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Seidel D, Thyrian JR. Burden of caring for people with dementia - comparing family caregivers and professional caregivers. A descriptive study. J Multidiscip Healthc 2019; 12:655-663. [PMID: 31616154 PMCID: PMC6698592 DOI: 10.2147/jmdh.s209106] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/10/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose Caring for people with dementia is known to be accompanied by burden for the caregiver. This study aims at describing family caregivers’ and professional caregivers’ burden immediately after hospitalization of the person with dementia. Materials and methods Twenty-five family caregivers and twenty-five professional caregivers of the locked gerontopsychiatric ward of a hospital in Northern Germany completed a questionnaire (BIZA-D-PV), which was evaluated in matched samples. The distribution of frequencies, differences in mean values and correlations were determined. Furthermore, family caregivers were categorized into risk groups. Results Family caregivers perceived a higher burden due to cognitive impairment as well as aggressive and disoriented behavior of the person with dementia compared to professional caregivers. Differences with regard to care tasks were not detected. Female family caregivers rated a higher burden compared to male family caregivers, whereas in the sample of professional caregivers males perceived a higher burden. Correlations between several dimensions of burden and caregivers’ age, severity of dementia as well as physical symptoms were described. Categorizing family caregivers into risk groups showed high risks for depression of the caregiver, violence against the person with dementia and institutionalization of the person with dementia within the next months in 44–72% of cases. Conclusion Our findings emphasize the importance of acquiring knowledge about caregivers’ burden in the course of time in order to develop targeting interventions to decrease caregivers’ burden and to prevent hospital admissions of people with dementia due to a crisis of home caring.
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Affiliation(s)
- Désirée Seidel
- Department of Psychiatry and Psychotherapy, Helios Kliniken, Schwerin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald , Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald , Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine, Greifswald, Germany
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Abstract
Neurodegenerative diseases are sporadic and rare hereditary disorders of the central nervous system, which cause a slowly progressive loss of function of specific neuron populations and their connections. Severe impairments and care dependency can be the sequelae. Neurodegenerative disorders are diseases of older people; therefore, the demographic shift leads to an increase in the number of affected patients. Radiologists will also become more involved. For this reason important neurodegenerative diseases are presented in this article. In addition to Alzheimer's and Parkinson's diseases these also include frontotemporal lobar degeneration, Lewy body dementia, vascular dementia, Creutzfeldt-Jakob disease and Huntington's chorea. The clinical symptoms and diagnostics are described, whereby the focus lies on typical results of morphological imaging.
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53
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Mixed Small Vessel Disease in a Patient with Dementia with Lewy Bodies. Brain Sci 2019; 9:brainsci9070159. [PMID: 31277472 PMCID: PMC6680661 DOI: 10.3390/brainsci9070159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 01/14/2023] Open
Abstract
Background: Cerebral amyloid angiopathy (CAA) is characterized by deposition of amyloid in small/medium size brain vessels, and may coexist with Alzheimer’s disease or dementia with Lewy bodies (DLB). We describe a patient with a clinical diagnosis of DLB and imaging/biochemical characteristics suggestive of mixed small vessel disease (both CAA and non-amyloid microangiopathy). Methods: Clinical evaluation according to recent diagnostic criteria, magnetic resonance imaging, dopamine-transporter scan (DAT-scan) and cerebrospinal fluid (CSF) analysis for dementia biomarkers were all performed. Results: The patient is a 71-year-old male, fulfilling criteria for probable DLB, with a positive DAT-scan, but with multiple microbleeds in a cortical-subcortical location suggestive of CAA, some microbleeds in deep brain nuclei suggestive of non-amyloid microangiopathy and abnormal levels of only amyloid-beta (Aβ42) in CSF. Conclusion: Coexistent mixed vascular and neurodegenerative disorders are frequent in older subjects with dementia and each one of the underlying pathologies may contribute to, or modify the clinical presentation.
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Espinosa-Parrilla Y, Gonzalez-Billault C, Fuentes E, Palomo I, Alarcón M. Decoding the Role of Platelets and Related MicroRNAs in Aging and Neurodegenerative Disorders. Front Aging Neurosci 2019; 11:151. [PMID: 31312134 PMCID: PMC6614495 DOI: 10.3389/fnagi.2019.00151] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/11/2019] [Indexed: 12/22/2022] Open
Abstract
Platelets are anucleate cells that circulate in blood and are essential components of the hemostatic system. During aging, platelet numbers decrease and their aggregation capacity is reduced. Platelet dysfunctions associated with aging can be linked to molecular alterations affecting several cellular systems that include cytoskeleton rearrangements, signal transduction, vesicular trafficking, and protein degradation. Age platelets may adopt a phenotype characterized by robust secretion of extracellular vesicles that could in turn account for about 70-90% of blood circulating vesicles. Interestingly these extracellular vesicles are loaded with messenger RNAs and microRNAs that may have a profound impact on protein physiology at the systems level. Age platelet dysfunction is also associated with accumulation of reactive oxygen species. Thereby understanding the mechanisms of aging in platelets as well as their age-dependent dysfunctions may be of interest when evaluating the contribution of aging to the onset of age-dependent pathologies, such as those affecting the nervous system. In this review we summarize the findings that link platelet dysfunctions to neurodegenerative diseases including Alzheimer's Disease, Parkinson's Disease, Multiple Sclerosis, Huntington's Disease, and Amyotrophic Lateral Sclerosis. We discuss the role of platelets as drivers of protein dysfunctions observed in these pathologies, their association with aging and the potential clinical significance of platelets, and related miRNAs, as peripheral biomarkers for diagnosis and prognosis of neurodegenerative diseases.
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Affiliation(s)
- Yolanda Espinosa-Parrilla
- School of Medicine, Universidad de Magallanes, Punta Arenas, Chile
- Laboratory of Molecular Medicine-LMM, Center for Education, Healthcare and Investigation-CADI, Universidad de Magallanes, Punta Arenas, Chile
- Thematic Task Force on Healthy Aging, CUECH Research Network, Santiago, Chile
| | - Christian Gonzalez-Billault
- Thematic Task Force on Healthy Aging, CUECH Research Network, Santiago, Chile
- Laboratory of Cell and Neuronal Dynamics, Department of Biology, Faculty of Sciences, Universidad de Chile, Santiago, Chile
- Geroscience Center for Brain Health and Metabolism GERO, Santiago, Chile
- The Buck Institute for Research on Aging, Novato, CA, United States
| | - Eduardo Fuentes
- Thematic Task Force on Healthy Aging, CUECH Research Network, Santiago, Chile
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences and Research Center for Aging, Universidad de Talca, Talca, Chile
| | - Ivan Palomo
- Thematic Task Force on Healthy Aging, CUECH Research Network, Santiago, Chile
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences and Research Center for Aging, Universidad de Talca, Talca, Chile
| | - Marcelo Alarcón
- Thematic Task Force on Healthy Aging, CUECH Research Network, Santiago, Chile
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences and Research Center for Aging, Universidad de Talca, Talca, Chile
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55
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Tau and TDP-43 proteinopathies: kindred pathologic cascades and genetic pleiotropy. J Transl Med 2019; 99:993-1007. [PMID: 30742063 PMCID: PMC6609463 DOI: 10.1038/s41374-019-0196-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 12/11/2022] Open
Abstract
We review the literature on Tau and TDP-43 proteinopathies in aged human brains and the relevant underlying pathogenetic cascades. Complex interacting pathways are implicated in Alzheimer's disease and related dementias (ADRD), wherein multiple proteins tend to misfold in a manner that is "reactive," but, subsequently, each proteinopathy may contribute strongly to the clinical symptoms. Tau proteinopathy exists in brains of individuals across a broad spectrum of primary underlying conditions-e.g., developmental, traumatic, and inflammatory/infectious diseases. TDP-43 proteinopathy is also expressed in a wide range of clinical disorders. Although TDP-43 proteinopathy was first described in the central nervous system of patients with amyotrophic lateral sclerosis (ALS) and in subtypes of frontotemporal dementia (FTD/FTLD), TDP-43 proteinopathy is also present in chronic traumatic encephalopathy, cognitively impaired persons in advanced age with hippocampal sclerosis, Huntington's disease, and other diseases. We list known Tau and TDP-43 proteinopathies. There is also evidence of cellular co-localization between Tau and TDP-43 misfolded proteins, suggesting common pathways or protein interactions facilitating misfolding in one protein by the other. Multiple pleiotropic gene variants can alter risk for Tau or TDP-43 pathologies, and certain gene variants (e.g., APOE ε4, Huntingtin triplet repeats) are associated with increases of both Tau and TDP-43 proteinopathies. Studies of genetic risk factors have provided insights into multiple nodes of the pathologic cascades involved in Tau and TDP-43 proteinopathies. Variants from a specific gene can be either a low-penetrant risk factor for a group of diseases, or alternatively, a different variant of the same gene may be a disease-driving allele that is associated with a relatively aggressive and early-onset version of a clinically and pathologically specific disease type. Overall, a complex but enlightening paradigm has emerged, wherein both Tau and TDP-43 proteinopathies are linked to numerous overlapping upstream influences, and both are associated with multiple downstream pathologically- and clinically-defined deleterious effects.
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56
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Nelson PT, Dickson DW, Trojanowski JQ, Jack CR, Boyle PA, Arfanakis K, Rademakers R, Alafuzoff I, Attems J, Brayne C, Coyle-Gilchrist ITS, Chui HC, Fardo DW, Flanagan ME, Halliday G, Hokkanen SRK, Hunter S, Jicha GA, Katsumata Y, Kawas CH, Keene CD, Kovacs GG, Kukull WA, Levey AI, Makkinejad N, Montine TJ, Murayama S, Murray ME, Nag S, Rissman RA, Seeley WW, Sperling RA, White III CL, Yu L, Schneider JA. Limbic-predominant age-related TDP-43 encephalopathy (LATE): consensus working group report. Brain 2019; 142:1503-1527. [PMID: 31039256 PMCID: PMC6536849 DOI: 10.1093/brain/awz099] [Citation(s) in RCA: 795] [Impact Index Per Article: 159.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/10/2019] [Accepted: 02/25/2019] [Indexed: 12/18/2022] Open
Abstract
We describe a recently recognized disease entity, limbic-predominant age-related TDP-43 encephalopathy (LATE). LATE neuropathological change (LATE-NC) is defined by a stereotypical TDP-43 proteinopathy in older adults, with or without coexisting hippocampal sclerosis pathology. LATE-NC is a common TDP-43 proteinopathy, associated with an amnestic dementia syndrome that mimicked Alzheimer's-type dementia in retrospective autopsy studies. LATE is distinguished from frontotemporal lobar degeneration with TDP-43 pathology based on its epidemiology (LATE generally affects older subjects), and relatively restricted neuroanatomical distribution of TDP-43 proteinopathy. In community-based autopsy cohorts, ∼25% of brains had sufficient burden of LATE-NC to be associated with discernible cognitive impairment. Many subjects with LATE-NC have comorbid brain pathologies, often including amyloid-β plaques and tauopathy. Given that the 'oldest-old' are at greatest risk for LATE-NC, and subjects of advanced age constitute a rapidly growing demographic group in many countries, LATE has an expanding but under-recognized impact on public health. For these reasons, a working group was convened to develop diagnostic criteria for LATE, aiming both to stimulate research and to promote awareness of this pathway to dementia. We report consensus-based recommendations including guidelines for diagnosis and staging of LATE-NC. For routine autopsy workup of LATE-NC, an anatomically-based preliminary staging scheme is proposed with TDP-43 immunohistochemistry on tissue from three brain areas, reflecting a hierarchical pattern of brain involvement: amygdala, hippocampus, and middle frontal gyrus. LATE-NC appears to affect the medial temporal lobe structures preferentially, but other areas also are impacted. Neuroimaging studies demonstrated that subjects with LATE-NC also had atrophy in the medial temporal lobes, frontal cortex, and other brain regions. Genetic studies have thus far indicated five genes with risk alleles for LATE-NC: GRN, TMEM106B, ABCC9, KCNMB2, and APOE. The discovery of these genetic risk variants indicate that LATE shares pathogenetic mechanisms with both frontotemporal lobar degeneration and Alzheimer's disease, but also suggests disease-specific underlying mechanisms. Large gaps remain in our understanding of LATE. For advances in prevention, diagnosis, and treatment, there is an urgent need for research focused on LATE, including in vitro and animal models. An obstacle to clinical progress is lack of diagnostic tools, such as biofluid or neuroimaging biomarkers, for ante-mortem detection of LATE. Development of a disease biomarker would augment observational studies seeking to further define the risk factors, natural history, and clinical features of LATE, as well as eventual subject recruitment for targeted therapies in clinical trials.
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Affiliation(s)
| | | | | | | | | | - Konstantinos Arfanakis
- Rush University Medical Center, Chicago, IL, USA
- Illinois Institute of Technology, Chicago, IL, USA
| | | | | | | | | | | | - Helena C Chui
- University of Southern California, Los Angeles, CA, USA
| | | | | | - Glenda Halliday
- The University of Sydney Brain and Mind Centre and Central Clinical School Faculty of Medicine and Health, Sydney, Australia
| | | | | | | | | | | | | | - Gabor G Kovacs
- Institute of Neurology Medical University of Vienna, Vienna, Austria
| | | | | | | | | | - Shigeo Murayama
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | | | - Sukriti Nag
- Rush University Medical Center, Chicago, IL, USA
| | | | | | | | | | - Lei Yu
- Rush University Medical Center, Chicago, IL, USA
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57
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Meng Y, Yu K, Zhang L, Liu Y. Cognitive Decline in Asymptomatic Middle Cerebral Artery Stenosis Patients with Moderate and Poor Collaterals: A 2-Year Follow-Up Study. Med Sci Monit 2019; 25:4051-4058. [PMID: 31148547 PMCID: PMC6558999 DOI: 10.12659/msm.913797] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to determine whether poor collaterals contribute to the occurrence of certain types of cognitive disorders in asymptomatic middle cerebral artery stenosis (MCAS). Material/Methods Patients aged ≥45 years with asymptomatic MCAS confirmed by computed tomography angiography were included in a single-center retrospective study. They did not have prior stroke or dementia. Within 7 days of admission, MRI and comprehensive neuropsychological assessment were performed. Cognitive assessment was conducted after 2 years. Two independent neuroradiologists evaluated intracranial collaterals by using the Miteff scale. Demographic date and Fazekas scores were collected. Results A total of 173 patients with asymptomatic MCAS (66% men, mean age 59.4 years) and 42 controls (45% men, mean age 61.4 years) were enrolled. Executive function, attention, and information-processing speed in poor collateral circulation patients were more frequently and more often impaired than those in good collateral circulation patients. Throughout the study period, patients with poor collateral circulation had worse executive function, attention, and information-processing speed than those with moderate collateral circulation. Over time, MCAS patients with good collateral circulation did not show an association with cognitive function. Conclusions MCAS patients with moderate and poor collateral circulation have impairment of ≥1 cognitive domain over time. The affected domains are consistent with the profile of vascular cognitive impairment. Good collateral circulation is more important in patients with MCAS, and is associated with less risk of cognitive disorders.
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Affiliation(s)
- Yuanyuan Meng
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, Shandong, China (mainland)
| | - Kun Yu
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, Shandong, China (mainland)
| | - Ligong Zhang
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, Shandong, China (mainland)
| | - Yingchun Liu
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, Shandong, China (mainland)
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58
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Govindpani K, McNamara LG, Smith NR, Vinnakota C, Waldvogel HJ, Faull RL, Kwakowsky A. Vascular Dysfunction in Alzheimer's Disease: A Prelude to the Pathological Process or a Consequence of It? J Clin Med 2019; 8:E651. [PMID: 31083442 PMCID: PMC6571853 DOI: 10.3390/jcm8050651] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 12/19/2022] Open
Abstract
Alzheimer's disease (AD) is the most prevalent form of dementia. Despite decades of research following several theoretical and clinical lines, all existing treatments for the disorder are purely symptomatic. AD research has traditionally been focused on neuronal and glial dysfunction. Although there is a wealth of evidence pointing to a significant vascular component in the disease, this angle has been relatively poorly explored. In this review, we consider the various aspects of vascular dysfunction in AD, which has a significant impact on brain metabolism and homeostasis and the clearance of β-amyloid and other toxic metabolites. This may potentially precede the onset of the hallmark pathophysiological and cognitive symptoms of the disease. Pathological changes in vessel haemodynamics, angiogenesis, vascular cell function, vascular coverage, blood-brain barrier permeability and immune cell migration may be related to amyloid toxicity, oxidative stress and apolipoprotein E (APOE) genotype. These vascular deficits may in turn contribute to parenchymal amyloid deposition, neurotoxicity, glial activation and metabolic dysfunction in multiple cell types. A vicious feedback cycle ensues, with progressively worsening neuronal and vascular pathology through the course of the disease. Thus, a better appreciation for the importance of vascular dysfunction in AD may open new avenues for research and therapy.
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Affiliation(s)
- Karan Govindpani
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Laura G McNamara
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Nicholas R Smith
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Chitra Vinnakota
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Henry J Waldvogel
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Richard Lm Faull
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Andrea Kwakowsky
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Lehmann S, Paquet C, Malaplate-Armand C, Magnin E, Schraen S, Quillard-Muraine M, Bousiges O, Delaby C, Dumurgier J, Hugon J, Sablonnière B, Blanc F, Wallon D, Gabelle A, Laplanche JL, Bouaziz-Amar E, Peoc'h K. Diagnosis associated with Tau higher than 1200 pg/mL: Insights from the clinical and laboratory practice. Clin Chim Acta 2019; 495:451-456. [PMID: 31051163 DOI: 10.1016/j.cca.2019.04.081] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 01/25/2023]
Abstract
CONTEXT Cerebrospinal fluid (CSF) biomarkers are valuable tools for the diagnosis of neurological diseases. We aimed to investigate within a retrospective multicentric study the final diagnosis associated with very high CSF Tau levels and to identify patterns of biomarkers that would differentiate them in clinical practice, to help clinical biologists into physicians' counseling. PATIENTS AND METHODS Within the national multicentric network ePLM, we included 1743 patients from January 1, 2008, to December 31, 2013, with CSF biomarkers assayed by the same Innotest assays (protein Tau, phospho-Tau [pTau], and Aβ 1-42). We identified 205 patients with protein Tau concentration higher than 1200 pg/mL and final diagnosis. RESULTS Among those patients, 105 (51.2%) were suffering from Alzheimer's disease, 37 (18%) from sporadic Creuztfeldt-Jakob disease, and 63 (30.7%) from other neurological diseases including paraneoplastic/ central nervous system tumor, frontotemporal dementia, other diagnoses, amyloid angiopathy, Lewy body dementia, and infections of the central nervous system. Phospho-Tau, Aβ1-42 and Aβ1-42/pTau values differed significantly between the three groups of patients (p < .001). An Aβ1-42/pTau ratio between 4.7 and 9.7 was suggestive of other neurological diseases (threshold in AD: 8.3). CSF 14-3-3 was useful to discriminate Alzheimer's disease from Creuztfeldt-Jakob disease in case of Aβ1-42 concentrations <550 pg/mL or pTau>60 pg/mL. CONCLUSION This work emphasizes the interest of a well-thought-out interpretation of CSF biomarkers in neurological diseases, particularly in the case of high Tau protein concentrations in the CSF.
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Affiliation(s)
- S Lehmann
- CHU de Montpellier and Université de Montpellier, IRMB, CRB, Laboratoire de Biochimie et Protéomique Clinique, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - C Paquet
- Centre de Neurologie Cognitive, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal APHP, INSERM U942, Université Paris Diderot, France
| | - C Malaplate-Armand
- Laboratoire de Biochimie et Biologie Moléculaire, UF Oncologie - Endocrinologie - Neurobiologie, Hôpital Central, Centre Hospitalier Universitaire, Nancy, France
| | - E Magnin
- Centre Mémoire Ressources Recherche Besançon Franche-Comté, Departement of Neurology, CHU Besançon, Besançon, France
| | - S Schraen
- Univ.Lille, Inserm, CHU-Lille, UMR-S1172 and Neurobiology Unit, Centre de Biologie-Pathologie, Lille, France
| | | | - O Bousiges
- Laboratoire de Biochimie et de Biologie Moléculaire, Hôpital de Hautepierre, Hôpitaux Universitaire de Strasbourg, Strasbourg, France; Laboratoire de Neurosciences cognitives et Adaptatives (LNCA), UMR7364 Unistra/CNRS, Strasbourg, France
| | - C Delaby
- CHU de Montpellier and Université de Montpellier, IRMB, CRB, Laboratoire de Biochimie et Protéomique Clinique, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - J Dumurgier
- Centre de Neurologie Cognitive, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal APHP, INSERM U942, Université Paris Diderot, France
| | - J Hugon
- Centre de Neurologie Cognitive, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal APHP, INSERM U942, Université Paris Diderot, France
| | - B Sablonnière
- Centre Mémoire Ressources Recherche Besançon Franche-Comté, Departement of Neurology, CHU Besançon, Besançon, France
| | - F Blanc
- 2ICube laboratory and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS-Neurocrypto, University of Strasbourg and CNRS, Strasbourg, France
| | - D Wallon
- Inserm U1079, University of Rouen, Department of Neurology, France
| | - A Gabelle
- Centre Mémoire Ressources Recherche, CHU de Montpellier, Hôpital Gui de Chauliac, Montpellier, Université Montpellier, Montpellier, France
| | - J L Laplanche
- Service de Biochimie et Biologie moléculaire, GH Saint-Louis-Lariboisière-Fernand Widal, APHP, Paris, France
| | - E Bouaziz-Amar
- Service de Biochimie et Biologie moléculaire, GH Saint-Louis-Lariboisière-Fernand Widal, APHP, Paris, France
| | - K Peoc'h
- Service de Biochimie et Biologie moléculaire, GH Saint-Louis-Lariboisière-Fernand Widal, APHP, Paris, France; APHP, HUPNVS, Hôpital Beaujon, Biochimie clinique, Clichy, France; Université Paris Diderot, France.
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60
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Hofmann W, Wille E, Kaminsky S. [Guideline-conform exact diagnosis and coding of dementia]. Z Gerontol Geriatr 2019; 52:179-194. [PMID: 30830315 DOI: 10.1007/s00391-019-01509-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/11/2019] [Accepted: 01/17/2019] [Indexed: 11/24/2022]
Abstract
All of the currently available guidelines specify a two-stage procedure. The first stage entails performing a comprehensive description, diagnosis and confirmation of the dementia syndrome. The second stage involves the precise etiological classification. Alzheimer's disease represents the most common cause followed by vascular dementia and Parkinson's disease dementia, Lewy body dementia, frontotemporal lobar degeneration and others. Dementia encompasses a variety of underlying conditions. This review gives an overview of the clinically oriented diagnosis according to the updated S3 guidelines in Germany.
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Affiliation(s)
- W Hofmann
- Geriatrisches Zentrum Neumünster & Bad Bramstedt, Friesenstr. 11, 24534, Neumünster, Deutschland. .,Institut für Allgemeinmedizin, Campus Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland.
| | - E Wille
- FEK Friedrich-Ebert-Krankenhaus Neumünster GmbH, Neumünster, Deutschland
| | - S Kaminsky
- Geriatrisches Zentrum Neumünster & Bad Bramstedt, Friesenstr. 11, 24534, Neumünster, Deutschland
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62
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The risk of neurodegeneration in REM sleep behavior disorder: A systematic review and meta-analysis of longitudinal studies. Sleep Med Rev 2019; 43:37-46. [DOI: 10.1016/j.smrv.2018.09.008] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 01/23/2023]
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63
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Outeiro TF, Koss DJ, Erskine D, Walker L, Kurzawa-Akanbi M, Burn D, Donaghy P, Morris C, Taylor JP, Thomas A, Attems J, McKeith I. Dementia with Lewy bodies: an update and outlook. Mol Neurodegener 2019; 14:5. [PMID: 30665447 PMCID: PMC6341685 DOI: 10.1186/s13024-019-0306-8] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/08/2019] [Indexed: 01/17/2023] Open
Abstract
Dementia with Lewy bodies (DLB) is an age-associated neurodegenerative disorder producing progressive cognitive decline that interferes with normal life and daily activities. Neuropathologically, DLB is characterised by the accumulation of aggregated α-synuclein protein in Lewy bodies and Lewy neurites, similar to Parkinson’s disease (PD). Extrapyramidal motor features characteristic of PD, are common in DLB patients, but are not essential for the clinical diagnosis of DLB. Since many PD patients develop dementia as disease progresses, there has been controversy about the separation of DLB from PD dementia (PDD) and consensus reports have put forward guidelines to assist clinicians in the identification and management of both syndromes. Here, we present basic concepts and definitions, based on our current understanding, that should guide the community to address open questions that will, hopefully, lead us towards improved diagnosis and novel therapeutic strategies for DLB and other synucleinopathies.
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Affiliation(s)
- Tiago Fleming Outeiro
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK. .,Department of Experimental Neurodegeneration, Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, Göttingen, Germany. .,Max Planck Institute for Experimental Medicine, Göttingen, Germany.
| | - David J Koss
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Daniel Erskine
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Lauren Walker
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Marzena Kurzawa-Akanbi
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - David Burn
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Paul Donaghy
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Christopher Morris
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - John-Paul Taylor
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Alan Thomas
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Johannes Attems
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Ian McKeith
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.
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64
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Sepúlveda C, Hernández B, Burgos CF, Fuentes E, Palomo I, Alarcón M. The cAMP/PKA Pathway Inhibits Beta-amyloid Peptide Release from Human Platelets. Neuroscience 2018; 397:159-171. [PMID: 30496824 DOI: 10.1016/j.neuroscience.2018.11.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/30/2018] [Accepted: 11/15/2018] [Indexed: 12/12/2022]
Abstract
The main component of Alzheimer's disease (AD) is the amyloid-beta peptide (Aβ), the brain of these patients is characterized by deposits in the parenchyma and cerebral blood vessels known as cerebral amyloid angiopathy (CAA). On the other hand, the platelets are the major source of the Aβ peptide in circulation and once secreted can activate the platelets and endothelial cells producing the secretion of several inflammatory mediators that finally end up unchaining the CAA and later AD. In the present study we demonstrate that cAMP/PKA pathway plays key roles in the regulation of calpain activation and secretion of Aβ in human platelets. We confirmed that inhibition of platelet functionality occurred when platelets were incubated with forskolin (molecule that rapidly increased cAMP levels). In this sense we found that platelets pre-incubated with forskolin (20 μM) present a complete inhibition of calpain activity and this effect is reversed using an inhibitor of protein kinase A. Consequentially, when platelets were inhibited by forskolin a reduction in the processing of the APP with the consequent decrease in the Aβ peptide secretion was observed. Therefore our study provides novel insight in relation to the mechanism of processing and release of the Aβ peptide from human platelets.
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Affiliation(s)
- C Sepúlveda
- Thrombosis Reasearch Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Chile; Centro de Estudios en Alimentos Procesados (CEAP), CONICYT-Regional, Gore Maule, R09I2001 Talca, Chile
| | - B Hernández
- Thrombosis Reasearch Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Chile; Centro de Estudios en Alimentos Procesados (CEAP), CONICYT-Regional, Gore Maule, R09I2001 Talca, Chile
| | - C F Burgos
- Department of Physiology, Faculty of Biological Sciences, Universidad de Concepción, Chile
| | - E Fuentes
- Thrombosis Reasearch Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Chile; Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Universidad de Talca, Talca 3460000, Chile; Centro de Estudios en Alimentos Procesados (CEAP), CONICYT-Regional, Gore Maule, R09I2001 Talca, Chile
| | - I Palomo
- Thrombosis Reasearch Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Chile; Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Universidad de Talca, Talca 3460000, Chile; Centro de Estudios en Alimentos Procesados (CEAP), CONICYT-Regional, Gore Maule, R09I2001 Talca, Chile
| | - M Alarcón
- Thrombosis Reasearch Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Chile; Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Universidad de Talca, Talca 3460000, Chile; Centro de Estudios en Alimentos Procesados (CEAP), CONICYT-Regional, Gore Maule, R09I2001 Talca, Chile.
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65
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Pretorius L, Kell DB, Pretorius E. Iron Dysregulation and Dormant Microbes as Causative Agents for Impaired Blood Rheology and Pathological Clotting in Alzheimer's Type Dementia. Front Neurosci 2018; 12:851. [PMID: 30519157 PMCID: PMC6251002 DOI: 10.3389/fnins.2018.00851] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/30/2018] [Indexed: 12/13/2022] Open
Abstract
Alzheimer’s disease and other similar dementias are debilitating neurodegenerative disorders whose etiology and pathogenesis remain largely unknown, even after decades of research. With the anticipated increase in prevalence of Alzheimer’s type dementias among the more susceptible aging population, the need for disease-modifying treatments is urgent. While various hypotheses have been put forward over the last few decades, we suggest that Alzheimer’s type dementias are triggered by external environmental factors, co-expressing in individuals with specific genetic susceptibilities. These external stressors are defined in the Iron Dysregulation and Dormant Microbes (IDDM) hypothesis, previously put forward. This hypothesis is consistent with current literature in which serum ferritin levels of individuals diagnosed with Alzheimer’s disease are significantly higher compared those of age- and gender-matched controls. While iron dysregulation contributes to oxidative stress, it also causes microbial reactivation and virulence of the so-called dormant blood (and tissue) microbiome. Dysbiosis (changes in the microbiome) or previous infections can contribute to the dormant blood microbiome (atopobiosis1), and also directly promotes systemic inflammation via the amyloidogenic formation and shedding of potent inflammagens such as lipopolysaccharides. The simultaneous iron dysregulation and microbial aberrations affect the hematological system, promoting fibrin amylodiogenesis, and pathological clotting. Systemic inflammation and oxidative stress can contribute to blood brain barrier permeability and the ensuing neuro-inflammation, characteristic of Alzheimer’s type dementias. While large inter-individual variability exists, especially concerning disease pathogenesis, the IDDM hypothesis acknowledges primary causative factors which can be targeted for early diagnosis and/or for prevention of disease progression.
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Affiliation(s)
- Lesha Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Douglas B Kell
- School of Chemistry, The University of Manchester, Manchester, United Kingdom.,The Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
| | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
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66
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Hampel H, Vergallo A, Aguilar LF, Benda N, Broich K, Cuello AC, Cummings J, Dubois B, Federoff HJ, Fiandaca M, Genthon R, Haberkamp M, Karran E, Mapstone M, Perry G, Schneider LS, Welikovitch LA, Woodcock J, Baldacci F, Lista S. Precision pharmacology for Alzheimer’s disease. Pharmacol Res 2018; 130:331-365. [DOI: 10.1016/j.phrs.2018.02.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 02/11/2018] [Accepted: 02/12/2018] [Indexed: 12/12/2022]
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67
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Paraskevaidi M, Martin-Hirsch PL, Martin FL. Progress and Challenges in the Diagnosis of Dementia: A Critical Review. ACS Chem Neurosci 2018; 9:446-461. [PMID: 29390184 DOI: 10.1021/acschemneuro.8b00007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Longer life expectancies have led to an increased number of neurodegenerative disease cases globally. Accurate diagnosis of this devastating disorder is of crucial importance but is still feasible only by a brain biopsy after death. An enormous amount of attention and research has been in place over the years toward the better understanding of the mechanisms, as well as the early diagnosis, of neurodegeneration. However, numerous studies have been contradictory from time to time, while new diagnostic methods are constantly developed in a tireless effort to tackle the disease. Nonetheless, there is not yet a conclusive report covering a broader range of techniques for the diagnosis of different types of dementia. In this paper, we critically review current knowledge on the different hypotheses about the pathogenesis of distinct types of dementia, as well as risk factors and current diagnostic approaches in a clinical setting, including neuroimaging, cerebrospinal (CSF), and blood tests. Encouraging research results for the diagnosis and investigation of neurodegenerative disorders are also reported. Particular attention is given to the field of spectroscopy as an emerging tool to detect dementias, follow-up patients, and potentially monitor the patients' response to a therapeutic approach. Spectroscopic techniques, such as infrared and Raman spectroscopy, have facilitated numerous disease-related studies, including neurodegenerative disorders, and are currently undergoing trials for clinical implementation. This review constitutes a comprehensive report with an in-depth focus on promising imaging, molecular biomarker and spectroscopic tests in the field of dementive diseases.
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Affiliation(s)
- Maria Paraskevaidi
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, United Kingdon
| | - Pierre L. Martin-Hirsch
- Department of Obstetrics and Gynaecology, Central Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, United Kingdom
| | - Francis L. Martin
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, United Kingdon
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68
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Thomas AJ, Mahin-Babaei F, Saidi M, Lett D, Taylor JP, Walker L, Attems J. Improving the identification of dementia with Lewy bodies in the context of an Alzheimer's-type dementia. ALZHEIMERS RESEARCH & THERAPY 2018; 10:27. [PMID: 29490691 PMCID: PMC5831205 DOI: 10.1186/s13195-018-0356-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/07/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Dementia due to Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are the two most common neurodegenerative causes of dementia. They commonly occur together, especially in older people, but clinical identification of these diseases in dementia is difficult in such circumstances. We therefore conducted a study using cases with both comprehensive prospective clinical assessments and complete neuropathological examination to determine if it is possible to identify such mixed cases clinically and to determine features which may identify DLB in the presence of AD dementia. METHODS At Newcastle Brain Bank we identified subjects who had a clinical diagnosis of dementia and who also had autopsy diagnoses of pure AD, pure DLB, or mixed AD+DLB. All subjects had undergone prospective longitudinal clinical assessments. Mixed AD+DLB patients met neuropathological criteria for both DLB (limbic/neocortical Lewy body disease) and AD (Braak stage V/VI and CERAD B/C). The records of these subjects were carefully reviewed by two specialists in old-age psychiatry blind to autopsy findings to determine baseline and final clinical diagnoses based on these detailed records. The presence of characteristic Lewy body symptoms and other clinical information was also recorded. RESULTS Of 59 subjects included, 19 were AD, 18 DLB, and 22 mixed AD+DLB. At baseline no subjects were correctly identified as having mixed AD+DLB and by final diagnosis only 23% were identified. The only symptom which helped in identifying the presence of Lewy body disease in the context of a mixed AD+DLB dementia was complex visual hallucinations. CONCLUSIONS Whilst the identification of DLB in the context of a dementia with an AD pattern is difficult, the emergence of complex visual hallucinations in the context of such a degenerative dementia suggests the presence of Lewy body disease and should encourage a careful assessment. Biomarkers appear likely to be necessary to help improve identification of different disease subtypes underlying dementia.
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Affiliation(s)
- Alan J Thomas
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - Fariba Mahin-Babaei
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Mohammad Saidi
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Debbie Lett
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - John Paul Taylor
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Lauren Walker
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Johannes Attems
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
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69
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70
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Vinters HV, Zarow C, Borys E, Whitman JD, Tung S, Ellis WG, Zheng L, Chui HC. Review: Vascular dementia: clinicopathologic and genetic considerations. Neuropathol Appl Neurobiol 2018; 44:247-266. [DOI: 10.1111/nan.12472] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/13/2018] [Indexed: 12/21/2022]
Affiliation(s)
- H. V. Vinters
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - C. Zarow
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
| | - E. Borys
- Department of Pathology; University of California Davis School of Medicine; Sacramento CA USA
- Department of Pathology; Loyola University Medical Center; Maywood IL USA
| | - J. D. Whitman
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
- Departments of Pathology & Laboratory Medicine; UC San Francisco Medical Center; San Francisco CA USA
| | - S. Tung
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - W. G. Ellis
- Department of Pathology; University of California Davis School of Medicine; Sacramento CA USA
| | - L. Zheng
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
| | - H. C. Chui
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
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71
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Lu R, Wang J, Tao R, Wang J, Zhu T, Guo W, Sun Y, Li H, Gao Y, Zhang W, Fowler CJ, Li Q, Chen S, Wu Z, Masters CL, Zhong C, Jing N, Wang Y, Wang Y. Reduced TRPC6 mRNA levels in the blood cells of patients with Alzheimer's disease and mild cognitive impairment. Mol Psychiatry 2018; 23:767-776. [PMID: 28696436 DOI: 10.1038/mp.2017.136] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 04/24/2017] [Accepted: 05/10/2017] [Indexed: 02/01/2023]
Abstract
Transient receptor potential canonical 6 (TRPC6) inhibits β-amyloid (Aβ) production. Hyperforin, the TRPC6 agonist, reduces Aβ levels and improves cognitive performance in Alzheimer's disease (AD) models. However, it's unknown whether TRPC6 expression is changed in AD patients. In this case-control study, we measured TRPC6 expression levels in the peripheral blood cells of four independent AD sets from five hospitals and one mild cognitive impairment (MCI) set from a local community (229 AD, 70 MCI, 40 Parkinson disease and 359 controls from China, total n=698) using quantitative real-time PCR assay. We found a specific reduction of TRPC6 mRNA levels in four AD sets and one MCI set. The median TRPC6 mRNA levels were lower in the following: (1) combined AD patients than in age-matched controls (0.78 vs 1.73, P<0.001); (2) mild-to-moderate AD patients than in age-matched controls (0.81 vs 1.73, P<0.001); and (3) MCI patients than in age-matched controls (0.76 vs 1.72, P<0.001). In the receiver-operating characteristic curve analysis, the area under curve was 0.85 for combined AD, 0.84 for mild-to-moderate AD and 0.79 for MCI. In a subgroup of AD patients with brain Aβ examination, TRPC6 was associated with standardized uptake value ratio of Pittsburgh Compound B (Spearman's r=-0.49, P=0.04) and cerebrospinal fluid Aβ42 (Spearman's r=0.43, P=0.04). The TRPC6 reduction in AD patients was further confirmed in blood RNA samples from The Australian Imaging, Biomarkers and Lifestyle Flagship Study of Aging, in post-mortem brain tissues from The Netherlands Brain Bank and in induced pluripotent stem cells-derived neurons from Chinese donors. We conclude that TRPC6 mRNA levels in the blood cells are specifically reduced in AD and MCI patients, and TRPC6 might be a biomarker for the early diagnosis of AD.
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Affiliation(s)
- R Lu
- Laboratory of Neural Signal Transduction, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China.,Graduate School of Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China.,Beijing Institute of Medical Sciences, Beijing, China
| | - J Wang
- Laboratory of Neural Signal Transduction, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - R Tao
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - J Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - T Zhu
- Laboratory of Neural Signal Transduction, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - W Guo
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China.,School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Y Sun
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - H Li
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Y Gao
- Department of Neurology and Institute of Neurology, Rui Jin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - W Zhang
- Department of Geriatrics, Tiantan Hospital, Capital Medical University, Beijing, China
| | - C J Fowler
- The Florey Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Q Li
- The Florey Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - S Chen
- Department of Neurology and Institute of Neurology, Rui Jin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Z Wu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - C L Masters
- The Florey Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - C Zhong
- Department of Neurology, Zhongshan Hospital and Shanghai Medical College, State Key Laboratory of Medical Neurobiology, Institute of Brain Science, Fudan University, Shanghai, China
| | - N Jing
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China.,School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Y Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Y Wang
- Laboratory of Neural Signal Transduction, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China.,Beijing Institute of Medical Sciences, Beijing, China
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Cho K, Kim J, Kim GW. Changes in Blood Factors and Ultrasound Findings in Mild Cognitive Impairment and Dementia. Front Aging Neurosci 2018; 9:427. [PMID: 29311909 PMCID: PMC5742568 DOI: 10.3389/fnagi.2017.00427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 12/12/2017] [Indexed: 01/16/2023] Open
Abstract
The present study aimed to assess the changes in blood factors and ultrasound measures of atherosclerosis burden patient with mild cognitive impairment (MCI) and dementia. Peripheral blood samples and ultrasonography findings were obtained for 53 enrolled participants. Flow cytometry was used to evaluate levels of activated platelets and platelet-leukocyte aggregates (PLAs). The number of platelets expressing p-selectin was correlated with intima media thickness (IMT) and plaque number in both the MCI and dementia groups. The number of platelets expressing p-selectin glycoprotein ligand (PSGL) was strongly correlated with IMT in patients with MCI, whereas the number of platelets expressing PGSL was correlated with plaque number rather than IMT in patients with dementia. PLAs was associated with both IMT and plaque number in patients with MCI but not in those with dementia. Our findings demonstrate that alterations in IMT and plaque number are associated with an increased risk of cognitive decline as well as conversion from MCI to dementia and that blood factor analysis may aid to detect the severity of cognitive decline.
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Affiliation(s)
- Kyoungjoo Cho
- Department of Life Science, Kyonggi University, Suwon, South Korea
| | - Jihye Kim
- Department of Neurology, College of Medicine, Yonsei University, Seoul, South Korea
| | - Gyung W Kim
- Department of Neurology, College of Medicine, Yonsei University, Seoul, South Korea
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73
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Yashkin AP, Akushevich I, Ukraintseva S, Yashin A. The Effect of Adherence to Screening Guidelines on the Risk of Alzheimer's Disease in Elderly Individuals Newly Diagnosed With Type 2 Diabetes Mellitus. Gerontol Geriatr Med 2018; 4:2333721418811201. [PMID: 30450369 PMCID: PMC6236474 DOI: 10.1177/2333721418811201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/02/2018] [Accepted: 10/15/2018] [Indexed: 12/12/2022] Open
Abstract
Objective: The aim of this study was to examine the possibility that type 2 diabetes and Alzheimer's disease may share common behavioral protective factors such as adherence to type 2 diabetes treatment guidelines given that these two diseases have both epidemiological and metabolic similarities. Method: The method used in this study is a retrospective cohort study of 3,797 U.S. Medicare fee-for-service beneficiaries aged 66+ newly diagnosed with type 2 diabetes and without a prior record of Alzheimer's disease based on the Health and Retirement Study. Results: Results of a left-truncated Cox model showed that adherence reduces the risk of Alzheimer's disease by 20% to 24%. Other significant effects were college education (hazard ratio [HR]: 0.65; p value: .023), stroke (HR: 1.40; p value: .013), and 4+ limitations in physical functioning (HR: 1.33; p value: .008). Discussion: Risk of Alzheimer's disease can be reduced by behavioral factors. Possible mechanisms may include earlier start of interventions to reduce blood glucose levels and improve insulin sensitivity.
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Abstract
Dementia is a syndrome seen most commonly in older people and characterized by a decline in cognitive performance which impacts on the person's ability to function. There are approximately 47 million people worldwide with dementia and there are 10 million new cases every year. It is a major cause of disability and dependence and impacts on the physical, psychologic, and social well-being of families and carers. Alzheimer's disease is the most common form of dementia. Gait and balance impairments are common in people with dementia and contribute to the significantly elevated risk of falls. Older people with dementia are at increased risk of injury, institutionalization, hospitalization, morbidity, and death after a fall. There is preliminary evidence, predominantly from relatively small studies, that falls and disability can be prevented in this population. However, more good-quality research is needed, both to provide some certainty around the existing evidence base as well as to explore alternate approaches to prevention, including combined cognitive-motor training and cognitive pharmacotherapy.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
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75
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Custodio N, Montesinos R, Lira D, Herrera-Pérez E, Bardales Y, Valeriano-Lorenzo L. Mixed dementia: A review of the evidence. Dement Neuropsychol 2017; 11:364-370. [PMID: 29354216 PMCID: PMC5769994 DOI: 10.1590/1980-57642016dn11-040005] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Mixed dementia is the coexistence of Alzheimer's disease and cerebrovascular disease (CVD) in the same demented patient. Currently, its diagnosis and treatment remains a challenge for practitioners. To provide an overview of the epidemiology, pathogenesis, natural history, diagnosis, and therapy of Mixed Vascular-Alzheimer Dementia (MVAD). The literature was reviewed for articles published between 1990-2016 by using the keywords linked to MVAD. Neuropathological studies indicate that MVAD is a very common pathological finding in the elderly with a prevalence about of 22%. The distinction between Alzheimer's dementia and vascular dementia (VD) is complex because their clinical presentation can overlap. There are international criteria for the MVAD diagnosis. The pharmacologic therapy shows modest clinical benefits that are similar among all drugs used in patients with Alzheimer's dementia and VD. The non-pharmacologic therapy includes the rigorous management of cardiovascular risk factors (especially hypertension) and the promotion of a healthy diet. The diagnosis and treatment of MVAD cannot be improved without further studies. Currently available medications provide only modest clinical benefits once a patient has developed MVAD. In subjects at risk, the antihypertensive therapy and healthy diet should be recommend for preventing or slowing the progression of MVAD.
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Affiliation(s)
- Nilton Custodio
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Neurología. Instituto Peruano de Neurociencias. Lima, Perú
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Medicina de Rehabilitación. Instituto Peruano de Neurociencias. Lima, Perú
| | - David Lira
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Neurología. Instituto Peruano de Neurociencias. Lima, Perú
| | - Eder Herrera-Pérez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Unidad de Diseño y Elaboración de Proyectos de Investigación. Instituto Nacional de Salud del Niño. Lima, Perú.,GESID. Lima, Peru
| | - Yadira Bardales
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Unidad de Geriatría. Instituto Peruano de neurociencias. Lima, Perú
| | - Lucía Valeriano-Lorenzo
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Unidad de Neuropsicología. Instituto Peruano de Neurociencias. Lima. Perú
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76
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Yun HJ, Moon SH, Kim HJ, Lockhart SN, Choe YS, Lee KH, Na DL, Lee JM, Seo SW. Centiloid method evaluation for amyloid PET of subcortical vascular dementia. Sci Rep 2017; 7:16322. [PMID: 29176753 PMCID: PMC5701176 DOI: 10.1038/s41598-017-16236-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/27/2017] [Indexed: 11/08/2022] Open
Abstract
Reference region selection is important for proper amyloid PET analysis, especially in subcortical vascular dementia (SVaD) patients. We investigated reference region differences between SVaD and Alzheimer's disease (AD) using Centiloid scores. In 57 [C-11] Pittsburgh compound B (PiB) positive (+) AD and 23 PiB (+) SVaD patients, we assessed standardized PiB uptake and Centiloid scores in disease-specific cortical regions, with several reference regions: cerebellar gray (CG), whole cerebellum (WC), WC with brainstem (WC + B), pons, and white matter (WM). We calculated disease group differences from young controls (YC) and YC variance according to reference region. SVaD patients showed large effect sizes (Cohen's d > 0.8) using all reference regions. WM and pons showed larger YC variances than other regions. Findings were similar for AD patients. CG, WC, and WC + B, but not WM or pons, are reliable reference regions for amyloid imaging analysis in SVaD.
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Affiliation(s)
- Hyuk Jin Yun
- Department of Biomedical Engineering, Hanyang University, Seoul, 04763, Korea
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, 02115, MA, USA
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, 06351, Korea
| | - Samuel N Lockhart
- Helen Wills Neuroscience Institute, University of California, Berkeley, 94720, CA, USA
- Department of Internal Medicine, Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, 27157, NC, USA
| | - Yearn Seong Choe
- Department of Nuclear Medicine, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Kyung Han Lee
- Department of Nuclear Medicine, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, 06351, Korea
- Department of Health Sciences and Technology, Sungkyunkwan University, Seoul, 06351, Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, 04763, Korea.
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
- Neuroscience Center, Samsung Medical Center, Seoul, 06351, Korea.
- Department of Health Sciences and Technology, Sungkyunkwan University, Seoul, 06351, Korea.
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06351, Korea.
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Corriveau RA, Koroshetz WJ, Gladman JT, Jeon S, Babcock D, Bennett DA, Carmichael ST, Dickinson SLJ, Dickson DW, Emr M, Fillit H, Greenberg SM, Hutton ML, Knopman DS, Manly JJ, Marder KS, Moy CS, Phelps CH, Scott PA, Seeley WW, Sieber BA, Silverberg NB, Sutherland ML, Taylor A, Torborg CL, Waddy SP, Gubitz AK, Holtzman DM. Alzheimer's Disease-Related Dementias Summit 2016: National research priorities. Neurology 2017; 89:2381-2391. [PMID: 29117955 DOI: 10.1212/wnl.0000000000004717] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/05/2017] [Indexed: 01/02/2023] Open
Abstract
Goal 1 of the National Plan to Address Alzheimer's Disease is to prevent and effectively treat Alzheimer disease and Alzheimer disease-related dementias by 2025. To help inform the research agenda toward achieving this goal, the NIH hosts periodic summits that set and refine relevant research priorities for the subsequent 5 to 10 years. This proceedings article summarizes the 2016 Alzheimer's Disease-Related Dementias Summit, including discussion of scientific progress, challenges, and opportunities in major areas of dementia research, including mixed-etiology dementias, Lewy body dementia, frontotemporal degeneration, vascular contributions to cognitive impairment and dementia, dementia disparities, and dementia nomenclature.
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Affiliation(s)
- Roderick A Corriveau
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO.
| | - Walter J Koroshetz
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Jordan T Gladman
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Sophia Jeon
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Debra Babcock
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - David A Bennett
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - S Thomas Carmichael
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Susan L-J Dickinson
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Dennis W Dickson
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Marian Emr
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Howard Fillit
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Steven M Greenberg
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Michael L Hutton
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - David S Knopman
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Jennifer J Manly
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Karen S Marder
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Claudia S Moy
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Creighton H Phelps
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Paul A Scott
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - William W Seeley
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Beth-Anne Sieber
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Nina B Silverberg
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Margaret L Sutherland
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Angela Taylor
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Christine L Torborg
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Salina P Waddy
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Amelie K Gubitz
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - David M Holtzman
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
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Lipoprotein-associated Phospholipase A2 Is Associated with Risk of Mild Cognitive Impairment in Chinese Patients with Type 2 Diabetes. Sci Rep 2017; 7:12311. [PMID: 28951620 PMCID: PMC5615059 DOI: 10.1038/s41598-017-12515-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/12/2017] [Indexed: 12/18/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a low-grade chronic inflammatory diseases, which have been implicated in the pathogenesis of cognitive decline. We aim to evaluate associations between inflammatory markers and the risk of mild cognitive impairment (MCI) in T2DM. This study of 140 diabetic patients involved 71 with MCI and 69 controls. Clinical parameters, neuropsychological tests, high sensitivity C reactive protein (hsCRP), interleukin-6 (IL-6), lipoprotein-associated Phospholipase A2 (Lp-PLA2) mass and activity were measured. The results showed significantly higher plasma hsCRP, IL-6, Lp-PLA2 mass and activity in MCI group compared to controls. In T2DM with MCI, the Montreal Cognitive Assessment (MoCA) score was positively correlated with education level and high-density lipoprotein cholesterol (HDL-c), but inversely correlated with age, glycosylated hemoglobin, intima-media thickness (IMT), hsCRP, IL-6, and Lp-PLA2 mass and activity. Correlation analysis showed that both plasma Lp-PLA2 mass and activity were positively correlated with total cholesterol, low-density lipoprotein cholesterol, and IMT but negatively associated with MoCA score. Multivariable logistic regression analysis indicated higher hsCRP, Lp-PLA2 mass, Lp-PLA2 activity, and lower HDL-c to be independent risk factors increasing the possibility of MCI in T2DM. In conclusion, plasma Lp-PLA2 and hsCRP were found to be associated with the risk of MCI among T2DM patients.
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Llorens F, Schmitz M, Knipper T, Schmidt C, Lange P, Fischer A, Hermann P, Zerr I. Cerebrospinal Fluid Biomarkers of Alzheimer's Disease Show Different but Partially Overlapping Profile Compared to Vascular Dementia. Front Aging Neurosci 2017; 9:289. [PMID: 28955218 PMCID: PMC5601075 DOI: 10.3389/fnagi.2017.00289] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/18/2017] [Indexed: 11/13/2022] Open
Abstract
Vascular factors increase the risks of developing Alzheimer's disease (AD) and they contribute to AD pathology. Since amyloid beta (Aβ) deposits can be observed in both diseases, there is an overlap which impedes a clear discrimination and difficult clinical diagnosis. In the present study, we compared cerebrospinal fluid (CSF) profiles of neurodegenerative and inflammatory biomarkers in a patient cohort of controls (n = 50), AD (n = 65) and vascular dementia (VaD) (n = 31) cases. Main results were validated in a second cohort composed of AD (n = 26), rapidly progressive AD (rpAD) (n = 15), VaD (n = 21), and cognitively unimpaired patients with vascular encephalopathy (VE) (n = 25) cases. In the study, cohort significant differences were detected in tau, p-tau, and Aβ1-42 (Aβ42) levels between AD and VaD patients, but not for the neuron-specific enolase (NSE), S100B protein, 14-3-3 and YKL-40. Differential tau, p-tau, and Aβ42 levels between AD and VaD were confirmed in the validation cohort, which additionally showed no differences between AD and rpAD, nor between VaD and VE. The evaluation of the biomarker performance in discrimination between AD and VaD patients revealed that the best diagnostic accuracy could be obtained when tau, p-tau, and Aβ42 were combined in form of Aβ42/p-tau (AUC 0.84-0.90, sensitivity 77-81%, specificity 80-93%) and (tau × p-tau)/Aβ42 ratio (AUC 0.83-0.87, sensitivity 73-81%, specificity 78-87%). Altogether, our studies provided neurodegenerative biomarker profiles in two cohorts of AD and VaD patients favoring the combination of CSF biomarker to differentiate between diseases.
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Affiliation(s)
- Franc Llorens
- Department of Neurology, Universitätsmedizin GöttingenGöttingen, Germany
- Center for Networked Biomedical Research on Neurodegenerative DiseasesBarcelona, Spain
| | - Matthias Schmitz
- Department of Neurology, Universitätsmedizin GöttingenGöttingen, Germany
- German Center for Neurodegenerative Diseases–DZNE Site GöttingenBonn, Germany
| | - Tobias Knipper
- Department of Neurology, Universitätsmedizin GöttingenGöttingen, Germany
| | - Christian Schmidt
- Department of Neurology, Universitätsmedizin GöttingenGöttingen, Germany
| | - Peter Lange
- Department of Neurology, Universitätsmedizin GöttingenGöttingen, Germany
| | - Andre Fischer
- German Center for Neurodegenerative Diseases–DZNE Site GöttingenBonn, Germany
| | - Peter Hermann
- Department of Neurology, Universitätsmedizin GöttingenGöttingen, Germany
- German Center for Neurodegenerative Diseases–DZNE Site GöttingenBonn, Germany
| | - Inga Zerr
- Department of Neurology, Universitätsmedizin GöttingenGöttingen, Germany
- German Center for Neurodegenerative Diseases–DZNE Site GöttingenBonn, Germany
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Kollack-Walker S, Liu CY, Fleisher AS. The Role of Neuroimaging in the Assessment of the Cognitively Impaired Elderly. Neurol Clin 2017; 35:231-262. [PMID: 28410658 DOI: 10.1016/j.ncl.2017.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article reviews the current diagnostic tools that are available for structural, functional, and molecular imaging of the brain, summarizing some of the key findings that have been reported in individuals diagnosed with Alzheimer disease, mild cognitive impairment, prodromal AD, or other prevalent dementias. Given recent advances in the development of amyloid PET tracers, current guidelines for the use of amyloid PET imaging in patients with cognitive complaints are reviewed. In addition, data addressing the potential value of amyloid PET imaging in the clinical setting are highlighted.
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Affiliation(s)
- Sara Kollack-Walker
- Scientific Comm, Global Med Comm - Bio-Medicines BU-NS, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - Collin Y Liu
- Department of Neurology, Keck School of Medicine at the University of Southern California, 1520 San Pablo Street, HCC-2, Suite 3000, Los Angeles, CA 90033, USA
| | - Adam S Fleisher
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
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Dearborn JL, Zhang Y, Qiao Y, Suri MFK, Liu L, Gottesman RF, Rawlings AM, Mosley TH, Alonso A, Knopman DS, Guallar E, Wasserman BA. Intracranial atherosclerosis and dementia: The Atherosclerosis Risk in Communities (ARIC) Study. Neurology 2017; 88:1556-1563. [PMID: 28330958 DOI: 10.1212/wnl.0000000000003837] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 01/24/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To explore the association of intracranial atherosclerotic disease (ICAD) with mild cognitive impairment (MCI) and dementia. METHODS From 2011 to 2013, 1,744 participants completed high-resolution vessel wall MRI from the population-based Atherosclerosis Risk in Communities Study by a sampling strategy that allowed weighting back to the cohort. We defined ICAD by plaque features (presence, territory, stenosis, number). Trained clinicians used an algorithm incorporating information from interviews and neuropsychological and neurologic examinations to adjudicate for MCI and dementia. We determined the relative prevalence ratio (RPR) of MCI or dementia after adjusting for risk factors at midlife using multinomial logistic regression. RESULTS A total of 601 (34.5%) participants had MCI (mean age ± SD, 76.6 ± 5.2 years), 83 (4.8%) had dementia (79.1 ± 5.3 years), and 857 (49.1%) were current or former smokers. Anterior cerebral artery (ACA) plaque (adjusted RPR 3.81, 95% confidence interval [CI] 1.57-9.23), >2 territories with plaque (adjusted RPR 2.12, 95% CI 1.00-4.49), and presence of stenosis >50% (adjusted RPR 1.92, 95% CI 1.01-3.65) were associated with increased prevalence of dementia in separate models. Posterior cerebral artery plaque was associated with MCI but did not reach statistical significance for dementia (adjusted RPR MCI 1.43, 95% CI 1.04-1.98; adjusted RPR dementia 1.58, 95% CI 0.79-2.85). There were no associations with middle cerebral artery atherosclerotic lesions or cognitive impairment. Many participants had plaque in >1 territory (n = 291, 46%) and participants with ACA plaques (n = 69) had the greatest number of plaques in other territories (mean 6.0, SD 4.4). CONCLUSIONS This study demonstrates associations between ICAD and clinical MCI and dementia.
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Affiliation(s)
- Jennifer L Dearborn
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Yiyi Zhang
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Ye Qiao
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Muhammad Fareed K Suri
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Li Liu
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Rebecca F Gottesman
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Andreea M Rawlings
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Thomas H Mosley
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Alvaro Alonso
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - David S Knopman
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Eliseo Guallar
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Bruce A Wasserman
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
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Fiford CM, Manning EN, Bartlett JW, Cash DM, Malone IB, Ridgway GR, Lehmann M, Leung KK, Sudre CH, Ourselin S, Biessels GJ, Carmichael OT, Fox NC, Cardoso MJ, Barnes J. White matter hyperintensities are associated with disproportionate progressive hippocampal atrophy. Hippocampus 2017; 27:249-262. [PMID: 27933676 PMCID: PMC5324634 DOI: 10.1002/hipo.22690] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/30/2016] [Indexed: 01/18/2023]
Abstract
This study investigates relationships between white matter hyperintensity (WMH) volume, cerebrospinal fluid (CSF) Alzheimer's disease (AD) pathology markers, and brain and hippocampal volume loss. Subjects included 198 controls, 345 mild cognitive impairment (MCI), and 154 AD subjects with serial volumetric 1.5‐T MRI. CSF Aβ42 and total tau were measured (n = 353). Brain and hippocampal loss were quantified from serial MRI using the boundary shift integral (BSI). Multiple linear regression models assessed the relationships between WMHs and hippocampal and brain atrophy rates. Models were refitted adjusting for (a) concurrent brain/hippocampal atrophy rates and (b) CSF Aβ42 and tau in subjects with CSF data. WMH burden was positively associated with hippocampal atrophy rate in controls (P = 0.002) and MCI subjects (P = 0.03), and with brain atrophy rate in controls (P = 0.03). The associations with hippocampal atrophy rate remained following adjustment for concurrent brain atrophy rate in controls and MCIs, and for CSF biomarkers in controls (P = 0.007). These novel results suggest that vascular damage alongside AD pathology is associated with disproportionately greater hippocampal atrophy in nondemented older adults. © 2016 The Authors Hippocampus Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Cassidy M Fiford
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, United Kingdom
| | - Emily N Manning
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, United Kingdom
| | | | - David M Cash
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, United Kingdom.,Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Ian B Malone
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, United Kingdom
| | - Gerard R Ridgway
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, University of Oxford, United Kingdom.,Wellcome Trust Centre for Neuroimaging, London, United Kingdom
| | - Manja Lehmann
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, United Kingdom
| | - Kelvin K Leung
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, United Kingdom
| | - Carole H Sudre
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, United Kingdom.,Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Sebastien Ourselin
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, United Kingdom.,Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus University Medical Center Utrecht, The Netherlands
| | | | - Nick C Fox
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, United Kingdom
| | - M Jorge Cardoso
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, United Kingdom.,Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Josephine Barnes
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, United Kingdom
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Abstract
This report describes the public health impact of Alzheimer's disease, including incidence and prevalence, mortality rates, costs of care, and the overall impact on caregivers and society. It also examines in detail the financial impact of Alzheimer's on families, including annual costs to families and the difficult decisions families must often make to pay those costs. An estimated 5.4 million Americans have Alzheimer's disease. By mid-century, the number of people living with Alzheimer's disease in the United States is projected to grow to 13.8 million, fueled in large part by the aging baby boom generation. Today, someone in the country develops Alzheimer's disease every 66 seconds. By 2050, one new case of Alzheimer's is expected to develop every 33 seconds, resulting in nearly 1 million new cases per year. In 2013, official death certificates recorded 84,767 deaths from Alzheimer's disease, making it the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age ≥ 65 years. Between 2000 and 2013, deaths resulting from stroke, heart disease, and prostate cancer decreased 23%, 14%, and 11%, respectively, whereas deaths from Alzheimer's disease increased 71%. The actual number of deaths to which Alzheimer's disease contributes is likely much larger than the number of deaths from Alzheimer's disease recorded on death certificates. In 2016, an estimated 700,000 Americans age ≥ 65 years will die with Alzheimer's disease, and many of them will die because of the complications caused by Alzheimer's disease. In 2015, more than 15 million family members and other unpaid caregivers provided an estimated 18.1 billion hours of care to people with Alzheimer's and other dementias, a contribution valued at more than $221 billion. Average per-person Medicare payments for services to beneficiaries age ≥ 65 years with Alzheimer's disease and other dementias are more than two and a half times as great as payments for all beneficiaries without these conditions, and Medicaid payments are 19 times as great. Total payments in 2016 for health care, long-term care and hospice services for people age ≥ 65 years with dementia are estimated to be $236 billion. The costs of Alzheimer's care may place a substantial financial burden on families, who often have to take money out of their retirement savings, cut back on buying food, and reduce their own trips to the doctor. In addition, many family members incorrectly believe that Medicare pays for nursing home care and other types of long-term care. Such findings highlight the need for solutions to prevent dementia-related costs from jeopardizing the health and financial security of the families of people with Alzheimer's and other dementias.
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85
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Alzheimer's disease pathology in synucleinopathies. Lancet Neurol 2017; 16:22-23. [DOI: 10.1016/s1474-4422(16)30282-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 10/07/2016] [Indexed: 11/23/2022]
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Trusova NA, Levin OS, Arablinsky AV. [Clinical and neuropsychological features of Alzheimer's disease in the combination with cerebrovascular disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:46-53. [PMID: 27723710 DOI: 10.17116/jnevro20161166246-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study clinical/neuropsychological and neuroimaging characteristics of Alzheimer's disease in the combination with cerebrovascular disease (CVD). MATERIAL AND METHODS Ninety patients with dementia, including 35 patients with AD, 35 patients with mixed dementia (MD) and 20 patients with vascular dementia, were examined. The character of dementia was established according to NINCDS-ADRDA and NINDS-AIREN criteria. The neuropsychological battery included Addenbrooke's Cognitive Examination (ACE-R), Montreal Cognitive Assessment scale (MoCA), fluency test and the visual memory test (SCT). Affective and behavioral disorders were assessed with the Cornell Depression Scale in patients with dementia and a short version of NPI-4 in AD patients. Focal and diffuse changes were assessed with MRI. RESULTS AND CONCLUSION Patients with MD were older, had more often pseudobulbar syndrome (74%), postural instability (66%), frontal gait disorders (57%), Neuropsychological profile of patients with MD had mixed amnestic-dysexecutive character and, depending on the severity of vascular pathology, was closer to AD or to vascular dementia. Neuroimaging changes of patients with MD were correlated with clinical manifestations. The authors propose the approaches to the differential diagnosis of MD that allow to determine the main directions of treatment more precisely and to predict disease course.
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Affiliation(s)
- N A Trusova
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - O S Levin
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - A V Arablinsky
- Sechenov First Moscow State Medical University, Moscow, Russia; Botkin City Clinical Hospital, Moscow, Russia
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Hatanaka H, Hanyu H, Fukasawa R, Hirao K, Shimizu S, Kanetaka H, Iwamoto T. Differences in peripheral oxidative stress markers in Alzheimer's disease, vascular dementia and mixed dementia patients. Geriatr Gerontol Int 2016; 15 Suppl 1:53-8. [PMID: 26671158 DOI: 10.1111/ggi.12659] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 02/06/2023]
Abstract
AIMS We determined whether the possible roles of oxidative stress differ in the pathophysiology and cognitive decline of Alzheimer's disease (AD), vascular dementia (VaD) and mixed Alzheimer's/vascular dementia (MD). METHODS We measured the levels of diacron reactive oxygen metabolite (dROM), reflecting the amount of organic hydroperoxides, and biological anti-oxidant potential (BAP), measuring the ferric reducing ability of blood plasma, in 72 patients with AD, 27 with VaD, 24 with MD and 53 non-demented outpatients (control group). In addition, endogenous plasma anti-oxidants, such as albumin, total bilirubin and uric acid, were compared among the groups. All participants with VaD and MD showed extensive white matter hyperintensity, in addition to multiple lacunes. RESULTS The dROM levels were significantly higher in the AD and MD groups than in the control group. The BAP levels were significantly lower in the MD group than in the control, AD and VaD groups. The AD group showed significantly lower levels of bilirubin and uric acid than the control group. The MD group showed a significantly lower level of albumin than the control and AD groups, and a significantly lower level of bilirubin than the control group. The Mini-Mental State examination scores correlated significantly with dROM levels and BAP/dROM ratios in the AD group. CONCLUSIONS An imbalance in pro-oxidant and anti-oxidant defenses is apparently involved in the pathophysiology of the AD and MD groups. The extent of oxidative stress damage might differ in subtypes of dementia by being greater in the MD group than in other types of dementia. Synergic effects of the degenerative element of AD and white matter lesions might be associated with oxidative stress damage in the MD group.
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Affiliation(s)
- Hirokuni Hatanaka
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Haruo Hanyu
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Raita Fukasawa
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Kentaro Hirao
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Soichiro Shimizu
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Kanetaka
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Toshihiko Iwamoto
- Department of Geriatric Medicine, International University of Health and Welfare, Yaita, Japan
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Pillai JA, Butler RS, Bonner-Jackson A, Leverenz JB. Impact of Alzheimer's Disease, Lewy Body and Vascular Co-Pathologies on Clinical Transition to Dementia in a National Autopsy Cohort. Dement Geriatr Cogn Disord 2016; 42:106-16. [PMID: 27623397 PMCID: PMC5451902 DOI: 10.1159/000448243] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS We examined the effect of vascular or Lewy body co-pathologies in subjects with autopsy-confirmed Alzheimer's disease (AD) on the rate of cognitive and functional decline and transition to dementia. METHODS In an autopsy sample of prospectively characterized subjects from the National Alzheimer's Coordinating Center database, neuropathology diagnosis was used to define the groups of pure AD (pAD, n = 84), mixed vascular and AD (ADV, n = 54), and mixed Lewy body disease and AD (ADLBD, n = 31). Subjects had an initial Clinical Dementia Rating-Global (CDR-G) score <1, Mini-Mental State Examination ≥15, a final visit CDR-G >1, ≥3 evaluations, and Braak tangle stage ≥III. We compared the rate of cognitive and functional decline between the groups. RESULTS The rate of functional and cognitive decline was lower for ADV, and ADV patients had less severe deficits on CDR-G and the CDR-Sum of Boxes scores at the last visit than pAD and ADLBD patients. No significant differences were noted between ADLBD and pAD patients. After controlling for age at death, the odds of reaching CDR ≥1 at the last visit were lower in the ADV subjects compared to the pAD subjects. CONCLUSIONS The mean rate of functional and cognitive decline among ADV subjects was slower than among either pAD or ADLBD patients. Vascular pathology did not increase the odds of attaining CDR ≥1 when occurring with AD in this national cohort.
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Affiliation(s)
- Jagan A Pillai
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio, USA
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89
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Gavett BE, John SE, Gurnani AS, Bussell CA, Saurman JL. The Role of Alzheimer's and Cerebrovascular Pathology in Mediating the Effects of Age, Race, and Apolipoprotein E Genotype on Dementia Severity in Pathologically-Confirmed Alzheimer's Disease. J Alzheimers Dis 2016; 49:531-45. [PMID: 26444761 DOI: 10.3233/jad-150252] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Dementia severity can be modeled as the construct δ, representing the "cognitive correlates of functional status." OBJECTIVE We recently validated a model for estimating δ in the National Alzheimer's Coordinating Center's Uniform Data Set; however, the association of δ with neuropathology remains untested. METHODS We used data from 727 decedents evaluated at Alzheimer's Disease (AD) Centers nationwide. Participants spoke English, had no genetic abnormalities, and were pathologically diagnosed with AD as a primary or contributing etiology. Clinical data from participants' last visit prior to death were used to estimate dementia severity (δ). RESULTS A structural equation model using age, education, race, and apolipoprotein E (APOE) genotype (number of ɛ2 and ɛ4 alleles) as predictors and latent AD pathology and cerebrovascular disease (CVD) pathology as mediators fit the data well (RMSEA = 0.031; CFI = 0.957). AD pathology mediated the effects of age and APOE genotype on dementia severity. An older age at death and more ɛ2 alleles were associated with less AD pathology and, in turn, with less severe dementia. In contrast, more ɛ4 alleles were associated with more pathology and more severe dementia. Although age and race contributed to differences in CVD pathology, CVD pathology was not related to dementia severity in this sample of decedents with pathologically-confirmed AD. CONCLUSIONS Using δ as an estimate of dementia severity fits well within a structural model in which AD pathology directly affects dementia severity and mediates the relationship between age and APOE genotype on dementia severity.
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Abstract
Vascular dementia (VaD) is a major contributor to the dementia syndrome and is described as having problems with reasoning, planning, judgment, and memory caused by impaired blood flow to the brain and damage to the blood vessels resulting from events such as stroke. There are a variety of etiologies that contribute to the development of vascular cognitive impairment and VaD, and these are often associated with other dementia-related pathologies such as Alzheimer disease. The diagnosis of VaD is difficult due to the number and types of lesions and their locations in the brain. Factors that increase the risk of vascular diseases such as stroke, high blood pressure, high cholesterol, and smoking also raise the risk of VaD. Therefore, controlling these risk factors can help lower the chances of developing VaD. This update describes the subtypes of VaD, with details of their complex presentation, associated pathological lesions, and issues with diagnosis, prevention, and treatment.
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Affiliation(s)
- Ayesha Khan
- Wolfson Centre for Age Related Diseases, Guys Campus, London, United Kingdom of Great Britain and Northern Ireland Institute of NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA
| | - Raj N Kalaria
- Institute for Ageing and Health, Wolfson Research Centre, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anne Corbett
- Wolfson Centre for Age Related Diseases, Guys Campus, London, United Kingdom of Great Britain and Northern Ireland
| | - Clive Ballard
- Wolfson Centre for Age Related Diseases, Guys Campus, London, United Kingdom of Great Britain and Northern Ireland
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91
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McAleese KE, Walker L, Erskine D, Thomas AJ, McKeith IG, Attems J. TDP-43 pathology in Alzheimer's disease, dementia with Lewy bodies and ageing. Brain Pathol 2016; 27:472-479. [PMID: 27495267 DOI: 10.1111/bpa.12424] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022] Open
Abstract
Intracellular inclusions consisting of TAR DNA binding protein-43 (TDP-43 pathology) are present in up to 57% of Alzheimer's disease (AD) cases and follow a distinct topographical pattern of progression described in the TDP-43 in AD staging scheme. This scheme has not been applied to the assessment of TDP-43 pathology in dementia with Lewy bodies (DLB) and aged controls. We investigated TDP-43 pathology prevalence and severity in AD, DLB, mixed AD/DLB (Mx AD/DLB) and aged controls. One hundred and nineteen human post-mortem brains were included, neuropathologically diagnosed as AD: 46, DLB: 15, Mx AD/DLB: 19 and aged controls: 39. Paraffin sections inclusive of the amygdala, hippocampus, striatum and neocortex were immunohistochemically stained with antibodies against phosphorylated TDP-43 and staged according to the TDP-43 in AD staging scheme. TDP-43 pathology was present in all groups: AD: 73.9%, DLB: 33.3%, Mx AD/DLB: 52.6% and controls: 17.9%. Prevalence of TDP-43 pathology was significantly higher in AD and Mx AD/DLB compared to controls. In controls, higher age at death was associated with prevalence of TDP-43 pathology and higher TDP-43 in AD stage, suggesting that this type of TDP-43 pathology may partly be an age-associated phenomenon. Significantly higher prevalence of TDP-43 pathology in the AD group indicates that AD pathology possibly triggers and aggravates TDP-43 pathology. The validity of the TDP-43 in AD staging scheme is not limited to AD and should be applied to assess TDP-43 pathology in post mortem brains of aged individuals to further elucidate the role of TDP-43 pathology in age associated neurodegeneration.
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Affiliation(s)
- Kirsty E McAleese
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Lauren Walker
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Daniel Erskine
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Ian G McKeith
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Johannes Attems
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
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92
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Kang HS, Kwon JH, Kim S, Na DL, Kim SY, Lee JH, Han SH, Choi SH, Kim S, Carroll BJ, Kim DK. Comparison of neuropsychological profiles in patients with Alzheimer's disease and mixed dementia. J Neurol Sci 2016; 369:134-138. [PMID: 27653879 DOI: 10.1016/j.jns.2016.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/15/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022]
Abstract
OBJECTS We designed this study to extensively compare the neuropsychological profiles of Alzheimer's disease (AD) and mixed dementia (MD) in a large multicenter cohort of patients. Specifically, we performed subgroup analyses to examine group differences associated with dementia severity. METHODS A total of 1021 AD patients and 577 MD patients were included from the Clinical Research Center for Dementia of South Korea (CREDOS) Study. All patients underwent comprehensive neuropsychological and functional ratings, as well as complete physical and neurological examinations. To avoid floor confounds, only patients with Clinical Dementia Rating (CDR) scores of 0.5-2.0 were included. RESULTS Overall, MD patients showed worse performance in frontal/executive function than those with AD. Stratification by dementia severity revealed a significant difference in global cognitive function scores between AD and MD patients only in the low severity groups (CDR 0.5). Also, MD patients showed worse performance in frontal/executive function domains in the CDR 0.5 groups whereas they had better performance in the memory domain in the CDR 1 groups than did AD patients. Additionally, AD patients showed better performance than MD patients with respect to activities of daily living at CDR levels 0.5 and 1. All differences had disappeared at the CDR 2 level of global dementia severity. CONCLUSION This study suggests that there are significant differences in neuropsychological profiles between AD and MD patients, with the pattern of this difference varying distinctively according to dementia severity.
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Affiliation(s)
- Hyo Shin Kang
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea; Department of Clinical and Counseling Psychology, Korea University, Seoul, Republic of Korea
| | - Jung Hye Kwon
- Department of Clinical and Counseling Psychology, Korea University, Seoul, Republic of Korea
| | - Sangha Kim
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Yoon Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Doh Kwan Kim
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea; Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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93
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Donner L, Fälker K, Gremer L, Klinker S, Pagani G, Ljungberg LU, Lothmann K, Rizzi F, Schaller M, Gohlke H, Willbold D, Grenegard M, Elvers M. Platelets contribute to amyloid-β aggregation in cerebral vessels through integrin αIIbβ3-induced outside-in signaling and clusterin release. Sci Signal 2016; 9:ra52. [PMID: 27221710 DOI: 10.1126/scisignal.aaf6240] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cerebral amyloid angiopathy (CAA) is a vascular dysfunction disorder characterized by deposits of amyloid-β (Aβ) in the walls of cerebral vessels. CAA and Aβ deposition in the brain parenchyma contribute to dementia and Alzheimer's disease (AD). We investigated the contribution of platelets, which accumulate at vascular Aβ deposits, to CAA. We found that synthetic monomeric Aβ40 bound through its RHDS (Arg-His-Asp-Ser) sequence to integrin αIIbβ3, which is the receptor for the extracellular matrix protein fibrinogen, and stimulated the secretion of adenosine diphosphate (ADP) and the chaperone protein clusterin from platelets. Clusterin promoted the formation of fibrillar Aβ aggregates, and ADP acted through its receptors P2Y1 and P2Y12 on platelets to enhance integrin αIIbβ3 activation, further increasing the secretion of clusterin and Aβ40 binding to platelets. Platelets from patients with Glanzmann's thrombasthenia, a bleeding disorder in which platelets have little or dysfunctional αIIbβ3, indicated that the abundance of this integrin dictated Aβ-induced clusterin release and platelet-induced Aβ aggregation. The antiplatelet agent clopidogrel, which irreversibly inhibits P2Y12, inhibited Aβ aggregation in platelet cultures; in transgenic AD model mice, this drug reduced the amount of clusterin in the circulation and the incidence of CAA. Our findings indicate that activated platelets directly contribute to CAA by promoting the formation of Aβ aggregates and that Aβ, in turn, activates platelets, creating a feed-forward loop. Thus, antiplatelet therapy may alleviate fibril formation in cerebral vessels of AD patients.
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Affiliation(s)
- Lili Donner
- Department of Clinical and Experimental Hemostasis, Hemotherapy and Transfusion Medicine, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Knut Fälker
- Cardiovascular Research Centre, Örebro University, SE-701 82 Örebro, Sweden
| | - Lothar Gremer
- Institute of Physical Biology, Heinrich Heine University, 40225 Düsseldorf, Germany. Institute of Structural Biochemistry (ICS-6), Research Centre Jülich, 52425 Jülich, Germany
| | - Stefan Klinker
- Institute of Physical Biology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Giulia Pagani
- Institute for Pharmaceutical and Medicinal Chemistry, Department of Mathematics and Natural Sciences, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Liza U Ljungberg
- Cardiovascular Research Centre, Örebro University, SE-701 82 Örebro, Sweden
| | - Kimberley Lothmann
- Institute of Physical Biology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Federica Rizzi
- Department of Biomedical, Biotechnological, and Translation Sciences, University of Parma, Via Volturno 39/a, 43126 Parma, Italy. Centre for Molecular and Translational Oncology (COMT), University of Parma, Parco Area delle Scienze 11/a, 43124 Parma, Italy. National Institute of Biostructure and Biosystems (INBB), Viale Medaglie d'Oro 305, 00136 Rome, Italy
| | - Martin Schaller
- Department of Dermatology, University of Tübingen, 72076 Tübingen, Germany
| | - Holger Gohlke
- Institute for Pharmaceutical and Medicinal Chemistry, Department of Mathematics and Natural Sciences, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Dieter Willbold
- Institute of Physical Biology, Heinrich Heine University, 40225 Düsseldorf, Germany. Institute of Structural Biochemistry (ICS-6), Research Centre Jülich, 52425 Jülich, Germany
| | - Magnus Grenegard
- Cardiovascular Research Centre, Örebro University, SE-701 82 Örebro, Sweden
| | - Margitta Elvers
- Department of Clinical and Experimental Hemostasis, Hemotherapy and Transfusion Medicine, Heinrich Heine University, 40225 Düsseldorf, Germany.
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De Reuck J, Deramecourt V, Cordonnier C, Pasquier F, Leys D, Maurage CA, Bordet R. The incidence of post-mortem neurodegenerative and cerebrovascular pathology in mixed dementia. J Neurol Sci 2016; 366:164-166. [PMID: 27288798 DOI: 10.1016/j.jns.2016.05.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/09/2016] [Accepted: 05/11/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The clinical picture of dementia in most aged patients is due to a combination of different neurodegenerative processes and frequently associated to cerebrovascular lesions. They are called mixed dementia (MixD) cases, to be differentiated from those with pure vascular dementia (VaD) and those with Alzheimer's dementia (AD). The present study compares the frequency of different associated lesions in these disease groups. MATERIALS AND METHODS Out of a series of 252 autopsied patients 36 with MixD, 20 with VaD and 64 with AD disease were compared concerning the frequency of the associated lesions. Small cerebrovascular lesions were evaluated on a large coronal section of a cerebral hemisphere. Mean values of frequency and severity were compared between the 3 groups. RESULTS Of the 120 examined brains 30% were classified as MixD, 17% as VaD and 53% as AD. In 20% of the AD patients Lewy body pathology (LBP) was observed with a low incidence of cerebrovascular lesions, except for cerebral amyloid angiopathy (CAA). The MixD patients had more severe CAA and were significantly older than those with VaD and AD. Lacunar infarcts, on the other hand, were significantly more frequent in the VaD patients. DISCUSSION The most responsible vascular lesions in MixD and VaD are different. There is an inverse correlation between the presence of LBP and vascular pathology. MixD has to be considered as the end stage of AD.
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Affiliation(s)
| | | | | | | | - Didier Leys
- Université Lille 2, INSERM U1171, F-59000 Lille, France
| | | | - Regis Bordet
- Université Lille 2, INSERM U1171, F-59000 Lille, France
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Corriveau RA, Bosetti F, Emr M, Gladman JT, Koenig JI, Moy CS, Pahigiannis K, Waddy SP, Koroshetz W. The Science of Vascular Contributions to Cognitive Impairment and Dementia (VCID): A Framework for Advancing Research Priorities in the Cerebrovascular Biology of Cognitive Decline. Cell Mol Neurobiol 2016; 36:281-8. [PMID: 27095366 DOI: 10.1007/s10571-016-0334-7] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/22/2016] [Indexed: 01/17/2023]
Abstract
The World Health Organization reports that 47.5 million people are affected by dementia worldwide. With aging populations and 7.7 million new cases each year, the burden of illness due to dementia approaches crisis proportions. Despite significant advances in our understanding of the biology of Alzheimer's disease (AD), the leading dementia diagnosis, the actual causes of dementia in affected individuals are unknown except for rare fully penetrant genetic forms. Evidence from epidemiology and pathology studies indicates that damage to the vascular system is associated with an increased risk of many types of dementia. Both Alzheimer's pathology and cerebrovascular disease increase with age. How AD affects small blood vessel function and how vascular dysfunction contributes to the molecular pathology of Alzheimer's are areas of intense research. The science of vascular contributions to cognitive impairment and dementia (VCID) integrates diverse aspects of biology and incorporates the roles of multiple cell types that support the function of neural tissue. Because of the proven ability to prevent and treat cardiovascular disease and hypertension with population benefits for heart and stroke outcomes, it is proposed that understanding and targeting the biological mechanisms of VCID can have a similarly positive impact on public health.
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Affiliation(s)
- Roderick A Corriveau
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA.
| | - Francesca Bosetti
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - Marian Emr
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - Jordan T Gladman
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - James I Koenig
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - Claudia S Moy
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - Katherine Pahigiannis
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - Salina P Waddy
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - Walter Koroshetz
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and (select 8682 from (select(sleep(5)))aqxj)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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97
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 order by 1-- rkdf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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98
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 waitfor delay '0:0:5'-- bmov] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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99
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100
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 order by 1-- bcpd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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