2013 Alzheimer's disease facts and figures

Synthesis and evaluation of curcumin-based near-infrared fluorescent probes for the in vivo optical imaging of amyloid-β plaques

The abnormal self-assembly of amyloid-beta (Aβ) peptides into oligomers, as well as insoluble fibrils, has been identified as a key factor for monitoring the progression of Alzheimer's disease (AD). The noninvasive imaging of Aβ aggregates utilizing chemical probes can be a powerful and practical technique for accurately diagnosing and monitoring the progress of AD, as well as evaluating the effectiveness of therapeutic drug candidates in treating or managing it. Particularly, the near-infrared (NIR) fluorescence imaging of Aβ plaques is a potentially promising approach toward the efficient detection of the biomarker. In this study, we describe a new NIR fluorophore, which was based on curcumin derivatives. The fluorophore is equipped with desirable optical properties for in vivo brain imaging. The emission wavelength of the probe, 8b, is 667 nm, and its fluorescent intensity is significantly increased through binding with the Aβ aggregates. The probe allows the clear visualization of the Aβ plaques 10 min post administration, and the intensity of the fluorescent signal in the brain of a 5XFAD transgenic mouse model is more than three times higher than that of the normal control group. These results demonstrate that the designed probe can be an effective tool for visualizing Aβ plaques, as well as investigating the pathological progress of AD.

Sex-specific Changes in Brain Estrogen Metabolism Induced by Acute Trimethyltin Exposure

BACKGROUND/AIM

In this study, we investigated sex-specific effects of acute exposure to trimethyltin, a known neurotoxicant on metabolic steroids.

MATERIALS AND METHODS

We administered intraperitoneally 2.3 mg/kg trimethyltin to 4-week-old male mice and measured the levels of metabolic steroids 24 h after treatment. We also measured mRNA and protein levels of cytochrome P450 1B1 using real-time polymerase chain reaction and western blotting.

RESULTS

Cortisol levels in the cortex increased in both sexes following acute trimethyltin exposure. The estradiol levels decreased, and the 4-hydroxyestradiol levels increased only in females. We also observed increased cytochrome P450 1B1 mRNA and protein levels only in the female cortex.

CONCLUSION

Acute trimethyltin exposure induces distinct sex-specific metabolic changes in the brain before significant sexual maturation.

The Conspicuous Link between Ear, Brain and Heart-Could Neurotrophin-Treatment of Age-Related Hearing Loss Help Prevent Alzheimer's Disease and Associated Amyloid Cardiomyopathy?

Alzheimer's disease (AD), the most common cause of dementia in the elderly, is a neurodegenerative disorder associated with neurovascular dysfunction and cognitive decline. While the deposition of amyloid β peptide (Aβ) and the formation of neurofibrillary tangles (NFTs) are the pathological hallmarks of AD-affected brains, the majority of cases exhibits a combination of comorbidities that ultimately lead to multi-organ failure. Of particular interest, it can be demonstrated that Aβ pathology is present in the hearts of patients with AD, while the formation of NFT in the auditory system can be detected much earlier than the onset of symptoms. Progressive hearing impairment may beget social isolation and accelerate cognitive decline and increase the risk of developing dementia. The current review discusses the concept of a brain-ear-heart axis by which Aβ and NFT inhibition could be achieved through targeted supplementation of neurotrophic factors to the cochlea and the brain. Such amyloid inhibition might also indirectly affect amyloid accumulation in the heart, thus reducing the risk of developing AD-associated amyloid cardiomyopathy and cardiovascular disease.

Novel 1,2,4-oxadiazole derivatives as selective butyrylcholinesterase inhibitors: Design, synthesis and biological evaluation

Alzheimer's disease (AD) is a progressive mental disorder that brings a huge economic burden to the healthcare systems. During this illness, acetylcholine levels in the cholinergic systems gradually diminish, which results in severe memory loss and cognitive impairments. Moreover, Butyrylcholinesterase (BuChE) enzyme participates in cholinergic neurotransmission regulation by playing a prominent role in the latter phase of AD. In this study, based on donepezil, which is an effective acetylcholinesterase (AChE) inhibitor, a series of 1,2,4-oxadiazole compounds were designed, synthesized and their inhibitory activities towards AChE and BuChE enzymes were evaluated. Some structures exhibited a higher selectivity rate towards BuChE in comparison to donepezil. Notably, compound 6n with an IC₅₀ value of 5.07 µM and an SI ratio greater than 19.72 showed the highest potency and selectivity towards BuChE enzyme. The docking result revealed that compound 6n properly fitted the active site pocket of BuChE enzyme, and formed desirable lipophilic interactions and hydrogen bonds. Moreover, according to in silico ADME studies, these compounds have proper potential for being developed as new oral anti-Alzheimer's agents (Figure 1(Fig. 1)).

Pathogenic Factors Identification of Brain Imaging and Gene in Late Mild Cognitive Impairment

Mild cognitive impairment (MCI) is a dangerous signal of severe cognitive decline. It can be separated into two steps: early MCI (EMCI) and late MCI (LMCI). As the post-state of MCI and pre-state of Alzheimer's disease (AD), LMCI receives insufficient attention in the field of brain science, causing the internal mechanism of LMCI has not been well understood. To better explore the focus and pathological mechanism of LMCI, a method called genetic evolved random forest (GERF) is applied. Resting functional magnetic resonance imaging (rfMRI) and gene data are obtained from 62 subjects (36 LMCI and 26 normal controls), and Pearson correlation analysis is adopted to perform the multimodal fusion of two types of data to construct fusion features. We identified pathogenic brain regions and genes that are highly related to LMCI using GERF and achieves a good effect. Compared with the normal control (NC) group, the abnormal brain regions of LMCI are PUT.L, PreCG.L, IFGtriang.R, REC.R, DCG.R, PoCG.L, and HES.L, and the pathogenic genes are FHIT, RF00019, FRMD4A, PTPRD, and RBFOX1. More importantly, most of these risk genes and abnormal brain regions have been confirmed to be related to AD and MCI in previous studies. In this study, we mapped them to LMCI with higher accuracies, so as to provide a more robust understanding of the physiological mechanism of MCI.

Hispanic ethnicity and in-hospital morbidity and mortality outcomes in Alzheimer's Disease: A U.S. National Study 2005-2015

BACKGROUND

Hispanics are one of the largest and fastest-growing population in the United States. Having been reported as one of the high-risk ethnicities to develop Alzheimer's Disease (AD) makes elder Hispanics one of the significant groups of AD in the country, indicating a need to study the disparities in Hispanics vs. non-Hispanics patients. We aimed to determine the prevalence, morbidity, and mortality outcomes of AD in Hispanics.

METHODS

We surveyed Healthcare Cost and Utilization Project (HCUP) from 2005 to 2015 to identify patients older than 50 years who were admitted for any reason and had AD diagnosis. Prevalence, demographics, age brackets, in-hospital deaths, disease severity, and hospital length of stay (LOS) were compared between the Hispanics and Non-Hispanics.

RESULTS

Among 14,135,560 Hispanic discharges, 2.76% had AD, compared with 207,515,260 discharges in Non-Hispanic with 2.61% AD, p < 0.001. Hispanics had significantly more AD in all age brackets, especially over 90 years of age, p < 0.001. A significantly higher prevalence of AD in both Hispanic Females (3.27% vs. 3.10%) and Males (2.17% vs. 2.04%) was noticed, p < 0.001. In northeast and south regions of the country and urban hospitals, AD was more among Hispanics (p < 0.001). Hispanic patients were younger (81.8 ± 7.77 vs. 82.6 ± 7.50, p < 0.001), had longer LOS (6.41 ± 7.72 vs. 6.08 ± 7.05, p < 0.001), had higher hospital charges ($45,989 vs. $37,688, p < 0.001). Hispanic AD patients had higher disease severity and mortality risk (p < 0.001). However, the inpatient mortality was not different between the Hispanic and non-Hispanics. Multivariate analysis showed that Hispanics had the highest AD prevalence in the inpatient setting (OR, 1.38; 95% CI, 1.37-1.39, p < 0.001).

CONCLUSION

The prevalence of AD was significantly higher in inpatient Hispanics than non-Hispanics. Hispanic AD patients had a younger age compared with non-Hispanic AD. Disease severity and mortality risks were higher in Hispanics with AD than non-Hispanics with AD. However, no difference was seen in mortality rate during admission in Hispanics vs. non-Hispanics.

Enhanced amyloid-β generation by γ-secretase complex in DRM microdomains with reduced cholesterol levels

A neuropathologic hallmark of Alzheimer's disease (AD) is the presence of senile plaques that contain neurotoxic amyloid-β protein (Aβ) species, which are generated by the cleavage of amyloid β-protein precursor by secretases such as the γ-secretase complex, preferentially located in detergent-resistant membrane (DRM) regions and comprising endoproteolysed amino- and carboxy-terminal fragments of presenilin, nicastrin, anterior pharynx defective 1 and presenilin enhancer 2. Whereas some of familial AD patients harbor causative PSEN mutations that lead to more generation of neurotoxic Aβ42, the contribution of Aβ generation to sporadic/late-onset AD remains unclear. We found that the carboxy-terminal fragment of presenilin 1 was redistributed from DRM regions to detergent-soluble membrane (non-DRM) regions in brain tissue samples from individuals with sporadic AD. DRM fractions from AD brain sample had the ability to generate significantly more Aβ and had a lower cholesterol content than DRM fractions from non-demented control subjects. We further demonstrated that lowering the cholesterol content of DRM regions from cultured cells contributed to the redistribution of γ-secretase components and Aβ production. Taken together, the present analyses suggest that the lowered cholesterol content in DRM regions may be a cause of sporadic/late-onset AD by enhancing overall Aβ generation.

Deep Large-Scale Multitask Learning Network for Gene Expression Inference

Gene expression profiling makes it possible to conduct many biological studies in a variety of fields due to its thorough characterization of cellular states under various experimental conditions. Despite recent advances in high-throughput technology, profiling an entire set of genomes is still difficult and expensive. Due to the high correlation between expression patterns of different genes, the aforementioned problem can be solved with a cost-effective approach that collects only a small subset of genes, called landmark genes, representing the entire set of genes, and infer the remaining genes, called target genes, using a computational model. There are several shallow and deep regression models in literature to estimate the expressions of target genes from the landmark genes. However, the shallow mostly have limited capacity in learning the nonlinear and complex gene expression data and are prone to underfitting, and the deep models generally do not take advantage of correlation among target genes in the learning process and suffer from overfitting. Considering the gene expression inference as a multitask learning problem, we propose a new deep multitask learning algorithm to tackle these issues. Our learning framework automatically learns the correlation between target genes and uses this knowledge to improve its generalization. Specifically, we utilize a subnetwork with low-dimensional latent variables to discover the relationships between target genes and enforce a seamless and easy to implement regularization to our deep regression model. Unlike the existing multitask learning methods that can only deal with dozens or hundreds of tasks, our algorithm is able to efficiently learn the relationships between ∼10,000 target genes and, thus, is scalable to a large number of tasks. Our proposed method outperforms the shallow and deep regression models for gene expression inference and alternative multitask learning algorithms on two large-scale datasets regardless of the network architecture.

Multi-Target-Directed Ligands as an Effective Strategy for the Treatment of Alzheimer's Disease

Alzheimer's disease (AD) is a complex neurological disorder, and multiple pathological factors are believed to be involved in the genesis and progression of the disease. A number of hypotheses, including Acetylcholinesterase, Monoamine oxidase, β-Amyloid, Tau protein, etc., have been proposed for the initiation and progression of the disease. At present, acetylcholine esterase inhibitors and memantine (NMDAR antagonist) are the only approved therapies for the symptomatic management of AD. Most of these single-target drugs have miserably failed in the treatment or halting the progression of the disease. Multi-factorial diseases like AD require complex treatment strategies that involve simultaneous modulation of a network of interacting targets. Since the last few years, Multi-Target-Directed Ligands (MTDLs) strategy, drugs that can simultaneously hit multiple targets, is being explored as an effective therapeutic approach for the treatment of AD. In the current review article, the authors have briefly described various pathogenic pathways associated with AD. The importance of Multi-Target-Directed Ligands and their design strategies in recently reported articles have been discussed in detail. Potent leads are identified through various structure-activity relationship studies, and their drug-like characteristics are described. Recently developed promising compounds have been summarized in the article. Some of these MTDLs with balanced activity profiles against different targets have the potential to be developed as drug candidates for the treatment of AD.

Dichlorodiphenyltrichloroethane Impairs Amyloid Beta Clearance by Decreasing Liver X Receptor α Expression

Abnormal amyloid beta (Aβ) clearance is a distinctive pathological mechanism for Alzheimer’s disease (AD). ATP-binding cassette transporter A1 (ABCA1), which mediates the lipidation of apolipoprotein E, plays a critical role in Aβ clearance. As an environmental factor for AD, dichlorodiphenyltrichloroethane (DDT) can decrease ATP-binding cassette transporter A1 (ABCA1) expression and disrupt Aβ clearance. Liver X receptor α (LXRα) is an autoregulatory transcription factor for ABCA1 and a target of some environmental pollutants, such as organophosphate pesticides. In this study, we aimed to investigate whether DDT could affect Aβ clearance by targeting LXRα. The DDT-pretreated H4 human neuroglioma cells and immortalized astrocytes were incubated with exogenous Aβ to evaluate Aβ consumption. Meanwhile, cytotoxicity and LXRα expression were determined in the DDT-treated cells. Subsequently, the antagonism of DDT on LXRα agonist T0901317 was determined in vitro. The interaction between DDT and LXRα was predicted by molecular docking and molecular dynamics simulation technology. We observed that DDT could inhibit Aβ clearance and decrease the levels of LXRα mRNA and LXRα protein. Moreover, DDT is supposed to strongly bind to LXRα and exert antagonistic effects on LXRα. In conclusion, this study firstly presented that DDT could inhibit LXRα expression, which would contribute to Aβ clearance decline in vitro. It provides an experimental basis to search for potential therapeutic targets of AD.

Associations of Infectious Agents with Alzheimer's Disease: A Systematic Review and Meta-Analysis

BACKGROUND

The role of infectious agents in the development of Alzheimer's disease (AD) has long been debated, however, uncertainties still persist.

OBJECTIVE

We aimed to illuminate the associations between infectious agents and risk of AD comprehensively.

METHODS

Studies examining the associations between AD and infectious agents were identified through a systematic search of PubMed, Embase, and Cochrane library. A random-effects meta-analysis was conducted. Publication bias was explored using funnel plot.

RESULTS

Fifty-one studies were included in the systematic review, of which forty-seven studies with 108,723 participants and 4,039 AD cases were eligible for meta-analysis. Evidence based on case control studies demonstrated that Chlamydia pneumoniae [odds ratio (OR): 4.39, 95% CI = 1.81-10.67; I2 = 68%)], Human herpes virus-6 (OR: 3.97, 95% CI = 2.04-7.75; I2 = 0%, Epstein-Barr virus (OR:1.45, 95% CI = 1.00-2.08; I2 = 0%), Herpes simplex virus-1 (OR:1.34, 95% CI = 1.02-1.75; I2 = 0%), and the Herpesviridae family (OR:1.41, 95% CI = 1.15-1.74; I2 = 12%) infection were associated with a higher risk of AD. No significant evidence of publication bias was found.

CONCLUSION

These findings strengthened the evidence that infection may play an important role in AD. Additional research is required to determine whether treatment strategies targeting infectious diseases to prevent AD are viable in the future.

Regulation of amyloid-β levels by matrix metalloproteinase-2/9 (MMP2/9) in the media of lung cancer cells

In this study, we set out to identify regulators of intact amyloid-β40/42 (Aβ) levels in A549 (p53 wild-type) and H1299 (p53-null) lung cancer cell media. Higher Aβ levels were detected in the media of A549 than H1299 cells without or with treatment with 4-methylumbelliferone (4-MU) and/or the anti-CD44 antibody (5F12). Using inhibitors, we found that PI3K, AKT, and NFκB are likely involved in regulating Aβ levels in the media. However, increased Aβ levels that more closely resembled those found upon 4-MU co-treatment resulted from MMP2/9 inhibition, suggesting that MMP2/9 maybe the main contributors to regulation of Aβ levels in the media. Differences in Aβ levels might be accounted for, in part, by p53 since blocking p53 function in A549 cells resulted in decreased Aβ levels, increased MMP2/9 levels, increased PI3K/AKT activities and the phospho/total NFκB ratio. Using siRNA targeted against MMP2 or MMP9, we found increased Aβ levels in the media, however, MMP2 knockdown led to Aβ levels closely mimicking those detected by co-treatment with 4-MU. Cell viability or apoptosis upon treatment with either MMP2 or MMP9 siRNA along with Aβ immunodepletion, showed that MMP2 is the predominant regulator of the cytotoxic effects induced by Aβ in lung cancer cells.

Feasibility of reducing frailty components in older adults with Alzheimer's dementia: a randomized controlled home-based exercise trial (AD-HOMEX)

OBJECTIVES

There is a need for interventions to reduce frailty in older people with Alzheimer's dementia (AD). The purpose of this study was to investigate the effect of a home-based multimodal exercise program for older adults with AD (AD-HOMEX) on frailty.

DESIGN

A parallel single-blind randomized controlled trial comparing a home-based exercise program and usual care.

SETTING AND PARTICIPANTS

A home-based program in Brazil. Forty individuals aged 65years or older with mild to moderate AD.

METHODS

The intervention group (IG) participated in a 16-week protocol involving three 60-minute sessions per week of progressive individualized physical exercises supervised by a physical therapist. The participants in the control group (CG) maintained their usual care. Frailty was assessed using the FRAIL questionnaire, the Edmonton Frail Scale (EFS) and a subjective assessment by the evaluator (SAE) at baseline and follow-up. Per-protocol analysis was performed.

RESULTS

Thirty-five participants completed the program (IG = 16; CG = 19). Frailty improved in the IG based on the EFS (P = .004) and FRAIL (P ≤ .001). An interaction between group and time (P = .008) and a significant difference between times (P = .047) were found for the SAE responsiveness domain. An improvement in the classification of frailty (EFS and FRAIL) was found between times in the IG (P = .003) and between groups at follow-up (P = .027). A significant difference in the SAE classification was found between groups at follow-up (P = .034), with a worsening between times in the CG (P = .032). Interestingly, a more favorable frailty transition pattern was found in the IG based on both the EFS and FRAIL.

CONCLUSIONS AND IMPLICATIONS

AD-HOMEX seems to reduce frailty and improve frailty transition patterns. Our findings provide a further theoretical basis for designing home-based physical interventions as routine practice for older frail adults with AD.

Association between Living with Patients with Dementia and Family Caregivers' Depressive Symptoms-Living with Dementia Patients and Family Caregivers' Depressive Symptoms

Depression among family caregivers is becoming an increasingly important issue due to a growing elderly population. This study aimed to examine the association of living with a patient with dementia and family caregivers' depressive symptoms, among Korean adults. This study used the data of 371,287 participants after excluding those who indicated having dementia themselves from the Korea Community Health Survey of 2018-2019. Depressive symptoms were measured using the Patient Health Questionnaire-9. Data were analyzed using multiple logistic regression. The rates of spouse caregivers having depressive symptoms were 9.4% and 10.8% among men and women, respectively. The odds ratio for risk of depressive symptoms among male and female spouse caregivers in comparison to non-caregivers was 2.65 and 2.28, respectively. In the subgroup analysis, the highest income group was associated with risk of depressive symptoms, with an odds ratio of 4.28 for men, and 3.02 for women. Having a patient with dementia in the family was significantly associated with family caregivers' depressive symptoms. In particular, when the patient with dementia was a spouse, both women and men were likely to have depressive symptoms. To reduce the burden of caregivers, we need management policies and interventions for family caregivers.

Age-Related Memory Impairment and Sex-Specific Alterations in Phosphorylation of the Rpt6 Proteasome Subunit and Polyubiquitination in the Basolateral Amygdala and Medial Prefrontal Cortex

Aging is marked by an accumulation of damaged and modified brain proteins, and the ubiquitin-proteasome system (UPS) is important for cellular protein degradation. Recent work has established a critical role for the UPS in memory and synaptic plasticity, but the role of the UPS in age-related cognitive decline remains poorly understood. We trained young, middle-aged, and aged male and female rats using trace fear conditioning (TFC) to investigate the effects of age and sex on memory. We then measured markers of UPS-related protein degradation (phosphorylation of the Rpt6 proteasome regulatory subunit and K48-linked polyubiquitination) using western blots. We found that aged males, but not aged females, showed behavioral deficits at memory retrieval. Aged males also displayed reduced phosphorylation of the Rpt6 proteasome subunit and accumulation of K48 in the basolateral amygdala, while aged females displayed a similar pattern in the medial prefrontal cortex. These findings suggest that markers of UPS function are differentially affected by age and sex in a brain region-dependent manner. Together these results provide an important step toward understanding the UPS and circuit-level differences in aging males and females.

High-Order Laplacian Regularized Low-Rank Representation for Multimodal Dementia Diagnosis

Multimodal heterogeneous data, such as structural magnetic resonance imaging (MRI), positron emission tomography (PET), and cerebrospinal fluid (CSF), are effective in improving the performance of automated dementia diagnosis by providing complementary information on degenerated brain disorders, such as Alzheimer's prodromal stage, i.e., mild cognitive impairment. Effectively integrating multimodal data has remained a challenging problem, especially when these heterogeneous data are incomplete due to poor data quality and patient dropout. Besides, multimodal data usually contain noise information caused by different scanners or imaging protocols. The existing methods usually fail to well handle these heterogeneous and noisy multimodal data for automated brain dementia diagnosis. To this end, we propose a high-order Laplacian regularized low-rank representation method for dementia diagnosis using block-wise missing multimodal data. The proposed method was evaluated on 805 subjects (with incomplete MRI, PET, and CSF data) from the real Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort. Experimental results suggest the effectiveness of our method in three tasks of brain disease classification, compared with the state-of-the-art methods.

Dissecting Sex-Related Cognition between Alzheimer's Disease and Diabetes: From Molecular Mechanisms to Potential Therapeutic Strategies

The brain is a sexually dimorphic organ that implies different functions and structures depending on sex. Current pharmacological approaches against different neurological diseases act distinctly in male and female brains. In all neurodegenerative diseases, including Alzheimer's disease (AD), sex-related outcomes regarding pathogenesis, prevalence, and response to treatments indicate that sex differences are important for precise diagnosis and therapeutic strategy. Pathogenesis of AD includes vascular dementia, and in most cases, this is accompanied by metabolic complications with similar features as those assembled in diabetes. This review discusses how AD-associated dementia and diabetes affect cognition in relation to sex difference, as both diseases share similar pathological mechanisms. We highlight potential protective strategies to mitigate amyloid-beta (Aβ) pathogenesis, emphasizing how these drugs act in the male and female brains.

Intranasal drug delivery for treatment of Alzheimer's disease

The Alzheimer's disease is a neurodegenerative condition with severe consequences interfering with patient quality of life. It is characterized as a progressive and irreversible brain disorder hampering memory and thinking, affecting the capacity to perform daily tasks leading to physical and cognitive incapacitation. The conventional treatment occurs by the oral route, but it presents relevant drawbacks such as low bioavailability, fast metabolism, limited brain exposure, and undesirable side effects. The intranasal route has been proposed as a promising alternative to deliver drugs and improve the Alzheimer's disease treatment. Still, there is not a clear alternative delivery system available in the market with advantageous bioavailability and safety. The aim of this review is to perform an overview on the strategies for drug intranasal delivery for Alzheimer's disease treatment. The advantages and disadvantages of this delivery route and the delivery systems developed so far are discussed. A special focus is given on the use of permeation enhancers, the types of intranasal drug delivery devices, as well as possible toxicity concerns.

Headache - A Window to Dementia: An Unexpected Twist

Migraine and other types of headaches have several symptoms associated with them. The association between migraine and dementia has been considered. It is a topic of discussion and appears to be multifactorial. Dementia is a cluster of symptoms, with memory loss and cognitive dysfunction being the prominent symptoms. In this review, we discussed the association of headache and cognitive dysfunction in a broader context and how the practiced treatment of headaches may silently lead to dementia. We conducted a thorough literature search using PubMed as our main database. The articles exploring the association between headache (both migraine and non-migraine) and dementia were included. Some risk factors like migraine-induced stroke and inherent vascular diseases in migraine patients channeling to stroke and dementia were not considered. A total of 28 studies were included for review. All the reviewed studies put together showed an association between headache and cognitive dysfunction of any form. They showed that the frequency and duration of headache is a determinant for dementia. Few studies also focused on how treating headaches with certain drugs can lead to dementia. The reviewed published literature showed that headaches of any sort and their treatment are potentially linked to dementia. Not all headache patients will require medical treatment, as the benefit might outweigh the risk sometimes. It is interim to understand these facts and formulate a better protocol for treating headache patients. However, due to some discordant results, further studies are needed.

Multimodal deep learning models for early detection of Alzheimer's disease stage

Most current Alzheimer's disease (AD) and mild cognitive disorders (MCI) studies use single data modality to make predictions such as AD stages. The fusion of multiple data modalities can provide a holistic view of AD staging analysis. Thus, we use deep learning (DL) to integrally analyze imaging (magnetic resonance imaging (MRI)), genetic (single nucleotide polymorphisms (SNPs)), and clinical test data to classify patients into AD, MCI, and controls (CN). We use stacked denoising auto-encoders to extract features from clinical and genetic data, and use 3D-convolutional neural networks (CNNs) for imaging data. We also develop a novel data interpretation method to identify top-performing features learned by the deep-models with clustering and perturbation analysis. Using Alzheimer's disease neuroimaging initiative (ADNI) dataset, we demonstrate that deep models outperform shallow models, including support vector machines, decision trees, random forests, and k-nearest neighbors. In addition, we demonstrate that integrating multi-modality data outperforms single modality models in terms of accuracy, precision, recall, and meanF1 scores. Our models have identified hippocampus, amygdala brain areas, and the Rey Auditory Verbal Learning Test (RAVLT) as top distinguished features, which are consistent with the known AD literature.

The Association Between Trace Elements Exposure and the Cognition in the Elderly in China

This study aimed to evaluate the association between aluminum (Al), arsenic (As), barium (Ba), cobalt (Co), manganese (Mn), selenium (Se), strontium (Sr), thallium (Tl), and vanadium (V) levels in whole blood and the cognitive ability of people over 60 years old. A total of 1217 eligible participants were enrolled in our study in Lu'an city, Anhui province, China. The inductively coupled plasma mass spectrometry (ICP-MS) was used to determine the concentration of nine trace elements in the whole blood, which reflect their exposure levels. Mini-mental State Examination (MMSE) scale was employed to screen the cognitive function of the elderly. Logistic regression was applied to assess the associations of nine whole blood trace elements with cognition. In the work, it has found that high levels of whole blood As and Se are risk factors for cognitive dysfunction. As and Se quartile were correlated with increased risk of cognitive dysfunction, and with the odds ratio (OR) of 2.06 (95% CI 1.30-3.25; p-trend = 0.002), 1.947 (95% CI 1.20-3.17; p-trend = 0.007) in the highest quartile. However, high concentration of Al, V, and Ba in whole blood were protective factors for cognitive function [OR = 0.63 (95% CI 0.40-0.98; p-trend = 0.040), 0.549 (95% CI 0.36-0.85; p-trend = 0.007), 0.460 (95% CI 0.28-0.75; p-trend = 0.002) respectively]. The study suggested that the exposure of some trace elements (As, Se) were associated with the increased risk of cognitive dysfunction; on the contrary, other elements (Al, V, Ba) could be protective factor for cognitive function. These findings need to be confirmed in additional research of a large elderly population.

Alterations and interactions of subcortical modulatory systems in Alzheimer's disease

The pathogenesis of Alzheimer's disease (AD) is not fully understood. Here we summarize current knowledge on the involvement of the serotonergic, noradrenergic, dopaminergic, cholinergic, and opioid systems in AD, emphasizing the importance of interactions between the serotonergic and the other subcortical modulatory systems during the progression of AD. In physiological conditions, all neurotransmitter systems function in concert and are interdependent at both the neuroanatomical and molecular levels. Through their early involvement in AD, cognitive and behavioral abilities that rely on their interactions also become disrupted. Considering that serotonin (5HT) regulates the release of noradrenaline (NA), dopamine (DA) and acetylcholine (ACh), any alteration in 5HT levels leads to disturbance of NA, DA, and ACh homeostasis in the brain. One of the earliest pathological changes during the prodromal phase of AD is a decrease of serotonergic transmission throughout the brain, with serotonergic receptors being also affected. Additionally, serotonergic and noradrenergic as well as serotonergic and dopaminergic nuclei are reciprocally interconnected. As the serotonergic dorsal raphe nucleus (DRN) is affected by pathological changes early in AD, and the noradrenergic locus coeruleus (LC) and dopaminergic ventral tegmental area (VTA) exhibit AD-related pathological changes, their connectivity also becomes altered in AD. Such disrupted interactions among neurotransmitter systems in AD can be used in the development of multi-target drugs. Some of the potential AD therapeutics (such as ASS234, RS67333, tropisetron) target multiple neurotransmitter systems to achieve the best possible improvement of cognitive and behavioral deficits observed in AD. Here, we review how serotonergic system interacts with other subcortical modulatory systems (noradrenergic, dopaminergic, cholinergic, and opioid systems) during AD.

Whether cognitive behavioral therapy is effective for Alzheimer's disease: A protocol for systematic review and network meta-analysis

BACKGROUND

Alzheimer disease (AD) is a progressive neurodegenerative disease characterized by impaired memory and cognitive judgment. It is the leading cause of dementia in the elderly, and its high morbidity and mortality have also brought a significant social burden. So far, there is no method can completely cure Alzheimer's dementia, but there are many non-drug treatments that have been praised by people, especially the cognitive behavioral therapy proposed in recent years. The main purpose of this article is to evaluate the effect of cognitive behavioral therapy on the cognitive function improvement of patients with Alzheimer's dementia.

METHODS

We did a network meta-analysis to identify both direct and indirect evidence in relevant studies. A systematic literature search will be performed in the Cochrane Library, PubMed, and EMBASE from inception to October 2020. We extracted the relevant information from these trials with a predefined data extraction sheet and assessed the risk of bias with the Cochrane risk of bias tool.The outcomes investigated were Mini-Mental State Examination and AD Assessment Scale-Cognitive section scores. We did a pair-wise meta-analysis using the fixed-effects model and then did a random-effects network meta-analysis within a Bayesian framework. The = the Assessment of Multiple Systematic Reviews-2 scale, Preferred Reporting Items for Systematic Reviews and Meta-Analyses scale and Grading of Recommendations Assessment, Development and Evaluation were used to assess the quality and evidence grade of the literature. General characteristics of the eligible randomized controlled trials will be summarized and described. Meanwhile, The ADDIS software will be used to perform the network meta-analysis, and the result figures will be generated by STATA 15.0 software.

RESULTS

Using the draft search strategy of databases and after screening,7 randomized controlled trials met the a priori criteria and were included. This network mate-analysis will be published in a peer-reviewed journal.

CONCLUSION

Our study will provide evidence for cognitive behavioral intervention in AD patients. And provide recommendations and guidelines for the clinic.

PROTOCOL REGISTRATION

INPLASY2020110052.

Detection of Dementia-Related Abnormal Behaviour Using Recursive Auto-Encoders

Age-related health issues have been increasing with the rise of life expectancy all over the world. One of these problems is cognitive impairment, which causes elderly people to have problems performing their daily activities. Detection of cognitive impairment at an early stage would enable medical doctors to deepen diagnosis and follow-up on patient status. Recent studies show that daily activities can be used to assess the cognitive status of elderly people. Additionally, the intrinsic structure of activities and the relationships between their sub-activities are important clues for capturing the cognitive abilities of seniors. Existing methods perceive each activity as a stand-alone unit while ignoring their inner structural relationships. This study investigates such relationships by modelling activities hierarchically from their sub-activities, with the overall goal of detecting abnormal activities linked to cognitive impairment. For this purpose, recursive auto-encoders (RAE) and their linear vs. greedy and supervised vs. semi-supervised variants are adopted to model the activities. Then, abnormal activities are systematically detected using RAE's reconstruction error. Moreover, to apply RAEs for this problem, we introduce a new sensor representation called raw sensor measurement (RSM) that captures the intrinsic structure of activities, such as the frequency and the order of sensor activations. As real-world data are not accessible, we generated data by simulating abnormal behaviour, which reflects on cognitive impairment. Extensive experiments show that RAEs can be used as a decision-supporting tool, especially when the training set is not labelled to detect early indicators of dementia.

Alzheimer's Disease: New Concepts on the Role of Autoimmunity and NLRP3 Inflammasome in the Pathogenesis of the Disease

Alzheimer's disease (AD), recognized as the most common neurodegenerative disorder, is clinically characterized by the presence of extracellular beta-amyloid (Aβ) plaques and by intracellular neurofibrillary tau tangles, accompanied by glial activation and neuroinflammation. Increasing evidence suggests that self-misfolded proteins stimulate an immune response mediated by glial cells, inducing the release of inflammatory mediators and the recruitment of peripheral macrophages into the brain, which in turn aggravate AD pathology. The present review aims to update the current knowledge on the role of autoimmunity and neuroinflammation in the pathogenesis of the disease, indicating a new target for therapeutic intervention. We mainly focused on the NLRP3 microglial inflammasome as a critical factor in stimulating innate immune responses, thus sustaining chronic inflammation. Additionally, we discussed the involvement of the NLRP3 inflammasome in the gut-brain axis. Direct targeting of the NLRP3 inflammasome and the associated receptors could be a potential pharmacological strategy since its inhibition would selectively reduce AD neuroinflammation.

Modeling protein-protein interactions in axon initial segment to understand their potential impact on action potential initiation

The axon initial segment (AIS) region is crucial for action potential initiation due to the presence of high-density AIS protein voltage-gated sodium channels (Na_v). Na_v channels comprise several serine residues responsible for the recruitment of Na_v channels into the structure of AIS through interactions with ankyrin-G (AnkG). In this study, a series of computational experiments are performed to understand the role of AIS proteins casein kinase 2 and AnkG on Na_v channel recruitment into the AIS. The computational simulation results using Virtual cell software indicate that Na_v channels with all serine sites available for phosphorylation bind to AnkG with strong affinity. At the low initial concentration of AnkG and casein kinase 2, the concentration of Na_v channels reduces significantly, suggesting the importance of casein kinase 2 and AnkG in the recruitment of Na_v channels.

The Association of Blood-Based Inflammatory Factors IL-1β, TGF-β and CRP with Cognitive Function in Alzheimer's Disease and Mild Cognitive Impairment

OBJECTIVE

Many patients suffer from dementia in its most common form, Alzheimer's disease (AD). In this study, the levels of IL-1β, TGF-β and CRP, which are involved in the inflammatory response in Alzheimer's disease and its mild cognitive impairment (MCI), were measured and analyzed.

METHODS

Seventy nine subjects participated in this study (mean age: 75.56 years, female: 54.3%, AD: 26, MCI: 28, normal: 25). The overall cognitive function of the subjects and the severity of the disease stage were assessed using the Mini-Mental State Examination (MMSE-K), the Clinical Dementia Rating (CDR), the Global Deterioration Scale (GDS) and the Geriatric Depression Scale-Korean (GDS-K).

RESULTS

It was observed that patients with AD had significantly higher levels of IL-1β and TGF-β than the patients with MCI and normal controls. In addition, the MCI group showed a statistically significantly higher TGF-β concentration than the normal group.

CONCLUSION

These results suggest that IL-1β and TGF-β may be useful biological markers for patients with Alzheimer's disease.

Electrical stimulation of the fornix for the treatment of brain diseases

Deep brain stimulation (DBS) has proven to be safe and effective for both hypo- and hyperkinetic movement disorders of basal ganglia origin, while its application to other neural pathways such as the circuit of Papez is under investigation. In particular, the fornix has gained interest as potential DBS target to decrease rates of cognitive decline, enhance memory, aid visuospatial memorization, and improve verbal recollection. While the exact mechanisms of action of fornix DBS are not completely understood, studies found enhanced hippocampal acetylcholine release, synaptic plasticity, and decreased inflammatory responses in cortex and hippocampus. Nevertheless, it is still premature to conclude that fornix DBS can be used in the treatment of cognitive disorders, and the field needs sound, preclinically tested, and disease-specific a posteriori hypotheses.

Circadian Rhythm Disruption and Alzheimer's Disease: The Dynamics of a Vicious Cycle

All mammalian cells exhibit circadian rhythm in cellular metabolism and energetics. Autonomous cellular clocks are modulated by various pathways that are essential for robust time keeping. In addition to the canonical transcriptional translational feedback loop, several new pathways of circadian timekeeping - non-transcriptional oscillations, post-translational modifications, epigenetics and cellular signaling in the circadian clock - have been identified. The physiology of circadian rhythm is expansive, and its link to the neurodegeneration is multifactorial. Circadian rhythm disruption is prevelant in contamporary society where light-noise, shift-work, and transmeridian travel are commonplace, and is also reported from the early stages of Alzheimer's disease (AD). Circadian alignment by bright light therapy in conjunction with chronobiotics is beneficial for treating sundowning syndrome and other cognitive symptoms in advanced AD patients. We performed a comprehensive analysis of the clinical and translational reports to review the physiology of the circadian clock, delineate its dysfunction in AD, and unravel the dynamics of the vicious cycle between two pathologies. The review delineates the role of putative targets like clock proteins PER, CLOCK, BMAL1, ROR, and clock-controlled proteins like AVP, SIRT1, FOXO, and PK2 towards future approaches for management of AD. Furthermore, the role of circadian rhythm disruption in aging is delineated.

Transcriptomic Heterogeneity of Alzheimer's Disease Associated with Lipid Genetic Risk

Alzheimer's disease (AD) is a multifactorial disease that affects more than 5 million Americans. Multiple pathways might be involved in the AD pathogenesis. The implication of lipid genetic susceptibility on brain gene expression is yet to be investigated. The current study included 192 brain samples from AD patients who were enrolled in the ROSMAP study. The samples were genotyped and imputed to the HRC Reference Panel. Lipid polygenetic risk score was constructed from the weighted sum of genetic variants associated with low-density lipoprotein cholesterol (LDL-C). The gene expression was profiled by RNA sequencing, and the  association of gene expression with lipid polygenetic risk scores was tested by linear regression models adjusted for age, sex and APOE e4 alleles. Three genes were found to associate with lipid polygenetic risk scores, including HMCN2 (P = 3.6 × 10-7), PDLIM5 (P = 1.2 × 10-6), and FHL5 (P = 2.0 × 10-6). Network analysis revealed multiple related pathways, including dopaminergic synapse (P = 4.5 × 10-5), circadian entrainment (P = 1.1 × 10-4), and cholinergic synapse (P = 2.3 × 10-4). Our study underscores the importance of lipid regulation and metabolism to AD heterogeneity.

Interaction of amyloid beta with humanin and acetylcholinesterase is modulated by ATP

Humanin (HN) is known to bind amyloid beta (Aβ)‐inducing cytoprotective effects, while binding of acetylcholinesterase (AChE) to Aβ increases its aggregation and cytotoxicity. Previously, we showed that binding of HN to Aβ blocks aggregation induced by AChE and that HN decreases but does not abolish Aβ‐AChE interactions in A549 cell media. Here, we set out to shed light on factors that modulate the interactions of Aβ with HN and AChE. We found that binding of either HN or AChE to Aβ is not affected by heparan sulfate, while ATP, thought to reduce misfolding of Aβ, weakened interactions between AChE and Aβ but strengthened those between Aβ and HN. Using media from either A549 or H1299 lung cancer cells, we observed that more HN was bound to Aβ upon addition of ATP, while levels of AChE in a complex with Aβ were decreased by ATP addition to A549 cell media. Exogenous addition of ATP to either A549 or H1299 cell media increased interactions of endogenous HN with Aβ to a comparable extent despite differences in AChE expression in the two cell lines, and this was correlated with decreased binding of exogenously added HN to Aβ. Treatment with exogenous ATP had no effect on cell viability under all conditions examined. Exogenously added ATP did not affect viability of cells treated with AChE‐immunodepleted media, and there was no apparent protection against the cytotoxicity resulting from immunodepletion of HN. Moreover, exogenously added ATP had no effect on the relative abundance of oligomer versus total Aβ in either cell line.

Potent Acetylcholinesterase Inhibitors: Potential Drugs for Alzheimer's Disease

Alzheimer's disease (AD) is one of the cognitive or memory-related impairments occurring with advancing age. Since its exact mechanism is not known, the full therapy has still not been found. Acetylcholinesterase (AChE) has been reported to be a viable therapeutic target for the treatment of AD and other dementias. To this end, acetylcholinesterase inhibitors (AChEIs) are commonly used. AChE is a member of the hydrolase enzyme family. A hydrolase is an enzyme that catalyzes the hydrolysis of a chemical bond. AChE is useful for the development of novel and mechanism-based inhibitors. It has a role in the breakdown of acetylcholine (ACh) neurotransmitters, such as acetylcholinemediated neurotransmission. AChEIs are the most effective approaches to treat AD. AChE hydrolyzes ACh to acetate and choline, as an important neurotransmitter substance. Recently, Gülçin and his group explored new AChEIs. The most suggested mechanism for AD is the deficiency of ACh, which is an important neurotransmitter. In this regard, AChEIs are commonly used for the symptomatic treatment of AD. They act in different ways, such as by inhibiting AChE, protecting cells from free radical toxicity and β-amyloid-induced injury or inhibiting the release of cytokines from microglia and monocytes. This review focuses on the role of AChEIs in AD using commonly available drugs. Also, the aim of this review is to research and discuss the role of AChEIs in AD using commonly available drugs. Therefore, in our review, related topics like AD and AChEIs are highlighted. Also, the latest work related to AChEIs is compiled. In recent research studies, novel natural and synthetic AChEIs, used for AD, are quite noteworthy. These studies can be very promising in detecting potent drugs against AD.

What do family caregivers of people with dementia need? A mixed-method systematic review

Caring for people with dementia is a major challenge for relatives and society worldwide. Understanding the family caregivers' needs is crucial to promote their care-giving role during the disease trajectory. The aim of this mixed-method systematic review was to identify and synthetise the existing literature on the needs of family caregivers of people with dementia at home. PubMed, CINAHL, Cochrane Database of Systematic Reviews and PsycINFO databases were systematically explored to find quantitative, qualitative and mixed-method studies published between 2009 and 2019. A total of 1,196 citations were retrieved and 34 studies were included in the review. The variety of interrelated needs emerged from studies has been summarised in four themes: (a) Being supported, (b) Receiving accessible and personalised information, (c) Being trained and educated to care for their beloved with dementia and (d) Finding a balance. Care-giving for individuals with dementia is an ever-changing process characterised by continuous adjustments to their needs. The majority of a family caregivers' needs are oriented towards receiving support, help in offering daily care and finding a balance between the care-giving role and their own personal needs. For family caregivers, receiving information is a priority to improve their knowledge and to develop coping abilities, care skills and strategies aimed at promoting a balance between care assistance duties and their own needs. They also need social, psychological and emotional support and access to flexible, tailored and timely formal care. Further studies are recommended to detect changes in family caregivers' needs throughout the disease progression in order to tailor formal care offered by social and healthcare services.

Higher Resource Utilization and Costs in Long-Term Nursing Home Residents With Overactive Bladder: A Retrospective Study of Medicare Beneficiaries

OBJECTIVES

To determine the all-cause health care resource utilization and costs among long-term nursing home (LTNH) residents with and without overactive bladder (OAB).

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

Minimum Data Set (MDS)-linked Medicare Part A, B, and D claims data from 2013 to 2015 were analyzed. LTNH residents aged 65 years or older with a diagnosis of OAB (n = 216,731) were propensity score matched with LTNH residents without OAB (n = 300,327) (non-OAB cohort).

METHODS

We measured health care resource utilization and costs associated with OAB by setting (inpatient, outpatient, emergency department, or prescription) during the 6 months following nursing home admission. Descriptive and multivariate (negative binomial for health care resource utilization and 2-part model for costs) analyses were performed to examine the health care resource utilization and costs among LTNH residents with and without OAB. The annual cost attributed to OAB was calculated as the difference between total annual OAB costs and total annual non-OAB costs.

RESULTS

A total of 214,505 patients were included in each matched cohort. Across all health care resource categories, LTNH residents with OAB had higher health care resource utilization and costs compared to the non-OAB cohort (all P < .001). The mean annual direct total cost was $57,984 in the OAB cohort compared with $54,285 in the non-OAB cohort. The annual cost of OAB in nursing homes was estimated at $793 million. Adjusted analyses revealed that the OAB cohort was 9% more likely to have hospitalization and emergency department visits, 15% more likely to have outpatient visits, 27% more likely to have physician visits, and 12% more likely to have prescription counts compared with the non-OAB cohort.

CONCLUSIONS AND IMPLICATIONS

The study findings suggest that LTNH residents with OAB have significantly more health care resource utilization compared with patients without OAB. These results provide health care decision makers with recent estimates of the burden of OAB in LTNH to assist them with resource planning.

EGCG treats ICH via up-regulating miR-137-3p and inhibiting Parthanatos

Intracranial hemorrhage (ICH) causes high mortality and disability without effective treatment in the clinical setting. (-)-Epigallocatechin-3-gallate (EGCG) exerts an essential role in the central nervous system and offers a promising therapeutic agent for the treatment of oxidative damage-related diseases. MiR-137 can inhibit the oxidative stress and apoptosis to attenuate neuronal injury. However, the role of EGCG in regulating miR-137-3p and neuronal Parthanatos remains to be unclear. In the present study, we build the ICH mice model to investigate the antioxidant effects of EGCG via upregulating miR-137-3p and inhibiting neuronal Parthanatos. We revealed that EGCG upregulated miR-137-3p and inhibited neuronal Parthanatos, and promoted the functional recovery, alleviated ICH-induced brain injury, and reduced oxidative stress in mice following ICH. However, following the inhibition of miR-137-3p and activation of Parthanatos, EGCG was unable to exert neuroprotective roles. These combined results suggest that EGCG may upregulate miR-137-3p and inhibit neuronal Parthanatos to accelerate functional recovery in mice after ICH, laying the foundation for EGCG to be a novel strategy for the treatment of neuronal injuries related to Parthanatos.

Free-Text Documentation of Dementia Symptoms in Home Healthcare: A Natural Language Processing Study

Background

Little is known about symptom documentation related to Alzheimer's disease and related dementias (ADRD) by home healthcare (HHC) clinicians.

Objective

This study: (1) developed a natural language processing (NLP) algorithm that identifies common neuropsychiatric symptoms of ADRD in HHC free-text clinical notes; (2) described symptom clusters and hospitalization or emergency department (ED) visit rates for patients with and without these symptoms.

Method

We examined a corpus of -2.6 million free-text notes for 112,237 HHC episodes among 89,459 patients admitted to a non-profit HHC agency for post-acute care with any diagnosis. We used NLP software (NimbleMiner) to construct indicators of six neuropsychiatric symptoms. Structured HHC assessment data were used to identify known ADRD diagnoses and construct measures of hospitalization/ED use during HHC.

Results

Neuropsychiatric symptoms were documented for 40% of episodes. Common clusters included impaired memory, anxiety and/or depressed mood. One in three episodes without an ADRD diagnosis had documented symptoms. Hospitalization/ED rates increased with one or more symptoms present.

Conclusion

HHC providers should examine episodes with neuropsychiatric symptoms but no ADRD diagnoses to determine whether ADRD diagnosis was missed or to recommend ADRD evaluation. NLP-generated symptom indicators can help to identify high-risk patients for targeted interventions.

Food intake is associated with verbal interactions between nursing home staff and residents with dementia: A secondary analysis of videotaped observations

BACKGROUND

Nursing home residents with dementia commonly experience low food intake, leading to negative functional and nutritional consequences. While the importance of staff-resident (dyadic) interactions during mealtime is acknowledged, little research has examined the role of dyadic verbal interactions on food intake.

OBJECTIVES

This study aimed to examine the relationship between food intake and dyadic verbal interactions.

METHODS

This study was a secondary analysis of 110 videotaped observations of mealtime care interactions among 25 residents with dementia and 29 staff (42 unique dyads) in 9 nursing homes. Staff positive utterances and resident positive and negative utterances (independent variables) and food intake (dependent variable) were coded from the videotaped observations using the Cue Utilization and Engagement in Dementia video coding scheme. A linear mixed model was fit to the data. The two-way interaction effects of food type and video duration with each independent variable as well as two-way interaction effects among the independent variables were tested. Covariates included in the model were the number of years staff worked as a caregiver, and resident age, gender, and eating function.

RESULTS

The model included three significant interaction effects involving verbal variables: the interaction effect of staff positive utterances with resident positive utterances (p=.030), the interaction effect of staff positive utterances with food type (p=.027), and the interaction effect of resident negative utterances with video duration (p=0.002). Increased number of intakes of liquid food per minute was associated with increased number of staff positive utterances per minute when residents did not make positive utterances. Decreased number of intakes of solid food per minute was associated with increased number of staff positive utterances per minute, especially when residents made between 0 and 3 positive utterances per minute. As the duration of the videos increased, the number of intakes per minute increased for residents who made one or more negative utterances and decreased for residents who made no negative utterances in the videos. The number of intakes per minute was associated with resident gender in that male residents had increased number of intakes per minute compared with female residents (p=.017), and was not associated with other participant characteristics.

CONCLUSION

Intake was associated with dyadic verbal interactions, and such relationship was complex in that it was moderated by food type and video duration. Findings support the significant role of dyadic verbal interactions on intake, and inform the development of effective, tailored mealtime care interventions to promote intake.

Editan (Lasianthera africana) leaf-inclusive diets modulate some neuronal enzyme activities and antioxidant status of cyclophosphamide-treated Wistar rats

The effect of Editan (Lasianthera africana) leaf inclusive diet (ELD) on neuronal cholinesterases (ChE), ecto-5'-nucleotidase, and endogenous antioxidant indices [superoxide dismutase (SOD), catalase (CAT), glutathione (GSH)] in cyclophosphamide (CYP)-administered albino rats were investigated. Thirty male albino Wistar rats were dissevered appropriately (n = 6). Group I-normal control rats (NC), II-untreated CYP-administered rats, III-CYP-administered rats pre-treated with donepezil (DON), group IV-CYP-administered rats fed ELD, and V-normal rats fed with ELD for 21 days. Results obtained revealed that CYP-administered rats significantly (p < .05) had elevated activities of ChE, ecto-5'-nucleotidase and thiobarbituric acid reactive species (TBARS), and concomitantly decreased in the antioxidant indices. However, pre-treatment with either DON or ELD reversed these effects, thereby eliciting a therapeutic effect which could be linked to the rich polyphenol and alkaloid constituents in the studied leaf, and could be responsible for the potential ethnopharmacological actions of the ELD in the management neurodegeneration. PRACTICAL APPLICATIONS: Currently, the use of plant-food to control diseased conditions due to their phytochemicals has been explored, most especially, the indigenous edible vegetables from the Southwestern part of Nigeria. "Editan" leafy vegetable scientifically known as Lasianthera africana is commonly used in soups preparation and in folklore for the management of some human ailments. Editan leaf is a rich source of alkaloid and phenolic compounds, which could be used to treat and or manage neurological diseases. This study, therefore, unravels the fact that the studied leafy vegetable possesses therapeutic potentials toward the management of neurological disorders.

Topological Network Analysis of Early Alzheimer's Disease Based on Resting-State EEG

Previous studies made progress in the early diagnosis of Alzheimer's disease (AD) using electroencephalography (EEG) without considering EEG connectivity. To fill this gap, we explored significant differences between early AD patients and controls based on frequency domain and spatial properties using functional connectivity in mild cognitive impairment (MCI) and mild AD datasets. Four global metrics, network resilience, connection-level metrics and node versatility were used to distinguish between controls and patients. The results show that the main frequency bands that are different between MCI patients and controls are the θ and low α bands, and the differently affected brain areas are the frontal, left temporal and parietal areas. Compared to MCI patients, in patients with mild AD, the main frequency bands that are different are the low and high α bands, and the main differently affected brain region is a larger right temporal area. Four LOFC bands were used as input to train the ResNet-18 model. For the MCI dataset, the average accuracy of 20 runs was 93.42% and the best accuracy was 98.33%, while for the mild AD dataset, the average accuracy was 98.54% and the best accuracy was 100%. To determine the timing of early treatment and discovering the susceptible patients, and to slow the progression of the disease, we assume that the occurrence of MCI and mild AD and their progression to more serious AD and dementia could be inferred by analyzing the topological structure of the brain network generated by EEG. Our findings provide a novel solution for connectome-based biomarker analysis to improve personalized medicine.

Gene expression of serotonergic markers in peripheral blood mononuclear cells of patients with late-onset Alzheimer's disease

Serotonin or 5-hydroxytryptamine (5-HT) is primarily involved in the regulation of learning and memory. Pathological changes in metabolism or functional imbalance of 5-HT has been associated with Alzheimer's disease (AD). The hypothesis tested is that in peripheral blood, markers of the serotonergic pathway can be used as a diagnostic tool for AD. The current study measured the relative expression of 5-HT receptors (5-HTR2A and 5-HTR3A) as well as the 5-HT catalytic enzyme, Monoamine oxidase A (MAO-A) mRNA in Peripheral Blood Mononuclear Cells (PBMCs) of patients with late-onset Alzheimer's disease (LOAD) and age-matched controls. 5-HTR2A, 5-HTR3A, and MAO-A mRNA expressions were examined in PBMCs of 30 patients with LOAD and 30 control individuals. Real-time quantitative PCR was used to measure mRNA expression. The dementia status of patients in this study was assessed using a Mini-Mental State Examination (MMSE). Mean data of relative mRNA expression of 5-HTR2A, 5-HTR3A and MAO-A were significantly lower in PBMCs of patients with LOAD compared with controls. Based on the down-regulation of serotonergic markers in PBMCs, our findings may be another claim to the systemic nature of LOAD. The role of peripheral serotonergic downregulation, in the pathogenesis of AD, needs to be further studied. Given the extremely convenient access to PBMCs, these molecular events may represent more complete dimensions of AD neuropathophysiology or possibly lead to a new direction in studies focused on blood-based markers.

Association of genetic variants of ABCA1 with susceptibility to dementia: (SADEM study)

Because of the importance of cholesterol metabolism in the physiopathogenesis of dementia, and knowing the function of ATP-binding cassette A1 transporter (ABCA1) as a cholesterol flow pump at the cellular and cerebral level, it has been noted that the ABCA1 gene may be a good candidate for disease study. In order to evaluate the relationship between ABCA1 genetic variants and the risk of Alzheimer's disease and other dementia in Mexican individuals, we examined three ABCA1 polymorphisms located in the exonic region (rs2230808, rs2066718, rs2230806) and two in the promoter region (rs1800977, rs2422493) in a group of 557 normal controls and 221 cases of dementia. It was possible to distinguish one protective haplotype: CCCCGC (OR = 0,502, 95% CI = 0,370-0,681, p < 0.001), and one risk haplotype TCCCAT (OR = 2208, 95% CI = 1609-3031, p < 0.000) for the development of dementia. The results suggest that ABCA1 plays an important role in the pathophysiological mechanisms for the development of dementia.

Association between dementia and psychiatric disorders in long-term care residents: An observational clinical study

We examine the relationship between dementia and psychiatric disorder diagnoses among long-term care residents in nursing homes across the state of Rhode Island (RI), USA.Observational clinical study.Two hundred fifty-five residents with and without the diagnosis of dementia were included in this study.Prevalence analysis was used to elucidate information on psychiatric disorders in the overall cohort, and among residents with dementia. Questions from the quality of life questionnaire (EQ-5D-3L) that provides information on self-care, anxiety/depression, and resident's view of how healthy they are, were used to evaluate their association with dementia and psychiatric disorders. A logistic regression analysis was conducted to understand the relationship between dementia and mental illness diagnoses in long-term care facilities. Finally, a subgroup logistic regression analysis was performed for residents with Alzheimer disease.65.1% of all residents suffered from at least 1 psychiatric disorder. Anxiety was the most common diagnosis (36.5%), followed by depression (28.6%), and insomnia (14.9%). There was a positive and statistically significant association between any mental illness diagnosis and dementia (adjusted OR: 3.73; 95% CI: 1.34-10.41). Bipolar disorder and insomnia were negatively and statistically significantly associated with dementia (adjusted OR: 0.17; 95% CI: 0.03-0.89 AND adjusted OR: 0.39; 95% CI: 0.16-0.96 respectively). Age and COPD were also statistically associated with dementia (adjusted OR: 1.07; 95% CI: 1.03-1.11 AND adjusted OR: 0.28, 95% CI: 0.12-0.66). Alzheimer disease was positively and significantly associated with the diagnosis of any mental illness (adjusted OR: 3.77; 95% CI: 1.17-12.20).We studied the relationship between dementia and diagnoses of psychiatric disorders present in long-term care residents. We found that residents with a diagnosis of dementia were more likely to suffer from at least 1 psychiatric disorder. Further work is needed to establish the neuropathophysiological relationship between psychiatric disorders and dementia.

On the Etiopathogenesis and Pathophysiology of Alzheimer's Disease: A Comprehensive Theoretical Review

Alzheimers' disease (AD) is the most common cause of dementia, with an estimated 5 million new cases occurring annually. Among the elderly, AD shortens life expectancy, results in disability, decreases quality of life, and ultimately, leads to institutionalization. Despite extensive research in the last few decades, its heterogeneous pathophysiology and etiopathogenesis have made it difficult to develop an effective treatment and prevention strategy. Aging is the biggest risk factor for AD and evidence suggest that the total number of older people in the population is going to increase astronomically in the next decades. Also, there is evidence that air pollution and increasing income inequality may result in higher incidence and prevalence of AD. This makes the need for a comprehensive understanding of the etiopathogenesis and pathophysiology of the disease extremely critical. In this paper, a quintuple framework of thyroid dysfunction, vitamin D deficiency, sex hormones, and mitochondria dysfunction and oxidative stress are used to provide a comprehensive description of AD etiopathogenesis and pathophysiology. The individual role of each factor, their synergistic and genetic interactions, as well as the limitations of the framework are discussed.

Scopoletin: Antiamyloidogenic, Anticholinesterase, and Neuroprotective Potential of a Natural Compound Present in Argyreia speciosa Roots by In Vitro and In Silico Study

Alzheimer's disease (AD) is characterized by depositions of amyloid β (Aβ) peptides aggregates resulting in plaques formation in the central nervous system (CNS). This study evaluates the disease-modifying potential of scopoletin against multiple factors associated with AD such as cholinesterase enzymes, Aβ peptides, and neuroprotective properties against Aβ- and H2O2-induced cytotoxicity under in vitro conditions. Scopoletin was identified and quantified using UPLC-QTOF (ultra-high performance liquid chromatography-quadrupole time-of-flight) and high-performance liquid chromatography (HPLC), respectively. The antiamyloidogenic potential was evaluated by thioflavin T and congo red binding assay. Inhibition of key enzymes, that is, acetylcholinesterase and butyrylcholinesterase, was investigated by Ellman's assay. UPLC-QTOF analysis showed that most abundant phytoconstituent present in Argyreia speciosa hydroalcoholic root extract was scopoletin followed by festuclavine and ergometrine. Scopoletin was further quantified using novel reverse phase (RP)-HPLC method developed in this study. The neuroprotective potential of scopoletin was found to be 69% against Aβ42-induced neurotoxicity and 73% against H2O2-induced cytotoxicity in PC12 cell culture at 40 μM final concentration. At the same concentration, scopoletin inhibited Aβ42 fibril formation up to 57%. The IC50 concentration for AChE and BuChE enzyme inhibition by scopoletin was 5.34 and 9.11 μM, respectively. The antiaggregation and enzyme inhibition results were complemented with strong molecular interactions of scopoletin with target proteins validated by in silico molecular docking analysis. Based on this study, it can be concluded that scopoletin can be used as a lead for amelioration of symptoms and disease-modifying effects in AD.

Identifying diagnosis-specific genotype-phenotype associations via joint multitask sparse canonical correlation analysis and classification

MOTIVATION

Brain imaging genetics studies the complex associations between genotypic data such as single nucleotide polymorphisms (SNPs) and imaging quantitative traits (QTs). The neurodegenerative disorders usually exhibit the diversity and heterogeneity, originating from which different diagnostic groups might carry distinct imaging QTs, SNPs and their interactions. Sparse canonical correlation analysis (SCCA) is widely used to identify bi-multivariate genotype-phenotype associations. However, most existing SCCA methods are unsupervised, leading to an inability to identify diagnosis-specific genotype-phenotype associations.

RESULTS

In this article, we propose a new joint multitask learning method, named MT-SCCALR, which absorbs the merits of both SCCA and logistic regression. MT-SCCALR learns genotype-phenotype associations of multiple tasks jointly, with each task focusing on identifying one diagnosis-specific genotype-phenotype pattern. Meanwhile, MT-SCCALR cannot only select relevant SNPs and imaging QTs for each diagnostic group alone, but also allows the selection of those shared by multiple diagnostic groups. We derive an efficient optimization algorithm whose convergence to a local optimum is guaranteed. Compared with two state-of-the-art methods, MT-SCCALR yields better or similar canonical correlation coefficients and classification performances. In addition, it owns much better discriminative canonical weight patterns of great interest than competitors. This demonstrates the power and capability of MTSCCAR in identifying diagnostically heterogeneous genotype-phenotype patterns, which would be helpful to understand the pathophysiology of brain disorders.

AVAILABILITY AND IMPLEMENTATION

The software is publicly available at https://github.com/dulei323/MTSCCALR.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Predicting Alzheimer Disease From Mild Cognitive Impairment With a Deep Belief Network Based on 18F-FDG-PET Images

Objective:

Accurate diagnosis of early Alzheimer disease (AD) plays a critical role in preventing the progression of memory impairment. We aimed to develop a new deep belief network (DBN) framework using 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) metabolic imaging to identify patients at the mild cognitive impairment (MCI) stage with presymptomatic AD and to discriminate them from other patients with MCI.

Methods:

18F-fluorodeoxyglucose-PET images of 109 patients recruited in the ongoing longitudinal Alzheimer’s Disease Neuroimaging Initiative study were included in this analysis. Patients were grouped into 2 classes: (1) stable mild cognitive impairment (n = 62) or (2) progressive mild cognitive impairment (n = 47). Our framework is composed of 4 steps: (1) image preprocessing: normalization and smoothing; (2) identification of regions of interest (ROIs); (3) feature learning using deep neural networks; and (4) classification by support vector machine with 3 kernels. All classification experiments were performed with a 5-fold cross-validation. Accuracy, sensitivity, and specificity were used to validate the results.

Result:

A total of 1103 ROIs were obtained. One hundred features were learned from ROIs using the DBN. The classification accuracy using linear, polynomial, and RBF kernels was 83.9%, 79.2%, and 86.6%, respectively. This method may be a powerful tool for personalized precision medicine in the population with prediction of early AD progression.

Neuropathological Findings of Dementia Associated With Subjective Hearing Loss

OBJECTIVE

The relationship between hearing loss and cognitive decline is of great importance with growing evidence of hearing loss as an independent modifiable risk factor for dementia. Our goal was to evaluate for differences in dementia neuropathology between subjective normal hearing and hearing loss subjects, as well as subjects who wore hearing aids.

STUDY DESIGN

Retrospective database.

SETTING

Tertiary academic center.

PATIENTS

Brain tissue analyzed from our Center on Aging. Demographics, subjective hearing status, hearing aid use, cognitive status, and dementia neuropathology documented.

INTERVENTIONS

Dementia neuropathology analyzed in brains of normal hearing and hearing loss subjects.

MAIN OUTCOME MEASURES

Differences in dementia neuropathology between hearing groups. Groups were compared using logistic regression and analysis of covariance (ANCOVA).

RESULTS

Two-hundred and seventy-three subjects were included, 189 normal hearing and 84 subjective hearing loss subjects. No significant difference demonstrated in Alzheimer's disease neuropathology (p > 0.05) or pathologic stage (p = 0.2471). No significant difference observed in neuropathology of other major dementia types, specifically, presence of Lewy bodies (p > 0.05), Lewy body disease pathologic stage (p = 0.9778), or presence of micro-infarcts, macro-infarcts, or arteriosclerosis (p > 0.05). Hearing aid-wearing subjects had a lower prevalence of clinical dementia (39.1% versus 57.9%; p = 0.0208) with no significant difference in dementia neuropathology (p > 0.05).

CONCLUSION

Subjective hearing loss was not found to be associated with significantly different dementia neuropathology, which counters hypotheses on hearing loss causing permanent neurodegeneration and cognitive decline. Hearing aid users were found to have a lower prevalence of dementia for similar levels of neurodegeneration, suggesting a potential neuroprotective effect of hearing aids.