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Ingram RU, Ocal D, Halai A, Pobric G, Cash DM, Crutch S, Yong KX, Lambon Ralph MA. Graded Multidimensional Clinical and Radiologic Variation in Patients With Alzheimer Disease and Posterior Cortical Atrophy. Neurology 2024; 103:e209679. [PMID: 39042846 PMCID: PMC11314952 DOI: 10.1212/wnl.0000000000209679] [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: 10/17/2023] [Accepted: 05/17/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Alzheimer disease (AD) spans heterogeneous typical and atypical phenotypes. Posterior cortical atrophy (PCA) is a striking example, characterized by prominent impairment in visual and other posterior functions in contrast to typical, amnestic AD. The primary study objective was to establish how the similarities and differences of cognition and brain volumes within AD and PCA (and by extension other AD variants) can be conceptualized as systematic variations across a transdiagnostic, graded multidimensional space. METHODS This was a cross-sectional, single-center, observational, cohort study performed at the National Hospital for Neurology & Neurosurgery, London, United Kingdom. Data were collected from a cohort of patients with PCA and AD, matched for age, disease duration, and Mini-Mental State Examination (MMSE) scores. There were 2 sets of outcome measures: (1) scores on a neuropsychological battery containing 22 tests spanning visuoperceptual and visuospatial processing, episodic memory, language, executive functions, calculation, and visuospatial processing and (2) measures extracted from high-resolution T1-weighted volumetric MRI scans. Principal component analysis was used to extract the transdiagnostic dimensions of phenotypical variation from the detailed neuropsychological data. Voxel-based morphometry was used to examine associations between the PCA-derived clinical phenotypes and the structural measures. RESULTS We enrolled 93 participants with PCA (mean: age = 59.9 years, MMSE = 21.2; 59/93 female) and 58 AD participants (mean: age = 57.1 years, MMSE = 19.7; 22/58 female). The principal component analysis for PCA (sample adequacy confirmed: Kaiser-Meyer-Olkin = 0.865) extracted 3 dimensions accounting for 61.0% of variance in patients' performance, reflecting general cognitive impairment, visuoperceptual deficits, and visuospatial impairments. Plotting AD cases into the PCA-derived multidimensional space, and vice versa, revealed graded, overlapping variations between cases along these dimensions, with no evidence for categorical-like patient clustering. Similarly, the relationship between brain volumes and scores on the extracted dimensions was overlapping for PCA and AD cases. DISCUSSION These results provide evidence supporting a reconceptualization of clinical and radiologic variation in these heterogenous AD phenotypes as being along shared phenotypic continua spanning PCA and AD, arising from systematic graded variations within a transdiagnostic, multidimensional neurocognitive geometry.
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Affiliation(s)
- Ruth U Ingram
- From the Division of Psychology and Mental Health (R.U.I., G.P.), University of Manchester; Dementia Research Centre (D.O., D.M.C., S.C., K.X.Y.), UCL Institute of Neurology, London; and MRC Cognition and Brain Sciences Unit (A.H., M.A.L.R.), University of Cambridge, United Kingdom
| | - Dilek Ocal
- From the Division of Psychology and Mental Health (R.U.I., G.P.), University of Manchester; Dementia Research Centre (D.O., D.M.C., S.C., K.X.Y.), UCL Institute of Neurology, London; and MRC Cognition and Brain Sciences Unit (A.H., M.A.L.R.), University of Cambridge, United Kingdom
| | - Ajay Halai
- From the Division of Psychology and Mental Health (R.U.I., G.P.), University of Manchester; Dementia Research Centre (D.O., D.M.C., S.C., K.X.Y.), UCL Institute of Neurology, London; and MRC Cognition and Brain Sciences Unit (A.H., M.A.L.R.), University of Cambridge, United Kingdom
| | - Gorana Pobric
- From the Division of Psychology and Mental Health (R.U.I., G.P.), University of Manchester; Dementia Research Centre (D.O., D.M.C., S.C., K.X.Y.), UCL Institute of Neurology, London; and MRC Cognition and Brain Sciences Unit (A.H., M.A.L.R.), University of Cambridge, United Kingdom
| | - David M Cash
- From the Division of Psychology and Mental Health (R.U.I., G.P.), University of Manchester; Dementia Research Centre (D.O., D.M.C., S.C., K.X.Y.), UCL Institute of Neurology, London; and MRC Cognition and Brain Sciences Unit (A.H., M.A.L.R.), University of Cambridge, United Kingdom
| | - Sebastian Crutch
- From the Division of Psychology and Mental Health (R.U.I., G.P.), University of Manchester; Dementia Research Centre (D.O., D.M.C., S.C., K.X.Y.), UCL Institute of Neurology, London; and MRC Cognition and Brain Sciences Unit (A.H., M.A.L.R.), University of Cambridge, United Kingdom
| | - Keir X Yong
- From the Division of Psychology and Mental Health (R.U.I., G.P.), University of Manchester; Dementia Research Centre (D.O., D.M.C., S.C., K.X.Y.), UCL Institute of Neurology, London; and MRC Cognition and Brain Sciences Unit (A.H., M.A.L.R.), University of Cambridge, United Kingdom
| | - Matthew A Lambon Ralph
- From the Division of Psychology and Mental Health (R.U.I., G.P.), University of Manchester; Dementia Research Centre (D.O., D.M.C., S.C., K.X.Y.), UCL Institute of Neurology, London; and MRC Cognition and Brain Sciences Unit (A.H., M.A.L.R.), University of Cambridge, United Kingdom
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Choe YS, Kim RE, Kim HW, Kim J, Lee H, Lee MK, Lee M, Kim KY, Kim SH, Kim JH, Lee JY, Kim E, Kim D, Lim HK. Automated Scoring of Alzheimer's Disease Atrophy Scale with Subtype Classification Using Deep Learning-Based T1-Weighted Magnetic Resonance Image Segmentation. J Alzheimers Dis Rep 2024; 8:863-876. [PMID: 38910943 PMCID: PMC11191633 DOI: 10.3233/adr-230105] [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: 08/07/2023] [Accepted: 03/27/2024] [Indexed: 06/25/2024] Open
Abstract
Background Application of visual scoring scales for regional atrophy in Alzheimer's disease (AD) in clinical settings is limited by their high time cost and low intra/inter-rater agreement. Objective To provide automated atrophy scoring using objective volume driven from deep-learning segmentation methods for AD subtype classification using magnetic resonance imaging (MRI). Methods We enrolled 3,959 participants (1,732 cognitively normal [CN], 1594 with mild cognitive impairment [MCI], and 633 with AD). The occupancy indices for each regional volume were calculated by dividing each volume by the size of the lateral and inferior ventricular volumes. MR images from 355 participants (119 CN, 119 MCI, and 117 AD) from three different centers were used for validation. Two neuroradiologists performed visual assessments of the medial temporal, posterior, and global cortical atrophy scores in the frontal lobe using T1-weighted MR images. Images were also analyzed using the deep learning-based segmentation software, Neurophet AQUA. Cutoff values for the three scores were determined using the data distribution according to age. The scoring results were compared for consistency and reliability. Results Four volumetric-driven scoring results showed a high correlation with the visual scoring results for AD, MCI, and CN. The overall agreement with human raters was weak-to-moderate for atrophy scoring in CN participants, and good-to-almost perfect in AD and MCI participants. AD subtyping by automated scores also showed usefulness as a research tool. Conclusions Determining AD subtypes using automated atrophy scoring for late-MCI and AD could be useful in clinical settings or multicenter studies with large datasets.
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Affiliation(s)
- Yeong Sim Choe
- Research Institute, Neurophet Inc., Seoul, Republic of Korea
| | - Regina E.Y. Kim
- Research Institute, Neurophet Inc., Seoul, Republic of Korea
| | - Hye Weon Kim
- Research Institute, Neurophet Inc., Seoul, Republic of Korea
| | - JeeYoung Kim
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyunji Lee
- Research Institute, Neurophet Inc., Seoul, Republic of Korea
| | - Min Kyoung Lee
- Department of Radiology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Minho Lee
- Research Institute, Neurophet Inc., Seoul, Republic of Korea
| | - Keun You Kim
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Se-Hong Kim
- Department of Family Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
- Department of Psychiatry and Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eosu Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Brain Korea 21 FOUR Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghyeon Kim
- Research Institute, Neurophet Inc., Seoul, Republic of Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Ding H, Wang B, Hamel AP, Karjadi C, Ang TFA, Au R, Lin H. Exploring cognitive progression subtypes in the Framingham Heart Study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12574. [PMID: 38515438 PMCID: PMC10955221 DOI: 10.1002/dad2.12574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Alzheimer's disease (AD) is a heterogeneous disorder characterized by complex underlying neuropathology that is not fully understood. This study aimed to identify cognitive progression subtypes and examine their correlation with clinical outcomes. METHODS Participants of this study were recruited from the Framingham Heart Study. The Subtype and Stage Inference (SuStaIn) method was used to identify cognitive progression subtypes based on eight cognitive domains. RESULTS Three cognitive progression subtypes were identified, including verbal learning (Subtype 1), abstract reasoning (Subtype 2), and visual memory (Subtype 3). These subtypes represent different domains of cognitive decline during the progression of AD. Significant differences in age of onset among the different subtypes were also observed. A higher SuStaIn stage was significantly associated with increased mortality risk. DISCUSSION This study provides a characterization of AD heterogeneity in cognitive progression, emphasizing the importance of developing personalized approaches for risk stratification and intervention. Highlights We used the Subtype and Stage Inference (SuStaIn) method to identify three cognitive progression subtypes.Different subtypes have significant variations in age of onset.Higher stages of progression are associated with increased mortality risk.
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Affiliation(s)
- Huitong Ding
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Biqi Wang
- Department of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
| | - Alexander P. Hamel
- Department of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
| | - Cody Karjadi
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Ting F. A. Ang
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Slone Epidemiology CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Rhoda Au
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Slone Epidemiology CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
- Departments of Neurology and MedicineBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Honghuang Lin
- Department of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
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Nguyen TTT, Lee HH, Huang LK, Hu CJ, Yeh CY, Yang WCV, Lin MC. Heterogeneity of Alzheimer's disease identified by neuropsychological test profiling. PLoS One 2023; 18:e0292527. [PMID: 37797059 PMCID: PMC10553816 DOI: 10.1371/journal.pone.0292527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023] Open
Abstract
Alzheimer's disease (AD) is a highly heterogeneous disorder. Untangling this variability could lead to personalized treatments and improve participant recruitment for clinical trials. We investigated the cognitive subgroups by using a data-driven clustering technique in an AD cohort. People with mild-moderate probable AD from Taiwan was included. Neuropsychological test results from the Cognitive Abilities Screening Instrument were clustered using nonnegative matrix factorization. We identified two clusters in 112 patients with predominant deficits in memory (62.5%) and non-memory (37.5%) cognitive domains, respectively. The memory group performed worse in short-term memory and orientation and better in attention than the non-memory group. At baseline, patients in the memory group had worse global cognitive status and dementia severity. Linear mixed effect model did not reveal difference in disease trajectory within 3 years of follow-up between the two clusters. Our results provide insights into the cognitive heterogeneity in probable AD in an Asian population.
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Affiliation(s)
- Truc Tran Thanh Nguyen
- Graduate Institute of Biomedical Informatics, Division of Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Memory and Dementia Center, Hospital 30–4, Ho Chi Minh City, Vietnam
| | - Hsun-Hua Lee
- Department of Neurology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Dizziness and Balance Disorder Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Li-Kai Huang
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Graduate Institute of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yang Yeh
- Graduate Institute of Biomedical Informatics, Division of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chung Vivian Yang
- The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Ming-Chin Lin
- Graduate Institute of Biomedical Informatics, Division of Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Biomedical Informatics, Division of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Li J, Mountz EJ, Mizuno A, Shah AM, Weinstein A, Cohen AD, Klunk WE, Snitz BE, Aizenstein HJ, Karim HT. Functional Asymmetry During Working Memory and Its Association with Markers of Alzheimer's Disease in Cognitively Normal Older Adults. J Alzheimers Dis 2023; 95:1077-1089. [PMID: 37638440 DOI: 10.3233/jad-230379] [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] [Indexed: 08/29/2023]
Abstract
BACKGROUND Amyloid-β (Aβ) deposits asymmetrically early in Alzheimer's disease (AD). This process is variable and has been associated with asymmetric hypometabolism. OBJECTIVE We investigated whether neural asymmetry during working memory and executive function processing was associated with AD genetic risk and markers of AD as well as other brain neuropathology biomarkers, cognitive function, and cognitive reserve in cognitively normal older adults. METHODS We analyzed data from 77 cognitively healthy, older adults who completed functional magnetic resonance imaging, positron emission tomography, and cognitive testing. We identified regions of significant activation and asymmetry during the Digital Symbol Substitution Task (DSST). We examined associations between regions with significant hemispheric asymmetry (directional and absolute) and global cerebral Aβ, cerebral glucose metabolism, white matter hyperintensities, APOE ɛ4 allele status, DSST reaction time, age, sex, education, and cognitive function. RESULTS Asymmetry was not associated with several factors including cognitive function, Aβ, and white matter hyperintensities. The presence of at least one ɛ4 APOE allele in participants was associated with less asymmetric activation in the angular gyrus (right dominant activation). Greater education was associated with less asymmetric activation in mediodorsal thalamus (left dominant activation). CONCLUSIONS Genetic risk of AD was associated with lower asymmetry in angular gyrus activation, while greater education was associated with lower asymmetry in mediodorsal thalamus activation. Changes in asymmetry may reflect components of compensation or cognitive reserve. Asymmetric neural recruitment during working memory may be related to maintenance of cognitive function in cognitively normal older adults.
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Affiliation(s)
- Jinghang Li
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth J Mountz
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Akiko Mizuno
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashti M Shah
- Physician Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrea Weinstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - William E Klunk
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beth E Snitz
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard J Aizenstein
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Helmet T Karim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Snead R, Dumenci L, Jones RM. A latent class analysis of cognitive decline in US adults, BRFSS 2015-2020. BMC Public Health 2022; 22:1560. [PMID: 35974367 PMCID: PMC9380313 DOI: 10.1186/s12889-022-14001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive decline can be an early indicator for dementia. Using quantitative methods and national representative survey data, we can monitor the potential burden of disease at the population-level. METHODS BRFSS is an annual, nationally representative questionnaire in the United States. The optional cognitive decline module is a six-item self-reported scale pertaining to challenges in daily life due to memory loss and growing confusion over the past twelve months. Respondents are 45+, pooled from 2015-2020. Latent class analysis was used to determine unobserved subgroups of subjective cognitive decline (SCD) based on item response patterns. Multinomial logistic regression predicted latent class membership from socio-demographic covariates. RESULTS A total of 54,771 reported experiencing SCD. The optimal number of latent classes was three, labeled as Mild, Moderate, and Severe SCD. Thirty-five percent of the sample belonged to the Severe group. Members of this subgroup were significantly less likely to be older (65+ vs. 45-54 OR = 0.29, 95% CI: 0.23-0.35) and more likely to be non-Hispanic Black (OR = 1.80, 95% CI: 1.53-2.11), have not graduated high school (OR = 1.60, 95% CI: 1.34-1.91), or earned <$15K a year (OR = 3.03, 95% CI: 2.43-3.77). CONCLUSIONS This study determined three latent subgroups indicating severity of SCD and identified socio-demographic predictors. Using a single categorical indicator of SCD severity instead of six separate items improves the versatility of population-level surveillance.
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Affiliation(s)
- Ryan Snead
- Department of Epidemiology & Biostatistics, Temple University, Philadelphia, Pennsylvania, USA.
| | - Levent Dumenci
- Department of Epidemiology & Biostatistics, Temple University, Philadelphia, Pennsylvania, USA.,Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Resa M Jones
- Department of Epidemiology & Biostatistics, Temple University, Philadelphia, Pennsylvania, USA.,Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
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Daigle KM, Pietrzykowski MO, Waters AB, Swenson LP, Gansler DA. Central Executive Network and Executive Function in Patients With Alzheimer's Disease and Healthy Individuals: Meta-Analysis of Structural and Functional MRI. J Neuropsychiatry Clin Neurosci 2022; 34:204-213. [PMID: 35272491 DOI: 10.1176/appi.neuropsych.20110279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The neural architecture of executive function is of interest given its utility as a transdiagnostic predictor of adaptive functioning. However, a gap exists in the meta-analytic literature assessing this relationship in neuropsychiatric populations, concordance between structural and functional architecture, and the relationship with neuropsychological assessment of executive function. Given the importance of the central executive network (CEN) in Alzheimer's disease, this population may be useful in understanding this relationship in Alzheimer's disease pathology. METHODS A meta-analysis of studies (k=21) was conducted to elucidate the relationship between executive function and CEN for structural architecture (k=10; N=1,027) among patients with Alzheimer's disease (k=6; N=250) and healthy control subjects (HCs) (k=4; N=777) and for functional architecture (k=11; N=522) among patients with Alzheimer's disease (k=6; N=306) and HCs (k=5; N=216). Random-effects modeling was used to increase accuracy of conclusions about population means. RESULTS Analyses revealed a positive brain-behavior relationship (pr=0.032, 95% CI=0.07, 0.54), although there was a lack of statistically significant heterogeneity between functional and structural neuroimaging (Q=9.89, p=0.971, I2=0.00%) and between the Alzheimer's and HC groups in functional (Q=8.18, p=0.612, I2=0.00%) and structural (Q=1.60, p=0.996, I2=0.00%) neuroimaging. Similarly, a lack of statistically significant heterogeneity was revealed between functional and structural neuroimaging among patients with Alzheimer's disease (Q=3.59, p=0.980, I2=0.00%) and HCs (Q=3.67, p=0.885, I2=0.00%). CONCLUSIONS Structural and functional imaging in the CEN are predictive of executive function performance among patients with Alzheimer's disease and HCs. Regardless of how the CEN is affected, behavior is correlated to the degree to which the CEN is affected. Findings are significant in the context of methodological decisions in multimodal neuroimaging research.
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Affiliation(s)
- Katrina M Daigle
- Clinical Neuroscience of Cognitive Control Laboratory, Department of Psychology, Suffolk University, Boston (Daigle, Pietrzykowski, Waters, Gansler); and Department of Psychology, Suffolk University, Boston (Swenson)
| | - Malvina O Pietrzykowski
- Clinical Neuroscience of Cognitive Control Laboratory, Department of Psychology, Suffolk University, Boston (Daigle, Pietrzykowski, Waters, Gansler); and Department of Psychology, Suffolk University, Boston (Swenson)
| | - Abigail B Waters
- Clinical Neuroscience of Cognitive Control Laboratory, Department of Psychology, Suffolk University, Boston (Daigle, Pietrzykowski, Waters, Gansler); and Department of Psychology, Suffolk University, Boston (Swenson)
| | - Lance P Swenson
- Clinical Neuroscience of Cognitive Control Laboratory, Department of Psychology, Suffolk University, Boston (Daigle, Pietrzykowski, Waters, Gansler); and Department of Psychology, Suffolk University, Boston (Swenson)
| | - David A Gansler
- Clinical Neuroscience of Cognitive Control Laboratory, Department of Psychology, Suffolk University, Boston (Daigle, Pietrzykowski, Waters, Gansler); and Department of Psychology, Suffolk University, Boston (Swenson)
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Perovnik M, Tomše P, Jamšek J, Emeršič A, Tang C, Eidelberg D, Trošt M. Identification and validation of Alzheimer's disease-related metabolic brain pattern in biomarker confirmed Alzheimer's dementia patients. Sci Rep 2022; 12:11752. [PMID: 35817836 PMCID: PMC9273623 DOI: 10.1038/s41598-022-15667-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 06/28/2022] [Indexed: 12/12/2022] Open
Abstract
Metabolic brain biomarkers have been incorporated in various diagnostic guidelines of neurodegenerative diseases, recently. To improve their diagnostic accuracy a biologically and clinically homogeneous sample is needed for their identification. Alzheimer's disease-related pattern (ADRP) has been identified previously in cohorts of clinically diagnosed patients with dementia due to Alzheimer's disease (AD), meaning that its diagnostic accuracy might have been reduced due to common clinical misdiagnosis. In our study, we aimed to identify ADRP in a cohort of AD patients with CSF confirmed diagnosis, validate it in large out-of-sample cohorts and explore its relationship with patients' clinical status. For identification we analyzed 2-[18F]FDG PET brain scans of 20 AD patients and 20 normal controls (NCs). For validation, 2-[18F]FDG PET scans from 261 individuals with AD, behavioral variant of frontotemporal dementia, mild cognitive impairment and NC were analyzed. We identified an ADRP that is characterized by relatively reduced metabolic activity in temporoparietal cortices, posterior cingulate and precuneus which co-varied with relatively increased metabolic activity in the cerebellum. ADRP expression significantly differentiated AD from NC (AUC = 0.95) and other dementia types (AUC = 0.76-0.85) and its expression correlated with clinical measures of global cognition and neuropsychological indices in all cohorts.
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Affiliation(s)
- Matej Perovnik
- Department of Neurology, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Petra Tomše
- Department of Nuclear Medicine, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia
| | - Jan Jamšek
- Department of Nuclear Medicine, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia
| | - Andreja Emeršič
- Laboratory for CSF Diagnostics, Department of Neurology, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia
| | - Chris Tang
- Center for Neurosciences, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Maja Trošt
- Department of Neurology, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
- Department of Nuclear Medicine, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia
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Garcia-Romeu A, Darcy S, Jackson H, White T, Rosenberg P. Psychedelics as Novel Therapeutics in Alzheimer's Disease: Rationale and Potential Mechanisms. Curr Top Behav Neurosci 2021; 56:287-317. [PMID: 34734390 DOI: 10.1007/7854_2021_267] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Serotonin 2A receptor (5-HT2AR) agonist "classic psychedelics" are drawing increasing interest as potential mental health treatments. Recent work suggests psychedelics can exert persisting anxiolytic and antidepressant effects lasting up to several months after a single administration. Data indicate acute subjective drug effects as important psychological factors involved in observed therapeutic benefits. Additionally, animal models have shown an important role for 5-HT2AR agonists in modulating learning and memory function with relevance for Alzheimer's Disease (AD) and related dementias. A number of biological mechanisms of action are under investigation to elucidate 5-HT2AR agonists' therapeutic potential, including enhanced neuroplasticity, anti-inflammatory effects, and alterations in brain functional connectivity. These diverse lines of research are reviewed here along with a discussion of AD pathophysiology and neuropsychiatric symptoms to highlight classic psychedelics as potential novel pharmacotherapies for patients with AD. Human clinical research suggests a possible role for high-dose psychedelic administration in symptomatic treatment of depressed mood and anxiety in early-stage AD. Preclinical data indicate a potential for low- or high-dose psychedelic treatment regimens to slow or reverse brain atrophy, enhance cognitive function, and slow progression of AD. In conclusion, rationale and potential approaches for preliminary research with psychedelics in patients with AD are presented, and ramifications of this line of investigation for development of novel AD treatments are discussed.
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Affiliation(s)
- Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Sean Darcy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hillary Jackson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Toni White
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Memory and Alzheimer's Treatment Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Memory and Alzheimer's Treatment Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Zhou J, Li K, Luo X, Zeng Q, Jiaerken Y, Wang S, Xu X, Liu X, Li Z, Zhang T, Fu Y, Zhao S, Huang P, Zhang M. Distinct impaired patterns of intrinsic functional network centrality in patients with early- and late-onset Alzheimer's disease. Brain Imaging Behav 2021; 15:2661-2670. [PMID: 33844192 DOI: 10.1007/s11682-021-00470-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
Early-onset Alzheimer's disease (EOAD) involves multiple cognitive domains and shows more rapid progression than late-onset Alzheimer's disease (LOAD). However, the difference in pathogenesis between EOAD and LOAD is still unclear. Accordingly, we applied intrinsic network analysis to explore the potential neuropathological mechanism underlying distinct clinical phenotypes. According to the cut-off age of 65, we included 20 EOAD patients, 20 LOAD patients, and 36 age-matched controls (19 young and 17 old controls). We employed resting-state functional MRI and network centrality analysis to explore the local (degree centrality (DC)) and global (eigenvector centrality (EC)) functional integrity. Two-sample t-test analysis was performed, with gray matter volume, age, gender, and education as covariates. Furthermore, we performed a correlation analysis between network metrics and cognition. Compared to young controls, EOAD patients exhibited lower DC in the middle temporal gyrus (MTG), parahippocampal gyrus (PHG), superior temporal gyrus (STG), and lower EC in the MTG, PHG, and postcentral gyrus. In contrast, LOAD patients exhibited lower DC in the STG and anterior cingulum gyrus and higher DC in the middle frontal gyrus compared to old controls. No significant difference in EC was observed in LOAD patients. Furthermore, both DC and EC correlated with cognitive performance. Our study demonstrated divergent functional network impairments in EOAD and LOAD patients. EOAD patients showed more complex network damage involving both local and global centrality properties, while LOAD patients mainly featured local functional connectivity changes. Such centrality impairments are related to poor cognition, especially regarding memory performance.
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Affiliation(s)
- Jiong Zhou
- Department of Neurology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Kaicheng Li
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jie-fang Road, Shang-cheng District, Hangzhou, 310009, China
| | - Xiao Luo
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jie-fang Road, Shang-cheng District, Hangzhou, 310009, China
| | - Qingze Zeng
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jie-fang Road, Shang-cheng District, Hangzhou, 310009, China
| | - Yerfan Jiaerken
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jie-fang Road, Shang-cheng District, Hangzhou, 310009, China
| | - Shuyue Wang
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jie-fang Road, Shang-cheng District, Hangzhou, 310009, China
| | - Xiaopei Xu
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jie-fang Road, Shang-cheng District, Hangzhou, 310009, China
| | - Xiaocao Liu
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jie-fang Road, Shang-cheng District, Hangzhou, 310009, China
| | - Zheyu Li
- Department of Neurology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Tianyi Zhang
- Department of Neurology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yanv Fu
- Department of Neurology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shuai Zhao
- Department of Neurology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jie-fang Road, Shang-cheng District, Hangzhou, 310009, China.
| | - Minming Zhang
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jie-fang Road, Shang-cheng District, Hangzhou, 310009, China.
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11
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Groot C, Grothe MJ, Mukherjee S, Jelistratova I, Jansen I, van Loenhoud AC, Risacher SL, Saykin AJ, Mac Donald CL, Mez J, Trittschuh EH, Gryglewski G, Lanzenberger R, Pijnenburg YAL, Barkhof F, Scheltens P, van der Flier WM, Crane PK, Ossenkoppele R. Differential patterns of gray matter volumes and associated gene expression profiles in cognitively-defined Alzheimer's disease subgroups. Neuroimage Clin 2021; 30:102660. [PMID: 33895633 PMCID: PMC8186562 DOI: 10.1016/j.nicl.2021.102660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/25/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023]
Abstract
The clinical presentation of Alzheimer's disease (AD) varies widely across individuals but the neurobiological mechanisms underlying this heterogeneity are largely unknown. Here, we compared regional gray matter (GM) volumes and associated gene expression profiles between cognitively-defined subgroups of amyloid-β positive individuals clinically diagnosed with AD dementia (age: 66 ± 7, 47% male, MMSE: 21 ± 5). All participants underwent neuropsychological assessment with tests covering memory, executive-functioning, language and visuospatial-functioning domains. Subgroup classification was achieved using a psychometric framework that assesses which cognitive domain shows substantial relative impairment compared to the intra-individual average across domains, which yielded the following subgroups in our sample; AD-Memory (n = 41), AD-Executive (n = 117), AD-Language (n = 33), AD-Visuospatial (n = 171). We performed voxel-wise contrasts of GM volumes derived from 3Tesla structural MRI between subgroups and controls (n = 127, age 58 ± 9, 42% male, MMSE 29 ± 1), and observed that differences in regional GM volumes compared to controls closely matched the respective cognitive profiles. Specifically, we detected lower medial temporal lobe GM volumes in AD-Memory, lower fronto-parietal GM volumes in AD-Executive, asymmetric GM volumes in the temporal lobe (left < right) in AD-Language, and lower GM volumes in posterior areas in AD-Visuospatial. In order to examine possible biological drivers of these differences in regional GM volumes, we correlated subgroup-specific regional GM volumes to brain-wide gene expression profiles based on a stereotactic characterization of the transcriptional architecture of the human brain as provided by the Allen human brain atlas. Gene-set enrichment analyses revealed that variations in regional expression of genes involved in processes like mitochondrial respiration and metabolism of proteins were associated with patterns of regional GM volume across multiple subgroups. Other gene expression vs GM volume-associations were only detected in particular subgroups, e.g., genes involved in the cell cycle for AD-Memory, specific sets of genes related to protein metabolism in AD-Language, and genes associated with modification of gene expression in AD-Visuospatial. We conclude that cognitively-defined AD subgroups show neurobiological differences, and distinct biological pathways may be involved in the emergence of these differences.
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Affiliation(s)
- Colin Groot
- Department of Neurology & Alzheimer Center, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands.
| | - Michel J Grothe
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.
| | | | | | - Iris Jansen
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands.
| | - Anna Catharina van Loenhoud
- Department of Neurology & Alzheimer Center, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands.
| | | | - Andrew J Saykin
- Indiana University School of Medicine, Indianapolis, IN, USA.
| | | | - Jesse Mez
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Alzheimer's Disease Center, Boston University School of Medicine, MA, USA.
| | - Emily H Trittschuh
- Psychiatry & Behavioral Science, University of Washington, Seattle, WA, USA; Veterans Affairs Puget Sound Health Care System, Geriatric Research, Education, & Clinical Center, Seattle, WA, USA.
| | - Gregor Gryglewski
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| | - Yolande A L Pijnenburg
- Department of Neurology & Alzheimer Center, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands.
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands; University College London, Institutes of Neurology & Healthcare Engineering, London, United Kingdom.
| | - Philip Scheltens
- Department of Neurology & Alzheimer Center, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands.
| | - Wiesje M van der Flier
- Department of Neurology & Alzheimer Center, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands; Epidemiology and Biostatistics, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands.
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Rik Ossenkoppele
- Department of Neurology & Alzheimer Center, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands; Lund University, Clinical Memory Research Unit, Lund, Sweden.
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12
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Ingram RU, Halai AD, Pobric G, Sajjadi S, Patterson K, Lambon Ralph MA. Graded, multidimensional intra- and intergroup variations in primary progressive aphasia and post-stroke aphasia. Brain 2021; 143:3121-3135. [PMID: 32940648 PMCID: PMC7586084 DOI: 10.1093/brain/awaa245] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/30/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022] Open
Abstract
Language impairments caused by stroke (post-stroke aphasia, PSA) and neurodegeneration (primary progressive aphasia, PPA) have overlapping symptomatology, nomenclature and are classically divided into categorical subtypes. Surprisingly, PPA and PSA have rarely been directly compared in detail. Rather, previous studies have compared certain subtypes (e.g. semantic variants) or have focused on a specific cognitive/linguistic task (e.g. reading). This study assessed a large range of linguistic and cognitive tasks across the full spectra of PSA and PPA. We applied varimax-rotated principal component analysis to explore the underlying structure of the variance in the assessment scores. Similar phonological, semantic and fluency-related components were found for PSA and PPA. A combined principal component analysis across the two aetiologies revealed graded intra- and intergroup variations on all four extracted components. Classification analysis was used to test, formally, whether there were any categorical boundaries for any subtypes of PPA or PSA. Semantic dementia formed a true diagnostic category (i.e. within group homogeneity and distinct between-group differences), whereas there was considerable overlap and graded variations within and between other subtypes of PPA and PSA. These results suggest that (i) a multidimensional rather than categorical classification system may be a better conceptualization of aphasia from both causes; and (ii) despite the very different types of pathology, these broad classes of aphasia have considerable features in common.
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Affiliation(s)
- Ruth U Ingram
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, UK
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Gorana Pobric
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, UK
| | - Seyed Sajjadi
- Department of Neurology, University of California, Irvine, Irvine, USA
| | - Karalyn Patterson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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13
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Sood A, Pavlik V, Darby E, Chan W, Doody R. Different Cognitive Profiles Are Associated with Progression Rate and Age at Death in Probable Alzheimer's Disease. J Alzheimers Dis 2021; 80:735-747. [PMID: 33579838 DOI: 10.3233/jad-201124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive profiles characterized by primarily language or visuospatial deficits have been documented in individuals meeting diagnostic criteria for probable Alzheimer's disease (AD), but their association with progression rate or overall survival is not well described. OBJECTIVE To compare time from diagnosis to severe disease stage and death in probable AD patients classified into three groups based on neuropsychological test performance: marked verbal impairment (Verb-PI) with relatively preserved visuospatial function, marked visuospatial impairment with preserved verbal function (Vis-PI), and balanced verbal and visuospatial impairments (Bal-PI). METHODS This prospective cohort study included 540 probable AD patients attending an academic memory clinic who were enrolled from 1995-2013 and followed annually. Eligible individuals had a Mini-Mental State Exam (MMSE) score ≥10 at baseline, and at least one annual follow up visit. We used Cox proportional hazards modeling to analyze the association of cognitive profiles with time to decline in MMSE and CDR Global Score. RESULTS Sixty-one (11.3%) individuals had a Verb-PI profile, 86 (16%) had a Vis-PI profile, and 393 (72.8%) a Bal-PI profile. MMSE decline to <10 was faster in Verb-PI than Vis-PI (HR 2.004, 95%CI, 1.062-3.780; p = 0.032). Progression to CDR-GS = 3 was faster in Verb-PI individuals compared to Bal-PI (HR 1.604, 95%CI, 1.022-2.515; p = 0.040) or Vis-PI (HR 2.388, 95%CI, 1.330-4.288; p = 0.004) individuals. Baseline cognitive profile did not affect mortality. CONCLUSION A recognition of different AD profiles may help to personalize care by providing a better understanding of pathogenesis and expected progression.
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Affiliation(s)
- Ajay Sood
- Rush Alzheimer's Disease Center (RADC), Rush University Medical Center, Chicago, IL, USA
| | - Valory Pavlik
- Department of Neurology and Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, USA
| | - Eveleen Darby
- Department of Neurology and Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rachelle Doody
- Genentech, San Francisco, CA, USA.,Hoffmann-La Roche, Basel, Switzerland
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14
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Kim DH, Kim HA, Han YS, Jeon WK, Han JS. Recognition memory impairments and amyloid-beta deposition of the retrosplenial cortex at the early stage of 5XFAD mice. Physiol Behav 2020; 222:112891. [PMID: 32442584 DOI: 10.1016/j.physbeh.2020.112891] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/26/2020] [Accepted: 03/21/2020] [Indexed: 12/31/2022]
Abstract
Early diagnosis and treatment of AD are critical for delaying its progression. The present study, therefore, examined the cognitive status and neuropathological characteristics of 4-month-old 5X familial AD (5XFAD) transgenic (Tg) mice, as an early stage of AD animal model. The novel object recognition task was performed with retention tests at varying intervals (i.e., 10 min, 1 h, 4 h, and 24 h) to measure the retention capacity of recognition memory of 5XFAD mice. At the 4h retention interval, 5XFAD mice exhibited worse performances than non-Tg control mice. Therefore, using amyloid-beta (Aβ) 42- and 4G8-immunoreactive plaques, the accumulation of Aβ was examined in the gray and white matter of the system that was necessary for the retention of recognition memory, with a focus on the hippocampus and retrosplenial cortex. The expression of ionized calcium-binding adapter molecule-1 (Iba-1) was also examined to measure microglial activation. The immunohistological analysis of Aβ and Iba-1 revealed that the retrosplenial cortex was the most affected region in the brains of 4-month-old 5XFAD mice. These findings indicate that the cognitive and neuropathological characteristics of 4-month-old 5XFAD mice would provide a research platform for studying early diagnosis and treatment of AD.
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Affiliation(s)
- Dong-Hee Kim
- Department of Biological Sciences, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Hye-A Kim
- Department of Biological Sciences, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Ye Sun Han
- Department of Advanced Technology Fusion, Konkuk University, Seoul 05029, Republic of Korea
| | - Won Kyung Jeon
- Herbal Medicine Research Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Daejeon 34054, Republic of Korea; Convergence Research Center for Diagnosis, Treatment and Care System of Dementia, Korea Institute of Science and Technology, Seoul 02792, The Republic of Korea.
| | - Jung-Soo Han
- Department of Biological Sciences, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea.
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15
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Kim Y, Jiang X, Giancardo L, Pena D, Bukhbinder AS, Amran AY, Schulz PE. Multimodal Phenotyping of Alzheimer's Disease with Longitudinal Magnetic Resonance Imaging and Cognitive Function Data. Sci Rep 2020; 10:5527. [PMID: 32218482 PMCID: PMC7099007 DOI: 10.1038/s41598-020-62263-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/06/2020] [Indexed: 01/26/2023] Open
Abstract
Alzheimer's disease (AD) varies a great deal cognitively regarding symptoms, test findings, the rate of progression, and neuroradiologically in terms of atrophy on magnetic resonance imaging (MRI). We hypothesized that an unbiased analysis of the progression of AD, regarding clinical and MRI features, will reveal a number of AD phenotypes. Our objective is to develop and use a computational method for multi-modal analysis of changes in cognitive scores and MRI volumes to test for there being multiple AD phenotypes. In this retrospective cohort study with a total of 857 subjects from the AD (n = 213), MCI (n = 322), and control (CN, n = 322) groups, we used structural MRI data and neuropsychological assessments to develop a novel computational phenotyping method that groups brain regions from MRI and subsets of neuropsychological assessments in a non-biased fashion. The phenotyping method was built based on coupled nonnegative matrix factorization (C-NMF). As a result, the computational phenotyping method found four phenotypes with different combination and progression of neuropsychologic and neuroradiologic features. Identifying distinct AD phenotypes here could help explain why only a subset of AD patients typically respond to any single treatment. This, in turn, will help us target treatments more specifically to certain responsive phenotypes.
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Affiliation(s)
- Yejin Kim
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA.
| | - Xiaoqian Jiang
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Luca Giancardo
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Diagnostic and Interventional Imaging, the McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Danilo Pena
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Avram S Bukhbinder
- Department of Neurology, the McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Albert Y Amran
- Department of Neurology, the McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Paul E Schulz
- Department of Neurology, the McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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16
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Abstract
PURPOSE OF REVIEW This article presents an overview of the clinical syndrome of posterior cortical atrophy (PCA), including its pathologic underpinnings, clinical presentation, investigation findings, diagnostic criteria, and management. RECENT FINDINGS PCA is usually an atypical form of Alzheimer disease with relatively young age at onset. New diagnostic criteria allow patients to be diagnosed on a syndromic basis as having a primary visual (pure) form or more complex (plus) form of PCA and, when possible, on a disease-specific basis using biomarkers or underlying pathology. Imaging techniques have demonstrated that some pathologic processes are concordant (atrophy, hypometabolism, tau deposition) with clinical symptoms and some are discordant (widespread amyloid deposition). International efforts are under way to establish the genetic underpinnings of this typically sporadic form of Alzheimer disease. In the absence of specific disease-modifying therapies, a number of practical suggestions can be offered to patients and their families to facilitate reading and activities of daily living, promote independence, and improve quality of life SUMMARY: While rare, PCA is an important diagnostic entity for neurologists, ophthalmologists, and optometrists to recognize to allow for early accurate diagnosis and appropriate patient management. PCA provides an important opportunity to investigate the causes of selective vulnerability in Alzheimer disease.
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17
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Qiu Y, Jacobs DM, Messer K, Salmon DP, Feldman HH. Cognitive heterogeneity in probable Alzheimer disease: Clinical and neuropathologic features. Neurology 2019; 93:e778-e790. [PMID: 31320469 PMCID: PMC6711663 DOI: 10.1212/wnl.0000000000007967] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/28/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify heterogeneity in cognitive profiles of patients with probable Alzheimer disease (AD) who have mild to moderate dementia and satisfy inclusion and exclusion criteria for a typical AD clinical trial, and to determine whether cognitive profiles are systematically related to the clinical course and neuropathologic features of the disease. METHODS Neuropsychological test data from patients with mild to moderate probable AD (n = 4,711) were obtained from the National Alzheimer's Coordinating Center. Inclusion and exclusion criteria usually used in AD clinical trials were applied. Principal component analysis and model-based clustering were used to identify cognitive profiles in a subset of patients with autopsy-verified AD (n = 800) and validated in the overall (nonautopsy) sample and an independent cohort with similar test data. Relationships between cognitive profile, clinical characteristics, and rate of decline were examined with mixed-effects models. RESULTS In the autopsy-confirmed sample, 79.6% of patients had a typical AD cognitive profile (greater impairment of episodic memory than other cognitive functions), and 20.4% had an atypical profile (comparable impairment across cognitive domains). Similar results were obtained in the overall (typical 79.8%, atypical 20.2%) and validation (typical 71.8%, atypical 28.2%) samples. Atypicality was associated with younger age, male sex, lower probability of APOE ε4, less severe global dementia, higher depression scores, lower Braak stage at autopsy, and slower cognitive decline. CONCLUSION We can reliably identify distinct cognitive profiles among patients with clinically diagnosed probable AD that are associated with tangle pathology and with different rates of decline. This may have implications for clinical trials in AD, especially therapies targeting tau.
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Affiliation(s)
- Yuqi Qiu
- From the Department of Family Medicine and Public Health (Y.Q., K.M.), Department of Neurosciences (D.M.J., D.P.S., H.H.F.), and Shiley-Marcos Alzheimer's Disease Research Center (D.M.J., D.P.S., H.H.F.), University of California, San Diego, La Jolla
| | - Diane M Jacobs
- From the Department of Family Medicine and Public Health (Y.Q., K.M.), Department of Neurosciences (D.M.J., D.P.S., H.H.F.), and Shiley-Marcos Alzheimer's Disease Research Center (D.M.J., D.P.S., H.H.F.), University of California, San Diego, La Jolla
| | - Karen Messer
- From the Department of Family Medicine and Public Health (Y.Q., K.M.), Department of Neurosciences (D.M.J., D.P.S., H.H.F.), and Shiley-Marcos Alzheimer's Disease Research Center (D.M.J., D.P.S., H.H.F.), University of California, San Diego, La Jolla
| | - David P Salmon
- From the Department of Family Medicine and Public Health (Y.Q., K.M.), Department of Neurosciences (D.M.J., D.P.S., H.H.F.), and Shiley-Marcos Alzheimer's Disease Research Center (D.M.J., D.P.S., H.H.F.), University of California, San Diego, La Jolla
| | - Howard H Feldman
- From the Department of Family Medicine and Public Health (Y.Q., K.M.), Department of Neurosciences (D.M.J., D.P.S., H.H.F.), and Shiley-Marcos Alzheimer's Disease Research Center (D.M.J., D.P.S., H.H.F.), University of California, San Diego, La Jolla.
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18
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Meyer F, Wehenkel M, Phillips C, Geurts P, Hustinx R, Bernard C, Bastin C, Salmon E. Characterization of a temporoparietal junction subtype of Alzheimer's disease. Hum Brain Mapp 2019; 40:4279-4286. [PMID: 31243829 DOI: 10.1002/hbm.24701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 01/01/2023] Open
Abstract
Alzheimer's disease (AD) subtypes have been described according to genetics, neuropsychology, neuropathology, and neuroimaging. Thirty-one patients with clinically probable AD were selected based on perisylvian metabolic decrease on FDG-PET. They were compared to 25 patients with a typical pattern of decreased posterior metabolism. Tree-based machine learning was used on those 56 images to create a classifier that was subsequently applied to 207 Alzheimer's Disease Neuroimaging Initiative (ADNI) patients with AD. Machine learning was also used to discriminate between the two ADNI groups based on neuropsychological scores. Compared to AD patients with a typical precuneus metabolic decrease, the new subtype showed stronger hypometabolism in the temporoparietal junction. The classifier was able to distinguish the two groups in the ADNI population. Both groups could only be distinguished cognitively by Trail Making Test-A scores. This study further confirms that there is more than a typical metabolic pattern in probable AD with amnestic presentation.
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Affiliation(s)
- François Meyer
- GIGA-Cyclotron Research Centre in vivo imaging, University of Liège, Liège, Belgium
| | - Marie Wehenkel
- GIGA-Cyclotron Research Centre in vivo imaging, University of Liège, Liège, Belgium.,Department of Electrical Engineering and Computer Science, University of Liège, Liège, Belgium
| | - Christophe Phillips
- GIGA-Cyclotron Research Centre in vivo imaging, University of Liège, Liège, Belgium
| | - Pierre Geurts
- Department of Electrical Engineering and Computer Science, University of Liège, Liège, Belgium
| | - Roland Hustinx
- Nuclear Medecine Department, CHU of Liège, University of Liège, Liège, Belgium
| | - Claire Bernard
- Nuclear Medecine Department, CHU of Liège, University of Liège, Liège, Belgium
| | - Christine Bastin
- GIGA-Cyclotron Research Centre in vivo imaging, University of Liège, Liège, Belgium
| | - Eric Salmon
- GIGA-Cyclotron Research Centre in vivo imaging, University of Liège, Liège, Belgium
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19
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Mendez MF, Moheb N, Desarzant RE, Teng EH. The Progressive Acalculia Presentation of Parietal Variant Alzheimer's Disease. J Alzheimers Dis 2019; 63:941-948. [PMID: 29710718 DOI: 10.3233/jad-180024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Many patients with early-onset Alzheimer's disease (EOAD; age of onset <65 years) have non-amnestic presentations involving language (logopenic primary progressive aphasia, lvPPA), visuospatial abilities (posterior cortical atrophy, PCA), and even asymmetric symptoms consistent with corticobasal syndrome (CBS). An inferior parietal lobule variant of EOAD commonly presents with progressive difficulty with calculations. METHODS We reviewed 276 EOAD patients for presentations with predominant acalculia. These patients were diagnosed with clinically probable Alzheimer's disease (AD) verified by positron emission tomography (PET) or cerebrospinal fluid amyloid-β or tau biomarkers. RESULTS We identified 18 (9M/9F) (6.5%) EOAD patients with progressive acalculia that did not meet most criteria for lvPPA, visual PCA, or CBS. Their ages of onset and presentation were 56.6 (5.0) and 59.4 (6.5), respectively. Their acalculia was consistent with a primary acalculia ("anarithmetia") not explained by language or visuospatial impairments. Many also had anomia (14/18), ideomotor apraxia (13/18), and the complete Gerstmann's syndrome (7/18). Visual analysis of their diverse magnetic resonance imaging disclosed biparietal atrophy, disproportionately worse on the left. CONCLUSIONS Primary acalculia may be the most common manifestation of an inferior parietal presentation of EOAD affecting the left intraparietal sulcus. This parietal variant also commonly involves progressive anomia, ideomotor apraxia, and other elements of Gerstmann's syndrome. The early recognition of patients with this variant, which is distinguishable from lvPPA, visual PCA, or CBS, would be facilitated by its recognition as a unique subtype of EOAD.
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Affiliation(s)
- Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Negar Moheb
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Randy E Desarzant
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Edmond H Teng
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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20
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Sui X, Rajapakse JC. Profiling heterogeneity of Alzheimer's disease using white-matter impairment factors. NEUROIMAGE-CLINICAL 2018; 20:1222-1232. [PMID: 30412925 PMCID: PMC6226553 DOI: 10.1016/j.nicl.2018.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/28/2018] [Accepted: 10/23/2018] [Indexed: 01/09/2023]
Abstract
The clinical presentation of Alzheimer's disease (AD) is not unitary as heterogeneity exists in the disease's clinical and anatomical characteristics. MRI studies have revealed that heterogeneous gray matter atrophy patterns are associated with specific traits of cognitive decline. Although white matter (WM) impairment also contributes to AD pathology, its heterogeneity remains unclear. The Latent Dirichlet Allocation (LDA) method is a suitable framework to study heterogeneity and allows to identify latent impairment factors of AD instead of simply mapping an overall disease effect. By exploring whole brain WM skeleton images by using LDA, three latent factors were revealed in AD: a temporal-frontal impairment factor (temporal and frontal lobes, especially hippocampus and para-hippocampus), a parietal factor (parietal lobe, especially precuneus), and a long fibre bundle factor (corpus callosum and superior longitudinal fasciculus). As revealed by longitudinal analysis, the latent factors have distinct impact on cognitive decline: for executive function (EF), the temporal-frontal factor was more strongly associated with baseline EF compared with the parietal factor, while the long-fibre bundle factor was most associated with decline rate of EF; for memory, the three factors showed almost equal effect on the baseline memory and decline rate. For each participant, LDA estimates his/her composition profile of latent impairment factors, which indicates disease subtype. We also found that the APOE genotype affects the AD subtype. Specifically, APOE ε4 was more associated with the long fibre bundle factor and APOE ε2 was more associated with temporal-frontal factor. By investigating heterogeneity and subtypes of AD through white matter impairment factors, our study could facilitate precision medicine. LDA revealed three latent white matter impairment factors in Alzheimer’s disease. Latent factors associate with executive function and memory decline differently. Individual factor composition indicates disease subtype. The APOE genotype is associated with the factor composition.
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Affiliation(s)
- Xiuchao Sui
- School of Computer Science and Engineering, Nanyang Technological University, 639798, Singapore
| | - Jagath C Rajapakse
- School of Computer Science and Engineering, Nanyang Technological University, 639798, Singapore.
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- School of Computer Science and Engineering, Nanyang Technological University, 639798, Singapore
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21
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Herholz K, Haense C, Gerhard A, Jones M, Anton-Rodriguez J, Segobin S, Snowden JS, Thompson JC, Kobylecki C. Metabolic regional and network changes in Alzheimer's disease subtypes. J Cereb Blood Flow Metab 2018; 38:1796-1806. [PMID: 28675110 PMCID: PMC6168902 DOI: 10.1177/0271678x17718436] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/10/2017] [Accepted: 05/19/2017] [Indexed: 11/16/2022]
Abstract
Clinical variants of Alzheimer's disease (AD) include the common amnestic subtype as well as subtypes characterised by leading visual processing impairments or by multimodal neurocognitive deficits. We investigated regional metabolic patterns and networks between AD subtypes. The study comprised 9 age-matched controls and 25 patients with mild to moderate AD. Methods included clinical and neuropsychological assessment, high-resolution FDG PET and T1-weighted 3D MR imaging with PET-MR coregistration, grey matter segmentation, atlas-based regions-of-interest, linear mixed effects and regional correlation analysis. Regional metabolic patterns differed significantly between groups, but significant hypometabolism in the posterior cingulate cortex (PCC) was common to all subtypes. The most distinctive regional abnormality was occipital hypometabolism in the visual subtype. In controls, two large clusters of positive regional metabolic correlations were observed. The most pronounced breakdown of the normal correlation pattern was found in amnestic patients who, in contrast, showed the least regional focal metabolic deficits. The normal positive correlation between PCC and hippocampus was lost in all subtypes. In conclusion, PCC hypometabolism and metabolic correlation breakdown between PCC and hippocampus are the common functional core of all AD subtypes. Network alterations exceed focal regional impairment and are most prominent in the amnestic subtype.
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Affiliation(s)
- Karl Herholz
- Division of Informatics, Imaging and
Data Sciences, University of Manchester, Wolfson Molecular Imaging Centre,
Manchester, UK
- Division of Neuroscience and
Experimental Psychology, University of Manchester, Manchester, UK
| | - Cathleen Haense
- Division of Informatics, Imaging and
Data Sciences, University of Manchester, Wolfson Molecular Imaging Centre,
Manchester, UK
| | - Alex Gerhard
- Division of Informatics, Imaging and
Data Sciences, University of Manchester, Wolfson Molecular Imaging Centre,
Manchester, UK
- Division of Neuroscience and
Experimental Psychology, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust,
Salford, UK
- Department of Nuclear Medicine and
Lehrstuhl für Geriatrie, Universitätsklinikum Essen, Essen, Germany
| | - Matthew Jones
- Division of Neuroscience and
Experimental Psychology, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust,
Salford, UK
| | - José Anton-Rodriguez
- Division of Informatics, Imaging and
Data Sciences, University of Manchester, Wolfson Molecular Imaging Centre,
Manchester, UK
| | - Shailendra Segobin
- Division of Informatics, Imaging and
Data Sciences, University of Manchester, Wolfson Molecular Imaging Centre,
Manchester, UK
| | - Julie S Snowden
- Division of Neuroscience and
Experimental Psychology, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust,
Salford, UK
| | - Jennifer C Thompson
- Division of Neuroscience and
Experimental Psychology, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust,
Salford, UK
| | - Christopher Kobylecki
- Division of Neuroscience and
Experimental Psychology, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust,
Salford, UK
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22
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Li KC, Luo X, Zeng QZ, Xu XJ, Huang PY, Shen ZJ, Xu JJ, Zhou J, Zhang MM. Distinct Patterns of Interhemispheric Connectivity in Patients With Early- and Late-Onset Alzheimer's Disease. Front Aging Neurosci 2018; 10:261. [PMID: 30237764 PMCID: PMC6136638 DOI: 10.3389/fnagi.2018.00261] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/14/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Early-onset Alzheimer’s disease (EOAD) presents a different clinical profile than late-onset Alzheimer’s disease (LOAD). Neuroimaging studies have demonstrated that patients with EOAD present more atrophy and functional disconnection than LOAD patients. However, it remains unknown whether the interhemispheric functional disconnection or its underlying structural impairment contributes to the different clinical profiles of EOAD and LOAD. Methods: According to the arbitrary cut-off age of 65, we included 22 EOAD patients, 27 LOAD patients and 38 healthy controls (further divided into 21 relatively young and 17 old controls). Participants underwent resting-state functional MRI, diffusion tensor imaging (DTI) and comprehensive neuropsychological assessments. We used voxel-mirrored homotopic connectivity (VMHC) to examine interhemispheric functional connectivity. Then, we calculated the diffusion index based on tract-based spatial statistics (TBSS). Two-sample t-tests were used to assess the interhemispheric connectivity differences between each patient group and its corresponding control group. Results: We found that the EOAD patients had lower VMHC in the hippocampus, parahippocampal gyrus (PHG), superior temporal gyrus (STG) and inferior parietal cortex (IPC) than did controls. Consistently, the EOAD patients exhibited white matter (WM) tract impairment in the posterior regions. On the other hand, the LOAD patients displayed increased VMHC and impaired WM tracts in the frontal region. Correlation analyses showed that VMHC in the IPC was related to executive function in the EOAD patients (r = −0.67, P < 0.05). Conclusion: In contrast to the LOAD patients, patients with EOAD exhibited more widely disrupted interhemispheric functional and structural connectivity, which overlapped well across brain regions. In addition, for the EOAD patients, decreased interhemispheric connectivity related to executive deficits. Our study suggested that different interhemispheric connectivity damage patterns may contribute to the distinct clinical profiles in EOAD and LOAD.
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Affiliation(s)
- Kai-Cheng Li
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Luo
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qing-Ze Zeng
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Jun Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Pei-Yu Huang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhu-Jing Shen
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jing-Jing Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jiong Zhou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Min-Ming Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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23
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Mattsson N, Ossenkoppele R, Smith R, Strandberg O, Ohlsson T, Jögi J, Palmqvist S, Stomrud E, Hansson O. Greater tau load and reduced cortical thickness in APOE ε4-negative Alzheimer's disease: a cohort study. Alzheimers Res Ther 2018; 10:77. [PMID: 30086796 PMCID: PMC6081879 DOI: 10.1186/s13195-018-0403-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/09/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Alzheimer's disease is characterized by aggregated β-amyloid and tau proteins, but the clinical presentations and patterns of brain atrophy vary substantially. A part of this heterogeneity may be linked to the risk allele APOE ε4. The spread of tau pathology is related to atrophy and cognitive decline, but little data exist on the effects of APOE ε4 on tau. The objective of this preliminary study was therefore to test if tau load and brain structure differ by APOE ε4 in Alzheimer's disease. METHODS Sixty-five β-amyloid-positive patients at the prodromal and dementia stages of Alzheimer's disease were enrolled, including APOE ε4-positive (n = 46) and APOE ε4-negative (n = 19) patients. 18F-AV-1451 positron emission tomography was used to measure tau and brain magnetic resonance imaging (MRI) was used to measure cortical thickness. RESULTS Compared with their APOE ε4-positive counterparts, APOE ε4-negative patients had greater tau load and reduced cortical thickness, with the most pronounced effects for both in the parietal cortex. Relative to the overall cortical tau load, APOE ε4-positive patients had greater tau load in the entorhinal cortex. APOE ε4-positive patients also had slightly greater cortical β-amyloid load. There was an interaction between APOE ε4 and 18F-AV-1451 on cortical thickness, with greater effects of 18F-AV-1451 on cortical thickness in APOE ε4-negative patients. APOE ε4 and 18F-AV-1451 were independent predictors of cognition, but showed distinct associations with different cognitive tests. CONCLUSIONS APOE genotype may be associated with differences in pathways in Alzheimer's disease, potentially through differential development and spread of tau, as well as through effects on cognitive outcomes involving non-tau-related mechanisms.
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Affiliation(s)
- Niklas Mattsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Rik Ossenkoppele
- Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Ruben Smith
- Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Olof Strandberg
- Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Tomas Ohlsson
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Jonas Jögi
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
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24
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Venneri A, Jahn-Carta C, de Marco M, Quaranta D, Marra C. Diagnostic and prognostic role of semantic processing in preclinical Alzheimer's disease. Biomark Med 2018; 12:637-651. [PMID: 29896968 DOI: 10.2217/bmm-2017-0324] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Relatively spared during most of the timeline of normal aging, semantic memory shows a subtle yet measurable decline even during the pre-clinical stage of Alzheimer's disease. This decline is thought to reflect early neurofibrillary changes and impairment is detectable using tests of language relying on lexical-semantic abilities. A promising approach is the characterization of semantic parameters such as typicality and age of acquisition of words, and propositional density from verbal output. Seminal research like the Nun Study or the analysis of the linguistic decline of famous writers and politicians later diagnosed with Alzheimer's disease supports the early diagnostic value of semantic processing and semantic memory. Moreover, measures of these skills may play an important role for the prognosis of patients with mild cognitive impairment.
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Affiliation(s)
- Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | | | - Matteo de Marco
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Davide Quaranta
- Neurology Unit, Fondazione Policlinico Universitario 'A Gemelli', Rome, Italy
| | - Camillo Marra
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome; Memory Clinic, Fondazione Policlinico Universitario 'A Gemelli', Rome, Italy
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25
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Rivero-Santana A, Ferreira D, Perestelo-Pérez L, Westman E, Wahlund LO, Sarría A, Serrano-Aguilar P. Cerebrospinal Fluid Biomarkers for the Differential Diagnosis between Alzheimer's Disease and Frontotemporal Lobar Degeneration: Systematic Review, HSROC Analysis, and Confounding Factors. J Alzheimers Dis 2018; 55:625-644. [PMID: 27716663 DOI: 10.3233/jad-160366] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Differential diagnosis in dementia is at present one of the main challenges both in clinical practice and research. Cerebrospinal fluid (CSF) biomarkers are included in the current diagnostic criteria of Alzheimer's disease (AD) but their clinical utility is still unclear. OBJECTIVE We performed a systematic review of studies analyzing the diagnostic performance of CSF Aβ42, total tau (t-tau), and phosphorylated tau (p-tau) in the discrimination between AD and frontotemporal lobar degeneration (FTLD) dementias. METHODS The following electronic databases were consulted until May 2016: Medline and PreMedline, EMBASE, PsycInfo, CINAHL, Cochrane Library, and CRD. For the first-time in the field, a Hierarchical Summary Receiver Operating Characteristic (HRSOC) model was applied, which avoids methodological problems of meta-analyses based on summary points of sensitivity and specificity values. We also investigated relevant confounders of CSF biomarkers' diagnostic performance such as age, disease duration, and global cognitive impairment. RESULTS The p-tau/Aβ42 ratio showed the best diagnostic performance. No statistically significant effects of the confounders were observed. Nonetheless, the p-tau/Aβ42 ratio may be especially indicated for younger patients. P-tau may be preferable for less cognitively impaired patients (high MMSE scores) and the t-tau/Aβ42 ratio for more cognitively impaired patients (low MMSE scores). CONCLUSION The p-tau/Aβ42 ratio has potential for being implemented in the clinical routine for the differential diagnosis between AD and FTLD. It is of utmost importance that future studies report information on confounders such as age, disease duration, and cognitive impairment, which should also stimulate understanding of the role of these factors in disease mechanisms and pathophysiology.
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Affiliation(s)
- Amado Rivero-Santana
- Canarian Foundation for Health Research (FUNCANIS), Tenerife, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lilisbeth Perestelo-Pérez
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.,Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Antonio Sarría
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain.,Agency for Health Technology Assessment (AETS), Institute of Health Carlos III, Madrid, Spain
| | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.,Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain
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26
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Harris JM, Saxon JA, Jones M, Snowden JS, Thompson JC. Neuropsychological differentiation of progressive aphasic disorders. J Neuropsychol 2018; 13:214-239. [PMID: 29424041 PMCID: PMC6618014 DOI: 10.1111/jnp.12149] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 12/10/2017] [Indexed: 12/02/2022]
Abstract
The differentiation of subtypes of primary progressive aphasia (PPA) remains challenging. We aimed to identify optimum neuropsychological measures for characterizing PPA, to examine the relationship between behavioural change and subtypes of PPA and to determine whether characteristic profiles of language, working memory, and behavioural changes occur in PPA. Forty‐seven patients with PPA and multi‐domain Alzheimer's disease (AD) together with 19 age‐matched controls underwent a large battery of working memory and language tests. We found that simple tasks of sentence ordering, narrative production, and buccofacial praxis were particularly useful in differentiating non‐fluent/agrammatic variant PPA (nfvPPA) from other PPA subtypes, whereas a test of single word comprehension was useful in detecting semantic dementia (SD). No individual tests were discriminating for logopenic variant PPA (lvPPA) relative to nfvPPA. LvPPA and multidomain AD exhibited similar language profiles. A principal components analysis revealed that characteristic PPA profiles extended beyond the realms of language, in particular, the presence of apraxia in nfvPPA, behavioural changes in SD, and working memory deficits in lvPPA. These findings suggest that not all tests are equally discriminatory for PPA and highlight the importance of a test profile in differentiating PPA. These results also support the view that lvPPA is a focal form of AD and emphasize the difficulties classifying lvPPA.
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Affiliation(s)
- Jennifer M Harris
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, UK.,Division of Neurosciences and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Jennifer A Saxon
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, UK.,Division of Neurosciences and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Matthew Jones
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, UK.,Division of Neurosciences and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Julie S Snowden
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, UK.,Division of Neurosciences and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Jennifer C Thompson
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, UK.,Division of Neurosciences and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
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27
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Kobylecki C, Haense C, Harris JM, Stopford CL, Segobin SH, Jones M, Richardson AMT, Gerhard A, Anton-Rodriguez J, Thompson JC, Herholz K, Snowden JS. Functional neuroanatomical associations of working memory in early-onset Alzheimer's disease. Int J Geriatr Psychiatry 2018; 33:176-184. [PMID: 28299814 DOI: 10.1002/gps.4703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/08/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To characterize metabolic correlates of working memory impairment in clinically defined subtypes of early-onset Alzheimer's disease. BACKGROUND Established models of working memory suggest a key role for frontal lobe function, yet the association in Alzheimer's disease between working memory impairment and visuospatial and language symptoms suggests that temporoparietal neocortical dysfunction may be responsible. METHODS Twenty-four patients with predominantly early-onset Alzheimer's disease were clinically classified into groups with predominantly amnestic, multidomain or visual deficits. Patients underwent neuropsychological evaluation focused on the domains of episodic and working memory, T1-weighted magnetic resonance imaging and brain fluorodeoxyglucose positron emission tomography. Fluorodeoxyglucose positron emission tomography data were analysed by using a region-of-interest approach. RESULTS Patients with multidomain and visual presentations performed more poorly on tests of working memory compared with amnestic Alzheimer's disease. Working memory performance correlated with glucose metabolism in left-sided temporoparietal, but not frontal neocortex. Carriers of the apolipoprotein E4 gene showed poorer episodic memory and better working memory performance compared with noncarriers. CONCLUSIONS Our findings support the hypothesis that working memory changes in early-onset Alzheimer's disease are related to temporoparietal rather than frontal hypometabolism and show dissociation from episodic memory performance. They further support the concept of subtypes of Alzheimer's disease with distinct cognitive profiles due to prominent neocortical dysfunction early in the disease course. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Christopher Kobylecki
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Cathleen Haense
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Jennifer M Harris
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Cheryl L Stopford
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Shailendra H Segobin
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,INSERM-EPHE-Université de Caen de Basse-Normandie, Caen, France
| | - Matthew Jones
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Anna M T Richardson
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Medical School, University of Manchester, Manchester, UK
| | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - José Anton-Rodriguez
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jennifer C Thompson
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Karl Herholz
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Julie S Snowden
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
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Scheltens NME, Tijms BM, Koene T, Barkhof F, Teunissen CE, Wolfsgruber S, Wagner M, Kornhuber J, Peters O, Cohn-Sheehy BI, Rabinovici GD, Miller BL, Kramer JH, Scheltens P, van der Flier WM. Cognitive subtypes of probable Alzheimer's disease robustly identified in four cohorts. Alzheimers Dement 2017; 13:1226-1236. [PMID: 28427934 PMCID: PMC5857387 DOI: 10.1016/j.jalz.2017.03.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Patients with Alzheimer's disease (AD) show heterogeneity in profile of cognitive impairment. We aimed to identify cognitive subtypes in four large AD cohorts using a data-driven clustering approach. METHODS We included probable AD dementia patients from the Amsterdam Dementia Cohort (n = 496), Alzheimer's Disease Neuroimaging Initiative (n = 376), German Dementia Competence Network (n = 521), and University of California, San Francisco (n = 589). Neuropsychological data were clustered using nonnegative matrix factorization. We explored clinical and neurobiological characteristics of identified clusters. RESULTS In each cohort, a two-clusters solution best fitted the data (cophenetic correlation >0.9): one cluster was memory-impaired and the other relatively memory spared. Pooled analyses showed that the memory-spared clusters (29%-52% of patients) were younger, more often apolipoprotein E (APOE) ɛ4 negative, and had more severe posterior atrophy compared with the memory-impaired clusters (all P < .05). CONCLUSIONS We could identify two robust cognitive clusters in four independent large cohorts with distinct clinical characteristics.
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Affiliation(s)
- Nienke M. E. Scheltens
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Betty M. Tijms
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Teddy Koene
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
- Institute of Neurology, University College London, London, UK
- Institute of Healthcare Engineering, University College London, London, UK
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Centre, Amsterdam, The Netherlands
| | - Steffen Wolfsgruber
- Department of Psychiatry, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Michael Wagner
- Department of Psychiatry, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Johannes Kornhuber
- Department of Psychiatry, Friedrich-Alexander-University Erlangen, Erlangen, Germany
| | - Oliver Peters
- Department of Psychiatry, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Brendan I. Cohn-Sheehy
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gil D. Rabinovici
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Joel H. Kramer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Wiesje M. van der Flier
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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29
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Saxon JA, Thompson JC, Jones M, Harris JM, Richardson AM, Langheinrich T, Neary D, Mann DM, Snowden JS. Examining the language and behavioural profile in FTD and ALS-FTD. J Neurol Neurosurg Psychiatry 2017; 88:675-680. [PMID: 28596248 PMCID: PMC5537548 DOI: 10.1136/jnnp-2017-315667] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/04/2017] [Accepted: 04/13/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND A proportion of patients with behavioural variant frontotemporal dementia (bvFTD) develop amyotrophic lateral sclerosis (ALS). It is currently unknown whether the behavioural and cognitive syndrome in bvFTD with ALS (ALS-FTD) is indistinguishable from that of bvFTD alone. METHODS A retrospective cohort of 241 patients with clinical diagnoses of bvFTD (n=185) or ALS-FTD (n=56) was examined with respect to behavioural, cognitive and neuropsychiatric symptoms. Features were rated as present or absent based on information recorded from clinical interviews and detailed neuropsychological assessment. RESULTS A number of behavioural and affective changes were reported more frequently in bvFTD than ALS-FTD: social disinhibition (p<0.001), inertia (p<0.001), loss of sympathy and empathy (p=0.008), repetitive behaviours (p<0.001) and dietary changes (p<0.001). Warmth of affect demonstrated in the clinic setting was reported more often in ALS-FTD than bvFTD (p<0.001). Executive impairments occurred equally in both groups. Language impairments were more common in ALS-FTD than bvFTD: agrammatism (p<0.017) and impaired sentence comprehension (p<0.036). Psychotic features were relatively rare and did not distinguish the groups. CONCLUSIONS Our findings suggest differences between bvFTD and ALS-FTD. In particular, while changes in social behaviour are prominent in bvFTD alone, there may be a comparatively greater degree of language impairment in ALS-FTD. Prospective exploration of the pattern of differences between these groups will be essential. Identification of a distinct neuropsychological phenotype in ALS-FTD may have clinical implications for early diagnosis, disease management and care planning and theoretical implications for our understanding of the relationship between ALS and FTD.
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Affiliation(s)
- Jennifer A Saxon
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK.,Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Jennifer C Thompson
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK.,Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Matthew Jones
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK.,Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Jennifer M Harris
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK.,Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Anna Mt Richardson
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK.,Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Tobias Langheinrich
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK.,Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - David Neary
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - David Ma Mann
- Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Julie S Snowden
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK.,Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
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30
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Martin M, Hermsdörfer J, Bohlhalter S, Weiss PH. [Networks involved in motor cognition : Physiology and pathophysiology of apraxia]. DER NERVENARZT 2017; 88:858-865. [PMID: 28664265 DOI: 10.1007/s00115-017-0370-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Apraxia is an umbrella term for different disorders of higher motor abilities that are not explained by elementary sensorimotor deficits (e. g. paresis or ataxia). Characteristic features of apraxia that are easy to recognize in clinical practice are difficulties in pantomimed or actual use of tools as well as in imitation of meaningless gestures. Apraxia is bilateral, explaining the cognitive motor disorders and occurs frequently (but not exclusively) after left hemispheric lesions, as well as in neurodegenerative diseases, such as corticobasal syndrome and Alzheimer's disease. Apraxic deficits can seriously impair activities of daily living, which is why the appropriate diagnosis is of great relevance. At the functional anatomical level, different cognitive motor skills rely on at least partly different brain networks, namely, a ventral processing pathway for semantic components, such as tool-action associations, a ventro-dorsal pathway for sensorimotor representations of learnt motor acts, as well as a dorso-dorsal pathway for on-line motor control and, probably, imitation of meaningless gestures. While these networks partially overlap with language-relevant regions, more clear cut dissociations are found between apraxia deficits and disorders of spatial attention. In addition to behavioral interventions, noninvasive neuromodulation approaches, as well as human-computer interface assistance systems are a growing focus of interest for the treatment of apraxia.
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Affiliation(s)
- M Martin
- Klinik für Neurologie und klinische Neurophysiologie, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg im Breisgau, Deutschland.
- BrainLinks-BrainTools Exzellenzcluster, Universität Freiburg, Freiburg im Breisgau, Deutschland.
| | - J Hermsdörfer
- Lehrstuhl für Bewegungswissenschaft, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, München, Deutschland
| | - S Bohlhalter
- Zentrum für Neurologie und Neurorehabilitation, Luzerner Kantonsspital, Luzern, Schweiz
| | - P H Weiss
- Kognitive Neurologie, Klinik und Poliklinik für Neurologie, Uniklinik Köln, Köln, Deutschland
- Kognitive Neurowissenschaften, Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich, Jülich, Deutschland
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Abstract
Early-onset Alzheimer disease (EOAD), with onset in individuals younger than 65 years, although overshadowed by the more common late-onset AD (LOAD), differs significantly from LOAD. EOAD comprises approximately 5% of AD and is associated with delays in diagnosis, aggressive course, and age-related psychosocial needs. One source of confusion is that a substantial percentage of EOAD are phenotypic variants that differ from the usual memory-disordered presentation of typical AD. The management of EOAD is similar to that for LOAD, but special emphasis should be placed on targeting the specific cognitive areas involved and more age-appropriate psychosocial support and education.
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Affiliation(s)
- Mario F Mendez
- Behavioral Neurology Program, David Geffen School of Medicine at UCLA, 300 Westwood Plaza, Suite B-200, Box 956975, Los Angeles, CA 90095, USA; Neurobehavior Unit, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Building 206, Los Angeles, CA 90073, USA.
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32
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Ferreira D, Verhagen C, Hernández-Cabrera JA, Cavallin L, Guo CJ, Ekman U, Muehlboeck JS, Simmons A, Barroso J, Wahlund LO, Westman E. Distinct subtypes of Alzheimer's disease based on patterns of brain atrophy: longitudinal trajectories and clinical applications. Sci Rep 2017; 7:46263. [PMID: 28417965 PMCID: PMC5394684 DOI: 10.1038/srep46263] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/08/2017] [Indexed: 12/27/2022] Open
Abstract
Atrophy patterns on MRI can reliably predict three neuropathological subtypes of Alzheimer’s disease (AD): typical, limbic-predominant, or hippocampal-sparing. A method to enable their investigation in the clinical routine is still lacking. We aimed to (1) validate the combined use of visual rating scales for identification of AD subtypes; (2) characterise these subtypes at baseline and over two years; and (3) investigate how atrophy patterns and non-memory cognitive domains contribute to memory impairment. AD patients were classified as either typical AD (n = 100), limbic-predominant (n = 33), or hippocampal-sparing (n = 35) by using the Scheltens’ scale for medial temporal lobe atrophy (MTA), the Koedam’s scale for posterior atrophy (PA), and the Pasquier’s global cortical atrophy scale for frontal atrophy (GCA-F). A fourth group with no atrophy was also identified (n = 30). 230 healthy controls were also included. There was great overlap among subtypes in demographic, clinical, and cognitive variables. Memory performance was more dependent on non-memory cognitive functions in hippocampal-sparing and the no atrophy group. Hippocampal-sparing and the no atrophy group showed less aggressive disease progression. Visual rating scales can be used to identify distinct AD subtypes. Recognizing AD heterogeneity is important and visual rating scales may facilitate investigation of AD heterogeneity in clinical routine.
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Affiliation(s)
- Daniel Ferreira
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Chloë Verhagen
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Lena Cavallin
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital in Huddinge, Huddinge, Sweden
| | - Chun-Jie Guo
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, The First Hospital of Jilin University, Jilin, China
| | - Urban Ekman
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - J-Sebastian Muehlboeck
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Andrew Simmons
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre for Mental Health, London, UK.,NIHR Biomedical Research Unit for Dementia, London, UK
| | - José Barroso
- Faculty of Psychology, University of La Laguna, Tenerife, Spain
| | - Lars-Olof Wahlund
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Eric Westman
- Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Abstract
BACKGROUND/OBJECTIVE Unimanual gesture production or imitation has often been studied in Alzheimer's disease (AD) during apraxia testing. In the present study, it was hypothesized that bimanual motor tasks may be a sensitive method to detect impairments of motor cognition in AD due to increased demands on the cognitive system. METHODS We investigated bimanual, meaningless gesture imitation in 45 AD outpatients, 38 subjects with mild cognitive impairment (MCI), and 50 normal controls (NC) attending a memory clinic. Participants performed neuropsychological background testing and three tasks: the Interlocking Finger Test (ILF), Imitation of Alternating Hand Movements (AHM), and Bimanual Rhythm Tapping (BRT). RESULTS The tasks were short and easy to administer. Inter-rater reliability was high across all three tests. AD patients performed significantly poorer than NC and MCI participants; a deficit to imitate bimanual gestures was rarely found in MCI and NC participants. Sensitivity to detect AD ranged from 0.5 and 0.7, specificity beyond 0.9. ROC analyses revealed good diagnostic accuracy (0.77 to 0.92). Impairment to imitate bimanual gestures was mainly predicted by diagnosis and disease severity. CONCLUSION Our findings suggest that an impairment to imitate bimanual, meaningless gestures is a valid disease marker of mild to moderate AD and can easily be assessed in memory clinic settings. Based on our preliminary findings, it appears to be a separate impairment which can be distinguished from other cognitive deficits.
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34
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Ricciarelli R, Fedele E. The Amyloid Cascade Hypothesis in Alzheimer's Disease: It's Time to Change Our Mind. Curr Neuropharmacol 2017; 15:926-935. [PMID: 28093977 PMCID: PMC5652035 DOI: 10.2174/1570159x15666170116143743] [Citation(s) in RCA: 218] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/04/2017] [Accepted: 01/14/2017] [Indexed: 01/18/2023] Open
Abstract
Since its discovery in 1984, the beta amyloid peptide has treaded the boards of neurosciences as the star molecule in Alzheimer's disease pathogenesis. In the last decade, however, this vision has been challenged by evidence-based medicine showing the almost complete failure of clinical trials that experimented anti-amyloid therapies with great hopes. Moreover, data have accumulated which clearly indicate that this small peptide plays a key role in the physiological processes of memory formation. In the present review, we will discuss the different aspects of the amyloid cascade hypothesis, highlighting its pros and cons, and we will analyse the results of the therapeutic approaches attempted to date that should change the direction of Alzheimer's disease research in the future.
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Affiliation(s)
- Roberta Ricciarelli
- Department of Experimental Medicine, Section of General Pathology, University of Genova, Genova, Italy
| | - Ernesto Fedele
- Department of Pharmacy, Section of Pharmacology and Toxicology, University of Genova, Genova, Italy
- Center of Excellence for Biomedical Research, University of Genova, Genova, Italy
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35
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Fraser KC, Meltzer JA, Rudzicz F. Linguistic Features Identify Alzheimer's Disease in Narrative Speech. J Alzheimers Dis 2016; 49:407-22. [PMID: 26484921 DOI: 10.3233/jad-150520] [Citation(s) in RCA: 237] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although memory impairment is the main symptom of Alzheimer's disease (AD), language impairment can be an important marker. Relatively few studies of language in AD quantify the impairments in connected speech using computational techniques. OBJECTIVE We aim to demonstrate state-of-the-art accuracy in automatically identifying Alzheimer's disease from short narrative samples elicited with a picture description task, and to uncover the salient linguistic factors with a statistical factor analysis. METHODS Data are derived from the DementiaBank corpus, from which 167 patients diagnosed with "possible" or "probable" AD provide 240 narrative samples, and 97 controls provide an additional 233. We compute a number of linguistic variables from the transcripts, and acoustic variables from the associated audio files, and use these variables to train a machine learning classifier to distinguish between participants with AD and healthy controls. To examine the degree of heterogeneity of linguistic impairments in AD, we follow an exploratory factor analysis on these measures of speech and language with an oblique promax rotation, and provide interpretation for the resulting factors. RESULTS We obtain state-of-the-art classification accuracies of over 81% in distinguishing individuals with AD from those without based on short samples of their language on a picture description task. Four clear factors emerge: semantic impairment, acoustic abnormality, syntactic impairment, and information impairment. CONCLUSION Modern machine learning and linguistic analysis will be increasingly useful in assessment and clustering of suspected AD.
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Affiliation(s)
- Kathleen C Fraser
- Department of Computer Science, University of Toronto, Toronto, Canada
| | | | - Frank Rudzicz
- Department of Computer Science, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute-UHN, Toronto, Canada
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36
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Price CC, Tanner JJ, Schmalfuss IM, Brumback B, Heilman KM, Libon DJ. Dissociating Statistically-Determined Alzheimer's Disease/Vascular Dementia Neuropsychological Syndromes Using White and Gray Neuroradiological Parameters. J Alzheimers Dis 2016; 48:833-47. [PMID: 26402109 DOI: 10.3233/jad-150407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is remarkable heterogeneity in clinical Alzheimer's disease (AD) or vascular dementia (VaD). OBJECTIVES 1) To statistically examine neuropsychological data to determine dementia subgroups for individuals clinically diagnosed with AD or VaD and then 2) examine group differences in specific gray/white matter regions of interest. METHODS A k-means cluster analysis requested a 3-group solution from neuropsychological data acquired from individuals diagnosed clinically with AD/VaD. MRI measures of hippocampal, caudate, ventricular, subcortical lacunar infarction, whole brain volume, and leukoaraiosis (LA) were analyzed. Three regions of LA volumes were quantified and these included the periventricular (5 mm around the ventricles), infracortical (5 mm beneath the gray matter), and deep (between periventricular and infracortical) regions. RESULTS Cluster analysis sorted AD/VaD patients into single domain amnestic (n = 41), single-domain dysexecutive (n = 26), and multi-domain (n = 26) phenotypes. Multi-domain patients exhibited worst performance on language tests; however, multi-domain patients were equally impaired on memory tests when compared to amnestic patients. Statistically-determined groups dissociated using neuroradiological parameters: amnestic and multi-domain groups presented with smaller hippocampal volume while the dysexecutive group presented with greater deep, periventricular, and whole brain LA. Neither caudate nor lacunae volume differed by group. Caudate nucleus volume negatively correlated with total LA in the dysexecutive and multi-domain groups. CONCLUSIONS There are at least three distinct subtypes embedded within patients diagnosed clinically with AD/VaD spectrum dementia. We encourage future research to assess a) the neuroradiological substrates underlying statistically-determined AD/VaD spectrum dementia and b) how statistical modeling can be integrated into existing diagnostic criteria.
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Affiliation(s)
- Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Jared J Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Ilona M Schmalfuss
- Department of Radiology, University of Florida, Gainesville, Florida, USA.,Department of Radiology, North Florida/South Georgia Veteran Administration, Gainesville, Florida, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Kenneth M Heilman
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - David J Libon
- Drexel Neuroscience Institute, Drexel University, College of Medicine, Philadelphia, PA, USA
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37
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Scheltens NME, Galindo-Garre F, Pijnenburg YAL, van der Vlies AE, Smits LL, Koene T, Teunissen CE, Barkhof F, Wattjes MP, Scheltens P, van der Flier WM. The identification of cognitive subtypes in Alzheimer's disease dementia using latent class analysis. J Neurol Neurosurg Psychiatry 2016; 87:235-43. [PMID: 25783437 DOI: 10.1136/jnnp-2014-309582] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/26/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Alzheimer's disease (AD) is a heterogeneous disorder with complex underlying neuropathology that is still not completely understood. For better understanding of this heterogeneity, we aimed to identify cognitive subtypes using latent class analysis (LCA) in a large sample of patients with AD dementia. In addition, we explored the relationship between the identified cognitive subtypes, and their demographical and neurobiological characteristics. METHODS We performed LCA based on neuropsychological test results of 938 consecutive probable patients with AD dementia using Mini-Mental State Examination as the covariate. Subsequently, we performed multinomial logistic regression analysis with cluster membership as dependent variable and dichotomised demographics, APOE genotype, cerebrospinal fluid biomarkers and MRI characteristics as independent variables. RESULTS LCA revealed eight clusters characterised by distinct cognitive profile and disease severity. Memory-impaired clusters-mild-memory (MILD-MEM) and moderate-memory (MOD-MEM)-included 43% of patients. Memory-spared clusters mild-visuospatial-language (MILD-VILA), mild-executive (MILD-EXE) and moderate-visuospatial (MOD-VISP) -included 29% of patients. Memory-indifferent clusters mild-diffuse (MILD-DIFF), moderate-language (MOD-LAN) and severe-diffuse (SEV-DIFF) -included 28% of patients. Cognitive clusters were associated with distinct demographical and neurobiological characteristics. In particular, the memory-spared MOD-VISP cluster was associated with younger age, APOE e4 negative genotype and prominent atrophy of the posterior cortex. CONCLUSIONS Using LCA, we identified eight distinct cognitive subtypes in a large sample of patients with AD dementia. Cognitive clusters were associated with distinct demographical and neurobiological characteristics.
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Affiliation(s)
- Nienke M E Scheltens
- Department of Neurology, Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Francisca Galindo-Garre
- Department of Epidemiology and Biostatistics, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Department of Neurology, Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Annelies E van der Vlies
- Department of Neurology, Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Lieke L Smits
- Department of Neurology, Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Teddy Koene
- Department of Medical Psychology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands Department of Epidemiology and Biostatistics, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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38
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Kuzmickienė J, Kaubrys G. Cognitive Results of CANTAB Tests and Their Change Due to the First Dose of Donepezil May Predict Treatment Efficacy in Alzheimer Disease. Med Sci Monit 2015; 21:3887-99. [PMID: 26656642 PMCID: PMC4684140 DOI: 10.12659/msm.896327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Ability to predict the efficacy of treatment in Alzheimer disease (AD) may be very useful in clinical practice. Cognitive predictors should be investigated alongside with the demographic, genetic, and other predictors of treatment efficacy. The aim of this study was to establish whether the baseline measures of CANTAB tests and their changes due to the first donepezil dose are able to predict the efficacy of treatment after 4 months of therapy. We also compared the predictive value of cognitive, clinical, and demographic predictors of treatment efficacy in AD. Material/Methods Seventy-two AD patients (62 treatment-naïve and 10 donepezil-treated) and 30 controls were enrolled in this prospective, randomized, rater-blinded, follow-up study. Treatment-naïve AD patients were randomized to 2 groups to take the first donepezil dose after the first or second CANTAB testing, separated by 4 hours. Follow-up Test 3 was performed 4 months after the initial assessment. Results The groups were similar in age, education, gender, Hachinski index, and depression. General Regression Models (GRM) have shown that cognitive changes after the first dose of donepezil in PAL (t-values for regression coefficients from 3.43 to 6.44), PRMd (t=4.33), SWM (t=5.85) test scores, and baseline results of PAL (t=2.57–2.86), PRM (t=3.08), and CRT (t=3.42) tests were significant predictors of long-term donepezil efficacy in AD (p<0.05). Conclusions The cognitive changes produced by the first donepezil dose in CANTAB PAL, PRM, and SWM test measures are able to predict the long-term efficacy of donepezil in AD. Baseline PAL, PRM, and CRT test results were significant predictors.
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Affiliation(s)
- Jurgita Kuzmickienė
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University; Center of Neurology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - Gintaras Kaubrys
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University; Center of Neurology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
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39
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Burrell JR, Piguet O. Lifting the veil: how to use clinical neuropsychology to assess dementia. J Neurol Neurosurg Psychiatry 2015; 86:1216-24. [PMID: 25814493 DOI: 10.1136/jnnp-2013-307483] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/24/2015] [Indexed: 11/04/2022]
Abstract
Neurologists often struggle to interpret the results of neuropsychological testing, even though cognitive assessments are an integral component of the diagnostic process in dementia syndromes. This article reviews the principles underlying clinical neuropsychology, background on common neuropsychological tests, and tips on how to interpret the results when assessing patients with dementia. General cognitive screening tools, appropriate for use by general neurologists and psychiatrists, as well as specific cognitive tests examining the main cognitive domains (attention and orientation, memory, visuospatial function, language and executive function) in patients with dementia are considered. Finally, the pattern of deficits, helpful in defining clinical dementia phenotypes and sometimes in predicting the underlying molecular pathology, are outlined. Such clinicopathological associations will become invaluable as disease-modifying treatments for dementia are developed and implemented.
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Affiliation(s)
- James R Burrell
- Neuroscience Research Australia, Sydney, New South Wales, Australia University of New South Wales, Sydney, New South Wales, Australia ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Olivier Piguet
- Neuroscience Research Australia, Sydney, New South Wales, Australia University of New South Wales, Sydney, New South Wales, Australia ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
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40
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Ossenkoppele R, Cohn-Sheehy BI, La Joie R, Vogel JW, Möller C, Lehmann M, van Berckel BNM, Seeley WW, Pijnenburg YA, Gorno-Tempini ML, Kramer JH, Barkhof F, Rosen HJ, van der Flier WM, Jagust WJ, Miller BL, Scheltens P, Rabinovici GD. Atrophy patterns in early clinical stages across distinct phenotypes of Alzheimer's disease. Hum Brain Mapp 2015; 36:4421-37. [PMID: 26260856 DOI: 10.1002/hbm.22927] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/29/2015] [Accepted: 07/27/2015] [Indexed: 12/12/2022] Open
Abstract
Alzheimer's disease (AD) can present with distinct clinical variants. Identifying the earliest neurodegenerative changes associated with each variant has implications for early diagnosis, and for understanding the mechanisms that underlie regional vulnerability and disease progression in AD. We performed voxel-based morphometry to detect atrophy patterns in early clinical stages of four AD phenotypes: Posterior cortical atrophy (PCA, "visual variant," n=93), logopenic variant primary progressive aphasia (lvPPA, "language variant," n=74), and memory-predominant AD categorized as early age-of-onset (EOAD, <65 years, n=114) and late age-of-onset (LOAD, >65 years, n=114). Patients with each syndrome were stratified based on: (1) degree of functional impairment, as measured by the clinical dementia rating (CDR) scale, and (2) overall extent of brain atrophy, as measured by a neuroimaging approach that sums the number of brain voxels showing significantly lower gray matter volume than cognitively normal controls (n=80). Even at the earliest clinical stage (CDR=0.5 or bottom quartile of overall atrophy), patients with each syndrome showed both common and variant-specific atrophy. Common atrophy across variants was found in temporoparietal regions that comprise the posterior default mode network (DMN). Early syndrome-specific atrophy mirrored functional brain networks underlying functions that are uniquely affected in each variant: Language network in lvPPA, posterior cingulate cortex-hippocampal circuit in amnestic EOAD and LOAD, and visual networks in PCA. At more advanced stages, atrophy patterns largely converged across AD variants. These findings support a model in which neurodegeneration selectively targets both the DMN and syndrome-specific vulnerable networks at the earliest clinical stages of AD.
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Affiliation(s)
- Rik Ossenkoppele
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California.,Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, California.,Department of Neurology & Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Brendan I Cohn-Sheehy
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California
| | - Renaud La Joie
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, California
| | - Jacob W Vogel
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, California
| | - Christiane Möller
- Department of Neurology & Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Manja Lehmann
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California.,Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Bart N M van Berckel
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, California
| | - William W Seeley
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California
| | - Yolande A Pijnenburg
- Department of Neurology & Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Maria L Gorno-Tempini
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California
| | - Joel H Kramer
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Howard J Rosen
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California
| | - Wiesje M van der Flier
- Department of Neurology & Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - William J Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, California
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California
| | - Philip Scheltens
- Department of Neurology & Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Gil D Rabinovici
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California.,Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, California
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41
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Sitek EJ, Barczak A, Kluj-Kozłowska K, Kozłowski M, Barcikowska M, Sławek J. Is descriptive writing useful in the differential diagnosis of logopenic variant of primary progressive aphasia, Alzheimer's disease and mild cognitive impairment? Neurol Neurochir Pol 2015; 49:239-44. [PMID: 26188940 DOI: 10.1016/j.pjnns.2015.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
Current classification of primary progressive aphasia (PPA) encompasses three variants: non-fluent (nfvPPA), semantic (svPPA) and logopenic (lvPPA). Previously lvPPA was regarded as aphasic form of Alzheimer's disease (AD). However, not all patients with lvPPA phenotype present with AD pathology. Despite abundant literature on differentiation of lvPPA from svPPA and nfvPPA, studies comparing lvPPA with AD and mild cognitive impairment (MCI) are scarce. This study aimed at analyzing written descriptive output in lvPPA, AD and MCI. Thirty-five patients participated in the study: 9 with lvPPA, 13 with AD and 13 with MCI. Most aspects of writing performance were comparable in three groups. However, letter insertion errors appeared in 44% patients with lvPPA, while they were absent in AD and MCI. Patients with lvPPA used more verbs than patients with AD. Writing profile may complement other neuropsychological assessment results in the differential diagnosis of lvPPA. Letter insertion errors and frequent verb use may raise a query of lvPPA.
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Affiliation(s)
- Emilia J Sitek
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdansk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland.
| | - Anna Barczak
- Neurology Department, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Klaudia Kluj-Kozłowska
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdansk, Poland; Speech Therapy Department, Faculty of Languages, University of Gdansk, Gdansk, Poland
| | - Marcin Kozłowski
- Speech Therapy Department, Faculty of Languages, University of Gdansk, Gdansk, Poland; Neurological Rehabilitation Department, Specialist Hospital in Koscierzyna, Dzierzazno, Poland
| | - Maria Barcikowska
- Neurodegenerative Disorders Department, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
| | - Jarosław Sławek
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdansk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland
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42
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Goryawala M, Duara R, Loewenstein DA, Zhou Q, Barker W, Adjouadi M, the Alzheimer’s Disease Neuro. Apolipoprotein-E4 (ApoE4) carriers show altered small-world properties in the default mode network of the brain. Biomed Phys Eng Express 2015. [DOI: 10.1088/2057-1976/1/1/015001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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43
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Ossenkoppele R, Mattsson N, Teunissen CE, Barkhof F, Pijnenburg Y, Scheltens P, van der Flier WM, Rabinovici GD. Cerebrospinal fluid biomarkers and cerebral atrophy in distinct clinical variants of probable Alzheimer's disease. Neurobiol Aging 2015; 36:2340-7. [PMID: 25990306 DOI: 10.1016/j.neurobiolaging.2015.04.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/27/2015] [Accepted: 04/18/2015] [Indexed: 11/17/2022]
Abstract
Different clinical variants of probable Alzheimer's disease (AD) share underlying plaques and tangles but show distinct atrophy patterns. We included 52 posterior cortical atrophy, 29 logopenic variant primary progressive aphasia, 53 early-onset and 42 late-onset AD patients, selected for abnormal cerebrospinal fluid (CSF)-amyloid-beta42, with CSF and magnetic resonance imaging data available. Bootstrapping revealed no differences in the prevalence of abnormal CSF total-tau and phosphorylated-tau between probable AD variants (range total-tau: 84.9%-92.3%, phosphorylated-tau: 79.2%-93.1%, p > 0.05). Voxelwise linear regressions showed various relationships between lower CSF-Aβ42 and syndrome-specific atrophy, involving precuneus, posterior cingulate, and medial temporal lobe in early-onset AD, occipital cortex and middle temporal gyrus in posterior cortical atrophy; anterior cingulate, insular cortex and precentral gyrus (left > right) in logopenic variant primary progressive aphasia; and medial temporal lobe, thalamus, and temporal pole in late-onset AD (all at p < 0.001 uncorrected). In contrast, CSF-tau was not related to gray matter atrophy in any group. Our findings suggest that lower CSF-amyloid-beta42 - and not increased total-tau and phosphorylated-tau - relates to reduced gray matter volumes, mostly in regions that are typically atrophied in distinct clinical variants of probable AD.
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Affiliation(s)
- Rik Ossenkoppele
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA; Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA; Department of Neurology & Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands; Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - Niklas Mattsson
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative diseases, San Francisco, CA, USA; Institute of Neuroscience and Physiology, Laboratory of Clinical Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte E Teunissen
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande Pijnenburg
- Department of Neurology & Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology & Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology & Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Gil D Rabinovici
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA; Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
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44
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Morris GP, Clark IA, Vissel B. Inconsistencies and controversies surrounding the amyloid hypothesis of Alzheimer's disease. Acta Neuropathol Commun 2014; 2:135. [PMID: 25231068 PMCID: PMC4207354 DOI: 10.1186/s40478-014-0135-5] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 08/30/2014] [Indexed: 12/16/2022] Open
Abstract
The amyloid hypothesis has driven drug development strategies for Alzheimer's disease for over 20 years. We review why accumulation of amyloid-beta (Aβ) oligomers is generally considered causal for synaptic loss and neurodegeneration in AD. We elaborate on and update arguments for and against the amyloid hypothesis with new data and interpretations, and consider why the amyloid hypothesis may be failing therapeutically. We note several unresolved issues in the field including the presence of Aβ deposition in cognitively normal individuals, the weak correlation between plaque load and cognition, questions regarding the biochemical nature, presence and role of Aβ oligomeric assemblies in vivo, the bias of pre-clinical AD models toward the amyloid hypothesis and the poorly explained pathological heterogeneity and comorbidities associated with AD. We also illustrate how extensive data cited in support of the amyloid hypothesis, including genetic links to disease, can be interpreted independently of a role for Aβ in AD. We conclude it is essential to expand our view of pathogenesis beyond Aβ and tau pathology and suggest several future directions for AD research, which we argue will be critical to understanding AD pathogenesis.
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Affiliation(s)
- Gary P Morris
- />Garvan Institute of Medical Research, Neuroscience Department, Neurodegenerative Disorders Laboratory, 384 Victoria Street, Darlinghurst, NSW 2010 Australia
- />Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ian A Clark
- />Research School of Biology, Australian National University, Canberra, Australia
| | - Bryce Vissel
- />Garvan Institute of Medical Research, Neuroscience Department, Neurodegenerative Disorders Laboratory, 384 Victoria Street, Darlinghurst, NSW 2010 Australia
- />Faculty of Medicine, University of New South Wales, Sydney, Australia
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45
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Jørgensen K, Kristensen MK, Waldemar G, Vogel A. The six-item Clock Drawing Test - reliability and validity in mild Alzheimer's disease. AGING NEUROPSYCHOLOGY AND COGNITION 2014; 22:301-11. [PMID: 24974730 DOI: 10.1080/13825585.2014.932325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study presents a reliable, short and practical version of the Clock Drawing Test (CDT) for clinical use and examines its diagnostic accuracy in mild Alzheimer's disease versus elderly nonpatients. Clock drawings from 231 participants were scored independently by four clinical neuropsychologists blind to diagnostic classification. The interrater agreement of individual scoring criteria was analyzed and items with poor or moderate reliability were excluded. The classification accuracy of the resulting scoring system - the six-item CDT - was examined. We explored the effect of further reducing the number of scoring items on classification accuracy and estimated classification accuracy associated with performances deviating from the optimal cutoff score. At a cutoff of 5/6, the six-item CDT had a sensitivity (SN) of 0.65 and a specificity of 0.80. Stepwise removal of up to three items reduced SN slightly. Classification accuracy associated with a score of four or less out of six was very high.
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Affiliation(s)
- Kasper Jørgensen
- a Department of Neurology , Danish Dementia Research Centre, Rigshospitalet , Copenhagen , Denmark
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46
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Automated classification of primary progressive aphasia subtypes from narrative speech transcripts. Cortex 2014; 55:43-60. [DOI: 10.1016/j.cortex.2012.12.006] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/13/2012] [Accepted: 12/06/2012] [Indexed: 11/19/2022]
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47
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Mez J, Cosentino S, Brickman AM, Huey ED, Mayeux R. Different demographic, genetic, and longitudinal traits in language versus memory Alzheimer's subgroups. J Alzheimers Dis 2014; 37:137-46. [PMID: 23788008 DOI: 10.3233/jad-130320] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study's objective was to compare demographics, APOE genotypes, and rate of rise over time in functional impairment in neuropsychologically defined language, typical, and memory subgroups of clinical Alzheimer's disease (AD). 1,368 participants from the National Alzheimer's Coordinating Center database with a diagnosis of probable AD (CDR 0.5-1.0) were included. A language subgroup (n = 229) was defined as having language performance >1 SD worse than memory performance. A memory subgroup (n = 213) was defined as having memory performance >1 SD worse than language performance. A typical subgroup (n = 926) was defined as having a difference in language and memory performance of <1 SD. Compared with the memory subgroup, the language subgroup was 3.7 years older and more frequently self-identified as African American (OR = 3.69). Under a dominant genetic model, the language subgroup had smaller odds of carrying at least one APOEε4 allele relative to the memory subgroup. While this difference was present for all ages, it was more striking at a younger age (OR = 0.19 for youngest tertile; OR = 0.52 for oldest tertile). Compared with the memory subgroup, the language subgroup rose 35% faster on the Functional Assessment Questionnaire and 44% faster on CDR sum of boxes over time. Among a subset of participants who underwent autopsy (n = 98), the language, memory, and typical subgroups were equally likely to have an AD pathologic diagnosis, suggesting that variation in non-AD pathologies across subtypes did not lead to the observed differences. The study demonstrates that a language subgroup of AD has different demographics, genetic profile, and disease course in addition to cognitive phenotype.
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Affiliation(s)
- Jesse Mez
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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48
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Carter SF, Embleton KV, Anton-Rodriguez JM, Burns A, Ralph MAL, Herholz K. Regional Neuronal Network Failure and Cognition in Late-Onset Sporadic Alzheimer Disease. AJNR Am J Neuroradiol 2014; 35:S18-30. [PMID: 24578281 DOI: 10.3174/ajnr.a3895] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- S F Carter
- From the Wolfson Molecular Imaging Centre (S.F.C., J.M.A.-R., K.H.)Institute of Population Health, Neuroscience and Aphasia Research Unit (S.F.C., M.A.L.R.)Alzheimer Neurobiology Centre (S.F.C.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | | | - A Burns
- Institute of Brain, Behaviour and Mental Health (A.B., K.H.), University of Manchester, Manchester, UK
| | - M A L Ralph
- Institute of Population Health, Neuroscience and Aphasia Research Unit (S.F.C., M.A.L.R.)
| | - K Herholz
- From the Wolfson Molecular Imaging Centre (S.F.C., J.M.A.-R., K.H.)Institute of Brain, Behaviour and Mental Health (A.B., K.H.), University of Manchester, Manchester, UK
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49
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Herholz SC, Herholz RS, Herholz K. Non-pharmacological interventions and neuroplasticity in early stage Alzheimer's disease. Expert Rev Neurother 2014; 13:1235-45. [DOI: 10.1586/14737175.2013.845086] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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50
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Vasconcelos LDG, Jackowski AP, Oliveira MOD, Flor YMR, Souza AAL, Bueno OFA, Brucki SMD. The thickness of posterior cortical areas is related to executive dysfunction in Alzheimer's disease. Clinics (Sao Paulo) 2014; 69:28-37. [PMID: 24473557 PMCID: PMC3870310 DOI: 10.6061/clinics/2014(01)05] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/17/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To establish whether alterations of brain structures in Alzheimer's disease are associated with executive dysfunction. METHODS Nineteen patients with Alzheimer's disease and 22 older control subjects underwent a comprehensive evaluation. The clock drawing test, digit span test, executive motor function test, Behavioral Assessment of the Dysexecutive Syndrome battery (Rule Shift Cards test), and Stroop test were used to evaluate executive dysfunction. A multiparametric approach using the FreeSurfer image analysis suite provided a description of volumetric and geometric features of the gray matter structures. RESULTS The cortical thickness maps showed a negative correlation between the Behavioral Assessment of the Dysexecutive Syndrome battery (Rule Shift Cards test) and the right middle frontal gyrus; a positive correlation between the executive motor function test and the left superior parietal gyrus, left middle temporal gyrus, bilateral supramarginal gyri, right middle frontal gyrus, and right precuneus; a negative correlation between the Stroop test (part III) and the right superior parietal gyrus; and a negative correlation between the Stroop test (part III) and the right middle temporal gyrus. CONCLUSION Executive dysfunction in Alzheimer's disease is correlated with alterations not only in the frontal areas but also within many temporal and parietal regions.
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Affiliation(s)
- Luciano de Gois Vasconcelos
- Psychobiology Department, Universidade Federal de São Paulo, São Paulo/SP, Brazil, Universidade Federal de São Paulo, Psychobiology Department, São Paulo/SP, Brazil
| | - Andrea Parolin Jackowski
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Psychiatry Department, Universidade Federal de São Paulo, São Paulo/SP, Brazil, Universidade Federal de São Paulo, Psychiatry Department, Laborato´ rio Interdisciplinar de Neurocieˆ ncias Clı´nicas (LiNC), São Paulo/SP, Brazil
| | - Maira Okada de Oliveira
- Hospital das Clínicas, Cognitive Neurology and Behavior Group, Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clı´nicas, Cognitive Neurology and Behavior Group, São Paulo/SP, Brazi
| | - Yoná Mayara Ribeiro Flor
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Psychiatry Department, Universidade Federal de São Paulo, São Paulo/SP, Brazil, Universidade Federal de São Paulo, Psychiatry Department, Laborato´ rio Interdisciplinar de Neurocieˆ ncias Clı´nicas (LiNC), São Paulo/SP, Brazil
| | - Altay Alves Lino Souza
- Psychobiology Department, Universidade Federal de São Paulo, São Paulo/SP, Brazil, Universidade Federal de São Paulo, Psychobiology Department, São Paulo/SP, Brazil
| | - Orlando Francisco Amodeo Bueno
- Psychobiology Department, Universidade Federal de São Paulo, São Paulo/SP, Brazil, Universidade Federal de São Paulo, Psychobiology Department, São Paulo/SP, Brazil
| | - Sonia Maria Dozzi Brucki
- Hospital das Clínicas, Cognitive Neurology and Behavior Group, Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clı´nicas, Cognitive Neurology and Behavior Group, São Paulo/SP, Brazi
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