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Lagarde J, Olivieri P, Bottlaender M, Sarazin M. Diagnosi clinicolaboratoristica della malattia di Alzheimer. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Valenzuela O, Jiang X, Carrillo A, Rojas I. Multi-Objective Genetic Algorithms to Find Most Relevant Volumes of the Brain Related to Alzheimer's Disease and Mild Cognitive Impairment. Int J Neural Syst 2018; 28:1850022. [DOI: 10.1142/s0129065718500223] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Computer-Aided Diagnosis (CAD) represents a relevant instrument to automatically classify between patients with and without Alzheimer's Disease (AD) using several actual imaging techniques. This study analyzes the optimization of volumes of interest (VOIs) to extract three-dimensional (3D) textures from Magnetic Resonance Image (MRI) in order to diagnose AD, Mild Cognitive Impairment converter (MCIc), Mild Cognitive Impairment nonconverter (MCInc) and Normal subjects. A relevant feature of the proposed approach is the use of 3D features instead of traditional two-dimensional (2D) features, by using 3D discrete wavelet transform (3D-DWT) approach for performing feature extraction from T-1 weighted MRI. Due to the high number of coefficients when applying 3D-DWT to each of the VOIs, a feature selection algorithm based on mutual information is used, as is the minimum Redundancy Maximum Relevance (mRMR) algorithm. Region optimization has been performed in order to discover the most relevant regions (VOIs) in the brain with the use of Multi-Objective Genetic Algorithms, being one of the objectives to be optimize the accuracy of the system. The error index of the system is computed by the confusion matrix obtained by the multi-class support vector machine (SVM) classifier. Principal Component Analysis (PCA) is used with the purpose of reducing the number of features to the classifier. The cohort of subjects used in the study consisted of 296 different patients. A first group of 206 patients was used to optimize VOI selection and another group of 90 independent subjects (that did not belong to the first group) was used to test the solutions yielded by the genetic algorithm. The proposed methodology obtains excellent results in multi-class classification achieving accuracies of 94.4% and also extracting significant information on the location of the most relevant points of the brain. This suggests that the proposed method could aid in the research of other neurodegenerative diseases, improving the accuracy of the diagnosis and finding the most relevant regions of the brain associated with them.
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Affiliation(s)
- Olga Valenzuela
- Department of Applied Mathematics, University of Granada, Spain
| | - Xiaoyi Jiang
- Department of Computer Science, University of Munster, Germany
| | - Antonio Carrillo
- Department of Computer Architecture and Computer Technology, University of Granada, Spain
| | - Ignacio Rojas
- Department of Computer Architecture and Computer Technology, CITIC-UGR, University of Granada, Spain
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Moonga I, Niccolini F, Wilson H, Pagano G, Politis M. Hypertension is associated with worse cognitive function and hippocampal hypometabolism in Alzheimer's disease. Eur J Neurol 2017; 24:1173-1182. [PMID: 28752644 DOI: 10.1111/ene.13374] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/12/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE A growing body of evidence suggests that cardiovascular disease risk factors including hypertension may be linked to sporadic Alzheimer's disease (AD). It is well known that hypertension is associated with cerebrovascular disease and vascular dementia on the basis of vascular remodeling. However, the mechanisms linking hypertension and AD remain unclear. METHODS We studied 197 patients with AD (86 male; mean age ± SD: 75.8 ± 7.4 years) from the Alzheimer's Disease Neuroimaging Initiative database with (n = 97) and without (n = 100) hypertension. We explored associations between hypertension and clinical, plasma, cerebrospinal fluid and imaging markers of AD pathology in order to elucidate the underlying mechanisms that may link AD and hypertension. RESULTS We found that patients with AD with hypertension had worse cognitive function (Alzheimer's disease Assessment Scale-cognitive subscale, P = 0.038) and higher neuropsychiatric symptom burden (Neuropsychiatric Inventory Questionnaire, P = 0.016) compared with those without hypertension. Patients with AD with hypertension showed reduced glucose hypometabolism in the right (P < 0.001) and left (P = 0.007) hippocampus. No differences were found in magnetic resonance imaging volumetric measurements, [18 F]florbetapir uptakes, plasma and cerebrospinal fluid between patients with AD with and without hypertension. CONCLUSIONS Although hypertension is associated with worse cognitive function, behavioural symptoms and hippocampal glucose hypometabolism, it is not associated with evidence of increased amyloid or tau pathology. Effective management of hypertension may potentially have a therapeutic role in the alleviation of symptoms in AD.
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Affiliation(s)
- I Moonga
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College London, London, UK
| | - F Niccolini
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College London, London, UK
| | - H Wilson
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College London, London, UK
| | - G Pagano
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College London, London, UK
| | - M Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College London, London, UK
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Carrabba LHG, Menta C, Fasolin EM, Loureiro F, Gomes I. Psychometric characteristics of the full and short versions of the IQCODE-BR among low income elderly persons with a low educational level. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.14034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : To study the psychometric characteristics of the Brazilian Portuguese version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-BR) using a sample of low income elderly persons with a low educational level, and compare the full and short versions of the questionnaire. Method : A cross-sectional study of a convenience sample of a population with a low educational level was performed. The IQCODE-BR was applied to the informants of 87 elderly persons (60-90 years old), who were triaged by psychiatrists and neurologists for the diagnosis of depression, mild cognitive impairment (MCI), and dementia. Results : The median age of the sample was 72 and the majority were women (72.4%). A total of 31 (35.6%) were illiterate, 30 (34.5%) had dementia, 21 (24.1%) suffered from depression, 20 (23.0%) had MCI, and 16 (18.4%) were diagnosed with none of these conditions. The median IQCODE-BR was higher in the groups with depression and MCI than the normal group, and was highest of all in the group with dementia. The full and reduced versions of the IQCODE-BR had similar levels of accuracy. Conclusion : In this sample the IQCODE-BR was shown to be an effective tool for tracking MCI and dementia. The use of the short version with cut-off points of 3.22 for MCI excluding a diagnosis of depression, and 3.48 for dementia irrespective of the presence of symptoms of depression, is suggested.
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Affiliation(s)
| | - Caroline Menta
- Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
| | | | | | - Irenio Gomes
- Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
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Hamelin L, Bertoux M, Bottlaender M, Corne H, Lagarde J, Hahn V, Mangin JF, Dubois B, Chupin M, de Souza LC, Colliot O, Sarazin M. Sulcal morphology as a new imaging marker for the diagnosis of early onset Alzheimer's disease. Neurobiol Aging 2015; 36:2932-2939. [PMID: 26256787 DOI: 10.1016/j.neurobiolaging.2015.04.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 11/16/2022]
Abstract
We investigated the utility of sulcal width measures in the diagnosis of Alzheimer's disease (AD). Sixty-six biologically confirmed AD patients (positive amyloid positron emission tomography [PET] and/or AD cerebrospinal fluid profile) were contrasted to 35 controls with negative amyloid PET. Patients were classified into prodromal or dementia stages as well as into late onset (LOAD, n = 31) or early onset (EOAD, n = 35) subgroups according to their age of onset. An automated method was used to calculate sulcal widths and hippocampal volumes (HV). In EOAD, the greatest ability to differentiate patients from age-matched controls, regardless of severity, was displayed by sulcal width of the temporoparietal cortex. In this region, diagnosis accuracy was better than the HV, especially at prodromal stage. In LOAD, HV provided the best discrimination power from age-matched controls. In conclusion, sulcal width measures are better markers than the HV for identifying prodromal AD in patients aged <65 years. In contrast, in older patients, the risk of over-diagnosis from using only sulcal enlargement is important.
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Affiliation(s)
- Lorraine Hamelin
- Department of Neurology of Memory and Language, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, Centre Hospitalier Sainte Anne, Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.
| | - Maxime Bertoux
- Department of Neurology of Memory and Language, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, Centre Hospitalier Sainte Anne, Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, Paris, France; Department of Clinical Neurosiences, University of Cambridge, UK
| | - Michel Bottlaender
- NeuroSpin, Institut d'Imagerie Biomédicale, Direction des sciences du vivant, Commissariat à l'Energie Atomique, Gif-sur-Yvette, France; Laboratoire Imagerie Moléculaire In Vivo, UMR 1023, Service Hospitalier Frédéric Joliot, Institut d'Imagerie Biomédicale, Direction des sciences du vivant, Commissariat à l'Energie Atomique, Orsay, France
| | - Helene Corne
- Department of Neurology of Memory and Language, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, Centre Hospitalier Sainte Anne, Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Julien Lagarde
- Department of Neurology of Memory and Language, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, Centre Hospitalier Sainte Anne, Paris, France
| | - Valérie Hahn
- Department of Neurology of Memory and Language, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, Centre Hospitalier Sainte Anne, Paris, France
| | - Jean-François Mangin
- NeuroSpin, Institut d'Imagerie Biomédicale, Direction des sciences du vivant, Commissariat à l'Energie Atomique, Gif-sur-Yvette, France
| | - Bruno Dubois
- Institut du Cerveau et de la Moelle épinière, ICM, Paris, France; Department of Neurology, Salpêtrière Hospital, APHP, Paris, France
| | - Marie Chupin
- Institut du Cerveau et de la Moelle épinière, ICM, Paris, France; Inserm, U1127, Paris, France; CNRS, UMR 7225, ICM, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Paris, France; Inria, Aramis project-team, Centre de Recherche Paris-Rocquencourt, France
| | - Leonardo Cruz de Souza
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Olivier Colliot
- Institut du Cerveau et de la Moelle épinière, ICM, Paris, France; Inserm, U1127, Paris, France; CNRS, UMR 7225, ICM, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Paris, France; Inria, Aramis project-team, Centre de Recherche Paris-Rocquencourt, France
| | - Marie Sarazin
- Department of Neurology of Memory and Language, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, Centre Hospitalier Sainte Anne, Paris, France
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Beckett LA, Donohue MC, Wang C, Aisen P, Harvey DJ, Saito N. The Alzheimer's Disease Neuroimaging Initiative phase 2: Increasing the length, breadth, and depth of our understanding. Alzheimers Dement 2015; 11:823-31. [PMID: 26194315 PMCID: PMC4510463 DOI: 10.1016/j.jalz.2015.05.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The Alzheimer's Disease Neuroimaging Initiative (ADNI) is a multisite study designed to characterize the trajectories of biomarkers across the aging process. We present ADNI Biostatistics Core analyses that integrate data over the length, breadth, and depth of ADNI. METHODS Relative progression of key imaging, fluid, and clinical measures was assessed. Individuals with subjective memory complaints (SMC) and early mild cognitive impairment (eMCI) were compared with normal controls (NC), MCI, and individuals with Alzheimer's disease. Amyloid imaging and magnetic resonance imaging (MRI) summaries were assessed as predictors of disease progression. RESULTS Relative progression of markers supports parts of the amyloid cascade hypothesis, although evidence of earlier occurrence of cognitive change exists. SMC are similar to NC, whereas eMCI fall between the cognitively normal and MCI groups. Amyloid leads to faster conversion and increased cognitive impairment. DISCUSSION Analyses support features of the amyloid hypothesis, but also illustrate the considerable heterogeneity in the aging process.
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Affiliation(s)
- Laurel A Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA.
| | - Michael C Donohue
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Cathy Wang
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Paul Aisen
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Danielle J Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Naomi Saito
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
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Snyder HM, Hendrix J, Bain LJ, Carrillo MC. Alzheimer's disease research in the context of the national plan to address Alzheimer's disease. Mol Aspects Med 2015; 43-44:16-24. [PMID: 26096321 DOI: 10.1016/j.mam.2015.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/10/2015] [Accepted: 06/10/2015] [Indexed: 12/22/2022]
Abstract
In 2012, the first National Plan to Address Alzheimer's Disease in the United States (U.S.) was released, a component of the National Alzheimer's Project Act legislation. Since that time, there have been incremental increases in U.S. federal funding for Alzheimer's disease and related dementia research, particularly in the areas of biomarker discovery, genetic link and related biological underpinnings, and prevention studies for Alzheimer's. A central theme in each of these areas has been the emphasis of cross-sector collaboration and private-public partnerships between government, non-profit organizations and for-profit organizations. This paper will highlight multiple private-public partnerships supporting the advancement of Alzheimer's research in the context of the National Plan to Address Alzheimer's.
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Affiliation(s)
- Heather M Snyder
- Alzheimer's Association, Medical & Scientific Relations, Chicago, IL, USA.
| | - James Hendrix
- Alzheimer's Association, Medical & Scientific Relations, Chicago, IL, USA
| | - Lisa J Bain
- Independent Science Writer, Philadelphia, PA, USA
| | - Maria C Carrillo
- Alzheimer's Association, Medical & Scientific Relations, Chicago, IL, USA
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Madeira C, Lourenco MV, Vargas-Lopes C, Suemoto CK, Brandão CO, Reis T, Leite REP, Laks J, Jacob-Filho W, Pasqualucci CA, Grinberg LT, Ferreira ST, Panizzutti R. d-serine levels in Alzheimer's disease: implications for novel biomarker development. Transl Psychiatry 2015; 5:e561. [PMID: 25942042 PMCID: PMC4471283 DOI: 10.1038/tp.2015.52] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 01/19/2015] [Accepted: 02/08/2015] [Indexed: 02/08/2023] Open
Abstract
Alzheimer's disease (AD) is a severe neurodegenerative disorder still in search of effective methods of diagnosis. Altered levels of the NMDA receptor co-agonist, d-serine, have been associated with neurological disorders, including schizophrenia and epilepsy. However, whether d-serine levels are deregulated in AD remains elusive. Here, we first measured D-serine levels in post-mortem hippocampal and cortical samples from nondemented subjects (n=8) and AD patients (n=14). We next determined d-serine levels in experimental models of AD, including wild-type rats and mice that received intracerebroventricular injections of amyloid-β oligomers, and APP/PS1 transgenic mice. Finally, we assessed d-serine levels in the cerebrospinal fluid (CSF) of 21 patients with a diagnosis of probable AD, as compared with patients with normal pressure hydrocephalus (n=9), major depression (n=9) and healthy controls (n=10), and results were contrasted with CSF amyloid-β/tau AD biomarkers. d-serine levels were higher in the hippocampus and parietal cortex of AD patients than in control subjects. Levels of both d-serine and serine racemase, the enzyme responsible for d-serine production, were elevated in experimental models of AD. Significantly, d-serine levels were higher in the CSF of probable AD patients than in non-cognitively impaired subject groups. Combining d-serine levels to the amyloid/tau index remarkably increased the sensitivity and specificity of diagnosis of probable AD in our cohort. Our results show that increased brain and CSF d-serine levels are associated with AD. CSF d-serine levels discriminated between nondemented and AD patients in our cohort and might constitute a novel candidate biomarker for early AD diagnosis.
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Affiliation(s)
- C Madeira
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - M V Lourenco
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - C Vargas-Lopes
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - C K Suemoto
- Discipline of Geriatrics, University of São Paulo Medical School, Sao Paulo, Brazil
| | - C O Brandão
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - T Reis
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R E P Leite
- Department of Pathology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - J Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - W Jacob-Filho
- Discipline of Geriatrics, University of São Paulo Medical School, Sao Paulo, Brazil
| | - C A Pasqualucci
- Department of Pathology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - L T Grinberg
- Department of Pathology, University of São Paulo Medical School, Sao Paulo, Brazil
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - S T Ferreira
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R Panizzutti
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
Specific therapies for neurologic diseases such as Alzheimer's disease provide the potential for better clinical outcomes. Expression of caspases in the brain is developmentally regulated, and dysregulated in neurologic disease, supporting that caspases may be therapeutic targets. The activity of caspases is carefully regulated via binding partners, cleavage, or endogenous inhibitors to prevent spontaneous activation, which could lead to aberrant cell death. This review serves as a brief examination of the current understanding of the regulation and function of caspases, and approaches to specifically target aberrant caspase activity. The use of proper tools to investigate individual caspases is addressed. Moreover, it summarizes the reports of various caspases in Alzheimer's disease studies. A better understanding of specific caspase pathways in heath and neurodegenerative disease is crucial for identifying specific targets for the development of therapeutic interventions.
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Affiliation(s)
- Carol M Troy
- Department of Pathology and Cell Biology, Columbia University Medical Center, 650 W. 168th Street, New York, NY, 10032, USA,
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Lehmann S, Dumurgier J, Schraen S, Wallon D, Blanc F, Magnin E, Bombois S, Bousiges O, Campion D, Cretin B, Delaby C, Hannequin D, Jung B, Hugon J, Laplanche JL, Miguet-Alfonsi C, Peoc'h K, Philippi N, Quillard-Muraine M, Sablonnière B, Touchon J, Vercruysse O, Paquet C, Pasquier F, Gabelle A. A diagnostic scale for Alzheimer's disease based on cerebrospinal fluid biomarker profiles. ALZHEIMERS RESEARCH & THERAPY 2014; 6:38. [PMID: 25478015 PMCID: PMC4255520 DOI: 10.1186/alzrt267] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/13/2014] [Indexed: 01/18/2023]
Abstract
Introduction The relevance of the cerebrospinal fluid (CSF) biomarkers for the diagnosis of Alzheimer’s disease (AD) and related disorders is clearly established. However, the question remains on how to use these data, which are often heterogeneous (not all biomarkers being pathologic). The objective of this study is to propose to physicians in memory clinics a biologic scale of probabilities that the patient with cognitive impairments has an Alzheimer’s disease (AD) pathologic process. Methods For that purpose, we took advantage of the multicenter data of our Paris-North, Lille, and Montpellier (PLM) study, which has emerged through the initial sharing of information from these memory centers. Different models combining the CSF levels of amyloid-β 42, tau, and p-tau(181) were tested to generate categories of patients with very low (<10%), low (<25%), high (>75%), and very high predictive values (>90%) for positive AD. In total, 1,273 patients (646 AD and 627 non-AD) from six independent memory-clinic cohorts were included. Results A prediction model based on logistic regressions achieved a very good stratification of the population but had the disadvantages of needing mathematical optimization and being difficult to use in daily clinical practice. Remarkably, a simple and intuitive model based on the number (from zero to three) of three pathologic CSF biomarkers resulted in a very efficient predictive scale for AD in patients seen in memory clinics. The scale’s overall predictive value for AD for the different categories were as follows: class 0, 9.6% (95% confidence interval (CI), 6.0% to 13.2%); class 1, 24.7% (95% CI, 18.0% to 31.3%); class 2, 77.2% (95% CI, 67.8% to 86.5%); and class 3, 94.2% (95% CI, 90.7% to 97.7%). In addition, with this scale, significantly more patients were correctly classified than with the logistic regression. Its superiority in model performance was validated by the computation of the net reclassification index (NRI). The model was also validated in an independent multicenter dataset of 408 patients (213 AD and 195 non-AD). Conclusions In conclusion, we defined a new scale that could be used to facilitate the interpretation and routine use of multivariate CSF data, as well as helping the stratification of patients in clinical research trials.
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Affiliation(s)
- Sylvain Lehmann
- CHU de Montpellier and Université Montpellier I, IRMB, CCBHM, Laboratoire de Biochimie Protéomique Clinique, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Julien Dumurgier
- Centre Mémoire Ressources Recherche Paris Nord Ile de France and Histologie et Biologie du Vieillissement, Groupe Hospitalier Saint-Louis Lariboisiere Fernand-Widal APHP, INSERM U942, Universite Paris Diderot, France
| | - Susanna Schraen
- Inserm U837 and Neurobiology Unit, Centre de Biologie-Pathologie, CHU, Universite Lille Nord de France, 59045 Lille, France
| | - David Wallon
- Inserm U1079, University of Rouen, Department of Neurology and Laboratoire de biochimie, Rouen University Hospital, Rouen, France
| | - Frédéric Blanc
- Centre Mémoire Ressources Recherche, Alsace; Department of Neurology, University Hospital of Strasbourg, Strasbourg, France ; 2 ICube laboratory and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS-Neurocrypto, University of Strasbourg and CNRS, Strasbourg, France
| | - Eloi Magnin
- Centre Mémoire Ressources Recherche Besancon Franche-Comté, Department of Neurology, CHU Besançon, Besançon, France
| | - Stéphanie Bombois
- Centre Mémoire Ressources Recherche, CHU, EA1040 Université Lille Nord de France, 59000 Lille, France
| | - Olivier Bousiges
- Centre Mémoire Ressources Recherche, Alsace; Department of Neurology, University Hospital of Strasbourg, Strasbourg, France ; Laboratoire de Biochimie et de Biologie Moléculaire, Hôpital de Hautepierre, Hôpitaux Universitaire de Strasbourg, Strasbourg, France ; Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), UMR7364, Université de Strasbourg-CNRS, Strasbourg, France
| | - Dominique Campion
- Inserm U1079, University of Rouen, Department of Neurology and Laboratoire de biochimie, Rouen University Hospital, Rouen, France
| | - Benjamin Cretin
- Centre Mémoire Ressources Recherche, Alsace; Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | - Constance Delaby
- CHU de Montpellier and Université Montpellier I, IRMB, CCBHM, Laboratoire de Biochimie Protéomique Clinique, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Didier Hannequin
- Inserm U1079, University of Rouen, Department of Neurology and Laboratoire de biochimie, Rouen University Hospital, Rouen, France
| | - Barbara Jung
- Centre Mémoire Ressources Recherche, Alsace; Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | - Jacques Hugon
- Centre Mémoire Ressources Recherche Paris Nord Ile de France and Histologie et Biologie du Vieillissement, Groupe Hospitalier Saint-Louis Lariboisiere Fernand-Widal APHP, INSERM U942, Universite Paris Diderot, France
| | - Jean-Louis Laplanche
- Laboratoire de Biochimie Lariboisière-Fernand Widal Hospital, APHP, University Paris 7-Denis Diderot, University Paris Descartes, Paris, France
| | | | - Katell Peoc'h
- Laboratoire de Biochimie Lariboisière-Fernand Widal Hospital, APHP, University Paris 7-Denis Diderot, University Paris Descartes, Paris, France
| | - Nathalie Philippi
- Centre Mémoire Ressources Recherche, Alsace; Department of Neurology, University Hospital of Strasbourg, Strasbourg, France ; 2 ICube laboratory and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS-Neurocrypto, University of Strasbourg and CNRS, Strasbourg, France
| | - Muriel Quillard-Muraine
- Inserm U1079, University of Rouen, Department of Neurology and Laboratoire de biochimie, Rouen University Hospital, Rouen, France
| | - Bernard Sablonnière
- Inserm U837 and Neurobiology Unit, Centre de Biologie-Pathologie, CHU, Universite Lille Nord de France, 59045 Lille, France
| | - Jacques Touchon
- Centre Mémoire Ressources Recherche Languedoc-Roussillon, CHU de Montpellier, Hôpital Gui de Chauliac, Montpellier, and Université Montpellier I, Montpellier, France
| | - Olivier Vercruysse
- Inserm U837 and Neurobiology Unit, Centre de Biologie-Pathologie, CHU, Universite Lille Nord de France, 59045 Lille, France
| | - Claire Paquet
- Centre Mémoire Ressources Recherche Paris Nord Ile de France and Histologie et Biologie du Vieillissement, Groupe Hospitalier Saint-Louis Lariboisiere Fernand-Widal APHP, INSERM U942, Universite Paris Diderot, France
| | - Florence Pasquier
- Centre Mémoire Ressources Recherche, CHU, EA1040 Université Lille Nord de France, 59000 Lille, France
| | - Audrey Gabelle
- CHU de Montpellier and Université Montpellier I, IRMB, CCBHM, Laboratoire de Biochimie Protéomique Clinique, 80 Avenue Augustin Fliche, 34295 Montpellier, France ; Centre Mémoire Ressources Recherche Languedoc-Roussillon, CHU de Montpellier, Hôpital Gui de Chauliac, Montpellier, and Université Montpellier I, Montpellier, France
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11
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Sarazin M, Hamelin L, Lamari F, Bottlaender M. Diagnosticare la malattia di Alzheimer. Neurologia 2014. [DOI: 10.1016/s1634-7072(14)67223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Wikler EM, Blendon RJ, Benson JM. Would you want to know? Public attitudes on early diagnostic testing for Alzheimer's disease. Alzheimers Res Ther 2013; 5:43. [PMID: 24010759 PMCID: PMC3978817 DOI: 10.1186/alzrt206] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 06/17/2013] [Accepted: 09/06/2013] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Research is underway to develop an early medical test for Alzheimer's disease (AD). METHODS To evaluate potential demand for such a test, we conducted a cross-sectional telephone survey of 2,678 randomly selected adults across the United States and four European countries. RESULTS Most surveyed adults (67%) reported that they are "somewhat" or "very likely" to get an early medical test if one becomes available in the future. Interest was higher among those worried about developing AD, those with an immediate blood relative with AD, and those who have served as caregivers for AD patients. Older respondents and those living in Spain and Poland also exhibited greater interest in testing. Knowing AD is a fatal condition did not influence demand for testing, except among those with an immediate blood relative with the disease. CONCLUSIONS Potential demand for early medical testing for AD could be high. A predictive test could not only advance medical research, it could transform political and legal landscapes by creating a large constituency of asymptomatic, diagnosed adults.
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Affiliation(s)
- Elizabeth M Wikler
- Harvard Graduate School of Arts and Sciences, 14 Story Street, 4th Floor, Cambridge, MA 02138 USA
| | - Robert J Blendon
- Department of Health Policy and Management, 677 Huntington Avenue, Kresge Building, Room 402, Boston, MA 02115 USA
| | - John M Benson
- Department of Health Policy and Management, 677 Huntington Avenue, Kresge Building, Room 402, Boston, MA 02115 USA
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13
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Gandy S, DeKosky ST. Toward the treatment and prevention of Alzheimer's disease: rational strategies and recent progress. Annu Rev Med 2013; 64:367-83. [PMID: 23327526 DOI: 10.1146/annurev-med-092611-084441] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Alzheimer's disease (AD) is the major cause of late-life brain failure. In the past 25 years, autosomal dominant forms of AD were found to be primariy attributable to mutations in one of two presenilins, polytopic proteins that contain the catalytic site of the γ-secretase protease that releases the amyloid beta (Aβ) peptide. Some familial AD is also due to mutations in the amyloid precursor protein (APP), but recently a mutation in APP was discovered that reduces Aβ generation and is protective against AD, further implicating amyloid metabolism. Prion-like seeding of amyloid fibrils and neurofibrillary tangles has been invoked to explain the stereotypical spread of AD within the brain. Treatment trials with anti-Aβ antibodies have shown target engagement, if not significant treatment effects. Attention is increasingly focused on presymptomatic intervention, because Aβ mismetabolism begins up to 25 years before symptoms begin. AD trials deriving from new biological information involve extraordinary international collaboration and may hold the best hope for success in the fight against AD.
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Affiliation(s)
- Sam Gandy
- Mount Sinai School of Medicine and James J. Peters Veterans Affairs Medical Center, New York, New York 10029, USA.
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14
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Leclerc B, Abulrob A. Perspectives in molecular imaging using staging biomarkers and immunotherapies in Alzheimer's disease. ScientificWorldJournal 2013; 2013:589308. [PMID: 23476143 PMCID: PMC3576798 DOI: 10.1155/2013/589308] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 12/20/2012] [Indexed: 01/02/2023] Open
Abstract
Sporadic Alzheimer's disease (AD) is an emerging chronic illness characterized by a progressive pleiotropic pathophysiological mode of actions triggered during the senescence process and affecting the elderly worldwide. The complex molecular mechanisms of AD not only are supported by cholinergic, beta-amyloid, and tau theories but also have a genetic basis that accounts for the difference in symptomatology processes activation among human population which will evolve into divergent neuropathological features underlying cognitive and behaviour alterations. Distinct immune system tolerance could also influence divergent responses among AD patients treated by immunotherapy. The complexity in nature increases when taken together the genetic/immune tolerance with the patient's brain reserve and with neuropathological evolution from early till advance AD clinical stages. The most promising diagnostic strategies in today's world would consist in performing high diagnostic accuracy of combined modality imaging technologies using beta-amyloid 42 peptide-cerebrospinal fluid (CSF) positron emission tomography (PET), Pittsburgh compound B-PET, fluorodeoxyglucose-PET, total and phosphorylated tau-CSF, and volumetric magnetic resonance imaging hippocampus biomarkers for criteria evaluation and validation. Early diagnosis is the challenge task that needs to look first at plausible mechanisms of actions behind therapies, and combining them would allow for the development of efficient AD treatment in a near future.
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Affiliation(s)
- Benoît Leclerc
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
| | - Abedelnasser Abulrob
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
- Institute for Biological Sciences, National Research Council Canada, 1200 Montreal Road, Building M-54, Ottawa, ON, Canada K1A 0R6
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15
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Sarazin M, de Souza LC, Lehéricy S, Dubois B. Clinical and Research Diagnostic Criteria for Alzheimer's Disease. Neuroimaging Clin N Am 2012; 22:23-32,viii. [DOI: 10.1016/j.nic.2011.11.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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16
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Hayden KM, Welsh-Bohmer KA. Epidemiology of cognitive aging and Alzheimer's disease: contributions of the cache county utah study of memory, health and aging. Curr Top Behav Neurosci 2012; 10:3-31. [PMID: 21809193 DOI: 10.1007/7854_2011_152] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Epidemiological studies of Alzheimer's disease (AD) provide insights into changing public health trends and their contribution to disease incidence. The current chapter considers how the population-based approach has contributed to our understanding of lifetime exposures that contribute to later disease risk and may act to modify onset of symptoms. We focus on the findings from a recent survey of an exceptionally long-lived population, the Cache County Utah Study of Memory, Health, and Aging. This study is confined to a single geographic population has allowed estimation of the genetic and environmental influences on AD expression across the expected human lifespan of 95+ years. Given the emphasis of this text on the behavioral neurosciences of aging, we highlight within the current chapter the particular contributions of this population-based study to the neuropsychology of aging and AD. We also discuss hypotheses generated from this survey with respect to factors that may either accelerate or delay symptom onset in AD and the conditions that appear to be associated with successful cognitive aging.
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Affiliation(s)
- Kathleen M Hayden
- Department of Psychiatry, Joseph and Kathleen Bryan Alzheimer's Disease Research Center-Division of Neurology, 2200 W. Main Street, Suite A200, Durham, NC, 27705, USA
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17
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de la Monte SM. Contributions of brain insulin resistance and deficiency in amyloid-related neurodegeneration in Alzheimer's disease. Drugs 2012; 72:49-66. [PMID: 22191795 PMCID: PMC4550303 DOI: 10.2165/11597760-000000000-00000] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Alzheimer's disease (AD) is the most common cause of dementia in North America. Growing evidence supports the concept that AD is fundamentally a metabolic disease that results in progressive impairment in the brain's capacity to utilize glucose and respond to insulin and insulin-like growth factor (IGF) stimulation. Moreover, the heterogeneous nature of AD is only partly explained by the brain's propensity to accumulate aberrantly processed, misfolded and aggregated oligomeric structural proteins, including amyloid-β peptides and hyperphosphorylated tau. Evidence suggests that other factors, including impaired energy metabolism, oxidative stress, neuroinflammation, insulin and IGF resistance, and insulin/IGF deficiency in the brain should be incorporated into an overarching hypothesis to develop more realistic diagnostic and therapeutic approaches to AD. In this review, the interrelationship between impaired insulin and IGF signalling and amyloid-β pathology is discussed along with potential therapeutic approaches. Impairments in brain insulin/IGF signalling lead to increased expression of amyloid-β precursor protein (AβPP) and accumulation of AβPP-Aβ. In addition, they promote oxidative stress and deficits in energy metabolism, leading to the activation of pro-AβPP-Aβ-mediated neurodegeneration cascades. Although brain insulin/IGF resistance and deficiency can be induced by primary or secondary disease processes, the soaring rates of peripheral insulin resistance associated with obesity, diabetes mellitus and metabolic syndrome quite likely play major roles in the current AD epidemic. Both clinical and experimental data have linked chronic hyperinsulinaemia to cognitive impairment and neurodegeneration with increased AβPP-Aβ accumulation/reduced clearance in the CNS. Correspondingly, both the restoration of insulin responsiveness and the use of insulin therapy can lead to improved cognitive performance, although with variable effects on brain AβPP-Aβ load. On the other hand, experimental evidence supports the concept that the toxic effects of AβPP-Aβ can promote insulin resistance. Together, these findings suggest that a positive feedback loop of progressive neurodegeneration can develop whereby insulin resistance drives AβPP-Aβ accumulation, and AβPP-Aβ fibril toxicity drives brain insulin resistance. This phenomenon could explain why measuring AβPP-Aβ levels in cerebrospinal fluid or imaging of the brain has proven to be inadequate as a stand-alone biomarker for diagnosing AD, and why the clinical trial results of anti-AβPP-Aβ monotherapy have been disappointing. Instead, the aggregate data suggest that brain insulin resistance and deficiency must also be therapeutically targeted to halt AD progression or reverse its natural course. The positive therapeutic effects of different treatments that address the role of brain insulin/IGF resistance and deficiency, including the use of intranasal insulin delivery, incretins and insulin sensitizer agents are discussed along with potential benefits of lifestyle changes to modify risk for developing mild cognitive impairment or AD. Altogether, the data strongly support the notion that we must shift toward the implementation of multimodal rather than unimodal diagnostic and therapeutic strategies for AD.
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Affiliation(s)
- Suzanne M de la Monte
- Department of Pathology, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
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18
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Neill D. Should Alzheimer's disease be equated with human brain ageing? A maladaptive interaction between brain evolution and senescence. Ageing Res Rev 2012; 11:104-22. [PMID: 21763787 DOI: 10.1016/j.arr.2011.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 06/26/2011] [Accepted: 06/28/2011] [Indexed: 10/18/2022]
Abstract
In this review Alzheimer's disease is seen as a maladaptive interaction between human brain evolution and senescence. It is predicted to occur in everyone although does not necessarily lead to dementia. The pathological process is initiated in relation to a senescence mediated functional down-regulation in the posteromedial cortex (Initiation Phase). This leads to a loss of glutamatergic excitatory input to layer II entorhinal cortex neurons. A human specific maladaptive neuroplastic response is initiated in these neurons leading to neuronal dysfunction, NFT formation and death. This leads to further loss of glutamatergic excitatory input and propagation of the maladaptive response along excitatory pathways linking evolutionary progressed vulnerable neurons (Propagation Phase). Eventually neurons are affected in many brain areas resulting in dementia. Possible therapeutic approaches include enhancing glutamatergic transmission. The theory may have implications with regards to how Alzheimer's disease is classified.
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Herrmann N, Chau SA, Kircanski I, Lanctôt KL. Current and Emerging Drug Treatment Options for Alzheimerʼs Disease. Drugs 2011; 71:2031-65. [DOI: 10.2165/11595870-000000000-00000] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Makino KM, Porsteinsson AP. Memantine: a treatment for Alzheimer’s disease with a new formulation. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In nearly 20 years, aside from cholinesterase inhibitors, memantine is the only drug approved for the treatment of Alzheimer’s disease (AD). Memantine is an uncompetitive N-methyl-D-aspartate receptor antagonist that blocks pathological glutamate activity while permitting normal physiological function, thus preventing glutamate-induced excitotoxicity. Three Phase III pivotal trials demonstrated memantine’s efficacy in treating moderate-to-severe AD, which led to its initial approval by the EMA in 2002 and US FDA in 2003. The recommended target dose is 10 mg twice daily. The US FDA recently approved an extended-release (ER) formulation of memantine for once-daily 28-mg dosing. Memantine ER was evaluated in a 24-week placebo-controlled trial of patients with moderate-to-severe AD, which found significant benefits for cognition, global assessment, behavior and caregiver burden, but not function. The most common adverse events were headache, dizziness, diarrhea, hypertension, anxiety and influenza. Overall, memantine in all formulations has a favorable safety/tolerability profile and is safe to use with cholinesterase inhibitors. Memantine ER has yet to be evaluated against conventionally dosed immediate-release memantine.
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Affiliation(s)
- Kelly M Makino
- University of Rochester School of Medicine & Dentistry, Rochester, NY 14620, USA
| | - Anton P Porsteinsson
- University of Rochester School of Medicine & Dentistry, Rochester, NY 14620, USA
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