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Sánchez‐Moreno B, Zhang L, Mateo G, Moldenhauer F, Brudfors M, Ashburner J, Nachev P, de Asúa DR, Strange BA. Voxel-based dysconnectomic brain morphometry with computed tomography in Down syndrome. Ann Clin Transl Neurol 2024; 11:143-155. [PMID: 38158639 PMCID: PMC10791030 DOI: 10.1002/acn3.51940] [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: 06/06/2023] [Revised: 09/23/2023] [Accepted: 10/20/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Alzheimer's disease (AD) is a major health concern for aging adults with Down syndrome (DS), but conventional diagnostic techniques are less reliable in those with severe baseline disability. Likewise, acquisition of magnetic resonance imaging to evaluate cerebral atrophy is not straightforward, as prolonged scanning times are less tolerated in this population. Computed tomography (CT) scans can be obtained faster, but poor contrast resolution limits its function for morphometric analysis. We implemented an automated analysis of CT scans to characterize differences across dementia stages in a cross-sectional study of an adult DS cohort. METHODS CT scans of 98 individuals were analyzed using an automatic algorithm. Voxel-based correlations with clinical dementia stages and AD plasma biomarkers (phosphorylated tau-181 and neurofilament light chain) were identified, and their dysconnectomic patterns delineated. RESULTS Dementia severity was negatively correlated with gray (GM) and white matter (WM) volumes in temporal lobe regions, including parahippocampal gyri. Dysconnectome analysis revealed an association between WM loss and temporal lobe GM volume reduction. AD biomarkers were negatively associated with GM volume in hippocampal and cingulate gyri. INTERPRETATION Our automated algorithm and novel dysconnectomic analysis of CT scans successfully described brain morphometric differences related to AD in adults with DS, providing a new avenue for neuroimaging analysis in populations for whom magnetic resonance imaging is difficult to obtain.
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Affiliation(s)
- Beatriz Sánchez‐Moreno
- Adult Down Syndrome Unit, Department of Internal MedicineHospital Universitario de La PrincesaMadridSpain
| | - Linda Zhang
- Alzheimer Disease Research UnitCIEN Foundation, Queen Sofia Foundation Alzheimer CentreMadridSpain
| | - Gloria Mateo
- Adult Down Syndrome Unit, Department of Internal MedicineHospital Universitario de La PrincesaMadridSpain
| | - Fernando Moldenhauer
- Adult Down Syndrome Unit, Department of Internal MedicineHospital Universitario de La PrincesaMadridSpain
| | - Mikael Brudfors
- Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
| | - John Ashburner
- Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
| | - Parashkev Nachev
- High‐Dimensional Neurology GroupUniversity College London Queen Square Institute of NeurologyLondonUK
| | - Diego Real de Asúa
- Adult Down Syndrome Unit, Department of Internal MedicineHospital Universitario de La PrincesaMadridSpain
| | - Bryan A. Strange
- Alzheimer Disease Research UnitCIEN Foundation, Queen Sofia Foundation Alzheimer CentreMadridSpain
- Laboratory for Clinical NeuroscienceCTB, Universidad Politécnica de MadridMadridSpain
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Sharp FR, DeCarli CS, Jin LW, Zhan X. White matter injury, cholesterol dysmetabolism, and APP/Abeta dysmetabolism interact to produce Alzheimer's disease (AD) neuropathology: A hypothesis and review. Front Aging Neurosci 2023; 15:1096206. [PMID: 36845656 PMCID: PMC9950279 DOI: 10.3389/fnagi.2023.1096206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
We postulate that myelin injury contributes to cholesterol release from myelin and cholesterol dysmetabolism which contributes to Abeta dysmetabolism, and combined with genetic and AD risk factors, leads to increased Abeta and amyloid plaques. Increased Abeta damages myelin to form a vicious injury cycle. Thus, white matter injury, cholesterol dysmetabolism and Abeta dysmetabolism interact to produce or worsen AD neuropathology. The amyloid cascade is the leading hypothesis for the cause of Alzheimer's disease (AD). The failure of clinical trials based on this hypothesis has raised other possibilities. Even with a possible new success (Lecanemab), it is not clear whether this is a cause or a result of the disease. With the discovery in 1993 that the apolipoprotein E type 4 allele (APOE4) was the major risk factor for sporadic, late-onset AD (LOAD), there has been increasing interest in cholesterol in AD since APOE is a major cholesterol transporter. Recent studies show that cholesterol metabolism is intricately involved with Abeta (Aβ)/amyloid transport and metabolism, with cholesterol down-regulating the Aβ LRP1 transporter and upregulating the Aβ RAGE receptor, both of which would increase brain Aβ. Moreover, manipulating cholesterol transport and metabolism in rodent AD models can ameliorate pathology and cognitive deficits, or worsen them depending upon the manipulation. Though white matter (WM) injury has been noted in AD brain since Alzheimer's initial observations, recent studies have shown abnormal white matter in every AD brain. Moreover, there is age-related WM injury in normal individuals that occurs earlier and is worse with the APOE4 genotype. Moreover, WM injury precedes formation of plaques and tangles in human Familial Alzheimer's disease (FAD) and precedes plaque formation in rodent AD models. Restoring WM in rodent AD models improves cognition without affecting AD pathology. Thus, we postulate that the amyloid cascade, cholesterol dysmetabolism and white matter injury interact to produce and/or worsen AD pathology. We further postulate that the primary initiating event could be related to any of the three, with age a major factor for WM injury, diet and APOE4 and other genes a factor for cholesterol dysmetabolism, and FAD and other genes for Abeta dysmetabolism.
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Affiliation(s)
- Frank R. Sharp
- Department of Neurology, The MIND Institute, University of California at Davis Medical Center, Sacramento, CA, United States
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Fernández A, Ramírez-Toraño F, Bruña R, Zuluaga P, Esteba-Castillo S, Abásolo D, Moldenhauer F, Shumbayawonda E, Maestú F, García-Alba J. Brain signal complexity in adults with Down syndrome: Potential application in the detection of mild cognitive impairment. Front Aging Neurosci 2022; 14:988540. [PMID: 36337705 PMCID: PMC9631477 DOI: 10.3389/fnagi.2022.988540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Down syndrome (DS) is considered the most frequent cause of early-onset Alzheimer’s disease (AD), and the typical pathophysiological signs are present in almost all individuals with DS by the age of 40. Despite of this evidence, the investigation on the pre-dementia stages in DS is scarce. In the present study we analyzed the complexity of brain oscillatory patterns and neuropsychological performance for the characterization of mild cognitive impairment (MCI) in DS. Materials and methods Lempel-Ziv complexity (LZC) values from resting-state magnetoencephalography recordings and the neuropsychological performance in 28 patients with DS [control DS group (CN-DS) (n = 14), MCI group (MCI-DS) (n = 14)] and 14 individuals with typical neurodevelopment (CN-no-DS) were analyzed. Results Lempel-Ziv complexity was lowest in the frontal region within the MCI-DS group, while the CN-DS group showed reduced values in parietal areas when compared with the CN-no-DS group. Also, the CN-no-DS group exhibited the expected pattern of significant increase of LZC as a function of age, while MCI-DS cases showed a decrease. The combination of reduced LZC values and a divergent trajectory of complexity evolution with age, allowed the discrimination of CN-DS vs. MCI-DS patients with a 92.9% of sensitivity and 85.7% of specificity. Finally, a pattern of mnestic and praxic impairment was significantly associated in MCI-DS cases with the significant reduction of LZC values in frontal and parietal regions (p = 0.01). Conclusion Brain signal complexity measured with LZC is reduced in DS and its development with age is also disrupted. The combination of both features might assist in the detection of MCI within this population.
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Affiliation(s)
- Alberto Fernández
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
- Institute of Sanitary Investigation (IdISSC), Hospital Universitario San Carlos, Madrid, Spain
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
| | - Federico Ramírez-Toraño
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense de Madrid, Madrid, Spain
| | - Ricardo Bruña
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Radiology, Universidad Complutense de Madrid, Madrid, Spain
- Department of Industrial Engineering & IUNE & ITB, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Pilar Zuluaga
- Statistics & Operations Research Department, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Susanna Esteba-Castillo
- Neurodevelopmental Group, Girona Biomedical Research Institute-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, Girona, Spain
| | - Daniel Abásolo
- Centre for Biomedical Engineering, School of Mechanical Engineering Sciences, University of Surrey, Guildford, United Kingdom
| | - Fernando Moldenhauer
- Adult Down Syndrome Unit, Internal Medicine Department, Health Research Institute, Hospital Universitario de La Princesa, Madrid, Spain
| | - Elizabeth Shumbayawonda
- Centre for Biomedical Engineering, School of Mechanical Engineering Sciences, University of Surrey, Guildford, United Kingdom
| | - Fernando Maestú
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier García-Alba
- Department of Research and Psychology in Education, Universidad Complutense de Madrid, Madrid, Spain
- *Correspondence: Javier García-Alba,
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Saini F, Dell’Acqua F, Strydom A. Structural Connectivity in Down Syndrome and Alzheimer's Disease. Front Neurosci 2022; 16:908413. [PMID: 35937882 PMCID: PMC9354601 DOI: 10.3389/fnins.2022.908413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/21/2022] [Indexed: 12/02/2022] Open
Abstract
Down syndrome (DS) arises from the triplication of chromosome 21, which leads to an atypical neurodevelopment and the overproduction of the amyloid precursor protein, predisposing to early Alzheimer's disease (AD). Not surprisingly, trisomy 21 is widely considered a model to study predementia stages of AD. After decades, in which neural loss was the main focus, research in AD is now moving toward understanding the neurodegenerative aspects affecting white matter. Motivated by the development of magnetic resonance imaging (MRI)-based diffusion techniques, this shift in focus has led to several exploratory studies on both young and older individuals with DS. In this review, we synthesise the initial efforts made by researchers in characterising in-vivo structural connectivity in DS, together with the AD footprint on top of such pre-existing connectivity related to atypical brain development. The white matter structures found to be affected in DS are the corpus callosum and all the main long-association fibres, namely the inferior fronto-occipital fasciculus, the inferior and superior longitudinal fasciculus, the uncinate fasciculus and the cingulum bundle. Furthermore, the cingulum bundle and the corpus callosum appear to be particularly sensitive to early AD changes in this population. Findings are discussed in terms of their functional significance, alongside methodological considerations and implications for future research.
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Affiliation(s)
- Fedal Saini
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Flavio Dell’Acqua
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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