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Alipour-Haris G, Armstrong MJ, Goodin AJ, Guo JS, Brown JD. End-of-Life Healthcare Utilization in Lewy Body Dementia. J Alzheimers Dis 2024:JAD240194. [PMID: 39121116 DOI: 10.3233/jad-240194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Abstract
Background Lewy body dementia (LBD) is the second most common neurodegenerative dementia in the US, presenting unique end-of-life challenges. Objective This study examined healthcare utilization and care continuity in the last year of life in LBD. Methods Medicare claims for enrollees with LBD, continuously enrolled in the year preceding death, were examined from 2011-2018. We assessed hospital stays, emergency department (ED) visits, intensive care unit (ICU) admissions, life-extending procedures, medications, and care continuity. Results We identified 45,762 LBD decedents, predominantly female (51.8%), White (85.9%), with average age of 84.1 years (SD 7.5). There was a median of 2 ED visits (IQR 1-5) and 1 inpatient stay (IQR 0-2). Higher age was inversely associated with ICU stays (Odds Ratio [OR] 0.96; 95% Confidence Interval [CI] 0.96-0.97) and life-extending procedures (OR 0.96; 95% CI 0.95-0.96). Black and Hispanic patients experienced higher rates of ED visits, inpatient hospitalizations, ICU admissions, life-extending procedures, and in-hospital deaths relative to White patients. On average, 15 (7.5) medications were prescribed in the last year. Enhanced care continuity correlated with reduced hospital (OR 0.72; 95% CI 0.70-0.74) and ED visits (OR 0.71; 95% CI 0.69-0.87) and fewer life-extending procedures (OR 0.71; 95% CI 0.64-0.79). Conclusions This study underscored the complex healthcare needs of people with LBD during their final year, which was influenced by age and race. Care continuity may reduce hospital and ED visits and life-extending procedures.
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Affiliation(s)
- Golnoosh Alipour-Haris
- Center of Drug Evaluation & Safety and Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Melissa J Armstrong
- Departments of Neurology and Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
- Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | - Amie J Goodin
- Center of Drug Evaluation & Safety and Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Jingchuan Serena Guo
- Center of Drug Evaluation & Safety and Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Joshua D Brown
- Center of Drug Evaluation & Safety and Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
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Ikeda M, Toya S, Manabe Y, Yamakage H, Hashimoto M. Post hoc analysis of the characteristics and treatment needs of patients with dementia with Lewy bodies (DLB) and their caregivers and their physicians' awareness of those treatment needs according to the duration after diagnosis of DLB. Int J Geriatr Psychiatry 2024; 39:e6122. [PMID: 39085743 DOI: 10.1002/gps.6122] [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: 02/28/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES To investigate the differences in patient/caregiver characteristics, their treatment needs, and the attending physician's understanding of those treatment needs according to the duration after diagnosis of dementia with Lewy bodies (DLB). METHODS This was a post hoc analysis of a multicenter, cross-sectional, questionnaire survey study. A total of 263 patient-caregiver pairs were reclassified into two groups according to the median duration after diagnosis of DLB as follows: short (<24 months; S-group) and long (≥24 months; L-group) post-DLB diagnosis duration. Treatment need was defined as the symptom domain that caused the patient or caregiver the most distress. Concordance rates between patient-physician and caregiver-physician were calculated for physicians' understanding of treatment needs. RESULTS In this analysis, 126 pairs (32 physicians) and 137 pairs (34 physicians) were classified as the S- and L-groups, respectively. Patient and caregiver characteristics were broadly similar between groups (mean age for patients 78.7 ± 6.6 vs. 79.8 ± 6.7, for caregivers 64.7 ± 12.9 vs. 64.9 ± 12.8; number of male/female for patients 61/65 vs. 67/70, for caregivers 34/92 vs. 38/99), but the prevalence of parkinsonism (82.5% vs. 66.7%) and autonomic dysfunction (49.6% vs. 33.3%), severity of parkinsonism (MDS-UPDRS Part III total scores, 29.2 ± 22.6 vs. 18.0 ± 16.4; Part II total score, 14.6 ± 12.0 vs. 7.6 ± 7.9), and caregiver burden (J-ZBI_8 score, 9.1 ± 6.7 vs. 7.5 ± 5.8) were higher in the L-group than the S-group. Regarding treatment needs, the invalid answer rates for patients were 34.9% and 46.8%, and those for caregivers were 28.6% and 34.9% in the S- and L groups, respectively. Patients' treatment needs did not significantly differ (p = 0.056), but S-group patients were more likely to select cognitive impairment (p = 0.045) as their treatment need, whereas L-group patients were more likely to select parkinsonism (p = 0.003). Caregivers' treatment needs significantly differed (p = 0.032) between groups. S-group caregivers were more likely to select cognitive impairment (p = 0.001), whereas L-group caregivers were more likely to select other symptom domains such as parkinsonism (S-group vs. L-group: 10.3% vs. 16.7%), psychiatric symptoms (20.6% vs. 24.6%), sleep-related disorder (4.0% vs. 7.1%), and autonomic dysfunction (4.8% vs. 9.5%). Concordance rates between patient-physician and caregiver-physician were low in both groups. CONCLUSIONS There were some differences in characteristics according to the duration after diagnosis of DLB. Cognitive dysfunction may be a particular concern for patients and caregivers soon after diagnosis of DLB. Treatment needs of patients and caregivers for parkinsonism, psychiatric symptoms, sleep-related disorder, or autonomic dysfunction were different according to the duration after diagnosis of DLB. Physicians' perception of patients'/caregivers' treatment needs was poor regardless of the duration after diagnosis of DLB. CLINICAL TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN000041844).
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Affiliation(s)
- Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shunji Toya
- Medical Science, Sumitomo Pharma Co., Ltd., Chuo-ku, Tokyo, Japan
| | - Yuta Manabe
- Department of Advanced Clinical Medicine, Division of Dementia and Geriatric Medicine, Kanagawa Dental University School of Dentistry, Yokosuka, Kanagawa, Japan
| | - Hajime Yamakage
- Insight Clinical Development Group, 3H Medi Solution Inc., Toshima-ku, Tokyo, Japan
| | - Mamoru Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
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Sghaier I, Nasri A, Atrous A, Abida Y, Gharbi A, Souissi A, Mrabet S, Ben Djebara M, Kacem I, Gargouri-Berrechid A, Gouider R. Clinical and molecular predictors of survival among atypical parkinsonian syndromes in a North African tertiary referral center. J Neurol Sci 2024; 464:123155. [PMID: 39106638 DOI: 10.1016/j.jns.2024.123155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION Atypical Parkinsonian Syndromes(APS) are challenging neurodegenerative disorders due to their heterogeneous phenotypic overlaps.So far,there are no validated biomarkers that can accurately predict disease progression,and survival studies were highly different and contradictory. AIM To investigate clinical and molecular survival factors among Tunisian APS patients. METHODS A retrospective study included Tunisian APS-patients.Using clinical and molecular parameters,survival was explored by Kaplan-Meier analysis. RESULTS We included 409-APS patients divided into 166-DLB,112-PSP,81-MSA and 50-CBS.Survival rate was similar in synucleinopathies, while it differed in tauopathies,being shorter in PSP compared to CBS.Median survival in DLB was different according to gender(p = 0.0048),early parkinsonism and cognitive disorders. Among MSA, prognosis was worse in MSA-C-patients(p = 0.012) and those with stridor(p = 0.0049),oculomotor and neuropsychiatric disorders. For tauopathies, survival was shorter in PSP-RS(p = 0.027),cerebellar phenotype, those with tremor and swallowing problems at onset, early parkinsonism and memory impairment. For CBS,prognosis was worse in patients with tremor,swallowing and cognitive problems.Significant differences were noted in terms of survival across APS non-carriers of APOE-ε4(p < 0.001) as well APS patients carriers of MAPT-H1.PSP patients had lower survival rate according to MAPT haplotype carriage. Moreover, the number of copies had an influence as patients with H1/H2-MAPT profile had better prognosis than those with H1/H1. CONCLUSION This study determined survival rates in APS subgroups,which were comparable across synucleinopathies but shorter in PSP and longer in CBS.It also characterized demographic,phenotypic,and genetic profiles identifying more aggressive forms within APS subgroups.These findings address clinical gaps,aiding counseling for patients and families and guiding clinical management.Furthermore,they could facilitate patient stratification in clinical trials where mortality is an outcome measure.
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Affiliation(s)
- Ikram Sghaier
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia
| | - Amina Nasri
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Amal Atrous
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia
| | - Youssef Abida
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Alya Gharbi
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Amira Souissi
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Saloua Mrabet
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Mouna Ben Djebara
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Imen Kacem
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Amina Gargouri-Berrechid
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Riadh Gouider
- Neurology Department, LR18SP03, Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 Rue des Orangers Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia.
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Hamilton CA, Donaghy PC, Durcan R, Ciafone J, Olsen K, Roberts G, Firbank MJ, Allan LM, Taylor JP, O'Brien JT, Thomas AJ. Outcomes of Patients With Mild Cognitive Impairment With Lewy Bodies or Alzheimer Disease at 3 and 5 Years After Diagnosis. Neurology 2024; 103:e209499. [PMID: 38870460 PMCID: PMC11244743 DOI: 10.1212/wnl.0000000000209499] [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: 12/19/2023] [Accepted: 03/26/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Retrospective studies indicate that dementia with Lewy bodies (DLB) may be preceded by a mild cognitive impairment (MCI) prodrome. Research criteria for the prospective identification of MCI with Lewy bodies (MCI-LB) have been developed. We aimed to assess the prognosis of a prospectively identified MCI-LB cohort at 2 key milestones, 3- and 5 years after diagnosis, to examine classification stability over time and rates of adverse outcomes (dementia or death). METHODS This was a retrospective examination of data from 2 longitudinal observational cohort studies where participants with MCI were prospectively recruited from North East England and differentially classified as MCI due to Alzheimer disease (MCI-AD), possible MCI-LB, or probable MCI-LB. Adverse outcomes (DLB/other dementia or death) and stability of disease-specific classifications were examined in each group. RESULTS Of 152 participants with baseline MCI (54 MCI-AD, 29 possible MCI-LB, and 69 probable MCI-LB), 126 were followed for up to 3 years (mean age 75.3 years; 40% female). We found that prospective probable MCI-LB classifications were both sensitive (91%) and specific (94%) to classifications either remaining as probable MCI-LB or progressing to DLB (in some cases autopsy confirmed) for 3 or more years after. Classifications were at least as stable as those in MCI-AD. In this cohort with disease-specific MCI classifications, rates of progression to dementia were high: 55% of MCI-LB had developed DLB within 3 years. Dementia occurred in 47% of MCI-AD over the same duration (odds ratio 1.68, 95% CI 0.66-4.26, p = 0.278). Premature death was a common competing risk, occurring in 9% of MCI-AD and 11% of MCI-LB within 3 years. DISCUSSION These findings support that prospectively identified probable MCI-LB is a prodromal presentation of DLB and that disease-specific classifications of MCI may reliably identify different prodromal dementias.
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Affiliation(s)
- Calum A Hamilton
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Paul C Donaghy
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Rory Durcan
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Joanna Ciafone
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Kirsty Olsen
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Gemma Roberts
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Michael J Firbank
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Louise M Allan
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - John-Paul Taylor
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - John T O'Brien
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Alan J Thomas
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
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Vrillon A, Bousiges O, Götze K, Demuynck C, Muller C, Ravier A, Schorr B, Philippi N, Hourregue C, Cognat E, Dumurgier J, Lilamand M, Cretin B, Blanc F, Paquet C. Plasma biomarkers of amyloid, tau, axonal, and neuroinflammation pathologies in dementia with Lewy bodies. Alzheimers Res Ther 2024; 16:146. [PMID: 38961441 PMCID: PMC11221164 DOI: 10.1186/s13195-024-01502-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: 03/12/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Increasing evidence supports the use of plasma biomarkers of amyloid, tau, neurodegeneration, and neuroinflammation for diagnosis of dementia. However, their performance for positive and differential diagnosis of dementia with Lewy bodies (DLB) in clinical settings is still uncertain. METHODS We conducted a retrospective biomarker study in two tertiary memory centers, Paris Lariboisière and CM2RR Strasbourg, France, enrolling patients with DLB (n = 104), Alzheimer's disease (AD, n = 76), and neurological controls (NC, n = 27). Measured biomarkers included plasma Aβ40/Aβ42 ratio, p-tau181, NfL, and GFAP using SIMOA and plasma YKL-40 and sTREM2 using ELISA. DLB patients with available CSF analysis (n = 90) were stratified according to their CSF Aβ profile. RESULTS DLB patients displayed modified plasma Aβ ratio, p-tau181, and GFAP levels compared with NC and modified plasma Aβ ratio, p-tau181, GFAP, NfL, and sTREM2 levels compared with AD patients. Plasma p-tau181 best differentiated DLB from AD patients (ROC analysis, area under the curve [AUC] = 0.80) and NC (AUC = 0.78), and combining biomarkers did not improve diagnosis performance. Plasma p-tau181 was the best standalone biomarker to differentiate amyloid-positive from amyloid-negative DLB cases (AUC = 0.75) and was associated with cognitive status in the DLB group. Combining plasma Aβ ratio, p-tau181 and NfL increased performance to identify amyloid copathology (AUC = 0.79). Principal component analysis identified different segregation patterns of biomarkers in the DLB and AD groups. CONCLUSIONS Amyloid, tau, neurodegeneration and neuroinflammation plasma biomarkers are modified in DLB, albeit with moderate diagnosis performance. Plasma p-tau181 can contribute to identify Aβ copathology in DLB.
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Affiliation(s)
- Agathe Vrillon
- AP-HP Nord, Cognitive Neurology Center Hôpital Lariboisière-Fernand Widal, Université Paris Cité, 200 rue du Faubourg Saint-Denis, Paris, 75010, France.
- Université Paris Cité, INSERM, UMRS 1144, Paris, France.
- University of California San Francisco, San Francisco, USA.
| | - Olivier Bousiges
- Laboratory of Biochemistry and Molecular Biology, University Hospital of Strasbourg, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS Strasbourg, Strasbourg, France
| | - Karl Götze
- Université Paris Cité, INSERM, UMRS 1144, Paris, France
| | - Catherine Demuynck
- CM2R (Memory Resource and Research Centre), Service of Gerontology Mobile-Neuro-Psy-Research, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
| | - Candice Muller
- CM2R (Memory Resource and Research Centre), Service of Gerontology Mobile-Neuro-Psy-Research, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
| | - Alix Ravier
- CM2R (Memory Resource and Research Centre), Service of Gerontology Mobile-Neuro-Psy-Research, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
| | - Benoît Schorr
- CM2R (Memory Resource and Research Centre), Service of Gerontology Mobile-Neuro-Psy-Research, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
| | - Nathalie Philippi
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS Strasbourg, Strasbourg, France
- CM2R (Memory Resource and Research Centre), Service of Gerontology Mobile-Neuro-Psy-Research, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
- Neuropsychology unit, Service of Neurology Strasbourg, University Hospital of Strasbourg, Strasbourg, France
| | - Claire Hourregue
- AP-HP Nord, Cognitive Neurology Center Hôpital Lariboisière-Fernand Widal, Université Paris Cité, 200 rue du Faubourg Saint-Denis, Paris, 75010, France
| | - Emmanuel Cognat
- AP-HP Nord, Cognitive Neurology Center Hôpital Lariboisière-Fernand Widal, Université Paris Cité, 200 rue du Faubourg Saint-Denis, Paris, 75010, France
- Université Paris Cité, INSERM, UMRS 1144, Paris, France
| | - Julien Dumurgier
- AP-HP Nord, Cognitive Neurology Center Hôpital Lariboisière-Fernand Widal, Université Paris Cité, 200 rue du Faubourg Saint-Denis, Paris, 75010, France
| | - Matthieu Lilamand
- AP-HP Nord, Cognitive Neurology Center Hôpital Lariboisière-Fernand Widal, Université Paris Cité, 200 rue du Faubourg Saint-Denis, Paris, 75010, France
| | - Benjamin Cretin
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS Strasbourg, Strasbourg, France
- CM2R (Memory Resource and Research Centre), Service of Gerontology Mobile-Neuro-Psy-Research, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
- Neuropsychology unit, Service of Neurology Strasbourg, University Hospital of Strasbourg, Strasbourg, France
| | - Frédéric Blanc
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS Strasbourg, Strasbourg, France
- CM2R (Memory Resource and Research Centre), Service of Gerontology Mobile-Neuro-Psy-Research, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
- Neuropsychology unit, Service of Neurology Strasbourg, University Hospital of Strasbourg, Strasbourg, France
| | - Claire Paquet
- AP-HP Nord, Cognitive Neurology Center Hôpital Lariboisière-Fernand Widal, Université Paris Cité, 200 rue du Faubourg Saint-Denis, Paris, 75010, France
- Université Paris Cité, INSERM, UMRS 1144, Paris, France
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Bolsewig K, van Unnik AAJM, Blujdea ER, Gonzalez MC, Ashton NJ, Aarsland D, Zetterberg H, Padovani A, Bonanni L, Mollenhauer B, Schade S, Vandenberghe R, Poesen K, Kramberger MG, Paquet C, Bousiges O, Cretin B, Willemse EAJ, Teunissen CE, Lemstra AW. Association of Plasma Amyloid, P-Tau, GFAP, and NfL With CSF, Clinical, and Cognitive Features in Patients With Dementia With Lewy Bodies. Neurology 2024; 102:e209418. [PMID: 38830138 PMCID: PMC11244745 DOI: 10.1212/wnl.0000000000209418] [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: 09/15/2023] [Accepted: 04/19/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Plasma β-amyloid-1-42/1-40 (Aβ42/40), phosphorylated-tau (P-tau), glial fibrillary acidic protein (GFAP), and neurofilament light (NfL) have been widely examined in Alzheimer disease (AD), but little is known about their reflection of copathologies, clinical importance, and predictive value in dementia with Lewy bodies (DLB). We aimed to evaluate associations of these biomarkers with CSF amyloid, cognition, and core features in DLB. METHODS This cross-sectional multicenter cohort study with prospective component included individuals with DLB, AD, and healthy controls (HCs), recruited from 2002 to 2020 with an annual follow-up of up to 5 years, from the European-Dementia With Lewy Bodies consortium. Plasma biomarkers were measured by single-molecule array (Neurology 4-Plex E kit). Amyloid status was determined by CSF Aβ42 concentrations, and cognition was assessed by Mini-Mental State Examination (MMSE). Biomarker differences across groups, associations with amyloid status, and clinical core features were assessed by analysis of covariance. Associations with cognitive impairment and decline were assessed by linear regression and linear mixed-effects models. RESULTS In our cohort consisting of 562 individuals (HC n = 89, DLB n = 342, AD n = 131; 250 women [44.5%], mean [SD] age of 71 [8] years), sex distribution did not differ between groups. Patients with DLB were significantly older, and had less years of education and worse baseline cognition than HC, but not AD. DLB participants stratified for amyloid status differed significantly in plasma Aβ42/40 ratio (decreased in amyloid abnormal: β = -0.008, 95% CI -0.016 to -0.0003, p = 0.01) and P-tau (increased in amyloid abnormal, P-tau181: β = 0.246, 95% CI 0.011-0.481; P-tau231: β = 0.227, 95% CI 0.035-0.419, both p < 0.05), but not in GFAP (β = 0.068, 95% CI -0.018 to 0.153, p = 0.119), and NfL (β = 0.004, 95% CI -0.087 to 0.096, p = 0.923) concentrations. Higher baseline GFAP, NfL, and P-tau concentrations were associated with lower MMSE scores in DLB, and GFAP and NfL were associated with a faster cognitive decline (GFAP: annual change of -2.11 MMSE points, 95% CI -2.88 to -1.35 MMSE points, p < 0.001; NfL: annual change of -2.13 MMSE points, 95% CI -2.97 to -1.29 MMSE points, p < 0.001). DLB participants with parkinsonism had higher concentrations of NfL (β = 0.08, 95% CI 0.02-0.14, p = 0.006) than those without. DISCUSSION Our study suggests a possible utility of plasma Aβ42/40, P-tau181, and P-tau231 as a noninvasive biomarkers to assess amyloid copathology in DLB, and plasma GFAP and NfL as monitoring biomarkers for cognitive symptoms in DLB.
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Affiliation(s)
- Katharina Bolsewig
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Annemartijn A J M van Unnik
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Elena R Blujdea
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Maria C Gonzalez
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Nicholas J Ashton
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Dag Aarsland
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Henrik Zetterberg
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Alessandro Padovani
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Laura Bonanni
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Brit Mollenhauer
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Sebastian Schade
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Rik Vandenberghe
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Koen Poesen
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Milica G Kramberger
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Claire Paquet
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Olivier Bousiges
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Benjamin Cretin
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Eline A J Willemse
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Charlotte E Teunissen
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Afina W Lemstra
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
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7
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Mekkes NJ, Groot M, Hoekstra E, de Boer A, Dagkesamanskaia E, Bouwman S, Wehrens SMT, Herbert MK, Wever DD, Rozemuller A, Eggen BJL, Huitinga I, Holtman IR. Identification of clinical disease trajectories in neurodegenerative disorders with natural language processing. Nat Med 2024; 30:1143-1153. [PMID: 38472295 PMCID: PMC11031398 DOI: 10.1038/s41591-024-02843-9] [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: 03/03/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
Neurodegenerative disorders exhibit considerable clinical heterogeneity and are frequently misdiagnosed. This heterogeneity is often neglected and difficult to study. Therefore, innovative data-driven approaches utilizing substantial autopsy cohorts are needed to address this complexity and improve diagnosis, prognosis and fundamental research. We present clinical disease trajectories from 3,042 Netherlands Brain Bank donors, encompassing 84 neuropsychiatric signs and symptoms identified through natural language processing. This unique resource provides valuable new insights into neurodegenerative disorder symptomatology. To illustrate, we identified signs and symptoms that differed between frequently misdiagnosed disorders. In addition, we performed predictive modeling and identified clinical subtypes of various brain disorders, indicative of neural substructures being differently affected. Finally, integrating clinical diagnosis information revealed a substantial proportion of inaccurately diagnosed donors that masquerade as another disorder. The unique datasets allow researchers to study the clinical manifestation of signs and symptoms across neurodegenerative disorders, and identify associated molecular and cellular features.
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Affiliation(s)
- Nienke J Mekkes
- Department of Biomedical Sciences, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Machine Learning Lab, Data Science Center in Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Minke Groot
- The Netherlands Brain Bank, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Eric Hoekstra
- Department of Biomedical Sciences, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alyse de Boer
- Department of Biomedical Sciences, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ekaterina Dagkesamanskaia
- Department of Biomedical Sciences, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Machine Learning Lab, Data Science Center in Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sander Bouwman
- Department of Biomedical Sciences, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sophie M T Wehrens
- The Netherlands Brain Bank, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Megan K Herbert
- The Netherlands Brain Bank, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Dennis D Wever
- The Netherlands Brain Bank, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | | | - Bart J L Eggen
- Department of Biomedical Sciences, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge Huitinga
- The Netherlands Brain Bank, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Inge R Holtman
- Department of Biomedical Sciences, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Machine Learning Lab, Data Science Center in Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- The Netherlands Brain Bank, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.
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8
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Burgio MI, Veronese N, Sarà D, Saccaro C, Masnata R, Vassallo G, Catania A, Catanese G, Mueller C, Smith L, Dominguez LJ, Vernuccio L, Barbagallo M. Markers for the detection of Lewy body disease versus Alzheimer's disease in mild cognitive impairment: a systematic review and meta-analysis. Aging Clin Exp Res 2024; 36:60. [PMID: 38451331 PMCID: PMC10920203 DOI: 10.1007/s40520-024-02704-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: 11/29/2023] [Accepted: 01/17/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Mild cognitive impairment (MCI) may evolve into dementia. Early recognition of possible evolution to Alzheimer's disease (AD) and dementia with Lewy Bodies (DLB) is of importance, but actual diagnostic criteria have some limitations. In this systematic review and meta-analysis, we aimed to find the most accurate markers that can discriminate patients with DLB versus AD, in MCI stage. METHODS We searched several databases up to 17 August 2023 including studies comparing markers that may distinguish DLB-MCI from AD-MCI. We reported data regarding sensitivity, specificity, and the area under the curves (AUCs) with their 95% confidence intervals (CIs). RESULTS Among 2219 articles initially screened, eight case-control studies and one cohort study were included for a total of 832 outpatients with MCI. The accuracy of cerebrospinal fluid (CSF) markers was the highest among the markers considered (AUC > 0.90 for the CSF markers), with the AUC of CSF Aβ42/Aβ40 of 0.94. The accuracy for clinical symptom scales was very good (AUC = 0.93), as evaluated in three studies. Although limited to one study, the accuracy of FDG-PET (cingulate island sign ratio) was very good (AUC = 0.95) in discriminating DLB from AD in MCI, while the accuracy of SPECT markers and EEG frequencies was variable. CONCLUSIONS Few studies have assessed the accuracy of biomarkers and clinical tools to distinguish DLB from AD at the MCI stage. While results are promising for CSF markers, FDG-PET and clinical symptoms scales, more studies, particularly with a prospective design, are needed to evaluate their accuracy and clinical usefulness. CLINICAL TRIAL REGISTRATION Prospero (CRD42023422600).
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Affiliation(s)
- Marianna Ilarj Burgio
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Nicola Veronese
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy.
| | - Davide Sarà
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Carlo Saccaro
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Roberta Masnata
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Giusy Vassallo
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Angela Catania
- International School of Advanced Studies, University of Camerino, Camerino, Italy
| | - Giuseppina Catanese
- Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Christoph Mueller
- South London and Maudsley National Health Service Foundation Trust, London, UK
- Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Ligia Juliana Dominguez
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Laura Vernuccio
- Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Mario Barbagallo
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
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Chen A, Li Q, Huang Y, Li Y, Chuang YN, Hu X, Guo S, Wu Y, Guo Y, Bian J. Feasibility of Identifying Factors Related to Alzheimer's Disease and Related Dementia in Real-World Data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.10.24302621. [PMID: 38405723 PMCID: PMC10889002 DOI: 10.1101/2024.02.10.24302621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
A comprehensive view of factors associated with AD/ADRD will significantly aid in studies to develop new treatments for AD/ADRD and identify high-risk populations and patients for prevention efforts. In our study, we summarized the risk factors for AD/ADRD by reviewing existing meta-analyses and review articles on risk and preventive factors for AD/ADRD. In total, we extracted 477 risk factors in 10 categories from 537 studies. We constructed an interactive knowledge map to disseminate our study results. Most of the risk factors are accessible from structured Electronic Health Records (EHRs), and clinical narratives show promise as information sources. However, evaluating genomic risk factors using RWD remains a challenge, as genetic testing for AD/ADRD is still not a common practice and is poorly documented in both structured and unstructured EHRs. Considering the constantly evolving research on AD/ADRD risk factors, literature mining via NLP methods offers a solution to automatically update our knowledge map.
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Affiliation(s)
- Aokun Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Qian Li
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Yu Huang
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Yongqiu Li
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Yu-Neng Chuang
- Department of Computer Science, George R. Brown School of Engineering, Rice University, 6100 Main St., Houston, TX 77005
| | - Xia Hu
- Department of Computer Science, George R. Brown School of Engineering, Rice University, 6100 Main St., Houston, TX 77005
| | - Serena Guo
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL 32610
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
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Guo Y, Ren J, Cui W, Dahmani L, Wang D, Fu X, Li M, Li S, Zhang Y, Lin X, Zhen Z, Xu Y, Xie D, Guan H, Yi F, Wang J, Shi Q, Liu H. Personalized brain MRI revealed distinct functional and anatomical disruptions in Creutzfeldt-Jakob disease and Alzheimer's disease. CNS Neurosci Ther 2024; 30:e14404. [PMID: 37577861 PMCID: PMC10848072 DOI: 10.1111/cns.14404] [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: 04/18/2023] [Revised: 07/01/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023] Open
Abstract
AIMS Creutzfeldt-Jakob disease (CJD) is a lethal neurodegenerative disorder, which leads to a rapidly progressive dementia. This study aimed to examine the cortical alterations in CJD, changes in these brain characteristics over time, and the differences between CJD and Alzheimer's disease (AD) that show similar clinical manifestations. METHODS To obtain reliable, subject-specific functional measures, we acquired 24 min of resting-state fMRI data from each subject. We applied an individual-based approach to characterize the functional brain organization of 10 patients with CJD, 8 matched patients with AD, and 8 normal controls. We measured cortical atrophy as well as disruption in resting-state functional connectivity (rsFC) and then investigated longitudinal brain changes in a subset of CJD patients. RESULTS CJD was associated with widespread cortical thinning and weakened rsFC. Compared with AD, CJD showed distinct atrophy patterns and greater disruptions in rsFC. Moreover, the longitudinal data demonstrated that the progressive cortical thinning and disruption in rsFC mainly affected the association rather than the primary cortex in CJD. CONCLUSIONS CJD shows unique anatomical and functional disruptions in the cerebral cortex, distinct from AD. Rapid progression of CJD affects both the cortical thickness and rsFC in the association cortex.
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Affiliation(s)
- Yanjun Guo
- Department of NeurologyBeijing Tongren Hospital, Capital Medical UniversityBeijingChina
| | | | - Weigang Cui
- School of Engineering MedicineBeihang UniversityBeijingChina
| | - Louisa Dahmani
- Department of RadiologyAthinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusettsUSA
| | - Danhong Wang
- Department of RadiologyAthinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusettsUSA
| | | | | | - Shiyi Li
- Changping LaboratoryBeijingChina
| | - Yi Zhang
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Xue Lin
- Department of NeurologyBeijing Tongren Hospital, Capital Medical UniversityBeijingChina
| | - Zhen Zhen
- Department of NeurologyBeijing Tongren Hospital, Capital Medical UniversityBeijingChina
| | - Yichen Xu
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Dan Xie
- Department of NeurologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Hongzhi Guan
- Department of NeurologyPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Fang Yi
- Department of NeurologyLishilu Outpatient, Jingzhong Medical District, Chinese PLA General HospitalBeijingChina
| | - Jiawei Wang
- Department of NeurologyBeijing Tongren Hospital, Capital Medical UniversityBeijingChina
| | - Qi Shi
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Viral Disease Control and PreventionChinese Center for Disease Control and PreventionBeijingChina
| | - Hesheng Liu
- Changping LaboratoryBeijingChina
- Biomedical Pioneering Innovation CenterPeking UniversityBeijingChina
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Goddard TR, Brookes KJ, Sharma R, Moemeni A, Rajkumar AP. Dementia with Lewy Bodies: Genomics, Transcriptomics, and Its Future with Data Science. Cells 2024; 13:223. [PMID: 38334615 PMCID: PMC10854541 DOI: 10.3390/cells13030223] [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: 12/14/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
Dementia with Lewy bodies (DLB) is a significant public health issue. It is the second most common neurodegenerative dementia and presents with severe neuropsychiatric symptoms. Genomic and transcriptomic analyses have provided some insight into disease pathology. Variants within SNCA, GBA, APOE, SNCB, and MAPT have been shown to be associated with DLB in repeated genomic studies. Transcriptomic analysis, conducted predominantly on candidate genes, has identified signatures of synuclein aggregation, protein degradation, amyloid deposition, neuroinflammation, mitochondrial dysfunction, and the upregulation of heat-shock proteins in DLB. Yet, the understanding of DLB molecular pathology is incomplete. This precipitates the current clinical position whereby there are no available disease-modifying treatments or blood-based diagnostic biomarkers. Data science methods have the potential to improve disease understanding, optimising therapeutic intervention and drug development, to reduce disease burden. Genomic prediction will facilitate the early identification of cases and the timely application of future disease-modifying treatments. Transcript-level analyses across the entire transcriptome and machine learning analysis of multi-omic data will uncover novel signatures that may provide clues to DLB pathology and improve drug development. This review will discuss the current genomic and transcriptomic understanding of DLB, highlight gaps in the literature, and describe data science methods that may advance the field.
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Affiliation(s)
- Thomas R. Goddard
- Mental Health and Clinical Neurosciences Academic Unit, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK
| | - Keeley J. Brookes
- Department of Biosciences, School of Science & Technology, Nottingham Trent University, Nottingham NG11 8NS, UK
| | - Riddhi Sharma
- Biodiscovery Institute, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
- UK Health Security Agency, Radiation Effects Department, Radiation Protection Science Division, Harwell Science Campus, Didcot, Oxfordshire OX11 0RQ, UK
| | - Armaghan Moemeni
- School of Computer Science, University of Nottingham, Nottingham NG8 1BB, UK
| | - Anto P. Rajkumar
- Mental Health and Clinical Neurosciences Academic Unit, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK
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Zhu CW, Grossman HT, Elder GA, Rosen H, Sano M. Apathy in Lewy body disease and its effects on functional impairment over time. Front Neurol 2024; 15:1339190. [PMID: 38313558 PMCID: PMC10835801 DOI: 10.3389/fneur.2024.1339190] [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: 11/15/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Background and objectives Apathy strongly affects function in Alzheimer's disease and frontotemporal dementia, however its effect on function in Lewy Body Disease (LBD) has not been well-described. This study aims to (1) examine the prevalence and persistence of apathy in a large, national cohort of well-characterized patients with LBD, and (2) estimate the effect of apathy on function over time. Methods Study included 676 participants with mild cognitive impairment (MCI) or dementia in the National Alzheimer's Coordinating Center Uniform Data Set. Participants were followed for an average of 3.4 ± 1.7 years and consistently had a primary diagnosis of LBD. Apathy was defined by clinician judgment, categorized into four mutually exclusive profiles: (1) never apathetic across all visits, (2) at least one but <50% of visits with apathy (intermittent apathy), (3) ≥50% but not all visits with apathy (persistent apathy), and (4) always apathy across all visits. Dementia severity was measured by baseline Clinical Dementia Rating score. Parkinsonism was defined by the presence of bradykinesia, resting tremor, rigidity, gait, and postural instability. Functional impairment was assessed using the Functional Assessment Questionnaire (FAQ). Results Baseline characteristics of the sample were: average age = 72.9 ± 6.9, years of education = 15.6 ± 3.4, Mini Mental State Exam (MMSE) = 24.4 ± 5.4, Geriatric Depression Scale (GDS) = 3.8 ± 3.2, FAQ = 12.0 ± 9.1. 78.8% were male and 89% were non-Hispanic white. Prevalence of apathy increased from 54.4% at baseline to 65.5% in year 4. 77% of participants had apathy at some point during follow-up. Independent of cognitive status and parkinsonian features, FAQ was significantly higher in participants with intermittent/persistent and always apathetic than never apathetic. Annual rate of decline in FAQ was faster in participants who were always apathetic than never apathy. Discussion In this large national longitudinal cohort of LBD patients with cognitive impairment, apathy was strongly associated with greater functional impairment at baseline and faster rate of decline over time. The magnitude of these effects were clinically important and were observed beyond the effects on function from participants' cognitive status and parkinsonism, highlighting the importance of specifically assessing for apathy in LBD.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Hillel T. Grossman
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gregory A. Elder
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Howie Rosen
- Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, United States
| | - Mary Sano
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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13
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Liu J, Li X, Yu W, Liu B, Yu W, Zhang W, Hu C, Qin Z, Chen Y, Lü Y. Prediction of survival of persons with advanced dementia using the advanced dementia prognostic tool: A 2-year prospective study. Geriatr Nurs 2024; 55:64-70. [PMID: 37976557 DOI: 10.1016/j.gerinurse.2023.11.005] [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: 07/21/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND In this prospective study, we evaluated the usefulness of the advanced dementia prognostic tool (ADEPT) for estimating the 2-year survival of persons with advanced dementia (AD) in China. METHODS The study predicted the 2-year mortality of 115 persons with AD using the ADEPT score. RESULTS In total, 115 persons with AD were included in the study. Of these persons, 48 died. The mean ADEPT score was 13.0. The AUROC for the prediction of the 2-year mortality rate using the ADEPT score was 0.62. The optimal threshold of the ADEPT score was 11.2, which had an AUROC of 0.63, specificity of 41.8, and sensitivity of 83.3. CONCLUSIONS The ADEPT score based on a threshold of 11.2 may serve as a prognostic tool to determine the 2-year survival rate of persons with AD in Chongqing, China. However, further studies are needed to explore the nature of this relationship.
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Affiliation(s)
- Junjin Liu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xuebing Li
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Weihua Yu
- Institutes of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Bei Liu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wuhan Yu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wenbo Zhang
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Cheng Hu
- Institutes of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Zhangjin Qin
- Institutes of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Yu Chen
- Institutes of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Yang Lü
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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de Melo Queiroz E, Marques Couto C, da Cruz Mecone CA, Souza Lima Macedo W, Caramelli P. Clinical profile and survival analysis of Alzheimer's disease patients in a Brazilian cohort. Neurol Sci 2024; 45:129-137. [PMID: 37540343 DOI: 10.1007/s10072-023-06937-z] [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: 02/21/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To investigate the clinical and epidemiological characteristics of a large sample of patients with dementia due to Alzheimer's disease (AD) who were followed up at a cognitive neurology outpatient clinic. METHODS Retrospective, longitudinal, and descriptive design. We collected data from patients with dementia due to AD who visited the outpatient clinic of the SARAH Network of Rehabilitation Hospitals in Rio de Janeiro, Brazil, between May 2009 and June 2019. The evaluated characteristics included age of onset, sex, education, family history, comorbidities, time until diagnosis, and survival rates. RESULTS Overall, 1434 patients were evaluated, 74% of whom were women, with a mean age at symptom onset of 72.7 years and 75.8 at diagnosis. A positive family history was reported in 602 patients, with a first-degree relative in 86.3% of them. Hypertension was the most prevalent comorbidity, affecting 61.2% of the sample, and 16.2% were classified as having early-onset AD. The mean survival rate for the sample population was 112.8 months (9.4 years). The sample population was positively affected by dyslipidaemia. CONCLUSIONS This study presents a clinical and epidemiological analysis of a large and diverse group of patients with AD. The study confirms previous observations such as a higher prevalence of AD in women, low education among sufferers, and the presence of a family history. The study also found that comorbidities significantly affected patient survival and provides new data on the survival rates of patients with early and late AD in the Brazilian population.
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Affiliation(s)
- Elisa de Melo Queiroz
- SARAH Network of Rehabilitation Hospitals, Avenida Abelardo Bueno, 1500, Jacarepaguá, Rio de Janeiro, RJ, 22775-040, Brazil.
| | - Christian Marques Couto
- SARAH Network of Rehabilitation Hospitals, Avenida Abelardo Bueno, 1500, Jacarepaguá, Rio de Janeiro, RJ, 22775-040, Brazil
| | - Cláudio Antônio da Cruz Mecone
- SARAH Network of Rehabilitation Hospitals, Avenida Abelardo Bueno, 1500, Jacarepaguá, Rio de Janeiro, RJ, 22775-040, Brazil
| | - Waneska Souza Lima Macedo
- SARAH Network of Rehabilitation Hospitals, Avenida Abelardo Bueno, 1500, Jacarepaguá, Rio de Janeiro, RJ, 22775-040, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte, 30130-100, Brazil
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Tolea MI, Ezzeddine R, Camacho S, Galvin JE. Emerging drugs for dementia with Lewy Bodies: a review of Phase II & III trials. Expert Opin Emerg Drugs 2023; 28:167-180. [PMID: 37531299 DOI: 10.1080/14728214.2023.2244425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Despite faster cognitive decline and greater negative impact on patients and family caregivers, drug development efforts in Dementia with Lewy Bodies (DLB) fall behind those for Alzheimer's Disease (AD). Current off-label drug DLB treatment options are limited to symptomatic agents developed to address cognitive deficits in AD, motor deficits in Parkinson's Disease, or behavioral symptoms in psychiatric disease. Aided by recent improvements in DLB diagnosis, a new focus on the development of disease-modifying agents (DMA) is emerging. AREAS COVERED Driven by evidence supporting different pathological mechanisms in DLB and PDD, this review assesses the evidence on symptomatic drug treatments and describes current efforts in DMA development in DLB. Specifically, our goals were to: (1) review evidence supporting the use of symptomatic drug treatments in DLB; (2) review the current DMA pipeline in DLB with a focus on Phase II and III clinical trials; and (3) identify potential issues with the development of DMA in DLB. Included in this review were completed and ongoing drug clinical trials in DLB registered on ClinicalTrials.gov (no time limits set for the search) or disseminated at the 2023 international conference on Clinical Trials in AD. Drug clinical trials registered in non-US clinical trial registries were not included. EXPERT OPINION Adoption of current symptomatic drug treatments used off-label in DLB relied on efficacy of benefits in other disorders rather than evidence from randomized controlled clinical trials. Symptoms remain difficult to manage. Several DMA drugs are currently being evaluated as either repurposing candidates or novel small molecules. Continued improvement in methodological aspects including development of DLB-specific outcome measures and biomarkers is needed to move the field of DMA drug development forward.
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Affiliation(s)
- Magdalena I Tolea
- Comprehensive Center for Brain Health, Lewy Body Dementia Research Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Reem Ezzeddine
- Comprehensive Center for Brain Health, Lewy Body Dementia Research Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Simone Camacho
- Comprehensive Center for Brain Health, Lewy Body Dementia Research Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Lewy Body Dementia Research Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Myrstad C, Engdahl BL, Costafreda SG, Krokstad S, Lin F, Livingston G, Strand BH, Øhre B, Selbæk G. Hearing impairment and risk of dementia in The HUNT Study (HUNT4 70+): a Norwegian cohort study. EClinicalMedicine 2023; 66:102319. [PMID: 38192588 PMCID: PMC10772264 DOI: 10.1016/j.eclinm.2023.102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 01/10/2024] Open
Abstract
Background Hearing impairment is strongly associated with future dementia. No studies have reported objectively measured hearing impairment in a cohort with a long period of follow-up (>20 years), and few have reported follow-up over 10 years. Hence, there is a need for high quality studies with sufficient follow-up time and data to account for reverse causality and confounding. We aimed to address this knowledge gap. Methods This cohort study used individual participant data from The Trøndelag Health Study (HUNT) in Norway. All current residents aged at least 20 years in the former Norwegian Nord-Trøndelag County were invited to participate in four decennial surveys: HUNT1 (1984-1986), HUNT2 (1995-1997), HUNT3 (2006-2008), and HUNT4 (2017-2019) with individuals aged at least 70 years included in a substudy, known as HUNT4 70+. Here, we report the findings of this substudy. HUNT4 70+ comprised 7135 participants who were assessed for dementia using the Diagnostic and Statistical Manual of Mental Disorders 5 criteria and who had audiometry between 1996 and 1998. The primary objective was to investigate, with gold standard audiometric testing and dementia diagnostic assessment, whether hearing impairment was an independent risk factor for all-cause dementia. The secondary objective was to investigate if a risk also applied to Alzheimer dementia and non-Alzheimer dementia. We analysed the association using Poisson regression and adjusted for confounders. This study is registered with ClinicalTrials.gov (NCT04284384). Findings At baseline, 1058 (15%) individuals had acquired hearing impairment with a hearing threshold of at least 25 decibel (dB) and, at follow-up, 1089 (15%) had dementia. In the total group, people with hearing impairment had a relative risk (RR) 1.04 (95% confidence interval (CI) 1.00-1.09) per 10 dB increase in hearing thresholds. For individuals younger than 85 years at follow-up the RR was 1.12 (95% CI 1.05-1.21). Associations between hearing impairment and Alzheimer dementia and non-Alzheimer dementia were similar. There was no association for individuals aged at least 85 years. Interpretation We found a moderate association between objectively measured hearing impairment and dementia in the younger age group (<85 years). The findings of no association in the older age group (≥85 years) might be due to the competing risk of death. The present study adds to the literature showing that acquired hearing impairment is a risk for dementias over a period which is too long for reverse causation, and with thorough consideration of confounders. Further research is needed to investigate associations between the different aetiologies of hearing loss and dementia subtypes, and risk differences for sexes. Funding The Norwegian National Centre for Ageing and Health with a grant from Health South-East.
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Affiliation(s)
- Christian Myrstad
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Bo Lars Engdahl
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Sergi Gonzales Costafreda
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Steinar Krokstad
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Frank Lin
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Bjørn Heine Strand
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Beate Øhre
- The Norwegian National Unit for Sensory Loss and Mental Health, Oslo University Hospital, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Gharbi A, Nasri A, Sghaier I, Kacem I, Mrabet S, Souissi A, Ben Djebara M, Gargouri A, Gouider R. Subtypes of Dementia with Lewy Bodies: Clinical Features, Survival, and Apolipoprotein E Effect. J Alzheimers Dis Rep 2023; 7:1277-1288. [PMID: 38143772 PMCID: PMC10741894 DOI: 10.3233/adr-230064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/01/2023] [Indexed: 12/26/2023] Open
Abstract
Background Dementia with Lewy bodies (DLB) is a progressive neurodegenerative disease with various clinical symptoms. Limited data have described the clinical subtypes of DLB. Objective We aimed to compare clinical subtypes of DLB according to initial symptoms and to study the effect of Apolipoprotein E (APOE) gene in DLB. Methods We included DLB patients classified into three groups based on initial symptoms: non-motor onset (cognitive and/or psychiatric) (NMO-DLB), motor onset (parkinsonism and/or gait disorders) (MO-DLB), and mixed onset (non-motor and motor symptoms) (MXO-DLB). Clinical and APOE genotype associations and survival were analyzed. Results A total of 268 patients were included (NMO-DLB = 75%, MXO-DLB = 15.3%, MO-DLB = 9.7%). Visual hallucinations were more frequent (p = 0.025), and attention was less commonly impaired in MXO-DLB (p = 0.047). When adjusting with APOE ɛ4 status (APOE genotype performed in 155 patients), earlier falls and frontal lobe syndrome were more common in MXO-DLB (p = 0.044 and p = 0.023, respectively). The median MMSE decline was 2.1 points/year and the median FAB decline was 1.9 points/year, with no effect of clinical subtypes. Median survival was 6 years. It was similar in DLB subtypes (p = 0.62), but shorter for patients with memory symptoms at onset (p = 0.04) and for males (p = 0.0058). Conclusions Our study revealed a few differences between DLB clinical subtypes. APOE ɛ4 appears to be associated with earlier falls and a higher prevalence of frontal syndrome in MXO-DLB. However, DLB clinical subtypes did not impact on survival. Nevertheless, survival analysis identified other poor prognosis factors, notably inaugural memory impairment and male gender.
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Affiliation(s)
- Alya Gharbi
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Amina Nasri
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Ikram Sghaier
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Imen Kacem
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Saloua Mrabet
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Amira Souissi
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Mouna Ben Djebara
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Amina Gargouri
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Riadh Gouider
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
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Harvey J, Pishva E, Chouliaras L, Lunnon K. Elucidating distinct molecular signatures of Lewy body dementias. Neurobiol Dis 2023; 188:106337. [PMID: 37918758 DOI: 10.1016/j.nbd.2023.106337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/15/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023] Open
Abstract
Dementia with Lewy bodies and Parkinson's disease dementia are common neurodegenerative diseases that share similar neuropathological profiles and spectra of clinical symptoms but are primarily differentiated by the order in which symptoms manifest. The question of whether a distinct molecular pathological profile could distinguish these disorders is yet to be answered. However, in recent years, studies have begun to investigate genomic, epigenomic, transcriptomic and proteomic differences that may differentiate these disorders, providing novel insights in to disease etiology. In this review, we present an overview of the clinical and pathological hallmarks of Lewy body dementias before summarizing relevant research into genetic, epigenetic, transcriptional and protein signatures in these diseases, with a particular interest in those resolving "omic" level changes. We conclude by suggesting future research directions to address current gaps and questions present within the field.
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Affiliation(s)
- Joshua Harvey
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Ehsan Pishva
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Leonidas Chouliaras
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Specialist Dementia and Frailty Service, Essex Partnership University NHS Foundation Trust, Epping, UK
| | - Katie Lunnon
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
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Sugimoto T, Sakurai T, Noguchi T, Komatsu A, Nakagawa T, Ueda I, Osawa A, Lee S, Shimada H, Kuroda Y, Fujita K, Matsumoto N, Uchida K, Kishino Y, Ono R, Arai H, Saito T. Developing a predictive model for mortality in patients with cognitive impairment. Int J Geriatr Psychiatry 2023; 38:e6020. [PMID: 37909125 DOI: 10.1002/gps.6020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES We developed a predictive model for all-cause mortality and examined the risk factors for cause-specific mortality among people with cognitive impairment in a Japanese memory clinic-based cohort (2010-2018). METHODS This retrospective cohort study included people aged ≥65 years with mild cognitive impairment or dementia. The survival status was assessed based on the response of participants or their close relatives via a postal survey. Potential predictors including demographic and lifestyle-related factors, functional status, and behavioral and psychological status were assessed at the first visit at the memory clinic. A backward stepwise Cox regression model was used to select predictors, and a predictive model was developed using a regression coefficient-based scoring approach. The discrimination and calibration were assessed via Harrell's C-statistic and a calibration plot, respectively. RESULTS A total of 2610 patients aged ≥65 years (men, 38.3%) were analyzed. Over a mean follow-up of 4.1 years, 544 patients (20.8%) died. Nine predictors were selected from the sociodemographic and clinical variables: age, sex, body mass index, gait performance, physical activity, and ability for instrumental activities of daily living, cognitive function, and self-reported comorbidities (pulmonary disease and diabetes). The model showed good discrimination and calibration for 1-5-year mortality (Harrell's C-statistic, 0.739-0.779). Some predictors were specifically associated with cause-specific mortality. CONCLUSIONS This predictive model has good discriminative ability for 1- to 5-year mortality and can be easily implemented for people with mild cognitive impairment and all stages of dementia referred to a memory clinic.
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Affiliation(s)
- Taiki Sugimoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
- Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taiji Noguchi
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ayane Komatsu
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takeshi Nakagawa
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ikue Ueda
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Aiko Osawa
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Sangyoon Lee
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiroyuki Shimada
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yujiro Kuroda
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kosuke Fujita
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Nanae Matsumoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kazuaki Uchida
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Yoshinobu Kishino
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rei Ono
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Tami Saito
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
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Conceição SDS, de Carvalho DSB, Batista JET, Lyrio AO, Souza ES, de Matos PJDS, Hintz AM, da Cruz SS, Gomes-Filho IS, Figueiredo ACMG. Temporal Trends in Mortality from Alzheimer's Disease in Federal District, Brazil: An Ecological Study (2010-2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6713. [PMID: 37754573 PMCID: PMC10530803 DOI: 10.3390/ijerph20186713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Neuropsychiatric diseases, particularly dementias, has become more prominent with a great impact on the quality of life of the elderly population. OBJECTIVE To verify the rate of increase in mortality due to Alzheimer's disease in the Federal District, Brazil from 2010 to 2018. METHOD An ecological study was conducted, with a time series, about the evolution of the mortality coefficient in the Federal District, Brazil carried out at the Federal District State Department of Health. Mortality rates were defined as the dependent variable and years evaluated as the independent variable-from 2010 to 2018. For temporal trend analysis, the Prais-Winsten linear regression model was used and the increment rate with the respective 95% confidence interval was estimated. RESULTS From 2010 to 2018, 1665 deaths which had Alzheimer's disease as the underlying cause were recorded in the Mortality Information System. The results showed an overall mortality rate of 6.55 deaths per 100,000 inhabitants, with a higher predominance in females, non-Black people, and those aged 80 years or older. There was an increase in the annual trend of the overall mortality coefficient in both sexes. CONCLUSION The findings demonstrated a significant increase in the temporal evolution of mortality due to Alzheimer's disease in the Federal District, Brazil. It was recommended to conduct original studies to evaluate the factors that can cause the disease in order to collaborate in the process of formulating policies in the area of public health and improvements in clinical practice.
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Affiliation(s)
| | | | | | | | - Elivan Silva Souza
- Department of Health, University of Brasília, Brasília 70910-900, Brazil
| | | | - Alexandre Marcelo Hintz
- Department of Health, Feira de Santana State University, Feira de Santana 44036-900, Bahia, Brazil
| | - Simone Seixas da Cruz
- Department of Epidemiology, Federal University of Recôncavo of Bahia, Santo Antônio de Jesus 44574-490, Bahia, Brazil
| | - Isaac Suzart Gomes-Filho
- Department of Health, Feira de Santana State University, Feira de Santana 44036-900, Bahia, Brazil
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Martin NB, Sekiya H, Kim M, Dickson DW, Koga S. Brain Bank Questionnaire Helps in Differential Diagnosis of Movement Disorders: An Autopsy Study of 150 Patients. Mov Disord Clin Pract 2023; 10:1131-1135. [PMID: 37476322 PMCID: PMC10354613 DOI: 10.1002/mdc3.13788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 07/22/2023] Open
Abstract
Background As part of the CurePSP brain donation program, a questionnaire was developed to gather basic clinical information on donors; however, its usefulness has not been evaluated. Objective To assess the value of information obtained from the questionnaire in differentiating between parkinsonian disorders. Methods We reviewed 150 questionnaires, including 50 patients, each with a neuropathologic diagnosis of Lewy body disease (LBD), multiple system atrophy (MSA), or progressive supranuclear palsy. The frequency of clinical features recorded in the questionnaires was compared for the three disorders, and a machine learning algorithm was used to identify features predicting neuropathologic diagnosis. Results The information from the questionnaires correlated with core clinical features for each disorder, such as hallucinations for LBD and autonomic dysfunction for MSA. Hallucinations and disorientations were identified as the key variables that contributed most to the prediction of neuropathology. Conclusion The questionnaire provides useful clinical information for clinicopathological correlative studies.
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Affiliation(s)
| | - Hiroaki Sekiya
- Department of Neuroscience, Mayo ClinicJacksonvilleFloridaUSA
| | - Minji Kim
- Department of Artificial Intelligence and Informatics Research, Mayo ClinicJacksonvilleFloridaUSA
| | | | - Shunsuke Koga
- Department of Neuroscience, Mayo ClinicJacksonvilleFloridaUSA
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Mutlay F, Kaya D, Ates Bulut E, Akpınar Söylemez B, Öntan MS, Isık AT. Validation of the Turkish version of the Lewy body composite risk score. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-7. [PMID: 37183974 DOI: 10.1080/23279095.2023.2212393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The Lewy Body Composite Risk Score (LBCRS) has been developed to increase the sensitivity and specificity of the diagnosis attributable to Lewy body pathology outside of specialty centers. We aimed to assess the validity and reliability of the Turkish version of the LBCRS in patients with dementia with Lewy Bodies (DLB) and investigate the discriminative power of the test in Turkish patients with Alzheimer's disease (AD) and DLB, and control group. The sample population (n = 512) comprised DLB (n = 113), DLB-Mild Cognitive Impairment (MCI)(n = 12), AD (n = 42), AD-MCI (n = 21), and control group (n = 324). A significant group difference was observed in the Turkish version of the LBCRS scores of the five groups (p < .001). The Cronbach's α value was 0.82 (95% CI: 0.799-0.868). The test-retest reliability score of the scale was r = 0.94 and p < .001. The subscales of the LBCRS (motor and nonmotor subdomains of the disease) were determined to explain 65.961% of the total variance with an eigenvalue >1. In patients with DLB, the cutoff score of ≥3 showed sensitivity (92%) and specificity (81%) (area under the curve [AUC] = 0.883, 95% CI: 0.815-0.951), p < .001) compared with the AD. Compared to the control group, the cutoff score of ≥3 showed a sensitivity of 98% and specificity of 97% (AUC = 0.994, 95% CI: 0.989-0.999, p < .001). The Turkish version of LBCRS permits accurate diagnosis of DLB with high sensitivity and specificity. Also, it can be useful to inform the caregivers regarding the course of the disease during the follow-up.
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Affiliation(s)
- Feyza Mutlay
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
- The Geriatric Science Association, Izmir, Turkey
| | - Derya Kaya
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
- The Geriatric Science Association, Izmir, Turkey
| | - Esra Ates Bulut
- The Geriatric Science Association, Izmir, Turkey
- Department of Geriatric Medicine, Adana City Research and Training Hospital, Adana, Turkey
| | - Burcu Akpınar Söylemez
- Department of Internal Medicine Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Mehmet Selman Öntan
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
- The Geriatric Science Association, Izmir, Turkey
| | - Ahmet Turan Isık
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
- The Geriatric Science Association, Izmir, Turkey
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Javanshiri K, Drakenberg T, Haglund M, Englund E. Sudden cardiac death in synucleinopathies. J Neuropathol Exp Neurol 2023; 82:242-249. [PMID: 36668680 PMCID: PMC9941831 DOI: 10.1093/jnen/nlad001] [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] [Indexed: 01/22/2023] Open
Abstract
The purpose of this study was to investigate the cause of death in subjects with α-synucleinopathies (ASs) and the confirmed presence of cardiac α-synuclein (α-syn), compared to non-AS disorders in a neuropathologically confirmed cohort. In total, 78 neuropathologically confirmed AS cases positive for cardiac α-syn were included in the study. Individuals with other neurocognitive diseases, having no α-syn in the brainstem or above, nor in cardiac nerves, served as controls (n = 53). Data regarding the cause of death, cardiac α-syn, pathological cardiac findings, and cardio- and cerebrovascular disease were assembled from autopsy reports and medical records. In the AS group, there was a significantly higher prevalence of sudden cardiac death ([SCD]; n = 40, 51.3%) compared to the control group (n = 12, 22.6%, p < 0.001). No statistically significant differences between the groups were reported regarding other cardiac conditions on autopsy or regarding cardio- and cerebrovascular disease from the medical records. The most prevalent cause of death in the AS group was SCD, which differed significantly from the control group. This suggests that α-syn deposits in cardiac nerves may cause lethal alterations in cardiac function, warranting further research.
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Affiliation(s)
- Keivan Javanshiri
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Tove Drakenberg
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Mattias Haglund
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Elisabet Englund
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Ono R, Sakurai T, Sugimoto T, Uchida K, Nakagawa T, Noguchi T, Komatsu A, Arai H, Saito T. Mortality Risks and Causes of Death by Dementia Types in a Japanese Cohort with Dementia: NCGG-Stories. J Alzheimers Dis 2023; 92:487-498. [PMID: 36776074 PMCID: PMC10041427 DOI: 10.3233/jad-221290] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Prognosis-related information regarding dementia needs to be updated, as changes in medical and long-term care environments for patients with dementia in recent decades may be improving the prognosis of the disease. OBJECTIVE We aimed to investigate the mortality, cause of death, and prognostic factors by types of dementia in a Japanese clinic-based cohort. METHODS The National Center for Geriatrics and Gerontology-Life Stories of People with Dementia consists of clinical records and prognostic data of patients who visited the Memory Clinic in Japan. Patients who attended the clinic between July 2010 and September 2018, or their close relatives, were asked about death information via a postal survey. A cohort of 3,229 patients (mean age, 76.9; female, 1,953) was classified into six groups: normal cognition (NC), mild cognitive impairment (MCI), Alzheimer's disease (AD), vascular dementia, dementia with Lewy bodies (DLB), and frontotemporal lobar degeneration. A Cox proportional hazards model was employed to compare the mortality of each type of dementia, MCI, and NC. RESULTS Patients with all types of dementia and MCI had higher mortality rates than those with NC (hazard risks: 2.61-5.20). The most common cause of death was pneumonia, followed by cancer. In the MCI, AD, and DLB groups, older age, male sex, and low cognitive function were common prognostic factors but not presence of apolipoprotein E ɛ4 allele. CONCLUSION Our findings suggest important differences in the mortality risk and cause of death among patients with dementia, which will be useful in advanced care planning and policymaking.
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Affiliation(s)
- Rei Ono
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.,Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan.,Department of Public Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan.,Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan.,Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Taiki Sugimoto
- Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan.,Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Kazuaki Uchida
- Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan.,Department of Public Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Takeshi Nakagawa
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Taiji Noguchi
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Ayane Komatsu
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Tami Saito
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
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Satış NK, Naharcı Mİ. Predictors of two-year mortality in patients with dementia with Lewy bodies. Turk J Med Sci 2023; 53:366-373. [PMID: 36945932 PMCID: PMC10388063 DOI: 10.55730/1300-0144.5593] [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: 07/26/2022] [Accepted: 12/13/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Data on adverse prognostic factors for mortality in patients with dementia with Lewy bodies (DLB) are limited. The objective of this study was to evaluate two-year mortality predictors in patients with DLB. METHODS : Individuals aged ≥ 60 years with a diagnosis of DLB, followed by a tertiary-referral geriatric outpatient clinic from 2006 to 2021, were assessed retrospectively using medical or patient records. The mortality status of the patients in the second year after diagnosis was determined. Demographic and clinical characteristics were reviewed to determine their impact on mortality prediction. RESULTS A total of 108 patients with DLB participated in this study. The mean age was 78.9 ± 6.6 years, and 49.1% were females. At the end of the two-year follow-up, 23 patients (21.3%) died and 85 patients (78.7%) were still alive. Malnutrition, and cognitive and functional impairments were significantly more common in the mortality group. Age, female sex, functional impairment, moderateto-severe clinical dementia rating, and malnutrition were associated with an increased mortality risk. On the multivariable analysis, malnutrition (HR = 5.00; 95% CI: 1.64-15.24; p: 0.005) was the only independent predictor of two-year-mortality. DISCUSSION Patients with DLB had an unfavorable survival outcomes. Approaches to prevent malnutrition can improve prognosis and reduce early mortality in this vulnerable group. However, further studies are needed to determine mortality risk factors in this population.
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Chandler J, Georgieva M, Desai U, Kirson N, Lane H, Cheung HC, Westermeyer B, Biglan K. Disease Progression and Longitudinal Clinical Outcomes of Lewy Body Dementia in the NACC Database. Neurol Ther 2023; 12:177-195. [PMID: 36378462 PMCID: PMC9837351 DOI: 10.1007/s40120-022-00417-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION As the identification of Lewy body dementia (LBD) is often confirmed postmortem, there is a paucity of evidence on the progression of disease antemortem. This study aimed to comprehensively assess the course of LBD over time across cognitive, functional, and neuropsychiatric outcomes using real-world data. METHODS Adults with at least one visit to an Alzheimer's Disease Center with a diagnosis of mild cognitive impairment/dementia (index date), indication of LBD, and at least one follow-up visit were identified in the National Alzheimer's Coordinating Center database (September 2005-June 2020). Participant characteristics, medication use, comorbidities, and changes in outcomes were assessed over a 5-year follow-up period and stratified by disease severity based on the Clinical Dementia Rating (CDR®) Dementia Staging Instrument-Sum of Boxes (CDR-SB) score at index. RESULTS A total of 2052 participants with LBD (mean age at index 73.4 years) were included (mild, 219; moderate, 988; severe, 845). Mean annualized increase over 5 years was 0.9 points for CDR-Global Score, 5.6 points for CDR-SB, 10.4 points for the Functional Activities Questionnaire, and 2.0 points for the Neuropsychiatric Inventory-Questionnaire. Disease progression was greater among participants with moderate and severe LBD at index compared with those with mild LBD. CONCLUSION Participants with LBD experienced decline across all outcomes over time, and impairment increased with disease severity. Findings highlight the substantial clinical burden associated with LBD and the importance of earlier diagnosis and effective treatment. Further research is needed to understand the predictors of cognitive and functional decline in LBD which may help inform clinical trials.
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Affiliation(s)
| | - Mihaela Georgieva
- Analysis Group, Inc, 111 Huntington Avenue, Floor 14, Boston, MA, 02199, USA
| | - Urvi Desai
- Analysis Group, Inc, 111 Huntington Avenue, Floor 14, Boston, MA, 02199, USA.
| | - Noam Kirson
- Analysis Group, Inc, 111 Huntington Avenue, Floor 14, Boston, MA, 02199, USA
| | - Henry Lane
- Analysis Group, Inc, 111 Huntington Avenue, Floor 14, Boston, MA, 02199, USA
| | - Hoi Ching Cheung
- Analysis Group, Inc, 111 Huntington Avenue, Floor 14, Boston, MA, 02199, USA
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Characterising the prodromal phase in dementia with Lewy bodies. Parkinsonism Relat Disord 2023; 107:105279. [PMID: 36630737 DOI: 10.1016/j.parkreldis.2023.105279] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Three presentations of prodromal dementia with Lewy bodies (DLB) have recently been proposed. This study investigates the frequency of symptoms in the prodromal phase of DLB. METHOD Patients diagnosed with DLB between the 1st of February 2017 and 1st of February 2021 were retrospectively identified and matched to a group of patients diagnosed with Alzheimer's disease (AD). Patient case files were reviewed identifying the first symptoms and symptoms in the prodromal phase (cognitive impairment, psychiatric symptoms, delirium/acute confusional episodes, RBD, motor symptoms indicative of Parkinson's disease, anosmia, and autonomic dysfunction). RESULTS A total of 166 DLB patient and 168 AD patients were included. Of the proposed presentations in patients diagnosed with DLB, 30% presented with cognitive impairment at onset in isolation, 6% with psychiatric symptoms, and 2% with delirium/acute confusional episodes. Prodromal DLB was more likely to present with no cognitive symptoms at initial presentation (38% vs 10%) and was more likely to involve other symptoms (69% vs 26%). Of other possible presentations, Rapid eye-movement sleep Behaviour Disorder (RBD) was found at onset in 22% with a mean prodromal length of 8.4 years (all symptoms: mean 4.3 years, SD 5.8). CONCLUSION We found some supportive evidence of the proposed cognitive and psychiatric presentations of prodromal DLB. Our findings build on previous findings that an RBD presentation exist, and further research is needed to characterise this presentation.
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Bayram E, Holden SK, Fullard M, Armstrong MJ. Race and Ethnicity in Lewy Body Dementia: A Narrative Review. J Alzheimers Dis 2023; 94:861-878. [PMID: 37355902 PMCID: PMC10448838 DOI: 10.3233/jad-230207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
Lewy body dementia is the third most common and costliest type of dementia. It is an umbrella term for dementia with Lewy bodies and Parkinson's disease dementia, both of which place a substantial burden on the person and society. Recent findings outline ethnoracial differences in dementia risk. Delayed and misdiagnosis across ethnoracial groups contribute to higher levels of burden. In this context, we aimed to summarize current knowledge, gaps, and unmet needs relating to race and ethnicity in Lewy body dementia. In this narrative review, we provide an overview of studies on Lewy body dementia focusing on differences across ethnoracial groups and outline several recommendations for future studies. The majority of the findings comparing different ethnoracial groups were from North American sites. There were no differences in clinical prevalence and progression across ethnoracial groups. Compared to people identifying as non-Hispanic White, co-pathologies were more common and clinical diagnostic accuracy was lower for people identifying as Black. Co-morbidities (e.g., diabetes, hypertension) were more common and medication use rates (e.g., antidepressants, antiparkinsonian agents) were lower for people identifying as Black or Hispanic compared to people identifying as White. More than 90% of clinical trial participants identified as non-Hispanic White. Despite increasing efforts to overcome disparities in Alzheimer's disease and related dementias, inclusion of individuals from minoritized communities in Lewy body dementia studies continues to be limited and the findings are inconclusive. Representation of diverse populations is crucial to improve the diagnostic and therapeutic efforts in Lewy body dementia.
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Affiliation(s)
- Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michelle Fullard
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
- Fixel Institute for Neurological Diseases, Gainesville, FL, USA
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Soysal P, Koc Okudur S, Uslu F, Smith L. Functional loss and worsening geriatric assessment parameters are more common in dementia with Lewy bodies than Alzheimer's disease. Psychogeriatrics 2023; 23:77-85. [PMID: 36349708 DOI: 10.1111/psyg.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/08/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The main aim of this study was to compare older patients with Alzheimer's disease (AD) to those with dementia with Lewy bodies (DLB) according to their dependency in daily living activities and comprehensive geriatric assessment parameters. METHOD A total of 227 AD and 123 DLB patients underwent a geriatric assessment that included comorbidities, number of drugs used, falls, urinary incontinence, hand grip strength, Mini-Nutritional Assessment (MNA), Tinetti Performance Oriented Mobility Assessment Scale, Insomnia Severity Index (ISI), and Epworth Sleepiness Scale. Basic and instrumental activities of daily living were assessed by the Barthel Index and the Lawton scale, respectively. RESULTS The mean age of the participants was 83.4 years, and 73% were female. There were no statistically significant differences between AD and DLB patients in age, gender, cognitive function, or comorbidities except for coronary artery disease (P < 0.05). The number of falls, drugs used, and ISI and Epworth scores were higher in patients with DLB than patients with AD (P < 0.05). DLB patients had lower MNA, Tinetti scale, and hand grip strength scores than AD patients. The ratio of patients highly dependent in basic daily activities as a whole was significantly greater in DLB than in AD (P < 0.05), but there was no significant difference in the overall levels of dependency in instrumental activities. CONCLUSION DLB patients are more dependent on their caregivers than AD patients. Nutritional deterioration, sleep disorders, falls, balance and gait problems, decreased muscle strength, and multiple drug use are more common in those with DLB compared to those with AD. The management of older patients with DLB may be more difficult than older patients with AD.
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Affiliation(s)
- Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkiye
| | - Saadet Koc Okudur
- Department of Geriatric Medicine, Manisa State Hospital, Manisa, Turkey
| | - Ferda Uslu
- Department of Neurology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkiye
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
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Zhu CW, Gu Y, Kociolek AJ, Fernandez KK, Cosentino S, Stern Y. Costs During the Last Five Years of Life for Patients with Clinical and Pathological Confirmed Diagnosis of Lewy Body Dementia and Alzheimer's Disease. J Alzheimers Dis 2023; 92:457-466. [PMID: 36776064 PMCID: PMC10120914 DOI: 10.3233/jad-221021] [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] [Accepted: 01/05/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Little is known regarding healthcare expenditures for patients with dementia with Lewy bodies (DLB) during the end of life. OBJECTIVE This study estimated Medicare expenditures during the last 5 years of life in a decedent sample of patients who were clinically diagnosed with Alzheimer's disease (AD) or DLB and had autopsy confirmed diagnosis. METHODS The study included 58 participants clinically diagnosed with mild dementia at study entry (AD: n = 44, DLB: n = 14) and also had autopsy-confirmed diagnoses of pure AD (n = 32), mixed AD+Lewy body (LB) (n = 5), or pure LB (n = 11). Total Medicare expenditures were compared by clinical and pathology confirmed diagnosis, adjusting for sex, age at death, and patient's cognition, function, comorbidities, and psychiatric and extrapyramidal symptoms. RESULTS When pathology diagnoses were not considered, predicted annualized total Medicare expenditures during the last 5 years of life were similar between clinically diagnosed AD ($7,465±1,098) and DLB ($7,783±1,803). When clinical diagnoses were not considered, predicted expenditures were substantially higher in patients with pathology confirmed mixed AD+LB ($12,005±2,455) than either pure AD ($6,173±941) or pure LB ($4,629±1,968) cases. Considering clinical and pathology diagnosis together, expenditures for patients with clinical DLB and pathology mixed AD+LB ($23,592±3,679) dwarfed other groups. CONCLUSION Medicare expenditures during the last 5 years of life were substantially higher in patients with mixed AD+LB pathology compared to those with pure-AD and pure-LB pathologies, particularly in those clinically diagnosed with DLB. Results highlight the importance of having both clinical and pathology diagnoses in examining healthcare costs.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, Bronx, NY, USA
| | - Yian Gu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anton J. Kociolek
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Kayri K. Fernandez
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Yaakov Stern
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
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Fleisher JE, Moshkovich A, Levin M, Akram F, Hess SP, Suresh M, Bentley CD, Manak T, Mattke M, Miller A, Pennsyl CE, Pierce CM, Voss M, Taylor A, Schroeder K, Chodosh J. Family Caregiver Comorbidities in Lewy Body Dementia Versus Alzheimer Disease and Associated Disorders. Alzheimer Dis Assoc Disord 2023; 37:42-49. [PMID: 36346930 PMCID: PMC10204123 DOI: 10.1097/wad.0000000000000535] [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: 06/15/2022] [Accepted: 09/18/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Family caregivers of people living with dementia have high caregiver strain and poor health consequences. Limited research exists on Lewy body dementia (LBD) caregivers and their specific comorbidities. This study aimed to (1) identify the prevalence of self-reported comorbidities among LBD caregivers and (2) contextualize these findings with historical data on caregivers of persons living with Alzheimer disease and associated disorders (ADADs). METHODS In a national, online survey, LBD family caregivers completed the Self-Administered Comorbidity Questionnaire and we compared these findings with extant literature on ADAD caregiver comorbidities. RESULTS Among 217 LBD caregivers, 84.3% were female, 39.1% were 64 years old or younger, and 66.8% had >2 years of caregiving experience. Caregivers self-identified as current (83.9%) or former (16.1%) caregivers. The most frequent comorbidities were hypertension (38.2%), depression (35.0%), back pain (34.1%), and arthritis (27.7%). LBD caregivers, particularly younger caregivers, had a higher prevalence of depression compared with ADAD caregivers and older adult populations, and back pain prevalence nearly equivalent to spinal cord injury caregivers. CONCLUSIONS Our study is the first to illustrate and contextualize specific comorbidities among LBD caregivers. Understanding the causality and impact of these conditions will be critical in designing effective interventions to improve the lives of families affected by LBD.
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Affiliation(s)
- Jori E Fleisher
- Department of Neurological Sciences, Rush University Medical Center
| | | | - Melissa Levin
- Department of Neurological Sciences, Rush University Medical Center
- Chicago Medical School - Rosalind Franklin University, North Chicago, IL
| | - Faizan Akram
- Department of Neurological Sciences, Rush University Medical Center
| | - Serena P Hess
- Department of Neurological Sciences, Rush University Medical Center
| | | | - Cintra D Bentley
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | - Thomas Manak
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | - Maraline Mattke
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | - Allegra Miller
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | - Claire E Pennsyl
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | - Carmen M Pierce
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | - Margaret Voss
- Lewy Body Dementia Caregiver Advisory Panel, Rush University Medical Center, Chicago
| | | | | | - Joshua Chodosh
- Department of Medicine, Division of Geriatric Medicine and Palliative Care, New York University Grossman School of Medicine
- VA New York Harbor Healthcare System, Medicine Service, New York, NY
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The Impact of Race–Ethnicity and Diagnosis of Alzheimer’s Disease and Related Dementias on Mammography Use. Cancers (Basel) 2022; 14:cancers14194726. [PMID: 36230648 PMCID: PMC9561983 DOI: 10.3390/cancers14194726] [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: 07/01/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Analyzing real-world data from the OneFlorida+ Clinical Research Network, we examined the impact of ADRD diagnosis and race–ethnicity on mammography use in breast cancer screening (BCS)-eligible women. We found that BCS-eligible women with Alzheimer’s disease (AD) and AD-related dementias (ADRD) were more likely to undergo a mammography than the BCS-eligible women without ADRD. Stratified by race–ethnicity, BCS-eligible Hispanic women with ADRD were more likely to undergo a mammography, whereas BCS-eligible non-Hispanic black and non-Hispanic other women with ADRD were less likely to undergo a mammography. Abstract Breast cancer screening (BCS) with mammography is a crucial method for improving cancer survival. In this study, we examined the association of Alzheimer’s disease (AD) and AD-related dementias (ADRD) diagnosis and race–ethnicity with mammography use in BCS-eligible women. In the real-world data from the OneFlorida+ Clinical Research Network, we extracted a cohort of 21,715 BCS-eligible women with ADRD and a matching comparison cohort of 65,145 BCS-eligible women without ADRD. In multivariable regression analysis, BCS-eligible women with ADRD were more likely to undergo a mammography than the BCS-eligible women without ADRD (odds ratio [OR] = 1.19, 95% confidence interval [CI] = 1.13–1.26). Stratified by race–ethnicity, BCS-eligible Hispanic women with ADRD were more likely to undergo a mammography (OR = 1.56, 95% CI = 1.39–1.75), whereas BCS-eligible non-Hispanic black (OR = 0.72, 95% CI = 0.62–0.83) and non-Hispanic other (OR = 0.65, 95% CI = 0.45–0.93) women with ADRD were less likely to undergo a mammography. This study was the first to report the impact of ADRD diagnosis and race–ethnicity on mammography use in BCS-eligible women using real-world data. Our results suggest ADRD patients might be undergoing BCS without detailed guidelines to maximize benefits and avoid harms.
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Liu S, Liu C, Hu W, Ji Y. Frequency, Severity, and Duration of Autonomic Symptoms in Patients of Prodromal Dementia with Lewy Bodies. J Alzheimers Dis 2022; 89:923-929. [DOI: 10.3233/jad-220275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Autonomic dysfunction is supportive clinical feature for diagnosis of prodromal dementia with Lewy bodies (DLB). Objective: To compare the features of autonomic symptoms in patients with mild cognitive impairment (MCI) due to Lewy bodies (MCI-LB) and Alzheimer’s disease (MCI-AD). Methods: Autonomic symptoms were evaluated in the MCI-LB and MCI-AD patients using the Scales for Outcomes in Parkinson’s disease for autonomic symptoms (SCOPA-AUT). Results: Thirty patients with MCI-LB and 90 patients with MCI-AD were recruited. The frequency of autonomic dysfunction was higher in patients with MCI-LB compared to the MCI-AD patients (80% versus 54.4%, p = 0.013) and the gastrointestinal symptoms were predominant (73.3% versus 35.6%, p < 0.001). Salivation, constipation, incontinence, incomplete emptying, lightheadedness when standing up or standing for some times, diurnal or nocturnal hyperhidrosis, and sexual dysfunction were more severe and protracted in the MCI-LB group compared to the MCI-AD group. Conclusion: The MCI-LB patients showed higher frequency and severity, as well as longer duration of autonomic symptoms compared to the MCI-AD group. These symptoms can facilitate early diagnosis of patients with DLB.
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Affiliation(s)
- Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
| | - Chunyan Liu
- Department of Neurology, Aviation General Hospital, Beijing, China
| | - Wenzheng Hu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Ji
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
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Inskip MJ, Mavros Y, Sachdev PS, Hausdorff JM, Hillel I, Singh MAF. Promoting independence in Lewy body dementia through exercise: the PRIDE study. BMC Geriatr 2022; 22:650. [PMID: 35945508 PMCID: PMC9361699 DOI: 10.1186/s12877-022-03347-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Lewy body dementia (LBD) is an aggressive type of dementia of rapid, fluctuating disease trajectory, higher incidence of adverse events, and poorer functional independence than observed in Alzheimer’s disease dementia. Non-pharmacological treatments such as progressive, high-intensity exercise are effective in other neurological cohorts but have been scarcely evaluated in LBD. Methods The Promoting Independence in Lewy Body Dementia through Exercise (PRIDE) trial was a non-randomised, non-blinded, crossover pilot trial involving older adults with LBD consisting of a baseline assessment, an 8-week wait-list, and an 8-week exercise intervention. The aims of this study were to evaluate the determinants of the primary outcome functional independence, as measured by the Movement Disorder Society Unified Parkinson’s Disease Rating Scale, and the feasibility and preliminary efficacy of an exercise intervention on this outcome. Additionally, important clinical characteristics were evaluated to explore associations and treatment targets. The exercise intervention was supervised, clinic-based, high-intensity progressive resistance training (PRT), challenging balance, and functional exercises, 3 days/week. Results Nine participants completed the baseline cross-sectional study, of which five had a diagnosis of Parkinson’s disease dementia (PDD), and four dementia with Lewy Bodies (DLB). Six completed the exercise intervention (three PDD, three DLB). The cohort was diverse, ranging from mild to severe dementia and living in various residential settings. Greater functional independence at baseline was significantly associated with better physical function, balance, cognition, quality of life, muscle mass ratio, walking endurance, faster walking speed and cadence, and lower dementia severity (p < 0.05). Participants declined by clinically meaningful amounts in functional independence, cognition, physical function, muscle mass, and weight over the wait-list period (p < 0.05). Following exercise, participants improved by clinically meaningful amounts in functional independence, cognition, physical function, and strength (p < 0.05). Progressive, high intensity exercise was well-tolerated (> 80% adherence), and only one minor exercise-related adverse event occurred. Conclusions PRIDE is the first exercise trial conducted specifically within individuals diagnosed with LBD, and provides important insight for the design of larger, randomized trials for further evaluation of progressive, high-intensity exercise as a valuable treatment in LBD. Trial registration The PRIDE trial protocol has previously been prospectively registered (08/04/2016, ANZCTR: ACTRN12616000466448). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03347-2.
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Affiliation(s)
- Michael J Inskip
- Sport and Exercise Science, College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia. .,Exercise and Sport Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Yorgi Mavros
- Exercise and Sport Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, NSW, Australia
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Inbar Hillel
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Maria A Fiatarone Singh
- Exercise and Sport Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Hebrew SeniorLife, Boston, MA, USA
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Shigemizu D, Asanomi Y, Akiyama S, Higaki S, Sakurai T, Ito K, Niida S, Ozaki K. Network-based meta-analysis and the candidate gene association studies reveal novel ethnicity-specific variants in MFSD3 and MRPL43 associated with dementia with Lewy bodies. Am J Med Genet B Neuropsychiatr Genet 2022; 189:139-150. [PMID: 35765761 PMCID: PMC9543256 DOI: 10.1002/ajmg.b.32908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/18/2022] [Accepted: 06/14/2022] [Indexed: 11/06/2022]
Abstract
Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia in elderly people, following Alzheimer's disease. Only three genes, SNCA (α-synuclein), APOE (apolipoprotein E), and GBA (glucosylceramidase), have been convincingly demonstrated to be associated with DLB. Here, we applied whole-genome sequencing to blood samples from 61 DLB patients and 45 cognitively normal controls. We used accumulation of candidate mutations to detect novel DLB-associated genes. Subsequent single nucleotide polymorphism (SNP) genotyping and association studies in a large number of samples from Japanese individuals revealed novel heterozygous variants in MFSD3 (rs143475431, c.888T>A:p.C296*; n = 5,421, p = 0.00063) and MRPL43 (chr10:102746730, c.241A>C:p.N81H; n = 4,782, p = 0.0029). We further found that the MFSD3 variant increased plasma levels of butyrylcholinesterase (n = 1,206, p = 0.029). We believe that our findings will contribute to the understanding of DLB and provide insight into its pathogenic mechanism for future studies.
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Affiliation(s)
- Daichi Shigemizu
- Medical Genome Center, Research InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
- RIKEN Center for Integrative Medical SciencesYokohamaKanagawaJapan
| | - Yuya Asanomi
- Medical Genome Center, Research InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
| | - Shintaro Akiyama
- Medical Genome Center, Research InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
| | - Sayuri Higaki
- Medical Genome Center, Research InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
| | - Takashi Sakurai
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, Research InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
- Department of Cognitive and Behavioral ScienceNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Kengo Ito
- National Center for Geriatrics and GerontologyObuAichiJapan
| | - Shumpei Niida
- Core Facility Administration, Research InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
| | - Kouichi Ozaki
- Medical Genome Center, Research InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
- RIKEN Center for Integrative Medical SciencesYokohamaKanagawaJapan
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36
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Gu Y, Kociolek A, Fernandez KK, Cosentino SA, Zhu CW, Jin Z, Leverenz JB, Stern YB. Clinical Trajectories at the End of Life in Autopsy-Confirmed Dementia Patients With Alzheimer Disease and Lewy Bodies Pathologies. Neurology 2022; 98:e2140-e2149. [PMID: 35379761 PMCID: PMC9169937 DOI: 10.1212/wnl.0000000000200259] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 02/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Evaluating and understanding the heterogeneity in dementia course has important implications for clinical practice, health care decision-making, and research. However, inconsistent findings have been reported with regard to the disease courses of the 2 most common dementias: Alzheimer disease (AD) and dementia with Lewy bodies (DLB). Using autopsy-confirmed diagnoses, we aimed to examine the disease trajectories in the years before death among patients with dementia with pure AD, pure DLB, or mixed (AD and DLB) pathologies. METHODS The current retrospective longitudinal study included 62 participants with autopsy-confirmed diagnoses of pure AD (n = 34), mixed AD and DLB (AD + DLB; n = 17), or pure DLB (n = 11) from the Predictors 2 Cohort Study, a prospective, clinic-based, cohort of patients with dementia. Generalized estimating equation models, with time zero at death, were used to examine the trajectory of cognition (Folstein Mini-Mental State Examination [MMSE]), function (activities of daily living [ADL]), and Dependence Scale among patients with different autopsy-confirmed diagnosis (pure AD, AD + DLB, and pure DLB). The models were adjusted for age, sex, education, and baseline features including extrapyramidal signs, MMSE, ADL, and Dependence Scale. RESULTS The participants on average received 9.4 ± 4.6 assessments at 6-month intervals during a mean 5.4 ± 2.9 years of follow-up. The 3 groups were similar in both cognition and function status at baseline. Cognition and function were highly correlated among patients with AD + DLB but not in pure AD or pure DLB at baseline. Patients of the 3 groups all declined in both cognition and function but had different trajectories of decline. More specifically, the patients with pure DLB experienced approximately double the rate of both cognitive decline and functional decline than the patients with pure AD, and the mixed pathology group showed double the rate of functional decline as compared to pure AD. DISCUSSION In this longitudinal study, we found that among patients with dementia, those with Lewy body pathology experienced faster cognitive and functional decline than those with pure AD pathology.
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Affiliation(s)
- Yian Gu
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH.
| | - Anton Kociolek
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Kayri K Fernandez
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Stephanie A Cosentino
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Carolyn Wei Zhu
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Zhezhen Jin
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - James B Leverenz
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Yaakov B Stern
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
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Dimet-Wiley A, Golovko G, Watowich SJ. One-Year Postfracture Mortality Rate in Older Adults With Hip Fractures Relative to Other Lower Extremity Fractures: Retrospective Cohort Study. JMIR Aging 2022; 5:e32683. [PMID: 35293865 PMCID: PMC8968577 DOI: 10.2196/32683] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/03/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hip fracture in older adults is tied to increased mortality risk. Deconvolution of the mortality risk specific to hip fracture from that of various other fracture types has not been performed in recent hip fracture studies but is critical to determining current unmet needs for therapeutic intervention. OBJECTIVE This study examined whether hip fracture increases the 1-year postfracture mortality rate relative to several other fracture types and determined whether dementia or type 2 diabetes (T2D) exacerbates postfracture mortality risk. METHODS TriNetX Diamond Network data were used to identify patients with a single event of fracture of the hip, the upper humerus, or several regions near and distal to the hip occurring from 60 to 89 years of age from 2010 to 2019. Propensity score matching, Kaplan-Meier, and hazard ratio analyses were performed for all fracture groupings relative to hip fracture. One-year postfracture mortality rates in elderly populations with dementia or T2D were established. RESULTS One-year mortality rates following hip fracture consistently exceeded all other lower extremity fracture groupings as well as the upper humerus. Survival probabilities were significantly lower in the hip fracture groups, even after propensity score matching was performed on cohorts for a variety of broad categories of characteristics. Dementia in younger elderly cohorts acted synergistically with hip fracture to exacerbate the 1-year mortality risk. T2D did not exacerbate the 1-year mortality risk beyond mere additive effects. CONCLUSIONS Elderly patients with hip fracture have a significantly decreased survival probability. Greatly increased 1-year mortality rates following hip fracture may arise from differences in bone quality, bone density, trauma, concomitant fractures, postfracture treatments or diagnoses, restoration of prefracture mobility, or a combination thereof. The synergistic effect of dementia may suggest detrimental mechanistic or behavioral combinations for these 2 comorbidities. Renewed efforts should focus on modulating the mechanisms behind this heightened mortality risk, with particular attention to mobility and comorbid dementia.
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Affiliation(s)
- Andrea Dimet-Wiley
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, United States
| | - George Golovko
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, United States
| | - Stanley J Watowich
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, United States
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Gender Differences in Demographic and Pharmacological Factors in Patients Diagnosed with Late-Onset of Alzheimer’s Disease. Brain Sci 2022; 12:brainsci12020160. [PMID: 35203924 PMCID: PMC8870110 DOI: 10.3390/brainsci12020160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Whether gender differences exist in late-onset of Alzheimer’s disease (LOAD) treated with cholinesterase inhibitors (ChEIs) is not fully understood. This study investigated demographic and pharmacological characteristics in LOAD patients to determine gender differences in LOAD patients treated with ChEIs alone and ChEIs with other medications. Methods: This 5-year retrospective data analysis included 9290 LOAD AD patients with 2949 men patients and 6341 women. Potential predictors of demographic and pharmacological characteristics associated gender differences in patients treated with and without ChEIs therapy were determined using univariate analysis, while multivariable models adjusted for demographic and pharmacological variables. Results: In the adjusted analysis, men patients with LOAD that presented with a history of alcohol use (ETOH) (OR = 1.339, 95% CI, 1.072–1.672, p = 0.010), treated with second generation antipsychotics (SGAs) (OR = 1.271, 95% CI, 1.003–1.610, p = 0.047), citalopram (OR = 5.103, 95% CI, 3.423–7.607, p < 0.001), memantine (OR = 4.409, 95% CI, 3.704–5.249, p < 0.001), and buspirone (OR = 2.166, 95% CI, 1.437–3.264, p < 0.001) were more likely to receive ChEIs therapy, whereas older men were less likely to be treated with ChEIs therapy. Women who were African Americans (OR = 1.387, 95% CI, 1.168–1.647, p < 0.001), that received memantine (OR = 3.412, 95% CI, 3.034–3.837, p < 0.001), selective serotonin reuptake inhibitor (SSRIs) (OR = 1.143, 95% CI, 1.016–1.287, p = 0.026), and a history of ETOH (OR = 2.109, 95% CI, 1.724–2.580, p < 0.001) were more likely to receive ChEIs therapy, whereas older women were less likely to receive ChEIs therapy. Conclusion: In both men and women patients, those with increasing age were less likely to be treated with ChEI therapy, while patients treated with memantine were also likely to receive ChEI therapy. Our findings highlight the importance for clinicians to optimize ChEI in LOAD to improve treatment effectiveness and eliminate gender differences in ChEI therapy.
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Armstrong MJ, Song S, Kurasz AM, Li Z. Predictors of Mortality in Individuals with Dementia in the National Alzheimer's Coordinating Center. J Alzheimers Dis 2022; 86:1935-1946. [PMID: 35253760 PMCID: PMC9153251 DOI: 10.3233/jad-215587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dementia is one of the top causes of death worldwide, but individuals with dementia and their caregivers report that knowing what to expect, including regarding approaching end of life, is an unmet need. OBJECTIVE To identify predictors of death in individuals with Alzheimer disease (AD) dementia, Lewy body dementia (LBD), vascular dementia, and frontotemporal dementia. METHODS The study used data from National Alzheimer's Coordinating Center participants with dementia and an etiologic diagnosis of AD, Lewy body disease, frontotemporal lobar degeneration (FTLD, with or without motor neuron disease), or vascular dementia. Analyses included median survival across dementia types and predictors of death at 5 years based on baseline demographics and clinical measure performance. Five-year survival probability tables were stratified by predictor values. RESULTS Individuals with AD had the longest survival (median 6 years), followed by FTLD (5 years), and vascular dementia and LBD (each 4 years). The strongest predictors of death for the full cohort were dementia type (higher risk with non-AD dementias), sex (higher risk with male sex), and race and ethnicity (higher risk with white and non-Hispanic participants). Age was associated with higher mortality risk across the non-Alzheimer dementias; other significant associations included worse cognitive status (FTLD, LBD) and more depression (LBD). CONCLUSION Results can help clinicians counsel individuals with dementia and families regarding average dementia trajectories; findings regarding individual risk factors can aid individualizing expectations. Further research is needed to investigate drivers of mortality in the non-AD dementias to improve counseling and help identify potentially modifiable factors.
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Affiliation(s)
- Melissa J. Armstrong
- Departments of Neurology and Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Shangchen Song
- Department of Biostatistics, University of Florida College of Public Health & Health Professions and College of Medicine, Gainesville, Florida, 32611, USA
| | - Andrea M. Kurasz
- Department of Clinical and Health Psychology, University of Florida College of Public Health & Health Professions, Gainesville, FL, 32611, USA
| | - Zhigang Li
- Department of Biostatistics, University of Florida College of Public Health & Health Professions and College of Medicine, Gainesville, Florida, 32611, USA
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Kurasz AM, De Wit L, Smith GE, Armstrong MJ. Neuropathological and Clinical Correlates of Lewy Body Disease Survival by Race and Ethnicity in the National Alzheimer's Coordinating Center. J Alzheimers Dis 2022; 89:1339-1349. [PMID: 36031892 PMCID: PMC9588566 DOI: 10.3233/jad-220297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Survival and associated clinical and pathological characteristics in Lewy body disease (LBD)-related dementias are understudied. Available studies focus primarily on white non-Hispanic samples. OBJECTIVE We investigated demographic, clinical, and pathological correlates of survival by race and ethnicity in an autopsy-confirmed cohort of LBD cases. METHODS Using National Alzheimer's Coordinating Center data, we selected participants who self-identified as Black, Hispanic, or white who had neuropathological assessments showing transitional or diffuse LBD pathology. We used Kruskal-Wallis and Pearson χ2 analyses to investigate group differences in demographic and presenting clinical and pathological characteristics. We used linear regressions to identify predictors of survival with sex, age at symptom onset, education, ethnoracial status, LBD pathology type, and Braak tangle stage included in the model. RESULTS Data from 1,441 white, 60 Black, and 54 Hispanic participants were available for analysis. Hispanics were more likely to have transitional LBD pathology and had a longer survival than white and Black participants. After controlling for demographic and pathological variables, length of survival did not differ between Hispanics and Black or white participants. Additional key findings demonstrated discrepancies between clinical diagnoses received at last visit and pathological findings, particularly among Black participants. CONCLUSION LBD survival differences by race and ethnicity can be accounted for by LBD pathology type and co-occurring Alzheimer's disease pathology. The discrepancies between clinical diagnoses and pathological findings raise the concern that dementia with Lewy bodies is underdiagnosed in NACC, especially for Black older adults.
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Affiliation(s)
- Andrea M. Kurasz
- Department of Clinical and Health Psychology, University of Florida College of Public Health & Health Professions, Gainesville, FL, 32611, USA
| | - Liselotte De Wit
- Department of Clinical and Health Psychology, University of Florida College of Public Health & Health Professions, Gainesville, FL, 32611, USA
| | - Glenn E. Smith
- Department of Clinical and Health Psychology, University of Florida College of Public Health & Health Professions, Gainesville, FL, 32611, USA
| | - Melissa J. Armstrong
- Departments of Neurology and Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, 32611, USA
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Payne S, Shofer JB, Shutes-David A, Li G, Jankowski A, Dean P, Tsuang D. Correlates of Conversion from Mild Cognitive Impairment to Dementia with Lewy Bodies: Data from the National Alzheimer's Coordinating Center. J Alzheimers Dis 2022; 86:1643-1654. [PMID: 35213374 PMCID: PMC9536845 DOI: 10.3233/jad-215428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many patients with dementia with Lewy bodies (DLB) miss out on the best standards of care and psychosocial support due to diagnostic delays or inaccuracies following symptom onset. OBJECTIVE This study seeks to identify baseline characteristics in individuals with mild cognitive impairment (MCI) that correlate with eventual conversion to DLB or Alzheimer's disease (AD). METHODS Baseline neuropsychological and neuropsychiatric data were analyzed in National Alzheimer's Coordinating Center participants who completed the Uniform Data Set between 2006 and 2020 and subsequently converted from MCI to DLB or AD (n = 1632). RESULTS Only 6% of participants with MCI converted to DLB. Among those who converted to DLB, multidomain amnestic MCI (aMCI) was the most common subtype at study entry. As part of logistic regression analyses, odds ratios (ORs) were estimated for conversion to DLB versus AD based on study-entry characteristics, adjusting for age, sex, education, and years to diagnosis. The strongest predictors of conversion to DLB (p≤0.0001) were nonamnestic MCI versus aMCI (OR 8.2, CI [5.0, 14]), multidomain MCI versus single-domain MCI (OR 2.7, CI [1.7. 4.2]), male sex (OR 4.2, CI [2.5, 7.1]), and presence of nighttime behaviors (OR 4.4 CI [2.8, 6.9]). CONCLUSION A diagnosis of prodromal DLB should be considered in individuals with MCI who present with prominent executive/visuospatial deficits, neuropsychiatric symptoms, and less memory impairment. Early diagnosis of DLB may guide treatment planning, including the avoidance of antipsychotic medications in patients who develop psychotic symptoms, caregiver support, and initiation of early treatment(s) once medications become available.
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Affiliation(s)
- Sarah Payne
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA
| | - Jane B. Shofer
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Andrew Shutes-David
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA, USA
| | - Ge Li
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Adrienne Jankowski
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA
| | - Pamela Dean
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Mental Health Service, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Debby Tsuang
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Correspondence to: Debby Tsuang, MD, MS, VA Puget Sound, Health Care System, 1660 S Columbian Way, MS-182, Seattle WA, 98108, USA. Tel.: +1 206 277 1333;
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Abstract
Primary palliative care is a fundamental aspect of high-quality care for patients with a serious illness such as dementia. The clinician caring for a patient and family suffering with dementia can provide primary palliative care in numerous ways. Perhaps the most important aspects are high quality communication while sharing a diagnosis, counseling the patient through progression of illness and prognostication, and referral to hospice when appropriate. COVID-19 presents additional risks of intensive care requirement and mortality which we must help patients and families navigate. Throughout all of these discussions, the astute clinician must monitor the patient's decision making capacity and balance respect for autonomy with protection against uninformed consent. Excellent primary palliative care also involves discussion of deprescribing medications of uncertain benefit such as long term use of cholinesterase inhibitors and memantine and being vigilant in the monitoring of pain with its relationship to behavioral disturbance in patients with dementia. Clinicians should follow a standardized approach to pain management in this vulnerable population. Caregiver burden is high for patients with dementia and comprehensive care should also address this burden and implement reduction strategies. When these aspects of care are particularly complex or initial managements strategies fall short, palliative care specialists can be an important additional resource not only for the patient and family, but for the care team struggling to guide the way through a disease with innumerable challenges.
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Affiliation(s)
- Neal Weisbrod
- Department of Neurology, University of Florida, 1505 SW Archer, Gainesville, FL, 32608, USA.
- Department of Medicine Division of Palliative Care, University of Florida, 1505 SW Archer, Gainesville, FL, 32608, USA.
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Hirt J, Langer G, Wilde F, Bauernschmidt D, Meyer G, Bieber A. Technology-based counselling in dementia (TeCoDem): study protocol of a mixed-methods systematic review with qualitative comparative analysis and meta-analysis. BMJ Open 2021; 11:e054157. [PMID: 34880025 PMCID: PMC8655568 DOI: 10.1136/bmjopen-2021-054157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Information technology can enhance timely and individual support for people with dementia and informal carers. There is some evidence that people with dementia and informal carers would benefit from technology-based counselling. However, it remains unclear which features of those interventions relate to beneficial outcomes and which aspects are necessary for a successful implementation. Therefore, the primary objectives are: (1) to identify conditions of successful implementation of technology-based counselling interventions in dementia and (2) to investigate the effectiveness of those interventions. METHODS AND ANALYSIS We will conduct a mixed-methods systematic review. The first primary objective requires evidence from various study designs addressing aspects on effective and non-effective implementation of technology-based counselling. This could be telephone-based, web-based or mobile-based interventions for people with dementia and informal carers. For the second primary objective, randomised controlled trials (RCTs) dealing with any outcomes will be included. Year of publication and language will not be restricted. We will search CINAHL, Cochrane Library, MEDLINE, PsycINFO and Web of Science up to April 2021. Additionally, we will perform web searching and citation tracking. To achieve the first primary objective, a Qualitative Comparative Analysis (QCA) will be conducted. The QCA enables us to identify necessary or sufficient components for a successful implementation. To reach the second primary objective, a meta-analysis will be performed with respect to potential clinical and statistical heterogeneity of RCTs. The revised Risk of Bias tool 2.0 will be used to check the risk of bias in RCTs. For all other study designs, the Mixed Method Appraisal Tool will be used. ETHICS AND DISSEMINATION Ethics approval is not required for this review. We will disseminate our findings through scientific and non-scientific journal articles and conference presentations as well as formats directed to the public and decision-makers in healthcare. PROSPERO REGISTRATION NUMBER CRD42021245473.
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Affiliation(s)
- Julian Hirt
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, St Gallen, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gero Langer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Fabian Wilde
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Dorothee Bauernschmidt
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Bieber
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Armstrong MJ. Advances in dementia with Lewy bodies. Ther Adv Neurol Disord 2021; 14:17562864211057666. [PMID: 34840608 PMCID: PMC8613883 DOI: 10.1177/17562864211057666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Dementia with Lewy bodies (DLB) is a clinical diagnosis representing a specific presentation of a pathological α-synucleinopathy (Lewy body disease). DLB is one entity under the broader term Lewy body dementia, which also includes Parkinson’s disease dementia. Recent advances in DLB include publication of updated diagnostic criteria and recognition of prodromal DLB states, including mild cognitive impairment, delirium-onset, and psychiatric-onset forms. Research criteria for the mild cognitive impairment form of DLB were published in 2020. Increasing research shows that concomitant Alzheimer’s disease pathology in individuals with DLB is common in addition to the α-synucleinopathy pathology. This has implications for biomarker use and expected progression. Identifying biomarkers for DLB is an area of active research. Cerebrospinal fluid and skin biopsy tests are now commercially available in the United States, but their role in routine clinical care is not yet established. Additional research and biomarkers are needed. Research suggests that median survival after DLB diagnosis is 3–4 years, but there are rapidly and slowly progressive forms. Most individuals with DLB die of complications of the disease. Clinical trials for individuals with DLB have increased over the last 5 years, targeting both symptoms and underlying pathology. Effective therapies remain an unmet need, however. This review focuses on recent advances with an emphasis on literature that informs clinical care.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, College of Medicine, University of Florida, P.O. Box 100268, Gainesville, FL 32611, USA
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Soysal P, Tan SG, Rogowska M, Jawad S, Smith L, Veronese N, Tsiptsios D, Tsamakis K, Stewart R, Mueller C. Weight loss in Alzheimer's disease, vascular dementia and dementia with Lewy bodies: Impact on mortality and hospitalization by dementia subtype. Int J Geriatr Psychiatry 2021; 37. [PMID: 34807996 DOI: 10.1002/gps.5659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/17/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Loss of weight is associated with cognitive decline as well as several adverse outcomes in dementia. The aim of this study was to assess whether weight loss is associated with mortality and hospitalization in dementia subtypes. METHODS A cohort of 11,607 patients with dementia in Alzheimer's disease (AD), vascular dementia (VD), or dementia with Lewy bodies (DLB) was assembled from a large dementia care health records database in Southeast London. A natural language processing algorithm was developed to established whether loss of weight was recorded around the time of dementia diagnosis. Cox proportional hazard models were applied to examine the associations of reported weight loss with mortality and emergency hospitalization. RESULTS Weight loss around the time of dementia was recorded in 25.5% of the whole sample and was most common in patients with DLB. A weight loss-related increased risk for mortality was detected after adjustment for confounders (Hazard ratio (HR):1.07; 95% confidence interval (CI):1.02-1.15) and in patients with AD (HR: 1.11; 95% CI: 1.04-1.20), but not in DLB and VD. Weight loss was associated with a significantly increased emergency hospitalization risk (HR: 1.14; 95% CI: 1.08-1.20) and in all three subtypes. CONCLUSIONS While there were associations with increased hospitalization risk for all three subtype diagnoses, weight loss was only associated with increased mortality in AD. Weight loss should be considered as an accompanying symptom in dementia and interventions should be considered to ameliorate risk of adverse outcomes.
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Affiliation(s)
- Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Semen Gokce Tan
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Sana Jawad
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Lee Smith
- Cambridge Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Dimitrios Tsiptsios
- Neurophysiology Department, Sunderland Royal Hospital, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, UK
| | - Konstantinos Tsamakis
- Second Department of Psychiatry, University General Hospital 'ATTIKON', School of Medicine, Athens, Greece
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christoph Mueller
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Tsamakis K, Mueller C. Challenges in Predicting Cognitive Decline in Dementia with Lewy Bodies. Dement Geriatr Cogn Disord 2021; 50:1-8. [PMID: 33780925 DOI: 10.1159/000515008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/01/2021] [Indexed: 11/19/2022] Open
Abstract
Despite being the second most common form of neurodegenerative dementia, dementia with Lewy bodies (DLB) is under-recognized and carries a worse prognosis than other subtypes of the condition. Cognitive impairment is a cardinal feature of all types of dementia and DLB presents with a distinct profile with deficits in attention, executive function, and visuoperceptual abilities. This difference from Alzheimer's disease and the common presence of neuropsychiatric symptoms may lead to challenges in predicting cognitive decline in this patient population. Firstly, the diagnosis of DLB is often delayed in clinical practice leading to variability from which time point in the disease course cognitive decline is measured. Secondly, the most frequently used measurement tools for cognitive difficulties focus on memory and naming rather than the domains affected by DLB. While there is now largely a consensus which tools are useful in diagnosing DLB, their validity in assessing deteriorating cognition is less clear. Thirdly, the presence of fluctuating cognition, the propensity to develop delirium episodes, as well as difficulties in distinguishing the two entities in clinical practice make it difficult to predict the disease course. Sleep disturbances are likely to influence cognitive decline but require further study in patients within established DLB. Fourthly, as in most cases of dementia, neuropathological comorbidities are frequently present in DLB. While the influence of Alzheimer's pathology on cognitive decline in DLB is comparatively well understood, the impact of other pathologies remains unclear. The recent definition of research criteria for mild cognitive impairment in DLB could facilitate earlier diagnosis and more structured follow-up. Assessment tools measuring cognitive domains predominantly affected in DLB need to be more consistently used in longitudinal studies and clinical practice, as well as concurrent measures of fluctuations in cognition. Greater availability of biomarkers and digital healthcare solutions can play an important role in enabling more accurate monitoring and prediction of cognitive decline in DLB.
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Affiliation(s)
- Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Second Department of Psychiatry, School of Medicine, University General Hospital 'ATTIKON', Athens, Greece
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Hamilton CA, Matthews FE, Donaghy PC, Taylor JP, O'Brien JT, Barnett N, Olsen K, McKeith IG, Thomas AJ. Prospective predictors of decline v. stability in mild cognitive impairment with Lewy bodies or Alzheimer's disease. Psychol Med 2021; 51:2590-2598. [PMID: 32366348 DOI: 10.1017/s0033291720001130] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) may gradually worsen to dementia, but often remains stable for extended periods of time. Little is known about the predictors of decline to help explain this variation. We aimed to explore whether this heterogeneous course of MCI may be predicted by the presence of Lewy body (LB) symptoms in a prospectively-recruited longitudinal cohort of MCI with Lewy bodies (MCI-LB) and Alzheimer's disease (MCI-AD). METHODS A prospective cohort (n = 76) aged ⩾60 years underwent detailed assessment after recent MCI diagnosis, and were followed up annually with repeated neuropsychological testing and clinical review of cognitive status and LB symptoms. Latent class mixture modelling identified data-driven sub-groups with distinct trajectories of global cognitive function. RESULTS Three distinct trajectories were identified in the full cohort: slow/stable progression (46%), intermediate progressive decline (41%) and a small group with a much faster decline (13%). The presence of LB symptomology, and visual hallucinations in particular, predicted decline v. a stable cognitive trajectory. With time zeroed on study end (death, dementia or withdrawal) where available (n = 39), the same subgroups were identified. Adjustment for baseline functioning obscured the presence of any latent classes, suggesting that baseline function is an important parameter in prospective decline. CONCLUSIONS These results highlight some potential signals for impending decline in MCI; poorer baseline function and the presence of probable LB symptoms - particularly visual hallucinations. Identifying people with a rapid decline is important but our findings are preliminary given the modest cohort size.
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Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, Level E4, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0SZ, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Ian G McKeith
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
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Brück CC, Wolters FJ, Ikram MA, de Kok IMCM. Heterogeneity in Reports of Dementia Disease Duration and Severity: A Review of the Literature. J Alzheimers Dis 2021; 84:1515-1522. [PMID: 34690139 PMCID: PMC8764595 DOI: 10.3233/jad-210544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The burden of dementia is changing due to population aging and changes in incidence and risk factor profiles. Reliable projections of future disease burden require accurate estimates of disease duration across different stages of dementia severity. OBJECTIVE To provide an overview of current evidence on severity stage and disease duration in patients with dementia. METHODS We reviewed the literature on duration of mild cognitive impairment (MCI), dementia, and various dementia severity stages. Data on study setting, country, sample size, severity stages, dementia type, and definition of disease duration was collected. Weighted averages and Q-statistics were calculated within severity stages and duration definitions. RESULTS Of 732 screened articles, 15 reported the duration of one or more severity stages and only half of those reported severity stage onset to conversion to the following stage. In those studies, MCI, very mild dementia, and mild dementia stages lasted 3-4 years and moderate and severe dementia stages lasted 1-2 years. Information on the disease duration was reported in 93 (13%) of screened articles and varied from 1 to 17 years. Reporting of dementia severity stage and disease duration in the literature was highly heterogeneous, which was accounted for only in part by dementia type, study setting, or continent of data collection. CONCLUSION The duration of dementia disease stages shortens with advancing stage. However, reliable modelling of future dementia burden and informing of intervention strategies will require more consistently reported duration estimates from studies that follow individuals longitudinally throughout their entire disease course.
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Affiliation(s)
- Chiara C Brück
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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49
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Taudorf L, Nørgaard A, Waldemar G, Laursen TM. Mortality in Dementia from 1996 to 2015: A National Registry-Based Cohort Study. J Alzheimers Dis 2021; 79:289-300. [PMID: 33252077 PMCID: PMC7902977 DOI: 10.3233/jad-200823] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND It remains unclear whether the increased focus on improving healthcare and providing appropriate care for people with dementia has affected mortality. OBJECTIVE To assess survival and to conduct a time trend analysis of annual mortality rate ratios (MRR) of dementia based on healthcare data from an entire national population. METHODS We assessed survival and annual MRR in all residents of Denmark ≥65 years from 1996-2015 using longitudinal registry data on dementia status and demographics. For comparison, mortality and survival were calculated for acute ischemic heart disease (IHD) and cancer. RESULTS The population comprised 1,999,366 people (17,541,315 person years). There were 165,716 people (529,629 person years) registered with dementia, 131,321 of whom died. From 1996-2015, the age-adjusted MRR for dementia declined (women: 2.76 to 2.05; men: 3.10 to 1.99) at a similar rate to elderly people without dementia. The sex-, age-, and calendar-year-adjusted MRR was 2.91 (95%CI: 2.90-2.93) for people with dementia. MRR declined significantly more for acute IHD and cancer. In people with dementia, the five-year survival for most age-groups was at a similar level or lower as that for acute IHD and cancer. CONCLUSION Although mortality rates declined over the 20-year period, MRR stayed higher for people with dementia, while the MRR gap, compared with elderly people without dementia, remained unchanged. For the comparison, during the same period, the MRR gap narrowed between people with and without acute IHD and cancer. Consequently, initiatives for improving health and decreasing mortality in dementia are still highly relevant.
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Affiliation(s)
- Lærke Taudorf
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ane Nørgaard
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus, Denmark
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50
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Uchida K, Morikawa K, Muguruma Y, Hosokawa M, Tsutsumiuchi K, Kaneda D, Hashizume Y, Akatsu H, Inoue K. LC-MS/MS assay for the investigation of acetylated Alpha-synuclein in serum from postmortem Alzheimer's disease pathology. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1181:122885. [PMID: 34479181 DOI: 10.1016/j.jchromb.2021.122885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
Alpha-synuclein (α-Syn), a neuronal protein, has been linked to the inflammation and development of neurodegenerative diseases. In a number of neurodegenerations, α-Syn has been investigated in the central nervous system and cerebrospinal fluid. However, there are few studies concerning the variations in peripheral α-Syn in postmortem Alzheimer's disease (AD) pathology. In this study, the quantitative procedure for the determination of peripheral acetylated α-Syn regarding N-terminal amino acid's site (α-Syn1-6; MDVFMK and Ac-α-Syn1-6; Ac-MDVFMK) was developed using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) and tryptic digestion without antibody. Serum samples were selected from postmortem specimens based on autopsy pathological examination of AD remark. The LC-MS/MS assay with ACQUITY UPLC BEH C18 column was applied on the basis of electrospray positive ionization. When subjected to N-terminal α-Syn peptides using MonoSpin Typsin HP preparation, doubly- and singly-charged α-Syn1-6 and Ac-α-Syn1-6 ions were observed at m/z 386 > 104 and m/z 813 > 72, respectively, which correspond to quantitative profiling with internal standards. In the calibration, the range of 10-1000 nmol/L showed r2 = 0.999 and recovery from 86.0% to 115.0% (RSD < 9.0%). Using this procedure, peripheral α-Syn1-6 from serum samples could not be detected. On the other hand, Ac-α-Syn1-6 levels were measured from 106.9 to 319.8 nmol/L (AD; n = 10) and 147.1-292.0 nmol/L (control; n = 10) with an insignificant difference. From these preliminary results, individual Ac-α-Syn levels in serum were inferred with nonspecific biomarker regarding to AD pathology.
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Affiliation(s)
- Kazuki Uchida
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan
| | - Kazunori Morikawa
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan
| | - Yoshio Muguruma
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan
| | - Masato Hosokawa
- Dementia Research Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6, Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan
| | - Kaname Tsutsumiuchi
- College of Bioscience and Biotechnology, Chubu University, 1200 Matsumoto, Kasugai, Aichi 487-8501, Japan
| | - Daita Kaneda
- Department of Neuropathology, Choju Medical Institute, Fukushimura Hospital, Noyori-cho, yamanaka, Toyohashi, Aichi 441-8124, Japan
| | - Yoshio Hashizume
- Department of Neuropathology, Choju Medical Institute, Fukushimura Hospital, Noyori-cho, yamanaka, Toyohashi, Aichi 441-8124, Japan
| | - Hiroyasu Akatsu
- Department of Community-Based Medical Education, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-0001, Japan
| | - Koichi Inoue
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan.
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