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Gauthreaux K, Bonnett TA, Besser LM, Brenowitz WD, Teylan M, Mock C, Chen YC, Chan KCG, Keene CD, Zhou XH, Kukull WA. Concordance of Clinical Alzheimer Diagnosis and Neuropathological Features at Autopsy. J Neuropathol Exp Neurol 2020; 79:465-473. [PMID: 32186726 PMCID: PMC7160616 DOI: 10.1093/jnen/nlaa014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/27/2019] [Indexed: 12/14/2022] Open
Abstract
It remains unclear what clinical features inform the accuracy of a clinical diagnosis of Alzheimer disease (AD). Data were obtained from the National Alzheimer's Coordinating Center to compare clinical and neuropathologic features among participants who did or did not have Alzheimer disease neuropathologic changes (ADNC) at autopsy. Participants (1854) had a clinical Alzheimer dementia diagnosis and ADNC at autopsy (Confirmed-AD), 204 participants had an AD diagnosis and no ADNC (AD-Mimics), and 253 participants had no AD diagnosis and ADNC (Unidentified-AD). Compared to Confirmed-AD participants, AD-Mimics had less severe cognitive impairment, while Unidentified-AD participants displayed more parkinsonian signs, depression, and behavioral problems. This study highlights the importance of developing a complete panel of biomarkers as a tool to inform clinical diagnoses, as clinical phenotypes that are typically associated with diseases other than AD may result in inaccurate diagnoses.
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Affiliation(s)
- Kathryn Gauthreaux
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
| | - Tyler A Bonnett
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, Maryland
| | - Lilah M Besser
- School of Urban and Regional Planning, Institute for Human Health and Disease Intervention, Florida Atlantic University, Boca Raton, Florida
| | - Willa D Brenowitz
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California
| | - Merilee Teylan
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
| | | | | | - Kwun C G Chan
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, Washington
| | - Xiao-Hua Zhou
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
| | - Walter A Kukull
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
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Beach TG, Adler CH, Zhang N, Serrano GE, Sue LI, Driver-Dunckley E, Mehta SH, Zamrini EE, Sabbagh MN, Shill HA, Belden CM, Shprecher DR, Caselli RJ, Reiman EM, Davis KJ, Long KE, Nicholson LR, Intorcia AJ, Glass MJ, Walker JE, Callan MM, Oliver JC, Arce R, Gerkin RC. Severe hyposmia distinguishes neuropathologically confirmed dementia with Lewy bodies from Alzheimer's disease dementia. PLoS One 2020; 15:e0231720. [PMID: 32320406 PMCID: PMC7176090 DOI: 10.1371/journal.pone.0231720] [Citation(s) in RCA: 24] [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: 11/14/2019] [Accepted: 03/30/2020] [Indexed: 11/19/2022] Open
Abstract
Many subjects with neuropathologically-confirmed dementia with Lewy bodies (DLB) are never diagnosed during life, instead being categorized as Alzheimer's disease dementia (ADD) or unspecified dementia. Unrecognized DLB therefore is a critical impediment to clinical studies and treatment trials of both ADD and DLB. There are studies that suggest that olfactory function tests may be able to distinguish DLB from ADD, but few of these had neuropathological confirmation of diagnosis. We compared University of Pennsylvania Smell Identification Test (UPSIT) results in 257 subjects that went on to autopsy and neuropathological examination. Consensus clinicopathological diagnostic criteria were used to define ADD and DLB, as well as Parkinson's disease with dementia (PDD), with (PDD+AD) or without (PDD-AD) concurrent AD; a group with ADD and Lewy body disease (LBD) not meeting criteria for DLB (ADLB) and a clinically normal control group were also included. The subjects with DLB, PDD+AD and PDD-AD all had lower (one-way ANOVA p < 0.0001, pairwise Bonferroni p < 0.05) first and mean UPSIT scores than the ADD, ADLB or control groups. For DLB subjects with first and mean UPSIT scores less than 20 and 17, respectively, Firth logistic regression analysis, adjusted for age, gender and mean MMSE score, conferred statistically significant odds ratios of 17.5 and 18.0 for the diagnosis, vs ADD. For other group comparisons (PDD+AD and PDD-AD vs ADD) and UPSIT cutoffs of 17, the same analyses resulted in odds ratios ranging from 16.3 to 31.6 (p < 0.0001). To our knowledge, this is the largest study to date comparing olfactory function in subjects with neuropathologically-confirmed LBD and ADD. Olfactory function testing may be a convenient and inexpensive strategy for enriching dementia studies or clinical trials with DLB subjects, or conversely, reducing the inclusion of DLB subjects in ADD studies or trials.
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Affiliation(s)
- Thomas G. Beach
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Charles H. Adler
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Nan Zhang
- Department of Biostatistics, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Geidy E. Serrano
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Lucia I. Sue
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | | | - Shayamal H. Mehta
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Edouard E. Zamrini
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Marwan N. Sabbagh
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, United States of America
| | - Holly A. Shill
- Barrow Neurological Institute, Phoenix, Arizona, United States of America
| | - Christine M. Belden
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - David R. Shprecher
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Richard J. Caselli
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Eric M. Reiman
- Banner Alzheimer’s Institute, Phoenix, Arizona, United States of America
| | - Kathryn J. Davis
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Kathy E. Long
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Lisa R. Nicholson
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Anthony J. Intorcia
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Michael J. Glass
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Jessica E. Walker
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Michael M. Callan
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Javon C. Oliver
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Richard Arce
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Richard C. Gerkin
- School of Life Sciences, Arizona State University, Tempe, Arizona, United States of America
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid-century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.
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Shaw LM, Korecka M, Figurski M, Toledo J, Irwin D, Kang JH, Trojanowski JQ. Detection of Alzheimer Disease Pathology in Patients Using Biochemical Biomarkers: Prospects and Challenges for Use in Clinical Practice. J Appl Lab Med 2020; 5:183-193. [PMID: 31848218 PMCID: PMC7246169 DOI: 10.1373/jalm.2019.029587] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Thirty-four years ago, amyloid-β 1-42 peptide was identified in amyloid plaques from brain tissue obtained from patients with Alzheimer disease (AD) and Down syndrome. This finding led to development of immunoassays for this marker of amyloid plaque burden in cerebrospinal fluid (CSF) approximately 10 years later. Subsequently, research immunoassays were developed for total τ protein and τ phosphorylated at the threonine 181 position. Subsequent studies documented the clinical utility of these biomarkers of amyloid plaque burden or τ tangle pathology in cohorts of living patients. CONTENT We describe the following: (a) clinical utility of AD biomarkers; (b) measurement challenges, including development of mass spectrometry-based reference methods and automated immunoassays; (c) development of "appropriate use criteria" (AUC) guidelines for safe/appropriate use of CSF testing for diagnosis of AD developed by neurologists, a neuroethicist, and laboratorians; (d) a framework, sponsored by the National Institute of Aging-Alzheimer's Association (NIA-AA), that defines AD on the basis of CSF and imaging methods for detecting amyloid plaque burden, τ tangle pathology, and neurodegeneration. This framework's purpose was investigative but has important implications for future clinical practice; (e) recognition of copathologies in AD patients and challenges for developing methods to detect these in living patients. SUMMARY The field can expect availability of validated research tools for detection of AD pathology that support clinical treatment trials of disease-modifying agents and, ultimately, use in clinical practice. Validated methods are becoming available for CSF testing; emergence of validated methods for AD biomarkers in plasma can be expected in the next few years.
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Affiliation(s)
- Leslie M Shaw
- Department of Pathology and Laboratory Medicine, University
of Pennsylvania, Philadelphia, PA 19104
| | - Magdalena Korecka
- Department of Pathology and Laboratory Medicine, University
of Pennsylvania, Philadelphia, PA 19104
| | - Michal Figurski
- Department of Pathology and Laboratory Medicine, University
of Pennsylvania, Philadelphia, PA 19104
| | - Jon Toledo
- Department of Neurology, Houston Methodist Hospital,
Houston, TX
| | - David Irwin
- Department of Neurology, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA 19104
| | - Ju Hee Kang
- Department of Pharmacology and Clinical Pharmacology,
College of Medicine, Inha University, Incheon, 22212, Republic of Korea
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, University
of Pennsylvania, Philadelphia, PA 19104
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Chimagomedova AS, Zorina NA, Arablinskii AV, Levin OS. [Clinical and neuroimaging heterogeneity of dementia with Lewy bodies]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:25-31. [PMID: 31825386 DOI: 10.17116/jnevro201911909225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study clinical characteristics of dementia with Lewy bodies (DLB) depending on neuropsychological, neuroimaging and concomitant cerebrovascular changes as well as on the character of disease onset. MATERIAL AND METHODS Forty-five patients with DLB (25 men and 20 women, men age 72.9±7.2 years, illness duration 2.9±2.2) were studied. The diagnosis was made according to international criteria (McKeith, et al, 2017). MRI, clinical/neurological examination and psychometric scales were used. RESULTS AND CONCLUSION Clinical, neuropsychological and neuroimaging results reveal the heterogeneity of DLB, which remains poorly investigated. An analysis of the clinical picture, cognitive profile, neuropsychiatric changes and MRI results identified three subtypes of DLB course: 1) typical; 2) with early psychotic manifestation; 3) atypical (mixed). This approach may improve the diagnosis of DLB, prognosis of disease course and treatment effectiveness.
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Affiliation(s)
- A Sh Chimagomedova
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - N A Zorina
- Botkin City Clinical Hospital, Moscow, Russia
| | - A V Arablinskii
- Sechenov First Moscow State Medical University, Moscow, Russia; Botkin City Clinical Hospital, Moscow, Russia
| | - O S Levin
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
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Alosco ML, Stein TD, Tripodis Y, Chua AS, Kowall NW, Huber BR, Goldstein LE, Cantu RC, Katz DI, Palmisano JN, Martin B, Cherry JD, Mahar I, Killiany RJ, McClean MD, Au R, Alvarez V, Stern RA, Mez J, McKee AC. Association of White Matter Rarefaction, Arteriolosclerosis, and Tau With Dementia in Chronic Traumatic Encephalopathy. JAMA Neurol 2019; 76:1298-1308. [PMID: 31380975 PMCID: PMC6686769 DOI: 10.1001/jamaneurol.2019.2244] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/28/2019] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head impacts, including those from US football, that presents with cognitive and neuropsychiatric disturbances that can progress to dementia. Pathways to dementia in CTE are unclear and likely involve tau and nontau pathologic conditions. OBJECTIVE To investigate the association of white matter rarefaction and cerebrovascular disease with dementia in deceased men older than 40 years who played football and had CTE. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study involves analyses of data from the ongoing Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Study, which is conducted via and included brain donors from the Veterans Affairs-Boston University-Concussion Legacy Foundation brain bank between 2008 and 2017. An original sample of 224 men who had played football and were neuropathologically diagnosed with CTE was reduced after exclusion of those younger than 40 years and those missing data. EXPOSURES The number of years of football play as a proxy for repetitive head impacts. MAIN OUTCOMES AND MEASURES Neuropathological assessment of white matter rarefaction and arteriolosclerosis severity (on a scale of 0-3, where 3 is severe); number of infarcts, microinfarcts, and microbleeds; and phosphorylated tau accumulation determined by CTE stage and semiquantitative rating of dorsolateral frontal cortex (DLFC) neurofibrillary tangles (NFTs) (none or mild vs moderate or severe). Informant-based retrospective clinical interviews determined dementia diagnoses via diagnostic consensus conferences. RESULTS A total of 180 men were included. The mean (SD) age of the sample at death was 67.9 (12.7) years. Of 180, 120 [66.7%]) were found to have had dementia prior to death. Moderate to severe white matter rarefaction (84 of 180 [46.6%]) and arteriolosclerosis (85 of 180 [47.2%]) were common; infarcts, microinfarcts, and microbleeds were not. A simultaneous equations regression model controlling for age and race showed that more years of play was associated with more severe white matter rarefaction (β, 0.16 [95% CI, 0.02-0.29]; P = .03) and greater phosphorylated tau accumulation (DLFC NFTs: β, 0.15 [95% CI, 0.004-0.30]; P = .04; CTE stage: β, 0.27 [95% CI, 0.14-0.41]; P < .001). White matter rarefaction (β, 0.16 [95% CI, 0.02-0.29]; P = .03) and DLFC NFTs (β, 0.16 [95% CI, 0.03-0.28]; P = .01) were associated with dementia. Arteriolosclerosis and years of play were not associated, but arteriolosclerosis was independently associated with dementia (β, 0.21 [95% CI, 0.07-0.35]; P = .003). CONCLUSIONS AND RELEVANCE Among older men who had played football and had CTE, more years of football play were associated with more severe white matter rarefaction and greater DLFC NFT burden. White matter rarefaction, arteriolosclerosis, and DLFC NFTs were independently associated with dementia. Dementia in CTE is likely a result of neuropathologic changes, including white matter rarefaction and phosphorylated tau, associated with repetitive head impact and pathologic changes not associated with head trauma, such as arteriolosclerosis.
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Affiliation(s)
- Michael L. Alosco
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Thor D. Stein
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- Bedford Veterans Affairs Medical Center, Bedford, Massachusetts
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Alicia S. Chua
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Neil W. Kowall
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Bertrand Russell Huber
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- National Center for Posttraumatic Stress Disorder, VA Boston Healthcare, Boston, Massachusetts
| | - Lee E. Goldstein
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Department of Electrical & Computer Engineering, Boston University College of Engineering, Boston, Massachusetts
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
- Department of Biomedical Engineering, Boston University College of Engineering, Boston, Massachusetts
| | - Robert C. Cantu
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts
- Concussion Legacy Foundation, Boston, Massachusetts
- Department of Neurosurgery, Emerson Hospital, Concord, Massachusetts
| | - Douglas I. Katz
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Joseph N. Palmisano
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Brett Martin
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Jonathan D. Cherry
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Ian Mahar
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Ronald J. Killiany
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
- Center for Biomedical Imaging, Boston University School of Medicine, Boston, Massachusetts
| | - Michael D. McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Rhoda Au
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Victor Alvarez
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Robert A. Stern
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Jesse Mez
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Ann C. McKee
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- Bedford Veterans Affairs Medical Center, Bedford, Massachusetts
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Faster cognitive decline in dementia due to Alzheimer disease with clinically undiagnosed Lewy body disease. PLoS One 2019; 14:e0217566. [PMID: 31237877 PMCID: PMC6592515 DOI: 10.1371/journal.pone.0217566] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/14/2019] [Indexed: 11/22/2022] Open
Abstract
Background Neuropathology has demonstrated a high rate of comorbid pathology in dementia due to Alzheimer’s disease (ADD). The most common major comorbidity is Lewy body disease (LBD), either as dementia with Lewy bodies (AD-DLB) or Alzheimer’s disease with Lewy bodies (AD-LB), the latter representing subjects with ADD and LBD not meeting neuropathological distribution and density thresholds for DLB. Although it has been established that ADD subjects with undifferentiated LBD have a more rapid cognitive decline than those with ADD alone, it is still unknown whether AD-LB subjects, who represent the majority of LBD and approximately one-third of all those with ADD, have a different clinical course. Methods Subjects with dementia included those with “pure” ADD (n = 137), AD-DLB (n = 64) and AD-LB (n = 114), all with two or more complete Mini Mental State Examinations (MMSE) and a full neuropathological examination. Results Linear mixed models assessing MMSE change showed that the AD-LB group had significantly greater decline compared to the ADD group (β = -0.69, 95% CI: -1.05, -0.33, p<0.001) while the AD-DLB group did not (β = -0.30, 95% CI: -0.73, 0.14, p = 0.18). Of those with AD-DLB and AD-LB, only 66% and 2.1%, respectively, had been diagnosed with LBD at any point during their clinical course. Compared with clinically-diagnosed AD-DLB subjects, those that were clinically undetected had significantly lower prevalences of parkinsonism (p = 0.046), visual hallucinations (p = 0.0008) and dream enactment behavior (0.013). Conclusions The probable cause of LBD clinical detection failure is the lack of a sufficient set of characteristic core clinical features. Core DLB clinical features were not more common in AD-LB as compared to ADD. Clinical identification of ADD with LBD would allow stratified analyses of ADD clinical trials, potentially improving the probability of trial success.
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Edwards III GA, Gamez N, Escobedo Jr. G, Calderon O, Moreno-Gonzalez I. Modifiable Risk Factors for Alzheimer's Disease. Front Aging Neurosci 2019; 11:146. [PMID: 31293412 PMCID: PMC6601685 DOI: 10.3389/fnagi.2019.00146] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/31/2019] [Indexed: 01/03/2023] Open
Abstract
Since first described in the early 1900s, Alzheimer's disease (AD) has risen exponentially in prevalence and concern. Research still drives to understand the etiology and pathogenesis of this disease and what risk factors can attribute to AD. With a majority of AD cases being of sporadic origin, the increasing exponential growth of an aged population and a lack of treatment, it is imperative to discover an easy accessible preventative method for AD. Some risk factors can increase the propensity of AD such as aging, sex, and genetics. Moreover, there are also modifiable risk factors-in terms of treatable medical conditions and lifestyle choices-that play a role in developing AD. These risk factors have their own biological mechanisms that may contribute to AD etiology and pathological consequences. In this review article, we will discuss modifiable risk factors and discuss the current literature of how each of these factors interplay into AD development and progression and if strategically analyzed and treated, could aid in protection against this neurodegenerative disease.
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Affiliation(s)
- George A. Edwards III
- The Mitchell Center for Alzheimer’s Disease and Related Brain Disorders, Department of Neurology, The University of Texas Houston Health Science Center at Houston, Houston, TX, United States
| | - Nazaret Gamez
- The Mitchell Center for Alzheimer’s Disease and Related Brain Disorders, Department of Neurology, The University of Texas Houston Health Science Center at Houston, Houston, TX, United States
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Department of Cell Biology, Facultad Ciencias, Universidad de Malaga, Malaga, Spain
| | - Gabriel Escobedo Jr.
- The Mitchell Center for Alzheimer’s Disease and Related Brain Disorders, Department of Neurology, The University of Texas Houston Health Science Center at Houston, Houston, TX, United States
| | - Olivia Calderon
- The Mitchell Center for Alzheimer’s Disease and Related Brain Disorders, Department of Neurology, The University of Texas Houston Health Science Center at Houston, Houston, TX, United States
| | - Ines Moreno-Gonzalez
- The Mitchell Center for Alzheimer’s Disease and Related Brain Disorders, Department of Neurology, The University of Texas Houston Health Science Center at Houston, Houston, TX, United States
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Department of Cell Biology, Facultad Ciencias, Universidad de Malaga, Malaga, Spain
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60
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Selvackadunco S, Langford K, Shah Z, Hurley S, Bodi I, King A, Aarsland D, Troakes C, Al-Sarraj S. Comparison of clinical and neuropathological diagnoses of neurodegenerative diseases in two centres from the Brains for Dementia Research (BDR) cohort. J Neural Transm (Vienna) 2019; 126:327-337. [PMID: 30730007 PMCID: PMC6449484 DOI: 10.1007/s00702-018-01967-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/15/2018] [Indexed: 11/28/2022]
Abstract
Early detection and accurate diagnosis of neurodegenerative disorders may provide better epidemiological data, closer monitoring of disease progression and enable more specialised intervention. We analysed the clinical records and pathology of brain donations from 180 patients from two Brains for Dementia Research cohorts to determine the agreement between in-life clinical diagnosis and post-mortem pathological results. Clinical diagnosis was extracted from medical records and cases assigned into broad clinical groups; control, Alzheimer’s disease (AD), vascular dementia (CVD), dementia with Lewy bodies (DLB), frontotemporal dementia (FTD) and combined diseases. Pathology was assessed blindly, and cases categorised into; control, intermediate AD, severe AD, CVD, AD and CVD combined, DLB, AD and DLB combined and frontotemporal lobar degeneration (FTLD), according to the major contributing pathologies. In more than a third of cases clinical diagnosis was different from final neuropathological diagnosis. The majority of AD, DLB and control clinical groups matched the pathological diagnosis; however, thirty-five percent of clinical AD cases showed additional prominent CVD or DLB pathology which had not been diagnosed clinically and twenty-five percent of clinical control cases were found to have intermediate Tau pathology (modified Braak stage III–IV) or CVD. CVD and AD + CVD clinical groups showed an average of only thirty-two percent pathological correlation, the majority actually having no CVD, and fifty-three percent of pathologically identified FTLD cases had been incorrectly clinically diagnosed. Our results underlie the importance of neuropathological confirmation of clinical diagnosis. The relatively low accuracy of clinical diagnosis demonstrates the need for standardised and validated diagnostic assessment procedures.
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Affiliation(s)
- Sashika Selvackadunco
- Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK
| | - Katie Langford
- Old Age Psychiatry Department, IoPPN, King's College London, London, UK
| | - Zohra Shah
- Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK
| | - Siobhan Hurley
- Old Age Psychiatry Department, IoPPN, King's College London, London, UK
| | - Istvan Bodi
- Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK.,Department of Clinical Neuropathology, Academic Neuroscience Centre, King's College Hospital, King's College Hospital NHS Foundation Trust, 1st Floor, Denmark Hill, London, SE5 9RS, UK
| | - Andrew King
- Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK.,Department of Clinical Neuropathology, Academic Neuroscience Centre, King's College Hospital, King's College Hospital NHS Foundation Trust, 1st Floor, Denmark Hill, London, SE5 9RS, UK
| | - Dag Aarsland
- Old Age Psychiatry Department, IoPPN, King's College London, London, UK
| | - Claire Troakes
- Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK
| | - Safa Al-Sarraj
- Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK. .,Department of Clinical Neuropathology, Academic Neuroscience Centre, King's College Hospital, King's College Hospital NHS Foundation Trust, 1st Floor, Denmark Hill, London, SE5 9RS, UK.
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Heinrich J, Vidal JS, Simon A, Rigaud AS, Hanon O, Epelbaum J, Viollet C, Duron E. Relationships Between Lower Olfaction and Brain White Matter Lesions in Elderly Subjects with Mild Cognitive Impairment. J Alzheimers Dis 2019; 61:1133-1141. [PMID: 29332036 DOI: 10.3233/jad-170378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Olfactory impairment is reported in mild cognitive impairment (MCI) and Alzheimer's disease (AD) and is associated with hippocampal atrophy. In elderly people, dementia with AD neuropathology and white matter lesions (WML) is common. In this context, olfactory impairment could also depend on the presence of WML. OBJECTIVE To assess the cross-sectional relationship between olfaction and WML in elderly subjects with MCI. METHODS Consecutive subjects, >65 years old, diagnosed as MCI after a comprehensive neuropsychological assessment in an expert memory center, with a brain MRI performed within a year and without major depressive state, were included. Olfaction was assessed by the Brief Smell Identification Test (BSIT). Two trained neuroradiologists, blind to cognitive and olfaction status, visually assessed hippocampal atrophy according to Scheltens' scale and WML according to Fazekas criteria. RESULTS Seventy-five MCI subjects (mean age (SD) = 77.1 (6.2) years, 74.7% of women) were included. After adjustment for age and sex, factors associated with low BSIT scores were older age (p = 0.007), lower BMI (p = 0.08), lower MMSE score (p = 0.05), lower FCRST (p = 0.008), hippocampal atrophy (p = 0.04), periventricular WML (p = 0.007), and deep WML burden (p = 0.005). In multivariate analysis, severe deep WML (OR (95% CI) = 6.29 (1.4-35.13), p = 0.02) remained associated with low BSIT score independently from hippocampal atrophy. CONCLUSION In elderly MCI subjects, low olfactory performances are associated with WML, whose progression may be slowed by vascular treatments. A longitudinal study to evaluate whether the progression of WML, hippocampal atrophy and low olfactory function, can predict accurately conversion from MCI to dementia is ongoing.
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Affiliation(s)
- Juliette Heinrich
- Centre de Psychiatrie et Neurosciences UMR S894 Inserm Université Paris Descartes, Paris, France.,Université Sorbonne Paris Cité, Paris, France.,Ecole Normale Supérieure Paris, France
| | - Jean-Sébastien Vidal
- Department of Geriatrics, AP-HP, Groupe Hospitalier Paris-Centre, Broca Hospital, Paris, France.,EA 4468, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Axelle Simon
- Centre de Psychiatrie et Neurosciences UMR S894 Inserm Université Paris Descartes, Paris, France.,Université Sorbonne Paris Cité, Paris, France
| | - Anne-Sophie Rigaud
- Department of Geriatrics, AP-HP, Groupe Hospitalier Paris-Centre, Broca Hospital, Paris, France.,EA 4468, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Olivier Hanon
- Department of Geriatrics, AP-HP, Groupe Hospitalier Paris-Centre, Broca Hospital, Paris, France.,EA 4468, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jacques Epelbaum
- Centre de Psychiatrie et Neurosciences UMR S894 Inserm Université Paris Descartes, Paris, France.,Université Sorbonne Paris Cité, Paris, France.,MECADEV UMR 7179 Centre National de la Recherche Scientifique, Muséum National d'Histoire Naturelle, Brunoy, France
| | - Cecile Viollet
- Centre de Psychiatrie et Neurosciences UMR S894 Inserm Université Paris Descartes, Paris, France.,Université Sorbonne Paris Cité, Paris, France
| | - Emmanuelle Duron
- Department of Geriatrics, AP-HP, Groupe Hospitalier Paris-Centre, Broca Hospital, Paris, France.,EA 4468, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Relationship Between Tau, β Amyloid and α-Synuclein Pathologies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1184:169-176. [PMID: 32096037 DOI: 10.1007/978-981-32-9358-8_14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
It is becoming increasing clear that multiple pathological lesions co-exist in the brains of the demented and non-demented elderly, and with putative interactions revealed at the molecular level in addition to the cumulative effects on brain damage, mounting evidence suggests manifestation of multiple protein aggregates will have implications for the clinical course of many neurodegenerative diseases associated with dementia. In this section we will discuss how the presence of multiple pathological lesions can affect the pathological and clinical phenotype of neurodegenerative disorders.
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63
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Robertson AD, Udow SJ, Espay AJ, Merola A, Camicioli R, Lang AE, Masellis M. Orthostatic hypotension and dementia incidence: links and implications. Neuropsychiatr Dis Treat 2019; 15:2181-2194. [PMID: 31447560 PMCID: PMC6683958 DOI: 10.2147/ndt.s182123] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/09/2019] [Indexed: 12/14/2022] Open
Abstract
Orthostatic hypotension (OH) is a common condition, particularly in patients with α-synucleinopathies such as Parkinson's disease, and has a significant impact on activities of daily living and quality of life. Recent data suggest an association with cognitive impairment. Herein, we review the evidence that OH increases the odds of incident mild cognitive impairment and dementia. Potential mechanisms underlying the putative relationship are discussed, including cerebral hypoperfusion, supine hypertension, white matter hyperintensities, and neurodegeneration. Finally, we highlight the challenges with respect to treatment and the negative impact on the quality of life and long-term prognosis presented by the coexistence of OH and dementia. Large population-based studies have reported that OH is associated with about a 20% increased risk of dementia in the general population, while smaller cohort studies suggest an even greater effect in patients with α-synucleinopathies (3- to 7-fold higher than controls). Ultimately, OH exposure is difficult to quantify, predominantly limited to pressure regulation during a one-time orthostatic challenge, and the causative association with dementia may turn out to be bidirectional, especially in α-synucleinopathies. Early diagnosis and treatment of OH may improve long-term prognosis.
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Affiliation(s)
- Andrew D Robertson
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Sean J Udow
- Division of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alberto J Espay
- Department of Neurology, James and Joan Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Aristide Merola
- Department of Neurology, James and Joan Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Richard Camicioli
- Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Cognitive and Movement Disorders Clinic, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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64
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Ishibashi M, Kimura N, Sumi K, Aso Y, Matsubara E. Comparison of brain perfusion patterns in dementia with Lewy bodies patients with or without cingulate island sign. Geriatr Gerontol Int 2018; 19:197-202. [PMID: 30548751 DOI: 10.1111/ggi.13586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to examine the differences in the brain perfusion single-photon emission computed tomography patterns compared in dementia with Lewy bodies (DLB) with or without cingulate island sign (CIS). METHODS A total of 43 patients with DLB and 63 patients with Alzheimer's disease (AD) were included in the study. The CIScore was determined based on the posterior cingulate area and the occipital cortex using the eZIS software. The CIScore was analyzed using receiver operating characteristic curve analysis. Statistical parametric mapping 8 was used for the voxel-by-voxel group analysis of single-photon emission computed tomography. RESULTS The mean CIScore was significantly lower in DLB patients than in Alzheimer's disease patients. The age at examination was higher in the normal CIScore subgroup than in the abnormal CIScore subgroup based on optimal cut-off value. Statistical parametric mapping 8 analysis showed Alzheimer's disease-specific hypoperfusion in the normal-CIScore subgroup. Furthermore, stratifying the patients by age before applying the optimal CIScore cut-off improved the largest area under the receiver operating characteristic curve in patients aged ≤78 years compared with patients aged >79 years. CONCLUSIONS The present findings suggest that older DLB patients might have a normal CIScore because of concomitant multiple pathology. Therefore, age should be considered when interpreting the CIScore. Geriatr Gerontol Int 2019; 19: 197-202.
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Affiliation(s)
- Masato Ishibashi
- Department of Neurology, Oita University, Faculty of Medicine, Oita, Japan
| | - Noriyuki Kimura
- Department of Neurology, Oita University, Faculty of Medicine, Oita, Japan
| | - Kaori Sumi
- Department of Neurology, Oita University, Faculty of Medicine, Oita, Japan
| | - Yasuhiro Aso
- Department of Neurology, Oita University, Faculty of Medicine, Oita, Japan
| | - Etsuro Matsubara
- Department of Neurology, Oita University, Faculty of Medicine, Oita, Japan
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65
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Shaw LM, Arias J, Blennow K, Galasko D, Molinuevo JL, Salloway S, Schindler S, Carrillo MC, Hendrix JA, Ross A, Illes J, Ramus C, Fifer S. Appropriate use criteria for lumbar puncture and cerebrospinal fluid testing in the diagnosis of Alzheimer's disease. Alzheimers Dement 2018; 14:1505-1521. [PMID: 30316776 PMCID: PMC10013957 DOI: 10.1016/j.jalz.2018.07.220] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/17/2018] [Accepted: 07/31/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The Alzheimer's Association convened a multidisciplinary workgroup to develop appropriate use criteria to guide the safe and optimal use of the lumbar puncture procedure and cerebrospinal fluid (CSF) testing for Alzheimer's disease pathology detection in the diagnostic process. METHODS The workgroup, experienced in the ethical use of lumbar puncture and CSF analysis, developed key research questions to guide the systematic review of the evidence and developed clinical indications commonly encountered in clinical practice based on key patient groups in whom the use of lumbar puncture and CSF may be considered as part of the diagnostic process. Based on their expertise and interpretation of the evidence from systematic review, members rated each indication as appropriate or inappropriate. RESULTS The workgroup finalized 14 indications, rating 6 appropriate and 8 inappropriate. DISCUSSION In anticipation of the emergence of more reliable CSF analysis platforms, the manuscript offers important guidance to health-care practitioners and suggestions for implementation and future research.
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Affiliation(s)
- Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Jalayne Arias
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, University of Gothenberg, Molndal, Sweden
| | - Douglas Galasko
- Department of Neuroscience, University of California, San Diego, CA, USA
| | | | - Stephen Salloway
- Butler Hospital Memory and Aging Program, The Warren Alpert Medical School of Brown University, Brown University, Providence, RI, USA
| | | | | | | | - April Ross
- Alzheimer's Association, Chicago, IL, USA
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66
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Besser LM, Kukull WA, Teylan MA, Bigio EH, Cairns NJ, Kofler JK, Montine TJ, Schneider JA, Nelson PT. The Revised National Alzheimer's Coordinating Center's Neuropathology Form-Available Data and New Analyses. J Neuropathol Exp Neurol 2018; 77:717-726. [PMID: 29945202 PMCID: PMC6044344 DOI: 10.1093/jnen/nly049] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Neuropathologic evaluation remains the gold standard for determining the presence and severity of aging-related neurodegenerative diseases. Researchers at U.S. Alzheimer's Disease Centers (ADCs) have worked for >30 years studying human brains, with the goals of achieving new research breakthroughs. Harmonization and sharing among the 39 current and past ADCs is promoted by the National Alzheimer's Coordinating Center (NACC), which collects, audits, and disburses ADC-derived data to investigators on request. The past decades have witnessed revised disease definitions paired with dramatic expansion in the granularity and multimodality of the collected data. The NACC database now includes cognitive test scores, comorbidities, drug history, neuroimaging, and links to genomics. Relatively, recent advances in the neuropathologic diagnoses of Alzheimer's disease, frontotemporal lobar degeneration (FTLD), and vascular contributions to cognitive impairment and dementia catalyzed a 2014 update to the NACC Neuropathology Form completed by all ADCs. New focal points include cerebrovascular disease (including arteriolosclerosis, microbleeds, and microinfarcts), hippocampal sclerosis, TDP-43, and FTLD. Here, we provide summary data and analyses to illustrate the potential for both hypothesis-testing and also generating new hypotheses using the NACC Neuropathology data set, which represents one of the largest multi-center databases of carefully curated neuropathologic information that is freely available to researchers worldwide.
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Affiliation(s)
- Lilah M Besser
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
- Institute for Healthy Aging and Lifespan Studies and School of Urban and Regional Planning, Florida Atlantic University, Boca Raton, Florida
| | - Walter A Kukull
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
| | - Merilee A Teylan
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
| | - Eileen H Bigio
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nigel J Cairns
- Department of Neurology, Washington University in St Louis, St. Louis, Missouri
| | - Julia K Kofler
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas J Montine
- Department of Pathology, Stanford University, Stanford, California
| | | | - Peter T Nelson
- Sanders-Brown Center on Aging, Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, Kentucky
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67
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Akhtar RS, Licata JP, Luk KC, Shaw LM, Trojanowski JQ, Lee VMY. Measurements of auto-antibodies to α-synuclein in the serum and cerebral spinal fluids of patients with Parkinson's disease. J Neurochem 2018; 145:489-503. [PMID: 29500813 DOI: 10.1111/jnc.14330] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/15/2018] [Accepted: 02/20/2018] [Indexed: 12/14/2022]
Abstract
Biomarkers for α-synuclein are needed for diagnosis and prognosis in Parkinson's disease (PD). Endogenous auto-antibodies to α-synuclein could serve as biomarkers for underlying synucleinopathy, but previous assessments of auto-antibodies have shown variability and inconsistent clinical correlations. We hypothesized that auto-antibodies to α-synuclein could be diagnostic for PD and explain its clinical heterogeneity. To test this hypothesis, we developed an enzyme-linked immunosorbent assay for measuring α-synuclein auto-antibodies in human samples. We evaluated 69 serum samples (16 healthy controls (HC) and 53 PD patients) and 145 CSF samples (52 HC and 93 PD patients) from our Institution. Both serum and CSF were available for 24 participants. Males had higher auto-antibody levels than females in both fluids. CSF auto-antibody levels were significantly higher in PD patients as compared with HC, whereas serum levels were not significantly different. CSF auto-antibody levels did not associate with amyloid-β1-42 , total tau, or phosphorylated tau. CSF auto-antibody levels correlated with performance on the Montreal Cognitive Assessment, even when controlled for CSF amyloidβ1-42 . CSF hemoglobin levels, as a proxy for contamination of CSF by blood during lumbar puncture, did not influence these observations. Using recombinant α-synuclein with N- and C-terminal truncations, we found that CSF auto-antibodies target amino acids 100 through 120 of α-synuclein. We conclude that endogenous CSF auto-antibodies are significantly higher in PD patients as compared with HC, suggesting that they could indicate the presence of underlying synucleinopathy. These auto-antibodies associate with poor cognition, independently of CSF amyloidβ1-42 , and target a select C-terminal region of α-synuclein. Read the Editorial Highlight for this article on page 433.
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Affiliation(s)
- Rizwan S Akhtar
- Center for Neurodegenerative Disease Research and Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph P Licata
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelvin C Luk
- Center for Neurodegenerative Disease Research and Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leslie M Shaw
- Center for Neurodegenerative Disease Research and Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research and Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Virginia M-Y Lee
- Center for Neurodegenerative Disease Research and Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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68
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Bennett DA, Buchman AS, Boyle PA, Barnes LL, Wilson RS, Schneider JA. Religious Orders Study and Rush Memory and Aging Project. J Alzheimers Dis 2018; 64:S161-S189. [PMID: 29865057 PMCID: PMC6380522 DOI: 10.3233/jad-179939] [Citation(s) in RCA: 642] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Religious Orders Study and Rush Memory and Aging Project are both ongoing longitudinal clinical-pathologic cohort studies of aging and Alzheimer's disease (AD). OBJECTIVES To summarize progress over the past five years and its implications for understanding neurodegenerative diseases. METHODS Participants in both studies are older adults who enroll without dementia and agree to detailed longitudinal clinical evaluations and organ donation. The last review summarized findings through the end of 2011. Here we summarize progress and study findings over the past five years and discuss new directions for how these studies can inform on aging and AD in the future. RESULTS We summarize 1) findings on the relation of neurobiology to clinical AD; 2) neurobiologic pathways linking risk factors to clinical AD; 3) non-cognitive AD phenotypes including motor function and decision making; 4) the development of a novel drug discovery platform. CONCLUSION Complexity at multiple levels needs to be understood and overcome to develop effective treatments and preventions for cognitive decline and AD dementia.
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Affiliation(s)
- David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Patricia A. Boyle
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Julie A Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
- Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL., USA
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69
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Khachaturian AS. Letter. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2017; 9:84-87. [PMID: 29255790 PMCID: PMC5725207 DOI: 10.1016/j.dadm.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ara S. Khachaturian
- Corresponding author. Tel.: 301-309-6730; Fax: (844) 309-6730. http://www.alzheimersanddementia.orghttp://adj.edmgr.com
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70
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Alexopoulos P, Roesler J, Werle L, Thierjung N, Lentzari I, Ortner M, Grimmer T, Laskaris N, Politis A, Gourzis P, Kurz A, Perneczky R. Fluid biomarker agreement and interrelation in dementia due to Alzheimer’s disease. J Neural Transm (Vienna) 2017; 125:193-201. [DOI: 10.1007/s00702-017-1810-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 11/07/2017] [Indexed: 11/30/2022]
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71
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Chimagomedova AS, Vasenina EE, Levin OS. [Diagnostic of prodromal dementia with Levy bodies]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:23-32. [PMID: 28980609 DOI: 10.17116/jnevro20171176223-32] [Citation(s) in RCA: 2] [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
The issues of diagnosis of prodromal dementia with Lewy bodies are considered. Despite numerous studies using international diagnostic criteria, clinical and diagnosis are often inconsistent. Early and more accurate detection of dementia with Lewy bodies is needed for prognosis, optimal management and effective pharmacotherapy.
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Affiliation(s)
- A Sh Chimagomedova
- Russian Medical Academy of Continued Professional Education, Moscow, Russia
| | - E E Vasenina
- Russian Medical Academy of Continued Professional Education, Moscow, Russia
| | - O S Levin
- Russian Medical Academy of Continued Professional Education, Moscow, Russia
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72
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Brenowitz WD, Hubbard RA, Keene CD, Hawes SE, Longstreth WT, Woltjer RL, Kukull WA. Mixed neuropathologies and associations with domain-specific cognitive decline. Neurology 2017; 89:1773-1781. [PMID: 28939667 DOI: 10.1212/wnl.0000000000004567] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 07/31/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test whether decline in specific cognitive domains associated with Alzheimer disease neuropathologic change (ADNC) is modified by co-occurrence of other neuropathologies such as Lewy body disease (LBD) or vascular brain injury (VBI). METHODS Data came from 1,603 autopsied participants evaluated at US Alzheimer's Disease Centers. Standardized z scores in memory, attention, language, and executive function were derived from neuropsychological test scores assessed at each annual visit. Multivariable linear mixed-effects models assessed associations between neuropathologies and longitudinal trajectories of domain scores. RESULTS Compared to other participants, those with ADNC + LBD generally had worse cognitive trajectories, particularly lower initial executive function and faster attention decline. Participants with ADNC + VBI typically had less impairment and slower decline. Interactions were significant between LBD and ADNC for memory (p = 0.046) and between VBI and ADNC for language (p = 0.03); decline was slower than expected if these neuropathologies acted additively on the rate of decline. In secondary models, these interactions were limited to those with high ADNC (but not intermediate ADNC). In a subset of 260 participants with data on microinfarct location, cortical and subcortical microinfarcts were associated with decline in memory, language, and executive function in those without ADNC, but this effect was reduced among those with ADNC. CONCLUSIONS ADNC + LBD (but not ADNC + VBI) was associated with poorer executive function and attention compared to other pathology groupings. However, the effect of co-occurring pathologies on cognitive trajectories may depend on the severity of ADNC. Future studies using antemortem biomarkers should seek to replicate these neuropathologic observations.
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Affiliation(s)
- Willa D Brenowitz
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco.
| | - Rebecca A Hubbard
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - C Dirk Keene
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Stephen E Hawes
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - W T Longstreth
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Randy L Woltjer
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Walter A Kukull
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
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Kapasi A, DeCarli C, Schneider JA. Impact of multiple pathologies on the threshold for clinically overt dementia. Acta Neuropathol 2017; 134:171-186. [PMID: 28488154 PMCID: PMC5663642 DOI: 10.1007/s00401-017-1717-7] [Citation(s) in RCA: 388] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 12/14/2022]
Abstract
Longitudinal clinical-pathological studies have increasingly recognized the importance of mixed pathologies (the coexistence of one or more neurodegenerative and cerebrovascular disease pathologies) as important factors in the development of Alzheimer's disease (AD) and other forms of dementia. Older persons with AD pathology, often have concomitant cerebrovascular disease pathologies (macroinfarcts, microinfarcts, atherosclerosis, arteriolosclerosis, cerebral amyloid angiopathy) as well as other concomitant neurodegenerative disease pathologies (Lewy bodies, TDP-43, hippocampal sclerosis). These additional pathologies lower the threshold for clinical diagnosis of AD. Many of these findings from pathologic studies, especially for CVD, have been confirmed using sophisticated neuroimaging technologies. In vivo biomarker studies are necessary to provide an understanding of specific pathologic contributions and time course relationships along the spectrum of accumulating pathologies. In this review, we provide a clinical-pathological perspective on the role of multiple brain pathologies in dementia followed by a review of the available clinical and biomarker data on some of the mixed pathologies.
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Affiliation(s)
- Alifiya Kapasi
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, USA
- Department of Pathology, Rush University Medical Center, Chicago, USA
| | - Charles DeCarli
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, USA.
- Department of Pathology, Rush University Medical Center, Chicago, USA.
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA.
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