric properties in cross-sectional studies are not necessarily the best items at measuring change over time, such as cognitive decline. Applications of the methodological approach described and illustrated in this study can advance our understanding regarding the types of items that best detect fine-grained early pathological changes in cognition. (PsycINFO Database Record
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Affiliation(s)
- N Maritza Dowling
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison
| | - Daniel M Bolt
- Department of Educational Psychology, University of Wisconsin-Madison
| | - Sien Deng
- Department of Educational Psychology, University of Wisconsin-Madison
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90
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Luchsinger JA, Perez T, Chang H, Mehta P, Steffener J, Pradabhan G, Ichise M, Manly J, Devanand DP, Bagiella E. Metformin in Amnestic Mild Cognitive Impairment: Results of a Pilot Randomized Placebo Controlled Clinical Trial. J Alzheimers Dis 2016; 51:501-14. [PMID: 26890736 PMCID: PMC5079271 DOI: 10.3233/jad-150493] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diabetes and hyperinsulinemia may be risk factors for Alzheimer's disease (AD). We conducted a pilot study of metformin, a medication efficacious in treating and preventing diabetes while reducing hyperinsulinemia, among persons with amnestic mild cognitive impairment (aMCI) with the goal of collecting preliminary data on feasibility, safety, and efficacy. Participants were 80 men and women aged 55 to 90 years with aMCI, overweight or obese, without treated diabetes. We randomized participants to metformin 1000 mg twice a day or matching placebo for 12 months. The co-primary clinical outcomes were changes from baseline to 12 months in total recall of the Selective Reminding Test (SRT) and the score of the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog). The secondary outcome was change in relative glucose uptake in the posterior cingulate-precuneus in brain fluorodeoxyglucose positron emission tomography. Change in plasma Aβ42 was an exploratory outcome. The mean age of participants was 65 years. Fifty percent of participants were women. The only baseline variable that was different between the arms was the ADAS-Cog. Metformin could not be tolerated by 7.5% of participants; 15% tolerated 500 mg/day, 35% tolerated 1000 mg/day, 32.5% tolerated 1500 mg/day, and only 10% tolerated the maximum dose. There were no serious adverse events related to metformin. The 7.5% of persons who did not tolerate metformin reported gastrointestinal symptoms. After adjusting for baseline ADAS-cog, changes in total recall of the SRT favored the metformin group (9.7±8.5 versus 5.3±8.5; p = 0.02). Differences for other outcomes were not significant. A larger trial seems warranted to evaluate the efficacy and cognitive safety of metformin in prodromal AD.
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Affiliation(s)
- José A. Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Medical Center, 630 West 168 street, New York, NY 10032. USA
| | - Thania Perez
- Deparment of Medicine, Columbia University Medical Center, 630 West 168 street, New York, NY 10032. USA
| | - Helena Chang
- Department of Statistics, Mt. Sinai Medical Center, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Pankaj Mehta
- New York Institute for Basic Research, 1050 Forest Hill Road, Staten Island, NY 10314, USA
| | - Jason Steffener
- Gertrude H. Sergievsky Center, Columbia University, 630 West 168 Street, New York, NY 10032, USA
| | - Gnanavalli Pradabhan
- Department of Psychiatry, Columbia University Medical Center, and Division of Geriatric Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Masanori Ichise
- Department of Radiology, Columbia University Medical Center, 622 West 168 street, New York, NY 10032, USA
| | - Jennifer Manly
- Gertrude H. Sergievsky Center, Columbia University, 630 West 168 Street, New York, NY 10032, USA
| | - Devangere P. Devanand
- Department of Psychiatry, Columbia University Medical Center, and Division of Geriatric Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Emilia Bagiella
- Department of Statistics, Mt. Sinai Medical Center, 1425 Madison Avenue, New York, NY, 10029, USA
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91
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Grochowalski JH, Liu Y, Siedlecki KL. Examining the reliability of ADAS-Cog change scores. AGING NEUROPSYCHOLOGY AND COGNITION 2015; 23:513-29. [DOI: 10.1080/13825585.2015.1127320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Ying Liu
- Department of Psychology, Fordham University, Bronx, NY, USA
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92
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Verma N, Beretvas SN, Pascual B, Masdeu JC, Markey MK. New scoring methodology improves the sensitivity of the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) in clinical trials. ALZHEIMERS RESEARCH & THERAPY 2015; 7:64. [PMID: 26560146 PMCID: PMC4642693 DOI: 10.1186/s13195-015-0151-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 09/28/2015] [Indexed: 01/11/2023]
Abstract
Introduction As currently used, the Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-Cog) has low sensitivity for measuring Alzheimer’s disease progression in clinical trials. A major reason behind the low sensitivity is its sub-optimal scoring methodology, which can be improved to obtain better sensitivity. Methods Using item response theory, we developed a new scoring methodology (ADAS-CogIRT) for the ADAS-Cog, which addresses several major limitations of the current scoring methodology. The sensitivity of the ADAS-CogIRT methodology was evaluated using clinical trial simulations as well as a negative clinical trial, which had shown an evidence of a treatment effect. Results The ADAS-Cog was found to measure impairment in three cognitive domains of memory, language, and praxis. The ADAS-CogIRT methodology required significantly fewer patients and shorter trial durations as compared to the current scoring methodology when both were evaluated in simulated clinical trials. When validated on data from a real clinical trial, the ADAS-CogIRT methodology had higher sensitivity than the current scoring methodology in detecting the treatment effect. Conclusions The proposed scoring methodology significantly improves the sensitivity of the ADAS-Cog in measuring progression of cognitive impairment in clinical trials focused in the mild-to-moderate Alzheimer’s disease stage. This provides a boost to the efficiency of clinical trials requiring fewer patients and shorter durations for investigating disease-modifying treatments. Electronic supplementary material The online version of this article (doi:10.1186/s13195-015-0151-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nishant Verma
- Department of Biomedical Engineering, The University of Texas at Austin, 107 W. Dean Keeton Street Stop C0800, Austin, TX, 78712, USA. .,NeuroTexas Institute Research Foundation, St. David's HealthCare, 1015 E. 32nd Street Suite 404, Austin, TX, 78705, USA.
| | - S Natasha Beretvas
- Department of Educational Psychology, The University of Texas at Austin, 1 University Station D5800, Austin, TX, 78712, USA.
| | - Belen Pascual
- Nantz National Alzheimer Center, Houston Methodist Neurological Institute, 6560 Fannin Street, Houston, TX, 77030, USA.
| | - Joseph C Masdeu
- Nantz National Alzheimer Center, Houston Methodist Neurological Institute, 6560 Fannin Street, Houston, TX, 77030, USA.
| | - Mia K Markey
- Department of Biomedical Engineering, The University of Texas at Austin, 107 W. Dean Keeton Street Stop C0800, Austin, TX, 78712, USA. .,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street FCT14.50000, Houston, TX, 77030, USA.
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93
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Weiner MW, Veitch DP, Aisen PS, Beckett LA, Cairns NJ, Cedarbaum J, Green RC, Harvey D, Jack CR, Jagust W, Luthman J, Morris JC, Petersen RC, Saykin AJ, Shaw L, Shen L, Schwarz A, Toga AW, Trojanowski JQ. 2014 Update of the Alzheimer's Disease Neuroimaging Initiative: A review of papers published since its inception. Alzheimers Dement 2015; 11:e1-120. [PMID: 26073027 PMCID: PMC5469297 DOI: 10.1016/j.jalz.2014.11.001] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/18/2013] [Indexed: 01/18/2023]
Abstract
The Alzheimer's Disease Neuroimaging Initiative (ADNI) is an ongoing, longitudinal, multicenter study designed to develop clinical, imaging, genetic, and biochemical biomarkers for the early detection and tracking of Alzheimer's disease (AD). The initial study, ADNI-1, enrolled 400 subjects with early mild cognitive impairment (MCI), 200 with early AD, and 200 cognitively normal elderly controls. ADNI-1 was extended by a 2-year Grand Opportunities grant in 2009 and by a competitive renewal, ADNI-2, which enrolled an additional 550 participants and will run until 2015. This article reviews all papers published since the inception of the initiative and summarizes the results to the end of 2013. The major accomplishments of ADNI have been as follows: (1) the development of standardized methods for clinical tests, magnetic resonance imaging (MRI), positron emission tomography (PET), and cerebrospinal fluid (CSF) biomarkers in a multicenter setting; (2) elucidation of the patterns and rates of change of imaging and CSF biomarker measurements in control subjects, MCI patients, and AD patients. CSF biomarkers are largely consistent with disease trajectories predicted by β-amyloid cascade (Hardy, J Alzheimer's Dis 2006;9(Suppl 3):151-3) and tau-mediated neurodegeneration hypotheses for AD, whereas brain atrophy and hypometabolism levels show predicted patterns but exhibit differing rates of change depending on region and disease severity; (3) the assessment of alternative methods of diagnostic categorization. Currently, the best classifiers select and combine optimum features from multiple modalities, including MRI, [(18)F]-fluorodeoxyglucose-PET, amyloid PET, CSF biomarkers, and clinical tests; (4) the development of blood biomarkers for AD as potentially noninvasive and low-cost alternatives to CSF biomarkers for AD diagnosis and the assessment of α-syn as an additional biomarker; (5) the development of methods for the early detection of AD. CSF biomarkers, β-amyloid 42 and tau, as well as amyloid PET may reflect the earliest steps in AD pathology in mildly symptomatic or even nonsymptomatic subjects and are leading candidates for the detection of AD in its preclinical stages; (6) the improvement of clinical trial efficiency through the identification of subjects most likely to undergo imminent future clinical decline and the use of more sensitive outcome measures to reduce sample sizes. Multimodal methods incorporating APOE status and longitudinal MRI proved most highly predictive of future decline. Refinements of clinical tests used as outcome measures such as clinical dementia rating-sum of boxes further reduced sample sizes; (7) the pioneering of genome-wide association studies that leverage quantitative imaging and biomarker phenotypes, including longitudinal data, to confirm recently identified loci, CR1, CLU, and PICALM and to identify novel AD risk loci; (8) worldwide impact through the establishment of ADNI-like programs in Japan, Australia, Argentina, Taiwan, China, Korea, Europe, and Italy; (9) understanding the biology and pathobiology of normal aging, MCI, and AD through integration of ADNI biomarker and clinical data to stimulate research that will resolve controversies about competing hypotheses on the etiopathogenesis of AD, thereby advancing efforts to find disease-modifying drugs for AD; and (10) the establishment of infrastructure to allow sharing of all raw and processed data without embargo to interested scientific investigators throughout the world.
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Affiliation(s)
- 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.
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Paul S Aisen
- Department of Neurosciences, University of California, San Diego, La Jolla, 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
| | - Jesse Cedarbaum
- Neurology Early Clinical Development, Biogen Idec, Cambridge, MA, 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
| | - Johan Luthman
- Neuroscience Clinical Development, Neuroscience & General Medicine Product Creation Unit, Eisai Inc., Philadelphia, PA, USA
| | - John C Morris
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, 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 Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Li Shen
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Adam Schwarz
- Tailored Therapeutics, Eli Lilly and Company, Indianapolis, IN, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - John Q Trojanowski
- 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; Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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94
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A Risk-Benefit Assessment of Dementia Medications: Systematic Review of the Evidence. Drugs Aging 2015; 32:453-67. [DOI: 10.1007/s40266-015-0266-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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95
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Benzoate, a D-amino acid oxidase inhibitor, for the treatment of early-phase Alzheimer disease: a randomized, double-blind, placebo-controlled trial. Biol Psychiatry 2014; 75:678-85. [PMID: 24074637 DOI: 10.1016/j.biopsych.2013.08.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/25/2013] [Accepted: 08/05/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND N-methyl-D-aspartate receptor (NMDAR)-mediated neurotransmission is vital for learning and memory. Hypofunction of NMDAR has been reported to play a role in the pathophysiology of Alzheimer disease (AD), particularly in the early phase. Enhancing NMDAR activation might be a novel treatment approach. One of the methods to enhance NMDAR activity is to raise the levels of NMDA coagonists by blocking their metabolism. This study examined the efficacy and safety of sodium benzoate, a D-amino acid oxidase inhibitor, for the treatment of amnestic mild cognitive impairment and mild AD. METHODS We conducted a randomized, double-blind, placebo-controlled trial in four major medical centers in Taiwan. Sixty patients with amnestic mild cognitive impairment or mild AD were treated with 250-750 mg/day of sodium benzoate or placebo for 24 weeks. Alzheimer's Disease Assessment Scale-cognitive subscale (the primary outcome) and global function (assessed by Clinician Interview Based Impression of Change plus Caregiver Input) were measured every 8 weeks. Additional cognition composite was measured at baseline and endpoint. RESULTS Sodium benzoate produced a better improvement than placebo in Alzheimer's Disease Assessment Scale-cognitive subscale (p = .0021, .0116, and .0031 at week 16, week 24, and endpoint, respectively), additional cognition composite (p = .007 at endpoint) and Clinician Interview Based Impression of Change plus Caregiver Input (p = .015, .016, and .012 at week 16, week 24, and endpoint, respectively). Sodium benzoate was well-tolerated without evident side-effects. CONCLUSIONS Sodium benzoate substantially improved cognitive and overall functions in patients with early-phase AD. The preliminary results show promise for D-amino acid oxidase inhibition as a novel approach for early dementing processes.
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96
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Ahmad R, Goffin K, Van den Stock J, De Winter FL, Cleeren E, Bormans G, Tournoy J, Persoons P, Van Laere K, Vandenbulcke M. In vivo type 1 cannabinoid receptor availability in Alzheimer's disease. Eur Neuropsychopharmacol 2014; 24:242-50. [PMID: 24189376 DOI: 10.1016/j.euroneuro.2013.10.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/04/2013] [Accepted: 10/09/2013] [Indexed: 11/16/2022]
Abstract
The endocannabinoid system (ECS) is an important modulatory and potentially neuroprotective homeostatic system in the brain. In Alzheimer's disease (AD), the role of type 1 cannabinoid receptor (CB₁R) is unclear, with contradictory findings in post-mortem studies showing upregulation, downregulation or unchanged CB₁R status. We have investigated CB₁R availability in vivo in patients with AD, in relation to amyloid deposition, cognitive functioning and apolipoprotein E (ApoE) genotype. Eleven AD patients and 7 healthy volunteers (HV) underwent combined [¹⁸F]MK-9470 PET and [¹¹C]PIB PET scans to assess CB₁R availability and amyloid deposition, respectively, and T1 volumetric MRI for partial volume correction. We found no difference in CB₁R availability between AD and HV, VOI-based fractional uptake values (FUR) were 0.043±0.01 for AD and 0.045±0.01 for controls (p=0.9). CB₁R availability did not correlate with neuropsychological test scores and was not modulated by ApoE genotype. As expected, global [¹¹C]PIB SUVR (standardized uptake value ratio) was increased in AD (SUVR 1.9±0.3) compared to HV (1.2±0.1) with p<0.001, but no correlation was found between amyloid β (Aβ) deposition and CB₁R availability. In conclusion, we found no in vivo evidence for a difference in CB₁R availability in AD compared to age-matched controls. Taken together with recently reported in vivo CB₁R changes in Parkinson's and Huntington's disease, these data suggest that the CB₁R is differentially involved in neurodegenerative disorders.
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Affiliation(s)
- Rawaha Ahmad
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Belgium; Department of Imaging & Pathology, KU Leuven, Belgium.
| | - Karolien Goffin
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Belgium; Department of Imaging & Pathology, KU Leuven, Belgium
| | - Jan Van den Stock
- Department of Old Age Psychiatry, University Hospitals Leuven, Belgium; Department of Neurosciences, KU Leuven, Belgium
| | - François-Laurent De Winter
- Department of Old Age Psychiatry, University Hospitals Leuven, Belgium; Department of Neurosciences, KU Leuven, Belgium
| | - Evy Cleeren
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Belgium; Department of Imaging & Pathology, KU Leuven, Belgium
| | - Guy Bormans
- Laboratory for Radiopharmacy, KU Leuven, Belgium
| | - Jos Tournoy
- Geriatric Medicine, University Hospitals Leuven, Belgium; Department of Clinical and Experimental Medicine, KU Leuven, Belgium
| | - Philippe Persoons
- Department of Old Age Psychiatry, University Hospitals Leuven, Belgium; Department of Neurosciences, KU Leuven, Belgium
| | - Koen Van Laere
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Belgium; Department of Imaging & Pathology, KU Leuven, Belgium
| | - Mathieu Vandenbulcke
- Department of Old Age Psychiatry, University Hospitals Leuven, Belgium; Department of Neurosciences, KU Leuven, Belgium
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97
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O'Caoimh R, Svendrovski A, Johnston BC, Gao Y, McGlade C, Eustace J, Timmons S, Guyatt G, Molloy DW. The Quick Mild Cognitive Impairment screen correlated with the Standardized Alzheimer's Disease Assessment Scale–cognitive section in clinical trials. J Clin Epidemiol 2014; 67:87-92. [DOI: 10.1016/j.jclinepi.2013.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 07/06/2013] [Accepted: 07/09/2013] [Indexed: 11/15/2022]
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98
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O'Caoimh R, Gao Y, Gallagher PF, Eustace J, McGlade C, Molloy DW. Which part of the Quick mild cognitive impairment screen (Qmci) discriminates between normal cognition, mild cognitive impairment and dementia? Age Ageing 2013; 42:324-30. [PMID: 23612864 PMCID: PMC3633367 DOI: 10.1093/ageing/aft044] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: the Qmci is a sensitive and specific test to differentiate between normal cognition (NC), mild cognitive impairment (MCI) and dementia. We compared the sensitivity and specificity of the subtests of the Qmci to determine which best discriminated NC, MCI and dementia. Objective: the objective was to determine the contribution each subtest of the Qmci makes, to its sensitivity and specificity in differentiating MCI from NC and dementia, to refine and shorten the instrument. Methods: existing data from our previous study of 965 subjects, testing the Qmci, was analysed to compare the sensitivity and specificity of the Qmci subtests. Results: all the subtests of the Qmci differentiated MCI from NC. Logical memory (LM) performed the best (area under the receiver operating curve of 0.80), registration the worst, (0.56). LM and verbal fluency had the largest median differences (expressed as percentage of total score) between MCI and NC, 20 and 25%, respectively. Other subtests did not have clinically useful differences. LM was best at differentiating MCI from NC, irrespective of age or educational status. Conclusion: the Qmci incorporates several important cognitive domains making it useful across the spectrum of cognitive impairment. LM is the best performing subtest for differentiating MCI from NC.
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Affiliation(s)
- Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, St Finbarrs Hospital, Douglas Road, Cork City, Ireland.
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99
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Mungas D, Crane PK, Gibbons LE, Manly JJ, Glymour MM, Jones RN. Advanced psychometric analysis and the Alzheimer's Disease Neuroimaging Initiative: reports from the 2011 Friday Harbor conference. Brain Imaging Behav 2012; 6:485-8. [PMID: 23232798 PMCID: PMC3532555 DOI: 10.1007/s11682-012-9211-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article summarizes a special series of articles from The Advanced Psychometric Methods in Cognitive Aging Research conference, held in June, 2011 at Friday Harbor, Washington. This conference used data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) to address cognitive change associated with Alzheimer's disease (AD) and how it related to neuroimaging, genetic, and cerebrospinal fluid biomarkers. The 13 articles in this series present innovative approaches to measuring cognition and studying determinants of cognitive decline in AD.
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Affiliation(s)
- Dan Mungas
- Department of Neurology, University of California, Davis, Davis, CA, USA.
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100
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Cummings J, Gould H, Zhong K. Advances in designs for Alzheimer's disease clinical trials. AMERICAN JOURNAL OF NEURODEGENERATIVE DISEASE 2012; 1:205-216. [PMID: 23383393 PMCID: PMC3560467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 10/29/2012] [Indexed: 06/01/2023]
Abstract
There is an urgent need to identify new treatments for the rapidly growing population of people with Alzheimer's disease (AD). Innovations in clinical trial designs many help to reduce development time, provide more definitive answers regarding drug efficacy, and facilitate prioritizing compounds to be advanced to Phase III clinical trials. Standard designs compare drug and placebo changes from baseline on a rating scale. Baysian adaptive clinical trials allow the use of data collected in the trial to modify doses, sample size, trial duration, and entry criteria in an ongoing way as the data are collected. Disease-modification is supported by findings on staggered start and delayed withdrawal designs. Futility designs can use historical controls and may shorten trial duration. Combination therapy designs may allow investigation of additive or synergistic treatment effects. Novel trial selection criteria allow investigation of treatment effects in asymptomatic or minimally symptomatic, prodromal AD populations. The Clinical Dementia Rating-Sum of Boxes (CDR-SOB) can be considered as a single trial outcome in early disease populations. Alternate forms of the Alzheimer's Disease Assessment Scale-Cognitive Portion (ADAS-cog), computerized measures, and pharmacoeconomic scales provide new and relevant information on drug effects. Comparative dose strategies are used in trials of symptomatic agents, and novel methods including withdrawal designs, symptom emergence analyses, and sequential designs are being utilized to assess the efficacy of putative psychotropic agents. The choice of trial design is driven by the question to be answered by the clinical trial; an increasing number of design approaches are available and may be useful in accelerating and refining AD drug development.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health Las Vegas, Nevada; Cleveland, Ohio; Weston, Florida
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