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de Havenon A, Gottesman RF, Willamson JD, Rost N, Sharma R, Li V, Littig L, Stulberg E, Falcone GJ, Prabhakaran S, Schneider ALC, Sheth KN, Pajewski NM, Brickman AM. White matter hyperintensity on MRI and plasma Aβ42/40 ratio additively increase the risk of cognitive impairment in hypertensive adults. Alzheimers Dement 2024. [PMID: 39229896 DOI: 10.1002/alz.14126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/04/2024] [Accepted: 06/18/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Dementia often involves comorbid Alzheimer's and vascular pathology, but their combined impact warrants additional study. METHODS We analyzed the Systolic Blood Pressure Intervention Trial and categorized white matter hyperintensity (WMH) volume into highest versus lowest/mid tertile and the amyloid beta (Aβ)42/40 ratio into lowest versus mid/highest ratio tertile. Using these binary variables, we created four exposure categories: (1) combined low risk, (2) Aβ risk, (3) WMH risk, and (4) combined high risk. RESULTS In the cohort of 467 participants (mean age 69.7 ± 7.1, 41.8% female, 31.9% nonwhite or Hispanic) during 4.8 years of follow-up and across the four exposure categories the rates of cognitive impairment were 5.3%, 7.8%, 11.8%, and 22.6%. Compared to the combined low-risk category, the adjusted hazard ratio for cognitive impairment was 4.12 (95% confidence interval, 1.71 to 9.94) in the combined high-risk category. DISCUSSION This study emphasizes the potential impact of therapeutic approaches to dementia prevention that target both vascular and amyloid pathology. HIGHLIGHTS White matter hyperintensity (WMH) and plasma amyloid (Aβ42/40) are additive risk factors for the development of cognitive impairment in the SPRINT MIND trial. Individuals in the high-risk categories of both WMH and Aβ42/40 had a near fivefold increase in risk of cognitive impairment during 4.8 years of follow-up on average. These findings suggest that treatment strategies targeting both vascular health and amyloid burden warrant further research.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Jeff D Willamson
- Department of Internal Medicine, Wake Forrest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richa Sharma
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Vivian Li
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lauren Littig
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eric Stulberg
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Guido J Falcone
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Andrea L C Schneider
- Department of Neurology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kevin N Sheth
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forrest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and the Department of Neurology, Columbia University, New York, New York, USA
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Shirzadi Z, Boyle R, Yau WYW, Coughlan G, Fu JF, Properzi MJ, Buckley RF, Yang HS, Scanlon CE, Hsieh S, Amariglio RE, Papp K, Rentz D, Price JC, Johnson KA, Sperling RA, Chhatwal JP, Schultz AP. Vascular contributions to cognitive decline: Beyond amyloid and tau in the Harvard Aging Brain Study. J Cereb Blood Flow Metab 2024; 44:1319-1328. [PMID: 38452039 PMCID: PMC11342726 DOI: 10.1177/0271678x241237624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 03/09/2024]
Abstract
In addition to amyloid and tau pathology, elevated systemic vascular risk, white matter injury, and reduced cerebral blood flow contribute to late-life cognitive decline. Given the strong collinearity among these parameters, we proposed a framework to extract the independent latent features underlying cognitive decline using the Harvard Aging Brain Study (N = 166 cognitively unimpaired older adults at baseline). We used the following measures from the baseline visit: cortical amyloid, inferior temporal cortex tau, relative cerebral blood flow, white matter hyperintensities, peak width of skeletonized mean diffusivity, and Framingham Heart Study cardiovascular disease risk. We used exploratory factor analysis to extract orthogonal factors from these variables and their interactions. These factors were used in a regression model to explain longitudinal Preclinical Alzheimer Cognitive Composite-5 (PACC) decline (follow-up = 8.5 ±2.7 years). We next examined whether gray matter volume atrophy acts as a mediator of factors and PACC decline. Latent factors of systemic vascular risk, white matter injury, and relative cerebral blood flow independently explain cognitive decline beyond amyloid and tau. Gray matter volume atrophy mediates these associations with the strongest effect on white matter injury. These results suggest that systemic vascular risk contributes to cognitive decline beyond current markers of cerebrovascular injury, amyloid, and tau.
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Affiliation(s)
- Zahra Shirzadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rory Boyle
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Wai-Ying W Yau
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gillian Coughlan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessie Fanglu Fu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J Properzi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel F Buckley
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hyun-Sik Yang
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Catherine E Scanlon
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephanie Hsieh
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca E Amariglio
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathryn Papp
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Dorene Rentz
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie C Price
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jasmeer P Chhatwal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron P Schultz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Raichlen DA, Ally M, Aslan DH, Sayre MK, Bharadwaj PK, Maltagliati S, Lai MHC, Wilcox RR, Habeck CG, Klimentidis YC, Alexander GE. Associations between accelerometer-derived sedentary behavior and physical activity with white matter hyperintensities in middle-aged to older adults. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e70001. [PMID: 39183745 PMCID: PMC11342350 DOI: 10.1002/dad2.70001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION We examined the relationship between sedentary behavior (SB), moderate-to-vigorous physical activity (MVPA), and white matter hyperintensity (WMH) volumes, a common magnetic resonance imaging (MRI) marker associated with risk of neurodegenerative disease in middle-aged to older adults. METHODS We used data from the UK Biobank (n = 14,415; 45 to 81 years) that included accelerometer-derived measures of SB and MVPA, and WMH volumes from MRI. RESULTS Both MVPA and SB were associated with WMH volumes (βMVPA = -0.03 [-0.04, -0.01], p < 0.001; βSB = 0.02 [0.01, 0.03], p = 0.007). There was a significant interaction between SB and MVPA on WMH volumes (βSB×MVPA = -0.015 [-0.028, -0.001], p SB×MVPA = 0.03) where SB was positively associated with WMHs at low MVPA, and MVPA was negatively associated with WMHs at high SB. DISCUSSION While this study cannot establish causality, the results highlight the potential importance of considering both MVPA and SB in strategies aimed at reducing the accumulation of WMH volumes in middle-aged to older adults. Highlights SB is associated with greater WMH volumes and MVPA is associated with lower WMH volumes.Relationships between SB and WMH are strongest at low levels of MVPA.Associations between MVPA and WMH are strongest at high levels of SB.Considering both SB and MVPA may be effective strategies for reducing WMHs.
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Affiliation(s)
- David A. Raichlen
- Human and Evolutionary Biology SectionDepartment of Biological SciencesUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of AnthropologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Madeline Ally
- Department of PsychologyUniversity of ArizonaTucsonArizonaUSA
| | - Daniel H. Aslan
- Human and Evolutionary Biology SectionDepartment of Biological SciencesUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | | | - Silvio Maltagliati
- Human and Evolutionary Biology SectionDepartment of Biological SciencesUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mark H. C. Lai
- Department of PsychologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Rand R. Wilcox
- Department of PsychologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Christian G. Habeck
- Cognitive Neuroscience DivisionDepartment of Neurology and Taub InstituteColumbia UniversityNew YorkNew YorkUSA
| | - Yann C. Klimentidis
- Department of Epidemiology and BiostatisticsMel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
- BIO5 InstituteUniversity of ArizonaTucsonArizonaUSA
| | - Gene E. Alexander
- Department of PsychologyUniversity of ArizonaTucsonArizonaUSA
- BIO5 InstituteUniversity of ArizonaTucsonArizonaUSA
- Evelyn F. McKnight Brain InstituteUniversity of ArizonaTucsonArizonaUSA
- Department of PsychiatryUniversity of ArizonaTucsonArizonaUSA
- Neuroscience Graduate Interdisciplinary ProgramUniversity of ArizonaTucsonArizonaUSA
- Physiological Sciences Graduate Interdisciplinary ProgramUniversity of ArizonaTucsonArizonaUSA
- Arizona Alzheimer's ConsortiumPhoenixArizonaUSA
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Costa AS, Albrecht M, Reich A, Nikoubashman O, Schulz JB, Reetz K, Pinho J. Non-hemorrhagic imaging markers of cerebral amyloid angiopathy in memory clinic patients. Alzheimers Dement 2024; 20:4792-4802. [PMID: 38865440 PMCID: PMC11247708 DOI: 10.1002/alz.13920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/21/2024] [Accepted: 03/22/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION The Boston criteria v2.0 for cerebral amyloid angiopathy (CAA) incorporated non-hemorrhagic imaging markers. Their prevalence and significance in patients with cognitive impairment remain uncertain. METHODS We studied 622 memory clinic patients with available magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) biomarkers. Two raters assessed non-hemorrhagic markers, and we explored their association with clinical characteristics through multivariate analyses. RESULTS Most patients had mild cognitive impairment; median age was 71 years and 50% were female. Using the v2.0 criteria, possible or probable CAA increased from 75 to 383 patients. Sixty-eight percent of the sample had non-hemorrhagic CAA markers, which were independently associated with age (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.01-1.07), female sex (OR = 1.68, 95% CI = 1.11-2.54), and hemorrhagic CAA markers (OR = 2.11, 95% CI = 1.02-4.35). DISCUSSION Two-thirds of patients from a memory clinic cohort had non-hemorrhagic CAA markers, increasing the number of patients meeting the v2.0 CAA criteria. Longitudinal approaches should explore the implications of these markers, particularly the hemorrhagic risk in this population. HIGHLIGHTS The updated Boston criteria for cerebral amyloid angiopathy (CAA) now include non-hemorrhagic markers. The prevalence of non-hemorrhagic CAA markers in memory clinic patients is unknown. Two-thirds of patients in our memory clinic presented non-hemorrhagic CAA markers. The presence of these markers was associated with age, female sex, and hemorrhagic CAA markers. The hemorrhagic risk of patients presenting these type of markers remains unclear.
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Affiliation(s)
- Ana Sofia Costa
- Department of NeurologyUniversity Hospital RWTH AachenAachenGermany
- JARA Institute Molecular Neuroscience and Neuroimaging (INM‐11)Juelich Research Center GmbH and RWTH Aachen UniversityAachenGermany
| | - Milena Albrecht
- Department of NeurologyUniversity Hospital RWTH AachenAachenGermany
| | - Arno Reich
- Department of NeurologyUniversity Hospital RWTH AachenAachenGermany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional NeuroradiologyUniversity Hospital RWTH AachenAachenGermany
| | - Jörg B. Schulz
- Department of NeurologyUniversity Hospital RWTH AachenAachenGermany
- JARA Institute Molecular Neuroscience and Neuroimaging (INM‐11)Juelich Research Center GmbH and RWTH Aachen UniversityAachenGermany
| | - Kathrin Reetz
- Department of NeurologyUniversity Hospital RWTH AachenAachenGermany
- JARA Institute Molecular Neuroscience and Neuroimaging (INM‐11)Juelich Research Center GmbH and RWTH Aachen UniversityAachenGermany
| | - João Pinho
- Department of NeurologyUniversity Hospital RWTH AachenAachenGermany
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Mirza S, Wilkinson T, Masellis M. APOE Genotype and White Matter Hyperintensities in Sporadic Alzheimer Disease. JAMA Neurol 2024; 81:662-663. [PMID: 38683620 DOI: 10.1001/jamaneurol.2024.0986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
- Saira Mirza
- L. C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mario Masellis
- L. C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada
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Shirzadi Z, Chhatwal J. APOE Genotype and White Matter Hyperintensities in Sporadic Alzheimer Disease-Reply. JAMA Neurol 2024; 81:663. [PMID: 38683603 DOI: 10.1001/jamaneurol.2024.0983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
- Zahra Shirzadi
- Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jasmeer Chhatwal
- Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Tranfa M, Lorenzini L, Collij LE, Vállez García D, Ingala S, Pontillo G, Pieperhoff L, Maranzano A, Wolz R, Haller S, Blennow K, Frisoni G, Sudre CH, Chételat G, Ewers M, Payoux P, Waldman A, Martinez‐Lage P, Schwarz AJ, Ritchie CW, Wardlaw JM, Gispert JD, Brunetti A, Mutsaerts HJMM, Wink AM, Barkhof F. Alzheimer's Disease and Small Vessel Disease Differentially Affect White Matter Microstructure. Ann Clin Transl Neurol 2024; 11:1541-1556. [PMID: 38757392 PMCID: PMC11187968 DOI: 10.1002/acn3.52071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/09/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE Alzheimer's disease (AD) and cerebral small vessel disease (cSVD), the two most common causes of dementia, are characterized by white matter (WM) alterations diverging from the physiological changes occurring in healthy aging. Diffusion tensor imaging (DTI) is a valuable tool to quantify WM integrity non-invasively and identify the determinants of such alterations. Here, we investigated main effects and interactions of AD pathology, APOE-ε4, cSVD, and cardiovascular risk on spatial patterns of WM alterations in non-demented older adults. METHODS Within the prospective European Prevention of Alzheimer's Dementia study, we selected 606 participants (64.9 ± 7.2 years, 376 females) with baseline cerebrospinal fluid samples of amyloid β1-42 and p-Tau181 and MRI scans, including DTI scans. Longitudinal scans (mean follow-up time = 1.3 ± 0.5 years) were obtained in a subset (n = 223). WM integrity was assessed by extracting fractional anisotropy and mean diffusivity in relevant tracts. To identify the determinants of WM disruption, we performed a multimodel inference to identify the best linear mixed-effects model for each tract. RESULTS AD pathology, APOE-ε4, cSVD burden, and cardiovascular risk were all associated with WM integrity within several tracts. While limbic tracts were mainly impacted by AD pathology and APOE-ε4, commissural, associative, and projection tract integrity was more related to cSVD burden and cardiovascular risk. AD pathology and cSVD did not show any significant interaction effect. INTERPRETATION Our results suggest that AD pathology and cSVD exert independent and spatially different effects on WM microstructure, supporting the role of DTI in disease monitoring and suggesting independent targets for preventive medicine approaches.
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Affiliation(s)
- Mario Tranfa
- Department of Advanced Biomedical SciencesUniversity “Federico II”NaplesItaly
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical CentreVrije UniversiteitAmsterdamThe Netherlands
| | - Luigi Lorenzini
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical CentreVrije UniversiteitAmsterdamThe Netherlands
- Amsterdam Neuroscience, Brain ImagingAmsterdamThe Netherlands
| | - Lyduine E. Collij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical CentreVrije UniversiteitAmsterdamThe Netherlands
- Amsterdam Neuroscience, Brain ImagingAmsterdamThe Netherlands
- Clinical Memory Research Unit, Department of Clinical SciencesLund UniversityMalmöSweden
| | - David Vállez García
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical CentreVrije UniversiteitAmsterdamThe Netherlands
- Amsterdam Neuroscience, Brain ImagingAmsterdamThe Netherlands
| | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical CentreVrije UniversiteitAmsterdamThe Netherlands
- Amsterdam Neuroscience, Brain ImagingAmsterdamThe Netherlands
- Department of RadiologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
- Cerebriu A/SCopenhagenDenmark
| | - Giuseppe Pontillo
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical CentreVrije UniversiteitAmsterdamThe Netherlands
| | - Leonard Pieperhoff
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical CentreVrije UniversiteitAmsterdamThe Netherlands
- Amsterdam Neuroscience, Brain ImagingAmsterdamThe Netherlands
| | - Alessio Maranzano
- Department of Neurology and Laboratory of NeuroscienceIRCCS Istituto Auxologico ItalianoMilanItaly
| | | | - Sven Haller
- CIMC ‐ Centre d'Imagerie Médicale de CornavinGenevaSwitzerland
- Department of Surgical Sciences, RadiologyUppsala UniversityUppsalaSweden
- Department of Radiology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and PhysiologyThe Sahlgrenska Academy at the University of GothenburgGothenburgSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
| | - Giovanni Frisoni
- Laboratory Alzheimer's Neuroimaging & EpidemiologyIRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
- University Hospitals and University of GenevaGenevaSwitzerland
| | - Carole H. Sudre
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and PhysiologyThe Sahlgrenska Academy at the University of GothenburgGothenburgSweden
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC)University College London (UCL)LondonUK
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Gael Chételat
- Normandie Univ, Unicaen, Inserm, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, institut Blood‐and‐Brain @ Caen‐Normandie, CyceronUniversité de NormandieCaenFrance
| | - Michael Ewers
- German Center for Neurodegenerative Diseases (DZNE)MunichGermany
| | - Pierre Payoux
- Department of Nuclear MedicineToulouse University HospitalToulouseFrance
- ToNIC, Toulouse NeuroImaging CenterUniversity of Toulouse, Inserm, UPSToulouseFrance
| | - Adam Waldman
- Centre for Clinical Brain SciencesThe University of EdinburghEdinburghUK
- Department of MedicineImperial College LondonLondonUK
| | - Pablo Martinez‐Lage
- Centro de Investigación y Terapias Avanzadas, Neurología, CITA‐Alzheimer FoundationSan SebastiánSpain
| | - Adam J. Schwarz
- Takeda Pharmaceuticals, Ltd.CambridgeMassachusettsUSA
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | - Craig W. Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Outpatient Department 2, Western General HospitalUniversity of EdinburghEdinburghUK
- Brain Health ScotlandEdinburghUK
| | - Joanna M. Wardlaw
- Centre for Clinical Brain SciencesThe University of EdinburghEdinburghUK
- UK Dementia Research Institute Centre at the University of EdinburghEdinburghUK
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall FoundationBarcelonaSpain
- CIBER Bioingeniería, Biomateriales y Nanomedicina (CIBER‐BBN)MadridSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Universitat Pompeu FabraBarcelonaSpain
| | - Arturo Brunetti
- Department of Advanced Biomedical SciencesUniversity “Federico II”NaplesItaly
| | - Henk J. M. M. Mutsaerts
- Amsterdam Neuroscience, Brain ImagingAmsterdamThe Netherlands
- Ghent Institute for Functional and Metabolic Imaging (GIfMI)Ghent UniversityGhentBelgium
| | - Alle Meije Wink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical CentreVrije UniversiteitAmsterdamThe Netherlands
- Amsterdam Neuroscience, Brain ImagingAmsterdamThe Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical CentreVrije UniversiteitAmsterdamThe Netherlands
- Institute of Neurology and Healthcare EngineeringUniversity College LondonLondonUK
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Silbert LC, Roese NE, Krajbich V, Hurworth J, Lahna D, Schwartz DL, Dodge HH, Woltjer RL. White matter hyperintensities and the surrounding normal appearing white matter are associated with water channel disruption in the oldest old. Alzheimers Dement 2024; 20:3839-3851. [PMID: 38629888 PMCID: PMC11180942 DOI: 10.1002/alz.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/08/2024] [Accepted: 03/08/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Age-related magnetic resonance imaging (MRI) T2 white matter hyperintensities (WMHs) are common and associated with neurological decline. We investigated the histopathological underpinnings of MRI WMH and surrounding normal appearing white matter (NAWM), with a focus on astroglial phenotypes. METHODS Brain samples from 51 oldest old Oregon Alzheimer's Disease Research Center participants who came to autopsy underwent post mortem (PM) 7 tesla MRI with targeted histopathological sampling of WMHs and NAWM. Stained slides were digitized and quantified. Mixed-effects models determined differences in molecular characteristics between WMHs and the NAWM and across NAWM. RESULTS PM MRI-targeted WMHs are characterized by demyelination, microglial activation, and prominent astrocytic alterations, including disrupted aquaporin (AQP) expression. Similar changes occur within the surrounding NAWM in a pattern of decreasing severity with increased distance from WMHs. DISCUSSION Decreased AQP expression within WMH and proximal NAWM suggest an overwhelmed system wherein water homeostasis is no longer maintained, contributing to WM damage in older individuals. HIGHLIGHTS Post mortem magnetic resonance imaging (MRI) was used to characterize the pathology of white matter hyperintensities (WMHs) and surrounding normal appearing white matter (NAWM). Stained immunohistochemical (IHC) slides from targeted WMH and NAWM samples were digitized and quantified. WMHs and NAWM were associated with inflammation, demyelination, and gliosis. WMHs and NAWM astrocytic changes included decreased AQP1 and AQP4 expression. Abnormal NAWM pathology diminished in severity with increasing distance from WMH.
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Affiliation(s)
- Lisa C. Silbert
- National Institute on Aging, Layton Aging & Alzheimer's Disease Research CenterDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Department of NeurologyPortland Veterans Affairs Health Care SystemPortlandOregonUSA
| | - Natalie E. Roese
- National Institute on Aging, Layton Aging & Alzheimer's Disease Research CenterDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - Victoria Krajbich
- Department of PathologyOregon Health & Science UniversityPortlandOregonUSA
| | - Justin Hurworth
- National Institute on Aging, Layton Aging & Alzheimer's Disease Research CenterDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - David Lahna
- National Institute on Aging, Layton Aging & Alzheimer's Disease Research CenterDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - Daniel L. Schwartz
- National Institute on Aging, Layton Aging & Alzheimer's Disease Research CenterDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Advanced Imaging Research CenterOregon Health & Science UniversityPortlandOregonUSA
| | - Hiroko H. Dodge
- Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Randall L. Woltjer
- National Institute on Aging, Layton Aging & Alzheimer's Disease Research CenterDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Department of PathologyOregon Health & Science UniversityPortlandOregonUSA
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9
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Lao P, Edwards N, Flores-Aguilar L, Alshikho M, Rizvi B, Tudorascu D, Rosas HD, Yassa M, Christian BT, Mapstone M, Handen B, Zimmerman ME, Gutierrez J, Wilcock D, Head E, Brickman AM. Cerebrovascular disease emerges with age and Alzheimer's disease in adults with Down syndrome. Sci Rep 2024; 14:12334. [PMID: 38811657 PMCID: PMC11137035 DOI: 10.1038/s41598-024-61962-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024] Open
Abstract
Adults with Down syndrome have a genetic form of Alzheimer's disease (AD) and evidence of cerebrovascular disease across the AD continuum, despite few systemic vascular risk factors. The onset and progression of AD in Down syndrome is highly age-dependent, but it is unknown at what age cerebrovascular disease emerges and what factors influence its severity. In the Alzheimer's Biomarker Consortium-Down Syndrome study (ABC-DS; n = 242; age = 25-72), we estimated the age inflection point at which MRI-based white matter hyperintensities (WMH), enlarged perivascular spaces (PVS), microbleeds, and infarcts emerge in relation to demographic data, risk factors, amyloid and tau, and AD diagnosis. Enlarged PVS and infarcts appear to develop in the early 30s, while microbleeds, WMH, amyloid, and tau emerge in the mid to late 30s. Age-residualized WMH were higher in women, in individuals with dementia, and with lower body mass index. Participants with hypertension and APOE-ε4 had higher age-residualized PVS and microbleeds, respectively. Lifespan trajectories demonstrate a dramatic cerebrovascular profile in adults with Down syndrome that appears to evolve developmentally in parallel with AD pathophysiology approximately two decades prior to dementia symptoms.
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Affiliation(s)
- Patrick Lao
- Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PS Box 16, New York, NY, 10032, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Natalie Edwards
- Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PS Box 16, New York, NY, 10032, USA
| | - Lisi Flores-Aguilar
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA, 92697, USA
| | - Mohamad Alshikho
- Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PS Box 16, New York, NY, 10032, USA
| | - Batool Rizvi
- Department of Neurology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Dana Tudorascu
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - H Diana Rosas
- Department of Neurology, Massachusetts General Hospital, Harvard Medical Center, Boston, MA, 02114, USA
| | - Michael Yassa
- Department of Neurology, University of California, Irvine, Irvine, CA, 92697, USA
| | | | - Mark Mapstone
- Department of Neurology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Benjamin Handen
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | | | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Donna Wilcock
- Departments of Neurology and Anatomy, Cell Biology, and Physiology, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA, 92697, USA
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, 92697, USA
| | - Adam M Brickman
- Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PS Box 16, New York, NY, 10032, USA.
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.
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Chu M, Jiang D, Nan H, Wen L, Liu L, Qu M, Wu L. Vascular dysfunction in sporadic bvFTD: white matter hyperintensity and peripheral vascular biomarkers. Alzheimers Res Ther 2024; 16:72. [PMID: 38581060 PMCID: PMC10998369 DOI: 10.1186/s13195-024-01422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/28/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Vascular dysfunction was recently reported to be involved in the pathophysiological process of neurodegenerative diseases, but its role in sporadic behavioral variant frontotemporal dementia (bvFTD) remains unclear. The aim of this study was to systematically explore vascular dysfunction, including changes in white matter hyperintensities (WMHs) and peripheral vascular markers in bvFTD. METHODS Thirty-two patients with bvFTD who with no vascular risk factors were enrolled in this cross-sectional study and assessed using positron emission tomography/magnetic resonance (PET/MRI) imaging, peripheral plasma vascular/inflammation markers, and neuropsychological examinations. Group differences were tested using Student's t-tests and Mann-Whitney U tests. A partial correlation analysis was implemented to explore the association between peripheral vascular markers, neuroimaging, and clinical measures. RESULTS WMH was mainly distributed in anterior brain regions. All peripheral vascular factors including matrix metalloproteinases-1 (MMP-1), MMP-3, osteopontin, and pentraxin-3 were increased in the bvFTD group. WMH was associated with the peripheral vascular factor pentraxin-3. The plasma level of MMP-1 was negatively correlated with the gray matter metabolism of the frontal, temporal, insula, and basal ganglia brain regions. The WMHs in the frontal and limbic lobes were associated with plasma inflammation markers, disease severity, executive function, and behavior abnormality. Peripheral vascular markers were associated with the plasma inflammation markers. CONCLUSIONS WMHs and abnormalities in peripheral vascular markers were found in patients with bvFTD. These were found to be associated with the disease-specific pattern of neurodegeneration, indicating that vascular dysfunction may be involved in the pathogenesis of bvFTD. This warrants further confirmation by postmortem autopsy. Targeting the vascular pathway might be a promising approach for potential therapy.
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Affiliation(s)
- Min Chu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Deming Jiang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Haitian Nan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Lulu Wen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Li Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Miao Qu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
| | - Liyong Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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11
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Hong H, Chen Y, Liu W, Luo X, Zhang M. Distinct patterns of voxel- and connection-based white matter hyperintensity distribution and associated factors in early-onset and late-onset Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12585. [PMID: 38651161 PMCID: PMC11033836 DOI: 10.1002/dad2.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/12/2024] [Accepted: 03/15/2024] [Indexed: 04/25/2024]
Abstract
Introduction The distribution of voxel- and connection-based white matter hyperintensity (WMH) patterns in early-onset Alzheimer's disease (EOAD) and late-onset Alzheimer's disease (LOAD), as well as factors associated with these patterns, remain unclear. Method We analyzed the WMH distribution patterns in EOAD and LOAD at the voxel and connection levels, each compared with their age-matched cognitively unimpaired participants. Linear regression assessed the independent effects of amyloid and vascular risk factors on WMH distribution patterns in both groups. Results Patients with EOAD showed increased WMH burden in the posterior region at the voxel level, and in occipital region tracts and visual network at the connection level, compared to controls. LOAD exhibited extensive involvement across various brain areas in both levels. Amyloid accumulation was associated WMH distribution in the early-onset group, whereas the late-onset group demonstrated associations with both amyloid and vascular risk factors. Discussion EOAD showed posterior-focused WMH distribution pattern, whereas LOAD was with a wider distribution. Amyloid accumulation was associated with connection-based WMH patterns in both early-onset and late-onset groups, with additional independent effects of vascular risk factors in late-onset group. Highlights Both early-onset Alzheimer's disease (EOAD) and late-onset AD (LOAD) showed increased white matter hyperintensity (WMH) volume compared with their age-matched cognitively unimpaired participants.EOAD and LOAD exhibited distinct patterns of WMH distribution, with EOAD showing a posterior-focused pattern and LOAD displaying a wider distribution across both voxel- and connection-based levels.In both EOAD and LOAD, amyloid accumulation was associated with connection-based WMH patterns, with additional independent effects of vascular risk factors observed in LOAD.
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Affiliation(s)
- Hui Hong
- Department of RadiologyThe Second Affiliated Hospital of Zhejiang UniversitySchool of MedicineHangzhouChina
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - Yutong Chen
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - Weiran Liu
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - Xiao Luo
- Department of RadiologyThe Second Affiliated Hospital of Zhejiang UniversitySchool of MedicineHangzhouChina
| | - Minming Zhang
- Department of RadiologyThe Second Affiliated Hospital of Zhejiang UniversitySchool of MedicineHangzhouChina
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12
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Biesbroek JM, Coenen M, DeCarli C, Fletcher EM, Maillard PM, Barkhof F, Barnes J, Benke T, Chen CPLH, Dal‐Bianco P, Dewenter A, Duering M, Enzinger C, Ewers M, Exalto LG, Franzmeier N, Hilal S, Hofer E, Koek HL, Maier AB, McCreary CR, Papma JM, Paterson RW, Pijnenburg YAL, Rubinski A, Schmidt R, Schott JM, Slattery CF, Smith EE, Sudre CH, Steketee RME, Teunissen CE, van den Berg E, van der Flier WM, Venketasubramanian N, Venkatraghavan V, Vernooij MW, Wolters FJ, Xin X, Kuijf HJ, Biessels GJ. Amyloid pathology and vascular risk are associated with distinct patterns of cerebral white matter hyperintensities: A multicenter study in 3132 memory clinic patients. Alzheimers Dement 2024; 20:2980-2989. [PMID: 38477469 PMCID: PMC11032573 DOI: 10.1002/alz.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION White matter hyperintensities (WMH) are associated with key dementia etiologies, in particular arteriolosclerosis and amyloid pathology. We aimed to identify WMH locations associated with vascular risk or cerebral amyloid-β1-42 (Aβ42)-positive status. METHODS Individual patient data (n = 3,132; mean age 71.5 ± 9 years; 49.3% female) from 11 memory clinic cohorts were harmonized. WMH volumes in 28 regions were related to a vascular risk compound score (VRCS) and Aß42 status (based on cerebrospinal fluid or amyloid positron emission tomography), correcting for age, sex, study site, and total WMH volume. RESULTS VRCS was associated with WMH in anterior/superior corona radiata (B = 0.034/0.038, p < 0.001), external capsule (B = 0.052, p < 0.001), and middle cerebellar peduncle (B = 0.067, p < 0.001), and Aß42-positive status with WMH in posterior thalamic radiation (B = 0.097, p < 0.001) and splenium (B = 0.103, p < 0.001). DISCUSSION Vascular risk factors and Aß42 pathology have distinct signature WMH patterns. This regional vulnerability may incite future studies into how arteriolosclerosis and Aß42 pathology affect the brain's white matter. HIGHLIGHTS Key dementia etiologies may be associated with specific patterns of white matter hyperintensities (WMH). We related WMH locations to vascular risk and cerebral Aβ42 status in 11 memory clinic cohorts. Aβ42 positive status was associated with posterior WMH in splenium and posterior thalamic radiation. Vascular risk was associated with anterior and infratentorial WMH. Amyloid pathology and vascular risk have distinct signature WMH patterns.
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13
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Morales CD, Cotton-Samuel D, Lao PJ, Chang JF, Pyne JD, Alshikho MJ, Lippert RV, Bista K, Hale C, Edwards NC, Igwe KC, Deters K, Zimmerman ME, Brickman AM. Small vessel cerebrovascular disease is associated with cognition in prospective Alzheimer's clinical trial participants. Alzheimers Res Ther 2024; 16:25. [PMID: 38308344 PMCID: PMC10836014 DOI: 10.1186/s13195-024-01395-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Secondary prevention clinical trials for Alzheimer's disease (AD) target amyloid accumulation in asymptomatic, amyloid-positive individuals, but it is unclear to what extent other pathophysiological processes, such as small vessel cerebrovascular disease, account for participant performance on the primary cognitive outcomes in those trials. White matter hyperintensities are areas of increased signal on T2-weighted magnetic resonance imaging (MRI) that reflect small vessel cerebrovascular disease. They are associated with cognitive functioning in older adults and with clinical presentation and course of AD, particularly when distributed in posterior brain regions. The purpose of this study was to examine to what degree regional WMH volume is associated with performance on the primary cognitive outcome measure in the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) study, a secondary prevention trial. METHODS Data from 1791 participants (59.5% women, mean age (SD) 71.6 (4.74)) in the A4 study and the Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) companion study at the screening visit were used to quantify WMH volumes on T2-weighted fluid-attenuated inversion recovery (FLAIR) MR images. Cognition was assessed with the preclinical Alzheimer cognitive composite (PACC). We tested the association of total and regional WMH volumes with PACC performance, adjusting for age, education, and amyloid positivity status, with general linear models. We also considered interactions between WMH and amyloid positivity status. RESULTS Increased frontal and parietal lobe WMH volume was associated with poorer performance on the PACC. While amyloid positivity was also associated with lower cognitive test scores, WMH volumes did not interact with amyloid positivity status. CONCLUSION These results highlight the potential of small vessel cerebrovascular disease to drive AD-related cognitive profiles. Measures of small vessel cerebrovascular disease should be considered when evaluating outcome in trials, both as potential effect modifiers and as a possible target for intervention or prevention.
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Affiliation(s)
- Clarissa D Morales
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Dejania Cotton-Samuel
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Patrick J Lao
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Julia F Chang
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Jeffrey D Pyne
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Mohamad J Alshikho
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Rafael V Lippert
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Kelsang Bista
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Christiane Hale
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Natalie C Edwards
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Kay C Igwe
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Kacie Deters
- Department of Integrative Biology & Physiology, University of California, Los Angeles, CA, USA
| | | | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.
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14
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Shirzadi Z, Schultz AP, Properzi M, Yaari R, Yau WYW, Brickman AM, Rafii MS, Donohue MC, Ernstrom K, Wang S, Jack CR, Greenberg SM, Raman R, Aisen P, Sperling RA, Chhatwal JP. Greater White Matter Hyperintensity Volume Is Associated with the Number of Microhemorrhages in Preclinical Alzheimer's Disease. J Prev Alzheimers Dis 2024; 11:869-873. [PMID: 39044495 PMCID: PMC11266366 DOI: 10.14283/jpad.2024.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/26/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Increased white matter hyperintensity (WMH) volume visible on MRI is a common finding in Alzheimer's disease (AD). We hypothesized that WMH in preclinical AD is associated with the presence of advanced vessel amyloidosis manifested as microhemorrhages (MCH). OBJECTIVES 1) To assess the relationship between baseline WMH volume and baseline MCH. 2) To assess the relationship between longitudinal WMH accumulation and last MRI MCH during the double-blind phase of the A4 trial. DESIGN A multicenter, randomized, double-blind, placebo-controlled, Phase 3 study comparing solanezumab with placebo given as infusions once every 4 weeks over 4.5 years in subjects with preclinical AD, defined as having evidence of elevated brain amyloid before the stage of clinically evident cognitive impairment, with an optional open-label extension period. SETTING Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) study. PARTICIPANTS A sample of 1157 cognitively unimpaired older adults (mean age = 71.9 years [SD = 4.8 years], 59% women, 59% APOE ε4 carriers). MEASUREMENTS A linear regression model was used to assess the impact of baseline MCH amount (0, 1, 2+) on WMH volume. A linear mixed-effects model was used to assess the impact of last MRI MCH on longitudinal WMH. All models were corrected for age, sex, grey matter volume, cortical amyloid PET, APOE ε4 status, and treatment group. RESULTS Baseline WMH volume was greater in individuals with more than one MCH compared to those with no MCH (t=4.8, p<0.001). The longitudinal increase in WMH amongst individuals with one (t=2.3, p=0.025) and more than one MCH (t=6.7, p<0.001) at the last MRI was greater than those with no MCH. CONCLUSION These results indicate a strong association between WMH and MCH, a common manifestation of cerebral amyloid angiopathy and ARIA-H. These results suggest that increased WMH volume may represent an early sign of vessel amyloidosis, likely prior to the emergence of MCH.
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Affiliation(s)
- Z Shirzadi
- Zahra Shirzadi, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, e-mail:
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15
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Yaari R, Holdridge KC, Mancini M, Rafii MS, Case M, Battioui C, Sims JR, Aisen PS, Sperling RA. Safety Profile of a Cognitively Unimpaired Older Population with Elevated Cerebral Amyloid in a 4.5-Year Clinical Trial. J Prev Alzheimers Dis 2024; 11:857-868. [PMID: 39044494 PMCID: PMC11266256 DOI: 10.14283/jpad.2024.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/18/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Preclinical Alzheimer's disease is increasingly studied in clinical trials. Although safety signals are routinely monitored in clinical trial populations with Alzheimer's disease, it can be challenging to identify new safety signals against background rates of age-related medical comorbidities. OBJECTIVES To report detailed safety data from a cognitively unimpaired older population with evidence of elevated cerebral amyloid levels on amyloid positron emission tomography in the placebo arm of a Phase 3 clinical trial. DESIGN Phase 3, 4.5-year, multicenter, placebo-controlled trial. SETTING Placebo data from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) study. PARTICIPANTS Enrolled participants were aged 65-85 years with a global Clinical Dementia Rating score of 0, a Mini-Mental State Examination score of 25-30, a Wechsler Memory Scale Logical Memory IIa (delayed recall) score of 6-18, and elevated brain amyloid levels on 18F-florbetapir positron emission tomography. MEASUREMENTS Study participants who received placebo were followed up with post-baseline safety measures. Assessments included review of concomitant medication and adverse events, the Columbia Suicide Severity Rating Scale, electrocardiograms, and neuroimaging (brain magnetic resonance imaging). RESULTS In total, 591 study participants (mean age [standard deviation] 71.9 [5.0] years) were assigned to and received placebo in the A4 study, and were followed up to 240 weeks. Participants were primarily White (93.9%) and from the United States (86.8%); 60.4% were women. The most common serious adverse events (incidence rate per 100 person-years) were pneumonia (incidence rate=0.4; 95% confidence interval=0.2-0.7) and atrial fibrillation (incidence rate=0.4; 95% confidence interval=0.2-0.7). The most common treatment-emergent adverse events were upper respiratory tract infection (incidence rate=10.9; 95% confidence interval=9.4-12.5), fall (incidence rate=7.7; 95% confidence interval=6.6-9.0), and nasopharyngitis (incidence rate=5.8; 95% confidence interval=4.8-6.9). The most common ischemia-related findings on magnetic resonance imaging were subcortical infarction (incidence rate=1.4; 95% confidence interval=1.0-2.0) and acute ischemia (incidence rate=0.6; 95% confidence interval=0.3-1.0). Emergent amyloid-related imaging abnormalities with hemosiderin deposition occurred in 32.8% of participants who received placebo; the primary factor associated with these events during the post-baseline period was the number of microhemorrhages at baseline (odds ratio=349.9; 95% confidence interval=247.6-494.4; adjusted p<0.001). CONCLUSION Safety findings in the placebo-treated group from the A4 study provide a robust characterization of expected safety in a clinical trial population with preclinical Alzheimer's disease. These results may provide context in planning future studies and safety evaluations during ongoing blinded studies in preclinical Alzheimer's disease.
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Affiliation(s)
- R Yaari
- Roy Yaari, Eli Lilly and Company, Indianapolis, IN, USA,
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16
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Wang X, Wang C, Miao P, Wei Y, Lin L, Li Z, Zhang Y, Cheng J, Ren C. Reduced GABA concentration in patients with white matter hyperintensities. Front Neurosci 2023; 17:1320247. [PMID: 38156270 PMCID: PMC10752961 DOI: 10.3389/fnins.2023.1320247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
To investigate potential alterations of white matter hyperintensities (WMHs) on J-edited MR spectroscopy (MRS) measures of the primary inhibitory neurotransmitter γ-aminobutyric acid (GABA). Twenty-four WMHs patients and 20 healthy controls (HCs) were recruited to undergo magnetic resonance spectroscopy (MRS) scan at 3T from voxels in left centrum semiovale white matter, using the MEGA point resolved spectroscopy (MEGA-PRESS) technique with the MATLAB-based Gannet tool to estimate GABA+ co-edited macromolecule (GABA+) levels and using Tarquin software to estimate levels of glutamate + glutamine (Glx), total N-acetylaspartate (tNAA), total choline (tCho), and total creatine (tCr). Independent t-tests or Mann-Whitney U-tests were used to test group differences between WMHs and HCs. Additionally, WMHs patients were divided into mild and moderate-severe WMHs subgroup according to the Fazekas scale. Analysis of variance (ANOVA) and post-hoc tests were used among WMHs subgroups and HCs. We found there was a significant reduction in GABA+ levels (p = 0.018) in WMHs patients compared with healthy controls. In subgroup analyses, there was also a significant reduction of GABA+ levels in moderate-severe WMHs subgroup (p = 0.037) and mild WMHs subgroup (p = 0.047) when compared to HCs. Besides, the moderate-severe WMHs subgroup had significantly higher levels of tCho compared with healthy controls (p = 0.019). In conclusion, reduced GABA+ levels in WMHs patients and elevated tCho levels in moderate-severe WMHs were observed when compared with HCs. These results demonstrate that abnormalities of the GABAergic system and choline metabolism may contribute to the pathogenesis of WMHs.
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Affiliation(s)
- Xin Wang
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Caihong Wang
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peifang Miao
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Wei
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liangjie Lin
- Clinical and Technical Support, Philips Healthcare, Beijing, China
| | - Zhen Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cuiping Ren
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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17
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Edwards NC, Lao PJ, Alshikho MJ, Ericsson OM, Rizvi B, Petersen ME, O’Bryant S, Flores-Aguilar L, Simoes S, Mapstone M, Tudorascu DL, Janelidze S, Hansson O, Handen BL, Christian BT, Lee JH, Lai F, Rosas HD, Zaman S, Lott IT, Yassa MA, Gutierrez J, Wilcock DM, Head E, Brickman AM. Cerebrovascular disease drives Alzheimer plasma biomarker concentrations in adults with Down syndrome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.28.23298693. [PMID: 38076904 PMCID: PMC10705616 DOI: 10.1101/2023.11.28.23298693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Importance By age 40 years over 90% of adults with Down syndrome (DS) have Alzheimer's disease (AD) pathology and most progress to dementia. Despite having few systemic vascular risk factors, individuals with DS have elevated cerebrovascular disease (CVD) markers that track with the clinical progression of AD, suggesting a role for CVD that is hypothesized to be mediated by inflammatory factors. Objective To examine the pathways through which small vessel CVD contributes to AD-related pathophysiology and neurodegeneration in adults with DS. Design Cross sectional analysis of neuroimaging, plasma, and clinical data. Setting Participants were enrolled in Alzheimer's Biomarker Consortium - Down Syndrome (ABC-DS), a multisite study of AD in adults with DS. Participants One hundred eighty-five participants (mean [SD] age=45.2 [9.3] years) with available MRI and plasma biomarker data were included. White matter hyperintensity (WMH) volumes were derived from T2-weighted FLAIR MRI scans and plasma biomarker concentrations of amyloid beta (Aβ42/Aβ40), phosphorylated tau (p-tau217), astrocytosis (glial fibrillary acidic protein, GFAP), and neurodegeneration (neurofilament light chain, NfL) were measured with ultrasensitive immunoassays. Main Outcomes and Measures We examined the bivariate relationships of WMH, Aβ42/Aβ40, p-tau217, and GFAP with age-residualized NfL across AD diagnostic groups. A series of mediation and path analyses examined causal pathways linking WMH and AD pathophysiology to promote neurodegeneration in the total sample and groups stratified by clinical diagnosis. Results There was a direct and indirect bidirectional effect through GFAP of WMH on p-tau217 concentration, which was associated with NfL concentration in the entire sample. Among cognitively stable participants, WMH was directly and indirectly, through GFAP, associated with p-tau217 concentration, and in those with MCI, there was a direct effect of WMH on p-tau217 and NfL concentrations. There were no associations of WMH with biomarker concentrations among those diagnosed with dementia. Conclusions and Relevance The findings suggest that among individuals with DS, CVD promotes neurodegeneration by increasing astrocytosis and tau pathophysiology in the presymptomatic phases of AD. This work joins an emerging literature that implicates CVD and its interface with neuroinflammation as a core pathological feature of AD in adults with DS.
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Affiliation(s)
- Natalie C. Edwards
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York City, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
- Department of Neuroscience, Columbia University, New York City, NY, USA
| | - Patrick J. Lao
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York City, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Mohamad J. Alshikho
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York City, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Olivia M. Ericsson
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York City, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Batool Rizvi
- Department of Neurobiology & Behavior, University of California, Irvine, CA, USA
| | | | - Sid O’Bryant
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Lisi Flores-Aguilar
- Department of Pathology and Laboratory Medicine, University of California Irvine School of Medicine, University of California, Irvine, CA, USA
| | - Sabrina Simoes
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York City, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Mark Mapstone
- Department of Neurology, University of California, Irvine, CA, USA
| | - Dana L. Tudorascu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shorena Janelidze
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | | | | | - Joseph H. Lee
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York City, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Florence Lai
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - H Diana Rosas
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Center for Neuroimaging of Aging and neurodegenerative Diseases, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Shahid Zaman
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ira T. Lott
- Department of Pediatrics and Neurology, School of Medicine, University of California, Irvine, CA, USA
| | - Michael A. Yassa
- Department of Neurobiology & Behavior, University of California, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA
| | - José Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Donna M. Wilcock
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
- Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, University of California Irvine School of Medicine, University of California, Irvine, CA, USA
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York City, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
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