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Xia Y, Dore V, Fripp J, Bourgeat P, Laws SM, Fowler CJ, Rainey-Smith SR, Martins RN, Rowe C, Masters CL, Coulson EJ, Maruff P. Association of Basal Forebrain Atrophy With Cognitive Decline in Early Alzheimer Disease. Neurology 2024; 103:e209626. [PMID: 38885444 PMCID: PMC11254448 DOI: 10.1212/wnl.0000000000209626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/09/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES In early Alzheimer disease (AD), β-amyloid (Aβ) deposition is associated with volume loss in the basal forebrain (BF) and cognitive decline. However, the extent to which Aβ-related BF atrophy manifests as cognitive decline is not understood. This study sought to characterize the relationship between BF atrophy and the decline in memory and attention in patients with early AD. METHODS Participants from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study who completed Aβ-PET imaging and repeated MRI and cognitive assessments were included. At baseline, participants were classified based on their clinical dementia stage and Aβ status, yielding groups that were cognitively unimpaired (CU) Aβ-, CU Aβ+, and mild cognitive impairment (MCI) Aβ+. Linear mixed-effects models were used to assess changes in volumetric measures of BF subregions and the hippocampus and changes in AIBL memory and attention composite scores for each group compared with CU Aβ- participants. Associations between Aβ burden, brain atrophy, and cognitive decline were evaluated and explored further using mediation analyses. RESULTS The cohort included 476 participants (72.6 ± 5.9 years, 55.0% female) with longitudinal data from a median follow-up period of 6.1 years. Compared with the CU Aβ- group (n = 308), both CU Aβ+ (n = 107) and MCI Aβ+ (n = 61) adults showed faster decline in BF and hippocampal volumes and in memory and attention (Cohen d = 0.73-1.74). Rates of atrophy in BF subregions and the hippocampus correlated with cognitive decline, and each individually mediated the impact of Aβ burden on memory and attention decline. When all mediators were considered simultaneously, hippocampal atrophy primarily influenced the effect of Aβ burden on memory decline (β [SE] = -0.139 [0.032], proportion mediated [PM] = 28.0%) while the atrophy of the posterior nucleus basalis of Meynert in the BF (β [SE] = -0.068 [0.029], PM = 13.1%) and hippocampus (β [SE] = -0.121 [0.033], PM = 23.4%) distinctively influenced Aβ-related attention decline. DISCUSSION These findings highlight the significant role of BF atrophy in the complex pathway linking Aβ to cognitive impairment in early stages of AD. Volumetric assessment of BF subregions could be essential in elucidating the relationships between the brain structure and behavior in AD.
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Affiliation(s)
- Ying Xia
- From the The Australian e-Health Research Centre (Y.X., V.D., J.F., P.B.), CSIRO Health and Biosecurity, Brisbane; Department of Nuclear Medicine and Centre for PET (V.D., C.R.), Austin Health, Melbourne; Centre for Precision Health (S.M.L.), Edith Cowan University; Collaborative Genomics and Translation Group (S.M.L.), School of Medical and Health Sciences, Edith Cowan University, Joondalup; Curtin Medical School (S.M.L.), Curtin University, Bentley; The Florey Institute of Neuroscience and Mental Health (C.J.F., C.R., C.L.M., P.M.), The University of Melbourne; Centre for Healthy Ageing (S.R.R.-S.), Health Futures Institute, Murdoch University; Australian Alzheimer's Research Foundation (S.R.R.-S., R.N.M.), Sarich Neuroscience Research Institute, Nedlands; School of Psychological Science (S.R.R.-S.), University of Western Australia, Crawley; School of Medical and Health Sciences (S.R.R.-S., R.N.M.), Edith Cowan University, Joondalup; Department of Biomedical Sciences (R.N.M.), Macquarie University, Sydney; Queensland Brain Institute (E.J.C.), and School of Biomedical Sciences (E.J.C.), The University of Queensland, Brisbane; and Cogstate Ltd. (P.M.), Melbourne, Australia
| | - Vincent Dore
- From the The Australian e-Health Research Centre (Y.X., V.D., J.F., P.B.), CSIRO Health and Biosecurity, Brisbane; Department of Nuclear Medicine and Centre for PET (V.D., C.R.), Austin Health, Melbourne; Centre for Precision Health (S.M.L.), Edith Cowan University; Collaborative Genomics and Translation Group (S.M.L.), School of Medical and Health Sciences, Edith Cowan University, Joondalup; Curtin Medical School (S.M.L.), Curtin University, Bentley; The Florey Institute of Neuroscience and Mental Health (C.J.F., C.R., C.L.M., P.M.), The University of Melbourne; Centre for Healthy Ageing (S.R.R.-S.), Health Futures Institute, Murdoch University; Australian Alzheimer's Research Foundation (S.R.R.-S., R.N.M.), Sarich Neuroscience Research Institute, Nedlands; School of Psychological Science (S.R.R.-S.), University of Western Australia, Crawley; School of Medical and Health Sciences (S.R.R.-S., R.N.M.), Edith Cowan University, Joondalup; Department of Biomedical Sciences (R.N.M.), Macquarie University, Sydney; Queensland Brain Institute (E.J.C.), and School of Biomedical Sciences (E.J.C.), The University of Queensland, Brisbane; and Cogstate Ltd. (P.M.), Melbourne, Australia
| | - Jurgen Fripp
- From the The Australian e-Health Research Centre (Y.X., V.D., J.F., P.B.), CSIRO Health and Biosecurity, Brisbane; Department of Nuclear Medicine and Centre for PET (V.D., C.R.), Austin Health, Melbourne; Centre for Precision Health (S.M.L.), Edith Cowan University; Collaborative Genomics and Translation Group (S.M.L.), School of Medical and Health Sciences, Edith Cowan University, Joondalup; Curtin Medical School (S.M.L.), Curtin University, Bentley; The Florey Institute of Neuroscience and Mental Health (C.J.F., C.R., C.L.M., P.M.), The University of Melbourne; Centre for Healthy Ageing (S.R.R.-S.), Health Futures Institute, Murdoch University; Australian Alzheimer's Research Foundation (S.R.R.-S., R.N.M.), Sarich Neuroscience Research Institute, Nedlands; School of Psychological Science (S.R.R.-S.), University of Western Australia, Crawley; School of Medical and Health Sciences (S.R.R.-S., R.N.M.), Edith Cowan University, Joondalup; Department of Biomedical Sciences (R.N.M.), Macquarie University, Sydney; Queensland Brain Institute (E.J.C.), and School of Biomedical Sciences (E.J.C.), The University of Queensland, Brisbane; and Cogstate Ltd. (P.M.), Melbourne, Australia
| | - Pierrick Bourgeat
- From the The Australian e-Health Research Centre (Y.X., V.D., J.F., P.B.), CSIRO Health and Biosecurity, Brisbane; Department of Nuclear Medicine and Centre for PET (V.D., C.R.), Austin Health, Melbourne; Centre for Precision Health (S.M.L.), Edith Cowan University; Collaborative Genomics and Translation Group (S.M.L.), School of Medical and Health Sciences, Edith Cowan University, Joondalup; Curtin Medical School (S.M.L.), Curtin University, Bentley; The Florey Institute of Neuroscience and Mental Health (C.J.F., C.R., C.L.M., P.M.), The University of Melbourne; Centre for Healthy Ageing (S.R.R.-S.), Health Futures Institute, Murdoch University; Australian Alzheimer's Research Foundation (S.R.R.-S., R.N.M.), Sarich Neuroscience Research Institute, Nedlands; School of Psychological Science (S.R.R.-S.), University of Western Australia, Crawley; School of Medical and Health Sciences (S.R.R.-S., R.N.M.), Edith Cowan University, Joondalup; Department of Biomedical Sciences (R.N.M.), Macquarie University, Sydney; Queensland Brain Institute (E.J.C.), and School of Biomedical Sciences (E.J.C.), The University of Queensland, Brisbane; and Cogstate Ltd. (P.M.), Melbourne, Australia
| | - Simon M Laws
- From the The Australian e-Health Research Centre (Y.X., V.D., J.F., P.B.), CSIRO Health and Biosecurity, Brisbane; Department of Nuclear Medicine and Centre for PET (V.D., C.R.), Austin Health, Melbourne; Centre for Precision Health (S.M.L.), Edith Cowan University; Collaborative Genomics and Translation Group (S.M.L.), School of Medical and Health Sciences, Edith Cowan University, Joondalup; Curtin Medical School (S.M.L.), Curtin University, Bentley; The Florey Institute of Neuroscience and Mental Health (C.J.F., C.R., C.L.M., P.M.), The University of Melbourne; Centre for Healthy Ageing (S.R.R.-S.), Health Futures Institute, Murdoch University; Australian Alzheimer's Research Foundation (S.R.R.-S., R.N.M.), Sarich Neuroscience Research Institute, Nedlands; School of Psychological Science (S.R.R.-S.), University of Western Australia, Crawley; School of Medical and Health Sciences (S.R.R.-S., R.N.M.), Edith Cowan University, Joondalup; Department of Biomedical Sciences (R.N.M.), Macquarie University, Sydney; Queensland Brain Institute (E.J.C.), and School of Biomedical Sciences (E.J.C.), The University of Queensland, Brisbane; and Cogstate Ltd. (P.M.), Melbourne, Australia
| | - Christopher J Fowler
- From the The Australian e-Health Research Centre (Y.X., V.D., J.F., P.B.), CSIRO Health and Biosecurity, Brisbane; Department of Nuclear Medicine and Centre for PET (V.D., C.R.), Austin Health, Melbourne; Centre for Precision Health (S.M.L.), Edith Cowan University; Collaborative Genomics and Translation Group (S.M.L.), School of Medical and Health Sciences, Edith Cowan University, Joondalup; Curtin Medical School (S.M.L.), Curtin University, Bentley; The Florey Institute of Neuroscience and Mental Health (C.J.F., C.R., C.L.M., P.M.), The University of Melbourne; Centre for Healthy Ageing (S.R.R.-S.), Health Futures Institute, Murdoch University; Australian Alzheimer's Research Foundation (S.R.R.-S., R.N.M.), Sarich Neuroscience Research Institute, Nedlands; School of Psychological Science (S.R.R.-S.), University of Western Australia, Crawley; School of Medical and Health Sciences (S.R.R.-S., R.N.M.), Edith Cowan University, Joondalup; Department of Biomedical Sciences (R.N.M.), Macquarie University, Sydney; Queensland Brain Institute (E.J.C.), and School of Biomedical Sciences (E.J.C.), The University of Queensland, Brisbane; and Cogstate Ltd. (P.M.), Melbourne, Australia
| | - Stephanie R Rainey-Smith
- From the The Australian e-Health Research Centre (Y.X., V.D., J.F., P.B.), CSIRO Health and Biosecurity, Brisbane; Department of Nuclear Medicine and Centre for PET (V.D., C.R.), Austin Health, Melbourne; Centre for Precision Health (S.M.L.), Edith Cowan University; Collaborative Genomics and Translation Group (S.M.L.), School of Medical and Health Sciences, Edith Cowan University, Joondalup; Curtin Medical School (S.M.L.), Curtin University, Bentley; The Florey Institute of Neuroscience and Mental Health (C.J.F., C.R., C.L.M., P.M.), The University of Melbourne; Centre for Healthy Ageing (S.R.R.-S.), Health Futures Institute, Murdoch University; Australian Alzheimer's Research Foundation (S.R.R.-S., R.N.M.), Sarich Neuroscience Research Institute, Nedlands; School of Psychological Science (S.R.R.-S.), University of Western Australia, Crawley; School of Medical and Health Sciences (S.R.R.-S., R.N.M.), Edith Cowan University, Joondalup; Department of Biomedical Sciences (R.N.M.), Macquarie University, Sydney; Queensland Brain Institute (E.J.C.), and School of Biomedical Sciences (E.J.C.), The University of Queensland, Brisbane; and Cogstate Ltd. (P.M.), Melbourne, Australia
| | - Ralph N Martins
- From the The Australian e-Health Research Centre (Y.X., V.D., J.F., P.B.), CSIRO Health and Biosecurity, Brisbane; Department of Nuclear Medicine and Centre for PET (V.D., C.R.), Austin Health, Melbourne; Centre for Precision Health (S.M.L.), Edith Cowan University; Collaborative Genomics and Translation Group (S.M.L.), School of Medical and Health Sciences, Edith Cowan University, Joondalup; Curtin Medical School (S.M.L.), Curtin University, Bentley; The Florey Institute of Neuroscience and Mental Health (C.J.F., C.R., C.L.M., P.M.), The University of Melbourne; Centre for Healthy Ageing (S.R.R.-S.), Health Futures Institute, Murdoch University; Australian Alzheimer's Research Foundation (S.R.R.-S., R.N.M.), Sarich Neuroscience Research Institute, Nedlands; School of Psychological Science (S.R.R.-S.), University of Western Australia, Crawley; School of Medical and Health Sciences (S.R.R.-S., R.N.M.), Edith Cowan University, Joondalup; Department of Biomedical Sciences (R.N.M.), Macquarie University, Sydney; Queensland Brain Institute (E.J.C.), and School of Biomedical Sciences (E.J.C.), The University of Queensland, Brisbane; and Cogstate Ltd. (P.M.), Melbourne, Australia
| | - Christopher Rowe
- From the The Australian e-Health Research Centre (Y.X., V.D., J.F., P.B.), CSIRO Health and Biosecurity, Brisbane; Department of Nuclear Medicine and Centre for PET (V.D., C.R.), Austin Health, Melbourne; Centre for Precision Health (S.M.L.), Edith Cowan University; Collaborative Genomics and Translation Group (S.M.L.), School of Medical and Health Sciences, Edith Cowan University, Joondalup; Curtin Medical School (S.M.L.), Curtin University, Bentley; The Florey Institute of Neuroscience and Mental Health (C.J.F., C.R., C.L.M., P.M.), The University of Melbourne; Centre for Healthy Ageing (S.R.R.-S.), Health Futures Institute, Murdoch University; Australian Alzheimer's Research Foundation (S.R.R.-S., R.N.M.), Sarich Neuroscience Research Institute, Nedlands; School of Psychological Science (S.R.R.-S.), University of Western Australia, Crawley; School of Medical and Health Sciences (S.R.R.-S., R.N.M.), Edith Cowan University, Joondalup; Department of Biomedical Sciences (R.N.M.), Macquarie University, Sydney; Queensland Brain Institute (E.J.C.), and School of Biomedical Sciences (E.J.C.), The University of Queensland, Brisbane; and Cogstate Ltd. (P.M.), Melbourne, Australia
| | - Colin L Masters
- From the The Australian e-Health Research Centre (Y.X., V.D., J.F., P.B.), CSIRO Health and Biosecurity, Brisbane; Department of Nuclear Medicine and Centre for PET (V.D., C.R.), Austin Health, Melbourne; Centre for Precision Health (S.M.L.), Edith Cowan University; Collaborative Genomics and Translation Group (S.M.L.), School of Medical and Health Sciences, Edith Cowan University, Joondalup; Curtin Medical School (S.M.L.), Curtin University, Bentley; The Florey Institute of Neuroscience and Mental Health (C.J.F., C.R., C.L.M., P.M.), The University of Melbourne; Centre for Healthy Ageing (S.R.R.-S.), Health Futures Institute, Murdoch University; Australian Alzheimer's Research Foundation (S.R.R.-S., R.N.M.), Sarich Neuroscience Research Institute, Nedlands; School of Psychological Science (S.R.R.-S.), University of Western Australia, Crawley; School of Medical and Health Sciences (S.R.R.-S., R.N.M.), Edith Cowan University, Joondalup; Department of Biomedical Sciences (R.N.M.), Macquarie University, Sydney; Queensland Brain Institute (E.J.C.), and School of Biomedical Sciences (E.J.C.), The University of Queensland, Brisbane; and Cogstate Ltd. (P.M.), Melbourne, Australia
| | - Elizabeth J Coulson
- From the The Australian e-Health Research Centre (Y.X., V.D., J.F., P.B.), CSIRO Health and Biosecurity, Brisbane; Department of Nuclear Medicine and Centre for PET (V.D., C.R.), Austin Health, Melbourne; Centre for Precision Health (S.M.L.), Edith Cowan University; Collaborative Genomics and Translation Group (S.M.L.), School of Medical and Health Sciences, Edith Cowan University, Joondalup; Curtin Medical School (S.M.L.), Curtin University, Bentley; The Florey Institute of Neuroscience and Mental Health (C.J.F., C.R., C.L.M., P.M.), The University of Melbourne; Centre for Healthy Ageing (S.R.R.-S.), Health Futures Institute, Murdoch University; Australian Alzheimer's Research Foundation (S.R.R.-S., R.N.M.), Sarich Neuroscience Research Institute, Nedlands; School of Psychological Science (S.R.R.-S.), University of Western Australia, Crawley; School of Medical and Health Sciences (S.R.R.-S., R.N.M.), Edith Cowan University, Joondalup; Department of Biomedical Sciences (R.N.M.), Macquarie University, Sydney; Queensland Brain Institute (E.J.C.), and School of Biomedical Sciences (E.J.C.), The University of Queensland, Brisbane; and Cogstate Ltd. (P.M.), Melbourne, Australia
| | - Paul Maruff
- From the The Australian e-Health Research Centre (Y.X., V.D., J.F., P.B.), CSIRO Health and Biosecurity, Brisbane; Department of Nuclear Medicine and Centre for PET (V.D., C.R.), Austin Health, Melbourne; Centre for Precision Health (S.M.L.), Edith Cowan University; Collaborative Genomics and Translation Group (S.M.L.), School of Medical and Health Sciences, Edith Cowan University, Joondalup; Curtin Medical School (S.M.L.), Curtin University, Bentley; The Florey Institute of Neuroscience and Mental Health (C.J.F., C.R., C.L.M., P.M.), The University of Melbourne; Centre for Healthy Ageing (S.R.R.-S.), Health Futures Institute, Murdoch University; Australian Alzheimer's Research Foundation (S.R.R.-S., R.N.M.), Sarich Neuroscience Research Institute, Nedlands; School of Psychological Science (S.R.R.-S.), University of Western Australia, Crawley; School of Medical and Health Sciences (S.R.R.-S., R.N.M.), Edith Cowan University, Joondalup; Department of Biomedical Sciences (R.N.M.), Macquarie University, Sydney; Queensland Brain Institute (E.J.C.), and School of Biomedical Sciences (E.J.C.), The University of Queensland, Brisbane; and Cogstate Ltd. (P.M.), Melbourne, Australia
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