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van den Berg RL, de Boer C, Zwan MD, Jutten RJ, van Liere M, van de Glind MCABJ, Dubbelman MA, Schlüter LM, van Harten AC, Teunissen CE, van de Giessen E, Barkhof F, Collij LE, Robin J, Simpson W, Harrison JE, van der Flier WM, Sikkes SAM. Digital remote assessment of speech acoustics in cognitively unimpaired adults: feasibility, reliability and associations with amyloid pathology. Alzheimers Res Ther 2024; 16:176. [PMID: 39090738 PMCID: PMC11293000 DOI: 10.1186/s13195-024-01543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Digital speech assessment has potential relevance in the earliest, preclinical stages of Alzheimer's disease (AD). We evaluated the feasibility, test-retest reliability, and association with AD-related amyloid-beta (Aβ) pathology of speech acoustics measured over multiple assessments in a remote setting. METHODS Fifty cognitively unimpaired adults (Age 68 ± 6.2 years, 58% female, 46% Aβ-positive) completed remote, tablet-based speech assessments (i.e., picture description, journal-prompt storytelling, verbal fluency tasks) for five days. The testing paradigm was repeated after 2-3 weeks. Acoustic speech features were automatically extracted from the voice recordings, and mean scores were calculated over the 5-day period. We assessed feasibility by adherence rates and usability ratings on the System Usability Scale (SUS) questionnaire. Test-retest reliability was examined with intraclass correlation coefficients (ICCs). We investigated the associations between acoustic features and Aβ-pathology, using linear regression models, adjusted for age, sex and education. RESULTS The speech assessment was feasible, indicated by 91.6% adherence and usability scores of 86.0 ± 9.9. High reliability (ICC ≥ 0.75) was found across averaged speech samples. Aβ-positive individuals displayed a higher pause-to-word ratio in picture description (B = -0.05, p = 0.040) and journal-prompt storytelling (B = -0.07, p = 0.032) than Aβ-negative individuals, although this effect lost significance after correction for multiple testing. CONCLUSION Our findings support the feasibility and reliability of multi-day remote assessment of speech acoustics in cognitively unimpaired individuals with and without Aβ-pathology, which lays the foundation for the use of speech biomarkers in the context of early AD.
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Affiliation(s)
- Rosanne L van den Berg
- Alzheimer Center Amsterdam, Neurology, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands.
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Movement and Behavioral Sciences, VU University, Amsterdam, The Netherlands.
| | - Casper de Boer
- Alzheimer Center Amsterdam, Neurology, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Marissa D Zwan
- Alzheimer Center Amsterdam, Neurology, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Roos J Jutten
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mariska van Liere
- Alzheimer Center Amsterdam, Neurology, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Marie-Christine A B J van de Glind
- Alzheimer Center Amsterdam, Neurology, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Alzheimer Center Groningen, Department of Neurology, Department of Neuropsychology and Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Alzheimer Center Erasmus MC and Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Mark A Dubbelman
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lisa Marie Schlüter
- Alzheimer Center Amsterdam, Neurology, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Argonde C van Harten
- Alzheimer Center Amsterdam, Neurology, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Neurochemistry Laboratory and Biobank, Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Elsmarieke van de Giessen
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Lyduine E Collij
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
- Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Lund, Sweden
| | | | | | - John E Harrison
- Alzheimer Center Amsterdam, Neurology, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
- Scottish Brain Sciences, Edinburgh, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Neurology, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Sietske A M Sikkes
- Alzheimer Center Amsterdam, Neurology, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Movement and Behavioral Sciences, VU University, Amsterdam, The Netherlands
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Rhodius-Meester HFM, van Maurik IS, Collij LE, van Gils AM, Koikkalainen J, Tolonen A, Pijnenburg YAL, Berkhof J, Barkhof F, van de Giessen E, Lötjönen J, van der Flier WM. Computerized decision support is an effective approach to select memory clinic patients for amyloid-PET. PLoS One 2024; 19:e0303111. [PMID: 38768188 PMCID: PMC11104589 DOI: 10.1371/journal.pone.0303111] [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: 10/26/2023] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND The use of amyloid-PET in dementia workup is upcoming. At the same time, amyloid-PET is costly and limitedly available. While the appropriate use criteria (AUC) aim for optimal use of amyloid-PET, their limited sensitivity hinders the translation to clinical practice. Therefore, there is a need for tools that guide selection of patients for whom amyloid-PET has the most clinical utility. We aimed to develop a computerized decision support approach to select patients for amyloid-PET. METHODS We included 286 subjects (135 controls, 108 Alzheimer's disease dementia, 33 frontotemporal lobe dementia, and 10 vascular dementia) from the Amsterdam Dementia Cohort, with available neuropsychology, APOE, MRI and [18F]florbetaben amyloid-PET. In our computerized decision support approach, using supervised machine learning based on the DSI classifier, we first classified the subjects using only neuropsychology, APOE, and quantified MRI. Then, for subjects with uncertain classification (probability of correct class (PCC) < 0.75) we enriched classification by adding (hypothetical) amyloid positive (AD-like) and negative (normal) PET visual read results and assessed whether the diagnosis became more certain in at least one scenario (PPC≥0.75). If this was the case, the actual visual read result was used in the final classification. We compared the proportion of PET scans and patients diagnosed with sufficient certainty in the computerized approach with three scenarios: 1) without amyloid-PET, 2) amyloid-PET according to the AUC, and 3) amyloid-PET for all patients. RESULTS The computerized approach advised PET in n = 60(21%) patients, leading to a diagnosis with sufficient certainty in n = 188(66%) patients. This approach was more efficient than the other three scenarios: 1) without amyloid-PET, diagnostic classification was obtained in n = 155(54%), 2) applying the AUC resulted in amyloid-PET in n = 113(40%) and diagnostic classification in n = 156(55%), and 3) performing amyloid-PET in all resulted in diagnostic classification in n = 154(54%). CONCLUSION Our computerized data-driven approach selected 21% of memory clinic patients for amyloid-PET, without compromising diagnostic performance. Our work contributes to a cost-effective implementation and could support clinicians in making a balanced decision in ordering additional amyloid PET during the dementia workup.
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Affiliation(s)
- Hanneke F. M. Rhodius-Meester
- Alzheimer Center Amsterdam, Neurology, Amsterdam UMC Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Internal Medicine, Geriatric Medicine Section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Geriatric Medicine, The Memory Clinic, Oslo University Hospital, Oslo, Norway
| | - Ingrid S. van Maurik
- Alzheimer Center Amsterdam, Neurology, Amsterdam UMC Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Lyduine E. Collij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aniek M. van Gils
- Alzheimer Center Amsterdam, Neurology, Amsterdam UMC Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | | | | | - Yolande A. L. Pijnenburg
- Alzheimer Center Amsterdam, Neurology, Amsterdam UMC Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Johannes Berkhof
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Elsmarieke van de Giessen
- Alzheimer Center Amsterdam, Neurology, Amsterdam UMC Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Neurology, Amsterdam UMC Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
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Fang T, Dai Y, Hu X, Xu Y, Qiao J. Evaluation of serum neurofilament light chain and glial fibrillary acidic protein in the diagnosis of Alzheimer's disease. Front Neurol 2024; 15:1320653. [PMID: 38352136 PMCID: PMC10861667 DOI: 10.3389/fneur.2024.1320653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Purpose This study aimed to evaluate the use of serum neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) in the diagnosis of Alzheimer's disease (AD) and the differential diagnosis between AD and mild cognitive impairment (MCI). Methods From September 2021 to October 2022, we collected venous blood from patients and healthy individuals who visited our hospital's Neurology Department, and we isolated serum to detect NfL and GFAP using direct chemiluminescence. The results were analyzed using one-way analysis of variance (ANOVA) analysis and receiver operating characteristic (ROC) curves. Results Pairwise comparisons among the three groups showed that compared with the health checkup (HC) group, serum NfL and GFAP were increased in both AD and MCI (PNfL < 0.05, PGFAP < 0.01). There were significant differences in GFAP between MCI and AD groups, and the level in AD group was higher (p < 0.01), while there was no difference in NfL. Both serum NfL and serum GFAP levels can independently diagnose AD (p < 0.01). The ROC curve showed that GFAP had a higher diagnostic efficacy, with an area under the ROC curve (AUC) of 0.928. The cut-off values of the two serum markers for the diagnosis of AD were NfL > 40.09 pg./mL and GFAP >31.40 pg./mL. Sensitivity and specificity for NfL in the diagnosis of AD were 59.6 and 76.2%, respectively, and for GFAP, they were 90.4 and 82.1%, respectively. The combined diagnosis of GFAP and NfL improved the diagnostic efficiency (AUC = 0.931, sensitivity = 78.8%, specificity = 92.3%). The cut-off value of GFAP for the differential diagnosis of MCI and AD was 46.05 pg./mL. Conclusion Both serum NfL and serum GFAP can be used as biomarkers for the diagnosis of AD. Serum GFAP has better diagnostic efficacy and can distinguish AD from MCI. A combined diagnosis can improve diagnostic specificity.
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Affiliation(s)
| | | | | | - Yuanhong Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jinping Qiao
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Collij LE, Farrar G, Zwan M, van de Giessen E, Ossenkoppele R, Barkhof F, Rozemuller AJM, Pijnenburg YAL, van der Flier WM, Bouwman F. Clinical outcomes up to 9 years after [ 18F]flutemetamol amyloid-PET in a symptomatic memory clinic population. Alzheimers Res Ther 2023; 15:207. [PMID: 38012799 PMCID: PMC10680192 DOI: 10.1186/s13195-023-01351-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Previous studies demonstrated increases in diagnostic confidence and change in patient management after amyloid-PET. However, studies investigating longitudinal outcomes over an extended period of time are limited. Therefore, we aimed to investigate clinical outcomes up to 9 years after amyloid-PET to support the clinical validity of the imaging technique. METHODS We analyzed longitudinal data from 200 patients (Mage = 61.8, 45.5% female, MMMSE = 23.3) suspected of early-onset dementia that underwent [18F]flutemetamol-PET. Baseline amyloid status was determined through visual read (VR). Information on mortality was available with a mean follow-up of 6.7 years (range = 1.1-9.3). In a subset of 108 patients, longitudinal cognitive scores and clinical etiological diagnosis (eDx) at least 1 year after amyloid-PET acquisition were available (M = 3.06 years, range = 1.00-7.02). VR - and VR + patients were compared on mortality rates with Cox Hazard's model, prevalence of stable eDx using chi-square test, and longitudinal cognition with linear mixed models. Neuropathological data was available for 4 patients (mean delay = 3.59 ± 1.82 years, range = 1.2-6.3). RESULTS At baseline, 184 (92.0%) patients were considered to have dementia. The majority of VR + patients had a primary etiological diagnosis of AD (122/128, 95.3%), while the VR - group consisted mostly of non-AD etiologies, most commonly frontotemporal lobar degeneration (30/72, 40.2%). Overall mortality rate was 48.5% and did not differ between VR - and VR + patients. eDx at follow-up was consistent with baseline diagnosis for 92/108 (85.2%) patients, with most changes observed in VR - cases (VR - = 14/35, 40% vs VR + = 2/73, 2.7%, χ2 = 26.03, p < 0.001), who at no time received an AD diagnosis. VR + patients declined faster than VR - patients based on MMSE (β = - 1.17, p = 0.004), episodic memory (β = - 0.78, p = 0.003), fluency (β = - 1.44, p < 0.001), and attention scores (β = 16.76, p = 0.03). Amyloid-PET assessment was in line with post-mortem confirmation in all cases; two cases were VR + and showed widespread AD pathology, while the other two cases were VR - and showed limited amyloid pathology. CONCLUSION In a symptomatic population, we observed that amyloid-status did not impact mortality rates, but is predictive of cognitive functioning over time across several domains. Also, we show particular validity for a negative amyloid-PET assessment, as these patients did not receive an AD diagnosis at follow-up.
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Affiliation(s)
- Lyduine E Collij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands.
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
| | | | - Marissa Zwan
- Alzheimer Center and Department of Neurology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Alzheimer Center and Department of Neurology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
- Centre for Medical Image Computing, and Queen Square Institute of Neurology, UCL, London, UK
| | | | - Yolande A L Pijnenburg
- Alzheimer Center and Department of Neurology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center and Department of Neurology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
| | - Femke Bouwman
- Alzheimer Center and Department of Neurology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
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Hazan J, Liu KY, Fox NC, Howard R. Online clinical tools to support the use of new plasma biomarker diagnostic technology in the assessment of Alzheimer's disease: a narrative review. Brain Commun 2023; 5:fcad322. [PMID: 38090277 PMCID: PMC10715781 DOI: 10.1093/braincomms/fcad322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/11/2023] [Accepted: 11/23/2023] [Indexed: 02/15/2024] Open
Abstract
Recent advances in new diagnostic technologies for Alzheimer's disease have improved the speed and precision of diagnosis. However, accessing the potential benefits of this technology poses challenges for clinicians, such as deciding whether it is clinically appropriate to order a diagnostic test, which specific test or tests to order and how to interpret test results and communicate these to the patient and their caregiver. Tools to support decision-making could provide additional structure and information to the clinical assessment process. These tools could be accessed online, and such 'e-tools' can provide an interactive interface to support patients and clinicians in the use of new diagnostic technologies for Alzheimer's disease. We performed a narrative review of the literature to synthesize information available on this research topic. Relevant studies that provide an understanding of how these online tools could be used to optimize the clinical utility of diagnostic technology were identified. Based on these, we discuss the ways in which e-tools have been used to assist in the diagnosis of Alzheimer's disease and propose recommendations for future research to aid further development.
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Affiliation(s)
- Jemma Hazan
- Division of Psychiatry, University College London, London W1T 7BN, UK
| | - Kathy Y Liu
- Division of Psychiatry, University College London, London W1T 7BN, UK
| | - Nick C Fox
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, W1T 7NF, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London W1T 7BN, UK
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Cahan JG, Vassar R, Bonakdarpour B. Lower Cerebrospinal Fluid Amyloid-β 42 Predicts Sooner Time to Antipsychotic Use in Alzheimer's Disease. J Alzheimers Dis Rep 2023; 7:641-647. [PMID: 37483323 PMCID: PMC10357113 DOI: 10.3233/adr-220064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background Cerebrospinal fluid (CSF) biomarkers of amyloid-β42 (Aβ42) and phosphorylated-tau help clinicians accurately diagnose Alzheimer's disease (AD). Whether biomarkers help prognosticate behavioral and psychological symptoms of dementia (BPSD) is unclear. Objective Determine whether CSF biomarker levels aid prognostication of BPSD in AD. Methods This retrospective cohort study included patients over 65 with a diagnosis of AD based on CSF biomarkers. We measured time from CSF testing to the first antipsychotic use in the following months. We then analyzed time to antipsychotic (AP) use with respect to Aβ42, total tau, phosphorylated tau, and amyloid-to-tau index using a survival analysis approach. Results Of 86 AD patients (average 72±5 years, 46.5% male), 11 patients (12.7%) received APs following CSF testing. Patients with Aβ42 below the median had sooner time-to-AP use. This was significant on a log-rank test (p = 0.04). There was no difference in time-to-AP use if the group was stratified by levels of total tau, phosphorylated tau, or amyloid-to-tau index. Conclusion These results suggest a relationship between lower CSF Aβ42 levels and sooner AP use. This supports prior reports suggesting a correlation between BPSD and Aβ deposition on PET. These results highlight the need for further prospective studies on Aβ levels and BPSD.
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Affiliation(s)
- Joshua G. Cahan
- Mesulam Center for Cognitive Neurology and Alzheimer Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert Vassar
- Mesulam Center for Cognitive Neurology and Alzheimer Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Borna Bonakdarpour
- Mesulam Center for Cognitive Neurology and Alzheimer Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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7
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Caprioglio C, Ribaldi F, Visser LNC, Minguillon C, Collij LE, Grau-Rivera O, Zeyen P, Molinuevo JL, Gispert JD, Garibotto V, Moro C, Walker Z, Edison P, Demonet JF, Barkhof F, Scheltens P, Alves IL, Gismondi R, Farrar G, Stephens AW, Jessen F, Frisoni GB, Altomare D. Analysis of Psychological Symptoms Following Disclosure of Amyloid-Positron Emission Tomography Imaging Results to Adults With Subjective Cognitive Decline. JAMA Netw Open 2023; 6:e2250921. [PMID: 36637820 PMCID: PMC9857261 DOI: 10.1001/jamanetworkopen.2022.50921] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE Individuals who are amyloid-positive with subjective cognitive decline and clinical features increasing the likelihood of preclinical Alzheimer disease (SCD+) are at higher risk of developing dementia. Some individuals with SCD+ undergo amyloid-positron emission tomography (PET) as part of research studies and frequently wish to know their amyloid status; however, the disclosure of a positive amyloid-PET result might have psychological risks. OBJECTIVE To assess the psychological outcomes of the amyloid-PET result disclosure in individuals with SCD+ and explore which variables are associated with a safer disclosure in individuals who are amyloid positive. DESIGN, SETTING, AND PARTICIPANTS This prospective, multicenter study was conducted as part of The Amyloid Imaging to Prevent Alzheimer Disease Diagnostic and Patient Management Study (AMYPAD-DPMS) (recruitment period: from April 2018 to October 2020). The setting was 5 European memory clinics, and participants included patients with SCD+ who underwent amyloid-PET. Statistical analysis was performed from July to October 2022. EXPOSURES Disclosure of amyloid-PET result. MAIN OUTCOMES AND MEASURES Psychological outcomes were defined as (1) disclosure related distress, assessed using the Impact of Event Scale-Revised (IES-R; scores of at least 33 indicate probable presence of posttraumatic stress disorder [PTSD]); and (2) anxiety and depression, assessed using the Hospital Anxiety and Depression scale (HADS; scores of at least 15 indicate probable presence of severe mood disorder symptoms). RESULTS After disclosure, 27 patients with amyloid-positive SCD+ (median [IQR] age, 70 [66-74] years; gender: 14 men [52%]; median [IQR] education: 15 [13 to 17] years, median [IQR] Mini-Mental State Examination [MMSE] score, 29 [28 to 30]) had higher median (IQR) IES-R total score (10 [2 to 14] vs 0 [0 to 2]; P < .001), IES-R avoidance (0.00 [0.00 to 0.69] vs 0.00 [0.00 to 0.00]; P < .001), IES-R intrusions (0.50 [0.13 to 0.75] vs 0.00 [0.00 to 0.25]; P < .001), and IES-R hyperarousal (0.33 [0.00 to 0.67] vs 0.00 [0.00 to 0.00]; P < .001) scores than the 78 patients who were amyloid-negative (median [IQR], age, 67 [64 to 74] years, 45 men [58%], median [IQR] education: 15 [12 to 17] years, median [IQR] MMSE score: 29 [28 to 30]). There were no observed differences between amyloid-positive and amyloid-negative patients in the median (IQR) HADS Anxiety (-1.0 [-3.0 to 1.8] vs -2.0 [-4.8 to 1.0]; P = .06) and Depression (-1.0 [-2.0 to 0.0] vs -1.0 [-3.0 to 0.0]; P = .46) deltas (score after disclosure - scores at baseline). In patients with amyloid-positive SCD+, despite the small sample size, higher education was associated with lower disclosure-related distress (ρ = -0.43; P = .02) whereas the presence of study partner was associated with higher disclosure-related distress (W = 7.5; P = .03). No participants with amyloid-positive SCD+ showed probable presence of PTSD or severe anxiety or depression symptoms at follow-up. CONCLUSIONS AND RELEVANCE The disclosure of a positive amyloid-PET result to patients with SCD+ was associated with a bigger psychological change, yet such change did not reach the threshold for clinical concern.
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Affiliation(s)
- Camilla Caprioglio
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Federica Ribaldi
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Leonie N. C. Visser
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm/Solna, Sweden
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC)–Location VUmc, Amsterdam, the Netherlands
| | - Carolina Minguillon
- Barcelonaßeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Lyduine E. Collij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (UMC)–Location VUmc, Amsterdam, the Netherlands
| | - Oriol Grau-Rivera
- Barcelonaßeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Philip Zeyen
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - José Luis Molinuevo
- Barcelonaßeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- H. Lundbeck A/S, Denmark
| | - Juan Domingo Gispert
- Barcelonaßeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanomedicina, (CIBER-BBN), Barcelona, Spain
| | - Valentina Garibotto
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
- Center for Biomedical Imaging (CIBM), Geneva, Switzerland
| | - Christian Moro
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, United Kingdom
- Margaret’s Hospital, Essex Partnership University NHS Foundation Trust, Essex, United Kingdom
| | - Paul Edison
- Division of Neurology, Department of Brain Sciences, Imperial College London, United Kingdom
| | | | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (UMC)–Location VUmc, Amsterdam, the Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Philip Scheltens
- Alzheimer Center, Department of Neurology, Amsterdam University Medical Centers (UMC)–Location VUmc, Amsterdam, the Netherlands
| | - Isadora Lopes Alves
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (UMC)–Location VUmc, Amsterdam, the Netherlands
| | | | | | | | - Frank Jessen
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
- Excellence Cluster Cellular Stress Responses in Aging-Related Diseases (CECAD), Medical Faculty, University of Cologne, Germany
| | - Giovanni B. Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Daniele Altomare
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
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8
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Collij LE, Salvadó G, de Wilde A, Altomare D, Shekari M, Gispert JD, Bullich S, Stephens A, Barkhof F, Scheltens P, Bouwman F, van der Flier WM. Quantification of [
18
F]florbetaben amyloid‐PET imaging in a mixed memory clinic population: The ABIDE project. Alzheimers Dement 2022. [DOI: 10.1002/alz.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Lyduine E. Collij
- Department of Radiology and Nuclear Medicine Amsterdam University Medical Center Amsterdam Neuroscience Amsterdam The Netherlands
| | - Gemma Salvadó
- Barcelonaβeta Brain Research Center (BBRC) Pasqual Maragall Foundation Barcelona Spain
- Clinical Memory Research Unit Department of Clinical Sciences Lund University Malmö Sweden
| | - Arno de Wilde
- Department of Neurology Alzheimer Center Amsterdam Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam The Netherlands
| | - Daniele Altomare
- Laboratory of Neuroimaging of Aging (LANVIE) University of Geneva Geneva Switzerland
- Memory Center Geneva University Hospitals Geneva Switzerland
| | - Mahnaz Shekari
- Barcelonaβeta Brain Research Center (BBRC) Pasqual Maragall Foundation Barcelona Spain
- IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
- Pompeu Fabra University Barcelona Spain
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC) Pasqual Maragall Foundation Barcelona Spain
- IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
- Centro de Investigación Biomédica en Red de Bioingeniería Biomateriales y Nanomedicina (CIBER‐BBN) Madrid Spain
| | | | | | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine Amsterdam University Medical Center Amsterdam Neuroscience Amsterdam The Netherlands
- Centre for Medical Image Computing and Queen Square Institute of Neurology UCL London UK
| | - Philip Scheltens
- Department of Neurology Alzheimer Center Amsterdam Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam The Netherlands
| | - Femke Bouwman
- Department of Neurology Alzheimer Center Amsterdam Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam The Netherlands
| | - Wiesje M. van der Flier
- Department of Neurology Alzheimer Center Amsterdam Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam The Netherlands
- Department of Epidemiology & Data Science Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam The Netherlands
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9
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van Maurik IS, Broulikova HM, Mank A, Bakker ED, de Wilde A, Bouwman FH, Stephens AW, van Berckel BNM, Scheltens P, van der Flier WM. A more precise diagnosis by means of amyloid PET contributes to delayed institutionalization, lower mortality, and reduced care costs in a tertiary memory clinic setting. Alzheimers Dement 2022; 19:2006-2013. [PMID: 36419238 DOI: 10.1002/alz.12846] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We aim to study the effect of a more precise diagnosis, by means of amyloid positron emission tomography (PET), on institutionalization, mortality, and health-care costs. METHODS Between October 27, 2014 and December 31, 2016, we offered amyloid PET to all patients as part of their diagnostic work-up. Patients who accepted to undergo amyloid PET (n = 449) were propensity score matched with patients without amyloid PET (n = 571, i.e., no PET). Matched groups (both n = 444) were compared on rate of institutionalization, mortality, and health-care costs in the years after diagnosis. RESULTS Amyloid PET patients had a lower risk of institutionalization (10% [n = 45] vs. 21% [n = 92]; hazard ratio [HR] = 0.48 [0.33-0.70]) and mortality rate (11% [n = 49] vs. 18% [n = 81]; HR = 0.51 [0.36-0.73]) and lower health-care costs in the years after diagnosis compared to matched no-PET patients (β = -4573.49 [-6524.76 to -2523.74], P-value < 0.001). DISCUSSION A more precise diagnosis in tertiary memory clinic patients positively influenced the endpoints of institutionalization, death, and health-care costs.
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Affiliation(s)
- Ingrid S. van Maurik
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam Epidemiology and Data Science Amsterdam the Netherlands
- Amsterdam Public Health Methodology Amsterdam the Netherlands
| | - Hana M. Broulikova
- Department of Health Sciences Faculty of Science Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | - Arenda Mank
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam Epidemiology and Data Science Amsterdam the Netherlands
- Amsterdam Public Health Methodology Amsterdam the Netherlands
| | - Els D. Bakker
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
| | - Arno de Wilde
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
- EQT Life Sciences Amsterdam the Netherlands
| | - Femke H. Bouwman
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
| | | | - Bart N. M. van Berckel
- Department of Radiology and Nuclear Medicine Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam the Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
- EQT Life Sciences Amsterdam the Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam Epidemiology and Data Science Amsterdam the Netherlands
- Amsterdam Public Health Methodology Amsterdam the Netherlands
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10
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Boccardi M, Handels R, Gold M, Grazia A, Lutz MW, Martin M, Nosheny R, Robillard JM, Weidner W, Alexandersson J, Thyrian JR, Winblad B, Barbarino P, Khachaturian AS, Teipel S. Clinical research in dementia: A perspective on implementing innovation. Alzheimers Dement 2022; 18:2352-2367. [PMID: 35325508 DOI: 10.1002/alz.12622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 01/31/2023]
Abstract
The increasing global prevalence of dementia demands concrete actions that are aimed strategically at optimizing processes that drive clinical innovation. The first step in this direction requires outlining hurdles in the transition from research to practice. The different parties needed to support translational processes have communication mismatches; methodological gaps hamper evidence-based decision-making; and data are insufficient to provide reliable estimates of long-term health benefits and costs in decisional models. Pilot projects are tackling some of these gaps, but appropriate methods often still need to be devised or adapted to the dementia field. A consistent implementation perspective along the whole translational continuum, explicitly defined and shared among the relevant stakeholders, should overcome the "research-versus-adoption" dichotomy, and tackle the implementation cliff early on. Concrete next steps may consist of providing tools that support the effective participation of heterogeneous stakeholders and agreeing on a definition of clinical significance that facilitates the selection of proper outcome measures.
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Affiliation(s)
- Marina Boccardi
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Rostock, Germany
| | - Ron Handels
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Division of Neurogeriatrics, Dept for Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - Alice Grazia
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Rostock, Germany.,Department of Psychosomatic Medicine, Rostock Universitätsmedizin, Rostock, Germany
| | - Michael W Lutz
- Department of Neurology Duke University School of Medicine, Durham, North Carolina, USA
| | - Mike Martin
- Gerontology Center, University of Zurich, Zürich, Switzerland
| | - Rachel Nosheny
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.,San Francisco Veteran's Administration Medical Center, San Francisco, California, USA
| | - Julie M Robillard
- The University of British Columbia; BC Children's & Women's Hospitals, Vancouver, Canada
| | | | | | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Healthcare, University Medicine of Greifswald, Greifswald, Germany
| | - Bengt Winblad
- Division of Neurogeriatrics, Dept for Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - Ara S Khachaturian
- Alzheimer's & Dementia: The Journal of the Alzheimer's Association, Rockville, Maryland, USA.,Campaign to Prevent Alzheimer's Disease, Rockville, Maryland, USA
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Rostock, Germany.,Department of Psychosomatic Medicine, Rostock Universitätsmedizin, Rostock, Germany
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11
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Vlegels N, Ossenkoppele R, van der Flier WM, Koek HL, Reijmer YD, Wisse LEM, Biessels GJ. Does Loss of Integrity of the Cingulum Bundle Link Amyloid-β Accumulation and Neurodegeneration in Alzheimer’s Disease? J Alzheimers Dis 2022; 89:39-49. [DOI: 10.3233/jad-220024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Alzheimer’s disease is characterized by the accumulation of amyloid-β (Aβ) into plaques, aggregation of tau into neurofibrillary tangles, and neurodegenerative processes including atrophy. However, there is a poorly understood spatial discordance between initial Aβ deposition and local neurodegeneration. Objective: Here, we test the hypothesis that the cingulum bundle links Aβ deposition in the cingulate cortex to medial temporal lobe (MTL) atrophy. Methods: 21 participants with mild cognitive impairment (MCI) from the UMC Utrecht memory clinic (UMCU, discovery sample) and 37 participants with MCI from Alzheimer’s Disease Neuroimaging Initiative (ADNI, replication sample) with available Aβ-PET scan, T1-weighted and diffusion-weighted MRI were included. Aβ load of the cingulate cortex was measured by the standardized uptake value ratio (SUVR), white matter integrity of the cingulum bundle was assessed by mean diffusivity and atrophy of the MTL by normalized MTL volume. Relationships were tested with linear mixed models, to accommodate multiple measures for each participant. Results: We found at most a weak association between cingulate Aβ and MTL volume (added R2 <0.06), primarily for the posterior hippocampus. In neither sample, white matter integrity of the cingulum bundle was associated with cingulate Aβ or MTL volume (added R2 <0.01). Various sensitivity analyses (Aβ-positive individuals only, posterior cingulate SUVR, MTL sub region volume) provided similar results. Conclusion: These findings, consistent in two independent cohorts, do not support our hypothesis that loss of white matter integrity of the cingulum is a connecting factor between cingulate gyrus Aβ deposition and MTL atrophy.
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Affiliation(s)
- Naomi Vlegels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, VU University Medical Center, Amsterdam, The Netherlands
| | - Huiberdina L. Koek
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yael D. Reijmer
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Laura EM Wisse
- Department of Diagnostic Radiology, Lund University, Lund, Sweden
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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12
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Multimer Detection System-Oligomerized Amyloid Beta (MDS-OA β): A Plasma-Based Biomarker Differentiates Alzheimer's Disease from Other Etiologies of Dementia. Int J Alzheimers Dis 2022; 2022:9960832. [PMID: 35547155 PMCID: PMC9085320 DOI: 10.1155/2022/9960832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/12/2022] [Indexed: 01/10/2023] Open
Abstract
With emerging amyloid therapies, documentation of the patient's amyloid status to confirm the etiology of a clinical diagnosis is warranted prior to instituting amyloid-based therapy. The Multimer Detection System-Oligomeric Amyloid-β (MDS-OAβ) is a noninvasive blood-based biomarker utilized to measure Aβ oligomerization tendency. We determined the difference in MDS-OAβ ratio across the groups: (a) no cognitive impairment or subjective cognitive impairment (NCI/SCI), (b) Alzheimer's disease (AD), (c) non-AD, and (d) mixed Alzheimer's disease-Vascular dementia (AD-VaD). MDS-OAβ level was not significantly different between AD and mixed AD-VaD, but both groups were significantly different from the NCI/SCI and from the non-AD group. An MDS-OAβ level of >1 could potentially indicate clinical variants of AD or mixed pathology (AD-VaD).
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13
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Bakker ED, van Maurik IS, Mank A, Zwan MD, Waterink L, van den Buuse S, van den Broeke JR, Gillissen F, van de Beek M, Lemstra E, van den Bosch KA, van Leeuwenstijn M, Bouwman FH, Scheltens P, van der Flier WM. Psychosocial Effects of COVID-19 Measures on (Pre-)Dementia Patients During Second Lockdown. J Alzheimers Dis 2022; 86:931-939. [PMID: 35034903 DOI: 10.3233/jad-215342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The COVID-19 pandemic poses enormous social challenges, especially during lockdown. People with cognitive decline and their caregivers are particularly at risk of lockdown consequences. OBJECTIVE To investigate psychosocial effects in (pre-)dementia patients and caregivers during second lockdown and compare effects between first and second lockdown. METHODS We included n = 511 (pre-)dementia patients and n = 826 caregivers from the Amsterdam Dementia Cohort and via Alzheimer Nederland. All respondents completed a self-designed survey on psychosocial effects of COVID-19. We examined relations between experienced support and psychosocial and behavioral symptoms using logistic regression. In a subset of patients and caregivers we compared responses between first and second lockdown using generalized estimating equation. RESULTS The majority of patients (≥58%) and caregivers (≥60%) reported that family and friends, hobbies, and music helped them cope. Support from family and friends was strongly related to less negative feelings in patients (loneliness: OR = 0.3[0.1-0.6]) and caregivers (loneliness: OR = 0.2[0.1-0.3]; depression: OR = 0.4[0.2-0.5]; anxiety: OR = 0.4[0.3-0.6]; uncertainty: OR = 0.3[0.2-0.5]; fatigue: OR = 0.3[0.2-0.4]; stress: OR = 0.3[0.2-0.5]). In second lockdown, less psychosocial and behavioral symptoms were reported compared to first lockdown (patients; e.g., anxiety: 22% versus 13%, p = 0.007; apathy: 27% versus 8%, p < 0.001, caregivers; e.g., anxiety: 23% versus 16%, p = 0.033; patient's behavioral problems: 50% versus 35%, p < 0.001). Patients experienced more support (e.g., family and friends: 52% versus 93%, p < 0.001; neighbors: 28% versus 66%, p < 0.001). CONCLUSION During second lockdown, patients and caregivers adapted to challenges posed by lockdown, as psychosocial and behavioral effects decreased, while patients experienced more social support compared to first lockdown. Support from family and friends is a major protective factor for negative outcomes in patients and caregivers.
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Affiliation(s)
- Els D Bakker
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ingrid S van Maurik
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Arenda Mank
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marissa D Zwan
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lisa Waterink
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - Freek Gillissen
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marleen van de Beek
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Evelien Lemstra
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Karlijn A van den Bosch
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mardou van Leeuwenstijn
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Femke H Bouwman
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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14
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Ingala S, van Maurik IS, Altomare D, Wurm R, Dicks E, van Schijndel RA, Zwan M, Bouwman F, Schoonenboom N, Boelaarts L, Roks G, van Marum R, van Harten B, van Uden I, Claus J, Wottschel V, Vrenken H, Wattjes MP, van der Flier WM, Barkhof F. Clinical applicability of quantitative atrophy measures on MRI in patients suspected of Alzheimer's disease. Eur Radiol 2022; 32:7789-7799. [PMID: 35639148 PMCID: PMC9668763 DOI: 10.1007/s00330-021-08503-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 11/03/2021] [Accepted: 12/01/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Neurodegeneration in suspected Alzheimer's disease can be determined using visual rating or quantitative volumetric assessments. We examined the feasibility of volumetric measurements of gray matter (GMV) and hippocampal volume (HCV) and compared their diagnostic performance with visual rating scales in academic and non-academic memory clinics. MATERIALS AND METHODS We included 231 patients attending local memory clinics (LMC) in the Netherlands and 501 of the academic Amsterdam Dementia Cohort (ADC). MRI scans were acquired using local protocols, including a T1-weighted sequence. Quantification of GMV and HCV was performed using FSL and FreeSurfer. Medial temporal atrophy and global atrophy were assessed with visual rating scales. ROC curves were derived to determine which measure discriminated best between cognitively normal (CN), mild cognitive impairment (MCI), and Alzheimer's dementia (AD). RESULTS Patients attending LMC (age 70.9 ± 8.9 years; 47% females; 19% CN; 34% MCI; 47% AD) were older, had more cerebrovascular pathology, and had lower GMV and HCV compared to those of the ADC (age 64.9 ± 8.2 years; 42% females; 35% CN, 43% MCI, 22% AD). While visual ratings were feasible in > 95% of scans in both cohorts, quantification was achieved in 94-98% of ADC, but only 68-85% of LMC scans, depending on the software. Visual ratings and volumetric outcomes performed similarly in discriminating CN vs AD in both cohorts. CONCLUSION In clinical settings, quantification of GM and hippocampal atrophy currently fails in up to one-third of scans, probably due to lack of standardized acquisition protocols. Diagnostic accuracy is similar for volumetric measures and visual rating scales, making the latter suited for clinical practice. In a real-life clinical setting, volumetric assessment of MRI scans in dementia patients may require acquisition protocol optimization and does not outperform visual rating scales. KEY POINTS • In a real-life clinical setting, the diagnostic performance of visual rating scales is similar to that of automatic volumetric quantification and may be sufficient to distinguish Alzheimer's disease groups. • Volumetric assessment of gray matter and hippocampal volumes from MRI scans of patients attending non-academic memory clinics fails in up to 32% of cases. • Clinical MR acquisition protocols should be optimized to improve the output of quantitative software for segmentation of Alzheimer's disease-specific outcomes.
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Affiliation(s)
- Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Location VUmc, PO Box 7057, 1007 MB Amsterdam, The Netherlands ,Department of Radiology and Nuclear Medicine, Noordwest Hospital Group, Alkmaar, The Netherlands
| | - Ingrid S. van Maurik
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands ,Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Daniele Altomare
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands ,Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland ,Memory Clinic, University Hospitals of Geneva, Geneva, Switzerland
| | - Raphael Wurm
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Location VUmc, PO Box 7057, 1007 MB Amsterdam, The Netherlands ,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Ellen Dicks
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Ronald A. van Schijndel
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Location VUmc, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Marissa Zwan
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Femke Bouwman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Niki Schoonenboom
- Geriatric Department, Noordwest Ziekenhuis Groep, Alkmaar, The Netherlands
| | - Leo Boelaarts
- Geriatric Department, Noordwest Ziekenhuis Groep, Alkmaar, The Netherlands
| | - Gerwin Roks
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Rob van Marum
- Department of Geriatrics, Jeroen Bosch Hospital, ‘S-Hertogenbosch, The Netherlands ,Department of Family Medicine and Elderly Care Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Barbera van Harten
- Department of Neurology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Inge van Uden
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jules Claus
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands
| | - Viktor Wottschel
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Location VUmc, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Location VUmc, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Mike P. Wattjes
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Location VUmc, PO Box 7057, 1007 MB Amsterdam, The Netherlands ,Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands ,Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Location VUmc, PO Box 7057, 1007 MB Amsterdam, The Netherlands ,Institutes of Neurology and Healthcare Engineering, UCL, London, UK
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15
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Altuna-Azkargorta M, Mendioroz-Iriarte M. Blood biomarkers in Alzheimer's disease. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:704-710. [PMID: 34752348 DOI: 10.1016/j.nrleng.2018.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/01/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Early diagnosis of Alzheimer disease (AD) through the use of biomarkers could assist in the implementation and monitoring of early therapeutic interventions, and has the potential to significantly modify the course of the disease. DEVELOPMENT The classic cerebrospinal fluid and approved structural and functional neuroimaging biomarkers are of limited clinical application given their invasive nature and/or high cost. The identification of more accessible and less costly biomarkers, such as blood biomarkers, would increase their use in clinical practice. We review the available published evidence on the main blood biochemical biomarkers potentially useful for diagnosing AD. CONCLUSIONS Blood biomarkers are more cost- and time-effective than CSF biomarkers. However, immediate applicability in clinical practice is relatively unlikely. The main limitations come from the difficulty of measuring and standardising thresholds between different laboratories and the failure to replicate results. Of all the molecules studied, apoptosis and neurodegeneration biomarkers and the biomarker panels obtained through "omics" approaches, such as isolated or combined metabolomics, offer the most promising results.
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Affiliation(s)
- M Altuna-Azkargorta
- Laboratorio de Neuroepigenética, Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.
| | - M Mendioroz-Iriarte
- Laboratorio de Neuroepigenética, Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain
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16
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Ebenau JL, van der Lee SJ, Hulsman M, Tesi N, Jansen IE, Verberk IM, van Leeuwenstijn M, Teunissen CE, Barkhof F, Prins ND, Scheltens P, Holstege H, van Berckel BN, van der Flier WM. Risk of dementia in APOE ε4 carriers is mitigated by a polygenic risk score. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12229. [PMID: 34541285 PMCID: PMC8438688 DOI: 10.1002/dad2.12229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION We investigated relationships among genetic determinants of Alzheimer's disease (AD), amyloid/tau/neurodegenaration (ATN) biomarkers, and risk of dementia. METHODS We studied cognitively normal individuals with subjective cognitive decline (SCD) from the Amsterdam Dementia Cohort and SCIENCe project. We examined associations between genetic variants and ATN biomarkers, and evaluated their predictive value for incident dementia. A polygenic risk score (PRS) was calculated based on 39 genetic variants. The APOE gene was not included in the PRS and was analyzed separately. RESULTS The PRS and APOE ε4 were associated with amyloid-positive ATN profiles, and APOE ε4 additionally with isolated increased tau (A-T+N-). A high PRS and APOE ε4 separately predicted AD dementia. Combined, a high PRS increased while a low PRS attenuated the risk associated with ε4 carriers. DISCUSSION Genetic variants beyond APOE are clinically relevant and contribute to the pathophysiology of AD. In the future, a PRS might be used in individualized risk profiling.
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Affiliation(s)
- Jarith L. Ebenau
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Sven J. van der Lee
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of Clinical GeneticsAmsterdam UMCAmsterdamthe Netherlands
| | - Marc Hulsman
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of Clinical GeneticsAmsterdam UMCAmsterdamthe Netherlands
- Delft Bioinformatics LabDelft University of TechnologyDelftthe Netherlands
| | - Niccolò Tesi
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of Clinical GeneticsAmsterdam UMCAmsterdamthe Netherlands
- Delft Bioinformatics LabDelft University of TechnologyDelftthe Netherlands
| | - Iris E. Jansen
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of Complex Trait GeneticsCenter for Neurogenomics and Cognitive ResearchAmsterdam NeuroscienceVU UniversityAmsterdamthe Netherlands
| | - Inge M.W. Verberk
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Neurochemistry LaboratoryDepartment of Clinical ChemistryVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Mardou van Leeuwenstijn
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry LaboratoryDepartment of Clinical ChemistryVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear MedicineAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image ComputingUniversity College LondonLondonUK
| | - Niels D. Prins
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Philip Scheltens
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Henne Holstege
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of Clinical GeneticsAmsterdam UMCAmsterdamthe Netherlands
- Delft Bioinformatics LabDelft University of TechnologyDelftthe Netherlands
| | - Bart N.M. van Berckel
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of Radiology & Nuclear MedicineAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam UMCAmsterdamthe Netherlands
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17
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Frederiksen KS, Nielsen TR, Winblad B, Schmidt R, Kramberger MG, Jones RW, Hort J, Grimmer T, Georges J, Frölich L, Engelborghs S, Dubois B, Waldemar G. European Academy of Neurology/European Alzheimer's Disease Consortium position statement on diagnostic disclosure, biomarker counseling, and management of patients with mild cognitive impairment. Eur J Neurol 2021; 28:2147-2155. [PMID: 33368924 PMCID: PMC8246881 DOI: 10.1111/ene.14668] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Careful counseling through the diagnostic process and adequate postdiagnostic support in patients with mild cognitive impairment (MCI) is important. Previous studies have indicated heterogeneity in practice and the need for guidance for clinicians. METHODS A joint European Academy of Neurology/European Alzheimer's Disease Consortium panel of dementia specialists was appointed. Through online meetings and emails, positions were developed regarding disclosing a syndrome diagnosis of MCI, pre- and postbiomarker sampling counseling, and postdiagnostic support. RESULTS Prior to diagnostic evaluation, motives and wishes of the patient should be sought. Diagnostic disclosure should be carried out by a dementia specialist taking the ethical principles of "the right to know" versus "the wish not to know" into account. Disclosure should be accompanied by written information and a follow-up plan. It should be made clear that MCI is not dementia. Prebiomarker counseling should always be carried out if biomarker sampling is considered and postbiomarker counseling if sampling is carried out. A dementia specialist knowledgeable about biomarkers should inform about pros and cons, including alternatives, to enable an autonomous and informed decision. Postbiomarker counseling will depend in part on the results of biomarkers. Follow-up should be considered for all patients with MCI and include brain-healthy advice and possibly treatment for specific underlying causes. Advice on advance directives may be relevant. CONCLUSIONS Guidance to clinicians on various aspects of the diagnostic process in patients with MCI is presented here as position statements. Further studies are needed to enable more evidence-based and standardized recommendations in the future.
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Affiliation(s)
| | - T. Rune Nielsen
- Department of NeurologyDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
| | - Bengt Winblad
- Division of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyCenter for Alzheimer ResearchKarolinska InstituteSolnaSweden
- Theme AgingKarolinska University HospitalStockholmSweden
| | | | - Milica G. Kramberger
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical CentreLjubljanaSlovenia
| | - Roy W. Jones
- RICE (The Research Institute for the Care of Older People)Royal United HospitalBath and University of BristolBristolUK
| | - Jakub Hort
- Department of NeurologyCognitive CenterSecond Faculty of Medicine and Motol University HospitalCharles UniversityPragueCzech Republic
| | - Timo Grimmer
- Department of Psychiatry and PsychotherapySchool of MedicineRechts der Isar HospitalTechnical University of MunichMunichGermany
| | | | - Lutz Frölich
- Department of Geriatric PsychiatryUniversity of HeidelbergMannheimGermany
| | - Sebastiaan Engelborghs
- Department of Neurology and Center for NeurosciencesUZ Brussel and Free University of Brussels (VUBBrusselsBelgium
- Reference Center for Biological Markers of Dementia (BIODEM)Institute Born‐BungeUniversity of AntwerpAntwerpBelgium
| | - Bruno Dubois
- Department of NeurologyDementia Research CenterSalpêtrière HospitalSorbonne UniversityParisFrance
| | - Gunhild Waldemar
- Department of NeurologyDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
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Willemse EAJ, Tijms BM, van Berckel BNM, Le Bastard N, van der Flier WM, Scheltens P, Teunissen CE. Comparing CSF amyloid-beta biomarker ratios for two automated immunoassays, Elecsys and Lumipulse, with amyloid PET status. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12182. [PMID: 33969174 PMCID: PMC8088096 DOI: 10.1002/dad2.12182] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/07/2021] [Accepted: 03/15/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We evaluated for two novel automated biomarker assays how cerebrospinal fluid (CSF) amyloid beta (Aβ)1- 42-ratios improved the concordance with amyloid positron emission tomography (PET) positivity compared to Aβ1- 42 alone. METHODS We selected 288 individuals from the Amsterdam Dementia Cohort across the Alzheimer's disease clinical spectrum when they had both CSF and amyloid PET visual read available, regardless of diagnosis. CSF Aβ1- 42, phosphorylated tau (p-tau), and total tau (t-tau) were measured with Elecsys and Lumipulse assays, and Aβ1-40 with Lumipulse. CSF cut-points were defined using receiver operating characteristic (ROC) for amyloid PET positivity. RESULTS For both Elecsys and Lumipulse the p-tau/Aβ1- 42, Aβ1- 42/Aβ1- 40, and t-tau/Aβ1- 42 ratios showed similarly good concordance with amyloid PET (Elecsys: 93,90,90%; Lumipulse: 94,92,90%) and were higher than Aβ1- 42 alone (Elecsys 85%; Lumipulse 84%). DISCUSSION Biomarker ratios p-tau/Aβ1- 42, Aβ1- 42/Aβ1- 40, t-tau/Aβ1- 42 on two automated platforms show similar optimal concordance with amyloid PET in a memory clinic cohort.
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Affiliation(s)
- Eline A. J. Willemse
- Department of Clinical ChemistryNeurochemistry LaboratoryAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Betty M. Tijms
- Department of NeurologyAlzheimer CenterAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Bart N. M. van Berckel
- Department of Radiology & Nuclear MedicineAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | | | - Wiesje M. van der Flier
- Department of NeurologyAlzheimer CenterAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Philip Scheltens
- Department of NeurologyAlzheimer CenterAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Charlotte E. Teunissen
- Department of Clinical ChemistryNeurochemistry LaboratoryAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
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Genome-wide haplotype association study in imaging genetics using whole-brain sulcal openings of 16,304 UK Biobank subjects. Eur J Hum Genet 2021; 29:1424-1437. [PMID: 33664500 PMCID: PMC8440755 DOI: 10.1038/s41431-021-00827-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 12/18/2020] [Accepted: 02/04/2021] [Indexed: 11/29/2022] Open
Abstract
Neuroimaging-genetics cohorts gather two types of data: brain imaging and genetic data. They allow the discovery of associations between genetic variants and brain imaging features. They are invaluable resources to study the influence of genetics and environment in the brain features variance observed in normal and pathological populations. This study presents a genome-wide haplotype analysis for 123 brain sulcus opening value (a measure of sulcal width) across the whole brain that include 16,304 subjects from UK Biobank. Using genetic maps, we defined 119,548 blocks of low recombination rate distributed along the 22 autosomal chromosomes and analyzed 1,051,316 haplotypes. To test associations between haplotypes and complex traits, we designed three statistical approaches. Two of them use a model that includes all the haplotypes for a single block, while the last approach considers each haplotype independently. All the statistics produced were assessed as rigorously as possible. Thanks to the rich imaging dataset at hand, we used resampling techniques to assess False Positive Rate for each statistical approach in a genome-wide and brain-wide context. The results on real data show that genome-wide haplotype analyses are more sensitive than single-SNP approach and account for local complex Linkage Disequilibrium (LD) structure, which makes genome-wide haplotype analysis an interesting and statistically sound alternative to the single-SNP counterpart.
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20
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Outcomes of clinical utility in amyloid-PET studies: state of art and future perspectives. Eur J Nucl Med Mol Imaging 2021; 48:2157-2168. [PMID: 33594474 PMCID: PMC8175294 DOI: 10.1007/s00259-020-05187-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To review how outcomes of clinical utility are operationalized in current amyloid-PET validation studies, to prepare for formal assessment of clinical utility of amyloid-PET-based diagnosis. METHODS Systematic review of amyloid-PET research studies published up to April 2020 that included outcomes of clinical utility. We extracted and analyzed (a) outcome categories, (b) their definition, and (c) their methods of assessment. RESULTS Thirty-two studies were eligible. (a) Outcome categories were clinician-centered (found in 25/32 studies, 78%), patient-/caregiver-centered (in 9/32 studies, 28%), and health economics-centered (5/32, 16%). (b) Definition: Outcomes were mainly defined by clinical researchers; only the ABIDE study expressly included stakeholders in group discussions. Clinician-centered outcomes mainly consisted of incremental diagnostic value (25/32, 78%) and change in patient management (17/32, 53%); patient-/caregiver-centered outcomes considered distress after amyloid-pet-based diagnosis disclosure (8/32, 25%), including quantified burden of procedure for patients' outcomes (n = 8) (1/8, 12.5%), impact of disclosure of results (6/8, 75%), and psychological implications of biomarker-based diagnosis (75%); and health economics outcomes focused on costs to achieve a high-confidence etiological diagnosis (5/32, 16%) and impact on quality of life (1/32, 3%). (c) Assessment: all outcome categories were operationalized inconsistently across studies, employing 26 different tools without formal rationale for selection. CONCLUSION Current studies validating amyloid-PET already assessed outcomes for clinical utility, although non-clinician-based outcomes were inconsistent. A wider participation of stakeholders may help produce a more thorough and systematic definition and assessment of outcomes of clinical utility and help collect evidence informing decisions on reimbursement of amyloid-PET.
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Horgan D, Nobili F, Teunissen C, Grimmer T, Mitrecic D, Ris L, Pirtosek Z, Bernini C, Federico A, Blackburn D, Logroscino G, Scarmeas N. Biomarker Testing: Piercing the Fog of Alzheimer's and Related Dementia. Biomed Hub 2021; 5:19-40. [PMID: 33564663 DOI: 10.1159/000511233] [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: 08/02/2020] [Accepted: 08/24/2020] [Indexed: 12/16/2022] Open
Abstract
Alzheimer's disease (AD) and related dementia is one of the growing threats to the sustainability of health and care systems in developed countries, and efforts to find therapies have had scant success. The main reasons for this are lack of efficient therapy, which is linked to too late discovery of the disease itself. With this in mind, biomarkers are recognised as an element which can bring a major contribution to research, helping elucidate the disease and the search for treatments. They are also playing an increasing role in early detection and timely diagnosis, which are considered the principal hopes of effective management in the absence of an effective drug. The current arsenal of biomarkers could already, if more widely deployed, provide an effective minimum service to patients and health systems. A concerted action by policy makers and stakeholders could drive progress in access to AD biomarker testing to provide an optimum service in the medium term. This paper discusses how to improve the use of and access to biomarker testing in the detection and diagnosis of AD and other diseases featuring dementia, and how EU healthcare systems could benefit. It outlines the challenges, lists the achievements to date, and highlights the actions needed to allow biomarker testing to deliver more fully on their potential in AD.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
| | - Flavio Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Charlotte Teunissen
- Neurochemistry Lab, Department of Clinical Chemistry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Timo Grimmer
- Klinikum rechts der Isar, School of Medicine, Technical University on Munich, Munich, Germany
| | - Dinko Mitrecic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | - Chiara Bernini
- European Alliance for Personalised Medicine, Brussels, Belgium
| | | | | | | | - Nikos Scarmeas
- National and Kapodistrian University of Athens Medical School, Athens, Greece
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de Leeuw FA, Tijms BM, Doorduijn AS, Hendriksen HMA, van de Rest O, de van der Schueren MAE, Visser M, van den Heuvel EGHM, van Wijk N, Bierau J, van Berckel BN, Scheltens P, Kester MI, van der Flier WM, Teunissen CE. LDL cholesterol and uridine levels in blood are potential nutritional biomarkers for clinical progression in Alzheimer's disease: The NUDAD project. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12120. [PMID: 33392381 PMCID: PMC7772937 DOI: 10.1002/dad2.12120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION We examined associations between nutritional biomarkers and clinical progression in individuals with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer's disease (AD)-type dementia. METHODS We included 528 individuals (64 ± 8 years, 46% F, follow-up 2.1 ± 0.87 years) with SCD (n = 204), MCI (n = 130), and AD (n = 194). Baseline levels of cholesterol, triglycerides, glucose, homocysteine, folate, vitamin A, B12, E and uridine were measured in blood and S-adenosylmethionine and S-adenosylhomocysteine in cerebrospinal fluid. We determined associations between nutritional biomarkers and clinical progression using Cox proportional hazard models. RESULTS Twenty-two (11%) patients with SCD, 45 (35%) patients with MCI, and 100 (52%) patients with AD showed clinical progression. In SCD, higher levels of low-density lipoprotein (LDL) cholesterol were associated with progression (hazard ratio [HR] [95% confidence interval (CI)] 1.88 [1.04 to 3.41]). In AD, lower uridine levels were associated with progression (0.79 [0.63 to 0.99]). DISCUSSION Our findings suggest that LDL cholesterol and uridine play a-stage-dependent-role in the clinical progression of AD.
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Affiliation(s)
- Francisca A. de Leeuw
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Betty M. Tijms
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Astrid S. Doorduijn
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Nutrition and Dietetics, Public Health Research InstituteVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Heleen M. A. Hendriksen
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Ondine van de Rest
- Division of Human Nutrition and HealthWageningen University and ResearchWageningenthe Netherlands
| | | | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | | | | | - Jörgen Bierau
- Department of Clinical GeneticsMaastricht UMC+Maastrichtthe Netherlands
| | - Bart N. van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | | | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
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Fruijtier AD, Visser LN, Bouwman FH, Lutz R, Schoonenboom N, Kalisvaart K, Hempenius L, Roks G, Boelaarts L, Claus JJ, Kleijer M, de Beer M, van der Flier WM, Smets EM. What patients want to know, and what we actually tell them: The ABIDE project. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12113. [PMID: 33344753 PMCID: PMC7744024 DOI: 10.1002/trc2.12113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND We studied to what degree and at whose initiative 25 informational topics, formerly identified as important, are discussed in diagnostic consultations. METHODS Audio recordings of clinician-patient consultations of 71 patients and 32 clinicians, collected in eight Dutch memory clinics, were independently content-coded by two coders. The coding scheme encompassed 25 informational topics. RESULTS Approximately half (Mdn = 12) of the 25 topics were discussed per patient during the diagnostic process, with a higher frequency among individuals receiving a dementia diagnosis (Mdn = 14) compared to others (Mdn = 11). Individual topics ranged from being discussed with 2/71 (3%) to 70/71 (99%) of patients. Patients and/or care partners rarely initiated topic discussion (10%). When they did, they often enquired about one of the least frequently addressed topics. CONCLUSION Most patients received information on approximately half of the important informational topics. Providing the topic list to patients and care partners beforehand could allow consultation preparation and stimulate participation.
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Affiliation(s)
- Agnetha D. Fruijtier
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Department of Medical PsychologyAcademic Medical CenterAmsterdam UMCAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Leonie N.C. Visser
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Department of Medical PsychologyAcademic Medical CenterAmsterdam UMCAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Femke H. Bouwman
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Rogier Lutz
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Niki Schoonenboom
- Department of Clinical GeriatricsSpaarne GasthuisHaarlemthe Netherlands
| | - Kees Kalisvaart
- Department of Clinical GeriatricsSpaarne GasthuisHaarlemthe Netherlands
| | | | - Gerwin Roks
- Department of NeurologyETZ HospitalTilburgthe Netherlands
| | - Leo Boelaarts
- Geriatric DepartmentNoordWest Ziekenhuis GroepAlkmaarthe Netherlands
| | - Jules J. Claus
- Department of NeurologyTergooi Hospital, Blaricumthe Netherlands
| | - Mariska Kleijer
- Department of NeurologyLangeLand ZiekenhuisZoetermeerthe Netherlands
| | - Marlijn de Beer
- Department of NeurologyReinier de Graaf GasthuisDelftthe Netherlands
| | - Wiesje M. van der Flier
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam NeuroscienceVU University Medical CenterAmsterdamthe Netherlands
| | - Ellen M.A. Smets
- Department of Medical PsychologyAcademic Medical CenterAmsterdam UMCAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
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24
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Wolters EE, van de Beek M, Ossenkoppele R, Golla SSV, Verfaillie SCJ, Coomans EM, Timmers T, Visser D, Tuncel H, Barkhof F, Boellaard R, Windhorst AD, van der Flier WM, Scheltens P, Lemstra AW, van Berckel BNM. Tau PET and relative cerebral blood flow in dementia with Lewy bodies: A PET study. Neuroimage Clin 2020; 28:102504. [PMID: 33395993 PMCID: PMC7714680 DOI: 10.1016/j.nicl.2020.102504] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Alpha-synuclein often co-occurs with Alzheimer's disease (AD) pathology in Dementia with Lewy Bodies (DLB). From a dynamic [18F]flortaucipir PET scan we derived measures of both tau binding and relative cerebral blood flow (rCBF). We tested whether regional tau binding or rCBF differed between DLB patients and AD patients and controls and examined their association with clinical characteristics of DLB. METHODS Eighteen patients with probable DLB, 65 AD patients and 50 controls underwent a dynamic 130-minute [18F]flortaucipir PET scan. DLB patients with positive biomarkers for AD based on cerebrospinal fluid or amyloid PET were considered as DLB with AD pathology (DLB-AD+). Receptor parametric mapping (cerebellar gray matter reference region) was used to extract regional binding potential (BPND) and R1, reflecting (AD-specific) tau pathology and rCBF, respectively. First, we performed regional comparisons of [18F]flortaucipir BPND and R1 between diagnostic groups. In DLB patients only, we performed regression analyses between regional [18F]flortaucipir BPND, R1 and performance on ten neuropsychological tests. RESULTS Regional [18F]flortaucipir BPND in DLB was comparable with tau binding in controls (p > 0.05). Subtle higher tau binding was observed in DLB-AD+ compared to DLB-AD- in the medial temporal and parietal lobe (both p < 0.05). Occipital and lateral parietal R1 was lower in DLB compared to AD and controls (all p < 0.01). Lower frontal R1 was associated with impaired performance on digit span forward (standardized beta, stβ = 0.72) and category fluency (stβ = 0.69) tests. Lower parietal R1 was related to lower delayed (stβ = 0.50) and immediate (stβ = 0.48) recall, VOSP number location (stβ = 0.70) and fragmented letters (stβ = 0.59) scores. Lower occipital R1 was associated to worse performance on VOSP fragmented letters (stβ = 0.61), all p < 0.05. CONCLUSION The amount of tau binding in DLB was minimal and did not differ from controls. However, there were DLB-specific occipital and lateral parietal relative cerebral blood flow reductions compared to both controls and AD patients. Regional rCBF, but not tau binding, was related to cognitive impairment. This indicates that assessment of rCBF may give more insight into disease mechanisms in DLB than tau PET.
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Affiliation(s)
- E E Wolters
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
| | - M van de Beek
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - R Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - S S V Golla
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - S C J Verfaillie
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - E M Coomans
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - T Timmers
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - D Visser
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - H Tuncel
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - F Barkhof
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Institutes of Neurology & Healthcare Engineering, UCL, London, United Kingdom
| | - R Boellaard
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - A D Windhorst
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - W M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ph Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - A W Lemstra
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - B N M van Berckel
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Doorduijn AS, de van der Schueren MAE, van de Rest O, de Leeuw FA, Hendriksen HMA, Teunissen CE, Scheltens P, van der Flier WM, Visser M. Nutritional Status Is Associated With Clinical Progression in Alzheimer's Disease: The NUDAD Project. J Am Med Dir Assoc 2020; 24:638-644.e1. [PMID: 33239240 DOI: 10.1016/j.jamda.2020.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/21/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In cognitively normal adults, nutritional parameters are related to cognitive decline and incidence of dementia. Studies on the role of nutrition in predementia stages subjective cognitive decline and mild cognitive impairment, and mild stages of Alzheimer's disease (AD) dementia in a clinical setting are lacking. In the absence of a curative treatment, this evidence is important for targeting nutritional factors to potentially prevent or delay further cognitive decline. Our aim is to investigate associations of nutritional parameters with clinical progression in patients ranging from those who are cognitively normal to those who have AD dementia. DESIGN Longitudinal. SETTING AND PARTICIPANTS Memory clinic, 551 patients (219 with subjective cognitive decline, 135 with mild cognitive impairment, and 197 with AD dementia), mean age 64 ± 8 years. MEASUREMENTS We assessed body mass index, fat-free mass, Mini-Nutritional Assessment, and dietary intake with the Dutch Healthy Diet food frequency questionnaire and the 238-item healthy life in an urban setting (HELIUS) food frequency questionnaire at baseline. Cox proportional hazard models were used to evaluate associations of nutritional parameters with clinical progression. Additional analyses were restricted to patients who were amyloid positive. RESULTS We observed clinical progression in 170 patients (31%) over 2.2 ± 0.9 years. Poorer Mini-Nutritional Assessment score [hazard ratio (95% confidence interval) 1.39 (1.18-1.64)], lower body mass index [1.15 (0.96-1.38)], lower fat-free mass [1.40 (0.93-2.10)], and a less healthy dietary pattern [1.22 (1.01-1.48)] were associated with a higher risk of clinical progression. Similar effect sizes were found in patients who were amyloid positive. CONCLUSIONS AND IMPLICATIONS Poorer nutritional status and a less healthy dietary pattern are associated with a higher risk of clinical progression. This study provides support for investigating whether improving nutritional status can alter the clinical trajectory of AD.
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Affiliation(s)
- Astrid S Doorduijn
- Department of Nutrition and Dietetics, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Marian A E de van der Schueren
- Department of Nutrition and Health, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands; Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Ondine van de Rest
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Francisca A de Leeuw
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Heleen M A Hendriksen
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Philip Scheltens
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Department of Epidemiology & Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Marjolein Visser
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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26
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Finsterwalder S, Vlegels N, Gesierich B, Caballero MÁA, Weaver NA, Franzmeier N, Georgakis MK, Konieczny MJ, Koek HL, Karch CM, Graff-Radford NR, Salloway S, Oh H, Allegri RF, Chhatwal JP, Jessen F, Düzel E, Dobisch L, Metzger C, Peters O, Incesoy EI, Priller J, Spruth EJ, Schneider A, Fließbach K, Buerger K, Janowitz D, Teipel SJ, Kilimann I, Laske C, Buchmann M, Heneka MT, Brosseron F, Spottke A, Roy N, Ertl-Wagner B, Scheffler K, Seo SW, Kim Y, Na DL, Kim HJ, Jang H, Ewers M, Levin J, Schmidt R, Pasternak O, Dichgans M, Biessels GJ, Duering M. Small vessel disease more than Alzheimer's disease determines diffusion MRI alterations in memory clinic patients. Alzheimers Dement 2020; 16:1504-1514. [PMID: 32808747 PMCID: PMC8102202 DOI: 10.1002/alz.12150] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Microstructural alterations as assessed by diffusion tensor imaging (DTI) are key findings in both Alzheimer's disease (AD) and small vessel disease (SVD). We determined the contribution of each of these conditions to diffusion alterations. METHODS We studied six samples (N = 365 participants) covering the spectrum of AD and SVD, including genetically defined samples. We calculated diffusion measures from DTI and free water imaging. Simple linear, multivariable random forest, and voxel-based regressions were used to evaluate associations between AD biomarkers (amyloid beta, tau), SVD imaging markers, and diffusion measures. RESULTS SVD markers were strongly associated with diffusion measures and showed a higher contribution than AD biomarkers in multivariable analysis across all memory clinic samples. Voxel-wise analyses between tau and diffusion measures were not significant. DISCUSSION In memory clinic patients, the effect of SVD on diffusion alterations largely exceeds the effect of AD, supporting the value of diffusion measures as markers of SVD.
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Affiliation(s)
- Sofia Finsterwalder
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Naomi Vlegels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Benno Gesierich
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Miguel Á. Araque Caballero
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Nick A. Weaver
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Marios K. Georgakis
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Marek J. Konieczny
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Huiberdina L. Koek
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Celeste M. Karch
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, USA
| | | | | | - Hwamee Oh
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ricardo F. Allegri
- Department of Cognitive Neurology, FLENI Institute for Neurological Research, Buenos Aires, Argentina
| | | | | | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg, Germany
| | - Laura Dobisch
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg, Germany
| | - Coraline Metzger
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - Oliver Peters
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | - Enise I. Incesoy
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | - Josef Priller
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | - Eike J. Spruth
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Klaus Fließbach
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Katharina Buerger
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Stefan J. Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Martina Buchmann
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Michael T. Heneka
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Frederic Brosseron
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University of Bonn, Bonn, Germany
| | - Nina Roy
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Birgit Ertl-Wagner
- Institute of Clinical Radiology, University Hospital, LMU Munich, Munich, Germany
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Klaus Scheffler
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | | | | | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
- Center for Imaging of Neurodegenerative Diseases, University of California, San Francisco
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea
| | - Yeshin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Korea
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine Chuncheon, Republic of Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Korea
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Korea
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Korea
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea
| | - Michael Ewers
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Johannes Levin
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Ofer Pasternak
- Department of Psychiatry and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Marco Duering
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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O'Malley M, Parkes J, Campbell J, Stamou V, LaFontaine J, Oyebode JR, Carter J. Receiving a diagnosis of young onset dementia: Evidence-based statements to inform best practice. DEMENTIA 2020; 20:1745-1771. [PMID: 33124442 PMCID: PMC8216318 DOI: 10.1177/1471301220969269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction Better understanding of patient experience is an important driver for service improvements and can act as a lever for system change. In the United Kingdom, the patient experience is now a central issue for the National Health Service Commissioning Board, clinical commissioning groups and the providers they commission from. Traditionally, dementia care in the United Kingdom has focused predominantly on the individual experience of those with late onset dementia, while the voice of those with young onset dementia has been, comparatively, unheard. This study aims to improve the understanding of the personal experience of younger people undergoing investigation for dementia. Methods A modified Delphi approach was undertaken with 18 younger people with dementia and 18 supporters of people with young onset dementia. Questions were informed by a scoping review of the literature (O’Malley, M., Carter, J., Stamou, V., Lafontaine, J., & Parkes, J. (2019a). Receiving a diagnosis of young onset dementia: A scoping review of lived experiences. Ageing & Mental Health, 0(0), 1-12). Summary individual statements were refined over two rounds to a final list of 29 key statements. Results Twenty-seven of these statements were rated as absolutely essential or very important and included (1) for the general practitioner to identify dementia in younger people, (2) clinicians should be compassionate, empathic and respectful during the assessment and particularly sensitive when providing information about a diagnosis, and (3) remembering that receiving the diagnosis is a lot to absorb for a person with dementia and their supporter. Statistical analyses found no difference in the scoring patterns between younger people with dementia and supporters, suggesting similar shared experiences during the diagnostic process. Conclusion Understanding the uniquely personal experience of young people going through the process of diagnosis for dementia is essential to provide person-centred, needs-led, and cost-effective services. Patient’s values and experiences should be used to support and guide clinical decision-making.
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Affiliation(s)
| | - Jacqueline Parkes
- UoN Dementia Research & Innovation Centre, Faculty of Health, Education and Society, 6087University of Northampton, Northampton, UK
| | - Jackie Campbell
- Faculty of Health, Education and Society, 6087University of Northampton, Northampton, UK
| | | | | | - Jan R Oyebode
- Centre for Applied Dementia Studies, Faculty of Health Studies, 1905University of Bradford, Bradford, UK
| | - Janet Carter
- Faculty of Brain Sciences, Division of Psychiatry, Maple House, 4919University College London, London, UK
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28
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Collij LE, Heeman F, Salvadó G, Ingala S, Altomare D, de Wilde A, Konijnenberg E, van Buchem M, Yaqub M, Markiewicz P, Golla SSV, Wottschel V, Wink AM, Visser PJ, Teunissen CE, Lammertsma AA, Scheltens P, van der Flier WM, Boellaard R, van Berckel BNM, Molinuevo JL, Gispert JD, Schmidt ME, Barkhof F, Lopes Alves I. Multitracer model for staging cortical amyloid deposition using PET imaging. Neurology 2020; 95:e1538-e1553. [PMID: 32675080 PMCID: PMC7713745 DOI: 10.1212/wnl.0000000000010256] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/20/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To develop and evaluate a model for staging cortical amyloid deposition using PET with high generalizability. METHODS Three thousand twenty-seven individuals (1,763 cognitively unimpaired [CU], 658 impaired, 467 with Alzheimer disease [AD] dementia, 111 with non-AD dementia, and 28 with missing diagnosis) from 6 cohorts (European Medical Information Framework for AD, Alzheimer's and Family, Alzheimer's Biomarkers in Daily Practice, Amsterdam Dementia Cohort, Open Access Series of Imaging Studies [OASIS]-3, Alzheimer's Disease Neuroimaging Initiative [ADNI]) who underwent amyloid PET were retrospectively included; 1,049 individuals had follow-up scans. With application of dataset-specific cutoffs to global standard uptake value ratio (SUVr) values from 27 regions, single-tracer and pooled multitracer regional rankings were constructed from the frequency of abnormality across 400 CU individuals (100 per tracer). The pooled multitracer ranking was used to create a staging model consisting of 4 clusters of regions because it displayed a high and consistent correlation with each single-tracer ranking. Relationships between amyloid stage, clinical variables, and longitudinal cognitive decline were investigated. RESULTS SUVr abnormality was most frequently observed in cingulate, followed by orbitofrontal, precuneal, and insular cortices and then the associative, temporal, and occipital regions. Abnormal amyloid levels based on binary global SUVr classification were observed in 1.0%, 5.5%, 17.9%, 90.0%, and 100.0% of individuals in stage 0 to 4, respectively. Baseline stage predicted decline in Mini-Mental State Examination (MMSE) score (ADNI: n = 867, F = 67.37, p < 0.001; OASIS: n = 475, F = 9.12, p < 0.001) and faster progression toward an MMSE score ≤25 (ADNI: n = 787, hazard ratio [HR]stage1 2.00, HRstage2 3.53, HRstage3 4.55, HRstage4 9.91, p < 0.001; OASIS: n = 469, HRstage4 4.80, p < 0.001). CONCLUSION The pooled multitracer staging model successfully classified the level of amyloid burden in >3,000 individuals across cohorts and radiotracers and detects preglobal amyloid burden and distinct risk profiles of cognitive decline within globally amyloid-positive individuals.
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Affiliation(s)
- Lyduine E Collij
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Fiona Heeman
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Gemma Salvadó
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Silvia Ingala
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Daniele Altomare
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Arno de Wilde
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Elles Konijnenberg
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Marieke van Buchem
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Maqsood Yaqub
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Pawel Markiewicz
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Sandeep S V Golla
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Viktor Wottschel
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Alle Meije Wink
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Pieter Jelle Visser
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Charlotte E Teunissen
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Adriaan A Lammertsma
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Philip Scheltens
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Wiesje M van der Flier
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Ronald Boellaard
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Bart N M van Berckel
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - José Luis Molinuevo
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Juan Domingo Gispert
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Mark E Schmidt
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Frederik Barkhof
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium
| | - Isadora Lopes Alves
- From Department of Radiology and Nuclear Medicine (L.E.C., F.H., S.I., M.Y., S.S.V.G., V.W., A.M.W., A.A.L., R.B., B.N.M.v.B., F.B., I.L.A.), Neurochemistry Laboratory (C.E.T.), Alzheimer Center (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), and Department of Neurology (D.A., A.d.W., E.K., M.v.B., P.J.V., P.S., W.M.v.d.F.), Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation (G.S., J.L.M., J.D.G.), Barcelona; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (J.D.G.); Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (J.L.M.), Madrid; IMIM (Hospital del Mar Medical Research Institute) (G.S., J.L.M., J.D.G.), Barcelona; Universitat Pompeu Fabra (J.L.M., J.D.G.), Barcelona, Spain; Laboratory of Neuroimaging of Aging (D.A.), University of Geneva; Memory Clinic (D.A.), University Hospital of Geneva, Switzerland; Centre for Medical Image Computing (P.M., F.B.), Medical Physics and Biomedical Engineering, University College London, London, UK; and Janssen Pharmaceutica NV (M.E.S.), Beerse, Belgium.
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Verhaar BJ, de Leeuw FA, Doorduijn AS, Fieldhouse JL, van de Rest O, Teunissen CE, van Berckel BN, Barkhof F, Visser M, de van der Schueren MA, Scheltens P, Kester MI, Muller M, van der Flier WM. Nutritional status and structural brain changes in Alzheimer's disease: The NUDAD project. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12063. [PMID: 32793798 PMCID: PMC7418890 DOI: 10.1002/dad2.12063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Weight loss is associated with higher mortality and progression of cognitive decline, but its associations with magnetic resonance imaging (MRI) changes related to Alzheimer's disease (AD) are unknown. METHODS We included 412 patients from the NUDAD project, comprising 129 with AD dementia, 107 with mild cognitive impairment (MCI), and 176 controls. Associations between nutritional status and MRI measures were analyzed using linear regression, adjusted for age, sex, education, cognitive functioning, and cardiovascular risk factors. RESULTS Lower body mass index (BMI), fat mass (FM), and fat free mass index were associated with higher medial temporal atrophy (MTA) scores. Lower BMI, FM, and waist circumference were associated with more microbleeds. Stratification by diagnosis showed that the observed associations with microbleeds were only significant in MCI. DISCUSSION Lower indicators of nutritional status were associated with more MTA and microbleeds, with largest effect sizes in MCI.
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Affiliation(s)
- Barbara J.H. Verhaar
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Internal Medicine, Amsterdam Cardiovascular SciencesVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Francisca A. de Leeuw
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Clinical Chemistry, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Astrid S. Doorduijn
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Nutrition and Dietetics, Amsterdam Public Health Research InstituteVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Jay L.P. Fieldhouse
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Ondine van de Rest
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenthe Netherlands
| | - Charlotte E. Teunissen
- Department of Clinical Chemistry, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Bart N.M. van Berckel
- Department of Radiology and Nuclear MedicineVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Frederik Barkhof
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Radiology and Nuclear MedicineVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- UCL Institutes of Neurology and Healthcare EngineeringLondonUnited Kingdom
| | - Marjolein Visser
- Department of Health Sciences, Faculty of ScienceVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Marian A.E. de van der Schueren
- Department of Nutrition and Dietetics, Amsterdam Public Health Research InstituteVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Nutrition and HealthHAN University of Applied SciencesNijmegenthe Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Maartje I. Kester
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Majon Muller
- Department of Internal Medicine, Amsterdam Cardiovascular SciencesVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
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Ebenau JL, Timmers T, Wesselman LMP, Verberk IMW, Verfaillie SCJ, Slot RER, van Harten AC, Teunissen CE, Barkhof F, van den Bosch KA, van Leeuwenstijn M, Tomassen J, Braber AD, Visser PJ, Prins ND, Sikkes SAM, Scheltens P, van Berckel BNM, van der Flier WM. ATN classification and clinical progression in subjective cognitive decline: The SCIENCe project. Neurology 2020; 95:e46-e58. [PMID: 32522798 PMCID: PMC7371376 DOI: 10.1212/wnl.0000000000009724] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/12/2019] [Indexed: 02/06/2023] Open
Abstract
Objective To investigate the relationship between the ATN classification system (amyloid, tau, neurodegeneration) and risk of dementia and cognitive decline in individuals with subjective cognitive decline (SCD). Methods We classified 693 participants with SCD (60 ± 9 years, 41% women, Mini-Mental State Examination score 28 ± 2) from the Amsterdam Dementia Cohort and Subjective Cognitive Impairment Cohort (SCIENCe) project according to the ATN model, as determined by amyloid PET or CSF β-amyloid (A), CSF p-tau (T), and MRI-based medial temporal lobe atrophy (N). All underwent extensive neuropsychological assessment. For 342 participants, follow-up was available (3 ± 2 years). As a control population, we included 124 participants without SCD. Results Fifty-six (n = 385) participants had normal Alzheimer disease (AD) biomarkers (A–T–N–), 27% (n = 186) had non-AD pathologic change (A–T–N+, A–T+N–, A–T+N+), 18% (n = 122) fell within the Alzheimer continuum (A+T–N–, A+T–N+, A+T+N–, A+T+N+). ATN profiles were unevenly distributed, with A–T+N+, A+T–N+, and A+T+N+ containing very few participants. Cox regression showed that compared to A–T–N–, participants in A+ profiles had a higher risk of dementia with a dose–response pattern for number of biomarkers affected. Linear mixed models showed participants in A+ profiles showed a steeper decline on tests addressing memory, attention, language, and executive functions. In the control group, there was no association between ATN and cognition. Conclusions Among individuals presenting with SCD at a memory clinic, those with a biomarker profile A–T+N+, A+T–N–, A+T+N–, and A+T+N+ were at increased risk of dementia, and showed steeper cognitive decline compared to A–T–N– individuals. These results suggest a future where biomarker results could be used for individualized risk profiling in cognitively normal individuals presenting at a memory clinic.
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Affiliation(s)
- Jarith L Ebenau
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden.
| | - Tessa Timmers
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Linda M P Wesselman
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Inge M W Verberk
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Sander C J Verfaillie
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Rosalinde E R Slot
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Argonde C van Harten
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Charlotte E Teunissen
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Frederik Barkhof
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Karlijn A van den Bosch
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Mardou van Leeuwenstijn
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Jori Tomassen
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Anouk den Braber
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Pieter Jelle Visser
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Niels D Prins
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Sietske A M Sikkes
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Philip Scheltens
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Bart N M van Berckel
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Wiesje M van der Flier
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
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Alber J, Maruff P, Santos CY, Ott BR, Salloway SP, Yoo DC, Noto RB, Thompson LI, Goldfarb D, Arthur E, Song A, Snyder PJ. Disruption of cholinergic neurotransmission, within a cognitive challenge paradigm, is indicative of Aβ-related cognitive impairment in preclinical Alzheimer's disease after a 27-month delay interval. Alzheimers Res Ther 2020; 12:31. [PMID: 32209123 PMCID: PMC7093953 DOI: 10.1186/s13195-020-00599-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 03/11/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Abnormal beta-amyloid (Aβ) is associated with deleterious changes in central cholinergic tone in the very early stages of Alzheimer's disease (AD), which may be unmasked by a cholinergic antagonist (J Prev Alzheimers Dis 1:1-4, 2017). Previously, we established the scopolamine challenge test (SCT) as a "cognitive stress test" screening measure to identify individuals at risk for AD (Alzheimer's & Dementia 10(2):262-7, 2014) (Neurobiol. Aging 36(10):2709-15, 2015). Here we aim to demonstrate the potential of the SCT as an indicator of cognitive change and neocortical amyloid aggregation after a 27-month follow-up interval. METHODS Older adults (N = 63, aged 55-75 years) with self-reported memory difficulties and first-degree family history of AD completed the SCT and PET amyloid imaging at baseline and were then seen for cognitive testing at 9, 18, and 27 months post-baseline. Repeat PET amyloid imaging was completed at the time of the 27-month exam. RESULTS Significant differences in both cognitive performance and in Aβ neocortical burden were observed between participants who either failed vs. passed the SCT at baseline, after a 27-month follow-up period. CONCLUSIONS Cognitive response to the SCT (Alzheimer's & Dementia 10(2):262-7, 2014) at baseline is related to cognitive change and PET amyloid imaging results, over the course of 27 months, in preclinical AD. The SCT may be a clinically useful screening tool to identify individuals who are more likely to both have positive evidence of amyloidosis on PET imaging and to show measurable cognitive decline over several years.
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Affiliation(s)
- Jessica Alber
- Department of Biological & Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 75 Lower College Road, 2nd Floor, Kingston, RI USA
- Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Paul Maruff
- Cogstate Ltd., Melbourne, Victoria Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria Australia
| | - Cláudia Y. Santos
- Department of Biological & Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 75 Lower College Road, 2nd Floor, Kingston, RI USA
| | - Brian R. Ott
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Stephen P. Salloway
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Don C. Yoo
- Department of Radiology, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Richard B. Noto
- Department of Radiology, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Louisa I. Thompson
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
| | | | - Edmund Arthur
- Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI USA
| | - Alex Song
- Brown University, Providence, RI USA
| | - Peter J. Snyder
- Department of Biological & Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 75 Lower College Road, 2nd Floor, Kingston, RI USA
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI USA
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Visser LNC, van Maurik IS, Bouwman FH, Staekenborg S, Vreeswijk R, Hempenius L, de Beer MH, Roks G, Boelaarts L, Kleijer M, van der Flier WM, Smets EMA. Clinicians' communication with patients receiving a MCI diagnosis: The ABIDE project. PLoS One 2020; 15:e0227282. [PMID: 31961882 PMCID: PMC6974141 DOI: 10.1371/journal.pone.0227282] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We aimed to explore clinicians' communication, including the discussion of diagnosis, cause, prognosis and care planning, in routine post-diagnostic testing consultations with patients with Mild Cognitive Impairment (MCI). METHODS Thematic content analysis was used to analyze audiotaped consultations in which 10 clinicians (eight neurologists and two geriatricians) from 7 memory clinics, disclosed diagnostic information to 13 MCI patients and their care partners. We assessed clinician-patient communication regarding diagnostic label, cause, prognosis and care planning to identify core findings. RESULTS Core findings were: clinicians 1) differed in how they informed about the MCI label; 2) tentatively addressed cause of symptoms; 3) (implicitly) steered against further biomarker testing; 4) rarely informed about the patient's risk of developing dementia; 5) often informed about the expected course of symptoms emphasizing potential symptom stabilization and/or improvement, and; 6) did not engage in a conversation on long-term (care) planning. DISCUSSION Clinicians' information provision about the underlying cause, prognosis and implications for long-term (care) planning in MCI could be more specific. Since most patients and care partners have a strong need to understand the patient's symptoms, and for information on the prognosis and implications for the future, clinicians' current approach may not match with those needs.
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Affiliation(s)
- Leonie N. C. Visser
- Department of Medical Psychology, Amsterdam Public Health research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ingrid S. van Maurik
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Femke H. Bouwman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Salka Staekenborg
- Department of Neurology, Tergooi Ziekenhuis, Blaricum, The Netherlands
| | - Ralph Vreeswijk
- Department of Clinical Geriatrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Liesbeth Hempenius
- Geriatric Center, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marlijn H. de Beer
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Gerwin Roks
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Leo Boelaarts
- Geriatric Department, NoordWest Ziekenhuis Groep, Alkmaar, The Netherlands
| | - Mariska Kleijer
- Department of Neurology, LangeLand Ziekenhuis, Zoetermeer, The Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ellen M. A. Smets
- Department of Medical Psychology, Amsterdam Public Health research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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van Maurik IS, Bakker ED, van den Buuse S, Gillissen F, van de Beek M, Lemstra E, Mank A, van den Bosch KA, van Leeuwenstijn M, Bouwman FH, Scheltens P, van der Flier WM. Psychosocial Effects of Corona Measures on Patients With Dementia, Mild Cognitive Impairment and Subjective Cognitive Decline. Front Psychiatry 2020; 11:585686. [PMID: 33192733 PMCID: PMC7649118 DOI: 10.3389/fpsyt.2020.585686] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/22/2020] [Indexed: 01/15/2023] Open
Abstract
Background: The recent COVID-19 pandemic is not only a major healthcare problem in itself, but also poses enormous social challenges. Though nursing homes increasingly receive attention, the majority of people with cognitive decline and dementia live at home. We aimed to explore the psychosocial effects of corona measures in memory clinic (pre-)dementia patients and their caregivers. Methods: Between April 28th and July 13th 2020, n = 389 patients of Alzheimer center Amsterdam [n = 121 symptomatic (age = 69 ± 6, 33%F, MMSE = 23 ± 5), n = 268 cognitively normal (age = 66 ± 8, 40% F, MMSE = 29 ± 1)] completed a survey on psychosocial effects of the corona measures. Questions related to social isolation, worries for faster cognitive decline, behavioral problems and discontinuation of care. In addition, n = 147 caregivers of symptomatic patients completed a similar survey with additional questions on caregiver burden. Results: Social isolation was experienced by n = 42 (35%) symptomatic and n = 67 (25%) cognitively normal patients and two third of patients [n = 129 (66%); n = 58 (75%) symptomatic, n = 71 (61%) cognitively normal] reported that care was discontinued. Worries for faster cognitive decline were existed in symptomatic patients [n = 44 (44%)] and caregivers [n = 73 (53%)], but were also reported by a subgroup of cognitively normal patients [n = 27 (14%)]. Both patients [n = 56 (46%) symptomatic, n = 102 (38%) cognitively normal] and caregivers [n = 72 (48%)] reported an increase in psychological symptoms. More than three quarter of caregivers [n = 111(76%)] reported an increase in patients' behavioral problems. A higher caregiver burden was experienced by n = 69 (56%) of caregivers and n = 43 (29%) of them reported that a need for more support. Discontinuation of care (OR = 3.3 [1.3-7.9]), psychological (OR = 4.0 [1.6-9.9]) and behavioral problems (OR = 3.0 [1.0-9.0]) strongly related to experiencing a higher caregiver burden. Lastly, social isolation (OR = 3.2 [1.2-8.1]) and psychological symptoms (OR = 8.1 [2.8-23.7]) were red flags for worries for faster cognitive decline. Conclusion: Not only symptomatic patients, but also cognitively normal patients express worries for faster cognitive decline and psychological symptoms. Moreover, we identified patients who are at risk of adverse outcomes of the corona measures, i.e., discontinued care, social isolation, psychological and behavioral problems. This underlines the need for health care professionals to provide ways to warrant the continuation of care and support (informal) networks surrounding patients and caregivers to mitigate the higher risk of negative psychosocial effects.
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Affiliation(s)
- Ingrid S van Maurik
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Els D Bakker
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Freek Gillissen
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marleen van de Beek
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Evelien Lemstra
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Arenda Mank
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Karlijn A van den Bosch
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mardou van Leeuwenstijn
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Femke H Bouwman
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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34
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Reimand J, de Wilde A, Teunissen CE, Zwan M, Windhorst AD, Boellaard R, Barkhof F, van der Flier WM, Scheltens P, van Berckel BNM, Ossenkoppele R, Bouwman F. PET and CSF amyloid-β status are differently predicted by patient features: information from discordant cases. Alzheimers Res Ther 2019; 11:100. [PMID: 31810489 PMCID: PMC6898919 DOI: 10.1186/s13195-019-0561-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Amyloid-β PET and CSF Aβ42 yield discordant results in 10-20% of memory clinic patients, possibly providing unique information. Although the predictive power of demographic, clinical, genetic, and imaging features for amyloid positivity has previously been investigated, it is unknown whether these features differentially predict amyloid-β status based on PET or CSF or whether this differs by disease stage. METHODS We included 768 patients (subjective cognitive decline (SCD, n = 194), mild cognitive impairment (MCI, n = 127), dementia (AD and non-AD, n = 447) with amyloid-β PET and CSF Aβ42 measurement within 1 year. Ninety-seven (13%) patients had discordant PET/CSF amyloid-β status. We performed parallel random forest models predicting separately PET and CSF status using 17 patient features (demographics, APOE4 positivity, CSF (p)tau, cognitive performance, and MRI visual ratings) in the total patient group and stratified by syndrome diagnosis. Thereafter, we selected features with the highest variable importance measure (VIM) as input for logistic regression models, where amyloid status on either PET or CSF was predicted by (i) the selected patient feature and (ii) the patient feature adjusted for the status of the other amyloid modality. RESULTS APOE4, CSF tau, and p-tau had the highest VIM for PET and CSF in all groups. In the amyloid-adjusted logistic regression models, p-tau was a significant predictor for PET-amyloid in SCD (OR = 1.02 [1.01-1.04], pFDR = 0.03), MCI (OR = 1.05 [1.02-1.07], pFDR < 0.01), and dementia (OR = 1.04 [1.03-1.05], pFDR < 0.001), but not for CSF-amyloid. APOE4 (OR = 3.07 [1.33-7.07], punc < 0.01) was associated with CSF-amyloid in SCD, while it was only predictive for PET-amyloid in MCI (OR = 9.44 [2.93, 30.39], pFDR < 0.01). Worse MMSE scores (OR = 1.21 [1.03-1.41], punc = 0.02) were associated to CSF-amyloid status in SCD, whereas worse memory (OR = 1.17 [1.05-1.31], pFDR = 0.02) only predicted PET positivity in dementia. CONCLUSION Amyloid status based on either PET or CSF was predicted by different patient features, and this varied by disease stage, suggesting that PET-CSF discordance yields unique information. The stronger associations of both APOE4 carriership and worse memory z-scores with CSF-amyloid in SCD suggest that CSF-amyloid is more sensitive early in the disease course. The higher predictive value of CSF p-tau for a positive PET scan suggests that PET is more specific to AD pathology.
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Affiliation(s)
- Juhan Reimand
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
- Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia.
- Radiology Centre, North Estonia Medical Centre, Tallinn, Estonia.
| | - Arno de Wilde
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Marissa Zwan
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Albert D Windhorst
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ronald Boellaard
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Centre for Medical Image Computing, Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Wiesje M van der Flier
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Epidemiology & Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Philip Scheltens
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Femke Bouwman
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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35
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Babapour Mofrad R, Visser LNC, Fruijtier AD, Scheltens P, Smets E(EMA, van der Flier WM, Teunissen CE. Cerebrospinal fluid collection: An informative animation video for patients and caregivers. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2019; 11:435-438. [PMID: 31211216 PMCID: PMC6562320 DOI: 10.1016/j.dadm.2019.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Daily clinical practice has shown that patients are often hesitant to undergo a lumbar puncture (LP) because of unfamiliarity with the awaiting procedure and/or unrealistic ideas concerning post-LP complications. In light of increased number of LPs in diagnostic and research settings, our institute has developed an educational video for patients and caregivers in which we inform them about and prepare them for the LP procedure. This video was based on the latest literature and was developed with the help of communication experts, medical doctors, and two separate patient panels.
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Affiliation(s)
- R. Babapour Mofrad
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Neurology, Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Leonie Nicoline Cornelia Visser
- Department of Neurology, Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam Public Health, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Agnetha Diantha Fruijtier
- Department of Neurology, Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam Public Health, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Wiesje Maria van der Flier
- Department of Neurology, Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Charlotte Elisabeth Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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Visser LNC, Pelt SAR, Kunneman M, Bouwman FH, Claus JJ, Kalisvaart KJ, Hempenius L, de Beer MH, Roks G, Boelaarts L, Kleijer M, van der Flier WM, Smets EMA, Hillen MA. Communicating uncertainties when disclosing diagnostic test results for (Alzheimer's) dementia in the memory clinic: The ABIDE project. Health Expect 2019; 23:52-62. [PMID: 31638322 PMCID: PMC6978856 DOI: 10.1111/hex.12964] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 02/06/2023] Open
Abstract
Background The development of novel diagnostics enables increasingly earlier diagnosis of Alzheimer's disease (AD). Timely diagnosis may benefit patients by reducing their uncertainty regarding the cause of symptoms, yet does not always provide patients with the desired certainty. Objective To examine, using both quantitative and qualitative methods, uncertainty communicated by memory clinic clinicians in post‐diagnostic testing consultations with patients and their caregivers. Methods First, we identified all uncertainty expressions of 22 clinicians in audiotaped post‐diagnostic testing consultations with 78 patients. Second, we statistically explored relationships between patient/clinician characteristics and uncertainty expressions. Third, the transcribed uncertainty expressions were qualitatively analysed, determining the topic to which they pertained, their source and initiator/elicitor (clinicians/patients/caregivers). Results Within 57/78 (73%) consultations, clinicians expressed in total 115 uncertainties, of which 37% elicited by the patient or caregiver. No apparent relationships were found between patient/clinician characteristics and whether or not, and how often clinicians expressed uncertainty. Uncertainty expressions pertained to ten different topics, most frequently patient's diagnosis and symptom progression. Expressed uncertainty was mostly related to the unpredictability of the future and limits to available knowledge. Discussion and conclusions The majority of clinicians openly discussed the limits of scientific knowledge and diagnostic testing with patients and caregivers in the dementia context. Noticeably, clinicians did not discuss uncertainty in about one quarter of consultations. More evidence is needed on the beneficial and/or harmful effects on patients of discussing uncertainty with them. This knowledge can be used to support clinicians to optimally convey uncertainty and facilitate patients' uncertainty management.
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Affiliation(s)
- Leonie N C Visser
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sophie A R Pelt
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA.,Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Femke H Bouwman
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jules J Claus
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands
| | - Kees J Kalisvaart
- Department of Clinical Geriatrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Liesbeth Hempenius
- Geriatric Center, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marlijn H de Beer
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Gerwin Roks
- Department of Neurology, ETZ Hospital, Tilburg, The Netherlands
| | - Leo Boelaarts
- Geriatric Department, NoordWest Ziekenhuis Groep, Alkmaar, The Netherlands
| | - Mariska Kleijer
- Department of Neurology, LangeLand Ziekenhuis, Zoetermeer, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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de Wilde A, Ossenkoppele R, Pelkmans W, Bouwman F, Groot C, van Maurik I, Zwan M, Yaqub M, Barkhof F, Lammertsma AA, Biessels GJ, Scheltens P, van Berckel BN, van der Flier WM. Assessment of the appropriate use criteria for amyloid PET in an unselected memory clinic cohort: The ABIDE project. Alzheimers Dement 2019; 15:1458-1467. [PMID: 31594684 DOI: 10.1016/j.jalz.2019.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/01/2019] [Accepted: 07/01/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The objective of this study was to assess the usefulness of the appropriate use criteria (AUC) for amyloid imaging in an unselected cohort. METHODS We calculated sensitivity and specificity of appropriate use (increased confidence and management change), as defined by Amyloid Imaging Taskforce in the AUC, and other clinical utility outcomes. Furthermore, we compared differences in post-positron emission tomography diagnosis and management change between "AUC-consistent" and "AUC-inconsistent" patients. RESULTS Almost half (250/507) of patients were AUC-consistent. In both AUC-consistent and AUC-inconsistent patients, post-positron emission tomography diagnosis (28%-21%) and management (32%-17%) change was substantial. The Amyloid Imaging Taskforce's definition of appropriate use occurred in 55/507 (13%) patients, detected by the AUC with a sensitivity of 93%, and a specificity of 56%. Diagnostic changes occurred independently of AUC status (sensitivity: 57%, specificity: 53%). DISCUSSION The current AUC are not sufficiently able to discriminate between patients who will benefit from amyloid positron emission tomography and those who will not.
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Affiliation(s)
- Arno de Wilde
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center, VU University, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Rik Ossenkoppele
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center, VU University, Amsterdam UMC, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University, Amsterdam UMC, Amsterdam, the Netherlands; Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Wiesje Pelkmans
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center, VU University, Amsterdam UMC, Amsterdam, the Netherlands
| | - Femke Bouwman
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center, VU University, Amsterdam UMC, Amsterdam, the Netherlands
| | - Colin Groot
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center, VU University, Amsterdam UMC, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ingrid van Maurik
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center, VU University, Amsterdam UMC, Amsterdam, the Netherlands
| | - Marissa Zwan
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center, VU University, Amsterdam UMC, Amsterdam, the Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University, Amsterdam UMC, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University, Amsterdam UMC, Amsterdam, the Netherlands; Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University, Amsterdam UMC, Amsterdam, the Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Philip Scheltens
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center, VU University, Amsterdam UMC, Amsterdam, the Netherlands
| | - Bart N van Berckel
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center, VU University, Amsterdam UMC, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center, VU University, Amsterdam UMC, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, VU University of Amsterdam, Amsterdam, the Netherlands
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de Wilde A, van der Flier WM, Pelkmans W, Bouwman F, Verwer J, Groot C, van Buchem MM, Zwan M, Ossenkoppele R, Yaqub M, Kunneman M, Smets EMA, Barkhof F, Lammertsma AA, Stephens A, van Lier E, Biessels GJ, van Berckel BN, Scheltens P. Association of Amyloid Positron Emission Tomography With Changes in Diagnosis and Patient Treatment in an Unselected Memory Clinic Cohort: The ABIDE Project. JAMA Neurol 2019; 75:1062-1070. [PMID: 29889941 DOI: 10.1001/jamaneurol.2018.1346] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Previous studies have evaluated the diagnostic effect of amyloid positron emission tomography (PET) in selected research cohorts. However, these research populations do not reflect daily practice, thus hampering clinical implementation of amyloid imaging. Objective To evaluate the association of amyloid PET with changes in diagnosis, diagnostic confidence, treatment, and patients' experiences in an unselected memory clinic cohort. Design, Setting, and Participants Amyloid PET using fluoride-18 florbetaben was offered to 866 patients who visited the tertiary memory clinic at the VU University Medical Center between January 2015 and December 2016 as part of their routine diagnostic dementia workup. Of these patients, 476 (55%) were included, 32 (4%) were excluded, and 358 (41%) did not participate. To enrich this sample, 31 patients with mild cognitive impairment from the University Medical Center Utrecht memory clinic were included. For each patient, neurologists determined a preamyloid and postamyloid PET diagnosis that existed of both a clinical syndrome (dementia, mild cognitive impairment, or subjective cognitive decline) and a suspected etiology (Alzheimer disease [AD] or non-AD), with a confidence level ranging from 0% to 100%. In addition, the neurologist determined patient treatment in terms of ancillary investigations, medication, and care. Each patient received a clinical follow-up 1 year after being scanned. Main Outcomes and Measures Primary outcome measures were post-PET changes in diagnosis, diagnostic confidence, and patient treatment. Results Of the 507 patients (mean [SD] age, 65 (8) years; 201 women [39%]; mean [SD] Mini-Mental State Examination score, 25 [4]), 164 (32%) had AD dementia, 70 (14%) non-AD dementia, 114 (23%) mild cognitive impairment, and 159 (31%) subjective cognitive decline. Amyloid PET results were positive for 242 patients (48%). The suspected etiology changed for 125 patients (25%) after undergoing amyloid PET, more often due to a negative (82 of 265 [31%]) than a positive (43 of 242 [18%]) PET result (P < .01). Post-PET changes in suspected etiology occurred more frequently in patients older (>65 years) than younger (<65 years) than the typical age at onset of 65 years (74 of 257 [29%] vs 51 of 250 [20%]; P < .05). Mean diagnostic confidence (SD) increased from 80 (13) to 89 (13%) (P < .001). In 123 patients (24%), there was a change in patient treatment post-PET, mostly related to additional investigations and therapy. Conclusions and Relevance This prospective diagnostic study provides a bridge between validating amyloid PET in a research setting and implementing this diagnostic tool in daily clinical practice. Both amyloid-positive and amyloid-negative results had substantial associations with changes in diagnosis and treatment, both in patients with and without dementia.
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Affiliation(s)
- Arno de Wilde
- 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 & Biostatistics, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Wiesje Pelkmans
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Femke Bouwman
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Jurre Verwer
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Colin Groot
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Marieke M van Buchem
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Marissa Zwan
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Marleen Kunneman
- Department of Medical Psychology, Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, England
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | | | | | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart N van Berckel
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Philip Scheltens
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
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Fruijtier AD, Visser LNC, van Maurik IS, Zwan MD, Bouwman FH, van der Flier WM, Smets EMA. ABIDE Delphi study: topics to discuss in diagnostic consultations in memory clinics. ALZHEIMERS RESEARCH & THERAPY 2019; 11:77. [PMID: 31472676 PMCID: PMC6717649 DOI: 10.1186/s13195-019-0531-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/19/2019] [Indexed: 12/13/2022]
Abstract
Background Information given to patients and caregivers during the clinician-patient encounter varies considerably between memory clinic professionals. Patients and caregivers express a clear desire for more information. It is unclear what information patients and caregivers value most during the diagnostic process and whether this is concordant with professionals’ opinion. We aimed to identify a topic list on which health care professionals, patients, and caregivers agree that these should be discussed during diagnostic consultations in memory clinics. Further, we aimed to establish the optimal moment for each topic to be discussed during the diagnostic process. Methods We performed a three-round Delphi consensus study. Professionals (N = 80), patients (N = 66), and caregivers (N = 76) rated the importance of 44 informative topics through an online questionnaire. Consensus was defined as a topic rating of 6 or 7 on a 7-point Likert scale by ≥ 75% of each panel. In round 2 and 3, a survey was added to identify the optimal moment during the diagnostic process to discuss each topic. Results By round 3, consensus was achieved on 17 topics divided into four categories, information about (1) diagnostic testing, (2) test results, (3) diagnosis, and (4) practical implications. Eight additional topics showed significant differences between panels. Most notable panel differences regard the risk for developing dementia and the distinction between Alzheimer’s disease and dementia, which patients and caregivers evaluated as more important compared to professionals. The optimal moment to discuss topics during the diagnostic process was identified for the 17 core topics, and the eight topics with significant differences. Conclusions We present a core list of informative topics, which professionals, patients, and caregivers agree they should be discussed during the diagnostic process in a memory clinic. The topic list can support professionals and empower patients and caregivers during diagnostic physician-patient consultations. Electronic supplementary material The online version of this article (10.1186/s13195-019-0531-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Agnetha D Fruijtier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands. .,Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Leonie N C Visser
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ingrid S van Maurik
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marissa D Zwan
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Femke H Bouwman
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Benvenutto A, Giusiano B, Koric L, Gueriot C, Didic M, Felician O, Guye M, Guedj E, Ceccaldi M. Imaging Biomarkers of Neurodegeneration in Alzheimer's Disease: Distinct Contributions of Cortical MRI Atrophy and FDG-PET Hypometabolism. J Alzheimers Dis 2019; 65:1147-1157. [PMID: 30124446 DOI: 10.3233/jad-180292] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neurodegeneration biomarkers are routinely used in the diagnosis of Alzheimer's disease (AD). OBJECTIVE To evaluate the respective contributions of two neuroimaging biomarkers, structural MRI and 18FDG-PET, in the assessment of neurodegeneration in AD dementia. METHODS Patients with mild AD dementia diagnosed based on clinical and cerebrospinal fluid criteria and cognitively healthy subjects, from the Marseille cohort ADAge with cognitive, structural MRI and 18FDG-PET assessments, were included. Extent of atrophy on MRI and of hypometabolism on 18FDG-PET were individually evaluated in each patient using a voxel-based analysis on whole-brain approach and compared to healthy subjects. Patients were divided in distinct groups according to their atrophy extent on the one hand and to their hypometabolism extent on the other, then, to their imaging profile combining the extent of the two biomarkers. RESULTS Fifty-two patients were included. The MMSE score was significantly lower in the "Extensive hypometabolism" group than in the "Limited hypometabolism" group (respectively 19.5/30 versus 23/30). A lower Innotest Amyloid Tau Index was associated with an extensive hypometabolism (p = 0.04). There were more patients with low educational level in the "Extensive atrophy" group, while a higher educational level was more found in the "Limited atrophy" group (p = 0.005). CONCLUSION 18FDG-PET hypometabolism extent is associated with the pathological processes and clinical severity of AD, while MRI atrophy seems to be influenced by the cognitive reserve. In the context of mild AD dementia, these two biomarkers of neurodegeneration are thus not interchangeable and require to be considered in combination rather than in isolation.
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Affiliation(s)
- Agnès Benvenutto
- Neurology and Neuropsychology Department and CMMR PACA Ouest, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Bernard Giusiano
- Department of Public Health, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Institut de Neurosciences des Systèmes, Aix-Marseille Univ, INSERM UMR 1106, Marseille, France
| | - Lejla Koric
- Neurology and Neuropsychology Department and CMMR PACA Ouest, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix Marseille Univ, CNRS, Centrale Marseille, Institut Fresnel, Marseille, France
| | - Claude Gueriot
- Neurology and Neuropsychology Department and CMMR PACA Ouest, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Mira Didic
- Neurology and Neuropsychology Department and CMMR PACA Ouest, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Institut de Neurosciences des Systèmes, Aix-Marseille Univ, INSERM UMR 1106, Marseille, France
| | - Olivier Felician
- Neurology and Neuropsychology Department and CMMR PACA Ouest, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Institut de Neurosciences des Systèmes, Aix-Marseille Univ, INSERM UMR 1106, Marseille, France
| | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,AP-HM, Timone University Hospital, CEMEREM, Marseille, France
| | - Eric Guedj
- Aix Marseille Univ, CNRS, Centrale Marseille, Institut Fresnel, Marseille, France.,Department of Nuclear Medecine, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,CERIMED, Aix-Marseille Univ, Marseille, France
| | - Mathieu Ceccaldi
- Neurology and Neuropsychology Department and CMMR PACA Ouest, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Institut de Neurosciences des Systèmes, Aix-Marseille Univ, INSERM UMR 1106, Marseille, France
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Clinician-patient communication during the diagnostic workup: The ABIDE project. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2019; 11:520-528. [PMID: 31388556 PMCID: PMC6667786 DOI: 10.1016/j.dadm.2019.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction We aimed to describe clinician-patient communication in the diagnostic process of memory clinics, specifically clinician behavior known to facilitate knowledgeable participation of patients during consultations. Methods In this multicenter, observational study, we audio-recorded routine diagnostic consultations of 41 clinicians and 136 patients/caregivers at eight memory clinics. Patients/caregivers completed surveys after each audiotaped consultation. We used a study-specific coding scheme to categorize communication behavior. Results Clinicians often provided information on (results of) diagnostic testing. They infrequently invited questions and/or checked understanding. Clinician behavior to involve patients in decision-making about diagnostic testing was limited. Of note, patients/caregivers rarely expressed their information or involvement preferences. Yet, approximately, one quarter of them would have liked to receive more information. Discussion Involving patients more explicitly by means of shared decision-making could benefit the quality of care provided in memory clinics because it enables clinicians to attune the diagnostic workup to the individual patient's needs. Considering patient preferences in the diagnostic process enables personalized care. Knowledgeable participation in diagnostic consultations is therefore warranted. Clinicians often provided information on diagnostic procedures and test results. Yet, they showed limited behavior to promote patients' understanding. And patients were seldom involved in decision-making about diagnostic testing.
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van Maurik IS, Visser LN, Pel-Littel RE, van Buchem MM, Zwan MD, Kunneman M, Pelkmans W, Bouwman FH, Minkman M, Schoonenboom N, Scheltens P, Smets EM, van der Flier WM. Development and Usability of ADappt: Web-Based Tool to Support Clinicians, Patients, and Caregivers in the Diagnosis of Mild Cognitive Impairment and Alzheimer Disease. JMIR Form Res 2019; 3:e13417. [PMID: 31287061 PMCID: PMC6643768 DOI: 10.2196/13417] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/31/2022] Open
Abstract
Background As a result of advances in diagnostic testing in the field of Alzheimer disease (AD), patients are diagnosed in earlier stages of the disease, for example, in the stage of mild cognitive impairment (MCI). This poses novel challenges for a clinician during the diagnostic workup with regard to diagnostic testing itself, namely, which tests are to be performed, but also on how to engage patients in this decision and how to communicate test results. As a result, tools to support decision making and improve risk communication could be valuable for clinicians and patients. Objective The aim of this study was to present the design, development, and testing of a Web-based tool for clinicians in a memory clinic setting and to ascertain whether this tool can (1) facilitate the interpretation of biomarker results in individual patients with MCI regarding their risk of progression to dementia, (2) support clinicians in communicating biomarker test results and risks to MCI patients and their caregivers, and (3) support clinicians in a process of shared decision making regarding the diagnostic workup of AD. Methods A multiphase mixed-methods approach was used. Phase 1 consisted of a qualitative needs assessment among professionals, patients, and caregivers; phase 2, consisted of an iterative process of development and the design of the tool (ADappt); and phase 3 consisted of a quantitative and qualitative assessment of usability and acceptability of ADappt. Across these phases, co-creation was realized via a user-centered qualitative approach with clinicians, patients, and caregivers. Results In phase 1, clinicians indicated the need for risk calculation tools and visual aids to communicate test results to patients. Patients and caregivers expressed their needs for more specific information on their risk for developing AD and related consequences. In phase 2, we developed the content and graphical design of ADappt encompassing 3 modules: a risk calculation tool, a risk communication tool including a summary sheet for patients and caregivers, and a conversation starter to support shared decision making regarding the diagnostic workup. In phase 3, ADappt was considered to be clear and user-friendly. Conclusions Clinicians in a memory clinic setting can use ADappt, a Web-based tool, developed using multiphase design and co-creation, for support that includes an individually tailored interpretation of biomarker test results, communication of test results and risks to patients and their caregivers, and shared decision making on diagnostic testing.
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Affiliation(s)
- Ingrid S van Maurik
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Leonie Nc Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Medical Psychology, Amsterdam Public Health Research Insitute, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Marieke M van Buchem
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Marissa D Zwan
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Marleen Kunneman
- Department of Medical Psychology, Amsterdam Public Health Research Insitute, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Wiesje Pelkmans
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Femke H Bouwman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Mirella Minkman
- Vilans Center of Expertise for Long Term Care, Utrecht, Netherlands.,Tilburg University, TIAS School for Business and Society, Tilburg, Netherlands
| | | | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Ellen Ma Smets
- Department of Medical Psychology, Amsterdam Public Health Research Insitute, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
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Triviño-Ibáñez EM, Sánchez-Vañó R, Sopena-Novales P, Romero-Fábrega JC, Rodríguez-Fernández A, Carnero Pardo C, Martínez Lozano MD, Gómez-Río M. Impact of amyloid-PET in daily clinical management of patients with cognitive impairment fulfilling appropriate use criteria. Medicine (Baltimore) 2019; 98:e16509. [PMID: 31335725 PMCID: PMC6708756 DOI: 10.1097/md.0000000000016509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate the use of amyloid-positron emission tomography (PET) in routine clinical practice, in a selected population with cognitive impairment that meets appropriate use criteria (AUC).A multicenter, observational, prospective case-series study of 211patients from 2 level-3 hospitals who fulfilled clinical AUC for amyloid-PET scan in a naturalistic setting. Certainty degree was evaluated using a 5-point Likert scale: 0 (very low probability); 1 (low probability); 2 (intermediate probability); 3 (high probability); and 4 (practically sure), before and after amyloid PET. The treatment plan was considered as cognition-specific or noncognition-specific.Amyloid-PET was positive in 118 patients (55.9%) and negative in 93 patients (44.1%). Diagnostic prescan confidence according amyloid-PET results showed that in both, negative and positive-PET subgroup, the most frequent category was intermediate probability (45.7% and 55.1%, respectively). After the amyloid-PET, the diagnostic confidence showed a very different distribution, that was, in the negative-PET group the most frequent categories are very unlikely (70.7%) and unlikely (29.3%), while in the positive-PET group were very probable (57.6%) and practically sure (39%). Only in 14/211 patients (6.6%) the result of the amyloid-PET did not influence the diagnostic confidence, while in 194 patients (93.4%), the diagnostic confidence improved significantly after amyloid-PET results. The therapeutic intention was modified in 93 patients (44.1%). Specific treatment for Alzheimer disease was started, before amyloid-PET, in 80 patients (37.9%).This naturalistic study provides evidence that the implementation of amyloid-PET is associated with a significant improvement in diagnostic confidence and has a high impact on the therapeutic management of patients with mild cognitive impairment fulfilled clinical AUC.
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Affiliation(s)
- Eva María Triviño-Ibáñez
- Department of Nuclear Medicine, Virgen de las Nieves University Hospital
- IBS, Granada Bio-Health Research Institute, Granada
| | - Raquel Sánchez-Vañó
- Department of Nuclear Medicine, La Fe University Hospital, Clinical Medicine and Public Health Doctoral Program of the University of Granada
| | | | | | - Antonio Rodríguez-Fernández
- Department of Nuclear Medicine, Virgen de las Nieves University Hospital
- IBS, Granada Bio-Health Research Institute, Granada
| | | | | | - Manuel Gómez-Río
- Department of Nuclear Medicine, Virgen de las Nieves University Hospital
- IBS, Granada Bio-Health Research Institute, Granada
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Akpan A, Tabue-Teguo M, Fougère B. Neurocognitive Disorders: Importance of Early/Timely Detection in Daily Clinical Practice. J Alzheimers Dis 2019; 70:317-322. [PMID: 31177208 DOI: 10.3233/jad-180381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neurocognitive disorders create important challenges for patients, their families, and clinicians who provide their health care. Early/timely detection in daily clinical practice allows for diagnosis and adequate treatment, psychosocial support, education, and engagement in shared decision-making related to health care, life planning, involvement in research, and financial matters. However, neurocognitive disorders, when present, are not detected or not diagnosed and not documented, in more than half of patients seen by primary care physicians. The aim of this paper is to highlight the strategies and the perspectives to improve the early/timely detection of neurocognitive disorders in daily clinical practice.
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Affiliation(s)
- Asangaedem Akpan
- Department of Medicine for Older People and Stroke, Aintree University Hospital NHS FT, Liverpool, UK
| | | | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France
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45
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Falgàs N, Tort-Merino A, Balasa M, Borrego-Écija S, Castellví M, Olives J, Bosch B, Férnandez-Villullas G, Antonell A, Augé JM, Lomeña F, Perissinotti A, Bargalló N, Sánchez-Valle R, Lladó A. Clinical applicability of diagnostic biomarkers in early-onset cognitive impairment. Eur J Neurol 2019; 26:1098-1104. [PMID: 30793432 DOI: 10.1111/ene.13945] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Several diagnostic biomarkers are currently available for clinical use in early-onset cognitive impairment. The decision on which biomarker is used in each patient depends on several factors such as its predictive value or tolerability. METHODS There were a total of 40 subjects with early-onset cognitive complaints (<65 years of age): 26 with Alzheimer's disease (AD), five with frontotemporal dementia and nine with diagnostic suspicion of non-neurodegenerative disorder. Clinical and neuropsychological evaluation, lumbar puncture for cerebrospinal fluid (CSF) AD core biochemical marker determination, medial temporal atrophy evaluation on magnetic resonance imaging, amyloid-positron emission tomography (PET) and 18 F-fluorodeoxyglucose-PET were performed. Neurologists provided pre- and post-biomarker diagnosis, together with diagnostic confidence and clinical/therapeutic management. Patients scored the tolerability of each procedure. RESULTS Cerebrospinal fluid biomarkers and amyloid-PET increased diagnostic confidence in AD (77.4%-86.2% after CSF, 92.4% after amyloid-PET, P < 0.01) and non-neurodegenerative conditions (53.6%-75% after CSF, 95% after amyloid-PET, P < 0.05). Biomarker results led to diagnostic (32.5%) and treatment (32.5%) changes. All tests were well tolerated. CONCLUSIONS Biomarker procedures are well tolerated and have an important diagnostic/therapeutic impact on early-onset cognitive impairment.
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Affiliation(s)
- N Falgàs
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Tort-Merino
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Balasa
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain.,Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - S Borrego-Écija
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Castellví
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Olives
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - B Bosch
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - G Férnandez-Villullas
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Antonell
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - J M Augé
- Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, Barcelona
| | - F Lomeña
- Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona
| | - A Perissinotti
- Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona
| | - N Bargalló
- Image Diagnostic Centre, IDIBAPS, Hospital Clínic de Barcelona, Barcelona, Spain
| | - R Sánchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Lladó
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
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46
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Willemse EA, van Maurik IS, Tijms BM, Bouwman FH, Franke A, Hubeek I, Boelaarts L, Claus JJ, Korf ES, van Marum RJ, Roks G, Schoonenboom N, Verwey N, Zwan MD, Wahl S, van der Flier WM, Teunissen CE. Diagnostic performance of Elecsys immunoassays for cerebrospinal fluid Alzheimer's disease biomarkers in a nonacademic, multicenter memory clinic cohort: The ABIDE project. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:563-572. [PMID: 30406175 PMCID: PMC6215060 DOI: 10.1016/j.dadm.2018.08.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction We compared the automated Elecsys and manual Innotest immunoassays for cerebrospinal fluid (CSF) Alzheimer's disease biomarkers in a multicenter diagnostic setting. Methods We collected CSF samples from 137 participants in eight local memory clinics. Amyloid β(1–42) (Aβ42), total tau (t-tau), and phosphorylated tau (p-tau) were centrally analyzed with Innotest and Elecsys assays. Concordances between methods were assessed. Results Biomarker results strongly correlated between assays with Spearman's ρ 0.94 for Aβ42, 0.98 for t-tau, and 0.98 for p-tau. Using Gaussian mixture modeling, cohort-specific cut-points were estimated at 1092 pg/mL for Aβ42, 235 pg/mL for t-tau, and 24 pg/mL for p-tau. We found an excellent concordance of biomarker abnormality between assays of 97% for Aβ42 and 96% for both t-tau and p-tau. Discussion The high concordances between Elecsys and Innotest in this nonacademic, multicenter cohort support the use of Elecsys for CSF Alzheimer's disease diagnostics and allow conversion of results between methods. Method comparison of 137 CSF samples collected in eight nonacademic memory clinics. Innotest and Elecsys strongly correlated: ρ = 0.94 Aβ42; 0.98 t-tau; 0.98 p-tau. Concordances of biomarker abnormalities: 97% Aβ42; 96% t-tau and p-tau. Concordance of NIA-AA–based Alzheimer's disease profile (Aβ42 decreased and p-tau increased): 89%. Preanalytical protocol deviations did not show effects on biomarker correlations.
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Affiliation(s)
- Eline A.J. Willemse
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Corresponding author. Tel.: +31-20-44-43029; Fax: +31-20-44-43857.
| | - Ingrid S. van Maurik
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Betty M. Tijms
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke H. Bouwman
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Isabelle Hubeek
- Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Leo Boelaarts
- Department of Geriatric Medicine, Noordwest Hospital Group, Alkmaar, The Netherlands
| | - Jules J. Claus
- Department of Neurology, Tergooi Hospital, Hilversum, The Netherlands
| | - Esther S.C. Korf
- Department of Neurology, Admiraal De Ruyter Hospital, Goes, The Netherlands
| | - Rob J. van Marum
- Department of Geriatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
- Department of Family Medicine and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gerwin Roks
- Department of Neurology, Elisabeth Tweesteden Hospital (ETZ), Tilburg, The Netherlands
| | | | - Nicolaas Verwey
- Department of Neurology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Marissa D. Zwan
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Wiesje M. van der Flier
- Department of Neurology, Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Lilja J, Leuzy A, Chiotis K, Savitcheva I, Sörensen J, Nordberg A. Spatial Normalization of 18F-Flutemetamol PET Images Using an Adaptive Principal-Component Template. J Nucl Med 2018; 60:285-291. [PMID: 29903930 PMCID: PMC8833851 DOI: 10.2967/jnumed.118.207811] [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: 01/12/2018] [Accepted: 06/07/2018] [Indexed: 11/29/2022] Open
Abstract
Though currently approved for visual assessment only, there is evidence to suggest that quantification of amyloid-β (Aβ) PET images may reduce interreader variability and aid in the monitoring of treatment effects in clinical trials. Quantification typically involves a regional atlas in standard space, requiring PET images to be spatially normalized. Different uptake patterns in Aβ-positive and Aβ-negative subjects, however, make spatial normalization challenging. In this study, we proposed a method to spatially normalize 18F-flutemetamol images using a synthetic template based on principal-component images to overcome these challenges. Methods:18F-flutemetamol PET and corresponding MR images from a phase II trial (n = 70), including subjects ranging from Aβ-negative to Aβ-positive, were spatially normalized to standard space using an MR-driven registration method (SPM12). 18F-flutemetamol images were then intensity-normalized using the pons as a reference region. Principal-component images were calculated from the intensity-normalized images. A linear combination of the first 2 principal-component images was then used to model a synthetic template spanning the whole range from Aβ-negative to Aβ-positive. The synthetic template was then incorporated into our registration method, by which the optimal template was calculated as part of the registration process, providing a PET-only–driven registration method. Evaluation of the method was done in 2 steps. First, coregistered gray matter masks generated using SPM12 were spatially normalized using the PET- and MR-driven methods, respectively. The spatially normalized gray matter masks were then visually inspected and quantified. Second, to quantitatively compare the 2 registration methods, additional data from an ongoing study were spatially normalized using both methods, with correlation analysis done on the resulting cortical SUV ratios. Results: All scans were successfully spatially normalized using the proposed method with no manual adjustments performed. Both visual and quantitative comparison between the PET- and MR-driven methods showed high agreement in cortical regions. 18F-flutemetamol quantification showed strong agreement between the SUV ratios for the PET- and MR-driven methods (R2 = 0.996; pons reference region). Conclusion: The principal-component template registration method allows for robust and accurate registration of 18F-flutemetamol images to a standardized template space, without the need for an MR image.
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48
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Altuna-Azkargorta M, Mendioroz-Iriarte M. Blood biomarkers in Alzheimer's disease. Neurologia 2018; 36:S0213-4853(18)30091-4. [PMID: 29752036 DOI: 10.1016/j.nrl.2018.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 02/20/2018] [Accepted: 03/01/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The early diagnosis of Alzheimer's disease (AD) via the use of biomarkers could facilitate the implementation and monitoring of early therapeutic interventions with the potential capacity to significantly modify the course of the disease. DEVELOPMENT Classic cerebrospinal fluid biomarkers and approved structural and functional neuroimaging have a limited clinical application given their invasive nature and/or high cost. The identification of more accessible and less costly biomarkers, such as blood biomarkers, would facilitate application in clinical practice. We present a literature review of the main blood biochemical biomarkers with potential use for diagnosing Alzheimer's disease. CONCLUSIONS Blood biomarkers are cost and time effective with regard to cerebrospinal fluid biomarkers. However, the immediate applicability of blood biochemical biomarkers in clinical practice is not very likely. The main limitations come from the difficulties in measuring and standardising thresholds between different laboratories and in failures to replicate results. Among all the molecules studied, apoptosis and neurodegeneration biomarkers and the biomarker panels obtained through omics approaches, such as isolated or combined metabolomics, offer the most promising results.
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Affiliation(s)
- M Altuna-Azkargorta
- Laboratorio de Neuroepigenética, Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, España.
| | - M Mendioroz-Iriarte
- Laboratorio de Neuroepigenética, Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, España; Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, España
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49
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van der Flier WM, Scheltens P. Amsterdam Dementia Cohort: Performing Research to Optimize Care. J Alzheimers Dis 2018; 62:1091-1111. [PMID: 29562540 PMCID: PMC5870023 DOI: 10.3233/jad-170850] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 01/01/2023]
Abstract
The Alzheimer center of the VU University Medical Center opened in 2000 and was initiated to combine both patient care and research. Together, to date, all patients forming the Amsterdam Dementia Cohort number almost 6,000 individuals. In this cohort profile, we provide an overview of the results produced based on the Amsterdam Dementia Cohort. We describe the main results over the years in each of these research lines: 1) early diagnosis, 2) heterogeneity, and 3) vascular factors. Among the most important research efforts that have also impacted patients' lives and/or the research field, we count the development of novel, easy to use diagnostic measures such as visual rating scales for MRI and the Amsterdam IADL Questionnaire, insight in different subgroups of AD, and findings on incidence and clinical sequelae of microbleeds. Finally, we describe in the outlook how our research endeavors have improved the lives of our patients.
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Affiliation(s)
- Wiesje M. van der Flier
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
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50
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Tijms BM, Willemse EAJ, Zwan MD, Mulder SD, Visser PJ, van Berckel BNM, van der Flier WM, Scheltens P, Teunissen CE. Unbiased Approach to Counteract Upward Drift in Cerebrospinal Fluid Amyloid-β 1-42 Analysis Results. Clin Chem 2017; 64:576-585. [PMID: 29208658 DOI: 10.1373/clinchem.2017.281055] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/20/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Low cerebrospinal fluid (CSF) amyloid-β 1-42 (Aβ 1-42) concentrations indicate amyloid plaque accumulation in the brain, a pathological hallmark of Alzheimer disease (AD). Innotest assay values of Aβ 1-42 have gradually increased over the past 2 decades, which might lead to misclassification of AD when a single cutpoint for abnormality is used. We propose an unbiased approach to statistically correct for drift. METHODS We determined year-specific cutpoints with Gaussian mixture modeling, based on the cross-section of bimodal distributions of Aβ 1-42 concentrations in 4397 memory clinic patients. This allowed us to realign year-specific cutpoints as an unbiased method to remove drift from the data. Sensitivity and specificity to detect AD dementia were compared between corrected and uncorrected values. RESULTS Aβ 1-42 values increased 22 pg/mL annually, and this could not be explained by changes in cohort composition. Our approach removed time dependencies [β (SE) = 0.07 (0.59); P = 0.91]. Statistically correcting for drift improved the sensitivity to detect AD dementia to 0.90 (95% CI, 0.89-0.92) from at least 0.66 (95% CI, 0.64-0.69) based on uncorrected data. Specificity became lower (0.69; 95% CI, 0.67-0.70) vs at most 0.80 (95% CI, 0.79-0.82) for uncorrected data. CONCLUSIONS This approach may also be useful to standardize Aβ 1-42 CSF concentrations across different centers and/or platforms, and to optimize use of CSF biomarker data collected over a long period.
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Affiliation(s)
- Betty M Tijms
- Alzheimer Center and Department of Neurology, VUmc, Amsterdam Neuroscience, Amsterdam, the Netherlands;
| | - Eline A J Willemse
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, VUmc, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Marissa D Zwan
- Alzheimer Center and Department of Neurology, VUmc, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Sandra D Mulder
- Alzheimer Center and Department of Neurology, VUmc, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center and Department of Neurology, VUmc, Amsterdam Neuroscience, Amsterdam, the Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center and Department of Neurology, VUmc, Amsterdam Neuroscience, Amsterdam, the Netherlands.,Department of Epidemiology and Biostatistics, VUmc, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, VUmc, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, VUmc, Amsterdam Neuroscience, Amsterdam, the Netherlands
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