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van Amerongen S, Das S, Kamps S, Goossens J, Bongers B, Pijnenburg YAL, Vanmechelen E, Vijverberg EGB, Teunissen CE, Verberk IMW. Cerebrospinal fluid biomarkers and cognitive trajectories in patients with Alzheimer's disease and a history of traumatic brain injury. Neurobiol Aging 2024; 141:121-128. [PMID: 38908030 DOI: 10.1016/j.neurobiolaging.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
Traumatic brain injury (TBI) and Alzheimer's disease (AD) have overlapping mechanisms but it remains unknown if pathophysiological characteristics and cognitive trajectories in AD patients are influenced by TBI history. Here, we studied AD patients (stage MCI or dementia) with TBI history (ADTBI+, n=110), or without (ADTBI-, n=110) and compared baseline CSF concentrations of amyloid beta 1-42 (Aβ42), phosphorylated tau181 (pTau181), total tau, neurofilament light chain (NfL), synaptosomal associated protein-25kDa (SNAP25), neurogranin (Ng), neuronal pentraxin-2 (NPTX2) and glutamate receptor-4 (GluR4), as well as differences in cognitive trajectories using linear mixed models. Explorative, analyses were repeated within stratified TBI groups by TBI characteristics (timing, severity, number). We found no differences in baseline CSF biomarker concentrations nor in cognitive trajectories between ADTBI+ and ADTBI- patients. TBI >5 years ago was associated with higher NPTX2 and a tendency for higher SNAP25 concentrations compared to TBI ≤ 5 years ago, suggesting that TBI may be associated with long-term synaptic dysfunction only when occurring before onset or in a pre-clinical disease stage of AD.
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Affiliation(s)
- Suzan van Amerongen
- Amsterdam Neuroscience, Neurodegeneration, De Boelelaan 1085, Amsterdam 1081 HV, the Netherlands; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands.
| | - Shreyasee Das
- Neurochemistry Laboratory, Department of Laboratory Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1117, Amsterdam 1081 HV, the Netherlands; ADx NeuroSciences, Technologiepark-Zwijnaarde 6, Gent 9052, Belgium
| | - Suzie Kamps
- Amsterdam Neuroscience, Neurodegeneration, De Boelelaan 1085, Amsterdam 1081 HV, the Netherlands; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands
| | - Julie Goossens
- ADx NeuroSciences, Technologiepark-Zwijnaarde 6, Gent 9052, Belgium
| | - Bram Bongers
- Neurochemistry Laboratory, Department of Laboratory Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1117, Amsterdam 1081 HV, the Netherlands
| | - Yolande A L Pijnenburg
- Amsterdam Neuroscience, Neurodegeneration, De Boelelaan 1085, Amsterdam 1081 HV, the Netherlands; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands
| | | | - Everard G B Vijverberg
- Amsterdam Neuroscience, Neurodegeneration, De Boelelaan 1085, Amsterdam 1081 HV, the Netherlands; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands
| | - Charlotte E Teunissen
- Amsterdam Neuroscience, Neurodegeneration, De Boelelaan 1085, Amsterdam 1081 HV, the Netherlands; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands; Neurochemistry Laboratory, Department of Laboratory Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1117, Amsterdam 1081 HV, the Netherlands
| | - Inge M W Verberk
- Amsterdam Neuroscience, Neurodegeneration, De Boelelaan 1085, Amsterdam 1081 HV, the Netherlands; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands; Neurochemistry Laboratory, Department of Laboratory Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1117, Amsterdam 1081 HV, the Netherlands
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van der Veere PJ, Hoogland J, Visser LNC, Van Harten AC, Rhodius-Meester HF, Sikkes SAM, Venkatraghavan V, Barkhof F, Teunissen CE, van de Giessen E, Berkhof J, Van Der Flier WM. Predicting Cognitive Decline in Amyloid-Positive Patients With Mild Cognitive Impairment or Mild Dementia. Neurology 2024; 103:e209605. [PMID: 38986053 PMCID: PMC11238942 DOI: 10.1212/wnl.0000000000209605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cognitive decline rates in Alzheimer disease (AD) vary greatly. Disease-modifying treatments may alter cognitive decline trajectories, rendering their prediction increasingly relevant. We aimed to construct clinically applicable prediction models of cognitive decline in amyloid-positive patients with mild cognitive impairment (MCI) or mild dementia. METHODS From the Amsterdam Dementia Cohort, we selected amyloid-positive participants with MCI or mild dementia and at least 2 longitudinal Mini-Mental State Examination (MMSE) measurements. Amyloid positivity was based on CSF AD biomarker concentrations or amyloid PET. We used linear mixed modeling to predict MMSE over time, describing trajectories using a cubic time curve and interactions between linear time and the baseline predictors age, sex, baseline MMSE, APOE ε4 dose, CSF β-amyloid (Aβ) 1-42 and pTau, and MRI total brain and hippocampal volume. Backward selection was used to reduce model complexity. These models can predict MMSE over follow-up or the time to an MMSE value. MCI and mild dementia were modeled separately. Internal 5-fold cross-validation was performed to calculate the explained variance (R2). RESULTS In total, 961 participants were included (age 65 ± 7 years, 49% female), 310 had MCI (MMSE 26 ± 2) and 651 had mild dementia (MMSE 22 ± 4), with 4 ± 2 measurements over 2 (interquartile range 1-4) years. Cognitive decline rates increased over time for both MCI and mild dementia (model comparisons linear vs squared vs cubic time fit; p < 0.05 favoring a cubic fit). For MCI, backward selection retained age, sex, and CSF Aβ1-42 and pTau concentrations as time-varying effects altering the MMSE trajectory. For mild dementia, retained time-varying effects were Aβ1-42, age, APOE ε4, and baseline MMSE. R2 was 0.15 for the MCI model and 0.26 for mild dementia in internal cross-validation. A hypothetical patient with MCI, baseline MMSE 28, and CSF Aβ1-42 of 925 pg/mL was predicted to reach an MMSE of 20 after 6.0 years (95% CI 5.4-6.7) and after 8.6 years with a hypothetical treatment reducing decline by 30%. DISCUSSION We constructed models for MCI and mild dementia that predict MMSE over time. These models could inform patients about their potential cognitive trajectory and the remaining uncertainty and aid in conversations about individualized potential treatment effects.
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Affiliation(s)
- Pieter J van der Veere
- From the Alzheimer Center and Department of Neurology (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., S.A.M.S., V.V., W.M.V.D.F.), and Department of Epidemiology and Biostatistics (P.J.v.d.V., J.H., L.N.C.V., J.B., W.M.V.D.F.), Amsterdam Neuroscience, VU University Medical Center; Amsterdam Neuroscience (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., V.V., C.E.T., E.G., W.M.V.D.F.), Neurodegeneration the Netherlands; Division of Clinical Geriatrics (L.N.C.V.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Psychology (L.N.C.V.), Amsterdam UMC Location AMC, University of Amsterdam; Amsterdam Public Health (L.N.C.V.), Quality of Care, Personalized Medicine; Internal Medicine (H.F.R.-M.), Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC Location VUmc; Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Movement and Behavioral Sciences, VU University; Department of Radiology & Nuclear Medicine (F.B., E.G.), Amsterdam UMC, Vrije Universiteit, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; and Neurochemistry Laboratory and Biobank (C.E.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, the Netherlands
| | - Jeroen Hoogland
- From the Alzheimer Center and Department of Neurology (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., S.A.M.S., V.V., W.M.V.D.F.), and Department of Epidemiology and Biostatistics (P.J.v.d.V., J.H., L.N.C.V., J.B., W.M.V.D.F.), Amsterdam Neuroscience, VU University Medical Center; Amsterdam Neuroscience (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., V.V., C.E.T., E.G., W.M.V.D.F.), Neurodegeneration the Netherlands; Division of Clinical Geriatrics (L.N.C.V.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Psychology (L.N.C.V.), Amsterdam UMC Location AMC, University of Amsterdam; Amsterdam Public Health (L.N.C.V.), Quality of Care, Personalized Medicine; Internal Medicine (H.F.R.-M.), Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC Location VUmc; Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Movement and Behavioral Sciences, VU University; Department of Radiology & Nuclear Medicine (F.B., E.G.), Amsterdam UMC, Vrije Universiteit, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; and Neurochemistry Laboratory and Biobank (C.E.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, the Netherlands
| | - Leonie N C Visser
- From the Alzheimer Center and Department of Neurology (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., S.A.M.S., V.V., W.M.V.D.F.), and Department of Epidemiology and Biostatistics (P.J.v.d.V., J.H., L.N.C.V., J.B., W.M.V.D.F.), Amsterdam Neuroscience, VU University Medical Center; Amsterdam Neuroscience (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., V.V., C.E.T., E.G., W.M.V.D.F.), Neurodegeneration the Netherlands; Division of Clinical Geriatrics (L.N.C.V.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Psychology (L.N.C.V.), Amsterdam UMC Location AMC, University of Amsterdam; Amsterdam Public Health (L.N.C.V.), Quality of Care, Personalized Medicine; Internal Medicine (H.F.R.-M.), Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC Location VUmc; Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Movement and Behavioral Sciences, VU University; Department of Radiology & Nuclear Medicine (F.B., E.G.), Amsterdam UMC, Vrije Universiteit, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; and Neurochemistry Laboratory and Biobank (C.E.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, the Netherlands
| | - Argonde C Van Harten
- From the Alzheimer Center and Department of Neurology (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., S.A.M.S., V.V., W.M.V.D.F.), and Department of Epidemiology and Biostatistics (P.J.v.d.V., J.H., L.N.C.V., J.B., W.M.V.D.F.), Amsterdam Neuroscience, VU University Medical Center; Amsterdam Neuroscience (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., V.V., C.E.T., E.G., W.M.V.D.F.), Neurodegeneration the Netherlands; Division of Clinical Geriatrics (L.N.C.V.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Psychology (L.N.C.V.), Amsterdam UMC Location AMC, University of Amsterdam; Amsterdam Public Health (L.N.C.V.), Quality of Care, Personalized Medicine; Internal Medicine (H.F.R.-M.), Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC Location VUmc; Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Movement and Behavioral Sciences, VU University; Department of Radiology & Nuclear Medicine (F.B., E.G.), Amsterdam UMC, Vrije Universiteit, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; and Neurochemistry Laboratory and Biobank (C.E.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, the Netherlands
| | - Hanneke F Rhodius-Meester
- From the Alzheimer Center and Department of Neurology (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., S.A.M.S., V.V., W.M.V.D.F.), and Department of Epidemiology and Biostatistics (P.J.v.d.V., J.H., L.N.C.V., J.B., W.M.V.D.F.), Amsterdam Neuroscience, VU University Medical Center; Amsterdam Neuroscience (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., V.V., C.E.T., E.G., W.M.V.D.F.), Neurodegeneration the Netherlands; Division of Clinical Geriatrics (L.N.C.V.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Psychology (L.N.C.V.), Amsterdam UMC Location AMC, University of Amsterdam; Amsterdam Public Health (L.N.C.V.), Quality of Care, Personalized Medicine; Internal Medicine (H.F.R.-M.), Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC Location VUmc; Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Movement and Behavioral Sciences, VU University; Department of Radiology & Nuclear Medicine (F.B., E.G.), Amsterdam UMC, Vrije Universiteit, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; and Neurochemistry Laboratory and Biobank (C.E.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, the Netherlands
| | - Sietske A M Sikkes
- From the Alzheimer Center and Department of Neurology (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., S.A.M.S., V.V., W.M.V.D.F.), and Department of Epidemiology and Biostatistics (P.J.v.d.V., J.H., L.N.C.V., J.B., W.M.V.D.F.), Amsterdam Neuroscience, VU University Medical Center; Amsterdam Neuroscience (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., V.V., C.E.T., E.G., W.M.V.D.F.), Neurodegeneration the Netherlands; Division of Clinical Geriatrics (L.N.C.V.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Psychology (L.N.C.V.), Amsterdam UMC Location AMC, University of Amsterdam; Amsterdam Public Health (L.N.C.V.), Quality of Care, Personalized Medicine; Internal Medicine (H.F.R.-M.), Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC Location VUmc; Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Movement and Behavioral Sciences, VU University; Department of Radiology & Nuclear Medicine (F.B., E.G.), Amsterdam UMC, Vrije Universiteit, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; and Neurochemistry Laboratory and Biobank (C.E.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, the Netherlands
| | - Vikram Venkatraghavan
- From the Alzheimer Center and Department of Neurology (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., S.A.M.S., V.V., W.M.V.D.F.), and Department of Epidemiology and Biostatistics (P.J.v.d.V., J.H., L.N.C.V., J.B., W.M.V.D.F.), Amsterdam Neuroscience, VU University Medical Center; Amsterdam Neuroscience (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., V.V., C.E.T., E.G., W.M.V.D.F.), Neurodegeneration the Netherlands; Division of Clinical Geriatrics (L.N.C.V.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Psychology (L.N.C.V.), Amsterdam UMC Location AMC, University of Amsterdam; Amsterdam Public Health (L.N.C.V.), Quality of Care, Personalized Medicine; Internal Medicine (H.F.R.-M.), Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC Location VUmc; Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Movement and Behavioral Sciences, VU University; Department of Radiology & Nuclear Medicine (F.B., E.G.), Amsterdam UMC, Vrije Universiteit, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; and Neurochemistry Laboratory and Biobank (C.E.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, the Netherlands
| | - Frederik Barkhof
- From the Alzheimer Center and Department of Neurology (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., S.A.M.S., V.V., W.M.V.D.F.), and Department of Epidemiology and Biostatistics (P.J.v.d.V., J.H., L.N.C.V., J.B., W.M.V.D.F.), Amsterdam Neuroscience, VU University Medical Center; Amsterdam Neuroscience (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., V.V., C.E.T., E.G., W.M.V.D.F.), Neurodegeneration the Netherlands; Division of Clinical Geriatrics (L.N.C.V.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Psychology (L.N.C.V.), Amsterdam UMC Location AMC, University of Amsterdam; Amsterdam Public Health (L.N.C.V.), Quality of Care, Personalized Medicine; Internal Medicine (H.F.R.-M.), Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC Location VUmc; Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Movement and Behavioral Sciences, VU University; Department of Radiology & Nuclear Medicine (F.B., E.G.), Amsterdam UMC, Vrije Universiteit, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; and Neurochemistry Laboratory and Biobank (C.E.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, the Netherlands
| | - Charlotte E Teunissen
- From the Alzheimer Center and Department of Neurology (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., S.A.M.S., V.V., W.M.V.D.F.), and Department of Epidemiology and Biostatistics (P.J.v.d.V., J.H., L.N.C.V., J.B., W.M.V.D.F.), Amsterdam Neuroscience, VU University Medical Center; Amsterdam Neuroscience (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., V.V., C.E.T., E.G., W.M.V.D.F.), Neurodegeneration the Netherlands; Division of Clinical Geriatrics (L.N.C.V.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Psychology (L.N.C.V.), Amsterdam UMC Location AMC, University of Amsterdam; Amsterdam Public Health (L.N.C.V.), Quality of Care, Personalized Medicine; Internal Medicine (H.F.R.-M.), Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC Location VUmc; Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Movement and Behavioral Sciences, VU University; Department of Radiology & Nuclear Medicine (F.B., E.G.), Amsterdam UMC, Vrije Universiteit, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; and Neurochemistry Laboratory and Biobank (C.E.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, the Netherlands
| | - Elsmarieke van de Giessen
- From the Alzheimer Center and Department of Neurology (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., S.A.M.S., V.V., W.M.V.D.F.), and Department of Epidemiology and Biostatistics (P.J.v.d.V., J.H., L.N.C.V., J.B., W.M.V.D.F.), Amsterdam Neuroscience, VU University Medical Center; Amsterdam Neuroscience (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., V.V., C.E.T., E.G., W.M.V.D.F.), Neurodegeneration the Netherlands; Division of Clinical Geriatrics (L.N.C.V.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Psychology (L.N.C.V.), Amsterdam UMC Location AMC, University of Amsterdam; Amsterdam Public Health (L.N.C.V.), Quality of Care, Personalized Medicine; Internal Medicine (H.F.R.-M.), Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC Location VUmc; Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Movement and Behavioral Sciences, VU University; Department of Radiology & Nuclear Medicine (F.B., E.G.), Amsterdam UMC, Vrije Universiteit, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; and Neurochemistry Laboratory and Biobank (C.E.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, the Netherlands
| | - Johannes Berkhof
- From the Alzheimer Center and Department of Neurology (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., S.A.M.S., V.V., W.M.V.D.F.), and Department of Epidemiology and Biostatistics (P.J.v.d.V., J.H., L.N.C.V., J.B., W.M.V.D.F.), Amsterdam Neuroscience, VU University Medical Center; Amsterdam Neuroscience (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., V.V., C.E.T., E.G., W.M.V.D.F.), Neurodegeneration the Netherlands; Division of Clinical Geriatrics (L.N.C.V.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Psychology (L.N.C.V.), Amsterdam UMC Location AMC, University of Amsterdam; Amsterdam Public Health (L.N.C.V.), Quality of Care, Personalized Medicine; Internal Medicine (H.F.R.-M.), Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC Location VUmc; Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Movement and Behavioral Sciences, VU University; Department of Radiology & Nuclear Medicine (F.B., E.G.), Amsterdam UMC, Vrije Universiteit, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; and Neurochemistry Laboratory and Biobank (C.E.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, the Netherlands
| | - Wiesje M Van Der Flier
- From the Alzheimer Center and Department of Neurology (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., S.A.M.S., V.V., W.M.V.D.F.), and Department of Epidemiology and Biostatistics (P.J.v.d.V., J.H., L.N.C.V., J.B., W.M.V.D.F.), Amsterdam Neuroscience, VU University Medical Center; Amsterdam Neuroscience (P.J.v.d.V., L.N.C.V., A.C.V.H., H.F.R.-M., V.V., C.E.T., E.G., W.M.V.D.F.), Neurodegeneration the Netherlands; Division of Clinical Geriatrics (L.N.C.V.), Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Psychology (L.N.C.V.), Amsterdam UMC Location AMC, University of Amsterdam; Amsterdam Public Health (L.N.C.V.), Quality of Care, Personalized Medicine; Internal Medicine (H.F.R.-M.), Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC Location VUmc; Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Movement and Behavioral Sciences, VU University; Department of Radiology & Nuclear Medicine (F.B., E.G.), Amsterdam UMC, Vrije Universiteit, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; and Neurochemistry Laboratory and Biobank (C.E.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, the Netherlands
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Verberk IMW, Jutte J, Kingma MY, Vigneswaran S, Gouda MMTEE, van Engelen MP, Alcolea D, Arranz J, Fortea J, Lleó A, Chevalier C, Marizzoni M, van de Giessen EM, Lemstra AW, Pijnenburg YAL, van der Flier WM, den Braber A, Wilson D, Schut MC, van Harten AC, Teunissen CE. Development of thresholds and a visualization tool for use of a blood test in routine clinical dementia practice. Alzheimers Dement 2024. [PMID: 39096164 DOI: 10.1002/alz.14088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION We developed a multimarker blood test result interpretation tool for the clinical dementia practice, including phosphorylated (P-)tau181, amyloid-beta (Abeta)42/40, glial fibrillary acidic protein (GFAP), and neurofilament light (NfL). METHODS We measured the plasma biomarkers with Simoa (n = 1199), applied LASSO regression for biomarker selection and receiver operating characteristics (ROC) analyses to determine diagnostic accuracy. We validated our findings in two independent cohorts and constructed a visualization approach. RESULTS P-tau181, GFAP, and NfL were selected. This combination had area under the curve (AUC) = 83% to identify amyloid positivity in pre-dementia stages, AUC = 87%-89% to differentiate Alzheimer's or controls from frontotemporal dementia, AUC = 74%-76% to differentiate Alzheimer's or controls from dementia with Lewy bodies. Highly reproducible AUCs were obtained in independent cohorts. The resulting visualization tool includes UpSet plots to visualize the stand-alone biomarker results and density plots to visualize the biomarker results combined. DISCUSSION Our multimarker blood test interpretation tool is ready for testing in real-world clinical dementia settings. HIGHLIGHTS We developed a multimarker blood test interpretation tool for clinical dementia practice. Our interpretation tool includes plasma biomarkers P-tau, GFAP, and NfL. Our tool is particularly useful for Alzheimer's and frontotemporal dementia diagnosis.
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Affiliation(s)
- Inge M W Verberk
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Jolien Jutte
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Translational Artificial Intelligence Laboratory, Department of Laboratory Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Maurice Y Kingma
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Translational Artificial Intelligence Laboratory, Department of Laboratory Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Sinthujah Vigneswaran
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Alzheimer Center, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Mariam M T E E Gouda
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Marie-Paule van Engelen
- Alzheimer Center, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Daniel Alcolea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Arranz
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Claire Chevalier
- Memory Centre, Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Moira Marizzoni
- Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elsmarieke M van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Afina W Lemstra
- Alzheimer Center, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Center, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology & Digital Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anouk den Braber
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Alzheimer Center, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - David Wilson
- Quanterix corporation, Billerica, Massachusetts, USA
| | - Martijn C Schut
- Translational Artificial Intelligence Laboratory, Department of Laboratory Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Argonde C van Harten
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Alzheimer Center, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
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4
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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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5
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Oosthoek M, Vermunt L, de Wilde A, Bongers B, Antwi-Berko D, Scheltens P, van Bokhoven P, Vijverberg EGB, Teunissen CE. Utilization of fluid-based biomarkers as endpoints in disease-modifying clinical trials for Alzheimer's disease: a systematic review. Alzheimers Res Ther 2024; 16:93. [PMID: 38678292 PMCID: PMC11055304 DOI: 10.1186/s13195-024-01456-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Clinical trials in Alzheimer's disease (AD) had high failure rates for several reasons, including the lack of biological endpoints. Fluid-based biomarkers may present a solution to measure biologically relevant endpoints. It is currently unclear to what extent fluid-based biomarkers are applied to support drug development. METHODS We systematically reviewed 272 trials (clinicaltrials.gov) with disease-modifying therapies starting between 01-01-2017 and 01-01-2024 and identified which CSF and/or blood-based biomarker endpoints were used per purpose and trial type. RESULTS We found that 44% (N = 121) of the trials employed fluid-based biomarker endpoints among which the CSF ATN biomarkers (Aβ (42/40), p/tTau) were used most frequently. In blood, inflammatory cytokines, NFL, and pTau were most frequently employed. Blood- and CSF-based biomarkers were used approximately equally. Target engagement biomarkers were used in 26% (N = 72) of the trials, mainly in drugs targeting inflammation and amyloid. Lack of target engagement markers is most prominent in synaptic plasticity/neuroprotection, neurotransmitter receptor, vasculature, epigenetic regulators, proteostasis and, gut-brain axis targeting drugs. Positive biomarker results did not always translate to cognitive effects, most commonly the small significant reductions in CSF tau isoforms that were seen following anti-Tau treatments. On the other hand, the positive anti-amyloid trials results on cognitive function were supported by clear effect in most fluid markers. CONCLUSIONS As the field moves towards primary prevention, we expect an increase in the use of fluid-based biomarkers to determine disease modification. Use of blood-based biomarkers will rapidly increase, but CSF markers remain important to determine brain-specific treatment effects. With improving techniques, new biomarkers can be found to diversify the possibilities in measuring treatment effects and target engagement. It remains important to interpret biomarker results in the context of the trial and be aware of the performance of the biomarker. Diversifying biomarkers could aid in the development of surrogacy biomarkers for different drug targets.
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Affiliation(s)
- Marlies Oosthoek
- Department of Laboratory Medicine, Neurochemistry Laboratory, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Lisa Vermunt
- Department of Laboratory Medicine, Neurochemistry Laboratory, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Arno de Wilde
- EQT Life Sciences, Johannes Vermeersplein 9, 1071 DV, Amsterdam, The Netherlands
| | - Bram Bongers
- Department of Laboratory Medicine, Neurochemistry Laboratory, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Daniel Antwi-Berko
- Department of Laboratory Medicine, Neurochemistry Laboratory, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Philip Scheltens
- EQT Life Sciences, Johannes Vermeersplein 9, 1071 DV, Amsterdam, The Netherlands
- Alzheimer Center, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | | | - Everard G B Vijverberg
- Alzheimer Center, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Department of Laboratory Medicine, Neurochemistry Laboratory, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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6
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Jonaitis EM, Jeffers B, VandenLangenberg M, Ma Y, Van Hulle C, Langhough R, Du L, Chin NA, Przybelski RJ, Hogan KJ, Christian BT, Betthauser TJ, Okonkwo OC, Bendlin BB, Asthana S, Carlsson CM, Johnson SC. CSF Biomarkers in Longitudinal Alzheimer Disease Cohorts: Pre-Analytic Challenges. Clin Chem 2024; 70:538-550. [PMID: 38431278 PMCID: PMC10908554 DOI: 10.1093/clinchem/hvad221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/27/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND The sensitivity of amyloid to pre-analytic factors complicates cerebrospinal fluid (CSF) diagnostics for Alzheimer disease. We report reliability and validity evidence for automated immunoassays from frozen and fresh CSF samples in an ongoing, single-site research program. METHODS CSF samples were obtained from 2 Wisconsin cohorts (1256 measurements; 727 participants). Levels of amyloid beta 1-42 (Aβ42), phosphorylated tau 181 (pTau181), and total tau (tTau) were obtained using an Elecsys cobas e 601 platform. Repeatability and fixed effects of storage tube type, extraction method, and freezing were assessed via mixed models. Concordance with amyloid positron emission tomography (PET) was investigated with 238 participants having a temporally proximal PET scan. RESULTS Repeatability was high with intraclass correlation (ICC) ≥0.9, but tube type strongly affected measurements. Discriminative accuracy for PET amyloid positivity was strong across tube types (area under the curve [AUC]: Aβ42, 0.87; pTau181Aβ42 , 0.96), although optimal thresholds differed. CONCLUSIONS Under real-world conditions, the Elecsys platform had high repeatability. However, strong effects of pre-analytic factors suggest caution in drawing longitudinal inferences.
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Affiliation(s)
- Erin M Jonaitis
- Wisconsin Alzheimer’s Institute, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Beckie Jeffers
- Wisconsin Alzheimer’s Institute, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Monica VandenLangenberg
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Yue Ma
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Carol Van Hulle
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Rebecca Langhough
- Wisconsin Alzheimer’s Institute, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Lianlian Du
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Nathaniel A Chin
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Robert J Przybelski
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Kirk J Hogan
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Bradley T Christian
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Tobey J Betthauser
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Ozioma C Okonkwo
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Barbara B Bendlin
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Sanjay Asthana
- Geriatric Research Education and Clinical Center of the Wm. S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Cynthia M Carlsson
- Geriatric Research Education and Clinical Center of the Wm. S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- Wisconsin Alzheimer’s Institute, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
| | - Sterling C Johnson
- Geriatric Research Education and Clinical Center of the Wm. S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- Wisconsin Alzheimer’s Institute, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, WI, United States
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7
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Moonen JEF, Haan R, Bos I, Teunissen C, van de Giessen E, Tomassen J, den Braber A, van der Landen SM, de Geus EJC, Legdeur N, van Harten AC, Trieu C, de Boer C, Kroeze L, Barkhof F, Visser PJ, van der Flier WM. Contributions of amyloid beta and cerebral small vessel disease in clinical decline. Alzheimers Dement 2024; 20:1868-1880. [PMID: 38146222 PMCID: PMC10984432 DOI: 10.1002/alz.13607] [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: 06/09/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION We assessed whether co-morbid small vessel disease (SVD) has clinical predictive value in preclinical or prodromal Alzheimer's disease. METHODS In 1090 non-demented participants (65.4 ± 10.7 years) SVD was assessed with magnetic resonance imaging and amyloid beta (Aβ) with lumbar puncture and/or positron emission tomography scan (mean follow-up for cognitive function 3.1 ± 2.4 years). RESULTS Thirty-nine percent had neither Aβ nor SVD (A-V-), 21% had SVD only (A-V+), 23% Aβ only (A+V-), and 17% had both (A+V+). Pooled cohort linear mixed model analyses demonstrated that compared to A-V- (reference), A+V- had a faster rate of cognitive decline. Co-morbid SVD (A+V+) did not further increase rate of decline. Cox regression showed that dementia risk was modestly increased in A-V+ (hazard ratio [95% confidence interval: 1.8 [1.0-3.2]) and most strongly in A+ groups. Also, mortality risk was increased in A+ groups. DISCUSSION In non-demented persons Aβ was predictive of cognitive decline, dementia, and mortality. SVD modestly predicts dementia in A-, but did not increase deleterious effects in A+. HIGHLIGHTS Amyloid beta (Aβ; A) was predictive for cognitive decline, dementia, and mortality. Small vessel disease (SVD) had no additional deleterious effects in A+. SVD modestly predicted dementia in A-. Aβ should be assessed even when magnetic resonance imaging indicates vascular cognitive impairment.
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Affiliation(s)
- Justine E. F. Moonen
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
| | - Renée Haan
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
| | - Isabelle Bos
- Nivel, Research Institute for Better CareUtrechtthe Netherlands
| | - Charlotte Teunissen
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
- Neurochemistry LaboratoryDepartment of Clinical ChemistryAmsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Elsmarieke van de Giessen
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
- Department of Radiology & Nuclear MedicineVrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
| | - Jori Tomassen
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
| | - Anouk den Braber
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
| | - Sophie M. van der Landen
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
| | - Eco J. C. de Geus
- Department of Biological PsychologyVU UniversityAmsterdamthe Netherlands
| | - Nienke Legdeur
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
| | - Argonde C. van Harten
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
| | - Calvin Trieu
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
| | - Casper de Boer
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
| | - Lior Kroeze
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear MedicineVrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Institute of Healthcare Engineering and the Institute of Neurology, University College LondonLondonUK
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
- Department of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNS), Maastricht UniversityMaastrichtthe Netherlands
- Department of Neurobiology, Care Sciences and Society, Division of NeurogeriatricsKarolinska InstitutetSolnaSweden
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmcAmsterdamthe Netherlands
- Amsterdam Neuroscience, NeurodegenerationAmsterdamthe Netherlands
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8
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Dubbelman MA, Hendriksen HMA, Harrison JE, Vijverberg EGB, Prins ND, Kroeze LA, Ottenhoff L, Van Leeuwenstijn MMSSA, Verberk IMW, Teunissen CE, van de Giessen EM, Van Harten AC, Van Der Flier WM, Sikkes SAM. Cognitive and Functional Change Over Time in Cognitively Healthy Individuals According to Alzheimer Disease Biomarker-Defined Subgroups. Neurology 2024; 102:e207978. [PMID: 38165338 PMCID: PMC10962908 DOI: 10.1212/wnl.0000000000207978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES It is unclear to what extent cognitive outcome measures are sensitive to capture decline in Alzheimer disease (AD) prevention trials. We aimed to analyze the sensitivity to changes over time of a range of neuropsychological tests in several cognitively unimpaired, biomarker-defined patient groups. METHODS Cognitively unimpaired individuals from the Amsterdam Dementia Cohort and the SCIENCe project with available AD biomarkers, obtained from CSF, PET scans, and plasma at baseline, were followed over time (4.5 ± 3.1 years, range 0.6-18.9 years). Based on common inclusion criteria for clinical trials, we defined groups (amyloid, phosphorylated tau [p-tau], APOE ε4). Linear mixed models, adjusted for age, sex, and education, were used to estimate change over time in neuropsychological tests, a functional outcome, and 2 cognitive composite measures. Standardized regression coefficients of time in years (βtime) were reported as outcome of interest. We analyzed change over time with full follow-up, as well as with follow-up limited to 1.5 and 3 years. RESULTS We included 387 individuals (aged 61.7 ± 8.6 years; 44% female) in the following (partly overlapping) biomarker groups: APOE ε4 carriers (n = 212), amyloid-positive individuals (n = 109), amyloid-positive APOE ε4 carriers (n = 66), CSF p-tau-positive individuals (n = 127), plasma p-tau-positive individuals (n = 71), and amyloid and CSF p-tau-positive individuals (n = 50), or in a control group (normal biomarkers; n = 65). An executive functioning task showed most decline in all biomarker groups (βtime range -0.30 to -0.71), followed by delayed word list recognition (βtime range -0.18 to -0.50). Functional decline (βtime range -0.17 to -0.63) was observed in all, except the CSF and plasma tau-positive groups. Both composites showed comparable amounts of change (βtime range -0.12 to -0.62) in all groups, except plasma p-tau-positive individuals. When limiting original follow-up duration, many effects disappeared or even flipped direction. DISCUSSION In conclusion, functional, composite, and neuropsychological outcome measures across all cognitive domains detect changes over time in various biomarker-defined groups, with changes being most evident among individuals with more AD pathology. AD prevention trials should use sufficiently long follow-up duration and/or more sensitive outcome measures to optimally capture subtle cognitive changes over time.
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Affiliation(s)
- Mark A Dubbelman
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Heleen M A Hendriksen
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - John E Harrison
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Everard G B Vijverberg
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Niels D Prins
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Lior A Kroeze
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Lois Ottenhoff
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Mardou M S S A Van Leeuwenstijn
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Inge M W Verberk
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Charlotte E Teunissen
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Elsmarieke M van de Giessen
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Argonde C Van Harten
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Wiesje M Van Der Flier
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Sietske A M Sikkes
- From the Alzheimer Center Amsterdam, Neurology (M.A.D., H.M.A.H., J.E.H., E.G.B.V., L.A.K., L.O., M.M.S.S.A.V.L., I.M.W.V., C.E.T., A.C.V.H., W.M.V.D.F., S.A.M.S.), and Departments of Radiology & Nuclear Medicine (E.M.v.d.G.), Epidemiology & Data Science (W.M.V.D.F.), and Neurochemistry Laboratory, Department of Laboratory Medicine (I.M.W.V., C.E.T.), Amsterdam UMC, Vrije Universiteit Amsterdam; Neurodegeneration, Amsterdam Neuroscience; Brain Research Center (N.D.P., L.O.); and Department of Clinical, Neuro and Developmental Psychology (S.A.M.S.), Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
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9
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Seligmann B, Camiolo S, Hernandez M, Yeakley JM, Sahagian G, McComb J. Molecular Gene Expression Testing to Identify Alzheimer's Disease with High Accuracy from Fingerstick Blood. J Alzheimers Dis 2024; 101:813-822. [PMID: 39269833 DOI: 10.3233/jad-240174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Background There is no molecular test for Alzheimer's disease (AD) using self-collected samples, nor is there a definitive molecular test for AD. We demonstrate an accurate and potentially definitive TempO-Seq® gene expression test for AD using fingerstick blood spotted and dried on filter paper, a sample that can be collected in any doctor's office or can be self-collected. Objective Demonstrate the feasibility of developing an accurate test for the classification of persons with AD from a minimally invasive sample of fingerstick blood spotted on filter paper which can be obtained in any doctor's office or self-collected to address health disparities. Methods Fingerstick blood samples from patients clinically diagnosed with AD, Parkinson's disease (PD), or asymptomatic controls were spotted onto filter paper in the doctor's office, dried, and shipped to BioSpyder for testing. Three independent patient cohorts were used for training/retraining and testing/retesting AD and PD classification algorithms. Results After initially identifying a 770 gene classification signature, a minimum set of 68 genes was identified providing classification test areas under the ROC curve of 0.9 for classifying patients as having AD, and 0.94 for classifying patients as having PD. Conclusions These data demonstrate the potential to develop a screening and/or definitive, minimally invasive, molecular diagnostic test for AD and PD using dried fingerstick blood spot samples that are collected in a doctor's office or clinic, or self-collected, and thus, can address health disparities. Whether the test can classify patients with AD earlier then possible with cognitive testing remains to be determined.
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Affiliation(s)
| | | | | | | | | | - Joel McComb
- BioSpyder Technologies, Inc., Carlsbad, CA, USA
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10
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van der Ende EL, In ‘t Veld SGJG, Hanskamp I, van der Lee S, Dijkstra JIR, Hok-A-Hin YS, Blujdea ER, van Swieten JC, Irwin DJ, Chen-Plotkin A, Hu WT, Lemstra AW, Pijnenburg YAL, van der Flier WM, del Campo M, Teunissen CE, Vermunt L. CSF proteomics in autosomal dominant Alzheimer's disease highlights parallels with sporadic disease. Brain 2023; 146:4495-4507. [PMID: 37348871 PMCID: PMC10629764 DOI: 10.1093/brain/awad213] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/24/2023] Open
Abstract
Autosomal dominant Alzheimer's disease (ADAD) offers a unique opportunity to study pathophysiological changes in a relatively young population with few comorbidities. A comprehensive investigation of proteome changes occurring in ADAD could provide valuable insights into AD-related biological mechanisms and uncover novel biomarkers and therapeutic targets. Furthermore, ADAD might serve as a model for sporadic AD, but in-depth proteome comparisons are lacking. We aimed to identify dysregulated CSF proteins in ADAD and determine the degree of overlap with sporadic AD. We measured 1472 proteins in CSF of PSEN1 or APP mutation carriers (n = 22) and age- and sex-matched controls (n = 20) from the Amsterdam Dementia Cohort using proximity extension-based immunoassays (PEA). We compared protein abundance between groups with two-sided t-tests and identified enriched biological pathways. Using the same protein panels in paired plasma samples, we investigated correlations between CSF proteins and their plasma counterparts. Finally, we compared our results with recently published PEA data from an international cohort of sporadic AD (n = 230) and non-AD dementias (n = 301). All statistical analyses were false discovery rate-corrected. We detected 66 differentially abundant CSF proteins (65 increased, 1 decreased) in ADAD compared to controls (q < 0.05). The most strongly upregulated proteins (fold change >1.8) were related to immunity (CHIT1, ITGB2, SMOC2), cytoskeletal structure (MAPT, NEFL) and tissue remodelling (TMSB10, MMP-10). Significant CSF-plasma correlations were found for the upregulated proteins SMOC2 and LILR1B. Of the 66 differentially expressed proteins, 36 had been measured previously in the sporadic dementias cohort, 34 of which (94%) were also significantly upregulated in sporadic AD, with a strong correlation between the fold changes of these proteins in both cohorts (rs = 0.730, P < 0.001). Twenty-nine of the 36 proteins (81%) were also upregulated among non-AD patients with suspected AD co-pathology. This CSF proteomics study demonstrates substantial biochemical similarities between ADAD and sporadic AD, suggesting involvement of the same biological processes. Besides known AD-related proteins, we identified several relatively novel proteins, such as TMSB10, MMP-10 and SMOC2, which have potential as novel biomarkers. With shared pathophysiological CSF changes, ADAD study findings might be translatable to sporadic AD, which could greatly expedite therapy development.
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Affiliation(s)
- Emma L van der Ende
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Sjors G J G In ‘t Veld
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Iris Hanskamp
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Sven van der Lee
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Genomics of Neurodegenerative Diseases and Aging, Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Janna I R Dijkstra
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Genomics of Neurodegenerative Diseases and Aging, Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Yanaika S Hok-A-Hin
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Elena R Blujdea
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - John C van Swieten
- Alzheimer Center and Department of Neurology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - David J Irwin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alice Chen-Plotkin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - William T Hu
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Afina W Lemstra
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Marta del Campo
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, 28003 Madrid, Spain
- Barcelonabeta Brain Research Center (BBRC), Pasqual Maragall Foundation, 08005 Barcelona, Spain
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Lisa Vermunt
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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11
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Dage JL, Eloyan A, Thangarajah M, Hammers DB, Fagan AM, Gray JD, Schindler SE, Snoddy C, Nudelman KNH, Faber KM, Foroud T, Aisen P, Griffin P, Grinberg LT, Iaccarino L, Kirby K, Kramer J, Koeppe R, Kukull WA, Joie RL, Mundada NS, Murray ME, Rumbaugh M, Soleimani-Meigooni DN, Toga AW, Touroutoglou A, Vemuri P, Atri A, Beckett LA, Day GS, Graff-Radford NR, Duara R, Honig LS, Jones DT, Masdeu JC, Mendez MF, Musiek E, Onyike CU, Riddle M, Rogalski E, Salloway S, Sha SJ, Turner RS, Wingo TS, Wolk DA, Womack KB, Carrillo MC, Dickerson BC, Rabinovici GD, Apostolova LG. Cerebrospinal fluid biomarkers in the Longitudinal Early-onset Alzheimer's Disease Study. Alzheimers Dement 2023; 19 Suppl 9:S115-S125. [PMID: 37491668 PMCID: PMC10877673 DOI: 10.1002/alz.13399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION One goal of the Longitudinal Early Onset Alzheimer's Disease Study (LEADS) is to define the fluid biomarker characteristics of early-onset Alzheimer's disease (EOAD). METHODS Cerebrospinal fluid (CSF) concentrations of Aβ1-40, Aβ1-42, total tau (tTau), pTau181, VILIP-1, SNAP-25, neurogranin (Ng), neurofilament light chain (NfL), and YKL-40 were measured by immunoassay in 165 LEADS participants. The associations of biomarker concentrations with diagnostic group and standard cognitive tests were evaluated. RESULTS Biomarkers were correlated with one another. Levels of CSF Aβ42/40, pTau181, tTau, SNAP-25, and Ng in EOAD differed significantly from cognitively normal and early-onset non-AD dementia; NfL, YKL-40, and VILIP-1 did not. Across groups, all biomarkers except SNAP-25 were correlated with cognition. Within the EOAD group, Aβ42/40, NfL, Ng, and SNAP-25 were correlated with at least one cognitive measure. DISCUSSION This study provides a comprehensive analysis of CSF biomarkers in sporadic EOAD that can inform EOAD clinical trial design.
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Affiliation(s)
- Jeffrey L. Dage
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ani Eloyan
- Department of Biostatistics, Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA
| | - Maryanne Thangarajah
- Department of Biostatistics, Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA
| | - Dustin B. Hammers
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Anne M. Fagan
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Julia D. Gray
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Suzanne E. Schindler
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Casey Snoddy
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kelly N. H. Nudelman
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kelley M. Faber
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Paul Aisen
- Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego, California, USA
| | - Percy Griffin
- Medical & Scientific Relations Division, Alzheimer’s Association, Chicago, Illinois, USA
| | - Lea T. Grinberg
- Department of Neurology, University of California – San Francisco, San Francisco, California, USA
- Department of Pathology, University of California – San Francisco, San Francisco, California, USA
| | - Leonardo Iaccarino
- Department of Neurology, University of California – San Francisco, San Francisco, California, USA
| | - Kala Kirby
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joel Kramer
- Department of Neurology, University of California – San Francisco, San Francisco, California, USA
| | - Robert Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Walter A. Kukull
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Renaud La Joie
- Department of Neurology, University of California – San Francisco, San Francisco, California, USA
| | - Nidhi S Mundada
- Department of Neurology, University of California – San Francisco, San Francisco, California, USA
| | | | - Malia Rumbaugh
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Arthur W. Toga
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Alexandra Touroutoglou
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Alireza Atri
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Laurel A. Beckett
- Department of Public Health Sciences, University of California-Davis, Davis, California, USA
| | - Gregory S. Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Ranjan Duara
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami, Florida, USA
| | - Lawrence S. Honig
- Taub Institute and Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - David T. Jones
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph C. Masdeu
- Nantz National Alzheimer Center, Houston Methodist and Weill Cornell Medicine, Houston, Texas, USA
| | - Mario F. Mendez
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Erik Musiek
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Chiadi U. Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Meghan Riddle
- Department of Neurology, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Emily Rogalski
- Department of Psychiatry and Behavioral Sciences, Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Stephen Salloway
- Department of Neurology, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Sharon J. Sha
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, USA
| | - Raymond S. Turner
- Department of Neurology, Georgetown University, Washington, D.C., USA
| | - Thomas S. Wingo
- Department of Neurology and Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David A. Wolk
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle B. Womack
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Maria C. Carrillo
- Medical & Scientific Relations Division, Alzheimer’s Association, Chicago, Illinois, USA
| | - Bradford C. Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Gil D. Rabinovici
- Department of Neurology, University of California – San Francisco, San Francisco, California, USA
| | - Liana G. Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego, California, USA
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine Indianapolis, Indianapolis, Indiana, USA
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Kerrebijn I, Wainberg M, Zhukovsky P, Chen Y, Davie M, Felsky D, Tripathy SJ. Case-control virtual histology elucidates cell types associated with cortical thickness differences in Alzheimer's disease. Neuroimage 2023; 276:120177. [PMID: 37211192 DOI: 10.1016/j.neuroimage.2023.120177] [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: 10/17/2022] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023] Open
Abstract
Many neuropsychiatric disorders are characterised by altered cortical thickness, but the cell types underlying these changes remain largely unknown. Virtual histology (VH) approaches map regional patterns of gene expression with regional patterns of MRI-derived phenotypes, such as cortical thickness, to identify cell types associated with case-control differences in those MRI measures. However, this method does not incorporate valuable information of case-control differences in cell type abundance. We developed a novel method, termed case-control virtual histology (CCVH), and applied it to Alzheimer's disease (AD) and dementia cohorts. Leveraging a multi-region gene expression dataset of AD cases (n = 40) and controls (n = 20), we quantified AD case-control differential expression of cell type-specific markers across 13 brain regions. We then correlated these expression effects with MRI-derived AD case-control cortical thickness differences across the same regions. Cell types with spatially concordant AD-related effects were identified through resampling marker correlation coefficients. Among regions thinner in AD, gene expression patterns identified by CCVH suggested fewer excitatory and inhibitory neurons, and greater proportions of astrocytes, microglia, oligodendrocytes, oligodendrocyte precursor cells, and endothelial cells in AD cases vs. controls. In contrast, original VH identified expression patterns suggesting that excitatory but not inhibitory neuron abundance was associated with thinner cortex in AD, despite the fact that both types of neurons are known to be lost in the disorder. Compared to original VH, cell types identified through CCVH are more likely to directly underlie cortical thickness differences in AD. Sensitivity analyses suggest our results are largely robust to specific analysis choices, like numbers of cell type-specific marker genes used and background gene sets used to construct null models. As more multi-region brain expression datasets become available, CCVH will be useful for identifying the cellular correlates of cortical thickness across neuropsychiatric illnesses.
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Affiliation(s)
- Isabel Kerrebijn
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Michael Wainberg
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peter Zhukovsky
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yuxiao Chen
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Melanie Davie
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel Felsky
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada
| | - Shreejoy J Tripathy
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada.
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Hok‐A‐Hin YS, Bolsewig K, Ruiters DN, Lleó A, Alcolea D, Lemstra AW, van der Flier WM, Teunissen CE, del Campo M. Thimet oligopeptidase as a potential CSF biomarker for Alzheimer's disease: A cross-platform validation study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12456. [PMID: 37502019 PMCID: PMC10369371 DOI: 10.1002/dad2.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Our previous antibody-based cerebrospinal fluid (CSF) proteomics study showed that Thimet oligopeptidase (THOP1), an amyloid beta (Aβ) neuropeptidase, was increased in mild cognitive impairment with amyloid pathology (MCI-Aβ+) and Alzheimer's disease (AD) dementia compared with controls and dementia with Lewy bodies (DLB), highlighting the potential of CSF THOP1 as an early specific biomarker for AD. We aimed to develop THOP1 immunoassays for large-scale analysis and validate our proteomics findings in two independent cohorts. METHODS We developed in-house CSF THOP1 immunoassays on automated Ella and Simoa platforms. The performance of the different assays were compared using Passing-Bablok regression analysis in a subset of CSF samples from the discovery cohort (n = 72). Clinical validation was performed in two independent cohorts (cohort 1: n = 200; cohort 2: n = 165) using the Ella platform. RESULTS THOP1 concentrations moderately correlated between proteomics analysis and our novel assays (Rho > 0.580). In both validation cohorts, CSF THOP1 was increased in MCI-Aβ+ (>1.3-fold) and AD (>1.2-fold) compared with controls; and between MCI-Aβ+ and DLB (>1.2-fold). Higher THOP1 concentrations were detected in AD compared with DLB only when both cohorts were analyzed together. In both cohorts, THOP1 correlated with CSF total tau (t-tau), phosphorylated tau (p-tau), and Aβ40 (Rho > 0.540) but not Aβ42. DISCUSSION Validation of our proteomics findings underpins the potential of CSF THOP1 as an early specific biomarker associated with AD pathology. The use of antibody-based platforms in both the discovery and validation phases facilitated the translation of proteomics findings, providing an additional workflow that may accelerate the development of biofluid-based biomarkers.
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Affiliation(s)
- Yanaika S. Hok‐A‐Hin
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam NeuroscienceVU University Medical Center, Amsterdam UMCAmsterdamThe Netherlands
| | - Katharina Bolsewig
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam NeuroscienceVU University Medical Center, Amsterdam UMCAmsterdamThe Netherlands
| | - Daimy N. Ruiters
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam NeuroscienceVU University Medical Center, Amsterdam UMCAmsterdamThe Netherlands
| | - Alberto Lleó
- Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau ‐ Hospital de Sant PauUniversitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Daniel Alcolea
- Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau ‐ Hospital de Sant PauUniversitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Afina W. Lemstra
- Alzheimer Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamThe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamThe Netherlands
- Department of Epidemiology and Data ScienceVU University Medical CentersAmsterdamThe Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam NeuroscienceVU University Medical Center, Amsterdam UMCAmsterdamThe Netherlands
| | - Marta del Campo
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam NeuroscienceVU University Medical Center, Amsterdam UMCAmsterdamThe Netherlands
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de FarmaciaUniversidad San Pablo‐CEU, CEU UniversitiesMadridSpain
- Bareclonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
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14
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Konen FF, Maier HB, Neyazi A, Bleich S, Neumann K, Skripuletz T. Alzheimer's disease biomarkers in cerebrospinal fluid are stable with the Elecsys immunoassay to most pre-analytical influencing factors except freezing at -80 °C. Neurol Res Pract 2023; 5:30. [PMID: 37381021 PMCID: PMC10308606 DOI: 10.1186/s42466-023-00257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/14/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Alzheimer´s disease is considered a neurodegenerative disease and is diagnosed by exclusion, while the detection of specific cerebrospinal fluid (CSF) biomarkers, namely amyloid-beta (Aβ) peptides Aβ1-42 (Aß42), phospho-tau (181P; P-tau), and total-tau (T-tau), has been shown to improve diagnostic accuracy. Recently, a new generation of sample tubes (Sarstedt false-bottom tubes) for the Elecsys CSF immunoassay for the determination of Alzheimer´s disease biomarkers in CSF was introduced, promising better measurability. However, the pre-analytic influencing factors have not yet been sufficiently investigated. METHODS In 29 patients without Alzheimer's disease diagnosis, CSF concentrations of Aß42, P-tau and T-tau were examined in native CSF and after different influencing interventions using the Elecsys immunoassay test method. The following influencing factors were analyzed: contamination with blood (10,000 and 20,000 erythrocytes/µl CSF), 14-day storage at 4 °C, blood contamination of CSF and 14-day storage at 4 °C, 14-day freezing at -80 °C in Sarstedt tubes or glass vials, 3-month intermediate storage at -80 °C in glass vials. RESULTS Both storage at -80 °C for 14 days in Sarstedt false-bottom tubes and in glass vials and storage at -80 °C for 3 months in glass vials resulted in significant decreases in Aß42 (13% after 14 days in Sarstedt and 22% in glass vials, 42% after 3 months in glass vials), P-tau (9% after 14 days in Sarstedt and 13% in glass vials, 12% after 3 months in glass vials) and T-tau (12% after 14 days in Sarstedt and 19% in glass vials, 20% after 3 months in glass vials) concentrations in CSF. No significant differences were found for the other pre-analytical influencing factors. CONCLUSIONS Measurements of the concentrations of Aß42, P-tau, and T-tau in CSF with use of the Elecsys immunoassay are robust to the pre-analytical influencing factors of blood contamination and duration of storage. Freezing at -80 °C results in significant reduction of biomarker concentrations regardless of the storage tube and must be considered in retrospective analysis.
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Affiliation(s)
- Franz Felix Konen
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Department of Psychiatry, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Hannah Benedictine Maier
- Department of Psychiatry, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Alexandra Neyazi
- Department of Psychiatry, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Stefan Bleich
- Department of Psychiatry, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Konstantin Neumann
- Institute of Clinical Chemistry, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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15
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Palmqvist S, Stomrud E, Cullen N, Janelidze S, Manuilova E, Jethwa A, Bittner T, Eichenlaub U, Suridjan I, Kollmorgen G, Riepe M, von Arnim CA, Tumani H, Hager K, Heidenreich F, Mattsson-Carlgren N, Zetterberg H, Blennow K, Hansson O. An accurate fully automated panel of plasma biomarkers for Alzheimer's disease. Alzheimers Dement 2023; 19:1204-1215. [PMID: 35950735 PMCID: PMC9918613 DOI: 10.1002/alz.12751] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION There is a great need for fully automated plasma assays that can measure amyloid beta (Aβ) pathology and predict future Alzheimer's disease (AD) dementia. METHODS Two cohorts (n = 920) were examined: Panel A+ (n = 32 cognitively unimpaired [CU], n = 106 mild cognitive impairment [MCI], and n = 89 AD) and BioFINDER-1 (n = 461 CU, n = 232 MCI). Plasma Aβ42/Aβ40, phosphorylated tau (p-tau)181, two p-tau217 variants, ApoE4 protein, neurofilament light, and GFAP were measured using Elecsys prototype immunoassays. RESULTS The best biomarker for discriminating Aβ-positive versus Aβ-negative participants was Aβ42/Aβ40 (are under the curve [AUC] 0.83-0.87). Combining Aβ42/Aβ40, p-tau181, and ApoE4 improved the AUCs significantly (0.90 to 0.93; P< 0.01). Adding additional biomarkers had marginal effects (ΔAUC ≤0.01). In BioFINDER, p-tau181, p-tau217, and ApoE4 predicted AD dementia within 6 years in CU (AUC 0.88) and p-tau181, p-tau217, and Aβ42/Aβ40 in MCI (AUC 0.87). DISCUSSION The high accuracies for Aβ pathology and future AD dementia using fully automated instruments are promising for implementing plasma biomarkers in clinical trials and clinical routine.
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Affiliation(s)
- Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Nicholas Cullen
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Shorena Janelidze
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Sweden
| | | | | | | | | | | | | | - Matthias Riepe
- Division of Geriatric Psychiatry, Ulm University, Germany
| | - Christine A.F. von Arnim
- Division of Geriatrics, University Medical Center Göttingen, Georg-August-University, Goettingen, Germany
| | | | - Klaus Hager
- Institute for General Medicine and Palliative Medicine, Hannover Medical School, Germany
| | - Fedor Heidenreich
- Dept. of Neurology and Clinical Neurophysiology, Diakovere Krankenhaus Henriettenstift, Hannover, Germany
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
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16
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Das S, Goossens J, Jacobs D, Dewit N, Pijnenburg YAL, In 't Veld SGJG, Teunissen CE, Vanmechelen E. Synaptic biomarkers in the cerebrospinal fluid associate differentially with classical neuronal biomarkers in patients with Alzheimer's disease and frontotemporal dementia. Alzheimers Res Ther 2023; 15:62. [PMID: 36964594 PMCID: PMC10037899 DOI: 10.1186/s13195-023-01212-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Loss of synaptic functionality has been recently identified as an early-stage indicator of neurological diseases. Consequently, monitoring changes in synaptic protein levels may be relevant for observing disease evolution or treatment responses in patients. Here, we have studied the relationship between fluid biomarkers of neurodegeneration and synaptic dysfunction in patients with Alzheimer's disease (AD), frontotemporal dementia (FTD), and subjective cognitive decline (SCD). METHODS The exploratory cohort consisted of cerebrospinal fluid (CSF) samples (n = 60) from patients diagnosed with AD (n = 20), FTD (n = 20), and SCD (n = 20) from the Amsterdam Dementia Cohort. We developed two novel immunoassays for the synaptic proteins synaptosomal-associated protein-25 (SNAP25) and vesicle-associated membrane protein-2 (VAMP2). We measured the levels of these biomarkers in CSF, in addition to neuronal pentraxin-2 (NPTX2), glutamate ionotropic receptor-4 (GluR4), and neurogranin (Ng) for this cohort. All in-house immunoassays were validated and analytically qualified prior to clinical application. CSF neurogranin (Ng) was measured using a commercially available ELISA. RESULTS This pilot study indicated that SNAP25, VAMP2, and Ng may not be specific biomarkers for AD as their levels were significantly elevated in patients with both AD and FTD compared to SCD. Moreover, the strength of the correlations between synaptic proteins was lower in the AD and FTD clinical groups compared to SCD. SNAP25, VAMP2, and Ng correlated strongly with each other as well as with total Tau (Tau) and phosphorylated Tau (PTau) in all three clinical groups. However, this correlation was weakened or absent with NPTX2 and GluR4. None of the synaptic proteins correlated to neurofilament light (NfL) in any clinical group. CONCLUSION The correlation of the synaptic biomarkers with CSF Tau and PTau but the lack thereof with NfL implies that distinct pathological pathways may be involved in synaptic versus axonal degeneration. Our results reflect the diversity of synaptic pathology in neurodegenerative dementias.
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Affiliation(s)
- Shreyasee Das
- ADxNeuroSciences NV, Zwijnaarde 94, 9052, Ghent, Belgium
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Program Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Julie Goossens
- ADxNeuroSciences NV, Zwijnaarde 94, 9052, Ghent, Belgium
| | - Dirk Jacobs
- ADxNeuroSciences NV, Zwijnaarde 94, 9052, Ghent, Belgium
| | - Nele Dewit
- Medpace, Technologielaan 11, 3001, Leuven, Belgium
| | - Yolande A L Pijnenburg
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Program Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Sjors G J G In 't Veld
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Program Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Program Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Zou Y, Yu S, Ma X, Ma C, Mao C, Mu D, Li L, Gao J, Qiu L. How far is the goal of applying β-amyloid in cerebrospinal fluid for clinical diagnosis of Alzheimer's disease with standardization of measurements? Clin Biochem 2023; 112:33-42. [PMID: 36473516 DOI: 10.1016/j.clinbiochem.2022.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/02/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Cerebrospinal fluid (CSF) β-amyloid (Aβ) is important for early diagnosis of Alzheimer's disease (AD). However, the cohort distributions and cut-off values have large variation across different analytical assays, kits, and laboratories. In this review, we summarize the cut-off values and diagnostic performance for CSF Aβ1-42 and Aβ1-42/Aβ1-40, and explore the important effect factors. Based on the Alzheimer's Association external quality control program (AAQC program), the peer group coefficient of variation of manual ELISA assays for CSF Aβ1-42 was unsatisfied (>20%). Fully automated platforms with better performance have recently been developed, but still not widely applied. In 2020, the certified reference material (CRM) for CSF Aβ1-42 was launched; however, the AAQC 2021-round results did not show effective improvements. Thus, further development and popularization of CRM for CSF Aβ1-42 and Aβ1-40 are urgently required. Standardizing the diagnostic procedures of AD and related status and the pre-analytical protocols of CSF samples, improving detection performance of analytical assays, and popularizing the application of fully automated platforms are also important for the establishment of uniform cut-off values. Moreover, each laboratory should verify the applicability of uniform cut-off values, and evaluate whether it is necessary to establish its own population- and assay-specific cut-off values.
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Affiliation(s)
- Yutong Zou
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Songlin Yu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Xiaoli Ma
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China; Medical Science Research Center, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Chaochao Ma
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Chenhui Mao
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Danni Mu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Lei Li
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Jing Gao
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China.
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China.
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18
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Leuzy A, Mattsson-Carlgren N, Cullen NC, Stomrud E, Palmqvist S, La Joie R, Iaccarino L, Zetterberg H, Rabinovici G, Blennow K, Janelidze S, Hansson O. Robustness of CSF Aβ42/40 and Aβ42/P-tau181 measured using fully automated immunoassays to detect AD-related outcomes. Alzheimers Dement 2023. [PMID: 36681387 DOI: 10.1002/alz.12897] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/26/2022] [Accepted: 11/10/2022] [Indexed: 01/23/2023]
Abstract
INTRODUCTION This study investigated the comparability of cerebrospinal fluid (CSF) cutoffs for Elecsys immunoassays for amyloid beta (Aβ)42/Aβ40 or Aβ42/phosphorylated tau (p-tau)181 and the effects of measurement variability when predicting Alzheimer's disease (AD)-related outcomes (i.e., Aβ-positron emission tomography [PET] visual read and AD neuropathology). METHODS We studied 750 participants (BioFINDER study, Alzheimer's Disease Neuroimaging Initiative [ADNI], and University of California San Francisco [UCSF]). Youden's index was used to identify cutoffs and to calculate accuracy (Aβ-PET visual read as outcome). Using longitudinal variability in Aβ-negative controls, we identified a gray zone around cut-points where the risk of an inconsistent predicted outcome was >5%. RESULTS For Aβ42/Aβ40, cutoffs across cohorts were <0.059 (BioFINDER), <0.057 (ADNI), and <0.058 (UCSF). For Aβ42/p-tau181, cutoffs were <41.90 (BioFINDER), <39.20 (ADNI), and <46.02 (UCSF). Accuracy was ≈90% for both Aβ42/Aβ40 and Aβ42/p-tau181 using these cutoffs. Using Aβ-PET as an outcome, 8.7% of participants fell within a gray zone interval for Aβ42/Aβ40, compared to 4.5% for Aβ42/p-tau181. Similar findings were observed using a measure of overall AD neuropathologic change (7.7% vs. 3.3%). In a subset with CSF and plasma Aβ42/40, the number of individuals within the gray zone was ≈1.5 to 3 times greater when using plasma Aβ42/40. DISCUSSION CSF Aβ42/p-tau181 was more robust to the effects of measurement variability, suggesting that it may be the preferred Elecsys-based measure in clinical practice and trials.
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Affiliation(s)
- Antoine Leuzy
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Nicholas C Cullen
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Gil Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA.,Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, California, USA.,Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, California, USA.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Shorena Janelidze
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
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19
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Lukkarinen H, Vanninen A, Tesseur I, Pemberton D, Van Der Ark P, Kokkola T, Herukka SK, Rauramaa T, Hiltunen M, Blennow K, Zetterberg H, Leinonen V. Concordance of Alzheimer's Disease-Related Biomarkers Between Intraventricular and Lumbar Cerebrospinal Fluid in Idiopathic Normal Pressure Hydrocephalus. J Alzheimers Dis 2023; 91:305-319. [PMID: 36404546 PMCID: PMC9881032 DOI: 10.3233/jad-220652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Alzheimer's disease cerebrospinal fluid (CSF) biomarkers amyloid-β 1-42 (Aβ42), total tau (T-tau), and phosphorylated tau 181 (P-tau181) are widely used. However, concentration gradient of these biomarkers between intraventricular (V-CSF) and lumbar CSF (L-CSF) has been demonstrated in idiopathic normal pressure hydrocephalus (iNPH), potentially affecting clinical utility. OBJECTIVE Here we aim to provide conversion factors for clinical and research use between V-CSF and L-CSF. METHODS Altogether 138 iNPH patients participated. L-CSF samples were obtained prior to shunt surgery. Intraoperative V-CSF samples were obtained from 97 patients. Post-operative follow-up L- and V-CSF (shunt reservoir) samples of 41 patients were obtained 1-73 months after surgery and then after 3, 6, and 18 months. CSF concentrations of Aβ42, T-tau, and P-tau181 were analyzed using commercial ELISA assays. RESULTS Preoperative L-CSF Aβ42, T-tau, and P-tau181 correlated to intraoperative V-CSF (ρ= 0.34-0.55, p < 0.001). Strong correlations were seen between postoperative L- and V-CSF for all biomarkers in every follow-up sampling point (ρs Aβ42: 0.77-0.88, T-tau: 0.91-0.94, P-tau181: 0.94-0.96, p < 0.0001). Regression equations were determined for intraoperative V- and preoperative L-CSF (Aβ42: V-CSF = 185+0.34*L-CSF, T-tau: Ln(V-CSF) = 3.11+0.49*Ln(L-CSF), P-tau181: V-CSF = 8.2+0.51*L-CSF), and for postoperative V- and L-CSF (Aβ42: V-CSF = 86.7+0.75*L-CSF, T-tau: V-CSF = 86.9+0.62*L-CSF, P-tau181: V-CSF = 2.6+0.74*L-CSF). CONCLUSION Aβ42, T-tau, and P-tau181 correlate linearly in-between V- and L-CSF, even stronger after CSF shunt surgery. Equations presented here, provide a novel tool to use V-CSF for diagnostic and prognostic entities relying on the L-CSF concentrations and can be applicable to clinical use when L-CSF samples are not available or less invasively obtained shunt reservoir samples should be interpreted.
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Affiliation(s)
- Heikki Lukkarinen
- Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland and Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland,Correspondence to: Heikki Lukkarinen, Department of Neurosurgery, Kuopio University Hospital, P.O. Box 100, FI-70029 KYS, Kuopio, Finland. Tel.: +358 45 895 4260; E-mail:
| | - Aleksi Vanninen
- Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland and Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Ina Tesseur
- UCB Biopharma SRL, Braine-l’Alleud, Belgium,Janssen Research & Development, A division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Darrel Pemberton
- Janssen Research & Development, A division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Peter Van Der Ark
- Janssen Research & Development, A division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Tarja Kokkola
- Department of Neurology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Department of Neurology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Tuomas Rauramaa
- Department of Pathology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden,
Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK,UK Dementia Research Institute, UCL, London, UK,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Ville Leinonen
- Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland and Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
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den Haan J, Hart de Ruyter FJ, Lochocki B, Kroon MA, Kemper EM, Teunissen CE, van Berckel B, Scheltens P, Hoozemans JJ, van de Kreeke A, Verbraak FD, de Boer JF, Bouwman FH. No difference in retinal fluorescence after oral curcumin intake in amyloid-proven AD cases compared to controls. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12347. [PMID: 35991218 PMCID: PMC9376971 DOI: 10.1002/dad2.12347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 11/11/2022]
Abstract
Introduction Previous work has showed the in vivo presence of retinal amyloid in Alzheimer's disease (AD) patients using curcumin. We aimed to replicate these findings in an amyloid biomarker-confirmed cohort. Methods Twenty-six patients with AD (age 66 [+9], Mini-Mental Status Examination [MMSE] ≥17) and 14 controls (age 71 [+12]) used one of three curcumin formulations: Longvida, Theracurmin, and Novasol. Plasma levels were determined and pre- and post-curcumin retinal fluorescence scans were assessed visually in all cases and quantitatively assessed in a subset. Results Visual assessment showed no difference between AD patients and controls for pre- and post-curcumin images. This was confirmed by quantitative analyses on a subset. Mean conjugated plasma curcumin levels were 198.7 nM (Longvida), 576.6 nM (Theracurmin), and 1605.8 nM (Novasol). Discussion We found no difference in retinal fluorescence between amyloid-confirmed AD cases and control participants, using Longvida and two additional curcumin formulations. Additional replication studies in amyloid-confirmed cohorts are needed to assess the diagnostic value of retinal fluorescence as an AD biomarker.
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Affiliation(s)
- Jurre den Haan
- Amsterdam UMC, location VUmcAlzheimer CenterNeurologyAmsterdamThe Netherlands
| | | | | | - Maurice A.G.M. Kroon
- Amsterdam UMC, location AMCDepartment of Pharmacy and Clinical PharmacologyAmsterdamThe Netherlands
| | - E. Marleen Kemper
- Amsterdam UMC, location AMCDepartment of Pharmacy and Clinical PharmacologyAmsterdamThe Netherlands
| | - Charlotte E. Teunissen
- Amsterdam UMC, location VUmcNeurochemistry LabDepartment of Clinical ChemistryAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Bart van Berckel
- Amsterdam UMC, location VUmcDepartment of Nuclear MedicineAmsterdamThe Netherlands
| | - Philip Scheltens
- Amsterdam UMC, location VUmcAlzheimer CenterNeurologyAmsterdamThe Netherlands
| | - Jeroen J. Hoozemans
- Amsterdam UMClocation VUmcDepartment of PathologyAmsterdam NeuroscienceAmsterdamThe Netherlands
| | | | - Frank D. Verbraak
- Amsterdam UMClocation VUmcOphthalmology DepartmentAmsterdamThe Netherlands
| | | | - Femke H. Bouwman
- Amsterdam UMC, location VUmcAlzheimer CenterNeurologyAmsterdamThe Netherlands
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Mank A, van Maurik IS, Rijnhart JJM, bakker ED, Bouteloup V, Le Scouarnec L, Teunissen CE, Barkhof F, Scheltens P, Berkhof J, van der Flier WM. Development of multivariable prediction models for institutionalization and mortality in the full spectrum of Alzheimer’s disease. Alzheimers Res Ther 2022; 14:110. [PMID: 35932034 PMCID: PMC9354423 DOI: 10.1186/s13195-022-01053-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022]
Abstract
Background Patients and caregivers express a desire for accurate prognostic information about time to institutionalization and mortality. Previous studies predicting institutionalization and mortality focused on the dementia stage. However, Alzheimer’s disease (AD) is characterized by a long pre-dementia stage. Therefore, we developed prediction models to predict institutionalization and mortality along the AD continuum of cognitively normal to dementia. Methods This study included SCD/MCI patients (subjective cognitive decline (SCD) or mild cognitive impairment (MCI)) and patients with AD dementia from the Amsterdam Dementia Cohort. We developed internally and externally validated prediction models with biomarkers and without biomarkers, stratified by dementia status. Determinants were selected using backward selection (p<0.10). All models included age and sex. Discriminative performance of the models was assessed with Harrell’s C statistics. Results We included n=1418 SCD/MCI patients (n=123 died, n=74 were institutionalized) and n=1179 patients with AD dementia (n=413 died, n=453 were institutionalized). For both SCD/MCI and dementia stages, the models for institutionalization and mortality included after backward selection clinical characteristics, imaging, and cerebrospinal fluid (CSF) biomarkers. In SCD/MCI, the Harrell’s C-statistics of the models were 0.81 (model without biomarkers: 0.76) for institutionalization and 0.79 (model without biomarker: 0.76) for mortality. In AD-dementia, the Harrell’s C-statistics of the models were 0.68 (model without biomarkers: 0.67) for institutionalization and 0.65 (model without biomarker: 0.65) for mortality. Models based on data from amyloid-positive patients only had similar discrimination. Conclusions We constructed prediction models to predict institutionalization and mortality with good accuracy for SCD/MCI patients and moderate accuracy for patients with AD dementia. The developed prediction models can be used to provide patients and their caregivers with prognostic information on time to institutionalization and mortality along the cognitive continuum of AD. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-022-01053-0.
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Faldu KG, Shah JS. Alzheimer's disease: a scoping review of biomarker research and development for effective disease diagnosis. Expert Rev Mol Diagn 2022; 22:681-703. [PMID: 35855631 DOI: 10.1080/14737159.2022.2104639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Alzheimer's disease (AD) is regarded as the foremost reason for neurodegeneration that prominently affects the geriatric population. Characterized by extracellular accumulation of amyloid-beta (Aβ), intracellular aggregation of hyperphosphorylated tau (p-tau), and neuronal degeneration that causes impairment of memory and cognition. Amyloid/tau/neurodegeneration (ATN) classification is utilized for research purposes and involves amyloid, tau, and neuronal injury staging through MRI, PET scanning, and CSF protein concentration estimations. CSF sampling is invasive, and MRI and PET scanning requires sophisticated radiological facilities which limit its widespread diagnostic use. ATN classification lacks effectiveness in preclinical AD. AREAS COVERED This publication intends to collate and review the existing biomarker profile and the current research and development of a new arsenal of biomarkers for AD pathology from different biological samples, microRNA (miRNA), proteomics, metabolomics, artificial intelligence, and machine learning for AD screening, diagnosis, prognosis, and monitoring of AD treatments. EXPERT OPINION It is an accepted observation that AD-related pathological changes occur over a long period of time before the first symptoms are observed providing ample opportunity for detection of biological alterations in various biological samples that can aid in early diagnosis and modify treatment outcomes.
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Affiliation(s)
- Khushboo Govind Faldu
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
| | - Jigna Samir Shah
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
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Orellana A, García-González P, Valero S, Montrreal L, de Rojas I, Hernández I, Rosende-Roca M, Vargas L, Tartari JP, Esteban-De Antonio E, Bojaryn U, Narvaiza L, Alarcón-Martín E, Alegret M, Alcolea D, Lleó A, Tárraga L, Pytel V, Cano A, Marquié M, Boada M, Ruiz A. Establishing In-House Cutoffs of CSF Alzheimer’s Disease Biomarkers for the AT(N) Stratification of the Alzheimer Center Barcelona Cohort. Int J Mol Sci 2022; 23:ijms23136891. [PMID: 35805894 PMCID: PMC9266894 DOI: 10.3390/ijms23136891] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Clinical diagnosis of Alzheimer’s disease (AD) increasingly incorporates CSF biomarkers. However, due to the intrinsic variability of the immunodetection techniques used to measure these biomarkers, establishing in-house cutoffs defining the positivity/negativity of CSF biomarkers is recommended. However, the cutoffs currently published are usually reported by using cross-sectional datasets, not providing evidence about its intrinsic prognostic value when applied to real-world memory clinic cases. Methods: We quantified CSF Aβ1-42, Aβ1-40, t-Tau, and p181Tau with standard INNOTEST® ELISA and Lumipulse G® chemiluminescence enzyme immunoassay (CLEIA) performed on the automated Lumipulse G600II. Determination of cutoffs included patients clinically diagnosed with probable Alzheimer’s disease (AD, n = 37) and subjective cognitive decline subjects (SCD, n = 45), cognitively stable for 3 years and with no evidence of brain amyloidosis in 18F-Florbetaben-labeled positron emission tomography (FBB-PET). To compare both methods, a subset of samples for Aβ1-42 (n = 519), t-Tau (n = 399), p181Tau (n = 77), and Aβ1-40 (n = 44) was analyzed. Kappa agreement of single biomarkers and Aβ1-42/Aβ1-40 was evaluated in an independent group of mild cognitive impairment (MCI) and dementia patients (n = 68). Next, established cutoffs were applied to a large real-world cohort of MCI subjects with follow-up data available (n = 647). Results: Cutoff values of Aβ1-42 and t-Tau were higher for CLEIA than for ELISA and similar for p181Tau. Spearman coefficients ranged between 0.81 for Aβ1-40 and 0.96 for p181TAU. Passing–Bablok analysis showed a systematic and proportional difference for all biomarkers but only systematic for Aβ1-40. Bland–Altman analysis showed an average difference between methods in favor of CLEIA. Kappa agreement for single biomarkers was good but lower for the Aβ1-42/Aβ1-40 ratio. Using the calculated cutoffs, we were able to stratify MCI subjects into four AT(N) categories. Kaplan–Meier analyses of AT(N) categories demonstrated gradual and differential dementia conversion rates (p = 9.815−27). Multivariate Cox proportional hazard models corroborated these findings, demonstrating that the proposed AT(N) classifier has prognostic value. AT(N) categories are only modestly influenced by other known factors associated with disease progression. Conclusions: We established CLEIA and ELISA internal cutoffs to discriminate AD patients from amyloid-negative SCD individuals. The results obtained by both methods are not interchangeable but show good agreement. CLEIA is a good and faster alternative to manual ELISA for providing AT(N) classification of our patients. AT(N) categories have an impact on disease progression. AT(N) classifiers increase the certainty of the MCI prognosis, which can be instrumental in managing real-world MCI subjects.
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Affiliation(s)
- Adelina Orellana
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
| | - Pablo García-González
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
| | - Sergi Valero
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain; (D.A.); (A.L.)
| | - Laura Montrreal
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
| | - Itziar de Rojas
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain; (D.A.); (A.L.)
| | - Isabel Hernández
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain; (D.A.); (A.L.)
| | - Maitee Rosende-Roca
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
| | - Liliana Vargas
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
| | - Juan Pablo Tartari
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
| | - Ester Esteban-De Antonio
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
| | - Urszula Bojaryn
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
| | - Leire Narvaiza
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
| | - Emilio Alarcón-Martín
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
| | - Montserrat Alegret
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain; (D.A.); (A.L.)
| | - Daniel Alcolea
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain; (D.A.); (A.L.)
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, 08029 Barcelona, Spain
| | - Alberto Lleó
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain; (D.A.); (A.L.)
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, 08029 Barcelona, Spain
| | - Lluís Tárraga
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain; (D.A.); (A.L.)
| | - Vanesa Pytel
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
| | - Amanda Cano
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain; (D.A.); (A.L.)
| | - Marta Marquié
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain; (D.A.); (A.L.)
| | - Mercè Boada
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain; (D.A.); (A.L.)
| | - Agustín Ruiz
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08029 Barcelona, Spain; (A.O.); (P.G.-G.); (S.V.); (L.M.); (I.d.R.); (I.H.); (M.R.-R.); (L.V.); (J.P.T.); (E.E.-D.A.); (U.B.); (L.N.); (E.A.-M.); (M.A.); (L.T.); (V.P.); (A.C.); (M.M.); (M.B.)
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain; (D.A.); (A.L.)
- Correspondence:
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Thijssen EH, Verberk IMW, Kindermans J, Abramian A, Vanbrabant J, Ball AJ, Pijnenburg Y, Lemstra AW, van der Flier WM, Stoops E, Hirtz C, Teunissen CE. Differential diagnostic performance of a panel of plasma biomarkers for different types of dementia. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12285. [PMID: 35603139 PMCID: PMC9107685 DOI: 10.1002/dad2.12285] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022]
Abstract
Introduction We explored what combination of blood‐based biomarkers (amyloid beta [Aβ]1‐42/1‐40, phosphorylated tau [p‐tau]181, neurofilament light [NfL], glial fibrillary acidic protein [GFAP]) differentiates Alzheimer's disease (AD) dementia, frontotemporal dementia (FTD), and dementia with Lewy bodies (DLB). Methods We measured the biomarkers with Simoa in two separate cohorts (n = 160 and n = 152). In one cohort, Aβ1‐42/1‐40 was also measured with mass spectrometry (MS). We assessed the differential diagnostic value of the markers, by logistic regression with Wald's backward selection. Results MS and Simoa Aβ1‐42/1‐40 similarly differentiated AD from controls. The Simoa panel that optimally differentiated AD from FTD consisted of NfL and p‐tau181 (area under the curve [AUC] = 0.94; cohort 1) or NfL, GFAP, and p‐tau181 (AUC = 0.90; cohort 2). For AD from DLB, the panel consisted of NfL, p‐tau181, and GFAP (AUC = 0.88; cohort 1), and only p‐tau181 (AUC = 0.81; cohort 2). Discussion A combination of plasma p‐tau181, NfL, and GFAP, but not Aβ1‐42/1‐40, might be useful to discriminate AD, FTD, and DLB.
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Affiliation(s)
- Elisabeth H Thijssen
- Neurochemistry Laboratory Department of Clinical Chemistry Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam the Netherlands
| | - Inge M W Verberk
- Neurochemistry Laboratory Department of Clinical Chemistry Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam the Netherlands
| | - Jana Kindermans
- IRMB-PPC, INM, Univ Montpellier, CHU Montpellier, INSERM CNRS Montpellier France
| | - Adlin Abramian
- Neurochemistry Laboratory Department of Clinical Chemistry Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam the Netherlands
| | | | | | - Yolande Pijnenburg
- Alzheimer Center Amsterdam Department of Neurology Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam the Netherlands
| | - Afina W Lemstra
- Alzheimer Center Amsterdam Department of Neurology Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam the Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam Department of Neurology Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam the Netherlands
| | | | - Christophe Hirtz
- IRMB-PPC, INM, Univ Montpellier, CHU Montpellier, INSERM CNRS Montpellier France
| | - Charlotte E Teunissen
- Neurochemistry Laboratory Department of Clinical Chemistry Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam the Netherlands
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25
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Exalto LG, Hendriksen HM, Barkhof F, van den Bosch KA, Ebenau JL, van Leeuwenstijn‐Koopman M, Prins ND, Teunissen CE, Visser LN, Scheltens P, van der Flier WM. Subjective cognitive decline and self-reported sleep problems: The SCIENCe project. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12287. [PMID: 35603141 PMCID: PMC9107682 DOI: 10.1002/dad2.12287] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022]
Abstract
We aim to investigate the frequency and type of sleep problems in memory clinic patients with subjective cognitive decline (SCD) and their association with cognition, mental health, brain magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) biomarkers. Three hundred eight subjects (65 ± 8 years, 44% female) were selected from the Subjective Cognitive Impairment Cohort (SCIENCe) project. All subjects answered two sleep questionnaires, Berlin Questionnaire (sleep apnea) and Pittsburgh Sleep Quality Index (sleep quality) and underwent a standardized memory clinic work-up. One hundred ninety-eight (64%) subjects reported sleep problems, based on 107 (35%) positive screenings on sleep apnea and 162 (53%) on poor sleep quality. Subjects with sleep problems reported more severe depressive symptoms, more anxiety, and more severe SCD. Cognitive tests, MRI, and CSF biomarkers did not differ between groups. Our results suggest that improvement of sleep quality and behaviors are potential leads for treatment in many subjects with SCD to relieve the experienced cognitive complaints.
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Affiliation(s)
- Lieza G. Exalto
- Department of Neurology, UMCU Brain CentreUniversity Medical Center UtrechtUtrechtthe Netherlands
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Heleen M.A. Hendriksen
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- UCL Institutes of Neurology and Healthcare EngineeringUniversity College LondonLondonUK
| | - Karlijn A. van den Bosch
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Jarith L. Ebenau
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Mardou van Leeuwenstijn‐Koopman
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Niels D. Prins
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Brain Research CenterAmsterdamthe Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry LaboratoryDepartment of Clinical Chemistry, Amsterdam NeuroscienceAmsterdam University Medical Centers, Vrije UniversiteitAmsterdamthe Netherlands
| | - Leonie N.C. Visser
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Division of Clinical Geriatrics, Center for Alzheimer's Research, Department of NeurobiologyCare Sciences and Society, Karolinska InstitutetStockholmSweden
| | - Philip Scheltens
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
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van Harten AC, Wiste HJ, Weigand SD, Mielke MM, Kremers WK, Eichenlaub U, Dyer RB, Algeciras‐Schimnich A, Knopman DS, Jack CR, Petersen RC. Detection of Alzheimer's disease amyloid beta 1-42, p-tau, and t-tau assays. Alzheimers Dement 2022; 18:635-644. [PMID: 34310035 PMCID: PMC9249966 DOI: 10.1002/alz.12406] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We aimed to provide cut points for the automated Elecsys Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers. METHODS Cut points for Elecsys amyloid beta 42 (Aβ42), total tau (t-tau), hyperphosphorylated tau (p-tau), and t-tau/Aβ42 and p-tau/Aβ42 ratios were evaluated in Mayo Clinic Study of Aging (n = 804) and Mayo Clinic Alzheimer's Disease Research Center (n = 70) participants. RESULTS The t-tau/Aβ42 and p-tau/Aβ42 ratios had a higher percent agreement with normal/abnormal amyloid positron emission tomography (PET) than the individual CSF markers. Reciever Operating Characteristic (ROC)-based cut points were 0.26 (0.24-0.27) for t-tau/Aβ42 and 0.023 (0.020-0.025) for p-tau/Aβ42. Ratio cut points derived from other cohorts performed as well in our cohort as our own did. Individual biomarkers had worse diagnostic properties and more variable results in terms of positive and negative percent agreement (PPA and NPA). CONCLUSION CSF t-tau/Aβ42 and p-tau/Aβ42 ratios are very robust indicators of AD. For individual biomarkers, the intended use should determine which cut point is chosen.
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Affiliation(s)
- Argonde C. van Harten
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Department of Neurology and Alzheimer Center Amsterdam UMCAmsterdamthe Netherlands
| | - Heather J. Wiste
- Department of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | | | - Michelle M. Mielke
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Department of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | - Walter K. Kremers
- Department of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | | | - Roy B. Dyer
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | | | | | | | - Ronald C. Petersen
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Department of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
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Verhaar BJH, Hendriksen HMA, de Leeuw FA, Doorduijn AS, van Leeuwenstijn M, Teunissen CE, Barkhof F, Scheltens P, Kraaij R, van Duijn CM, Nieuwdorp M, Muller M, van der Flier WM. Gut Microbiota Composition Is Related to AD Pathology. Front Immunol 2022; 12:794519. [PMID: 35173707 PMCID: PMC8843078 DOI: 10.3389/fimmu.2021.794519] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/31/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Several studies have reported alterations in gut microbiota composition of Alzheimer's disease (AD) patients. However, the observed differences are not consistent across studies. We aimed to investigate associations between gut microbiota composition and AD biomarkers using machine learning models in patients with AD dementia, mild cognitive impairment (MCI) and subjective cognitive decline (SCD). Materials and Methods We included 170 patients from the Amsterdam Dementia Cohort, comprising 33 with AD dementia (66 ± 8 years, 46%F, mini-mental state examination (MMSE) 21[19-24]), 21 with MCI (64 ± 8 years, 43%F, MMSE 27[25-29]) and 116 with SCD (62 ± 8 years, 44%F, MMSE 29[28-30]). Fecal samples were collected and gut microbiome composition was determined using 16S rRNA sequencing. Biomarkers of AD included cerebrospinal fluid (CSF) amyloid-beta 1-42 (amyloid) and phosphorylated tau (p-tau), and MRI visual scores (medial temporal atrophy, global cortical atrophy, white matter hyperintensities). Associations between gut microbiota composition and dichotomized AD biomarkers were assessed with machine learning classification models. The two models with the highest area under the curve (AUC) were selected for logistic regression, to assess associations between the 20 best predicting microbes and the outcome measures from these machine learning models while adjusting for age, sex, BMI, diabetes, medication use, and MMSE. Results The machine learning prediction for amyloid and p-tau from microbiota composition performed best with AUCs of 0.64 and 0.63. Highest ranked microbes included several short chain fatty acid (SCFA)-producing species. Higher abundance of [Clostridium] leptum and lower abundance of [Eubacterium] ventriosum group spp., Lachnospiraceae spp., Marvinbryantia spp., Monoglobus spp., [Ruminococcus] torques group spp., Roseburia hominis, and Christensenellaceae R-7 spp., was associated with higher odds of amyloid positivity. We found associations between lower abundance of Lachnospiraceae spp., Lachnoclostridium spp., Roseburia hominis and Bilophila wadsworthia and higher odds of positive p-tau status. Conclusions Gut microbiota composition was associated with amyloid and p-tau status. We extend on recent studies that observed associations between SCFA levels and AD CSF biomarkers by showing that lower abundances of SCFA-producing microbes were associated with higher odds of positive amyloid and p-tau status.
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Affiliation(s)
- Barbara J. H. Verhaar
- Department of Internal Medicine - Geriatrics, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- Department of Internal and Vascular Medicine, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Heleen M. A. Hendriksen
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Francisca A. de Leeuw
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Astrid S. Doorduijn
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Mardou van Leeuwenstijn
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Charlotte E. Teunissen
- Department of Clinical Chemistry, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- University College London (UCL) Institutes of Neurology, Faculty of Brain Sciences, London, United Kingdom
| | - Philip Scheltens
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Robert Kraaij
- Department of Internal Medicine, Erasmus Medical Center (MC), Rotterdam, Netherlands
| | - Cornelia M. van Duijn
- Department of Epidemiology, Erasmus Medical Center (MC), Rotterdam, Netherlands
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Majon Muller
- Department of Internal Medicine - Geriatrics, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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28
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Verberk IMW, Misdorp EO, Koelewijn J, Ball AJ, Blennow K, Dage JL, Fandos N, Hansson O, Hirtz C, Janelidze S, Kang S, Kirmess K, Kindermans J, Lee R, Meyer MR, Shan D, Shaw LM, Waligorska T, West T, Zetterberg H, Edelmayer RM, Teunissen CE. Characterization of pre-analytical sample handling effects on a panel of Alzheimer's disease-related blood-based biomarkers: Results from the Standardization of Alzheimer's Blood Biomarkers (SABB) working group. Alzheimers Dement 2021; 18:1484-1497. [PMID: 34845818 PMCID: PMC9148379 DOI: 10.1002/alz.12510] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 12/11/2022]
Abstract
Introduction Pre‐analytical sample handling might affect the results of Alzheimer's disease blood‐based biomarkers. We empirically tested variations of common blood collection and handling procedures. Methods We created sample sets that address the effect of blood collection tube type, and of ethylene diamine tetraacetic acid plasma delayed centrifugation, centrifugation temperature, aliquot volume, delayed storage, and freeze–thawing. We measured amyloid beta (Aβ)42 and 40 peptides with six assays, and Aβ oligomerization‐tendency (OAβ), amyloid precursor protein (APP)699‐711, glial fibrillary acidic protein (GFAP), neurofilament light (NfL), total tau (t‐tau), and phosphorylated tau181. Results Collection tube type resulted in different values of all assessed markers. Delayed plasma centrifugation and storage affected Aβ and t‐tau; t‐tau was additionally affected by centrifugation temperature. The other markers were resistant to handling variations. Discussion We constructed a standardized operating procedure for plasma handling, to facilitate introduction of blood‐based biomarkers into the research and clinical settings.
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Affiliation(s)
- Inge M W Verberk
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Els O Misdorp
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jannet Koelewijn
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Andrew J Ball
- Quanterix Corporation, Billerica, Massachusetts, USA
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, The Salhgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | | | | | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Christophe Hirtz
- IRMB-LBPC/PPC, INM, Univ Montpellier, CHU Montpellier, INSERM CNRS, Montpellier, France
| | | | | | | | - Jana Kindermans
- IRMB-LBPC/PPC, INM, Univ Montpellier, CHU Montpellier, INSERM CNRS, Montpellier, France
| | - Ryan Lee
- PeopleBio, Seongnam, South Korea
| | | | - Dandan Shan
- Quanterix Corporation, Billerica, Massachusetts, USA
| | - Leslie M Shaw
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Teresa Waligorska
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tim West
- C2N Diagnostics, St. Louis, Missouri, USA
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, The Salhgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,UK Dementia Research Institute at UCL, London, UK.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | | | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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29
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van den Bosch KA, Verberk IMW, Ebenau JL, van der Lee SJ, Jansen IE, Prins ND, Scheltens P, Teunissen CE, Van der Flier WM. BDNF-Met polymorphism and amyloid-beta in relation to cognitive decline in cognitively normal elderly: the SCIENCe project. Neurobiol Aging 2021; 108:146-154. [PMID: 34601245 DOI: 10.1016/j.neurobiolaging.2021.08.018] [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: 05/07/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Abstract
Brain-derived neurotrophic factor (BNDF) plays a role in synapse integrity. We investigated in 398 cognitively normal adults (60±8years, 41% female, MMSE=28±1) the joint association of the Val66Met polymorphism of the BDNF gene (Met+/-) and plasma BDNF levels and abnormal cerebrospinal fluid (CSF) amyloid-beta status (A+/-) with cognitive decline and dementia risk. Age-, sex- and education-adjusted linear mixed models showed that compared to Met-A-, Met+A+ showed steeper decline on tests of global cognition, memory, language, attention and executive functioning, while Met-A+ showed steeper decline on a smaller number of tests. There were no associations between Met+A- and cognitive decline. Cox models showed that compared to Met-A-, Met+A+ participants were at increased risk of dementia (HR=8.8, 95%CI: 2.8-27.9), as were Met-A+ participants (HR=6.5, 95%CI: 2.2-19.5). Lower plasma BDNF was associated with an increased risk of progression to dementia in the A+ participants. Our results imply that Met-carriage on top of amyloid-beta pathology might increase rate of cognitive decline to dementia.
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Affiliation(s)
- Karlijn A van den Bosch
- Alzheimer Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inge M W Verberk
- Alzheimer Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Neurochemistry Laboratory, Department of Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Jarith L Ebenau
- Alzheimer Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sven J van der Lee
- Alzheimer Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Department of Clinical Genetics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Iris E Jansen
- Alzheimer Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, VU, Amsterdam, The Netherlands
| | - Niels D Prins
- Alzheimer Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Brain Research Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Alzheimer Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Neurochemistry Laboratory, Department of Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M Van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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30
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Grothe MJ, Moscoso A, Ashton NJ, Karikari TK, Lantero-Rodriguez J, Snellman A, Zetterberg H, Blennow K, Schöll M. Associations of Fully Automated CSF and Novel Plasma Biomarkers With Alzheimer Disease Neuropathology at Autopsy. Neurology 2021; 97:e1229-e1242. [PMID: 34266917 PMCID: PMC8480485 DOI: 10.1212/wnl.0000000000012513] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/24/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To study CSF biomarkers of Alzheimer disease (AD) analyzed by fully automated Elecsys immunoassays compared to neuropathologic gold standards and to compare their accuracy to plasma phosphorylated tau (p-tau181) measured with a novel single molecule array method. METHODS We studied antemortem Elecsys-derived CSF biomarkers in 45 individuals who underwent standardized postmortem assessments of AD and non-AD neuropathologic changes at autopsy. In a subset of 26 participants, we also analyzed antemortem levels of plasma p-tau181 and neurofilament light (NfL). Reference biomarker values were obtained from 146 amyloid-PET-negative healthy controls (HC). RESULTS All CSF biomarkers clearly distinguished pathology-confirmed AD dementia (n = 27) from HC (area under the curve [AUC] 0.86-1.00). CSF total tau (t-tau), p-tau181, and their ratios with β-amyloid1-42 (Aβ1-42) also accurately distinguished pathology-confirmed AD from non-AD dementia (n = 8; AUC 0.94-0.97). In pathology-specific analyses, intermediate to high Thal amyloid phases were best detected by CSF Aβ1-42 (AUC [95% confidence interval] 0.91 [0.81-1]), while intermediate to high scores for Consortium to Establish a Registry for Alzheimer's Disease neuritic plaques and Braak tau stages were best detected by CSF p-tau181 (AUC 0.89 [0.79-0.99] and 0.88 [0.77-0.99], respectively). Optimal Elecsys biomarker cutoffs were derived at 1,097, 229, and 19 pg/mL for Aβ1-42, t-tau, and p-tau181. In the plasma subsample, both plasma p-tau181 (AUC 0.91 [0.86-0.96]) and NfL (AUC 0.93 [0.87-0.99]) accurately distinguished those with pathology-confirmed AD (n = 14) from HC. However, only p-tau181 distinguished AD from non-AD dementia cases (n = 4; AUC 0.96 [0.88-1.00]) and showed a similar, although weaker, pathologic specificity for neuritic plaques (AUC 0.75 [0.52-0.98]) and Braak stage (AUC 0.71 [0.44-0.98]) as CSF p-tau181. CONCLUSION Elecsys-derived CSF biomarkers detect AD neuropathologic changes with very high discriminative accuracy in vivo. Preliminary findings support the use of plasma p-tau181 as an easily accessible and scalable biomarker of AD pathology. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that fully automated CSF t-tau and p-tau181 measurements discriminate between autopsy-confirmed AD and other dementias.
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Affiliation(s)
- Michel J Grothe
- From the Unidad de Trastornos del Movimiento (M.J.G.), Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Department of Psychiatry and Neurochemistry (M.J.G., A.M., N.J.A., T.K.K., J.L.-R., A.S., H.Z., K.B., M.S.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, and Wallenberg Centre for Molecular and Translational Medicine (M.J.G., A.M., N.J.A., M.S.), University of Gothenburg, Sweden; King's College London (N.J.A.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation (N.J.A.), London, UK; Turku PET Centre (A.S.), University of Turku, Finland; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z., M.S.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London, UK.
| | - Alexis Moscoso
- From the Unidad de Trastornos del Movimiento (M.J.G.), Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Department of Psychiatry and Neurochemistry (M.J.G., A.M., N.J.A., T.K.K., J.L.-R., A.S., H.Z., K.B., M.S.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, and Wallenberg Centre for Molecular and Translational Medicine (M.J.G., A.M., N.J.A., M.S.), University of Gothenburg, Sweden; King's College London (N.J.A.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation (N.J.A.), London, UK; Turku PET Centre (A.S.), University of Turku, Finland; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z., M.S.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London, UK
| | - Nicholas J Ashton
- From the Unidad de Trastornos del Movimiento (M.J.G.), Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Department of Psychiatry and Neurochemistry (M.J.G., A.M., N.J.A., T.K.K., J.L.-R., A.S., H.Z., K.B., M.S.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, and Wallenberg Centre for Molecular and Translational Medicine (M.J.G., A.M., N.J.A., M.S.), University of Gothenburg, Sweden; King's College London (N.J.A.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation (N.J.A.), London, UK; Turku PET Centre (A.S.), University of Turku, Finland; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z., M.S.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London, UK
| | - Thomas K Karikari
- From the Unidad de Trastornos del Movimiento (M.J.G.), Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Department of Psychiatry and Neurochemistry (M.J.G., A.M., N.J.A., T.K.K., J.L.-R., A.S., H.Z., K.B., M.S.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, and Wallenberg Centre for Molecular and Translational Medicine (M.J.G., A.M., N.J.A., M.S.), University of Gothenburg, Sweden; King's College London (N.J.A.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation (N.J.A.), London, UK; Turku PET Centre (A.S.), University of Turku, Finland; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z., M.S.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London, UK
| | - Juan Lantero-Rodriguez
- From the Unidad de Trastornos del Movimiento (M.J.G.), Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Department of Psychiatry and Neurochemistry (M.J.G., A.M., N.J.A., T.K.K., J.L.-R., A.S., H.Z., K.B., M.S.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, and Wallenberg Centre for Molecular and Translational Medicine (M.J.G., A.M., N.J.A., M.S.), University of Gothenburg, Sweden; King's College London (N.J.A.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation (N.J.A.), London, UK; Turku PET Centre (A.S.), University of Turku, Finland; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z., M.S.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London, UK
| | - Anniina Snellman
- From the Unidad de Trastornos del Movimiento (M.J.G.), Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Department of Psychiatry and Neurochemistry (M.J.G., A.M., N.J.A., T.K.K., J.L.-R., A.S., H.Z., K.B., M.S.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, and Wallenberg Centre for Molecular and Translational Medicine (M.J.G., A.M., N.J.A., M.S.), University of Gothenburg, Sweden; King's College London (N.J.A.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation (N.J.A.), London, UK; Turku PET Centre (A.S.), University of Turku, Finland; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z., M.S.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London, UK
| | - Henrik Zetterberg
- From the Unidad de Trastornos del Movimiento (M.J.G.), Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Department of Psychiatry and Neurochemistry (M.J.G., A.M., N.J.A., T.K.K., J.L.-R., A.S., H.Z., K.B., M.S.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, and Wallenberg Centre for Molecular and Translational Medicine (M.J.G., A.M., N.J.A., M.S.), University of Gothenburg, Sweden; King's College London (N.J.A.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation (N.J.A.), London, UK; Turku PET Centre (A.S.), University of Turku, Finland; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z., M.S.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London, UK
| | - Kaj Blennow
- From the Unidad de Trastornos del Movimiento (M.J.G.), Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Department of Psychiatry and Neurochemistry (M.J.G., A.M., N.J.A., T.K.K., J.L.-R., A.S., H.Z., K.B., M.S.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, and Wallenberg Centre for Molecular and Translational Medicine (M.J.G., A.M., N.J.A., M.S.), University of Gothenburg, Sweden; King's College London (N.J.A.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation (N.J.A.), London, UK; Turku PET Centre (A.S.), University of Turku, Finland; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z., M.S.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London, UK
| | - Michael Schöll
- From the Unidad de Trastornos del Movimiento (M.J.G.), Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Department of Psychiatry and Neurochemistry (M.J.G., A.M., N.J.A., T.K.K., J.L.-R., A.S., H.Z., K.B., M.S.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, and Wallenberg Centre for Molecular and Translational Medicine (M.J.G., A.M., N.J.A., M.S.), University of Gothenburg, Sweden; King's College London (N.J.A.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation (N.J.A.), London, UK; Turku PET Centre (A.S.), University of Turku, Finland; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z., M.S.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London, UK.
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31
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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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32
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Trammell AR, McDaniel DJ, Obideen M, Okafor M, Thomas TL, Goldstein FC, Shaw LM, Hajjar IM. Perceived Stress is Associated with Alzheimer's Disease Cerebrospinal Fluid Biomarkers in African Americans with Mild Cognitive Impairment. J Alzheimers Dis 2021; 77:843-853. [PMID: 32741810 DOI: 10.3233/jad-200089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND African Americans (AA) have a higher Alzheimer's disease (AD) prevalence and report more perceived stress than White Americans. The biological basis of the stress-AD link is unclear. This study investigates the connection between stress and AD biomarkers in a biracial cohort. OBJECTIVE Establish biomarker evidence for the observed association between stress and AD, especially in AA. METHODS A cross-sectional study (n = 364, 41.8% AA) administering cognitive tests and the perceived stress scale (PSS) questionnaire. A subset (n = 309) provided cerebrospinal fluid for measurement of Aβ42, Tau, Ptau, Tau/Aβ42 (TAR), and Ptau/Aβ42 (PTAR). Multivariate linear regression, including factors that confound racial differences in AD, was performed. RESULTS Higher PSS scores were associated with higher Ptau (β= 0.43, p = 0.01) and PTAR (β= 0.005, p = 0.03) in AA with impaired cognition (mild cognitive impairment). CONCLUSION Higher PSS scores were associated with Tau-related AD biomarker indices in AA/MCI, suggesting a potential biological connection for stress with AD and its racial disparity.
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Affiliation(s)
- Antoine R Trammell
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Darius J McDaniel
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Malik Obideen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Maureen Okafor
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Tiffany L Thomas
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia C Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Ihab M Hajjar
- Department of Medicine and Neurology, Emory University School of Medicine, Atlanta, GA, USA
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33
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Peng Q, Zhang Z. The fluid biomarkers of Alzheimer’s disease. BRAIN SCIENCE ADVANCES 2021. [DOI: 10.26599/bsa.2021.9050001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Alzheimer’s disease (AD) is the most common neurodegenerative disorder. However, it still has no available disease‐modifying therapies. Its pathology cascade begins decades before symptomatic presentation. For these reasons, highly sensitive and highly specific fluid biomarkers should be developed for the early diagnosis of AD. In this study, the well‐established and emerging fluid biomarkers of AD are summarized, and recent advances on their role in early diagnosis and progression monitoring as well as their correlations with AD pathology are highlighted. Future prospects and related research directions are also discussed.
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Affiliation(s)
- Qinyu Peng
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhentao Zhang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan 430060, China
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34
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Rossi M, Baiardi S, Teunissen CE, Quadalti C, van de Beek M, Mammana A, Maserati MS, Van der Flier WM, Sambati L, Zenesini C, Caughey B, Capellari S, Lemstra A, Parchi P. Diagnostic Value of the CSF α-Synuclein Real-Time Quaking-Induced Conversion Assay at the Prodromal MCI Stage of Dementia With Lewy Bodies. Neurology 2021; 97:e930-e940. [PMID: 34210822 DOI: 10.1212/wnl.0000000000012438] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/03/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate whether the cerebrospinal fluid (CSF) α-synuclein (α-syn) real-time quaking-induced conversion (RT-QuIC) assay accurately identifies patients with mild cognitive impairment due to probable Lewy body disease (MCI-LB). METHODS We applied α-syn RT-QuIC to 289 CSF samples obtained from two independent cohorts, including 81 patients with probable MCI-LB (70.7±6.6 y, 13.6% F, MMSE 26.1±2.4), 120 with probable MCI-AD (68.6±7.4 y, 45.8% F, MMSE 25.5±2.8), and 30 with unspecified MCI (65.4±9.3 y, 30.0% F, MMSE 27.0±3.0). Fifty-eight individuals with no cognitive decline or evidence of neurodegenerative disease and 121 individuals lacking brain α-syn deposits at the neuropathological examination were used as controls. RESULTS RT-QuIC identified MCI-LB patients against cognitively unimpaired controls with 95% sensitivity, 97% specificity, and 96% accuracy, and showed 98% specificity in neuropathological controls. The accuracy of the test for MCI-LB was consistent between the two cohorts (97.3% vs. 93.7%). Thirteen percent of MCI-AD patients also had a positive test; of note, 44% of them developed one core or supportive clinical feature of dementia with Lewy bodies (DLB) at follow-up, suggesting an underlying LB co-pathology. CONCLUSIONS These findings indicate that CSF α-syn RT-QuIC is a robust biomarker for prodromal DLB. Further studies are needed to fully explore the added value of the assay to the current research criteria for MCI-LB. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that CSF α-syn RT-QuIC accurately identifies patients with MCI due to LB disease.
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Affiliation(s)
- Marcello Rossi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Simone Baiardi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Charlotte E Teunissen
- Neurochemistry Lab, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Corinne Quadalti
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marleen van de Beek
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Angela Mammana
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Wiesje M Van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Luisa Sambati
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Corrado Zenesini
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Byron Caughey
- LPVD, Rocky Mountain Laboratories, NIAID, NIH, Hamilton, MT, USA
| | - Sabina Capellari
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Afina Lemstra
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Piero Parchi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy .,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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35
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Ingala S, De Boer C, Masselink LA, Vergari I, Lorenzini L, Blennow K, Chételat G, Di Perri C, Ewers M, van der Flier WM, Fox NC, Gispert JD, Haller S, Molinuevo JL, Muniz‐Terrera G, Mutsaerts HJMM, Ritchie CW, Ritchie K, Schmidt M, Schwarz AJ, Vermunt L, Waldman AD, Wardlaw J, Wink AM, Wolz R, Wottschel V, Scheltens P, Visser PJ, Barkhof F. Application of the ATN classification scheme in a population without dementia: Findings from the EPAD cohort. Alzheimers Dement 2021; 17:1189-1204. [PMID: 33811742 PMCID: PMC8359976 DOI: 10.1002/alz.12292] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/11/2020] [Accepted: 12/22/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND We classified non-demented European Prevention of Alzheimer's Dementia (EPAD) participants through the amyloid/tau/neurodegeneration (ATN) scheme and assessed their neuropsychological and imaging profiles. MATERIALS AND METHODS From 1500 EPAD participants, 312 were excluded. Cerebrospinal fluid cut-offs of 1000 pg/mL for amyloid beta (Aß)1-42 and 27 pg/mL for p-tau181 were validated using Gaussian mixture models. Given strong correlation of p-tau and t-tau (R2 = 0.98, P < 0.001), neurodegeneration was defined by age-adjusted hippocampal volume. Multinomial regressions were used to test whether neuropsychological tests and regional brain volumes could distinguish ATN stages. RESULTS Age was 65 ± 7 years, with 58% females and 38% apolipoprotein E (APOE) ε4 carriers; 57.1% were A-T-N-, 32.5% were in the Alzheimer's disease (AD) continuum, and 10.4% suspected non-Alzheimer's pathology. Age and cerebrovascular burden progressed with biomarker positivity (P < 0.001). Cognitive dysfunction appeared with T+. Paradoxically higher regional gray matter volumes were observed in A+T-N- compared to A-T-N- (P < 0.001). DISCUSSION In non-demented individuals along the AD continuum, p-tau drives cognitive dysfunction. Memory and language domains are affected in the earliest stages.
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Affiliation(s)
- Silvia Ingala
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Casper De Boer
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Larissa A Masselink
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Ilaria Vergari
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Luigi Lorenzini
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Kaj Blennow
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
| | - Gaël Chételat
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders,”Institut Blood and Brain @ Caen‐NormandieCyceronCaenFrance
| | - Carol Di Perri
- Centre for Dementia PreventionEdinburgh Imaging, UK Dementia Research Institute at The University of EdinburghEdinburghUK
| | - Michael Ewers
- Institute for Stroke and Dementia ResearchKlinikum der Universitat MünchenLudwig‐Maximilians‐Universitat LMUMunichGermany
| | - Wiesje M van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Nick C Fox
- Dementia Research CentreDepartment of Neurodegenerative Disease & UK Dementia Research InstituteInstitute of NeurologyUniversity College LondonLondonUK
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
- Universitat Pompeu FabraBarcelonaSpain
| | - Sven Haller
- CIRD Centre d'Imagerie Rive DroiteGenevaSwitzerland
| | - José Luís Molinuevo
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- Hopsital Clínic‐IDIBAPSAlzheimer's Disease & Other Cognitive Disorders UnitBarcelonaSpain
| | - Graciela Muniz‐Terrera
- Centre for Dementia PreventionEdinburgh Imaging, UK Dementia Research Institute at The University of EdinburghEdinburghUK
| | - Henri JMM Mutsaerts
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Ghent Institute for Functional and Metabolic Imaging (GIfMI)Ghent UniversityGhentBelgium
| | - Craig W Ritchie
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Karen Ritchie
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | | | - Adam J Schwarz
- Takeda Pharmaceutical Company LtdCambridgeMassachusettsUSA
| | - Lisa Vermunt
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Adam D Waldman
- Centre for Dementia PreventionEdinburgh Imaging, UK Dementia Research Institute at The University of EdinburghEdinburghUK
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Joanna Wardlaw
- Centre for Dementia PreventionEdinburgh Imaging, UK Dementia Research Institute at The University of EdinburghEdinburghUK
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Alle Meije Wink
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | | | - Viktor Wottschel
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Philip Scheltens
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Department of Psychiatry & NeuropsychologySchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Institutes of Neurology and Healthcare EngineeringUniversity College LondonLondonUK
| | - the EPAD consortium
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
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36
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Willemse EAJ, Scheltens P, Teunissen CE, Vijverberg EGB. A neurologist's perspective on serum neurofilament light in the memory clinic: a prospective implementation study. ALZHEIMERS RESEARCH & THERAPY 2021; 13:101. [PMID: 34006321 PMCID: PMC8132439 DOI: 10.1186/s13195-021-00841-4] [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: 02/02/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022]
Abstract
Background Neurofilament light in serum (sNfL) is a biomarker for axonal damage with elevated levels in many neurological disorders, including neurodegenerative dementias. Since within-group variation of sNfL is large and concentrations increase with aging, sNfL’s clinical use in memory clinic practice remains to be established. The objective of the current study was to evaluate the clinical use of serum neurofilament light (sNfL), a cross-disease biomarker for axonal damage, in a tertiary memory clinic cohort. Methods Six neurologists completed questionnaires regarding the usefulness of sNfL (n = 5–42 questionnaires/neurologist). Patients that visited the Alzheimer Center Amsterdam for the first time between May and October 2019 (n = 109) were prospectively included in this single-center implementation study. SNfL levels were analyzed on Simoa and reported together with normal values in relation to age, as part of routine diagnostic work-up and in addition to cerebrospinal fluid (CSF) biomarker analysis. Results SNfL was perceived as useful in 53% (n = 58) of the cases. SNfL was more often perceived as useful in patients < 62 years (29/48, 60%, p = 0.05) and males (41/65, 63%, p < 0.01). Availability of CSF biomarker results at time of result discussion had no influence. We observed non-significant trends for increased perceived usefulness of sNfL for patients with the diagnosis subjective cognitive decline (64%), psychiatric disorder (71%), or uncertain diagnosis (67%). SNfL was mostly helpful to neurologists in confirming or excluding neurodegeneration. Whether sNfL was regarded as useful strongly depended on which neurologist filled out the questionnaire (ranging from 0 to 73% of useful cases/neurologist). Discussion Regardless of the availability of CSF biomarker results, sNfL was perceived as a useful tool in more than half of the evaluated cases in a tertiary memory clinic practice. Based on our results, we recommend the analysis of the biomarker sNfL to confirm or exclude neurodegeneration in patients below 62 years old and in males. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00841-4.
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Affiliation(s)
- E A J Willemse
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, De Boelelaan, 1117, Amsterdam, The Netherlands.
| | - P Scheltens
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - C E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - E G B Vijverberg
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, De Boelelaan, 1117, Amsterdam, The Netherlands.,Brain Research Center, Amsterdam, The Netherlands
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37
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Simonsen AH, Musaeus CS, Christensen GL, Hasselbalch SG, Waldemar G. Upwards Drift of Cerebrospinal Fluid Amyloid-β 42 Over Twelve Years in a Consecutive Clinical Cohort. J Alzheimers Dis 2021; 81:1369-1373. [PMID: 33935081 DOI: 10.3233/jad-201506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Amyloid-β 1-42 (Aβ1-42) measured in the cerebrospinal fluid (CSF) can be used as a diagnostic biomarker for Alzheimer's disease (AD) but an upward drift when using the INNOTEST ELISA has been suggested. We investigated the upwards drift of Aβ1-42 levels over a period of twelve years in a consecutive memory clinic cohort. We found a significant increase in Aβ1-42 from 2008 to 2019 independent of changes in tau. New methods for the quantification of CSF Aβ1-42 levels are being implemented but awareness of this upwards drift is crucial during the diagnostic work-up and when selecting historical samples for research.
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Affiliation(s)
- Anja Hviid Simonsen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Sandøe Musaeus
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Lund Christensen
- Centre of Diagnostic Investigations, Department of Clinical Chemistry, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Steen Gregers Hasselbalch
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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38
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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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39
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Budelier MM, Bateman RJ. Biomarkers of Alzheimer Disease. J Appl Lab Med 2021; 5:194-208. [PMID: 31843944 DOI: 10.1373/jalm.2019.030080] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/31/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Alzheimer disease (AD) was once a clinical diagnosis confirmed by postmortem autopsy. Today, with the development of AD biomarkers, laboratory assays to detect AD pathology are able to complement clinical diagnosis in symptomatic individuals with uncertain diagnosis. A variety of commercially available assays are performed as laboratory-developed tests, and many more are in development for both clinical and research purposes. CONTENT The role of laboratory medicine in diagnosing and managing AD is expanding; thus, it is important for laboratory professionals and ordering physicians to understand the strengths and limitations of both existing and emerging AD biomarker assays. In this review, we will provide an overview of the diagnosis of AD, discuss existing laboratory assays for AD and their recommended use, and examine the clinical performance of emerging AD biomarkers. SUMMARY The field of AD biomarker discovery and assay development is rapidly evolving, with recent studies promising to improve both the diagnosis of symptomatic individuals and enrollment and monitoring of asymptomatic individuals in research studies. However, care must be taken to ensure proper use and interpretation of these assays. For clinical purposes, these assays are meant to aid in diagnosis but are not themselves diagnostic. For individuals without symptoms, AD biomarker tests are still only appropriate for research purposes. Additionally, there are analytical challenges that require careful attention, especially for longitudinal use of AD tests.
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Affiliation(s)
- Melissa M Budelier
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Randall J Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
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40
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Moscoso A, Grothe MJ, Ashton NJ, Karikari TK, Rodriguez JL, Snellman A, Suárez-Calvet M, Zetterberg H, Blennow K, Schöll M. Time course of phosphorylated-tau181 in blood across the Alzheimer's disease spectrum. Brain 2021; 144:325-339. [PMID: 33257949 PMCID: PMC7880671 DOI: 10.1093/brain/awaa399] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 12/31/2022] Open
Abstract
Tau phosphorylated at threonine 181 (p-tau181) measured in blood plasma has recently been proposed as an accessible, scalable, and highly specific biomarker for Alzheimer’s disease. Longitudinal studies, however, investigating the temporal dynamics of this novel biomarker are lacking. It is therefore unclear when in the disease process plasma p-tau181 increases above physiological levels and how it relates to the spatiotemporal progression of Alzheimer’s disease characteristic pathologies. We aimed to establish the natural time course of plasma p-tau181 across the sporadic Alzheimer’s disease spectrum in comparison to those of established imaging and fluid-derived biomarkers of Alzheimer’s disease. We examined longitudinal data from a large prospective cohort of elderly individuals enrolled in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) (n = 1067) covering a wide clinical spectrum from normal cognition to dementia, and with measures of plasma p-tau181 and an 18F-florbetapir amyloid-β PET scan at baseline. A subset of participants (n = 864) also had measures of amyloid-β1–42 and p-tau181 levels in CSF, and another subset (n = 298) had undergone an 18F-flortaucipir tau PET scan 6 years later. We performed brain-wide analyses to investigate the associations of plasma p-tau181 baseline levels and longitudinal change with progression of regional amyloid-β pathology and tau burden 6 years later, and estimated the time course of changes in plasma p-tau181 and other Alzheimer’s disease biomarkers using a previously developed method for the construction of long-term biomarker temporal trajectories using shorter-term longitudinal data. Smoothing splines demonstrated that earliest plasma p-tau181 changes occurred even before amyloid-β markers reached abnormal levels, with greater rates of change correlating with increased amyloid-β pathology. Voxel-wise PET analyses yielded relatively weak, yet significant, associations of plasma p-tau181 with amyloid-β pathology in early accumulating brain regions in cognitively healthy individuals, while the strongest associations with amyloid-β were observed in late accumulating regions in patients with mild cognitive impairment. Cross-sectional and particularly longitudinal measures of plasma p-tau181 were associated with widespread cortical tau aggregation 6 years later, covering temporoparietal regions typical for neurofibrillary tangle distribution in Alzheimer’s disease. Finally, we estimated that plasma p-tau181 reaches abnormal levels ∼6.5 and 5.7 years after CSF and PET measures of amyloid-β, respectively, following similar dynamics as CSF p-tau181. Our findings suggest that plasma p-tau181 increases are associated with the presence of widespread cortical amyloid-β pathology and with prospective Alzheimer’s disease typical tau aggregation, providing clear implications for the use of this novel blood biomarker as a diagnostic and screening tool for Alzheimer’s disease.
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Affiliation(s)
- Alexis Moscoso
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden
| | - Michel J Grothe
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden.,Unidad de Trastornos del Movimiento, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, London, UK.,NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
| | - Thomas K Karikari
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Juan Lantero Rodriguez
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anniina Snellman
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden.,Turku PET Centre, University of Turku, FI-20520 Turku, Finland
| | - Marc Suárez-Calvet
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Servei de Neurologia, Hospital del Mar, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK.,UK Dementia Research Institute at University College London, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Michael Schöll
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden.,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
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41
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Briels CT, Stam CJ, Scheltens P, Gouw AA. The predictive value of normal EEGs in dementia due to Alzheimer's disease. Ann Clin Transl Neurol 2021; 8:1038-1048. [PMID: 33835723 PMCID: PMC8108419 DOI: 10.1002/acn3.51339] [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: 11/22/2020] [Revised: 02/13/2021] [Accepted: 02/21/2021] [Indexed: 12/05/2022] Open
Abstract
Objective To determine differences in clinical presentation and disease progression between patients with dementia due to AD with visually normal and abnormal EEG recordings. We hypothesized that patients with normal electroencephalographs (EEGs) are a representation of the heterogeneity of AD. We expected this group to have a phenotype with relatively predominant hippocampal atrophy, memory deficits, and a slower disease progression. Methods Patients were included based on diagnosis of dementia due to AD, positive amyloid and tau cerebrospinal fluid (CSF) biomarkers, and the availability of EEG recordings. Patients were categorized in groups of normal (N = 208) and abnormal (N = 336) EEG recordings based on visual assessment by experienced neurophysiologists. At baseline demographics, cognitive, MRI, and CSF measures were compared between groups. Cognitive data from follow‐up visits were assessed by linear mixed‐effects models (LMMs), and corrected for baseline value, sex, age, and educational level, to compare cognitive deterioration over time between groups. Results About 1 in 4.5 patients with AD dementia had a visually normal EEG and this group showed better overall cognitive performance compared to the abnormal group, where memory was the most prominent affected domain. The normal group showed less global and parietal but similar medial temporal atrophy. Follow‐up data showed a slower deterioration on all tested cognitive domains in the normal EEG group. Interpretation Patients with dementia due to AD and visually normal EEG recordings showed a milder clinical presentation and had a milder disease progression compared to patients with an abnormal EEG. These results provide evidence of clinical and biological heterogeneity within AD dementia.
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Affiliation(s)
- Casper T Briels
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Neurophysiology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology, 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, Amsterdam, The Netherlands
| | - Alida A Gouw
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Neurophysiology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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42
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Dakterzada F, López-Ortega R, Arias A, Riba-Llena I, Ruiz-Julián M, Huerto R, Tahan N, Piñol-Ripoll G. Assessment of the Concordance and Diagnostic Accuracy Between Elecsys and Lumipulse Fully Automated Platforms and Innotest. Front Aging Neurosci 2021; 13:604119. [PMID: 33746733 PMCID: PMC7970049 DOI: 10.3389/fnagi.2021.604119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/10/2021] [Indexed: 11/13/2022] Open
Abstract
Manual ELISA assays are the most commonly used methods for quantification of biomarkers; however, they often show inter- and intra-laboratory variability that limits their wide use. Here, we compared the Innotest ELISA method with two fully automated platforms (Lumipulse and Elecsys) to determine whether these new methods can provide effective substitutes for ELISA assays. We included 149 patients with AD (n = 34), MCI (n = 94) and non-AD dementias (n = 21). Aβ42, T-tau, and P-tau were quantified using the ELISA method (Innotest, Fujirebio Europe), CLEIA method on a Lumipulse G600II (Fujirebio Diagnostics), and ECLIA method on a Cobas e 601 (Roche Diagnostics) instrument. We found a high correlation between the three methods, although there were systematic differences between biomarker values measured by each method. Both Lumipulse and Elecsys methods were highly concordant with clinical diagnoses, and the combination of Lumipulse Aβ42 and P-tau had the highest discriminating power (AUC 0.915, 95% CI 0.822–1.000). We also assessed the agreement of AT(N) classification for each method with AD diagnosis. Although differences were not significant, the use of Aβ42/Aβ40 ratio instead of Aβ42 alone in AT(N) classification enhanced the diagnostic accuracy (AUC 0.798, 95% CI 0.649–0.947 vs. AUC 0.778, 95% CI 0.617–0.939). We determined the cut-offs for the Lumipulse and Elecsys assays based on the Aβ42/Aβ40 ratio ± status as a marker of amyloid pathology, and these cut-offs were consistent with those recommended by manufacturers, which had been determined based on visual amyloid PET imaging or diagnostic accuracy. Finally, the biomarker ratios (P-tau/Aβ42 and T-tau/Aβ42) were more consistent with the Aβ42/Aβ40 ratio for both Lumipulse and Elecsys methods, and Elecsys P-tau/Aβ42 had the highest consistency with amyloid pathology (AUC 0.994, 95% CI 0.986–1.000 and OPA 96.4%) at the ≥0.024 cut-off. The Lumipulse and Elecsys cerebrospinal fluid (CSF) AD assays showed high analytical and clinical performances. As both automated platforms were standardized for reference samples, their use is recommended for the measurement of CSF AD biomarkers compared with unstandardized manual methods, such as Innotest ELISA, that have demonstrated a high inter and intra-laboratory variability.
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Affiliation(s)
- Farida Dakterzada
- Cognitive Disorders Unit, Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Lleida, Spain
| | - Ricard López-Ortega
- Cognitive Disorders Unit, Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Lleida, Spain
| | - Alfonso Arias
- Cognitive Disorders Unit, Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Lleida, Spain
| | - Iolanda Riba-Llena
- Cognitive Disorders Unit, Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Lleida, Spain
| | - Maria Ruiz-Julián
- Cognitive Disorders Unit, Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Lleida, Spain
| | - Raquel Huerto
- Cognitive Disorders Unit, Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Lleida, Spain
| | - Nuria Tahan
- Cognitive Disorders Unit, Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Lleida, Spain
| | - Gerard Piñol-Ripoll
- Cognitive Disorders Unit, Clinical Neuroscience Research Group, Santa Maria University Hospital, IRBLleida, Lleida, Spain
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Reimand J, Groot C, Teunissen CE, Windhorst AD, Boellaard R, Barkhof F, Nazarenko S, van der Flier WM, van Berckel BNM, Scheltens P, Ossenkoppele R, Bouwman F. Why Is Amyloid-β PET Requested After Performing CSF Biomarkers? J Alzheimers Dis 2020; 73:559-569. [PMID: 31796674 PMCID: PMC7081099 DOI: 10.3233/jad-190836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Amyloid-β positron emission tomography (PET) and cerebrospinal fluid (CSF) Aβ42 are considered interchangeable for clinical diagnosis of Alzheimer's disease. OBJECTIVE To explore the clinical reasoning for requesting additional amyloid-β PET after performing CSF biomarkers. METHODS We retrospectively identified 72 memory clinic patients who underwent amyloid-β PET after CSF biomarkers analysis for clinical diagnostic evaluation between 2011 and 2019. We performed patient chart reviews to identify factors which led to additional amyloid-β PET. Additionally, we assessed accordance with appropriate-use-criteria (AUC) for amyloid-β PET. RESULTS Mean patient age was 62.0 (SD = 8.1) and mean Mini-Mental State Exam score was 23.6 (SD = 3.8). CSF analysis conflicting with the clinical diagnosis was the most frequent reason for requesting an amyloid-β PET scan (n = 53, 74%), followed by incongruent MRI (n = 16, 22%), unusual clinical presentation (n = 11, 15%) and young age (n = 8, 11%). An amyloid-β PET scan was rarely (n = 5, 7%) requested in patients with a CSF Aβ+/tau+ status. Fifteen (47%) patients with a post-PET diagnosis of AD had a predominantly non-amnestic presentation. In n = 11 (15%) cases, the reason that the clinician requested amyloid-β was not covered by AUC. This happened most often (n = 7) when previous CSF analysis did not support current clinical diagnosis, which led to requesting amyloid-β PET. CONCLUSION In this single-center study, the main reason for requesting an amyloid-β PET scan after performing CSF biomarkers was the occurrence of a mismatch between the primary clinical diagnosis and CSF Aβ/tau results.
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Affiliation(s)
- Juhan Reimand
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia.,Radiology Centre, North Estonia Medical Centre, Tallinn, Estonia
| | - Colin Groot
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, 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
| | - 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, United Kingdom
| | - Sergei Nazarenko
- Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Wiesje M van der Flier
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Bart N M van Berckel
- Department of Radiology & Nuclear Medicine, 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, Amsterdam, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, 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, Amsterdam, the Netherlands
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Gaetani L, Paolini Paoletti F, Bellomo G, Mancini A, Simoni S, Di Filippo M, Parnetti L. CSF and Blood Biomarkers in Neuroinflammatory and Neurodegenerative Diseases: Implications for Treatment. Trends Pharmacol Sci 2020; 41:1023-1037. [PMID: 33127098 DOI: 10.1016/j.tips.2020.09.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022]
Abstract
Neuroinflammatory and neurodegenerative diseases are characterized by the interplay of a number of molecular pathways that can be assessed through biofluids, especially cerebrospinal fluid and blood. Accordingly, the definition and classification of these disorders will move from clinical and pathological to biological criteria. The consequences of this biomarker-based diagnostic and prognostic approach are highly relevant to the field of drug development. Indeed, in view of the availability of disease-modifying drugs, fluid biomarkers offer a unique opportunity for improving the quality and applicability of results from clinical trials. Herein, we discuss the benefits of using fluid biomarkers for patient stratification, target engagement, and outcome assessment, as well as the most recent developments in neuroinflammatory and neurodegenerative diseases.
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Affiliation(s)
- Lorenzo Gaetani
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Giovanni Bellomo
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Andrea Mancini
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Simone Simoni
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Lucilla Parnetti
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy.
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Bellomo G, Cataldi S, Paciotti S, Paolini Paoletti F, Chiasserini D, Parnetti L. Measurement of CSF core Alzheimer disease biomarkers for routine clinical diagnosis: do fresh vs frozen samples differ? ALZHEIMERS RESEARCH & THERAPY 2020; 12:121. [PMID: 32993776 PMCID: PMC7526419 DOI: 10.1186/s13195-020-00689-0] [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: 04/10/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022]
Abstract
Background Cerebrospinal fluid (CSF) amyloid-beta (Aβ) 42/40 ratio, threonine-181-phosphorylated-tau (p-tau), and total-tau (t-tau) represent core biomarkers of Alzheimer disease (AD). The recent availability of automated platforms has represented a significant achievement for reducing the pre-analytical variability of these determinations in clinical setting. With respect to classical manual ELISAs, these platforms give us also the possibility to measure any single sample and to get the result within approximately 30 min. So far, reference values have been calculated from measurements obtained in frozen samples. In this work, we wanted to check if the values obtained in fresh CSF samples differ from those obtained in frozen samples, since this issue is mandatory in routine diagnostic work. Methods Fifty-eight consecutive CSF samples have been analyzed immediately after lumbar puncture and after 1-month deep freezing (− 80 °C). As an automated platform, we used Lumipulse G600-II (Fujirebio Inc.). Both the fresh and the frozen aliquots were analyzed in their storage tubes. Results In fresh samples, a mean increase of Aβ40 (6%), Aβ42 (2%), p-tau (2%), and t-tau (4%) was observed as compared to frozen samples, whereas a slight decrease was observed for Aβ42/Aβ40 ratio (4%), due to the higher deviation of Aβ40 in fresh samples compared to Aβ42. These differences are significant for Aβ40, Aβ42/Aβ40 ratio, p-tau, and t-tau. Nevertheless, the Aβ42/Aβ40 ratio showed a lower variability (smaller standard deviation of relative differences) with respect to Aβ42. With respect to the AD profile according to the A/T/(N) criteria for AD diagnosis, no significant changes in classification were observed when comparing results obtained in fresh vs frozen samples. Conclusions Small but significant differences have been found for Aβ40, Aβ42/Aβ40 ratio, p-tau, and t-tau in fresh vs frozen samples. Importantly, these differences did not imply a modification in the A/T/(N) classification system. In order to know if different cutoffs for fresh and frozen samples are required, larger, multi-center investigations are needed.
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Affiliation(s)
- Giovanni Bellomo
- Laboratory of Clinical Neurochemistry, Section of Neurology, University of Perugia, Piazzale Lucio Severi 1/8, 06132, Perugia, PG, Italy
| | - Samuela Cataldi
- Laboratory of Clinical Neurochemistry, Section of Neurology, University of Perugia, Piazzale Lucio Severi 1/8, 06132, Perugia, PG, Italy
| | - Silvia Paciotti
- Laboratory of Clinical Neurochemistry, Section of Neurology, University of Perugia, Piazzale Lucio Severi 1/8, 06132, Perugia, PG, Italy.,Department of Experimental Medicine, Section of Physiology and Biochemistry, University of Perugia, Piazza Lucio Severi 1/8, 06132, Perugia, PG, Italy
| | | | - Davide Chiasserini
- Department of Experimental Medicine, Section of Physiology and Biochemistry, University of Perugia, Piazza Lucio Severi 1/8, 06132, Perugia, PG, Italy
| | - Lucilla Parnetti
- Laboratory of Clinical Neurochemistry, Section of Neurology, University of Perugia, Piazzale Lucio Severi 1/8, 06132, Perugia, PG, Italy. .,Section of Neurology, University of Perugia, Piazzale Lucio Severi 1/8, 06132, Perugia, PG, Italy.
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Blanken AE, Dutt S, Li Y, Nation DA. Disentangling Heterogeneity in Alzheimer's Disease: Two Empirically-Derived Subtypes. J Alzheimers Dis 2020; 70:227-239. [PMID: 31177226 DOI: 10.3233/jad-190230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical-pathological Alzheimer's disease (AD) subtypes may help distill heterogeneity in patient presentation. To date, no studies have utilized neuropsychological and biological markers to identify preclinical subtypes with longitudinal stability. OBJECTIVE The objective of this study was to empirically derive AD endophenotypes using a combination of cognitive and biological markers. METHODS Hierarchical cluster analysis grouped dementia-free older adults using memory, executive and language abilities, and cerebrospinal fluid amyloid-β and phosphorylated tau. Brain volume differences, neuropsychological trajectory, and progression to dementia were compared, controlling for age, gender, education, and apolipoprotein E4 (ApoE4). RESULTS Subgroups included asymptomatic-normal (n = 653) with unimpaired cognition and subthreshold biomarkers, typical AD (TAD; n = 191) showing marked memory decline, high ApoE4 rates and abnormal biomarkers, and atypical AD (AAD; n = 132) with widespread cognitive decline, intermediate biomarker levels, older age, less education and more white matter lesions. Cognitive profiles showed longitudinal stability with corresponding patterns of cortical atrophy, despite nearly identical rates of progression to AD dementia. CONCLUSION Two clinical-pathological AD subtypes are identified with potential implications for preventative efforts.
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Affiliation(s)
- Anna E Blanken
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Shubir Dutt
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Yanrong Li
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Daniel A Nation
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
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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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48
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VandeVrede L, Dale ML, Fields S, Frank M, Hare E, Heuer HW, Keith K, Koestler M, Ljubenkov PA, McDermott D, Ohanesian N, Richards J, Rojas JC, Thijssen EH, Walsh C, Wang P, Wolf A, Quinn JF, Tsai R, Boxer AL. Open-Label Phase 1 Futility Studies of Salsalate and Young Plasma in Progressive Supranuclear Palsy. Mov Disord Clin Pract 2020; 7:440-447. [PMID: 32373661 PMCID: PMC7197321 DOI: 10.1002/mdc3.12940] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a neurodegenerative disease without approved therapies, and therapeutics are often tried off-label in the hope of slowing disease progression. Results from these experiences are seldom shared, which limits evidence-based knowledge to guide future treatment decisions. OBJECTIVES To describe an open-label experience, including safety/tolerability, and longitudinal changes in biomarkers of disease progression in PSP-Richardson's syndrome (PSP-RS) patients treated with either salsalate or young plasma and compare to natural history data from previous multicenter studies. METHODS For 6 months, 10 PSP-RS patients received daily salsalate 2,250 mg, and 5 patients received monthly infusions of four units of young plasma. Every 3 months, clinical severity was assessed with the Progressive Supranuclear Palsy Rating Scale (PSPRS), and MRI was obtained for volumetric measurement of midbrain. A range of exploratory biomarkers, including cerebrospinal fluid levels of neurofilament light chain, were collected at baseline and 6 months. Interventional data were compared to historical PSP-RS patients from the davunetide clinical trial and the 4-Repeat Tauopathy Neuroimaging Initiative. RESULTS Salsalate and young plasma were safe and well tolerated. PSPRS change from baseline (mean ± standard deviation [SD]) was similar in salsalate (+5.6 ± 9.6), young plasma (+5.0 ± 7.1), and historical controls (+5.6 ± 7.1), and change in midbrain volume (cm3 ± SD) did not differ between salsalate (-0.07 ± 0.03), young plasma (-0.06 ± 0.03), and historical controls (-0.06 ± 0.04). No differences were observed between groups on any exploratory endpoint. CONCLUSIONS Neither salsalate nor young plasma had a detectable effect on disease progression in PSP-RS. Focused open-label clinical trials incorporating historical clinical, neuropsychological, fluid, and imaging biomarkers provide useful preliminary data about the promise of novel PSP-directed therapies.
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Affiliation(s)
- Lawren VandeVrede
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Marian L. Dale
- OHSU Parkinson Center and Movement Disorder Program, Department of NeurologyOregon Health and Science UniversityPortland, OregonUSA
| | - Scott Fields
- Department of Pharmaceutical ServicesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Megan Frank
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Emma Hare
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Hilary W. Heuer
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Kellie Keith
- OHSU Parkinson Center and Movement Disorder Program, Department of NeurologyOregon Health and Science UniversityPortland, OregonUSA
| | - Mary Koestler
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Peter A. Ljubenkov
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Dana McDermott
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Noelle Ohanesian
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Jennifer Richards
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Julio C. Rojas
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Elisabeth H. Thijssen
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Neurochemistry Laboratory, Department of Clinical ChemistryVU University Medical CenterAmsterdamThe Netherlands
| | - Christine Walsh
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Ping Wang
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Amy Wolf
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Joseph F. Quinn
- OHSU Parkinson Center and Movement Disorder Program, Department of NeurologyOregon Health and Science UniversityPortland, OregonUSA
| | - Richard Tsai
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Adam L. Boxer
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
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49
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van de Beek M, Babapour Mofrad R, van Steenoven I, Vanderstichele H, Scheltens P, Teunissen CE, Lemstra AW, van der Flier WM. Sex-specific associations with cerebrospinal fluid biomarkers in dementia with Lewy bodies. ALZHEIMERS RESEARCH & THERAPY 2020; 12:44. [PMID: 32303272 PMCID: PMC7165383 DOI: 10.1186/s13195-020-00610-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/31/2020] [Indexed: 02/08/2023]
Abstract
Background Dementia with Lewy bodies (DLB) is more prevalent in men than in women. In addition, post-mortem studies found sex differences in underlying pathology. It remains unclear whether these differences are also present antemortem in in vivo biomarkers, and whether sex differences translate to variability in clinical manifestation. The objective of this study was to evaluate sex differences in cerebrospinal fluid (CSF) biomarker concentrations (i.e., alpha-synuclein (α-syn), amyloid β1-42 (Aβ42), total tau (Tau), phosphorylated tau at threonine 181 (pTau)) and clinical characteristics in DLB. Methods We included 223 DLB patients from the Amsterdam Dementia Cohort, of which 39 were women (17%, age 70 ± 6, MMSE 21 ± 6) and 184 men (83%, age 68 ± 7, MMSE 23 ± 4). Sex differences in CSF biomarker concentrations (i.e., α-syn, Aβ42, Tau, and pTau) were evaluated using age-corrected general linear models (GLM). In addition, we analyzed sex differences in core clinical features (i.e., visual hallucinations, parkinsonism, cognitive fluctuations, and REM sleep behavior disorder (RBD) and cognitive test scores using age- and education-adjusted GLM. Results Women had lower CSF α-syn levels (F 1429 ± 164 vs M 1831 ± 60, p = 0.02) and CSF Aβ42 levels (F 712 ± 39 vs M 821 ± 18, p = 0.01) compared to men. There were no sex differences for (p) Tau concentrations (p > 0.05). Clinically, women were older, had a shorter duration of complaints (F 2 ± 1 vs M 4 ± 3, p < 0.001), more frequent hallucinations (58% vs 38%, p = 0.02), and scored lower on MMSE and a fluency task (MMSE, p = 0.02; animal fluency, p = 0.006). Men and women did not differ on fluctuations, RBD, parkinsonism, or other cognitive tests. Conclusions Women had lower Aβ42 and α-syn levels than men, alongside a shorter duration of complaints. Moreover, at the time of diagnosis, women had lower cognitive test scores and more frequent hallucinations. Based on our findings, one could hypothesize that women have a more aggressive disease course in DLB compared to men. Future research should investigate whether women and men with DLB might benefit from sex-specific treatment strategies.
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Affiliation(s)
- M van de Beek
- Alzheimer Center Amsterdam & Department of Neurology, Neuroscience Campus Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
| | - R Babapour Mofrad
- Alzheimer Center Amsterdam & Department of Neurology, Neuroscience Campus Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.,Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - I van Steenoven
- Alzheimer Center Amsterdam & Department of Neurology, Neuroscience Campus Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.,Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | | | - P Scheltens
- Alzheimer Center Amsterdam & Department of Neurology, Neuroscience Campus Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - C E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - A W Lemstra
- Alzheimer Center Amsterdam & Department of Neurology, Neuroscience Campus Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - W M van der Flier
- Alzheimer Center Amsterdam & Department of Neurology, Neuroscience Campus Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
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50
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van de Beek M, van Steenoven I, van der Zande JJ, Barkhof F, Teunissen CE, van der Flier WM, Lemstra AW. Prodromal Dementia With Lewy Bodies: Clinical Characterization and Predictors of Progression. Mov Disord 2020; 35:859-867. [PMID: 32048343 PMCID: PMC7317511 DOI: 10.1002/mds.27997] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 01/06/2023] Open
Abstract
Objective The objective of this study was to examine clinical characteristics, cognitive decline, and predictors for time to dementia in prodromal dementia with Lewy bodies with mild cognitive impairment (MCI‐LB) compared with prodromal Alzheimer's disease (MCI‐AD). Methods We included 73 MCI‐LB patients (12% female; 68 ± 6 years; Mini Mental State Examination, 27 ± 2) and 124 MCI‐AD patients (48% female; 68 ± 7 years; Mini Mental State Examination, 27 ± 2) from the Amsterdam Dementia Cohort. Follow‐up was available for 61 MCI‐LB patients and all MCI‐AD patients (3 ± 2 years). We evaluated dementia with Lewy bodies core features, neuropsychiatric symptoms, caregiver burden (Zarit caregiver burden interview), MRI, apolipoprotein genotype, and cerebrospinal fluid biomarkers (tau/Aβ1–42 ratio). Longitudinal outcome measures included cognitive slopes (memory, attention, executive functions, and language and visuospatial functions) and time to dementia. Results Parkinsonism was the most frequently present core feature in MCI‐LB (69%). MCI‐LB patients more often had neuropsychiatric symptoms and scored higher on ZARIT when compared with the MCI‐AD patients. Linear mixed models showed that at baseline, MCI‐LB patients performed worse on nonmemory cognitive domains, whereas memory performance was worse in MCI‐AD patients. Over time, MCI‐LB patients declined faster on attention, whereas MCI‐AD patients declined faster on the Mini Mental State Examination and memory. Cox proportional hazards regressions showed that in the MCI‐LB patients, lower attention (hazard ratio [HR] = 1.6; 95% confidence interval [CI], 1.1–2.3) and more posterior cortical atrophy (HR = 3.0; 95% CI, 1.5–5.8) predicted shorter time to dementia. In the MCI‐AD patients, worse performance on memory (HR = 1.1; 95% CI, 1.0–1.2) and executive functions (HR = 1.3; 95% CI, 1.0–1.6) were independently associated with time to Alzheimer's dementia. Conclusion MCI‐LB patients have distinct neuropsychiatric and cognitive profiles with prominent decline in attention when compared with MCI‐AD patients. Our results highlight the importance of early diagnosis because symptoms already have an impact in the prodromal stages. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marleen van de Beek
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Inger van Steenoven
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jessica J van der Zande
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, the Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, England, United Kingdom
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Afina W Lemstra
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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