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Kan CN, Huang X, Zhang L, Hilal S, Reilhac A, Tanaka T, Venketasubramanian N, Chen C, Xu X. Comorbid amyloid with cerebrovascular disease in domain-specific cognitive and neuropsychiatric disturbances: a cross-sectional memory clinic study. Neurobiol Aging 2023; 132:47-55. [PMID: 37729769 DOI: 10.1016/j.neurobiolaging.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023]
Abstract
Dementia is a multifactorial disorder that is likely influenced by both Alzheimer's disease (AD) and vascular pathologies. We evaluated domain-specific cognitive and neuropsychiatric dysfunction using a two-neuroimaging biomarker construct (beta-amyloid [Aβ] and cerebrovascular disease [CeVD]). We analyzed data from 216 memory clinic participants (mean age = 75.9 ± 6.9; 56.5% female) with neuropsychological and neuropsychiatric assessments, 3T-MRI, and Aβ-PET imaging. Structural equation modeling showed that the largest Aβ (A+) effect was on memory (B = -1.50) and apathy (B = 0.26), whereas CeVD effects were largest on language (B = -1.62) and hyperactivity (B = 0.32). Group comparisons showed that the A+C+ group had greater memory impairment (B = -1.55), hyperactivity (B = 0.79), and apathy (B = 0.74) compared to A-C+; and greater language impairment (B = -1.26) compared to A+C-. These potentially additive effects of Aβ and CeVD burden underline the importance of early detection and treatment of Aβ alongside optimal control of vascular risk factors as a potential strategy in preventing cognitive and neurobehavioral impairment.
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Affiliation(s)
- Cheuk Ni Kan
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xuhua Huang
- School of Public Health and the Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Liwen Zhang
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Anthonin Reilhac
- Clinical Imaging Research Centre, National University of Singapore, Singapore
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | - Christopher Chen
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xin Xu
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; School of Public Health and the Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China.
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Wang W, Shi L, Ma H, Zhu S, Ge Y, Xu K. Comparison of the clinical value of MRI and plasma markers for cognitive impairment in patients aged ≥75 years: a retrospective study. PeerJ 2023; 11:e15581. [PMID: 37366421 PMCID: PMC10290829 DOI: 10.7717/peerj.15581] [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: 02/21/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Background Dementia has become the main cause of disability in older adults aged ≥75 years. Cerebral small vessel disease (CSVD) is involved in cognitive impairment (CI) and dementia and is a cause of vascular CI (VCI), which is manageable and its onset and progression can be delayed. Simple and effective markers will be beneficial to the early detection and intervention of CI. The aim of this study is to investigate the clinical application value of plasma amyloid β1-42 (Aβ42), phosphorylated tau 181 (p-tau181) and conventional structural magnetic resonance imaging (MRI) parameters for cognitive impairment (CI) in patients aged ≥75 years. Methods We retrospectively selected patients who visited the Affiliated Hospital of Xuzhou Medical University and were clinically diagnosed with or without cognitive dysfunction between May 2018 and November 2021. Plasma indicators (Aβ42 and p-tau181) and conventional structural MRI parameters were collected and analyzed. Multivariate logistic regression and receiver operator characteristic (ROC) curve were used to evaluate the diagnostic value. Results One hundred and eighty-four subjects were included, including 54 cases in CI group and 130 cases in noncognitive impairment (NCI) groups, respectively. Univariate logistic regression analysis revealed that the percentages of Aβ42+, P-tau 181+, and Aβ42+/P-tau181+ showed no significant difference between the groups of CI and NCI (all P > 0.05). Multivariate logistic regression analysis showed that moderate/severe periventricular WMH (PVWMH) (OR 2.857, (1.365-5.983), P = 0.005), lateral ventricle body index (LVBI) (OR 0.413, (0.243-0.700), P = 0.001), and cortical atrophy (OR 1.304, (1.079-1.575), P = 0.006) were factors associated with CI. The combined model including PVWMH, LVBI, and cortical atrophy to detect CI and NCI showed an area under the ROC curve (AUROC) is 0.782, with the sensitivity and specificity 68.5% and 78.5%, respectively. Conclusion For individuals ≥75 years, plasma Aβ42 and P-tau181 might not be associated with cognitive impairment, and MRI parameters, including PVWMH, LVBI and cortical atrophy, are related to CI. The cognitive statuses of people over 75 years old were used as the endpoint event in this study. Therefore, it can be considered that these MRI markers might have more important clinical significance for early assessment and dynamic observation, but more studies are still needed to verify this hypothesis.
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Affiliation(s)
- Wei Wang
- Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Institute of Medical Imaging and Digital Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lin Shi
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shangdong, China
| | - Hong Ma
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Institute of Medical Imaging and Digital Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shiguang Zhu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yaqiong Ge
- GE Healthcare, Precision Health Institution, Shanghai, China
| | - Kai Xu
- Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Institute of Medical Imaging and Digital Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Edwards L, Thomas KR, Weigand AJ, Edmonds EC, Clark AL, Walker KS, Brenner EK, Nation DA, Maillard P, Bondi MW, Bangen KJ. White Matter Hyperintensity Volume and Amyloid-PET Synergistically Impact Memory Independent of Tau-PET in Older Adults Without Dementia. J Alzheimers Dis 2023; 94:695-707. [PMID: 37302031 PMCID: PMC10357163 DOI: 10.3233/jad-221209] [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] [Accepted: 05/06/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) and cerebrovascular disease are common, co-existing pathologies in older adults. Whether the effects of cerebrovascular disease and AD biomarkers on cognition are additive or synergistic remains unclear. OBJECTIVE To examine whether white matter hyperintensity (WMH) volume moderates the independent association between each AD biomarker and cognition. METHODS In 586 older adults without dementia, linear regressions tested the interaction between amyloid-β (Aβ) positron emission tomography (PET) and WMH volume on cognition, independent of tau-PET. We also tested the interaction between tau-PET and WMH volume on cognition, independent of Aβ-PET. RESULTS Adjusting for tau-PET, the quadratic effect of WMH interacted with Aβ-PET to impact memory. There was no interaction between either the linear or quadratic effect of WMH and Aβ-PET on executive function. There was no interaction between WMH volume and tau-PET on either cognitive measure. CONCLUSION Results suggest that cerebrovascular lesions act synergistically with Aβ to affect memory, independent of tau, highlighting the importance of incorporating vascular pathology into biomarker assessment of AD.
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Affiliation(s)
- Lauren Edwards
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Kelsey R. Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emily C. Edmonds
- Banner Alzheimer’s Institute, Tucson, AZ, USA
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Alexandra L. Clark
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | | | - Einat K. Brenner
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Daniel A. Nation
- Department of Psychology, University of California Irvine, Irvine, CA, USA
| | - Pauline Maillard
- Department of Neurology, University of California, Davis, Davis, CA, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Leijenaar JF, Ingala S, Sudre CH, Mutsaerts HJMM, Leeuwis AE, van der Flier WM, Scheltens P, Weinstein HC, Barkhof F, van Gerven J, Groeneveld GJ, Prins ND. Decreased integrity of the monoaminergic tract is associated with a positive response to MPH in patients with vascular cognitive impairment - proof of principle study STREAM-VCI. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100128. [PMID: 36324417 PMCID: PMC9616323 DOI: 10.1016/j.cccb.2022.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/30/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022]
Abstract
Background Patients with vascular cognitive impairment (VCI) are very heterogeneous in both symptoms and type of cerebrovascular pathology. This might be an important reason why there is no symptomatic treatment available for VCI patients. In this study, we investigated in patients with VCI, whether there was an association between a positive response to methylphenidate and galantamine and the type of cerebrovascular disease, structural damage to specific neurotransmitter systems, cerebral perfusion, and presence of co-morbid Alzheimer (AD) pathology. Methods We included 27 VCI patients (mean age 67 years ± 8,30% female) from the STREAM-VCI trial who received placebo, methylphenidate(10 mg), and galantamine(16 mg) in a single challenge, cross-over design. In this study, we classified patients improving on a task for executive functioning after methylphenidate compared to placebo as methylphenidate responders (MPH+; resp. non-responders, MPH-) and patients improving on a task for memory after galantamine compared to placebo as galantamine responders (GAL+; resp. non-responders, GAL-). On baseline MRI, we visually assessed measures of cerebrovascular disease, automatically segmented white matter hyperintensities, used diffusion tensor imaging to visualize the integrity of monoaminergic and cholinergic neurotransmitter systems with mean diffusivity (MD) and fractional anisotropy (FA). Comorbid AD pathology was assessed using CSF or amyloid-PET. We tested differences between responders and non-responders using ANOVA, adjusting for age and sex. Results Nine patients were MPH+ vs 18 MPH-. MPH+ had higher MD (1.22 ± 0.07 vs 0.94 ± 0.05); p = .001) and lower FA (0.38 ± .01 vs 0.43 ± .01); p = .04) in the monoaminergic tract compared to MPH-. Eight patients were GAL+ and 18 GAL-. We found no differences between GAL+ and GAL- in any of the MRI measures. Information on co-morbid AD pathology was present in 17 patients. AD pathology tended to be more frequent in GAL+ vs GAL- (5(71%) vs 2(20%); p = .06). Conclusions In patients with VCI, we found that decreased integrity of the monoaminergic tract is associated with a positive response to MPH. Responsiveness to galantamine may be related to co-morbid AD pathology.
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Affiliation(s)
- Jolene F Leijenaar
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherland
| | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherland
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Henk-Jan MM Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherland
- Department of Radiology and Nuclear Medicine, University Hospital Ghent, Ghent, Belgium
| | - Anna E. Leeuwis
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherland
| | - Wiesje M van der Flier
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherland
- Department of Epidemiology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherland
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherland
| | - Henry C Weinstein
- Department of Neurology, Onze Lieve Vrouwe Gasthuis West, Amsterdam, the Netherland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherland
- Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom
| | | | - Geert Jan Groeneveld
- Centre for Human Drug Research, Leiden, the Netherland
- Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherland
| | - Niels D Prins
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherland
- Brain Research Center, Amsterdam, the Netherland
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Jiménez-Balado J, Corlier F, Habeck C, Stern Y, Eich T. Effects of white matter hyperintensities distribution and clustering on late-life cognitive impairment. Sci Rep 2022; 12:1955. [PMID: 35121804 PMCID: PMC8816933 DOI: 10.1038/s41598-022-06019-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
Abstract
White matter hyperintensities (WMH) are a key hallmark of subclinical cerebrovascular disease and are known to impair cognition. Here, we parcellated WMH using a novel system that segments WMH based on both lobar regions and distance from the ventricles, dividing the brain into a coordinate system composed of 36 distinct parcels ('bullseye' parcellation), and then investigated the effect of distribution on cognition using two different analytic approaches. Data from a well characterized sample of healthy older adults (58 to 84 years) who were free of dementia were included. Cognition was evaluated using 12 computerized tasks, factored onto 4 indices representing episodic memory, speed of processing, fluid reasoning and vocabulary. We first assessed the distribution of WMH according to the bullseye parcellation and tested the relationship between WMH parcellations and performance across the four cognitive domains. Then, we used a data-driven approach to derive latent variables within the WMH distribution, and tested the relation between these latent components and cognitive function. We observed that different, well-defined cognitive constructs mapped to specific WMH distributions. Speed of processing was correlated with WMH in the frontal lobe, while in the case of episodic memory, the relationship was more ubiquitous, involving most of the parcellations. A principal components analysis revealed that the 36 bullseye regions factored onto 3 latent components representing the natural aggrupation of WMH: fronto-parietal periventricular (WMH principally in the frontal and parietal lobes and basal ganglia, especially in the periventricular region); occipital; and temporal and juxtacortical WMH (involving WMH in the temporal lobe, and at the juxtacortical region from frontal and parietal lobes). We found that fronto-parietal periventricular and temporal & juxtacortical WMH were independently associated with speed of processing and episodic memory, respectively. These results indicate that different cognitive impairment phenotypes might present with specific WMH distributions. Additionally, our study encourages future research to consider WMH classifications using parcellations systems other than periventricular and deep localizations.
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Affiliation(s)
- Joan Jiménez-Balado
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Fabian Corlier
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Christian Habeck
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Yaakov Stern
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Teal Eich
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
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Romani A, Trentini A, van der Flier WM, Bellini T, Zuliani G, Cervellati C, Teunissen CE. Arylesterase Activity of Paraoxonase-1 in Serum and Cerebrospinal Fluid of Patients with Alzheimer's Disease and Vascular Dementia. Antioxidants (Basel) 2020; 9:antiox9050456. [PMID: 32466344 PMCID: PMC7278748 DOI: 10.3390/antiox9050456] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/08/2020] [Accepted: 05/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It has been suggested that circulating Paraoxonase-1 (PON1) and apolipoprotein A1 (APOA1), which closely interacts with the antioxidant enzyme, could be implicated in Alzheimer's disease (AD) and vascular dementia (VaD) development. This study aimed to evaluate PON1 changes in serum and cerebrospinal fluid (CSF) as evidence for its association with AD or VaD. METHODS Serum PON-arylesterase activity was measured in patients with AD, VaD, and CONTROLS distributed in two cohorts: Ferrara cohort (FC: n = 503, age = 74 years) and Amsterdam Dementia cohort (ADC: n = 71, age = 65 years). In the last cohort, CSF PON-arylesterase, CSF β-amyloid1-42, p-tau and t-tau, and imaging biomarkers were also measured. RESULTS AD and VaD patients of FC showed significantly lower levels of serum PON-arylesterase compared to CONTROLS, but this outcome was driven by older subjects (>71 years, p < 0.0001). In the younger ADC, a similar decreasing (but not significant) trend was observed in serum and CSF. Intriguingly, PON-arylesterase per APOA1 correlated with t-tau in AD group (r = -0.485, p = 0.002). CONCLUSION These results suggest that decreased peripheral PON-arylesterase might be a specific feature of older AD/VaD patients. Moreover, we showed that PON-arylesterase/APOA1 is inversely related to neurodegeneration in AD patients, suggesting a prognostic usefulness of this composite parameter.
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Affiliation(s)
- Arianna Romani
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (G.Z.); (C.C.)
| | - Alessandro Trentini
- Department of Biomedical and Specialist Surgical Sciences, Section of Medical Biochemistry, Molecular Biology and Genetics University of Ferrara, 44121 Ferrara, Italy;
- Correspondence: ; Tel.: +39-053-2455-322
| | - Wiesje M. van der Flier
- Department of Clinical Chemistry, Neurochemistry Lab and Biobank, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (W.M.v.d.F.); (C.E.T.)
- Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Tiziana Bellini
- Department of Biomedical and Specialist Surgical Sciences, Section of Medical Biochemistry, Molecular Biology and Genetics University of Ferrara, 44121 Ferrara, Italy;
| | - Giovanni Zuliani
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (G.Z.); (C.C.)
| | - Carlo Cervellati
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (G.Z.); (C.C.)
| | - Charlotte E. Teunissen
- Department of Clinical Chemistry, Neurochemistry Lab and Biobank, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (W.M.v.d.F.); (C.E.T.)
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