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Hoshi H, Hirata Y, Fukasawa K, Kobayashi M, Shigihara Y. Oscillatory characteristics of resting-state magnetoencephalography reflect pathological and symptomatic conditions of cognitive impairment. Front Aging Neurosci 2024; 16:1273738. [PMID: 38352236 PMCID: PMC10861731 DOI: 10.3389/fnagi.2024.1273738] [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: 08/07/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024] Open
Abstract
Background Dementia and mild cognitive impairment are characterised by symptoms of cognitive decline, which are typically assessed using neuropsychological assessments (NPAs), such as the Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB). Magnetoencephalography (MEG) is a novel clinical assessment technique that measures brain activities (summarised as oscillatory parameters), which are associated with symptoms of cognitive impairment. However, the relevance of MEG and regional cerebral blood flow (rCBF) data obtained using single-photon emission computed tomography (SPECT) has not been examined using clinical datasets. Therefore, this study aimed to investigate the relationships among MEG oscillatory parameters, clinically validated biomarkers computed from rCBF, and NPAs using outpatient data retrieved from hospital records. Methods Clinical data from 64 individuals with mixed pathological backgrounds were retrieved and analysed. MEG oscillatory parameters, including relative power (RP) from delta to high gamma bands, mean frequency, individual alpha frequency, and Shannon's spectral entropy, were computed for each cortical region. For SPECT data, three pathological parameters-'severity', 'extent', and 'ratio'-were computed using an easy z-score imaging system (eZIS). As for NPAs, the MMSE and FAB scores were retrieved. Results MEG oscillatory parameters were correlated with eZIS parameters. The eZIS parameters associated with Alzheimer's disease pathology were reflected in theta power augmentation and slower shift of the alpha peak. Moreover, MEG oscillatory parameters were found to reflect NPAs. Global slowing and loss of diversity in neural oscillatory components correlated with MMSE and FAB scores, whereas the associations between eZIS parameters and NPAs were sparse. Conclusion MEG oscillatory parameters correlated with both SPECT (i.e. eZIS) parameters and NPAs, supporting the clinical validity of MEG oscillatory parameters as pathological and symptomatic indicators. The findings indicate that various components of MEG oscillatory characteristics can provide valuable pathological and symptomatic information, making MEG data a rich resource for clinical examinations of patients with cognitive impairments. SPECT (i.e. eZIS) parameters showed no correlations with NPAs. The results contributed to a better understanding of the characteristics of electrophysiological and pathological examinations for patients with cognitive impairments, which will help to facilitate their co-use in clinical application, thereby improving patient care.
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Affiliation(s)
- Hideyuki Hoshi
- Precision Medicine Centre, Hokuto Hospital, Obihiro, Japan
| | - Yoko Hirata
- Department of Neurosurgery, Kumagaya General Hospital, Kumagaya, Japan
| | | | - Momoko Kobayashi
- Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, Japan
| | - Yoshihito Shigihara
- Precision Medicine Centre, Hokuto Hospital, Obihiro, Japan
- Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, Japan
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Cerebral perfusion and the risk of cognitive decline and dementia in community dwelling older people. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100125. [PMID: 36324415 PMCID: PMC9616444 DOI: 10.1016/j.cccb.2022.100125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/18/2022] [Accepted: 02/19/2022] [Indexed: 11/23/2022]
Abstract
Cerebral blood flow (CBF) and spatial coefficient of variation of the arterial transit time (ATT) are less sensitive markers of cognitive impairment and clinical dementia. Greater white matter hyperintensity volume (WMHV) was consistently associated with cognitive impairment and dementia, rendering it as a more sensitive longitudinal marker.
Background The arterial spin labeling-spatial coefficient of variation (sCoV) is a new vascular magnetic resonance imaging (MRI) parameter that could be a more sensitive marker for dementia-associated cerebral microvascular disease than the commonly used MRI markers cerebral blood flow (CBF) and white matter hyperintensity volume (WMHV). Methods 195 community-dwelling older people with hypertension were invited to undergo MRI twice, with a three-year interval. Cognition was evaluated every two years for 6-8 years using the mini-mental state examination (MMSE). We assessed relations of sCoV, CBF and WMHV with cognitive decline during follow-up. We also registered dementia diagnoses, up to 9 years after the first scan. In an additional analysis, we compared these MRI parameters between participants that did and did not develop dementia. Results 136/195 completed the second scan. sCoV and CBF were not associated with MMSE changes during 6-8 years of follow-up. Higher WMHV was associated with declining MMSE scores (-0.02 points/year/ml, 95%CI=-0.03 to -0.00). ScOv and CBF did not differ between participants who did (n=15) and did not (n=180) develop dementia, whereas higher WMHV was reported in participants who developed dementia after the first MRI (13.3 vs 6.1mL, p<0.001). There were no associations between longitudinal change in any of the MRI parameters and cognitive decline or subsequent dementia. Conclusion Global sCoV and CBF were less sensitive longitudinal markers of cognitive decline and dementia compared to WMHV in community-dwelling older people with hypertension. Larger longitudinal MRI perfusion studies are needed to identify possible (regional) patterns of cerebral perfusion preceding cognitive decline and dementia diagnosis.
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Turowicz A, Czapiga A, Malinowski M, Majcherek J, Litarski A, Janczak D. Carotid Revascularization Improves Cognition in Patients With Asymptomatic Carotid Artery Stenosis and Cognitive Decline. Greater Improvement in Younger Patients With More Disordered Neuropsychological Performance. J Stroke Cerebrovasc Dis 2021; 30:105608. [PMID: 33461024 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105608] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/24/2020] [Accepted: 01/02/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES There has been a growing interest in whether carotid revascularization may reverse cognitive decline. In this study the aim was to assess cognitive changes after carotid artery endarterectomy and stenting, using neuropsychological assessment with MoCA and CANTAB test. MATERIALS AND METHODS Seventy patients with asymptomatic carotid artery stenosis, qualified for CEA (study group A) and CAS (study group B) have been prospectively assessed. 20 patients with lower extremity artery disease (control group C) and 15 patients qualified for inguinal hernia surgery (control group D) have served as a control group. Patients have been evaluated 1 day before surgery and 6 months after, using MoCA and CANTAB test. Logistic regression models were built to determine variables affecting cognitive performance. RESULTS After the procedure in the study group A the cognitive evaluation showed improvement in 5 cognitive domains tested in MoCA: visuospatial/executive (p=.0496), naming (p=.0831), language (p=.0009), abstraction (p=.0126) and delayed recall (p=.0016). In CANTAB there were improvement in PAL (p=.0290) and SWM (p=.0105). In study group B positive cognitive changes were seen in visuospatial/executive (p=.0827) and delayed recall (p=.0041) tested with MoCA and in PAL (PALFAMS28 p=.0315, PALNPR28 p=.0090, PALTEA28 p=.0058) and SWM (p=.0882) tested with CANTAB. Using a regression model, the only strong predictors of cognitive improvement on the follow-up visit were younger age and lower MoCA score on the first visit. CONCLUSIONS Carotid revascularization, both open and endovascular, lead to cognitive improvement in patients with severe carotid stenosis and cognitive decline. This effect seems to be stronger in younger patients with worst cognitive performance before surgery.
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Affiliation(s)
- Agnieszka Turowicz
- Department of Vascular Surgery, 4th Military Teaching Hospital, 5 Weilga street, 50-981 Wrocław, Poland; Department of Vascular, General and Transplant Surgery, Faculty of Medicine, Wrocław Medical University, 213 Borowska street, 50-556 Wrocław, Poland.
| | - Alina Czapiga
- Institute of Psychology, University of Wroclaw, 1 Dawida street, 50-529 Wrocław, Poland.
| | - Maciej Malinowski
- Department of Vascular, General and Transplant Surgery, Faculty of Medicine, Wrocław Medical University, 213 Borowska street, 50-556 Wrocław, Poland.
| | - Jarosław Majcherek
- Department of Vascular Surgery, 4th Military Teaching Hospital, 5 Weilga street, 50-981 Wrocław, Poland.
| | - Andrzej Litarski
- Department of Vascular Surgery, 4th Military Teaching Hospital, 5 Weilga street, 50-981 Wrocław, Poland.
| | - Dariusz Janczak
- Department of Vascular, General and Transplant Surgery, Faculty of Medicine, Wrocław Medical University, 213 Borowska street, 50-556 Wrocław, Poland.
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Saito H, Kashiwakura I, Tsushima M, Mariya Y. Association between Regional Cerebral Blood Flow and Mini-Mental State Examination Score in Patients with Alzheimer's Disease. Curr Med Imaging 2021; 16:1290-1299. [PMID: 32107995 DOI: 10.2174/1573405616666200124125130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/04/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND In patients with Alzheimer's disease (AD), cerebral blood flow (CBF) is decreased from the early stages. CBF in AD is currently estimated from Z-scores using statistical analysis. However, the Z-score is not considered the impaired area ratio. METHODS In the present study, a novel indicator, ΣzS, associated with brain surface area and Zscores, is defined and the association with regional CBF has been estimated using Mini-Mental State Examination (MMSE) scores, which indicate the severity of cognitive impairment in patients with AD. RESULTS A negative correlation was detected between ΣzS in the posterior cingulate gyrus and the subset numbers 1, 2, and 5 of the total MMSE scores. Furthermore, a negative correlation was detected between the total MMSE score and ΣzS in Brodmann area 30, which is a subdivided area of the brain. CONCLUSION These results suggest that ΣzS may be a useful indicator of CBF metabolism, and thus may improve the current understanding of cognitive function in patients with AD.
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Affiliation(s)
- Hitoshi Saito
- Department of Radiology, Akita Kousei Medical Center, Akita, Japan
| | - Ikuo Kashiwakura
- Department of Radiological Life Science, Hirosaki University Graduate School of Health Science, Hirosaki, Aomori, Japan
| | - Megumi Tsushima
- Department of Radiological Life Science, Hirosaki University Graduate School of Health Science, Hirosaki, Aomori, Japan
| | - Yasushi Mariya
- Depatrment of Radiology, Mutsu General Hospital, Mutsu, Aomori, Japan
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Yoshino Y, Koga I, Kitazawa T, Sakurai K, Oba H, Matsuda H, Furui S, Ota Y. Cerebral blood flow in young and middle-aged people living with HIV. Infect Dis (Lond) 2019; 52:75-79. [PMID: 31608759 DOI: 10.1080/23744235.2019.1677939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Purpose: Neurocognitive disorder has been noted as a long-term complication in individuals with HIV. In people living with HIV, regardless of treatment, age-related changes like arteriosclerosis are well-known to be accelerated. Such accelerated aging changes may decrease cerebral blood flow in younger generations with HIV, increasing the rate of occurrence of neurocognitive disorders. We investigated regional cerebral blood flows in well-controlled Japanese people living with HIV under 65 years old to clarify whether age-related changes in regional cerebral blood flows are accelerated in people living with HIV.Method: Japanese male HIV patients >20 years old but <65 years old who visited Teikyo University Hospital between August 2013 and September 2015 were recruited to and enrolled in this study. Healthy coeval male volunteers during the same period were recruited as controls. Magnetic resonance imaging was performed. Twelve regional cerebral blood flows were calculated from pseudocontinuous arterial spine labelling data.Results: Participants in this study comprised 40 individuals with HIV (HIV-positive group) and 33 non-HIV individuals (Control group). Median age was 40.15 years [interquartile range (IQR), 32.80-50.55 years] for the HIV-positive group and 48.00 years [IQR, 37.75-59.25 years; p = 0.3585] for the Control group. No significant differences in regional cerebral blood flows were seen between groups. In the HIV-positive group, cerebral blood flows decreased with age in the neocortex, although no significant decrease was observed in any of the regions in the control group.Conclusions: Significant age-related declines in cerebral blood flows in the neocortex may occur earlier in HIV patients.
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Affiliation(s)
- Yusuke Yoshino
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Ichiro Koga
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Takatoshi Kitazawa
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Keita Sakurai
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Oba
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shigeru Furui
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuo Ota
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.,Department of Internal Medicine, National Hospital Organization Higashi Saitama Hospital, Saitama, Japan
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Temporal and Spatial Changes in Cerebral Blood Flow during Management for Preventing Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: Serial Semiquantitative Analysis. J Stroke Cerebrovasc Dis 2017; 26:2027-2037. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/21/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022] Open
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Baker JG, Williams AJ, Wack DS, Miletich RS. Correlation of cognition and SPECT perfusion: easy Z score and SPM analysis of a pilot sample with cerebral small vessel disease. Dement Geriatr Cogn Disord 2014; 36:290-9. [PMID: 23969991 DOI: 10.1159/000339587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS To associate neuropsychology test performance with perfusion on single-photon emission computed tomography (SPECT) among 12 patients with cerebral small vessel disease. METHODS The easy Z score imaging system (eZIS) was used to compare patient images to those of normal controls. Scores from neuropsychological tests commonly used to screen for dementia were associated with SPECT resting perfusion image values using the statistical parametric mapping (SPM) program. RESULTS Immediate Memory and Delayed Memory index scores, as well as memory subtests of the Repeatable Battery for Assessment of Neuropsychological Status showed cluster- and voxelwise positive correlations with hypoperfusion in frontal, temporal and cerebellar regions. Negative correlations, primarily in frontal regions, were interpreted as compensatory hyperperfusion. CONCLUSION eZIS and SPM analyses of SPECT images showed perfusion correlations with neuropsychological tests with small vessel disease.
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Affiliation(s)
- John G Baker
- Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, N.Y., USA
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Wakamori T, Agari T, Yasuhara T, Kameda M, Kondo A, Shinko A, Sasada S, Sasaki T, Furuta T, Date I. Cognitive functions in Parkinson's disease: Relation to disease severity and hallucination. Parkinsonism Relat Disord 2014; 20:415-20. [DOI: 10.1016/j.parkreldis.2014.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 12/16/2013] [Accepted: 01/04/2014] [Indexed: 10/25/2022]
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Shindo A, Terada S, Sato S, Ikeda C, Nagao S, Oshima E, Yokota O, Uchitomi Y. Trail making test part a and brain perfusion imaging in mild Alzheimer's disease. Dement Geriatr Cogn Dis Extra 2013; 3:202-11. [PMID: 23888166 PMCID: PMC3721127 DOI: 10.1159/000350806] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The Trail Making Test (TMT) has long been used to investigate deficits in cognitive processing speed and executive function in humans. However, there are few studies that elucidate the neural substrates of the TMT. The aim of the present study was to identify the regional perfusion patterns of the brain associated with performance on the TMT part A (TMT-A) in patients with Alzheimer's disease (AD). METHODS Eighteen AD patients with poor performance on the TMT-A and 36 age- and sex-matched AD patients with good performance were selected. All subjects underwent brain single photon emission computed tomography. RESULTS No significant differences between the good and poor performance groups were found with respect to years of education and revised Addenbrooke's Cognitive Examination scores. However, higher z-scores for hypoperfusion in the bilateral superior parietal lobule were observed in the group that scored poorly on the TMT-A compared with the good performance group. CONCLUSION Our results suggest that functional activity of the bilateral superior parietal lobules is closely related to performance time on the TMT-A. Thus, the performance time on the TMT-A might be a promising index of dysfunction of the superior parietal area among mild AD patients.
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Affiliation(s)
- Aki Shindo
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shuhei Sato
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Chikako Ikeda
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shigeto Nagao
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Etsuko Oshima
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Osamu Yokota
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Uchitomi
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Baker JG, Williams AJ, Ionita CC, Lee-Kwen P, Ching M, Miletich RS. Cerebral small vessel disease: cognition, mood, daily functioning, and imaging findings from a small pilot sample. Dement Geriatr Cogn Dis Extra 2012; 2:169-79. [PMID: 22590477 PMCID: PMC3347879 DOI: 10.1159/000333482] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cerebral small vessel disease, a leading cause of cognitive decline, is considered a relatively homogeneous disease process, and it can co-occur with Alzheimer's disease. Clinical reports of magnetic resonance imaging (MRI)/computed tomography and single photon emission computed tomography (SPECT) imaging and neuropsychology testing for a small pilot sample of 14 patients are presented to illustrate disease characteristics through findings from structural and functional imaging and cognitive assessment. Participants showed some decreases in executive functioning, attention, processing speed, and memory retrieval, consistent with previous literature. An older subgroup showed lower age-corrected scores at a single time point compared to younger participants. Performance on a computer-administered cognitive measure showed a slight overall decline over a period of 8–28 months. For a case study with mild neuropsychology findings, the MRI report was normal while the SPECT report identified perfusion abnormalities. Future research can test whether advances in imaging analysis allow for identification of cerebral small vessel disease before changes are detected in cognition.
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Affiliation(s)
- John G Baker
- Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, N.Y., USA
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Moustafa AA. Levodopa enhances reward learning but impairs reversal learning in Parkinson's disease patients. Front Hum Neurosci 2011; 4:240. [PMID: 21289872 PMCID: PMC3031770 DOI: 10.3389/fnhum.2010.00240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 12/30/2010] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ahmed A Moustafa
- Center for Molecular and Behavioral Neuroscience, Rutgers University Newark Newark, NJ, USA
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Chuang WL, Hsieh YC, Wang CY, Kuo HC, Huang CC. Association of apolipoproteins e4 and c1 with onset age and memory: a study of sporadic Alzheimer disease in Taiwan. J Geriatr Psychiatry Neurol 2010; 23:42-8. [PMID: 20145290 DOI: 10.1177/0891988709351804] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify clinical manifestations and neuropsychological effects of Alzheimer disease (AD) in apolipoprotein (ApoE) e4 carriers and to investigate the relationships between ApoE HhaI polymorphism and apolipoprotein C1 (APOC1) HpaI polymorphism in Taiwanese patients with AD. PARTICIPANTS AND METHODS A total of 127 patients with AD and 191 elderly individuals were screened for ApoE and APOC1 polymorphism. All patients underwent neuropsychological testing, including a Mini-Mental Status Examination (MMSE), Clinical Dementia Rating (CDR), and/or the Visual Association Memory Test (VAMT) with Cognitive Abilities Screening Instrument. RESULTS The frequencies of the e4 and A alleles were significantly higher in the AD group. In the patients with AD, the e4 and A allele effects on those with an age-of-onset of 60 to 79 years were stronger than those with an age-of-onset of 80 years or higher. Visual Association Memory Test performance was significantly worse in e4-allele carriers but not in A-allele carriers, in the early AD, particularly in those affected with AD for less than 2 years. Although there was no statistically significant difference in genotypic frequency between patients and controls, the 2 genes were linked. In addition, the presence of the AA genotype concomitant with the e4 allele may be better associated with AD diagnosis than either factor alone. CONCLUSION We conclude that the e4 allele affects neuropsychological performance and illness morbidity. Concomitantly, ApoE e4 and APOC1 A alleles have a better association with AD than ApoE e4 alone. In addition, APOC1 may partially contribute to the pathogenesis of AD, but the nature of its relationship with e4 requires further investigation.
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Affiliation(s)
- Wen-Li Chuang
- Department of Neurology, Chang Gung Memorial Hospital and University, Taipei, Taiwan
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