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Boylu ME, Uyar E. Early-onset Alzheimer dementia superimposed on schizophrenia: a rare case report. Neurocase 2024:1-5. [PMID: 38967250 DOI: 10.1080/13554794.2024.2374544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
Disorganized behavior is a primary sign of schizophrenia. Yet it is not unique to schizophrenia. Recently, there has been a growing understanding that endogenous mental disorders could be a prodromal stage of neurodegenerative dementia. As a result, the connection between endogenous mental disorders and dementia has become a subject of significant interest. In the present study, a 49-year-old female with schizophrenia since the age of 17 was diagnosed with early-onset Alzheimer's disease after a detailed examination with PET and cerebrospinal fluid, despite suspicion of organic disease due to progressive forgetfulness, abnormal behavior and delusions. Schizophrenia is not the only disorder in which disorganized behavior is seen. When such a clinical phenomenon develops, other possible causes should be considered. Dementia is one of the most important of these causes. In a psychiatric disorder with disorganized behavior, other possible causes, especially dementia, should be considered.
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Affiliation(s)
| | - Elifnaz Uyar
- Medical Faculty Department of Psychiatry, Bezmiâlem Foundation University, İstanbul, Turkey
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2
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Bell G, El Baou C, Saunders R, Buckman JEJ, Charlesworth G, Richards M, Fearn C, Brown B, Nurock S, Michael S, Ware P, Marchant NL, Aguirre E, Rio M, Cooper C, Pilling S, John A, Stott J. Predictors of primary care psychological therapy outcomes for depression and anxiety in people living with dementia: evidence from national healthcare records in England. Br J Psychiatry 2024; 224:205-212. [PMID: 38328941 DOI: 10.1192/bjp.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Psychological therapies can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD). However, factors associated with better therapy outcomes in PLWD are currently unknown. AIMS To investigate whether dementia-specific and non-dementia-specific factors are associated with therapy outcomes in PLWD. METHOD National linked healthcare records were used to identify 1522 PLWD who attended psychological therapy services across England. Associations between various factors and therapy outcomes were explored. RESULTS People with frontotemporal dementia were more likely to experience reliable deterioration in depression/anxiety symptoms compared with people with vascular dementia (odds ratio 2.98, 95% CI 1.08-8.22; P = 0.03) or Alzheimer's disease (odds ratio 2.95, 95% CI 1.15-7.55; P = 0.03). Greater depression severity (reliable recovery: odds ratio 0.95, 95% CI 0.92-0.98, P < 0.001; reliable deterioration: odds ratio 1.73, 95% CI 1.04-2.90, P = 0.04), lower work and social functioning (recovery: odds ratio 0.98, 95% CI 0.96-0.99, P = 0.002), psychotropic medication use (recovery: odds ratio 0.67, 95% CI 0.51-0.90, P = 0.01), being of working age (recovery: odds ratio 2.03, 95% CI 1.10-3.73, P = 0.02) and fewer therapy sessions (recovery: odds ratio 1.12, 95% CI 1.09-1.16, P < 0.001) were associated with worse therapy outcomes in PLWD. CONCLUSIONS Dementia type was generally not associated with outcomes, whereas clinical factors were consistent with those identified for the general population. Additional support and adaptations may be required to improve therapy outcomes in PLWD, particularly in those who are younger and have more severe depression.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Celine El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and iCope Psychological Therapies Service, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, UK
| | - Caroline Fearn
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Barbara Brown
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Shirley Nurock
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Stuart Michael
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Paul Ware
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | | | - Elisa Aguirre
- Redbridge Talking Therapies Service, North East London NHS Foundation Trust, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, University College London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
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3
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Jaye S, Sandau US, Saugstad JA. Clathrin mediated endocytosis in Alzheimer's disease: cell type specific involvement in amyloid beta pathology. Front Aging Neurosci 2024; 16:1378576. [PMID: 38694257 PMCID: PMC11061891 DOI: 10.3389/fnagi.2024.1378576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/03/2024] [Indexed: 05/04/2024] Open
Abstract
This review provides a comprehensive examination of the role of clathrin-mediated endocytosis (CME) in Alzheimer's disease (AD) pathogenesis, emphasizing its impact across various cellular contexts beyond neuronal dysfunction. In neurons, dysregulated CME contributes to synaptic dysfunction, amyloid beta (Aβ) processing, and Tau pathology, highlighting its involvement in early AD pathogenesis. Furthermore, CME alterations extend to non-neuronal cell types, including astrocytes and microglia, which play crucial roles in Aβ clearance and neuroinflammation. Dysregulated CME in these cells underscores its broader implications in AD pathophysiology. Despite significant progress, further research is needed to elucidate the precise mechanisms underlying CME dysregulation in AD and its therapeutic implications. Overall, understanding the complex interplay between CME and AD across diverse cell types holds promise for identifying novel therapeutic targets and interventions.
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Affiliation(s)
| | | | - Julie A. Saugstad
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, United States
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4
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Ainslie AP, Klaver M, Voshart DC, Gerrits E, den Dunnen WFA, Eggen BJL, Bergink S, Barazzuol L. Glioblastoma and its treatment are associated with extensive accelerated brain aging. Aging Cell 2024; 23:e14066. [PMID: 38234228 PMCID: PMC10928584 DOI: 10.1111/acel.14066] [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: 08/10/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024] Open
Abstract
Progressive neurocognitive dysfunction is the leading cause of a reduced quality of life in patients with primary brain tumors. Understanding how the human brain responds to cancer and its treatment is essential to improve the associated cognitive sequelae. In this study, we performed integrated transcriptomic and tissue analysis on postmortem normal-appearing non-tumor brain tissue from glioblastoma (GBM) patients that had received cancer treatments, region-matched brain tissue from unaffected control individuals and Alzheimer's disease (AD) patients. We show that normal-appearing non-tumor brain regions of patients with GBM display hallmarks of accelerated aging, in particular mitochondrial dysfunction, inflammation, and proteostasis deregulation. The extent and spatial pattern of this response decreased with distance from the tumor. Gene set enrichment analyses and a direct comparative analysis with an independent cohort of brain tissue samples from AD patients revealed a significant overlap in differentially expressed genes and a similar biological aging trajectory. Additionally, these responses were validated at the protein level showing the presence of increased lysosomal lipofuscin, phosphorylated microtubule-associated protein Tau, and oxidative DNA damage in normal-appearing brain areas of GBM patients. Overall, our data show that the brain of GBM patients undergoes accelerated aging and shared AD-like features, providing the basis for novel or repurposed therapeutic targets for managing brain tumor-related side effects.
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Affiliation(s)
- Anna P. Ainslie
- Department of Radiation OncologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- Department of Biomedical Sciences of Cells and SystemsUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- European Research Institute for the Biology of AgeingUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Myrthe Klaver
- Department of Radiation OncologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- Department of Biomedical Sciences of Cells and SystemsUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- European Research Institute for the Biology of AgeingUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Daniëlle C. Voshart
- Department of Radiation OncologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- Department of Biomedical Sciences of Cells and SystemsUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Emma Gerrits
- Department of Biomedical Sciences of Cells and SystemsUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Wilfred F. A. den Dunnen
- Department of Pathology and Medical BiologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Bart J. L. Eggen
- Department of Biomedical Sciences of Cells and SystemsUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Steven Bergink
- Department of Biomedical Sciences of Cells and SystemsUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- University College Groningen, University of GroningenGroningenThe Netherlands
| | - Lara Barazzuol
- Department of Radiation OncologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- Department of Biomedical Sciences of Cells and SystemsUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
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5
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Flotho M, Amand J, Hirsch P, Grandke F, Wyss-Coray T, Keller A, Kern F. ZEBRA: a hierarchically integrated gene expression atlas of the murine and human brain at single-cell resolution. Nucleic Acids Res 2024; 52:D1089-D1096. [PMID: 37941147 PMCID: PMC10767845 DOI: 10.1093/nar/gkad990] [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: 08/14/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023] Open
Abstract
The molecular causes and mechanisms of neurodegenerative diseases remain poorly understood. A growing number of single-cell studies have implicated various neural, glial, and immune cell subtypes to affect the mammalian central nervous system in many age-related disorders. Integrating this body of transcriptomic evidence into a comprehensive and reproducible framework poses several computational challenges. Here, we introduce ZEBRA, a large single-cell and single-nucleus RNA-seq database. ZEBRA integrates and normalizes gene expression and metadata from 33 studies, encompassing 4.2 million human and mouse brain cells sampled from 39 brain regions. It incorporates samples from patients with neurodegenerative diseases like Alzheimer's disease, Parkinson's disease, and Multiple sclerosis, as well as samples from relevant mouse models. We employed scVI, a deep probabilistic auto-encoder model, to integrate the samples and curated both cell and sample metadata for downstream analysis. ZEBRA allows for cell-type and disease-specific markers to be explored and compared between sample conditions and brain regions, a cell composition analysis, and gene-wise feature mappings. Our comprehensive molecular database facilitates the generation of data-driven hypotheses, enhancing our understanding of mammalian brain function during aging and disease. The data sets, along with an interactive database are freely available at https://www.ccb.uni-saarland.de/zebra.
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Affiliation(s)
- Matthias Flotho
- Helmholtz-Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research, Saarland University Campus, 66123 Saarbrücken, Germany
- Clinical Bioinformatics, Center for Bioinformatics, Saarland University, 66123 Saarbrücken, Germany
| | - Jérémy Amand
- Helmholtz-Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research, Saarland University Campus, 66123 Saarbrücken, Germany
- Clinical Bioinformatics, Center for Bioinformatics, Saarland University, 66123 Saarbrücken, Germany
| | - Pascal Hirsch
- Clinical Bioinformatics, Center for Bioinformatics, Saarland University, 66123 Saarbrücken, Germany
| | - Friederike Grandke
- Clinical Bioinformatics, Center for Bioinformatics, Saarland University, 66123 Saarbrücken, Germany
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
- The Phil and Penny Knight Initiative for Brain Resilience, Stanford University, Stanford, CA, USA
| | - Andreas Keller
- Helmholtz-Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research, Saarland University Campus, 66123 Saarbrücken, Germany
- Clinical Bioinformatics, Center for Bioinformatics, Saarland University, 66123 Saarbrücken, Germany
| | - Fabian Kern
- Helmholtz-Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research, Saarland University Campus, 66123 Saarbrücken, Germany
- Clinical Bioinformatics, Center for Bioinformatics, Saarland University, 66123 Saarbrücken, Germany
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6
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Khaled M, Al-Jamal H, Tajer L, El-Mir R. Alzheimer's Disease in Lebanon: Exploring Genetic and Environmental Risk Factors-A Comprehensive Review. J Alzheimers Dis 2024; 99:21-40. [PMID: 38640157 DOI: 10.3233/jad-231432] [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: 04/21/2024]
Abstract
Alzheimer's disease (AD) is a neurodegenerative condition that displays a high prevalence in Lebanon causing a local burden in healthcare and socio-economic sectors. Unfortunately, the lack of prevalence studies and clinical trials in Lebanon minimizes the improvement of AD patient health status. In this review, we include over 155 articles to cover the different aspects of AD ranging from mechanisms to possible treatment and management tools. We highlight some important modifiable and non-modifiable risk factors of the disease including genetics, age, cardiovascular diseases, smoking, etc. Finally, we propose a hypothetical genetic synergy model between APOE4 and TREM2 genes which constitutes a potential early diagnostic tool that helps in reducing the risk of AD based on preventative measures decades before cognitive decline. The studies on AD in Lebanon and the Middle East are scarce. This review points out the importance of genetic mapping in the understanding of disease pathology which is crucial for the emergence of novel diagnostic tools. Hence, we establish a rigid basis for further research to identify the most influential genetic and environmental risk factors for the purpose of using more specific diagnostic tools and possibly adopting a local management protocol.
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Affiliation(s)
| | - Hadi Al-Jamal
- Faculty of Public Health III, Lebanese University, Tripoli, Lebanon
| | - Layla Tajer
- Faculty of Public Health III, Lebanese University, Tripoli, Lebanon
| | - Reem El-Mir
- Faculty of Public Health III, Lebanese University, Tripoli, Lebanon
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7
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Cressot C, Vrillon A, Lilamand M, Francisque H, Méauzoone A, Hourregue C, Dumurgier J, Marlinge E, Paquet C, Cognat E. Psychosis in Neurodegenerative Dementias: A Systematic Comparative Review. J Alzheimers Dis 2024; 99:85-99. [PMID: 38669539 DOI: 10.3233/jad-231363] [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: 04/28/2024]
Abstract
Background Psychosis, characterized by delusions and/or hallucinations, is frequently observed during the progression of Alzheimer's disease (AD) and other neurodegenerative dementias (ND) (i.e., dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD)) and cause diagnostic and management difficulties. Objective This review aims at presenting a concise and up-to-date overview of psychotic symptoms that occur in patients with ND with a comparative approach. Methods A systematic review was conducted following the PRISMA guidelines. 98 original studies investigating psychosis phenotypes in neurodegenerative dementias were identified (40 cohort studies, 57 case reports). Results Psychosis is a frequently observed phenomenon during the course of ND, with reported prevalence ranging from 22.5% to 54.1% in AD, 55.9% to 73.9% in DLB, and 18% to 42% in FTD. Throughout all stages of these diseases, noticeable patterns emerge depending on their underlying causes. Misidentification delusions (16.6-78.3%) and visual hallucinations (50-69.6%) are frequently observed in DLB, while paranoid ideas and somatic preoccupations seem to be particularly common in AD and FTD, (respectively 9.1-60.3% and 3.10-41.5%). Limited data were found regarding psychosis in the early stages of these disorders. Conclusions Literature data suggest that different ND are associated with noticeable variations in psychotic phenotypes, reflecting disease-specific tendencies. Further studies focusing on the early stages of these disorders are necessary to enhance our understanding of early psychotic manifestations associated with ND and help in differential diagnosis issues.
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Affiliation(s)
- Coralie Cressot
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Agathe Vrillon
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Matthieu Lilamand
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Service de Gériatrie, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Hélène Francisque
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Aurélie Méauzoone
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Claire Hourregue
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Julien Dumurgier
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Université Paris Cité, Inserm U1153, Paris, France
| | - Emeline Marlinge
- Département de Psychiatrie, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Claire Paquet
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Emmanuel Cognat
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
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8
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Suárez-González A, John A, Brotherhood E, Camic PM, McKee-Jackson R, Melville M, Sullivan MP, Tudor-Edwards R, Windle G, Crutch S, Hoare Z, Stott J. "Better Living with Non-memory-led Dementia": protocol for a feasibility randomised controlled trial of a web-based caregiver educational programme. Pilot Feasibility Stud 2023; 9:172. [PMID: 37821924 PMCID: PMC10566043 DOI: 10.1186/s40814-023-01403-1] [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: 05/18/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Non-memory-led dementias such as posterior cortical atrophy (PCA), primary progressive aphasia (PPA) and behavioural variant frontotemporal dementia (bvFTD) are low prevalent and often affect individuals under the age of 65. Tailored educational and support resources for caregivers of people living with these dementia phenotypes are scarce and unevenly distributed geographically. Web-based educational programmes are emerging as promising alternatives to improve caregiver self-efficacy and well-being. Here, we present the protocol of a study aiming to assess the feasibility of a co-produced online educational programme for caregivers of people living PCA, PPA and bvFTD: the Better Living with Non-memory-led Dementia programme. METHODS A randomised controlled feasibility trial will be conducted on a sample of 30 caregivers of people living with PCA, PPA and bvFTD. Participants will be recruited among members of the support organisation Rare Dementia Support (based at UCL in the UK). The intervention group will be given access to an 8-week co-produced web-based educational programme consisting of 6 modules addressing education about PCA, PPA and bvFTD and support strategies for the person with dementia and for the caregiver. The control group will receive treatment as usual (TAU). Feasibility will be measured through feasibility of recruitment, clinical measurement tools and acceptability. Clinical measures will be used to assess preliminary efficacy and data on completion rates, missing data and variability used to decide on measures to be included in a full-scale trial. Allocation ratio will be 2:1 (intervention:control) stratified by diagnosis. Feasibility of recruitment and acceptability will be assessed. Clinical measures will be administered at baseline and 8-week and 3-month post-randomisation. The control group will be offered access to the intervention at the completion of data collection. Participants will be unblinded, and all measures will be self-reported online. DISCUSSION Online-delivered educational programmes show potential for improving care competency of caregivers and may contribute to overcoming geographical inequalities in local provision of support services. This pilot study will inform a fully powered international trial to determine the effectiveness of Better Living with Non-memory-led Dementia. TRIAL REGISTRATION This trial has been registered prospectively on the Clinical Trials Registry on 1st September 2022, registration number NCT05525377.
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Affiliation(s)
- Aida Suárez-González
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK.
| | - Amber John
- Psychology and Language Sciences, University College London, London, UK
| | - Emilie Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - Paul M Camic
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - Roberta McKee-Jackson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - Mel Melville
- Psychology and Language Sciences, University College London, London, UK
| | - Mary Pat Sullivan
- Faculty of Education and Professional Studies, School of Social Work, Nipissing University, North Bay, ON, Canada
| | | | - Gill Windle
- Dementia Services Development Centre, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Sebastian Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - Zoe Hoare
- School of Health Sciences, Bangor University, Bangor, UK
| | - Joshua Stott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
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9
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Dolphin H, Dyer AH, McHale C, O'Dowd S, Kennelly SP. An Update on Apathy in Alzheimer's Disease. Geriatrics (Basel) 2023; 8:75. [PMID: 37489323 PMCID: PMC10366907 DOI: 10.3390/geriatrics8040075] [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: 05/31/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
Apathy is a complex multi-dimensional syndrome that affects up to 70% of individuals with Alzheimer's disease (AD). Whilst many frameworks to define apathy in AD exist, most include loss of motivation or goal-directed behaviour as the central feature. Apathy is associated with significant impact on persons living with AD and their caregivers and is also associated with accelerated cognitive decline across the AD spectrum. Neuroimaging studies have highlighted a key role of fronto-striatial circuitry including the anterior cingulate cortex (ACC), orbito-frontal cortex (OFC) and associated subcortical structures. Importantly, the presence and severity of apathy strongly correlates with AD stage and neuropathological biomarkers of amyloid and tau pathology. Following from neurochemistry studies demonstrating a central role of biogenic amine neurotransmission in apathy syndrome in AD, recent clinical trial data suggest that apathy symptoms may improve following treatment with agents such as methylphenidate-which may have an important role alongside emerging non-pharmacological treatment strategies. Here, we review the diagnostic criteria, rating scales, prevalence, and risk factors for apathy in AD. The underlying neurobiology, neuropsychology and associated neuroimaging findings are reviewed in detail. Finally, we discuss current treatment approaches and strategies aimed at targeting apathy syndrome in AD, highlighting areas for future research and clinical trials in patient cohorts.
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Affiliation(s)
- Helena Dolphin
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
| | - Adam H Dyer
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
| | - Cathy McHale
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
| | - Sean O'Dowd
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Department of Neurology, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Academic Unit of Neurology, Trinity College Dublin, D02R590 Dublin, Ireland
| | - Sean P Kennelly
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
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10
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Singh NA, Martin PR, Graff-Radford J, Sintini I, Machulda MM, Duffy JR, Gunter JL, Botha H, Jones DT, Lowe VJ, Jack CR, Josephs KA, Whitwell JL. Altered within- and between-network functional connectivity in atypical Alzheimer's disease. Brain Commun 2023; 5:fcad184. [PMID: 37434879 PMCID: PMC10331277 DOI: 10.1093/braincomms/fcad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 05/04/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
Posterior cortical atrophy and logopenic progressive aphasia are atypical clinical presentations of Alzheimer's disease. Resting-state functional connectivity studies have shown functional network disruptions in both phenotypes, particularly involving the language network in logopenic progressive aphasia and the visual network in posterior cortical atrophy. However, little is known about how connectivity differs both within and between brain networks in these atypical Alzheimer's disease phenotypes. A cohort of 144 patients was recruited by the Neurodegenerative Research Group at Mayo Clinic, Rochester, MN, USA, and underwent structural and resting-state functional MRI. Spatially preprocessed data were analysed to explore the default mode network and the salience, sensorimotor, language, visual and memory networks. The data were analysed at the voxel and network levels. Bayesian hierarchical linear models adjusted for age and sex were used to analyse within- and between-network connectivity. Reduced within-network connectivity was observed in the language network in both phenotypes, with stronger evidence of reductions in logopenic progressive aphasia compared to controls. Only posterior cortical atrophy showed reduced within-network connectivity in the visual network compared to controls. Both phenotypes showed reduced within-network connectivity in the default mode and sensorimotor networks. No significant change was noted in the memory network, but a slight increase in the salience within-network connectivity was seen in both phenotypes compared to controls. Between-network analysis in posterior cortical atrophy showed evidence of reduced visual-to-language network connectivity, with reduced visual-to-salience network connectivity, compared to controls. An increase in visual-to-default mode network connectivity was noted in posterior cortical atrophy compared to controls. Between-network analysis in logopenic progressive aphasia showed evidence of reduced language-to-visual network connectivity and an increase in language-to-salience network connectivity compared to controls. Findings from the voxel-level and network-level analysis were in line with the Bayesian hierarchical linear model analysis, showing reduced connectivity in the dominant network based on diagnosis and more crosstalk between networks in general compared to controls. The atypical Alzheimer's disease phenotypes were associated with disruptions in connectivity, both within and between brain networks. Phenotype-specific differences in connectivity patterns were noted in the visual network for posterior cortical atrophy and the language network for logopenic progressive aphasia.
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Affiliation(s)
| | - Peter R Martin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Irene Sintini
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mary M Machulda
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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11
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Almkvist O, Nordberg A. A biomarker-validated time scale in years of disease progression has identified early- and late-onset subgroups in sporadic Alzheimer's disease. Alzheimers Res Ther 2023; 15:89. [PMID: 37131241 PMCID: PMC10152764 DOI: 10.1186/s13195-023-01231-8] [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: 11/29/2022] [Accepted: 04/14/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND It is possible to calculate the number of years to the expected clinical onset (YECO) of autosomal-dominant Alzheimer's disease (adAD). A similar time scale is lacking for sporadic Alzheimer's disease (sAD). The purpose was to design and validate a time scale in YECO for patients with sAD in relation to CSF and PET biomarkers. METHODS Patients diagnosed with Alzheimer's disease (AD, n = 48) or mild cognitive impairment (MCI, n = 46) participated in the study. They underwent a standardized clinical examination at the Memory clinic, Karolinska University Hospital, Stockholm, Sweden, which included present and previous medical history, laboratory screening, cognitive assessment, CSF biomarkers (Aβ42, total-tau, and p-tau), and an MRI of the brain. They were also assessed with two PET tracers, 11C-Pittsburgh compound B and 18F-fluorodeoxyglucose. Assuming concordance of cognitive decline in sAD and adAD, YECO for these patients was calculated using equations for the relationship between cognitive performance, YECO, and years of education in adAD (Almkvist et al. J Int Neuropsychol Soc 23:195-203, 2017). RESULTS The mean current point of disease progression was 3.2 years after the estimated clinical onset in patients with sAD and 3.4 years prior to the estimated clinical onset in patients with MCI, as indicated by the median YECO from five cognitive tests. The associations between YECO and biomarkers were significant, while those between chronological age and biomarkers were nonsignificant. The estimated disease onset (chronological age minus YECO) followed a bimodal distribution with frequency maxima before (early-onset) and after (late-onset) 65 years of age. The early- and late-onset subgroups differed significantly in biomarkers and cognition, but after control for YECO, this difference disappeared for all except the APOE e4 gene (more frequent in early- than in late-onset). CONCLUSIONS A novel time scale in years of disease progression based on cognition was designed and validated in patients with AD using CSF and PET biomarkers. Two early- and late-disease onset subgroups were identified differing with respect to APOE e4.
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Affiliation(s)
- Ove Almkvist
- Division of Clinical Geriatrics, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
- Department of Psychology, Stockholm University, Stockholm, Sweden.
| | - Agneta Nordberg
- Division of Clinical Geriatrics, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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12
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Chandregowda A, Clark HM, Machulda MM, Pham NTT, Lowe VJ, Josephs KA, Whitwell JL. A Case of Atypical Alzheimer's Disease With Clinical Manifestation That Straddled the Boundary Between Primary Progressive Aphasia and Posterior Cortical Atrophy. Neurologist 2023; 28:195-197. [PMID: 35981305 PMCID: PMC9938085 DOI: 10.1097/nrl.0000000000000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In the context of Alzheimer's disease phenotypes, patients may present with symptoms and signs that do not exclusively fit into one of the existing phenotypic categories, which often delays timely diagnosis and initiation of services to optimize patient awareness and coping. CASE REPORT A 74-year-old woman presented with the complaint of progressive word-finding difficulty, raising our suspicion for primary progressive aphasia. Clinical evaluations, however, also revealed emerging cortical visual deficits consistent with posterior cortical atrophy. During evaluation 1 year later, Gerstmann syndrome was evident. Her in vivo neuroimaging was positive for beta-amyloid and tau biomarkers of Alzheimer's disease pathology. CONCLUSION In addition to contributing to the literature on the heterogeneity of the clinical manifestations of Alzheimer's disease, this report highlights that a breakdown in the visual-lexical interface can account for anomia in posterior cortical atrophy at least in some cases. Other relevant clinical insights pertinent to this case are discussed.
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Affiliation(s)
| | | | | | | | | | - Keith A Josephs
- Neurology (Behavioral Neurology; Movement Disorders), Mayo Clinic, Tampa, FL
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13
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Loreto F, Gontsarova A, Scott G, Patel N, Win Z, Carswell C, Perry R, Malhotra P. Visual atrophy rating scales and amyloid PET status in an Alzheimer's disease clinical cohort. Ann Clin Transl Neurol 2023; 10:619-631. [PMID: 36872523 PMCID: PMC10109315 DOI: 10.1002/acn3.51749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVES Visual rating scales (VRS) are the quantification method closest to the approach used in routine clinical practice to assess brain atrophy. Previous studies have suggested that the medial temporal atrophy (MTA) rating scale is a reliable diagnostic marker for AD, equivalent to volumetric quantification, while others propose a higher diagnostic utility for the Posterior Atrophy (PA) scale in early-onset AD. METHODS Here, we reviewed 14 studies that assessed the diagnostic accuracy of PA and MTA, we explored the issue of cut-off heterogeneity, and assessed 9 rating scales in a group of patients with biomarker-confirmed diagnosis. A neuroradiologist blinded to all clinical information rated the MR images of 39 amyloid-positive and 38 amyloid-negative patients using 9 validated VRS assessing multiple brain regions. Automated volumetric analyses were performed on a subset of patients (n = 48) and on a group of cognitively normal individuals (n = 28). RESULTS No single VRS could differentiate amyloid-positive from amyloid-negative patients with other neurodegenerative conditions. 44% of amyloid-positive patients were deemed to have age-appropriate levels of MTA. In the amyloid-positive group, 18% had no abnormal MTA or PA scores. These findings were substantially affected by cut-off selection. Amyloid-positive and amyloid-negative patients had comparable hippocampal and parietal volumes, and MTA but not PA scores correlated with the respective volumetric measures. INTERPRETATION Consensus guidelines are needed before VRS can be recommended for use in the diagnostic workup of AD. Our data are suggestive of high intragroup variability and non-superiority of volumetric quantification of atrophy over visual assessment.
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Affiliation(s)
- Flavia Loreto
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | | | - Gregory Scott
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.,UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK
| | - Neva Patel
- Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Zarni Win
- Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London, UK
| | | | - Richard Perry
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.,Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
| | - Paresh Malhotra
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.,UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK.,Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
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14
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Wang C, Shen D, Hu Y, Chen J, Liu J, Huang Y, Yu X, Chu H, Zhang C, Yin L, Liu Y, Ma H. Selective Targeting of Class I HDAC Reduces Microglial Inflammation in the Entorhinal Cortex of Young APP/PS1 Mice. Int J Mol Sci 2023; 24:4805. [PMID: 36902234 PMCID: PMC10003411 DOI: 10.3390/ijms24054805] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
BG45 is a class Ⅰ histone deacetylase inhibitor (HDACI) with selectivity for HDAC3. Our previous study demonstrated that BG45 can upregulate the expression of synaptic proteins and reduce the loss of neurons in the hippocampus of APPswe/PS1dE9 (APP/PS1) transgenic mice (Tg). The entorhinal cortex is a pivotal region that, along with the hippocampus, plays a critical role in memory in the Alzheimer's disease (AD) pathology process. In this study, we focused on the inflammatory changes in the entorhinal cortex of APP/PS1 mice and further explored the therapeutic effects of BG45 on the pathologies. The APP/PS1 mice were randomly divided into the transgenic group without BG45 (Tg group) and the BG45-treated groups. The BG45-treated groups were treated with BG45 at 2 months (2 m group), at 6 months (6 m group), or twice at 2 and 6 months (2 and 6 m group). The wild-type mice group (Wt group) served as the control. All mice were killed within 24 h after the last injection at 6 months. The results showed that amyloid-β (Aβ) deposition and IBA1-positive microglia and GFAP-positive astrocytes in the entorhinal cortex of the APP/PS1 mice progressively increased over time from 3 to 8 months of age. When the APP/PS1 mice were treated with BG45, the level of H3K9K14/H3 acetylation was improved and the expression of histonedeacetylase1, histonedeacetylase2, and histonedeacetylase3 was inhibited, especially in the 2 and 6 m group. BG45 alleviated Aβ deposition and reduced the phosphorylation level of tau protein. The number of IBA1-positive microglia and GFAP-positive astrocytes decreased with BG45 treatment, and the effect was more significant in the 2 and 6 m group. Meanwhile, the expression of synaptic proteins synaptophysin, postsynaptic density protein 95, and spinophilin was upregulated and the degeneration of neurons was alleviated. Moreover, BG45 reduced the gene expression of inflammatory cytokines interleukin-1β and tumor necrosis factor-α. Closely related to the CREB/BDNF/NF-kB pathway, the expression of p-CREB/CREB, BDNF, and TrkB was increased in all BG45 administered groups compared with the Tg group. However, the levels of p-NF-kB/NF-kB in the BG45 treatment groups were reduced. Therefore, we deduced that BG45 is a potential drug for AD by alleviating inflammation and regulating the CREB/BDNF/NF-kB pathway, and the early, repeated administration of BG45 can play a more effective role.
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Affiliation(s)
- Chunyang Wang
- Department of Histology and Embryology, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
| | - Di Shen
- Department of Histology and Embryology, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
| | - Yingqiu Hu
- Department of Histology and Embryology, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
| | - Jie Chen
- Department of Histology and Embryology, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
| | - Jingyun Liu
- Department of Histology and Embryology, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
| | - Yufei Huang
- Department of Histology and Embryology, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
| | - Xuebin Yu
- Department of Histology and Embryology, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
| | - Haiying Chu
- Department of Histology and Embryology, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
| | - Chenghong Zhang
- Department of Histology and Embryology, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
| | - Liangwei Yin
- Department of Oncology, Dalian Municipal Central Hospital, Dalian 116089, China
| | - Yi Liu
- Department of Neurology, Dalian Municipal Central Hospital, Dalian 116089, China
| | - Haiying Ma
- Department of Histology and Embryology, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
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15
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Gorenflo MP, Davis PB, Kendall EK, Olaker VR, Kaelber DC, Xu R. Association of Aspirin Use with Reduced Risk of Developing Alzheimer's Disease in Elderly Ischemic Stroke Patients: A Retrospective Cohort Study. J Alzheimers Dis 2023; 91:697-704. [PMID: 36502331 DOI: 10.3233/jad-220901] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Currently there are no effective therapies to prevent or halt the development of Alzheimer's disease (AD). Multiple risk factors are involved in AD, including ischemic stroke (IS). Aspirin is often prescribed following IS to prevent blood clot formation. Observational studies have shown inconsistent findings with respect to the relationship between aspirin use and the risk of AD. OBJECTIVE To investigate the relationship between aspirin therapy after IS and the new diagnosis of AD in elderly patients. METHODS This retrospective cohort study leveraged a large database that contains over 90 million electronic health records to compare the hazard rates of AD after IS in elderly patients prescribed aspirin versus those not prescribed aspirin after propensity-score matching for relevant confounders. RESULTS At 1, 3, and 5 years after first IS, elderly patients prescribed aspirin were less likely to develop AD than those not prescribed aspirin: Hazard Ratio = 0.78 [0.65,0.94], 0.81 [0.70,0.94], and 0.76 [0.70,0.92]. CONCLUSION Our findings suggest that aspirin use may prevent AD in patients with IS, a subpopulation at high risk of developing the disease.
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Affiliation(s)
- Maria P Gorenflo
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pamela B Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ellen K Kendall
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Veronica R Olaker
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David C Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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16
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Morris JC, Weiner M, Xiong C, Beckett L, Coble D, Saito N, Aisen PS, Allegri R, Benzinger TLS, Berman SB, Cairns NJ, Carrillo MC, Chui HC, Chhatwal JP, Cruchaga C, Fagan AM, Farlow M, Fox NC, Ghetti B, Goate AM, Gordon BA, Graff-Radford N, Day GS, Hassenstab J, Ikeuchi T, Jack CR, Jagust WJ, Jucker M, Levin J, Massoumzadeh P, Masters CL, Martins R, McDade E, Mori H, Noble JM, Petersen RC, Ringman JM, Salloway S, Saykin AJ, Schofield PR, Shaw LM, Toga AW, Trojanowski JQ, Vöglein J, Weninger S, Bateman RJ, Buckles VD. Autosomal dominant and sporadic late onset Alzheimer's disease share a common in vivo pathophysiology. Brain 2022; 145:3594-3607. [PMID: 35580594 PMCID: PMC9989348 DOI: 10.1093/brain/awac181] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/12/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
The extent to which the pathophysiology of autosomal dominant Alzheimer's disease corresponds to the pathophysiology of 'sporadic' late onset Alzheimer's disease is unknown, thus limiting the extrapolation of study findings and clinical trial results in autosomal dominant Alzheimer's disease to late onset Alzheimer's disease. We compared brain MRI and amyloid PET data, as well as CSF concentrations of amyloid-β42, amyloid-β40, tau and tau phosphorylated at position 181, in 292 carriers of pathogenic variants for Alzheimer's disease from the Dominantly Inherited Alzheimer Network, with corresponding data from 559 participants from the Alzheimer's Disease Neuroimaging Initiative. Imaging data and CSF samples were reprocessed as appropriate to guarantee uniform pipelines and assays. Data analyses yielded rates of change before and after symptomatic onset of Alzheimer's disease, allowing the alignment of the ∼30-year age difference between the cohorts on a clinically meaningful anchor point, namely the participant age at symptomatic onset. Biomarker profiles were similar for both autosomal dominant Alzheimer's disease and late onset Alzheimer's disease. Both groups demonstrated accelerated rates of decline in cognitive performance and in regional brain volume loss after symptomatic onset. Although amyloid burden accumulation as determined by PET was greater after symptomatic onset in autosomal dominant Alzheimer's disease than in late onset Alzheimer's disease participants, CSF assays of amyloid-β42, amyloid-β40, tau and p-tau181 were largely overlapping in both groups. Rates of change in cognitive performance and hippocampal volume loss after symptomatic onset were more aggressive for autosomal dominant Alzheimer's disease participants. These findings suggest a similar pathophysiology of autosomal dominant Alzheimer's disease and late onset Alzheimer's disease, supporting a shared pathobiological construct.
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Affiliation(s)
- John C Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Weiner
- Department of Radiology, University of California at San Francisco, San Francisco, CA, USA
| | - Chengjie Xiong
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Laurel Beckett
- Department of Public Health Sciences, School of Medicine, University of California; Davis, Davis, CA, USA
| | - Dean Coble
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Naomi Saito
- Department of Public Health Sciences, School of Medicine, University of California; Davis, Davis, CA, USA
| | - Paul S Aisen
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ricardo Allegri
- Department of Cognitive Neurology, Neuropsychology and Neuropsychiatry, Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Tammie L S Benzinger
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah B Berman
- Department of Neurology and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nigel J Cairns
- College of Medicine and Health and the Living Systems Institute, University of Exeter, Exeter, UK
| | | | - Helena C Chui
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jasmeer P Chhatwal
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Anne M Fagan
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Martin Farlow
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nick C Fox
- Department of Neurodegenerative Disease and UK Dementia Research Institute, UCL Institute of Neurology, London, UK
| | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alison M Goate
- Ronald M. Loeb Center for Alzheimer’s Disease, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian A Gordon
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Jason Hassenstab
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata, Japan
| | | | - William J Jagust
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Mathias Jucker
- Cell Biology of Neurological Diseases Group, German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Johannes Levin
- DZNE Munich, Munich Cluster of Systems Neurology (SyNergy) and Ludwig-Maximilians-Universität, Munich, Germany
| | - Parinaz Massoumzadeh
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Colin L Masters
- Florey Institute, University of Melbourne, Melbourne, Australia
| | - Ralph Martins
- Sir James McCusker Alzheimer’s Disease Research Unit, Edith Cowan University, Nedlands, Australia
| | - Eric McDade
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hiroshi Mori
- Department of Neuroscience, Osaka City University Medical School, Osaka City, Japan
| | - James M Noble
- Department of Neurology, Taub Institute for Research on Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
| | | | - John M Ringman
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stephen Salloway
- Department of Neurology, Butler Hospital and Alpert Medical School of Brown University, Providence, RI, 02906, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences and the Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter R Schofield
- Neuroscience Research Australia and School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan Vöglein
- German Center for Neurodegenerative Diseases (DZNE) and Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Randall J Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Virginia D Buckles
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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17
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Shade RD, Ross JA, Van Bockstaele EJ. Targeting the cannabinoid system to counteract the deleterious effects of stress in Alzheimer’s disease. Front Aging Neurosci 2022; 14:949361. [PMID: 36268196 PMCID: PMC9577232 DOI: 10.3389/fnagi.2022.949361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022] Open
Abstract
Alzheimer’s disease is a progressive neurodegenerative disorder characterized histologically in postmortem human brains by the presence of dense protein accumulations known as amyloid plaques and tau tangles. Plaques and tangles develop over decades of aberrant protein processing, post-translational modification, and misfolding throughout an individual’s lifetime. We present a foundation of evidence from the literature that suggests chronic stress is associated with increased disease severity in Alzheimer’s patient populations. Taken together with preclinical evidence that chronic stress signaling can precipitate cellular distress, we argue that chronic psychological stress renders select circuits more vulnerable to amyloid- and tau- related abnormalities. We discuss the ongoing investigation of systemic and cellular processes that maintain the integrity of protein homeostasis in health and in degenerative conditions such as Alzheimer’s disease that have revealed multiple potential therapeutic avenues. For example, the endogenous cannabinoid system traverses the central and peripheral neural systems while simultaneously exerting anti-inflammatory influence over the immune response in the brain and throughout the body. Moreover, the cannabinoid system converges on several stress-integrative neuronal circuits and critical regions of the hypothalamic-pituitary-adrenal axis, with the capacity to dampen responses to psychological and cellular stress. Targeting the cannabinoid system by influencing endogenous processes or exogenously stimulating cannabinoid receptors with natural or synthetic cannabis compounds has been identified as a promising route for Alzheimer’s Disease intervention. We build on our foundational framework focusing on the significance of chronic psychological and cellular stress on the development of Alzheimer’s neuropathology by integrating literature on cannabinoid function and dysfunction within Alzheimer’s Disease and conclude with remarks on optimal strategies for treatment potential.
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Affiliation(s)
- Ronnie D. Shade
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States
| | - Jennifer A. Ross
- Department of Pharmacology and Physiology, College of Medicine, Drexel University, Philadelphia, PA, United States
- *Correspondence: Jennifer A. Ross,
| | - Elisabeth J. Van Bockstaele
- Department of Pharmacology and Physiology, College of Medicine, Drexel University, Philadelphia, PA, United States
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18
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Bell G, Baou CE, Saunders R, Buckman JEJ, Charlesworth G, Richards M, Brown B, Nurock S, Michael S, Ware P, Aguirre E, Rio M, Cooper C, Pilling S, John A, Stott J. Effectiveness of primary care psychological therapy services for the treatment of depression and anxiety in people living with dementia: Evidence from national healthcare records in England. EClinicalMedicine 2022; 52:101692. [PMID: 36313148 PMCID: PMC9596302 DOI: 10.1016/j.eclinm.2022.101692] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Depression and anxiety are common and deleterious in people living with dementia (PLWD). It is currently unknown whether routinely provided psychological therapy can help reduce these symptoms in PLWD. This study aimed to investigate improvements in depression and anxiety symptoms over the course of therapy offered in primary care psychological therapy services in PLWD and to compare outcomes to people without dementia. Methods National data from Improving Access to Psychological Therapies services (IAPT) across England linked with Hospital Episode Statistics data, the Mental Health Services Dataset, and HES-ONS mortality data were used to identify 1,549 PLWD who completed a course of psychological treatment in IAPT between 2012-2019 and a propensity score matched control group without identified dementia. Outcome measures included pre-post intervention changes in depression (PHQ-9) and anxiety (GAD-7) symptoms and therapy outcomes (reliable improvement, recovery, deterioration). Findings Symptoms of depression (t(1548)=31·05, p<·001) and anxiety (t(1548)=30·31, p<·001) improved in PLWD over the course of psychological therapy with large effect sizes (depression: d=-0·83; anxiety: d=-0·80). However, PLWD were less likely to reliably improve (OR=·75, 95%CI[·63,·88], p<·001) or recover (OR=·75, 95%CI[·64,·88], p=·001), and more likely to deteriorate (OR=1·35, 95%CI[1·03,1·78], p=·029) than a matched control sample without dementia. Interpretation Psychological therapy may be beneficial for PLWD with depression or anxiety, but it is currently not as effective as for people without dementia. More research is needed to improve access to psychological therapies and to understand this discrepancy and how therapies can be adapted to further improve outcomes. Funding This work was supported by the Alzheimer's Society.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Celine El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua E. J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
| | - Barbara Brown
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Shirley Nurock
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Stuart Michael
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Paul Ware
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Elisa Aguirre
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, UCL, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute for Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
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19
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Bolton CJ, Tam JW. Differential Involvement of the Locus Coeruleus in Early- and Late-Onset Alzheimer's Disease: A Potential Mechanism of Clinical Differences? J Geriatr Psychiatry Neurol 2022; 35:733-739. [PMID: 34496652 DOI: 10.1177/08919887211044755] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sporadic early-onset Alzheimer's disease (sEOAD) is often associated with atypical clinical features, yet the cause of this heterogeneity remains unclear. This study investigated post-mortem atrophy of the locus coeruleus (LC) in sEOAD and late-onset Alzheimer's disease (LOAD). Levels of LC atrophy, as estimated by pathologist-rating of hypopigmentation, were compared between sEOAD (n = 115) and LOAD (n = 672) participants while controlling for other measures of pathological progression. Subsequent analyses compared low vs. high LC atrophy sEOAD subgroups on neuropsychological test performance. Results show nearly 4 times greater likelihood of higher LC atrophy in sEOAD as compared to LOAD (p < .005). sEOAD participants with greater LC atrophy displayed significantly worse performance on various baseline measures of attentional functioning (p < .05), despite similar global cognition (p = .25). These findings suggest the LC is an important potential driver of clinical and pathological heterogeneity in sEOAD.
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Affiliation(s)
- Corey J Bolton
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joyce W Tam
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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20
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Holden SK, Pelak VS, Sooy T, Heffernan KS, McConnell BV, Pressman PS, Bettcher BM. Development of the Colorado posterior cortical questionnaire within an Alzheimer's disease study cohort. J Clin Exp Neuropsychol 2022; 44:226-236. [PMID: 35913095 PMCID: PMC9420807 DOI: 10.1080/13803395.2022.2105820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Non-amnestic presentations of neurodegenerative dementias, including posterior- and visual-predominant cognitive forms, are under-recognized. Specific screening measures for posterior cortical symptoms could allow for earlier, more accurate diagnosis and directed treatment. METHODS Based on clinical experience with posterior cortical atrophy evaluations, high-yield screening questions were collected and organized into a 15-item self-report questionnaire, titled the Colorado Posterior Cortical Questionnaire (CPC-Q). The CPC-Q was then piloted within a longitudinal cohort of cognitive aging, including 63 older adults, including healthy older adults (n = 33) and adults with either amnestic Alzheimer's disease (n = 21) or posterior cortical atrophy (PCA, n = 9). RESULTS The CPC-Q demonstrated acceptable psychometric properties (internal consistency, α = 0.89; mean item-total correlation = 0.62), correlated strongly with visuospatial measures on cognitive testing (p < 0.001), and could distinguish PCA from non-PCA groups (p < 0.001; AUC 0.95 (95% CI 0.88, 1.0)). CONCLUSIONS The CPC-Q captured posterior cortical symptoms in older adults, using a gold standard of expert consensus PCA diagnosis. Future studies will validate the CPC-Q in a larger cohort, with recruitment of additional PCA participants, to evaluate its convergent and discriminant validity more thoroughly. As a short, self-report tool, the CPC-Q demonstrates potential to improve detection of non-amnestic neurodegenerative dementias in the clinical setting.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Trevor Sooy
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kate S Heffernan
- Neuroscience Graduate Program, Division of Biological and Biomedical Sciences, Emory Laney Graduate School, Atlanta, GA, USA
| | - Brice V McConnell
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Peter S Pressman
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brianne M Bettcher
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
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21
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Sirkis DW, Bonham LW, Johnson TP, La Joie R, Yokoyama JS. Dissecting the clinical heterogeneity of early-onset Alzheimer's disease. Mol Psychiatry 2022; 27:2674-2688. [PMID: 35393555 PMCID: PMC9156414 DOI: 10.1038/s41380-022-01531-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 12/14/2022]
Abstract
Early-onset Alzheimer's disease (EOAD) is a rare but particularly devastating form of AD. Though notable for its high degree of clinical heterogeneity, EOAD is defined by the same neuropathological hallmarks underlying the more common, late-onset form of AD. In this review, we describe the various clinical syndromes associated with EOAD, including the typical amnestic phenotype as well as atypical variants affecting visuospatial, language, executive, behavioral, and motor functions. We go on to highlight advances in fluid biomarker research and describe how molecular, structural, and functional neuroimaging can be used not only to improve EOAD diagnostic acumen but also enhance our understanding of fundamental pathobiological changes occurring years (and even decades) before the onset of symptoms. In addition, we discuss genetic variation underlying EOAD, including pathogenic variants responsible for the well-known mendelian forms of EOAD as well as variants that may increase risk for the much more common forms of EOAD that are either considered to be sporadic or lack a clear autosomal-dominant inheritance pattern. Intriguingly, specific pathogenic variants in PRNP and MAPT-genes which are more commonly associated with other neurodegenerative diseases-may provide unexpectedly important insights into the formation of AD tau pathology. Genetic analysis of the atypical clinical syndromes associated with EOAD will continue to be challenging given their rarity, but integration of fluid biomarker data, multimodal imaging, and various 'omics techniques and their application to the study of large, multicenter cohorts will enable future discoveries of fundamental mechanisms underlying the development of EOAD and its varied clinical presentations.
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Affiliation(s)
- Daniel W Sirkis
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Luke W Bonham
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 94158, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Taylor P Johnson
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Jennifer S Yokoyama
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 94158, USA.
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, 94158, USA.
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22
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McDade EM. Alzheimer Disease. Continuum (Minneap Minn) 2022; 28:648-675. [PMID: 35678397 DOI: 10.1212/con.0000000000001131] [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: 11/15/2022]
Abstract
PURPOSE OF REVIEW Alzheimer disease (AD) is the most common cause of dementia in adults (mid to late life), highlighting the importance of understanding the risk factors, clinical manifestations, and recent developments in diagnostic testing and therapeutics. RECENT FINDINGS Advances in fluid (CSF and blood-based) and imaging biomarkers are allowing for a more precise and earlier diagnosis of AD (relative to non-AD dementias) across the disease spectrum and in patients with atypical clinical features. Specifically, tau- and amyloid-related AD pathologic changes can now be measured by CSF, plasma, and positron emission tomography (PET) with good precision. Additionally, a better understanding of risk factors for AD has highlighted the need for clinicians to address comorbidities to maximize prevention of cognitive decline in those at risk or to slow decline in patients who are symptomatic. Recent clinical trials of amyloid-lowering drugs have provided not only some optimism that amyloid reduction or prevention may be beneficial but also a recognition that addressing additional targets will be necessary for significant disease modification. SUMMARY Recent developments in fluid and imaging biomarkers have led to the improved understanding of AD as a chronic condition with a protracted presymptomatic phase followed by the clinical stage traditionally recognized by neurologists. As clinical trials of potential disease-modifying therapies continue, important developments in the understanding of the disease will improve clinical care now and lead to more effective therapies in the near future.
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23
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Daemen M, Bruinsma J, Bakker C, Zwaaftink RG, Koopmans R, Oostijen A, Loose B, Verhey F, de Vugt M, Peetoom K. A cross-sectional evaluation of the Dutch RHAPSODY program: online information and support for caregivers of persons with young-onset dementia. Internet Interv 2022; 28:100530. [PMID: 35433278 PMCID: PMC9005959 DOI: 10.1016/j.invent.2022.100530] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 12/04/2022] Open
Abstract
UNLABELLED Caregivers of persons with young-onset dementia (YOD) have an explicit need for tailored information and support about YOD. Therefore, during the European RHAPSODY project a web-based information and support program for YOD caregivers was developed. The program was recently tailored to the Dutch context. This study evaluates the Dutch version on user acceptability, usability, user satisfaction, and user behavior. METHODS A cross-sectional study was conducted to evaluate the publicly available Dutch RHAPSODY program. A pop-up survey, extensive survey, and a semi-structured interview were used to evaluate how visitors perceived the program in terms of acceptability, usability, and their satisfaction. Web metrics registered user behavior. Quantitative data were analyzed using descriptive statistics and a deductive content analysis was used to analyze qualitative data. RESULTS A total of 26 participants completed the pop-up survey, 19 completed the extensive survey, and 10 participated in the semi-structured interviews. Most participants were caregivers and healthcare professionals. They perceived the program as acceptable and usable in daily life and were satisfied with the quality of the content. The majority would use the program again and recommend it to others. Participants emphasized the necessity and desirability of a central platform incorporating educational and practical information about YOD. The page with an explanation about what YOD entails was most viewed (360 unique page views). Most time was spent on the page about the diagnostic process (6.5 min). CONCLUSIONS The Dutch RHAPSODY program showed good user acceptability, usability, and user satisfaction. The program met the need for tailored information and support regarding YOD and adds value to existing available support for YOD caregivers. Raising awareness about the program's existence among healthcare professionals may help caregivers to find appropriate post-diagnostic information. The program also provides educational opportunities for healthcare professionals.
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Affiliation(s)
- Maud Daemen
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Corresponding author.
| | - Jeroen Bruinsma
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands,Radboudumc Alzheimer Center, Nijmegen, the Netherlands,Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, the Netherlands
| | | | - Raymond Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands,Radboudumc Alzheimer Center, Nijmegen, the Netherlands,Joachim and Anna, Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| | | | - Bernard Loose
- Dutch Alzheimer's Society, Amersfoort, the Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Heikal SA, Salama M, Richard Y, Moustafa AA, Lawlor B. The Impact of Disease Registries on Advancing Knowledge and Understanding of Dementia Globally. Front Aging Neurosci 2022; 14:774005. [PMID: 35197840 PMCID: PMC8859161 DOI: 10.3389/fnagi.2022.774005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
To help address the increasing challenges related to the provision of dementia care, dementia registries have emerged around the world as important tools to gain insights and a better understanding of the disease process. Dementia registries provide a valuable source of standardized data collected from a large number of patients. This review explores the published research relating to different dementia registries around the world and discusses how these registries have improved our knowledge and understanding of the incidence, prevalence, risk factors, mortality, diagnosis, and management of dementia. A number of the best-known dementia registries with high research output including SveDem, NACC, ReDeGi, CREDOS and PRODEM were selected to study the publication output based on their data, investigate the key findings of these registry-based studies. Registries data contributed to understanding many aspects of the disease including disease prevalence in specific areas, patient characteristics and how they differ in populations, mortality risks, as well as the disease risk factors. Registries data impacted the quality of patients’ lives through determining the best treatment strategy for a patient based on previous patient outcomes. In conclusion, registries have significantly advanced scientific knowledge and understanding of dementia and impacted policy, clinical practice care delivery.
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Affiliation(s)
- Shimaa A. Heikal
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- *Correspondence: Shimaa A. Heikal,
| | - Mohamed Salama
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- Medical Experimental Research Center (MERC), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yuliya Richard
- Blue Horizon Counseling Services, Sydney, NSW, Australia
| | - Ahmed A. Moustafa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD, Australia
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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25
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Gray M, Madero EN, Gills JL, Paulson S, Jones MD, Campitelli A, Myers J, Bott NT, Glenn JM. Intervention for a Digital, Cognitive, Multi-Domain Alzheimer Risk Velocity Study: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e31841. [PMID: 35119374 PMCID: PMC8857690 DOI: 10.2196/31841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/04/2021] [Accepted: 10/26/2021] [Indexed: 01/09/2023] Open
Abstract
Background In the United States, more than 6 million adults live with Alzheimer disease (AD) that affects 1 out of every 3 older adults. Although there is no cure for AD currently, lifestyle-based interventions aimed at slowing the rate of cognitive decline or delaying the onset of AD have shown promising results. However, most studies primarily focus on older adults (>55 years) and use in-person interventions. Objective The aim of this study is to determine the effects of a 2-year digital lifestyle intervention on AD risk among at-risk middle-aged and older adults (45-75 years) compared with a health education control. Methods The lifestyle intervention consists of a digitally delivered, personalized health coaching program that directly targets the modifiable risk factors for AD. The primary outcome measure is AD risk as determined by the Australian National University-Alzheimer Disease Risk Index; secondary outcome measures are functional fitness, blood biomarkers (inflammation, glucose, cholesterol, and triglycerides), and cognitive function (Repeatable Battery for the Assessment of Neuropsychological Status and Neurotrack Cognitive Battery). Screening commenced in January 2021 and was completed in June 2021. Results Baseline characteristics indicate no difference between the intervention and control groups for AD risk (mean −1.68, SD 7.31; P=.90). Conclusions The intervention in the Digital, Cognitive, Multi-domain Alzheimer Risk Velocity is uniquely designed to reduce the risk of AD through a web-based health coaching experience that addresses the modifiable lifestyle-based risk factors. Trial Registration ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/show/NCT04559789 International Registered Report Identifier (IRRID) DERR1-10.2196/31841
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Affiliation(s)
- Michelle Gray
- Exercise Science Research Center, Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR, United States
| | - Erica N Madero
- Neurotrack Technologies, Inc, Redwood City, CA, United States
| | - Joshua L Gills
- Exercise Science Research Center, Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR, United States
| | - Sally Paulson
- Exercise Science Research Center, Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR, United States
| | - Megan D Jones
- Exercise Science Research Center, Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR, United States
| | - Anthony Campitelli
- Exercise Science Research Center, Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR, United States
| | - Jennifer Myers
- Neurotrack Technologies, Inc, Redwood City, CA, United States
| | - Nicholas T Bott
- Neurotrack Technologies, Inc, Redwood City, CA, United States
| | - Jordan M Glenn
- Neurotrack Technologies, Inc, Redwood City, CA, United States
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26
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Smirnov DS, Salmon DP, Galasko D, Goodwill VS, Hansen LA, Zhao Y, Edland SD, Léger GC, Peavy GM, Jacobs DM, Rissman R, Pizzo DP, Hiniker A. Association of Neurofibrillary Tangle Distribution With Age at Onset-Related Clinical Heterogeneity in Alzheimer Disease: An Autopsy Study. Neurology 2022; 98:e506-e517. [PMID: 34810247 PMCID: PMC8826459 DOI: 10.1212/wnl.0000000000013107] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Patients with earlier age at onset of sporadic Alzheimer disease (AD) are more likely than those with later onset to present with atypical clinical and cognitive features. We sought to determine whether this age-related clinical and cognitive heterogeneity is mediated by different topographic distributions of tau-aggregate neurofibrillary tangles (NFTs) or by variable amounts of concomitant non-AD neuropathology. METHODS The relative distribution of NFT density in hippocampus and midfrontal neocortex was calculated, and α-synuclein, TAR DNA binding protein 43 (TDP-43), and microvascular copathologies were staged, in patients with severe AD and age at onset of 51-60 (n = 40), 61-70 (n = 41), and >70 (n = 40) years. Regression, mediation, and mixed effects models examined relationships of pathologic findings with clinical features and longitudinal cognitive decline. RESULTS Patients with later age at onset of AD were less likely to present with nonmemory complaints (odds ratio [OR] 0.46 per decade, 95% confidence interval [CI] 0.22-0.88), psychiatric symptoms (β = -0.66, 95% CI -1.15 to -0.17), and functional impairment (β = -1.25, 95% CI -2.34 to -0.16). TDP-43 (OR 2.00, 95% CI 1.23-3.35) and microvascular copathology (OR 2.02, 95% CI 1.24-3.40) were more common in later onset AD, and α-synuclein copathology was not related to age at onset. NFT density in midfrontal cortex (β = -0.51, 95% CI -0.72 to -0.31) and midfrontal/hippocampal NFT ratio (β = -0.18, 95% CI -0.26 to -0.10) were lower in those with later age at onset. Executive function (β = 0.48, 95% CI 0.09-0.90) and visuospatial cognitive deficits (β = 0.97, 95% CI 0.46-1.46) were less impaired in patients with later age at onset. Mediation analyses showed that the effect of age at onset on severity of executive function deficits was mediated by midfrontal/hippocampal NFT ratio (β = 0.21, 95% CI 0.08-0.38) and not by concomitant non-AD pathologies. Midfrontal/hippocampal NFT ratio also mediated an association between earlier age at onset and faster decline on tests of global cognition, executive function, and visuospatial abilities. DISCUSSION Worse executive dysfunction and faster cognitive decline in people with sporadic AD with earlier rather than later age at onset is mediated by greater relative midfrontal neocortical to hippocampal NFT burden and not by concomitant non-AD neuropathology.
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Affiliation(s)
- Denis S Smirnov
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA
| | - David P Salmon
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA
| | - Douglas Galasko
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA
| | - Vanessa S Goodwill
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA
| | - Lawrence A Hansen
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA
| | - Yu Zhao
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA
| | - Steven D Edland
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA
| | - Gabriel C Léger
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA
| | - Guerry M Peavy
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA
| | - Diane M Jacobs
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA
| | - Robert Rissman
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA
| | - Donald P Pizzo
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA
| | - Annie Hiniker
- From the Departments of Neurosciences (D.S.S., D.P.S., D.G., G.C.L., G.M.P., D.M.J., R.R., A.H.), Pathology (V.S.G., L.A.H., D.P.P., A.H.), and Family Medicine and Public Health (Y.Z., S.D.E.), University of California, San Diego; and VA San Diego Healthcare System (D.G., R.R., A.H.), CA.
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Hwang DJ, Choi DH, Kwon KC, Kim EH, Kim TK, Koo JH, Cho JY. Exercise Reverses Amyloid Beta-Peptide-mediated Cognitive Deficits in Alzheimer's Disease Mice Expressing Mutant Presenilin-2. Med Sci Sports Exerc 2021; 54:551-565. [PMID: 34816813 DOI: 10.1249/mss.0000000000002834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The molecular mechanisms by which physical exercise produces beneficial effects on pathological features and behavioral symptoms of Alzheimer's disease (AD) are not well understood. Herein, we examined whether regular moderate exercise could improve cognitive function and produce transcriptomic responses in the brain. METHODS Four groups of mice were studied: non-transgenic control (Non-Tg), mice expressing the human presenilin-2 wild type (Tg-PS2w), mice expressing the human presenilin-2 with the N141I mutation (Tg-PS2m), and Tg-PS2m that were subjected to treadmill exercise (TE) at a speed of 10 m/min for 50 min/day, 5 days/week, for 6 weeks (Tg-PS2m/Ex). RESULTS Tg-PS2m/Ex mice exhibited increased preference in exploring a novel object than Tg-PS2m in the novel object recognition test (NORT), whereas differences observed in the water maze test and passive avoidance test were not significant. Western blot and histological analyses using amyloid oligomer (A11) and Aβ (6E10) antibody indicated that amyloid oligomer-reactive bands and plaque deposition in the hippocampus were reduced, though not significantly, after TE. Transcriptomic (RNA-sequencing) analysis and subsequent protein analysis revealed that the cell cycle regulatory gene, Cdc28 protein kinase regulatory subunit 2 (Cks2), was decreased, and the cell cycle- and apoptotic cell death-related factors, including cyclin D1, proliferating cell nuclear antigen, and cleaved caspase-3 were increased in the hippocampus of Tg-PS2m, whereas TE reversed their altered expression. CONCLUSION These results support the hypothesis that the pathological features and behavioral symptoms of AD caused by accumulation of amyloid beta-peptide in hippocampus, causing aberrant cell cycle re-entry and apoptosis, can be reversed by regular exercise.
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Affiliation(s)
- Dong-Joo Hwang
- Exercise Biochemistry Laboratory, Korea National Sport University, Seoul, Republic of Korea Department of Physical Education, Dongguk University, Seoul, Republic of Korea
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Analyzing the Effect of Weak External Transcranial Magnetic Stimulation on the Primary Dominant Frequencies of Alzheimer Patients Brain by Using MEG Recordings. Medicina (B Aires) 2021; 57:medicina57111164. [PMID: 34833381 PMCID: PMC8622009 DOI: 10.3390/medicina57111164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Backround and Objectives: Alternative, non-invasive, and non-pharmaceutical options are gaining place in the battle of Alzheimer’s Disease treatment control. Lately, the magnetic stimulation of the brain is the most prevalent technique with encouraging results. The aim of this study is to establish any possible change on the Primary Dominant Frequencies (PDF) (range 2–7 Hz) of the affected brain regions in Alzheimer Disease (AD) patients after applying extremely weak Transcranial Magnetic Stimulation. Materials and Methods: For this purpose, all AD patients were scanned with the use of MagnetoEncephaloGraphy (MEG) recordings through a whole-head 122–channel MEG system. Results: Our results exerted statistically significant PDF changes due to weak TMS accompanied by rabid attenuation of clinical symptoms. Conclusion: Thus, this is the first time that a positive therapeutic effect is being demonstrated even at pico-Tesla range magnetic fields in a small clinical group of studies for AD.
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Karami V, Nittari G, Traini E, Amenta F. An Optimized Decision Tree with Genetic Algorithm Rule-Based Approach to Reveal the Brain's Changes During Alzheimer's Disease Dementia. J Alzheimers Dis 2021; 84:1577-1584. [PMID: 34719494 DOI: 10.3233/jad-210626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is desirable to achieve acceptable accuracy for computer aided diagnosis system (CADS) to disclose the dementia-related consequences on the brain. Therefore, assessing and measuring these impacts is fundamental in the diagnosis of dementia. OBJECTIVE This study introduces a new CADS for deep learning of magnetic resonance image (MRI) data to identify changes in the brain during Alzheimer's disease (AD) dementia. METHODS The proposed algorithm employed a decision tree with genetic algorithm rule-based optimization to classify input data which were extracted from MRI. This pipeline is applied to the healthy and AD subjects of the Open Access Series of Imaging Studies (OASIS). RESULTS Final evaluation of the CADS and its comparison with other systems supported the potential of the proposed model as a novel tool for investigating the progression of AD and its great ability as an innovative computerized help to facilitate the decision-making procedure for the diagnosis of AD. CONCLUSION The one-second time response, together with the identified high accurate performance, suggests that this system could be useful in future cognitive and computational neuroscience studies.
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Affiliation(s)
- Vania Karami
- Department of Neurology and Neurosurgery, MontrealNeurological Institute-Hospital (MNI), McGill University, Montreal, Canada
| | - Giulio Nittari
- School of PharmaceuticalSciences and Health Products, University of Camerino, Camerino (MC), Italy
| | - Enea Traini
- School of PharmaceuticalSciences and Health Products, University of Camerino, Camerino (MC), Italy
| | - Francesco Amenta
- School of PharmaceuticalSciences and Health Products, University of Camerino, Camerino (MC), Italy
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Rujeedawa T, Carrillo Félez E, Clare ICH, Fortea J, Strydom A, Rebillat AS, Coppus A, Levin J, Zaman SH. The Clinical and Neuropathological Features of Sporadic (Late-Onset) and Genetic Forms of Alzheimer's Disease. J Clin Med 2021; 10:4582. [PMID: 34640600 PMCID: PMC8509365 DOI: 10.3390/jcm10194582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/17/2022] Open
Abstract
The purpose of this review is to compare and highlight the clinical and pathological aspects of genetic versus acquired Alzheimer's disease: Down syndrome-associated Alzheimer's disease in (DSAD) and Autosomal Dominant Alzheimer's disease (ADAD) are compared with the late-onset form of the disease (LOAD). DSAD and ADAD present in a younger population and are more likely to manifest with non-amnestic (such as dysexecutive function features) in the prodromal phase or neurological features (such as seizures and paralysis) especially in ADAD. The very large variety of mutations associated with ADAD explains the wider range of phenotypes. In the LOAD, age-associated comorbidities explain many of the phenotypic differences.
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Affiliation(s)
- Tanzil Rujeedawa
- Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge CB2 8PQ, UK; (T.R.); (E.C.F.); (I.C.H.C.)
| | - Eva Carrillo Félez
- Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge CB2 8PQ, UK; (T.R.); (E.C.F.); (I.C.H.C.)
| | - Isabel C. H. Clare
- Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge CB2 8PQ, UK; (T.R.); (E.C.F.); (I.C.H.C.)
- Cambridgeshire and Peterborough Foundation NHS Trust, Fulbourn CB21 5EF, UK
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, 08029 Barcelona, Spain
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK;
- South London and the Maudsley NHS Foundation Trust, The LonDowns Consortium, London SE5 8AZ, UK
| | | | - Antonia Coppus
- Department for Primary and Community Care, Department of Primary and Community Care (149 ELG), Radboud University Nijmegen Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands;
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, 80539 Munich, Germany;
- German Center for Neurodegenerative Diseases, Feodor-Lynen-Strasse 17, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Strasse 17, 81377 Munich, Germany
| | - Shahid H. Zaman
- Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge CB2 8PQ, UK; (T.R.); (E.C.F.); (I.C.H.C.)
- Cambridgeshire and Peterborough Foundation NHS Trust, Fulbourn CB21 5EF, UK
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Uretsky M, Gibbons LE, Mukherjee S, Trittschuh EH, Fardo DW, Boyle PA, Keene CD, Saykin AJ, Crane PK, Schneider JA, Mez J. Longitudinal cognitive performance of Alzheimer's disease neuropathological subtypes. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12201. [PMID: 34604500 PMCID: PMC8474122 DOI: 10.1002/trc2.12201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/03/2021] [Accepted: 06/17/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Alzheimer's disease (AD) neuropathological subtypes (limbic predominant [lpAD], hippocampal sparing [HpSpAD], and typical [tAD]), defined by relative neurofibrillary tangle (NFT) burden in limbic and cortical regions, have not been studied in prospectively characterized epidemiological cohorts with robust cognitive assessments. METHODS Two hundred ninety-two participants with neuropathologically confirmed AD from the Religious Orders Study and Memory and Aging Project were categorized by neuropathological subtype based on previously specified diagnostic criteria using quantitative regional NFT counts. Rates of cognitive decline were compared across subtypes using linear mixed-effects models that included subtype, time, and a subtype-time interaction as predictors and four cognitive domain factor scores (memory, executive function, language, visuospatial) and a global score as outcomes. To assess if memory was relatively preserved in HpSpAD, non-memory factor scores were included as covariates in the mixed-effects model with memory as the outcome. RESULTS There were 57 (20%) with lpAD, 22 (8%) with HpSpAD and 213 (73%) with tAD. LpAD died significantly later than the participants with tAD (2.4 years, P = .01) and with HpSpAD (3.8 years, P = .03). Compared to tAD, HpSpAD, but not lpAD, performed significantly worse in all cognitive domains at the time of initial impairment and declined significantly faster in memory, language, and globally. HpSpAD did not have relatively preserved memory performance at any time point. CONCLUSION The relative frequencies of AD neuropathological subtypes in an epidemiological sample were consistent with a previous report in a convenience sample. People with HpSpAD decline rapidly, but may not have a memory-sparing clinical syndrome. Cohort-specific differences in regional tau burden and comorbid neuropathology may explain the lack of clinicopathological correlation.
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Affiliation(s)
- Madeline Uretsky
- Boston University Alzheimer's Disease and CTE CentersBoston University School of MedicineBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Laura E. Gibbons
- Department of General Internal MedicineUniversity of Washington School of Medicine, University of WashingtonSeattleWashingtonUSA
| | - Shubhabrata Mukherjee
- Department of General Internal MedicineUniversity of Washington School of Medicine, University of WashingtonSeattleWashingtonUSA
| | - Emily H. Trittschuh
- Geriatric Research, Education, and Clinical CenterPuget Sound Veterans Affairs Health Care SystemSeattleWashingtonUSA
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - David W. Fardo
- Sanders‐Brown Center on AgingUniversity of Kentucky College of MedicineLexingtonKentuckyUSA
- College of Public Health and Department of BiostatisticsUniversity of KentuckyLexingtonKentuckyUSA
| | - Patricia A. Boyle
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Division of Behavioral SciencesRush Medical CollegeChicagoIllinoisUSA
| | - C. Dirk Keene
- University of Washington Alzheimer's Disease Research CenterUniversity of Washington School of MedicineSeattleWashingtonUSA
- Department of Laboratory Medicine and PathologyUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Andrew J. Saykin
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Radiology and Imaging ServicesIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Paul K. Crane
- Department of General Internal MedicineUniversity of Washington School of Medicine, University of WashingtonSeattleWashingtonUSA
- University of Washington Alzheimer's Disease Research CenterUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Julie A. Schneider
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of PathologyRush Medical College, ChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Jesse Mez
- Boston University Alzheimer's Disease and CTE CentersBoston University School of MedicineBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
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32
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Huang W, Bartosch AM, Xiao H, Maji S, Youth EHH, Flowers X, Leskinen S, Tomljanovic Z, Iodice G, Boyett D, Spinazzi E, Menon V, McGovern RA, McKhann GM, Teich AF. An immune response characterizes early Alzheimer's disease pathology and subjective cognitive impairment in hydrocephalus biopsies. Nat Commun 2021; 12:5659. [PMID: 34580300 PMCID: PMC8476497 DOI: 10.1038/s41467-021-25902-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 09/06/2021] [Indexed: 11/21/2022] Open
Abstract
Early Alzheimer's disease (AD) pathology can be found in cortical biopsies taken during shunt placement for Normal Pressure Hydrocephalus. This represents an opportunity to study early AD pathology in living patients. Here we report RNA-seq data on 106 cortical biopsies from this patient population. A restricted set of genes correlate with AD pathology in these biopsies, and co-expression network analysis demonstrates an evolution from microglial homeostasis to a disease-associated microglial phenotype in conjunction with increasing AD pathologic burden, along with a subset of additional astrocytic and neuronal genes that accompany these changes. Further analysis demonstrates that these correlations are driven by patients that report mild cognitive symptoms, despite similar levels of biopsy β-amyloid and tau pathology in comparison to patients who report no cognitive symptoms. Taken together, these findings highlight a restricted set of microglial and non-microglial genes that correlate with early AD pathology in the setting of subjective cognitive decline.
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Affiliation(s)
- Wenrui Huang
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Anne Marie Bartosch
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Harrison Xiao
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Suvrajit Maji
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Elliot H H Youth
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Xena Flowers
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Sandra Leskinen
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Neurology, Columbia University, New York, NY, USA
| | - Zeljko Tomljanovic
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Gail Iodice
- Department of Neurosurgery, Columbia University, New York, NY, USA
| | - Deborah Boyett
- Department of Neurosurgery, Columbia University, New York, NY, USA
| | | | - Vilas Menon
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Neurology, Columbia University, New York, NY, USA
| | - Robert A McGovern
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Guy M McKhann
- Department of Neurosurgery, Columbia University, New York, NY, USA
| | - Andrew F Teich
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA.
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA.
- Department of Neurology, Columbia University, New York, NY, USA.
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Song G, Yang H, Shen N, Pham P, Brown B, Lin X, Hong Y, Sinu P, Cai J, Li X, Leon M, Gordon MN, Morgan D, Zhang S, Cao C. An Immunomodulatory Therapeutic Vaccine Targeting Oligomeric Amyloid-β. J Alzheimers Dis 2021; 77:1639-1653. [PMID: 32925044 DOI: 10.3233/jad-200413] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Aging is considered the most important risk factor for Alzheimer's disease (AD). Recent research supports the theory that immunotherapy targeting the "oligomeric" forms of amyloid-β (Aβ) may halt the progression of AD. However, previous clinical trial of the vaccine against Aβ, called AN1792, was suspended due to cases of meningoencephalitis in patients. OBJECTIVE To develop a peptide sensitized dendritic cells (DCs) vaccine that would target oligomer Aβ and prevent an autoimmune response. METHODS Double transgenic APPswe/PS1ΔE9 (Tg) and C57BL/6J control mice were used in this study. Cytokine expression profile detection, characterization of antisera, brain GSK-3β, LC3 expression, and spatial working memory testing before and post-vaccination were obtained. RESULTS Epitope prediction indicated that E22W42 could generate 13 new T cell epitopes which can strengthen immunity in aged subjects and silence several T cell epitopes of the wild type Aβ. The silenced T cell epitope could help avoid the autoimmune response that was seen in some patients of the AN-1792 vaccine. The E22W42 not only helped sensitize bone marrow-derived DCs for the development of an oligomeric Aβ-specific antibody, but also delayed memory impairment in the APP/PS1 mouse model. Most importantly, this E22W42 peptide will not alter the DC's natural immunomodulatory properties. CONCLUSION The E22W42 vaccine is possibly safer for patients with impaired immune systems. Since there is increasing evidence that oligomeric form of Aβ are the toxic species to neurons, the E22W42 antibody's specificity for these "oligomeric" Aβ species could provide the opportunity to produce some clinical benefits in AD subjects.
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Affiliation(s)
- Ge Song
- Tianjin University of Traditional Chinese Medicine, Tianjin, P.R. China
| | - Haiqiang Yang
- College of Arts and Science, University of South Florida, Tampa, FL, USA
| | - Ning Shen
- College of Arts and Science, University of South Florida, Tampa, FL, USA
| | - Phillip Pham
- Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Breanna Brown
- Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Xiaoyang Lin
- Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Yuzhu Hong
- Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Paul Sinu
- Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Jianfeng Cai
- College of Arts and Science, University of South Florida, Tampa, FL, USA
| | - Xiaopeng Li
- College of Arts and Science, University of South Florida, Tampa, FL, USA
| | - Michael Leon
- Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Marcia N Gordon
- Department of Translational Neuroscience, College of Medicine, Michigan State University, Grand Rapids, MI, USA
| | - David Morgan
- Department of Translational Neuroscience, College of Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Sai Zhang
- Institution of Brain Trauma and Neurology Disease, Key Laboratory of Neurotrauma Repair of Tianjin, Tianjin, China
| | - Chuanhai Cao
- College of Arts and Science, University of South Florida, Tampa, FL, USA.,Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA.,College of Medicine, University of South Florida, Tampa, FL, USA
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Bergeron D, Beauregard JM, Soucy JP, Verret L, Poulin S, Matias-Guiu JA, Cabrera-Martín MN, Bouchard RW, Laforce R. Posterior Cingulate Cortex Hypometabolism in Non-Amnestic Variants of Alzheimer's Disease. J Alzheimers Dis 2021; 77:1569-1577. [PMID: 32925054 DOI: 10.3233/jad-200567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hypometabolism of the posterior cingulate cortex (PCC) is an important diagnostic feature of late-onset, amnestic Alzheimer's disease (AD) measured with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). However, it is unclear whether PCC hypometabolism has diagnostic value in young-onset, non-amnestic variants of AD, which exhibit less pathology in the hippocampus and default mode network. OBJECTIVE Evaluate the prevalence and diagnostic value of PCC hypometabolism in non-amnestic variants of AD. METHODS We retrospectively identified 60 patients with young-onset, atypical dementia who have undergone a detailed clinical evaluation, FDG-PET, and an amyloid biomarker (amyloid-PET or cerebrospinal fluid analysis). We quantitatively analyzed regional hypometabolism in 70 regions of interest (ROI) using the MIMneuro® software. RESULTS Based on a cut-off of z-score < -1.5 for significant PCC hypometabolism, the prevalence of PCC hypometabolism in non-amnestic variants of AD was 65% compared to 28% in clinical variants of frontotemporal dementia (FTD). The ROI with the maximal hypometabolism was the dominant middle temporal gyrus in the language variant of AD (mean z score -2.28), middle occipital gyrus in PCA (-3.24), middle temporal gyrus in frontal AD (-2.70), and angular gyrus in corticobasal syndrome due to AD (-2.31). The PCC was not among the 10 most discriminant regions between non-amnestic variants of AD versus clinical variants of FTD. CONCLUSION We conclude that PCC hypometabolism is not a discriminant feature to distinguish non-amnestic variants of AD from clinical variants of FTD-and should be interpreted with caution in patients with young-onset, non-amnestic dementia.
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Affiliation(s)
- David Bergeron
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, Québec, Canada
| | | | - Jean-Paul Soucy
- Department of Nuclear Medicine, Montreal Neurological Institute (MNI), Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Louis Verret
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, Québec, Canada
| | - Stéphane Poulin
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, Québec, Canada
| | - Jordi A Matias-Guiu
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - María Nieves Cabrera-Martín
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Rémi W Bouchard
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, Québec, Canada
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35
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Anderson EL, Richmond RC, Jones SE, Hemani G, Wade KH, Dashti HS, Lane JM, Wang H, Saxena R, Brumpton B, Korologou-Linden R, Nielsen JB, Åsvold BO, Abecasis G, Coulthard E, Kyle SD, Beaumont RN, Tyrrell J, Frayling TM, Munafò MR, Wood AR, Ben-Shlomo Y, Howe LD, Lawlor DA, Weedon MN, Davey Smith G. Is disrupted sleep a risk factor for Alzheimer's disease? Evidence from a two-sample Mendelian randomization analysis. Int J Epidemiol 2021; 50:817-828. [PMID: 33150399 PMCID: PMC8271193 DOI: 10.1093/ije/dyaa183] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/31/2022] Open
Abstract
Background It is established that Alzheimer’s disease (AD) patients experience sleep disruption. However, it remains unknown whether disruption in the quantity, quality or timing of sleep is a risk factor for the onset of AD. Methods We used the largest published genome-wide association studies of self-reported and accelerometer-measured sleep traits (chronotype, duration, fragmentation, insomnia, daytime napping and daytime sleepiness), and AD. Mendelian randomization (MR) was used to estimate the causal effect of self-reported and accelerometer-measured sleep parameters on AD risk. Results Overall, there was little evidence to support a causal effect of sleep traits on AD risk. There was some suggestive evidence that self-reported daytime napping was associated with lower AD risk [odds ratio (OR): 0.70, 95% confidence interval (CI): 0.50–0.99). Some other sleep traits (accelerometer-measured ‘eveningness’ and sleep duration, and self-reported daytime sleepiness) had ORs of a similar magnitude to daytime napping, but were less precisely estimated. Conclusions Overall, we found very limited evidence to support a causal effect of sleep traits on AD risk. Our findings provide tentative evidence that daytime napping may reduce AD risk. Given that this is the first MR study of multiple self-report and objective sleep traits on AD risk, findings should be replicated using independent samples when such data become available.
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Affiliation(s)
- Emma L Anderson
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Samuel E Jones
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Gibran Hemani
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Kaitlin H Wade
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Hassan S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Jacqueline M Lane
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Heming Wang
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richa Saxena
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ben Brumpton
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Roxanna Korologou-Linden
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Jonas B Nielsen
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gonçalo Abecasis
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth Coulthard
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Robin N Beaumont
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Jessica Tyrrell
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Timothy M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
| | - Andrew R Wood
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
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36
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Balendra V, Singh SK. Therapeutic potential of astaxanthin and superoxide dismutase in Alzheimer's disease. Open Biol 2021; 11:210013. [PMID: 34186009 PMCID: PMC8241491 DOI: 10.1098/rsob.210013] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Oxidative stress, the imbalance of the antioxidant system, results in an accumulation of neurotoxic proteins in Alzheimer's disease (AD). The antioxidant system is composed of exogenous and endogenous antioxidants to maintain homeostasis. Superoxide dismutase (SOD) is an endogenous enzymatic antioxidant that converts superoxide ions to hydrogen peroxide in cells. SOD supplementation in mice prevented cognitive decline in stress-induced cells by reducing lipid peroxidation and maintaining neurogenesis in the hippocampus. Furthermore, SOD decreased expression of BACE1 while reducing plaque burden in the brain. Additionally, Astaxanthin (AST), a potent exogenous carotenoid, scavenges superoxide anion radicals. Mice treated with AST showed slower memory decline and decreased depositions of amyloid-beta (Aβ) and tau protein. Currently, the neuroprotective potential of these supplements has only been examined separately in studies. However, a single antioxidant cannot sufficiently resist oxidative damage to the brain, therefore, a combinatory approach is proposed as a relevant therapy for ameliorating pathological changes in AD.
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Affiliation(s)
| | - Sandeep Kumar Singh
- Indian Scientific Education and Technology (ISET) Foundation, Lucknow 226002, India
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37
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Caspers S, Röckner ME, Jockwitz C, Bittner N, Teumer A, Herms S, Hoffmann P, Nöthen MM, Moebus S, Amunts K, Cichon S, Mühleisen TW. Pathway-Specific Genetic Risk for Alzheimer's Disease Differentiates Regional Patterns of Cortical Atrophy in Older Adults. Cereb Cortex 2021; 30:801-811. [PMID: 31402375 DOI: 10.1093/cercor/bhz127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/30/2019] [Accepted: 05/18/2019] [Indexed: 11/13/2022] Open
Abstract
Brain aging is highly variable and represents a challenge to delimit aging from disease processes. Moreover, genetic factors may influence both aging and disease. Here we focused on this issue and investigated effects of multiple genetic loci previously identified to be associated with late-onset Alzheimer's disease (AD) on brain structure of older adults from a population sample. We calculated a genetic risk score (GRS) using genome-wide significant single-nucleotide polymorphisms from genome-wide association studies of AD and tested its effect on cortical thickness (CT). We observed a common pattern of cortical thinning (right inferior frontal, left posterior temporal, medial occipital cortex). To identify CT changes by specific biological processes, we subdivided the GRS effect according to AD-associated pathways and performed follow-up analyses. The common pattern from the main analysis was further differentiated by pathway-specific effects yielding a more bilateral pattern. Further findings were located in the superior parietal and mid/anterior cingulate regions representing 2 unique pathway-specific patterns. All patterns, except the superior parietal pattern, were influenced by apolipoprotein E. Our step-wise approach revealed atrophy patterns that partially resembled imaging findings in early stages of AD. Our study provides evidence that genetic burden for AD contributes to structural brain variability in normal aging.
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Affiliation(s)
- Svenja Caspers
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, D-52428 Jülich, Germany.,Institute for Anatomy I, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,JARA-BRAIN, Jülich-Aachen Research Alliance, Jülich, Germany
| | - Melanie E Röckner
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, D-52428 Jülich, Germany.,Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Christiane Jockwitz
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, D-52428 Jülich, Germany.,JARA-BRAIN, Jülich-Aachen Research Alliance, Jülich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Medical Faculty, Aachen, Germany
| | - Nora Bittner
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, D-52428 Jülich, Germany.,Institute for Anatomy I, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Herms
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany.,Department of Biomedicine, University of Basel, Basel, Switzerland.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Per Hoffmann
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, D-52428 Jülich, Germany.,Institute of Human Genetics, University Hospital Bonn, Bonn, Germany.,Department of Biomedicine, University of Basel, Basel, Switzerland.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Katrin Amunts
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, D-52428 Jülich, Germany.,JARA-BRAIN, Jülich-Aachen Research Alliance, Jülich, Germany.,C. & O. Vogt Institute for Brain Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sven Cichon
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, D-52428 Jülich, Germany.,Institute of Human Genetics, University Hospital Bonn, Bonn, Germany.,Department of Biomedicine, University of Basel, Basel, Switzerland.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany.,Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Thomas W Mühleisen
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, D-52428 Jülich, Germany.,Department of Biomedicine, University of Basel, Basel, Switzerland.,C. & O. Vogt Institute for Brain Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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38
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Jia J, Xu J, Liu J, Wang Y, Wang Y, Cao Y, Guo Q, Qu Q, Wei C, Wei W, Zhang J, Yu E. Comprehensive Management of Daily Living Activities, behavioral and Psychological Symptoms, and Cognitive Function in Patients with Alzheimer's Disease: A Chinese Consensus on the Comprehensive Management of Alzheimer's Disease. Neurosci Bull 2021; 37:1025-1038. [PMID: 34050523 PMCID: PMC8275730 DOI: 10.1007/s12264-021-00701-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/06/2021] [Indexed: 01/05/2023] Open
Abstract
Alzheimer's disease (AD) is the most common cognitive disorder in the elderly. Its main clinical manifestations are cognitive decline (C), behavioral and psychological symptoms (B), and a decline in the activities of daily living (A), also known as ABC symptoms. Early identification and evaluation of ABC symptoms are helpful for establishing the accurate diagnosis, comprehensive treatment, and prognosis of AD. To guide Chinese clinical practice for optimization of the comprehensive management of AD, in 2018, The Academy of Cognitive Disorder of China gathered 22 neurologists and gerontologists in China to build a consensus on the comprehensive management of AD. Based on a review of the evidence, the consensus summarizes the pathogenesis, pathological changes, clinical manifestations, evaluation, diagnosis, drug and non-drug treatment, and patient care for AD. Focus group discussion was used to establish a flowchart of comprehensive ABC management for AD patients. The new consensus provides a feasible AD management process for clinicians.
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Affiliation(s)
- Jianjun Jia
- Department of Neurology, The Second Medical Center, People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Jun Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jun Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yongjun Wang
- Cognitive Impairment Department, Shenzhen Kangning Hospital, Shenzhen, 518118, China
| | - Yanjiang Wang
- Department of Neurology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Yunpeng Cao
- Department of Neurology, The First Hospital of China Medical University, Shenyang, 210112, China
| | - Qihao Guo
- Department of Gerontology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Qiuming Qu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Cuibai Wei
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Wenshi Wei
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Enyan Yu
- Department of Psychology, Chinese Academy of Sciences Cancer Hospital of the University of the Chinese Academy of Sciences, Hangzhou, 310022, China
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39
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Smirnov DS, Galasko D, Hiniker A, Edland SD, Salmon DP. Age-at-Onset and APOE-Related Heterogeneity in Pathologically Confirmed Sporadic Alzheimer Disease. Neurology 2021; 96:e2272-e2283. [PMID: 33722993 PMCID: PMC8166435 DOI: 10.1212/wnl.0000000000011772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/28/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize age-related clinical heterogeneity in Alzheimer disease (AD) and determine whether it is modified by APOE genotype or concomitant non-AD pathology, we analyzed data from 1,750 patients with sporadic, pathologically confirmed severe AD. METHODS In this retrospective cohort study, regression and mixed effects models assessed effects of estimated age at onset, APOE genotype, and their interaction on standardized clinical, cognitive, and pathologic outcome measures from the National Alzheimer's Coordinating Center database. RESULTS A bimodal distribution of age at onset frequency in APOE ε4- cases showed best separation at age 63. Using this age cutoff, cases were grouped as ε4- early-onset AD (EOAD) (n = 169), ε4+ EOAD (n = 273), ε4- late-onset AD (LOAD) (n = 511), and ε4+ LOAD (n = 797). Patients with EOAD were more likely than patients with LOAD to present with noncognitive behavioral or motor symptoms or nonmemory cognitive complaints, and had more executive dysfunction, but less language impairment on objective cognitive testing. Age at onset and ε4- genotype were independently associated with lower baseline Mini-Mental State Examination scores and greater functional impairment and patients with EOAD had faster cognitive and functional decline than patients with LOAD regardless of APOE genotype. Patients with EOAD were more likely than patients with LOAD to receive a non-AD clinical diagnosis even though they were more likely to have pure AD without concomitant vascular or other non-AD neurodegenerative pathology. CONCLUSIONS Early-onset sporadic AD is associated with a greater likelihood of an atypical, non-memory-dominant clinical presentation, especially in the absence of the APOE ε4 allele, which may lead to misattribution to non-AD underlying pathology.
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Affiliation(s)
- Denis S Smirnov
- From the Departments of Neurosciences (D. Smirnov, D.G., A.H., D. Salmon), Pathology (A.H.), and Family Medicine and Public Health (S. Edland), University of California San Diego
| | - Douglas Galasko
- From the Departments of Neurosciences (D. Smirnov, D.G., A.H., D. Salmon), Pathology (A.H.), and Family Medicine and Public Health (S. Edland), University of California San Diego
| | - Annie Hiniker
- From the Departments of Neurosciences (D. Smirnov, D.G., A.H., D. Salmon), Pathology (A.H.), and Family Medicine and Public Health (S. Edland), University of California San Diego
| | - Steven D Edland
- From the Departments of Neurosciences (D. Smirnov, D.G., A.H., D. Salmon), Pathology (A.H.), and Family Medicine and Public Health (S. Edland), University of California San Diego
| | - David P Salmon
- From the Departments of Neurosciences (D. Smirnov, D.G., A.H., D. Salmon), Pathology (A.H.), and Family Medicine and Public Health (S. Edland), University of California San Diego.
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40
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Wan Yaacob WMH, Long I, Zakaria R, Othman Z. Tualang honey and its methanolic fraction ameliorate lipopolysaccharide-induced oxidative stress, amyloid deposition and neuronal loss of the rat hippocampus. ADVANCES IN TRADITIONAL MEDICINE 2021. [DOI: 10.1007/s13596-020-00449-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Graff-Radford J, Yong KXX, Apostolova LG, Bouwman FH, Carrillo M, Dickerson BC, Rabinovici GD, Schott JM, Jones DT, Murray ME. New insights into atypical Alzheimer's disease in the era of biomarkers. Lancet Neurol 2021; 20:222-234. [PMID: 33609479 PMCID: PMC8056394 DOI: 10.1016/s1474-4422(20)30440-3] [Citation(s) in RCA: 207] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
Most patients with Alzheimer's disease present with amnestic problems; however, a substantial proportion, over-represented in young-onset cases, have atypical phenotypes including predominant visual, language, executive, behavioural, or motor dysfunction. In the past, these individuals often received a late diagnosis; however, availability of CSF and PET biomarkers of Alzheimer's disease pathologies and incorporation of atypical forms of Alzheimer's disease into new diagnostic criteria increasingly allows them to be more confidently diagnosed early in their illness. This early diagnosis in turn allows patients to be offered tailored information, appropriate care and support, and individualised treatment plans. These advances will provide improved access to clinical trials, which often exclude atypical phenotypes. Research into atypical Alzheimer's disease has revealed previously unrecognised neuropathological heterogeneity across the Alzheimer's disease spectrum. Neuroimaging, genetic, biomarker, and basic science studies are providing key insights into the factors that might drive selective vulnerability of differing brain networks, with potential mechanistic implications for understanding typical late-onset Alzheimer's disease.
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Affiliation(s)
| | - Keir X. X. Yong
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Liana G. Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Femke H. Bouwman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam University Medical Center
| | | | - Bradford C. Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gil D. Rabinovici
- Departments of Neurology, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Jonathan M. Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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42
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Loosli SV, Schmidt L, Nübling G, Wlasich E, Prix C, Danek A, Levin J. [Cognition in Down's Syndrome: Development across the Life Span and Neuropsychological Assessment in Adults]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:433-444. [PMID: 33647991 DOI: 10.1055/a-1362-9868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungDas Down-Syndrom ist die häufigste genetische Ursache einer Intelligenzminderung. Da Menschen mit einem Down-Syndrom ein erhöhtes Risiko aufweisen, an einer Alzheimer-Demenz zu erkranken, ist eine umfassende Untersuchung der kognitiven Funktionen indiziert, sowohl im jungen Erwachsenenalter (zur Erhebung des kognitiven Ausgangsniveaus) als auch im Verlauf zur Demenzdiagnostik. Das weite Spektrum an kognitiver Leistungsfähigkeit bei Menschen mit einem Down-Syndrom stellt eine diagnostische Herausforderung dar. Wir möchten daher einen Überblick geben (1) über die kognitive Entwicklung über die Lebensspanne, (2) über verschiedene mögliche Ursachen kognitiver Veränderungen bei erwachsenen Menschen mit einem Down-Syndrom und (3) über neuropsychologische Diagnostik und entsprechende Verfahren für den Erwachsenenbereich. Schließlich geben wir, auf der Grundlage unserer Erfahrungen, (4) allgemeine Empfehlungen zur Untersuchung und Befundinterpretation bei Menschen mit Intelligenzminderung.
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Affiliation(s)
- Sandra V Loosli
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität München
| | - Luisa Schmidt
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität München
| | - Georg Nübling
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität München
| | - Elisabeth Wlasich
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität München
| | - Catharina Prix
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität München.,Deutsches Zentrum für Neurodegenerative Erkrankungen, Standort München
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität München
| | - Johannes Levin
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität München.,Deutsches Zentrum für Neurodegenerative Erkrankungen, Standort München.,Munich Cluster for Systems Neurology (SyNergy)
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In vitro comparison of major memory-support dietary supplements for their effectiveness in reduction/inhibition of beta-amyloid protein fibrils and tau protein tangles: key primary targets for memory loss. Sci Rep 2021; 11:3001. [PMID: 33589649 PMCID: PMC7884837 DOI: 10.1038/s41598-020-79275-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023] Open
Abstract
Memory loss is primarily caused by the accumulation of both brain plaques [(consisting of beta-amyloid protein (Aβ) 1–42)] and neurofibrillary tangles (consisting of paired helical and straight filaments containing tau protein). Neuroinflammation is the third key and important factor that leads to accelerated memory loss and eventual dementia. Brain plaques, tangles and inflammation is the trilogy mainly responsible for causing memory loss that has now been documented for over 20 years in the scientific literature. The present investigation used in vitro quantitative methods to directly compare the ability of major memory-support dietary supplements to reduce pre-formed Aβ 1–42 fibrils (21 supplements tested) and tau protein paired helical/straight filaments (13 supplements tested)—two of the three most important targets for memory loss. Additionally, 18 different manufacturers of cat’s claw (Uncaria tomentosa) were directly compared for their ability to inhibit/reduce Aβ 1–42 fibrils and/or tau paired helical/straight filaments based on recent findings that PTI-00703 cat’s claw is a specific and potent inhibitor/reducer of all three targets -brain plaques, tangles and inflammation (Snow et al. in Sci Rep 9:561, 2019). In the present investigation quantitative Thioflavin T fluorometry was used on a comparative weight-to-weight basis at increasing concentrations with ingredients tested from the actual capsules the consumer ingests. Major memory-support dietary supplements were directly compared for their ability to inhibit and disaggregate/reduce both Aβ 1–42 fibrils and/or tau paired helical/straight filaments. Dietary supplements touted to enhance memory comparatively tested included Prevagen, FOCUSfactor, PROCERA AVH, Alpha Brain, NAD+OVIM, BRAIN JUICE, Cebria, EXCELEROL, NOOCUBE, US Doctor’s Clinical Brain Power ADVANCED, healthycell pro, LUMONOL, Brain Awake, BRAIN ARMOR, brainMD (BRAIN & MEMORY POWER BOOST), Brain Support, Clarity (BRAIN HEALTH FORMULA), brainMD (NEUROVITE PLUS), neuriva (Original and Plus) and percepta. This is the first paper to actually comparatively test these memory-support supplements for their ability to reduce Aβ fibrils and tau protein tangles. Percepta (PTI-00703 cat’s claw and a specific oolong tea extract) was determined to be the most effective and potent memory support dietary supplement to disaggregate/disrupt Aβ 1–42 fibrils (range of 25–89%) and tau paired helical/straight filaments (range of 26–86%) at all 3–4 doses tested in comparison to other major memory-support dietary supplements tested. This was at least more than double (> 50%) for percepta reducing Aβ 1–42 fibrils and in comparison to the other 20 memory-support dietary supplements tested. The ranking order for memory-support supplement effects based on reducing Aβ 1–42 fibrils (Aβ 1–42: memory-support supplement at 1:0.1 weight-to-weight in a 3-day study) was percepta (69.6% reduction) >>> Alpha Brain (34.9% reduction) = US Doctor’s Clinical Brain Power ADVANCED (32.4%) = BRAIN JUICE (30.1%) = neuriva Plus (27%) = neuriva Original (27%) > NEUROVITE PLUS (22.9%) = NOOCUBE (19.9%) = EXCELEROL (17.3%) = healthycell pro (17.2%) > Prevagen (12.9%) > PROCERA AVH (6.5%) = FOCUSfactor (5.5%) > Cebria (0%) = Brain Awake (0%) = Brain Support (0%) = brainMD (BRAIN & MEMORY POWER BOOST) (0%) = NAD+OVIM (0%) = BRAIN ARMOR (0%) = LUMONOL (0%). The ranking order for memory support supplement effects on reducing tau paired helical/straight filaments (tau:memory supplement at 1:1 weight-to-weight at 3 days) was percepta (85.7% reduction) >>> neuriva Plus (57.9%) >> BRAIN JUICE (41.9%) = EXCELEROL (41.0%) = neuriva Original (38.4%) = US Doctor’s Clinical Brain Power ADVANCED (38.3%) = healthycell pro (37.6%) >> Alpha Brain (27.9%) >> NOOCUBE (17.6%) >> FOCUSfactor (8.7%) > Cebria (3.6%) = PROCERA AVH (0%) = Prevagen (0%). Congo red staining, Thioflavin S fluorescence, circular dichroism (CD) spectroscopy and electron microscopy confirmed the positive results observed with the supplement percepta. CD spectroscopy demonstrated that percepta caused a marked inhibition of beta-sheet secondary folding of tau protein into paired helical filaments. PTI-00703 cat’s claw (main ingredient in percepta) was also identified as the most potent cat’s claw bark powder (Uncaria tomentosa) to reduce and inhibit Aβ 1–42 fibrils and tau tangles in comparison to 17 other manufacturers of cat’s claw extracts. Although there are thousands of brain memory-support dietary supplements in the marketplace today, none of them have been directly compared and analyzed for their ability to reduce and/or inhibit two major targets of memory loss i.e. Aβ 1–42 fibrils and tau paired helical/straight filaments (major constituents of brain plaques and tangles). In our comparison studies, we show that percepta has the most potent ability to disaggregate/reduce Aβ 1–42 fibrils and tau protein paired helical/straight filaments as demonstrated by a variety of methods most likely due to the specific polyphenol content in PTI-00703 cat’s claw (i.e. polyphenols and proanthocyanidins) as we have previously shown (Snow et al. in Sci Rep 9:561, 2019). Memory-support dietary supplements tested that also contained polyphenols and/or cat’s claw in their product demonstrated some Aβ fibril and tau protein tangle reducing activity, but were much less effective than percepta. Percepta’s main ingredient, PTI-00703 cat’s claw, has previously been shown to reduce brain amyloid plaques and Aβ 1–42/40 insoluble/soluble levels in brain (in plaque-producing transgenic mice) with marked concurrent memory improvements (shown by Morris water maze testing) (Snow et al. in Sci Rep 9:561, 2019). The present investigation further confirms that percepta is one of the best dietary supplements that causes a marked reduction and inhibition of Aβ fibrils and tau tangle filaments -two important major targets for memory-support. In addition, PTI-00703 cat’s claw was the most effective cat’s claw (Uncaria tomentosa) ingredient for reducing /disaggregating and inhibiting Aβ 1–42 fibrils and tau protein paired helical/straight filaments in comparison to 17 other manufacturers of cat’s claw extracts tested.
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Servizi S, Corrigan RR, Casadesus G. The Importance of Understanding Amylin Signaling Mechanisms for Therapeutic Development in the Treatment of Alzheimer's Disease. Curr Pharm Des 2020; 26:1345-1355. [PMID: 32188374 PMCID: PMC10088426 DOI: 10.2174/1381612826666200318151146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/04/2020] [Indexed: 12/12/2022]
Abstract
Type II Diabetes (T2D) is a major risk factor for Alzheimer's Disease (AD). These two diseases share several pathological features, including amyloid accumulation, inflammation, oxidative stress, cell death and cognitive decline. The metabolic hormone amylin and amyloid-beta are both amyloids known to self-aggregate in T2D and AD, respectively, and are thought to be the main pathogenic entities in their respective diseases. Furthermore, studies suggest amylin's ability to seed amyloid-beta aggregation, the activation of common signaling cascades in the pancreas and the brain, and the ability of amyloid beta to signal through amylin receptors (AMYR), at least in vitro. However, paradoxically, non-aggregating forms of amylin such as pramlintide are given to treat T2D and functional and neuroprotective benefits of amylin and pramlintide administration have been reported in AD transgenic mice. These paradoxical results beget a deeper study of the complex nature of amylin's signaling through the several AMYR subtypes and other receptors associated with amylin effects to be able to fully understand its potential role in mediating AD development and/or prevention. The goal of this review is to provide such critical insight to begin to elucidate how the complex nature of this hormone's signaling may explain its equally complex relationship with T2D and mechanisms of AD pathogenesis.
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Affiliation(s)
- Spencer Servizi
- School of Biomedical Sciences, Kent State University, Ohio, United States
| | - Rachel R Corrigan
- School of Biomedical Sciences, Kent State University, Ohio, United States
| | - Gemma Casadesus
- School of Biomedical Sciences, Kent State University, Ohio, United States.,Department of Biological Sciences, Kent State University, Ohio, United States
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Zhao Y, Jaber V, Alexandrov PN, Vergallo A, Lista S, Hampel H, Lukiw WJ. microRNA-Based Biomarkers in Alzheimer's Disease (AD). Front Neurosci 2020; 14:585432. [PMID: 33192270 PMCID: PMC7664832 DOI: 10.3389/fnins.2020.585432] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022] Open
Abstract
Alzheimer's disease (AD) is a multifactorial, age-related neurological disease characterized by complex pathophysiological dynamics taking place at multiple biological levels, including molecular, genetic, epigenetic, cellular and large-scale brain networks. These alterations account for multiple pathophysiological mechanisms such as brain protein accumulation, neuroinflammatory/neuro-immune processes, synaptic dysfunction, and neurodegeneration that eventually lead to cognitive and behavioral decline. Alterations in microRNA (miRNA) signaling have been implicated in the epigenetics and molecular genetics of all neurobiological processes associated with AD pathophysiology. These changes encompass altered miRNA abundance, speciation and complexity in anatomical regions of the CNS targeted by the disease, including modified miRNA expression patterns in brain tissues, the systemic circulation, the extracellular fluid (ECF) and the cerebrospinal fluid (CSF). miRNAs have been investigated as candidate biomarkers for AD diagnosis, disease prediction, prognosis and therapeutic purposes because of their involvement in multiple brain signaling pathways in both health and disease. In this review we will: (i) highlight the significantly heterogeneous nature of miRNA expression and complexity in AD tissues and biofluids; (ii) address how information may be extracted from these data to be used as a diagnostic, prognostic and/or screening tools across the entire continuum of AD, from the preclinical stage, through the prodromal, i.e., mild cognitive impairment (MCI) phase all the way to clinically overt dementia; and (iii) consider how specific miRNA expression patterns could be categorized using miRNA reporters that span AD pathophysiological initiation and disease progression.
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Affiliation(s)
- Yuhai Zhao
- LSU Neuroscience Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States
- Department of Cell Biology and Anatomy, Louisiana State University Health Science Center, New Orleans, LA, United States
| | - Vivian Jaber
- LSU Neuroscience Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | | | - Andrea Vergallo
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Simone Lista
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Brain & Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’Hôpital, Paris, France
- Institute of Memory and Alzheimer’s Disease (IM2A), Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l’hôpital, Paris, France
| | - Harald Hampel
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Walter J. Lukiw
- LSU Neuroscience Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States
- Russian Academy of Medical Sciences, Moscow, Russia
- Department of Ophthalmology, LSU Neuroscience Center Louisiana State University Health Science Center, New Orleans, LA, United States
- Department of Neurology, LSU Neuroscience Center Louisiana State University Health Science Center, New Orleans, LA, United States
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Pharmacological management of dementia with Lewy bodies with a focus on zonisamide for treating parkinsonism. Expert Opin Pharmacother 2020; 22:325-337. [PMID: 33021110 DOI: 10.1080/14656566.2020.1828350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Dementia with Lewy bodies (DLB) has no approved symptomatic or disease-modifying treatments in the US and Europe, despite being the second most common cause of neurodegenerative dementia. AREAS COVERED Herein, the authors briefly review the DLB drug development pipeline, providing a summary of the current pharmacological intervention studies. They then focus on the anticonvulsant zonisamide, a benzisoxazole derivative with a sulfonamide group and look at its value for treating parkinsonism in DLB. EXPERT OPINION Several new compounds are being tested in DLB, the most innovative being those aimed at decreasing brain accumulation of α-synuclein. Unfortunately, new drug testing is challenging in terms of consistent diagnostic criteria and lack of reliable biomarkers. Few randomized controlled trials (RCTs) are well-designed, with enough power to detect significant drug effects. Levodopa monotherapy can treat the parkinsonism in DLB, but it can cause agitation or visual hallucination worsening. Two Phase II/III RCTs of DLB patients recently reported a statistically significant improvement in motor function in those receiving zonisamide as an adjunctive treatment to levodopa. New biomarker strategies and validated outcome measures for DLB or prodromal DLB may enhance clinical trial design for the development of specific disease-modifying treatments.
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Dai DL, Tropea TF, Robinson JL, Suh E, Hurtig H, Weintraub D, Van Deerlin V, Lee EB, Trojanowski JQ, Chen-Plotkin AS. ADNC-RS, a clinical-genetic risk score, predicts Alzheimer's pathology in autopsy-confirmed Parkinson's disease and Dementia with Lewy bodies. Acta Neuropathol 2020; 140:449-461. [PMID: 32749525 PMCID: PMC7864557 DOI: 10.1007/s00401-020-02199-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
Abstract
Growing evidence suggests overlap between Alzheimer's disease (AD) and Parkinson's disease (PD) pathophysiology in a subset of patients. Indeed, 50-80% of autopsy cases with a primary clinicopathological diagnosis of Lewy body disease (LBD)-most commonly manifesting during life as PD-have concomitant amyloid-beta and tau pathology, the defining pathologies of AD. Here we evaluated common genetic variants in genome-wide association with AD as predictors of concomitant AD pathology in the brains of people with a primary clinicopathological diagnosis of PD or Dementia with Lewy Bodies (DLB), diseases both characterized by neuronal Lewy bodies. In the first stage of our study, 127 consecutive autopsy-confirmed cases of PD or DLB from a single center were assessed for AD neuropathological change (ADNC), and these same cases were genotyped at 20 single nucleotide polymorphisms (SNPs) found by genome-wide association study to associate with risk for AD. In these 127 training set individuals, we developed a logistic regression model predicting the presence of ADNC, using backward stepwise regression for model selection and tenfold cross-validation to estimate performance. The best-fit model generated a risk score for ADNC (ADNC-RS) based on age at disease onset and genotype at three SNPs (APOE, BIN1, and SORL1 loci), with an area under the receiver operating curve (AUC) of 0.751 in our training set. In the replication stage of our study, we assessed model performance in a separate test set of the next 81 individuals genotyped in our center. In the test set, the AUC was 0.781, and individuals with ADNC-RS in the top quintile had four-fold increased likelihood of having AD pathology at autopsy compared with those in each of the lowest two quintiles. Finally, in the validation stage of our study, we applied our ADNC-RS model to 70 LBD individuals from 20 Alzheimer's Disease Research Centers (ADRC) whose autopsy and genetic data were available in the National Alzheimer's Coordinating Center (NACC) database. In this validation set, the AUC was 0.754. Thus, in patients with autopsy-confirmed PD or DLB, a simple model incorporating three AD-risk SNPs and age at disease onset substantially enriches for concomitant AD pathology at autopsy, with implications for identifying LBD patients in which targeting amyloid-beta or tau is a therapeutic strategy.
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Affiliation(s)
- David L Dai
- Departments of Neurology, University of Pennsylvania, 3 West Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Thomas F Tropea
- Departments of Neurology, University of Pennsylvania, 3 West Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - John L Robinson
- Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eunran Suh
- Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Howard Hurtig
- Departments of Neurology, University of Pennsylvania, 3 West Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Daniel Weintraub
- Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parkinson's Disease and Mental Illness Research, Education and Clinical Centers (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Vivianna Van Deerlin
- Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward B Lee
- Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John Q Trojanowski
- Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alice S Chen-Plotkin
- Departments of Neurology, University of Pennsylvania, 3 West Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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Jimenez DA, Bond RL, Requena-Komuro MC, Sivasathiaseelan H, Marshall CR, Russell LL, Greaves C, Moore KM, Woollacott IO, Shafei R, Hardy CJ, Rohrer JD, Warren JD. Altered phobic reactions in frontotemporal dementia: A behavioural and neuroanatomical analysis. Cortex 2020; 130:100-110. [PMID: 32650059 PMCID: PMC7447974 DOI: 10.1016/j.cortex.2020.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Abnormal behavioural and physiological reactivity to emotional stimuli is a hallmark of frontotemporal dementia (FTD), particularly the behavioural variant (bvFTD). As part of this repertoire, altered phobic responses have been reported in some patients with FTD but are poorly characterised. METHODS We collected data (based on caregiver reports) concerning the prevalence and nature of any behavioural changes related to specific phobias in a cohort of patients representing canonical syndromes of FTD and Alzheimer's disease (AD), relative to healthy older controls. Neuroanatomical correlates of altered phobic reactivity were assessed using voxel-based morphometry. RESULTS 46 patients with bvFTD, 20 with semantic variant primary progressive aphasia, 25 with non-fluent variant primary progressive aphasia, 29 with AD and 55 healthy age-matched individuals participated. Changes in specific phobia were significantly more prevalent in the combined FTD cohort (15.4% of cases) and in the bvFTD group (17.4%) compared both to healthy controls (3.6%) and patients with AD (3.5%). Attenuation of phobic reactivity was reported for individuals in all participant groups, however new phobias developed only in the FTD cohort. Altered phobic reactivity was significantly associated with relative preservation of grey matter in left posterior middle temporal gyrus, right temporo-occipital junction and right anterior cingulate gyrus, brain regions previously implicated in contextual decoding, salience processing and reward valuation. CONCLUSION Altered phobic reactivity is a relatively common issue in patients with FTD, particularly bvFTD. This novel paradigm of strong fear experience has broad implications: clinically, for diagnosis and patient well-being; and neurobiologically, for our understanding of the pathophysiology of aversive sensory signal processing in FTD and the neural mechanisms of fear more generally.
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Affiliation(s)
- Daniel A Jimenez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Neurological Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rebecca L Bond
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Mai-Carmen Requena-Komuro
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Harri Sivasathiaseelan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Charles R Marshall
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Lucy L Russell
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Caroline Greaves
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Katrina M Moore
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Ione Oc Woollacott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rachelle Shafei
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Chris Jd Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
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Blenkinsop A, van der Flier WM, Wolk D, Lehmann M, Howard R, Frost C, Barnes J. Non-memory cognitive symptom development in Alzheimer's disease. Eur J Neurol 2020; 27:995-1002. [PMID: 32078209 PMCID: PMC10124327 DOI: 10.1111/ene.14185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 02/17/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Memory is known to be the most common first symptom in Alzheimer's disease (AD). Assessing non-memory cognitive symptom development in AD is important for understanding disease progression and the potential identification of treatment-responsive subtypes. METHODS Data from the National Alzheimer's Coordinating Center were examined. Logistic regression models were fitted evaluating the development of judgement, language, visuospatial and attention symptoms at first and second visits to Alzheimer's Disease Centers. Predictors were age and prior symptoms, adjusting for symptom length and sex. The models were then refitted assessing apolipoprotein E ε4 (APOE-ε4) effects. RESULTS Each decade reduction in presentation age increased the odds of language, visuospatial and attention symptom development at both visits by 8%-18% (P < 0.05, all tests), and judgement symptoms at the second visit by 13% (P < 0.05). Prior symptoms were not equally predictive of symptom development. For example, having first predominant language symptoms carried the lowest risk of developing other first-visit symptoms and having memory symptoms was a stronger predictor of developing judgement than other symptoms. The APOE-ε4 gene showed little impact on symptom development when included as a predictor. CONCLUSIONS Our findings provide support for the concept that younger-onset AD is associated with the progressive development of more non-memory symptoms beyond the first time point. Associations between symptoms were evident, which may reflect that pathology can remain isolated in a network for some time. APOE-ε4 status had little influence on cognitive symptom development which may indicate that the effect it has occurs very early in the disease course.
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Affiliation(s)
- Alexandra Blenkinsop
- Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, London, WC1V 6LJ
| | - Wiesje M. van der Flier
- Alzheimer Center, Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
- Department of Epidemiology & Biostatistics, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - David Wolk
- Penn Memory Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Manja Lehmann
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Box 16, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG
| | - Robert Howard
- Division of Psychiatry, 149 Tottenham Court Road, University College London, UK W1T 7NF
| | - Chris Frost
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT
| | - Josephine Barnes
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Box 16, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG
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Townley RA, Graff-Radford J, Mantyh WG, Botha H, Polsinelli AJ, Przybelski SA, Machulda MM, Makhlouf AT, Senjem ML, Murray ME, Reichard RR, Savica R, Boeve BF, Drubach DA, Josephs KA, Knopman DS, Lowe VJ, Jack CR, Petersen RC, Jones DT. Progressive dysexecutive syndrome due to Alzheimer's disease: a description of 55 cases and comparison to other phenotypes. Brain Commun 2020; 2:fcaa068. [PMID: 32671341 PMCID: PMC7325839 DOI: 10.1093/braincomms/fcaa068] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/13/2020] [Accepted: 04/15/2020] [Indexed: 02/05/2023] Open
Abstract
We report a group of patients presenting with a progressive dementia syndrome characterized by predominant dysfunction in core executive functions, relatively young age of onset and positive biomarkers for Alzheimer's pathophysiology. Atypical frontal, dysexecutive/behavioural variants and early-onset variants of Alzheimer's disease have been previously reported, but no diagnostic criteria exist for a progressive dysexecutive syndrome. In this retrospective review, we report on 55 participants diagnosed with a clinically defined progressive dysexecutive syndrome with 18F-fluorodeoxyglucose-positron emission tomography and Alzheimer's disease biomarkers available. Sixty-two per cent of participants were female with a mean of 15.2 years of education. The mean age of reported symptom onset was 53.8 years while the mean age at diagnosis was 57.2 years. Participants and informants commonly referred to initial cognitive symptoms as 'memory problems' but upon further inquiry described problems with core executive functions of working memory, cognitive flexibility and cognitive inhibitory control. Multi-domain cognitive impairment was evident in neuropsychological testing with executive dysfunction most consistently affected. The frontal and parietal regions which overlap with working memory networks consistently demonstrated hypometabolism on positron emission tomography. Genetic testing for autosomal dominant genes was negative in all eight participants tested and at least one APOE ε4 allele was present in 14/26 participants tested. EEG was abnormal in 14/17 cases with 13 described as diffuse slowing. Furthermore, CSF or neuroimaging biomarkers were consistent with Alzheimer's disease pathophysiology, although CSF p-tau was normal in 24% of cases. Fifteen of the executive predominate participants enrolled in research neuroimaging protocols and were compared to amnestic (n = 110), visual (n = 18) and language (n = 7) predominate clinical phenotypes of Alzheimer's disease. This revealed a consistent pattern of hypometabolism in parieto-frontal brain regions supporting executive functions with relative sparing of the medial temporal lobe (versus amnestic phenotype), occipital (versus visual phenotype) and left temporal (versus language phenotype). We propose that this progressive dysexecutive syndrome should be recognized as a distinct clinical phenotype disambiguated from behavioural presentations and not linked specifically to the frontal lobe or a particular anatomic substrate without further study. This clinical presentation can be due to Alzheimer's disease but is likely not specific for any single aetiology. Diagnostic criteria are proposed to facilitate additional research into this understudied clinical presentation.
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Affiliation(s)
- Ryan A Townley
- Department of Neurology Mayo Clinic, Rochester, MN 55902, USA
| | | | | | - Hugo Botha
- Department of Neurology Mayo Clinic, Rochester, MN 55902, USA
| | | | - Scott A Przybelski
- Department of Biomedical Statistics, Mayo Clinic, Rochester, MN 55902, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55902, USA
| | - Ahmed T Makhlouf
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55902, USA
| | - Matthew L Senjem
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55902, USA
| | - Melissa E Murray
- Department of Molecular Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ross R Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA
| | - Rodolfo Savica
- Department of Neurology Mayo Clinic, Rochester, MN 55902, USA
| | - Bradley F Boeve
- Department of Neurology Mayo Clinic, Rochester, MN 55902, USA
| | | | - Keith A Josephs
- Department of Neurology Mayo Clinic, Rochester, MN 55902, USA
| | - David S Knopman
- Department of Neurology Mayo Clinic, Rochester, MN 55902, USA
| | - Val J Lowe
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55902, USA
| | - Clifford R Jack
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55902, USA
| | | | - David T Jones
- Department of Neurology Mayo Clinic, Rochester, MN 55902, USA
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55902, USA
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