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Rosbergen MT, Wolters FJ, Vinke EJ, Mattace-Raso FUS, Roshchupkin GV, Ikram MA, Vernooij MW. Cluster-Based White Matter Signatures and the Risk of Dementia, Stroke, and Mortality in Community-Dwelling Adults. Neurology 2024; 103:e209864. [PMID: 39255426 PMCID: PMC11399066 DOI: 10.1212/wnl.0000000000209864] [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: 09/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Markers of white matter (WM) injury on brain MRI are important indicators of brain health. Different patterns of WM atrophy, WM hyperintensities (WMHs), and microstructural integrity could reflect distinct pathologies and disease risks, but large-scale imaging studies investigating WM signatures are lacking. This study aims to identify distinct WM signatures using brain MRI in community-dwelling adults, determine underlying risk factor profiles, and assess risks of dementia, stroke, and mortality associated with each signature. METHODS Between 2005 and 2016, we measured WMH volume, WM volume, fractional anisotropy (FA), and mean diffusivity (MD) using automated pipelines on structural and diffusion MRI in community-dwelling adults aged older than 45 years of the Rotterdam study. Continuous surveillance was conducted for dementia, stroke, and mortality. We applied hierarchical clustering to identify separate WM injury clusters and Cox proportional hazard models to determine their risk of dementia, stroke, and mortality. RESULTS We included 5,279 participants (mean age 65.0 years, 56.0% women) and identified 4 distinct data-driven WM signatures: (1) above-average microstructural integrity and little WM atrophy and WMH; (2) above-average microstructural integrity and little WMH, but substantial WM atrophy; (3) poor microstructural integrity and substantial WMH, but little WM atrophy; and (4) poor microstructural integrity with substantial WMH and WM atrophy. Prevalence of cardiovascular risk factors, lacunes, and cerebral microbleeds was higher in clusters 3 and 4 than in clusters 1 and 2. During a median 10.7 years of follow-up, 291 participants developed dementia, 220 had a stroke, and 910 died. Compared with cluster 1, dementia risk was increased for all clusters, notably cluster 3 (hazard ratio [HR] 3.06, 95% CI 2.12-4.42), followed by cluster 4 (HR 2.31, 95% CI 1.58-3.37) and cluster 2 (HR 1.67, 95% CI 1.17-2.38). Compared with cluster 1, risk of stroke was higher only for clusters 3 (HR 1.55, 95% CI 1.02-2.37) and 4 (HR 1.94, 95% CI 1.30-2.89), whereas mortality risk was increased in all clusters (cluster 2: HR 1.27, 95% CI 1.06-1.53, cluster 3: HR 1.65, 95% CI 1.35-2.03, cluster 4: HR 1.76, 95% CI 1.44-2.15), compared with cluster 1. Models including clusters instead of an individual imaging marker showed a superior goodness of fit for dementia and mortality, but not for stroke. DISCUSSION Clustering can derive WM signatures that are differentially associated with dementia, stroke, and mortality risk. Future research should incorporate spatial information of imaging markers.
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Affiliation(s)
- Mathijs T Rosbergen
- From the Department of Epidemiology (M.T.R., F.J.W., E.J.V., F.U.S.M.-R., G.V.R., M.A.I., M.W.V.), Department of Radiology and Nuclear Medicine (M.T.R., F.J.W., E.J.V., G.V.R., M.W.V.), Department of Internal Medicine (F.U.S.M.-R.), and Department of Medical Informatics (G.V.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Frank J Wolters
- From the Department of Epidemiology (M.T.R., F.J.W., E.J.V., F.U.S.M.-R., G.V.R., M.A.I., M.W.V.), Department of Radiology and Nuclear Medicine (M.T.R., F.J.W., E.J.V., G.V.R., M.W.V.), Department of Internal Medicine (F.U.S.M.-R.), and Department of Medical Informatics (G.V.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Elisabeth J Vinke
- From the Department of Epidemiology (M.T.R., F.J.W., E.J.V., F.U.S.M.-R., G.V.R., M.A.I., M.W.V.), Department of Radiology and Nuclear Medicine (M.T.R., F.J.W., E.J.V., G.V.R., M.W.V.), Department of Internal Medicine (F.U.S.M.-R.), and Department of Medical Informatics (G.V.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Francesco U S Mattace-Raso
- From the Department of Epidemiology (M.T.R., F.J.W., E.J.V., F.U.S.M.-R., G.V.R., M.A.I., M.W.V.), Department of Radiology and Nuclear Medicine (M.T.R., F.J.W., E.J.V., G.V.R., M.W.V.), Department of Internal Medicine (F.U.S.M.-R.), and Department of Medical Informatics (G.V.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Gennady V Roshchupkin
- From the Department of Epidemiology (M.T.R., F.J.W., E.J.V., F.U.S.M.-R., G.V.R., M.A.I., M.W.V.), Department of Radiology and Nuclear Medicine (M.T.R., F.J.W., E.J.V., G.V.R., M.W.V.), Department of Internal Medicine (F.U.S.M.-R.), and Department of Medical Informatics (G.V.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Mohammad Arfan Ikram
- From the Department of Epidemiology (M.T.R., F.J.W., E.J.V., F.U.S.M.-R., G.V.R., M.A.I., M.W.V.), Department of Radiology and Nuclear Medicine (M.T.R., F.J.W., E.J.V., G.V.R., M.W.V.), Department of Internal Medicine (F.U.S.M.-R.), and Department of Medical Informatics (G.V.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Meike W Vernooij
- From the Department of Epidemiology (M.T.R., F.J.W., E.J.V., F.U.S.M.-R., G.V.R., M.A.I., M.W.V.), Department of Radiology and Nuclear Medicine (M.T.R., F.J.W., E.J.V., G.V.R., M.W.V.), Department of Internal Medicine (F.U.S.M.-R.), and Department of Medical Informatics (G.V.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Jardim NYV, Bento-Torres NVO, Tomás AM, da Costa VO, Bento-Torres J, Picanço-Diniz CW. Unexpected cognitive similarities between older adults and young people: Scores variability and cognitive performances. Arch Gerontol Geriatr 2024; 117:105206. [PMID: 37742393 DOI: 10.1016/j.archger.2023.105206] [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: 06/23/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Increased interindividual variability in cognitive performance during aging has been proposed as an indicator of cognitive reserve. OBJECTIVE To determine if interindividual variability performance in episodic memory (PAL), working memory (SWM), reaction time (RTI), and sustained attention (RVP) could differentiate clusters of differential cognitive performance in healthy young and older adults and search for cognitive tests that most contribute to these differential performances. METHODS We employed hierarchical cluster and canonical discriminant function analyses of cognitive scores using the Cambridge Neuropsychological Test Automated Battery (CANTAB) to identify cognitive variability in older and young adults using the coefficient of variability of cognitive performances between and within groups. We also analyzed potential influences of age, education, and physical activity. RESULTS Cluster analysis distinguished groups with differential cognitive performance and correlation analysis revealed coefficient of variability and cognitive performance associations. The greater the coefficient of variability the poorer was cognitive performance in RTI but not in PAL and SWM. Older adults showed diverse trajectories of cognitive decline, and better education or higher percentage of physically active individuals exhibited better cognitive performance in both older and young adults. CONCLUSION PAL and SWM are the most sensitive tests to investigate the wide age range encompassing older and young adults. In older adults' intragroup analysis PAL showed greater discriminatory capacity, indicating its potential for clinical applications late in life. Our data underscore the importance of studying variability as a tool for early detection of subtle cognitive declines and for interpreting results that deviate from normality.
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Affiliation(s)
- Naina Yuki Vieira Jardim
- Neurodegeneration and Infection Research Laboratory, Institute of Biological Science, João de Barros Barreto University Hospital, Federal University of Pará, Belém, 66073 005, Brazil
| | - Natáli Valim Oliver Bento-Torres
- Neurodegeneration and Infection Research Laboratory, Institute of Biological Science, João de Barros Barreto University Hospital, Federal University of Pará, Belém, 66073 005, Brazil; Graduate Program in Human Movement Sciences, Federal University of Pará, Belém, 66075-110, Brazil.
| | - Alessandra Mendonça Tomás
- Neurodegeneration and Infection Research Laboratory, Institute of Biological Science, João de Barros Barreto University Hospital, Federal University of Pará, Belém, 66073 005, Brazil
| | - Victor Oliveira da Costa
- Neurodegeneration and Infection Research Laboratory, Institute of Biological Science, João de Barros Barreto University Hospital, Federal University of Pará, Belém, 66073 005, Brazil
| | - João Bento-Torres
- Neurodegeneration and Infection Research Laboratory, Institute of Biological Science, João de Barros Barreto University Hospital, Federal University of Pará, Belém, 66073 005, Brazil; Graduate Program in Human Movement Sciences, Federal University of Pará, Belém, 66075-110, Brazil
| | - Cristovam Wanderley Picanço-Diniz
- Neurodegeneration and Infection Research Laboratory, Institute of Biological Science, João de Barros Barreto University Hospital, Federal University of Pará, Belém, 66073 005, Brazil
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Rafii MS, Aisen PS. Detection and treatment of Alzheimer's disease in its preclinical stage. NATURE AGING 2023; 3:520-531. [PMID: 37202518 PMCID: PMC11110912 DOI: 10.1038/s43587-023-00410-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/29/2023] [Indexed: 05/20/2023]
Abstract
Longitudinal multimodal biomarker studies reveal that the continuum of Alzheimer's disease (AD) includes a long latent phase, referred to as preclinical AD, which precedes the onset of symptoms by decades. Treatment during the preclinical AD phase offers an optimal opportunity for slowing the progression of disease. However, trial design in this population is complex. In this Review, we discuss the recent advances in accurate plasma measurements, new recruitment approaches, sensitive cognitive instruments and self-reported outcomes that have facilitated the successful launch of multiple phase 3 trials for preclinical AD. The recent success of anti-amyloid immunotherapy trials in symptomatic AD has increased the enthusiasm for testing this strategy at the earliest feasible stage. We provide an outlook for standard screening of amyloid accumulation at the preclinical stage in clinically normal individuals, during which effective therapy to delay or prevent cognitive decline can be initiated.
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Affiliation(s)
- Michael S Rafii
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine University of Southern California, Los Angeles, CA, USA.
| | - Paul S Aisen
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
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4
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Chen H, Young A, Oxtoby NP, Barkhof F, Alexander DC, Altmann A. Transferability of Alzheimer's disease progression subtypes to an independent population cohort. Neuroimage 2023; 271:120005. [PMID: 36907283 DOI: 10.1016/j.neuroimage.2023.120005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/22/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023] Open
Abstract
In the past, methods to subtype or biotype patients using brain imaging data have been developed. However, it is unclear whether and how these trained machine learning models can be successfully applied to population cohorts to study the genetic and lifestyle factors underpinning these subtypes. This work, using the Subtype and Stage Inference (SuStaIn) algorithm, examines the generalisability of data-driven Alzheimer's disease (AD) progression models. We first compared SuStaIn models trained separately on Alzheimer's disease neuroimaging initiative (ADNI) data and an AD-at-risk population constructed from the UK Biobank dataset. We further applied data harmonization techniques to remove cohort effects. Next, we built SuStaIn models on the harmonized datasets, which were then used to subtype and stage subjects in the other harmonized dataset. The first key finding is that three consistent atrophy subtypes were found in both datasets, which match the previously identified subtype progression patterns in AD: 'typical', 'cortical' and 'subcortical'. Next, the subtype agreement was further supported by high consistency in individuals' subtypes and stage assignment based on the different models: more than 92% of the subjects, with reliable subtype assignment in both ADNI and UK Biobank dataset, were assigned to an identical subtype under the model built on the different datasets. The successful transferability of AD atrophy progression subtypes across cohorts capturing different phases of disease development enabled further investigations of associations between AD atrophy subtypes and risk factors. Our study showed that (1) the average age is highest in the typical subtype and lowest in the subcortical subtype; (2) the typical subtype is associated with statistically more-AD-like cerebrospinal fluid biomarkers values in comparison to the other two subtypes; and (3) in comparison to the subcortical subtype, the cortical subtype subjects are more likely to associate with prescription of cholesterol and high blood pressure medications. In summary, we presented cross-cohort consistent recovery of AD atrophy subtypes, showing how the same subtypes arise even in cohorts capturing substantially different disease phases. Our study opened opportunities for future detailed investigations of atrophy subtypes with a broad range of early risk factors, which will potentially lead to a better understanding of the disease aetiology and the role of lifestyle and behaviour on AD.
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Affiliation(s)
- Hanyi Chen
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering and Department of Computer Science, University College London, UK
| | - Alexandra Young
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Neil P Oxtoby
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering and Department of Computer Science, University College London, UK
| | - Frederik Barkhof
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering and Department of Computer Science, University College London, UK; Queen Square Institute of Neurology, University College London, UK; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, The Netherlands
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering and Department of Computer Science, University College London, UK
| | - Andre Altmann
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering and Department of Computer Science, University College London, UK.
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5
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Seo Y, Jang H, Lee H. Potential Applications of Artificial Intelligence in Clinical Trials for Alzheimer’s Disease. Life (Basel) 2022; 12:life12020275. [PMID: 35207561 PMCID: PMC8879055 DOI: 10.3390/life12020275] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 01/18/2023] Open
Abstract
Clinical trials for Alzheimer’s disease (AD) face multiple challenges, such as the high screen failure rate and the even allocation of heterogeneous participants. Artificial intelligence (AI), which has become a potent tool of modern science with the expansion in the volume, variety, and velocity of biological data, offers promising potential to address these issues in AD clinical trials. In this review, we introduce the current status of AD clinical trials and the topic of machine learning. Then, a comprehensive review is focused on the potential applications of AI in the steps of AD clinical trials, including the prediction of protein and MRI AD biomarkers in the prescreening process during eligibility assessment and the likelihood stratification of AD subjects into rapid and slow progressors in randomization. Finally, this review provides challenges, developments, and the future outlook on the integration of AI into AD clinical trials.
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Affiliation(s)
| | | | - Hyejoo Lee
- Correspondence: ; Tel.: +82-2-3410-1233; Fax: +82-2-3410-0052
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6
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Drouin SM, McFall GP, Potvin O, Bellec P, Masellis M, Duchesne S, Dixon RA. Data-Driven Analyses of Longitudinal Hippocampal Imaging Trajectories: Discrimination and Biomarker Prediction of Change Classes. J Alzheimers Dis 2022; 88:97-115. [PMID: 35570482 PMCID: PMC9277685 DOI: 10.3233/jad-215289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hippocampal atrophy is a well-known biomarker of neurodegeneration, such as that observed in Alzheimer's disease (AD). Although distributions of hippocampal volume trajectories for asymptomatic individuals often reveal substantial heterogeneity, it is unclear whether interpretable trajectory classes can be objectively detected and used for prediction analyses. OBJECTIVE To detect and predict hippocampal trajectory classes in a computationally competitive context using established AD-related risk factors/biomarkers. METHODS We used biomarker/risk factor and longitudinal MRI data in asymptomatic adults from the AD Neuroimaging Initiative (n = 351; Mean = 75 years; 48.7% female). First, we applied latent class growth analyses to left (LHC) and right (RHC) hippocampal trajectory distributions to identify distinct classes. Second, using random forest analyses, we tested 38 multi-modal biomarkers/risk factors for their relative importance in discriminating the lower (potentially elevated atrophy risk) from the higher (potentially reduced risk) class. RESULTS For both LHC and RHC trajectory distribution analyses, we observed three distinct trajectory classes. Three biomarkers/risk factors predicted membership in LHC and RHC lower classes: male sex, higher education, and lower plasma Aβ1-42. Four additional factors selectively predicted membership in the lower LHC class: lower plasma tau and Aβ1-40, higher depressive symptomology, and lower body mass index. CONCLUSION Data-driven analyses of LHC and RHC trajectories detected three classes underlying the heterogeneous distributions. Machine learning analyses determined three common and four unique biomarkers/risk factors discriminating the higher and lower LHC/RHC classes. Our sequential analytic approach produced evidence that the dynamics of preclinical hippocampal trajectories can be predicted by AD-related biomarkers/risk factors from multiple modalities.
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Affiliation(s)
- Shannon M. Drouin
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - G. Peggy McFall
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | | | - Pierre Bellec
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Simon Duchesne
- CERVO Brain Research Centre, Quebec, QC, Canada
- Radiology and Nuclear Medicine Department, Université Laval, Quebec, QC, Canada
| | - Roger A. Dixon
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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Young AL, Vogel JW, Aksman LM, Wijeratne PA, Eshaghi A, Oxtoby NP, Williams SCR, Alexander DC. Ordinal SuStaIn: Subtype and Stage Inference for Clinical Scores, Visual Ratings, and Other Ordinal Data. Front Artif Intell 2021; 4:613261. [PMID: 34458723 PMCID: PMC8387598 DOI: 10.3389/frai.2021.613261] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/20/2021] [Indexed: 12/28/2022] Open
Abstract
Subtype and Stage Inference (SuStaIn) is an unsupervised learning algorithm that uniquely enables the identification of subgroups of individuals with distinct pseudo-temporal disease progression patterns from cross-sectional datasets. SuStaIn has been used to identify data-driven subgroups and perform patient stratification in neurodegenerative diseases and in lung diseases from continuous biomarker measurements predominantly obtained from imaging. However, the SuStaIn algorithm is not currently applicable to discrete ordinal data, such as visual ratings of images, neuropathological ratings, and clinical and neuropsychological test scores, restricting the applicability of SuStaIn to a narrower range of settings. Here we propose 'Ordinal SuStaIn', an ordinal version of the SuStaIn algorithm that uses a scored events model of disease progression to enable the application of SuStaIn to ordinal data. We demonstrate the validity of Ordinal SuStaIn by benchmarking the performance of the algorithm on simulated data. We further demonstrate that Ordinal SuStaIn out-performs the existing continuous version of SuStaIn (Z-score SuStaIn) on discrete scored data, providing much more accurate subtype progression patterns, better subtyping and staging of individuals, and accurate uncertainty estimates. We then apply Ordinal SuStaIn to six different sub-scales of the Clinical Dementia Rating scale (CDR) using data from the Alzheimer's disease Neuroimaging Initiative (ADNI) study to identify individuals with distinct patterns of functional decline. Using data from 819 ADNI1 participants we identified three distinct CDR subtype progression patterns, which were independently verified using data from 790 ADNI2 participants. Our results provide insight into patterns of decline in daily activities in Alzheimer's disease and a mechanism for stratifying individuals into groups with difficulties in different domains. Ordinal SuStaIn is broadly applicable across different types of ratings data, including visual ratings from imaging, neuropathological ratings and clinical or behavioural ratings data.
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Affiliation(s)
- Alexandra L. Young
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Centre for Medical Image Computing, University College London, London, United Kingdom
- Department of Computer Science, University College London, London, United Kingdom
| | - Jacob W. Vogel
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, Unites States
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, Unites States
| | - Leon M. Aksman
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, Unites States
| | - Peter A. Wijeratne
- Centre for Medical Image Computing, University College London, London, United Kingdom
- Department of Computer Science, University College London, London, United Kingdom
| | - Arman Eshaghi
- Department of Computer Science, University College London, London, United Kingdom
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Neil P. Oxtoby
- Centre for Medical Image Computing, University College London, London, United Kingdom
- Department of Computer Science, University College London, London, United Kingdom
| | - Steven C. R. Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Daniel C. Alexander
- Centre for Medical Image Computing, University College London, London, United Kingdom
- Department of Computer Science, University College London, London, United Kingdom
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Rangaprakash D, Odemuyiwa T, Narayana Dutt D, Deshpande G. Density-based clustering of static and dynamic functional MRI connectivity features obtained from subjects with cognitive impairment. Brain Inform 2020; 7:19. [PMID: 33242116 PMCID: PMC7691406 DOI: 10.1186/s40708-020-00120-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022] Open
Abstract
Various machine-learning classification techniques have been employed previously to classify brain states in healthy and disease populations using functional magnetic resonance imaging (fMRI). These methods generally use supervised classifiers that are sensitive to outliers and require labeling of training data to generate a predictive model. Density-based clustering, which overcomes these issues, is a popular unsupervised learning approach whose utility for high-dimensional neuroimaging data has not been previously evaluated. Its advantages include insensitivity to outliers and ability to work with unlabeled data. Unlike the popular k-means clustering, the number of clusters need not be specified. In this study, we compare the performance of two popular density-based clustering methods, DBSCAN and OPTICS, in accurately identifying individuals with three stages of cognitive impairment, including Alzheimer’s disease. We used static and dynamic functional connectivity features for clustering, which captures the strength and temporal variation of brain connectivity respectively. To assess the robustness of clustering to noise/outliers, we propose a novel method called recursive-clustering using additive-noise (R-CLAN). Results demonstrated that both clustering algorithms were effective, although OPTICS with dynamic connectivity features outperformed in terms of cluster purity (95.46%) and robustness to noise/outliers. This study demonstrates that density-based clustering can accurately and robustly identify diagnostic classes in an unsupervised way using brain connectivity.
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Affiliation(s)
- D Rangaprakash
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA.,Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Toluwanimi Odemuyiwa
- Division of Engineering Science, Faculty of Applied Science & Engineering, University of Toronto, Toronto, ON, Canada
| | - D Narayana Dutt
- Department of Electrical Communication Engineering, Indian Institute of Science, Bangalore, India
| | - Gopikrishna Deshpande
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, 560 Devall Dr, Suite 266D, Auburn, AL, 36849, USA. .,Department of Psychological Sciences, Auburn University, Auburn, AL, USA. .,Alabama Advanced Imaging Consortium, University of Alabama Birmingham, Alabama, USA. .,Center for Health Ecology and Equity Research, Auburn University, Auburn, AL, USA. .,Center for Neuroscience, Auburn University, Auburn, AL, USA. .,School of Psychology, Capital Normal University, Beijing, China. .,Key Laboratory for Learning and Cognition, Capital Normal University, Beijing, China. .,Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
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9
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Peng Y, Chen B, Chi L, Zhou Q, Shi Z. Patterns of CSF Inflammatory Markers in Non-demented Older People: A Cluster Analysis. Front Aging Neurosci 2020; 12:577685. [PMID: 33132899 PMCID: PMC7573280 DOI: 10.3389/fnagi.2020.577685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/15/2020] [Indexed: 11/27/2022] Open
Abstract
Objective In this study, we aimed to examine if patterns of CSF inflammatory markers are correlated with global cognition, episodic memory, hippocampal volume, and CSF AD-related pathologies among non-demented older people. Methods We included 217 non-demented older individuals, including 87 subjects with normal cognition (NC) and 130 subjects with mild cognitive impairment (MCI) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) study. Hierarchical cluster analysis including nine inflammatory markers in CSF [Tumor necrosis factor-α(TNF-α), TNF-R1, TNF-R2, transforming growth factor-β1 (TGF-β1), TGF-β2, TGF-β3, Interleukin-21 (IL-21), IL-6, and IL-7] was conducted. Results We identified two clusters among non-demented older people based on nine inflammatory markers in CSF. Compared to the first cluster, the second cluster showed significantly higher levels of CSF inflammatory markers (TNF-R1, TNF-R2, TGF-β1, TGF-β3, and IL-6). Further, the second cluster was also associated with higher levels of t-tau and p-tau levels in CSF. Conclusion We observed a subgroup of non-demented older people characterized by increased levels of inflammatory markers in CSF. Further, this subgroup showed higher levels of t-tau and p-tau levels in CSF.
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Affiliation(s)
- Yangdi Peng
- Department of Respiratory Medicine, Yongjia County Traditional Chinese Medicine Hospital, Wenzhou, China
| | - Bin Chen
- Department of Respiratory Medicine, Yongjia County Traditional Chinese Medicine Hospital, Wenzhou, China
| | - Lifen Chi
- Department of Neurology, Ruian People's Hospital, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiang Zhou
- Department of Neurology, Ruian People's Hospital, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhenjing Shi
- Department of Intervention, Ruian People's Hospital, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Biomarker profiling beyond amyloid and tau: cerebrospinal fluid markers, hippocampal atrophy, and memory change in cognitively unimpaired older adults. Neurobiol Aging 2020; 93:1-15. [PMID: 32438258 DOI: 10.1016/j.neurobiolaging.2020.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 01/25/2023]
Abstract
Brain changes occurring in aging can be indexed by biomarkers. We used cluster analysis to identify subgroups of cognitively unimpaired individuals (n = 99, 64-93 years) with different profiles of the cerebrospinal fluid biomarkers beta amyloid 1-42 (Aβ42), phosphorylated tau (P-tau), total tau, chitinase-3-like protein 1 (YKL-40), fatty acid binding protein 3 (FABP3), and neurofilament light (NFL). Hippocampal volume and memory were assessed across multiple follow-up examinations covering up to 6.8 years. Clustering revealed one group (39%) with more pathological concentrations of all biomarkers, which could further be divided into one group (20%) characterized by tauopathy and high FABP3 and one (19%) by brain β-amyloidosis, high NFL, and slightly higher YKL-40. The clustering approach clearly outperformed classification based on Aβ42 and P-tau alone in prediction of memory decline, with the individuals with most tauopathy and FABP3 showing more memory decline, but not more hippocampal volume change. The results demonstrate that older adults can be classified based on biomarkers beyond amyloid and tau, with improved prediction of memory decline.
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Chen H, Huang L, Yang D, Ye Q, Guo M, Qin R, Luo C, Li M, Ye L, Zhang B, Xu Y. Nodal Global Efficiency in Front-Parietal Lobe Mediated Periventricular White Matter Hyperintensity (PWMH)-Related Cognitive Impairment. Front Aging Neurosci 2019; 11:347. [PMID: 31920627 PMCID: PMC6914700 DOI: 10.3389/fnagi.2019.00347] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/28/2019] [Indexed: 12/24/2022] Open
Abstract
White matter hyperintensity (WMH) is widely observed in the elderly population and serves as a key indicator of cognitive impairment (CI). However, the underlying mechanism remains to be elucidated. Herein, we investigated the topological patterns of resting state functional networks in WMH subjects and the relationship between the topological measures and CI. A graph theory-based analysis was employed in the resting-state functional magnetic resonance scans of 112 subjects (38 WMH subjects with cognitive impairment without dementia (CIND), 36 WMH subjects with normal cognition and 38 healthy controls (HCs), and we found that WMH-CIND subjects displayed decreased global efficiency at the levels of the whole brain, specific subnetworks [fronto-parietal network (FPN) and cingulo-opercular network (CON)] and certain nodes located in the FPN and CON, as well as decreased local efficiency in subnetworks. Our results demonstrated that nodal global efficiency in frontal and parietal regions mediated the impairment of information processing speed related to periventricular WMH (PWMH). Additionally, we performed support vector machine (SVM) analysis and found that altered functional efficiency can identify WMH-CIND subjects with high accuracy, sensitivity and specificity. These findings suggest impaired functional networks in WMH-CIND individuals and that decreased functional efficiency may be a feature of CI in WMH subjects.
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Affiliation(s)
- Haifeng Chen
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Lili Huang
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Dan Yang
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Qing Ye
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Mengdi Guo
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Ruomeng Qin
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Caimei Luo
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Mengchun Li
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Lei Ye
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yun Xu
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
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12
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Zou S, Zhang J, Chen W. Subtypes Based on Six Apolipoproteins in Non-Demented Elderly Are Associated with Cognitive Decline and Subsequent Tau Accumulation in Cerebrospinal Fluid. J Alzheimers Dis 2019; 72:413-423. [PMID: 31594221 DOI: 10.3233/jad-190314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Apolipoproteins (APOs) have been implicated in the pathogenesis of Alzheimer's disease (AD). In the present study, we aimed to investigate if patterns of cerebrospinal fluid (CSF) APOs (APOA-I, APOC-III, APOD, APOE, APOH, and APOJ) levels are associated with changes over time in cognition, memory performance, neuroimaging markers, and AD-related pathologies (CSF Aβ42, t-tau, and p-tau) in non-demented older adults. At baseline, a total of 241 non-demented older adults with CSF APOs data was included in the present analysis. Hierarchical agglomerative cluster analysis including the six CSF APOs was carried out. Among non-demented older adults, we identified two clusters. Compare with the first cluster, the second cluster had higher levels of APOs in CSF. Additionally, the second cluster showed a more benign disease course, including slower cognitive decline and slower p-tau accumulation in CSF. Our data highlight the importance of APOs in the pathogenesis of AD.
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Affiliation(s)
- Shengzhen Zou
- Department of Psychosomatic Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie Zhang
- Independent Researcher, Hangzhou, China
| | | | - Wei Chen
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Toschi N, Lista S, Baldacci F, Cavedo E, Zetterberg H, Blennow K, Kilimann I, Teipel SJ, Melo Dos Santos A, Epelbaum S, Lamari F, Genthon R, Habert MO, Dubois B, Floris R, Garaci F, Vergallo A, Hampel H. Biomarker-guided clustering of Alzheimer's disease clinical syndromes. Neurobiol Aging 2019; 83:42-53. [PMID: 31585366 DOI: 10.1016/j.neurobiolaging.2019.08.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 11/27/2022]
Abstract
Alzheimer's disease (AD) neuropathology is extremely heterogeneous, and the evolution from preclinical to mild cognitive impairment until dementia is driven by interacting genetic/biological mechanisms not fully captured by current clinical/research criteria. We characterized the heterogeneous "construct" of AD through a cerebrospinal fluid biomarker-guided stratification approach. We analyzed 5 validated pathophysiological cerebrospinal fluid biomarkers (Aβ1-42, t-tau, p-tau181, NFL, YKL-40) in 113 participants (healthy controls [N = 20], subjective memory complainers [N = 36], mild cognitive impairment [N = 20], and AD dementia [N = 37], age: 66.7 ± 10.4, 70.4 ± 7.7, 71.7 ± 8.4, 76.2 ± 3.5 years [mean ± SD], respectively) using Density-Based Spatial Clustering of Applications with Noise, which does not require a priori determination of the number of clusters. We found 5 distinct clusters (sizes: N = 38, 16, 24, 14, and 21) whose composition was independent of phenotypical groups. Two clusters showed biomarker profiles linked to neurodegenerative processes not associated with classical AD-related pathophysiology. One cluster was characterized by the neuroinflammation biomarker YKL-40. Combining nonlinear data aggregation with informative biomarkers can generate novel patient strata which are representative of cellular/molecular pathophysiology and may aid in predicting disease evolution and mechanistic drug response.
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Affiliation(s)
- Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy; Department of Radiology, "Athinoula A. Martinos" Center for Biomedical Imaging, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - 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, Paris, France; Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France
| | - Filippo Baldacci
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Brain & Spine Institute (ICM), INSERM U 1127, Paris, France; Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrica Cavedo
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Brain & Spine Institute (ICM), INSERM U 1127, Paris, France; Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France; Qynapse, Paris, France
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK; UK Dementia Research Institute, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Ingo Kilimann
- Department of Psychosomatic Medicine, University of Rostock & DZNE Rostock, Rostock, Germany
| | - Stefan J Teipel
- Department of Psychosomatic Medicine, University of Rostock & DZNE Rostock, Rostock, Germany
| | - Antonio Melo Dos Santos
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Brain & Spine Institute (ICM), INSERM U 1127, Paris, France; Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphane Epelbaum
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Brain & Spine Institute (ICM), INSERM U 1127, Paris, France; Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France
| | - Foudil Lamari
- AP-HP, UF Biochimie des Maladies Neuro-métaboliques, Service de Biochimie Métabolique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Remy Genthon
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France
| | - Marie-Odile Habert
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France; Centre pour l'Acquisition et le Traitement des Images, France; Département de Médecine Nucléaire, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Bruno Dubois
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Brain & Spine Institute (ICM), INSERM U 1127, Paris, France; Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France
| | - Roberto Floris
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy; Casa di Cura "San Raffaele Cassino", Cassino, Italy
| | - Andrea Vergallo
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Brain & Spine Institute (ICM), INSERM U 1127, Paris, France; Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France
| | - Harald Hampel
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Eisai Inc., Neurology Business Group, Woodcliff Lake, NJ, USA.
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Guzman-Martinez L, Maccioni RB, Farías GA, Fuentes P, Navarrete LP. Biomarkers for Alzheimer’s Disease. Curr Alzheimer Res 2019; 16:518-528. [DOI: 10.2174/1567205016666190517121140] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/08/2019] [Accepted: 04/25/2019] [Indexed: 12/15/2022]
Abstract
Alzheimer´s disease (AD) and related forms of dementia are increasingly affecting the aging population throughout the world, at an alarming rate. The World Alzheimer´s Report indicates a prevalence of 46.8 million people affected by AD worldwide. As population ages, this number is projected to triple by 2050 unless effective interventions are developed and implemented. Urgent efforts are required for an early detection of this disease. The ultimate goal is the identification of viable targets for the development of molecular markers and validation of their use for early diagnosis of AD that may improve treatment and the disease outcome in patients. The diagnosis of AD has been difficult to resolve since approaches for early and accurate detection and follow-up of AD patients at the clinical level have been reported only recently. Some proposed AD biomarkers include the detection of pathophysiological processes in the brain in vivo with new imaging techniques and novel PET ligands, and the determination of pathogenic proteins in cerebrospinal fluid showing anomalous levels of hyperphosphorylated tau and low Aβ peptide. These biomarkers have been increasingly accepted by AD diagnostic criteria and are important tools for the design of clinical trials, but difficulties in accessibility to costly and invasive procedures have not been completely addressed in clinical settings. New biomarkers are currently being developed to allow determinations of multiple pathological processes including neuroinflammation, synaptic dysfunction, metabolic impairment, protein aggregation and neurodegeneration. Highly specific and sensitive blood biomarkers, using less-invasive procedures to detect AD, are derived from the discoveries of peripheric tau oligomers and amyloid variants in human plasma and platelets. We have also developed a blood tau biomarker that correlates with a cognitive decline and also with neuroimaging determinations of brain atrophy.
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Martí-Juan G, Sanroma G, Piella G. Revealing heterogeneity of brain imaging phenotypes in Alzheimer's disease based on unsupervised clustering of blood marker profiles. PLoS One 2019; 14:e0211121. [PMID: 30830917 PMCID: PMC6398858 DOI: 10.1371/journal.pone.0211121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/08/2019] [Indexed: 01/02/2023] Open
Abstract
Alzheimer's disease (AD) affects millions of people and is a major rising problem in health care worldwide. Recent research suggests that AD could have different subtypes, presenting differences in how the disease develops. Characterizing those subtypes could be key to deepen the understanding of this complex disease. In this paper, we used a multivariate, non-supervised clustering method over blood-based markers to find subgroups of patients defined by distinctive blood marker profiles. Our analysis on ADNI database identified 4 possible subgroups, each with a different blood profile. More importantly, we show that subgroups with different profiles have a different relationship between brain phenotypes detected in magnetic resonance imaging and disease condition.
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Affiliation(s)
- Gerard Martí-Juan
- BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Gerard Sanroma
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Gemma Piella
- BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
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Uncovering the heterogeneity and temporal complexity of neurodegenerative diseases with Subtype and Stage Inference. Nat Commun 2018; 9:4273. [PMID: 30323170 PMCID: PMC6189176 DOI: 10.1038/s41467-018-05892-0] [Citation(s) in RCA: 253] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 07/20/2018] [Indexed: 12/13/2022] Open
Abstract
The heterogeneity of neurodegenerative diseases is a key confound to disease understanding and treatment development, as study cohorts typically include multiple phenotypes on distinct disease trajectories. Here we introduce a machine-learning technique—Subtype and Stage Inference (SuStaIn)—able to uncover data-driven disease phenotypes with distinct temporal progression patterns, from widely available cross-sectional patient studies. Results from imaging studies in two neurodegenerative diseases reveal subgroups and their distinct trajectories of regional neurodegeneration. In genetic frontotemporal dementia, SuStaIn identifies genotypes from imaging alone, validating its ability to identify subtypes; further the technique reveals within-genotype heterogeneity. In Alzheimer’s disease, SuStaIn uncovers three subtypes, uniquely characterising their temporal complexity. SuStaIn provides fine-grained patient stratification, which substantially enhances the ability to predict conversion between diagnostic categories over standard models that ignore subtype (p = 7.18 × 10−4) or temporal stage (p = 3.96 × 10−5). SuStaIn offers new promise for enabling disease subtype discovery and precision medicine. Progressive diseases tend to be heterogeneous in their underlying aetiology mechanism, disease manifestation, and disease time course. Here, Young and colleagues devise a computational method to account for both phenotypic heterogeneity and temporal heterogeneity, and demonstrate it using two neurodegenerative disease cohorts.
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Sapkota S, Ramirez J, Stuss DT, Masellis M, Black SE. Clinical dementia severity associated with ventricular size is differentially moderated by cognitive reserve in men and women. ALZHEIMERS RESEARCH & THERAPY 2018; 10:89. [PMID: 30185213 PMCID: PMC6123907 DOI: 10.1186/s13195-018-0419-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/07/2018] [Indexed: 01/08/2023]
Abstract
Background Interindividual differences in cognitive reserve (CR) are associated with complex and dynamic clinical phenotypes observed in cognitive impairment and dementia. We tested whether (1) CR early in life (E-CR; measured by education and IQ), (2) CR later in life (L-CR; measured by occupation), and (3) CR panel (CR-P) with the additive effects of E-CR and L-CR, act as moderating factors between baseline ventricular size and clinical dementia severity at baseline and across 2 years. We further examined whether this moderation is differentially represented by sex. Methods We examined a longitudinal model using patients (N = 723; mean age = 70.8 ± 9.4 years; age range = 38–90 years; females = 374) from the Sunnybrook Dementia Study. The patients represented Alzheimer’s disease (n = 439), mild cognitive impairment (n = 77), vascular cognitive impairment (n = 52), Lewy body disease (n = 30), and frontotemporal dementia (n = 125). Statistical analyses included (1) latent growth modeling to determine how clinical dementia severity changes over 2 years (measured by performance on the Dementia Rating Scale), (2) confirmatory factor analysis to establish a baseline E-CR factor, and (3) path analysis to predict dementia severity. Baseline age (continuous) and Apolipoprotein E status (ɛ4−/ɛ4+) were included as covariates. Results The association between higher baseline ventricular size and dementia severity was moderated by (1) E-CR and L-CR and (2) CR-P. This association was differentially represented in men and women. Specifically, men in only the low CR-P had higher baseline clinical dementia severity with larger baseline ventricular size. However, women in the low CR-P showed the (1) highest baseline dementia severity and (2) fastest 2-year decline with larger baseline ventricular size. Conclusions Clinical dementia severity associated with ventricular size may be (1) selectively moderated by complex and additive CR networks and (2) differentially represented by sex. Trials registration ClinicalTrials.gov, NCT01800214. Registered on 27 February 2013. Electronic supplementary material The online version of this article (10.1186/s13195-018-0419-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shraddha Sapkota
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M6-192, Toronto, ON, M4N 3M5, Canada.
| | - Joel Ramirez
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M6-192, Toronto, ON, M4N 3M5, Canada
| | - Donald T Stuss
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M6-192, Toronto, ON, M4N 3M5, Canada.,Departments of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliot Building, 3-805, Toronto, ON, M5G 2C4, Canada.,Department of Psychology, University of Toronto, 100 St. George Street, 4th Floor, Sidney Smith Hall, Toronto, ON, M5S 3G3, Canada.,Rotman Research Institute of Baycrest Centre, 3560 Bathurst Street, Toronto, ON, M6H 4A6, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M6-192, Toronto, ON, M4N 3M5, Canada.,Department of Medicine (Neurology), University of Toronto, 190 Elizabeth Street, R. Fraser Elliot Building, 3-805, Toronto, ON, M5G 2C4, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M6-192, Toronto, ON, M4N 3M5, Canada.,Department of Medicine (Neurology), University of Toronto, 190 Elizabeth Street, R. Fraser Elliot Building, 3-805, Toronto, ON, M5G 2C4, Canada
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Goyal D, Tjandra D, Migrino RQ, Giordani B, Syed Z, Wiens J. Characterizing heterogeneity in the progression of Alzheimer's disease using longitudinal clinical and neuroimaging biomarkers. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2018; 10:629-637. [PMID: 30456290 PMCID: PMC6234900 DOI: 10.1016/j.dadm.2018.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Models characterizing intermediate disease stages of Alzheimer's disease (AD) are needed to inform clinical care and prognosis. Current models, however, use only a small subset of available biomarkers, capturing only coarse changes along the complete spectrum of disease progression. We propose the use of machine learning techniques and clinical, biochemical, and neuroimaging biomarkers to characterize progression to AD. METHODS We used a large multimodal longitudinal data set of biomarkers and demographic and genotype information from 1624 participants from the Alzheimer's Disease Neuroimaging Initiative. Using hidden Markov models, we characterized intermediate disease stages. We validated inferred disease trajectories by comparing time to first clinical AD diagnosis. We trained an L2-regularized logistic regression model to predict disease trajectory and evaluated its discriminative performance on a test set. RESULTS We identified 12 distinct disease states. Progression to AD occurred most often through one of two possible paths through these states. Paths differed in terms of rate of disease progression (by 5.44 years on average), amyloid and total-tau (t-tau) burden (by 10% and 69%, respectively), and hippocampal neurodegeneration (P < .001). On the test set, the predictive model achieved an area under the receiver operating characteristic curve of 0.85. DISCUSSION Progression to AD, in terms of biomarker trajectories, can be predicted based on participant-specific factors. Such disease staging tools could help in targeting high-risk patients for therapeutic intervention trials. As longitudinal data with richer features are collected, such models will help increase our understanding of the factors that drive the different trajectories of AD.
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Affiliation(s)
- Devendra Goyal
- Computer Science and Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Donna Tjandra
- Computer Science and Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | - Bruno Giordani
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Zeeshan Syed
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Jenna Wiens
- Computer Science and Engineering, University of Michigan, Ann Arbor, MI, USA
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Dumurgier J, Hanseeuw BJ, Hatling FB, Judge KA, Schultz AP, Chhatwal JP, Blacker D, Sperling RA, Johnson KA, Hyman BT, Gómez-Isla T. Alzheimer's Disease Biomarkers and Future Decline in Cognitive Normal Older Adults. J Alzheimers Dis 2018; 60:1451-1459. [PMID: 29036824 DOI: 10.3233/jad-170511] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Identifying older adults at risk of cognitive decline represents a challenge as Alzheimer's disease (AD) modifying therapies move toward preclinical stages. OBJECTIVE To investigate the relationship between AD biomarkers and subsequent change in cognition in a cohort of cognitively intact older adults. METHODS 84 cognitively normal subjects (mean age 72.0 years, 59% women) were recruited through the Massachusetts Alzheimer's Disease Research Center and the Harvard Aging Brain Study and followed over 3 years. Measurements of amyloid-β 1-42 (Aβ42), total Tau (t-Tau), and Tau phosphorylated at threonine 181 (p-Tau181) in the cerebrospinal fluid (CSF) at study entry were available in all cases. Baseline brain MRI, FDG-PET, and PiB-PET data were available in the majority of participants. Relationship between baseline AD biomarkers and longitudinal change in cognition was assessed using Cox proportional hazard regression and linear mixed models. RESULTS 14% participants increased their global Clinical Dementia Rating (CDR) score from 0 to 0.5 during follow-up. A CDR score increase was associated with higher baseline CSF t-Tau and p-Tau181, higher global cortical PiB retention, and lower hippocampal volume. The combination of high CSF t-Tau and low Aβ42 or low hippocampal volume was more strongly related to cognitive outcome than each single biomarker. Higher CSF t-Tau was the only biomarker associated with subsequent decline in MMSE score. CONCLUSIONS Baseline CSF t-Tau and p-Tau181, in vivo amyloid load, and hippocampal volume were all independently associated with future decline in cognition. The discriminatory ability of these biomarkers to predict risk of cognitive decline, however, was only modest.
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Affiliation(s)
- Julien Dumurgier
- Department of Neurology, Massachusetts Alzheimer Disease Research Center, Massachusetts General Hospital, Boston, MA, USA.,INSERM U942 and Memory Clinical Center, Saint Louis - Lariboisiere - Fernand Widal Hospital, AP-HP, University Paris VII Denis Diderot, Paris, France
| | - Bernard J Hanseeuw
- Department of Neurology, Massachusetts Alzheimer Disease Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Frances B Hatling
- Department of Neurology, Massachusetts Alzheimer Disease Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kelly A Judge
- Department of Radiology, Massachusetts Alzheimer Disease Research Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA
| | - Aaron P Schultz
- Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA
| | - Jasmeer P Chhatwal
- Department of Neurology, Massachusetts Alzheimer Disease Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah Blacker
- Department of Psychiatry, Massachusetts Alzheimer Disease Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Reisa A Sperling
- Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA
| | - Keith A Johnson
- Department of Radiology, Massachusetts Alzheimer Disease Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Bradley T Hyman
- Department of Neurology, Massachusetts Alzheimer Disease Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Teresa Gómez-Isla
- Department of Neurology, Massachusetts Alzheimer Disease Research Center, Massachusetts General Hospital, Boston, MA, USA
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20
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Lange C, Suppa P, Pietrzyk U, Makowski MR, Spies L, Peters O, Buchert R. Prediction of Alzheimer's Dementia in Patients with Amnestic Mild Cognitive Impairment in Clinical Routine: Incremental Value of Biomarkers of Neurodegeneration and Brain Amyloidosis Added Stepwise to Cognitive Status. J Alzheimers Dis 2018; 61:373-388. [PMID: 29154285 DOI: 10.3233/jad-170705] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The aim of this study was to evaluate the incremental benefit of biomarkers for prediction of Alzheimer's disease dementia (ADD) in patients with mild cognitive impairment (MCI) when added stepwise in the order of their collection in clinical routine. The model started with cognitive status characterized by the ADAS-13 score. Hippocampus volume (HV), cerebrospinal fluid (CSF) phospho-tau (pTau), and the FDG t-sum score in an AD meta-region-of-interest were compared as neurodegeneration markers. CSF-Aβ1-42 was used as amyloidosis marker. The incremental prognostic benefit from these markers was assessed by stepwise Kaplan-Meier survival analysis in 402 ADNI MCI subjects. Predefined cutoffs were used to dichotomize patients as 'negative' or 'positive' for AD characteristic alteration with respect to each marker. Among the neurodegeneration markers, CSF-pTau provided the best incremental risk stratification when added to ADAS-13. FDG PET outperformed HV only in MCI subjects with relatively preserved cognition. Adding CSF-Aβ provided further risk stratification in pTau-positive subjects, independent of their cognitive status. Stepwise integration of biomarkers allows stepwise refinement of risk estimates for MCI-to-ADD progression. Incremental benefit strongly depends on the patient's status according to the preceding diagnostic steps. The stepwise Kaplan-Meier curves might be useful to optimize diagnostic workflow in individual patients.
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Affiliation(s)
- Catharina Lange
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,School of Mathematics and Natural Science, University of Wuppertal, Wuppertal, Germany
| | - Per Suppa
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,jung diagnostics GmbH, Hamburg, Germany
| | - Uwe Pietrzyk
- School of Mathematics and Natural Science, University of Wuppertal, Wuppertal, Germany.,Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Oliver Peters
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ralph Buchert
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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21
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Lawrence E, Vegvari C, Ower A, Hadjichrysanthou C, De Wolf F, Anderson RM. A Systematic Review of Longitudinal Studies Which Measure Alzheimer's Disease Biomarkers. J Alzheimers Dis 2018; 59:1359-1379. [PMID: 28759968 PMCID: PMC5611893 DOI: 10.3233/jad-170261] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Alzheimer’s disease (AD) is a progressive and fatal neurodegenerative disease, with no effective treatment or cure. A gold standard therapy would be treatment to slow or halt disease progression; however, knowledge of causation in the early stages of AD is very limited. In order to determine effective endpoints for possible therapies, a number of quantitative surrogate markers of disease progression have been suggested, including biochemical and imaging biomarkers. The dynamics of these various surrogate markers over time, particularly in relation to disease development, are, however, not well characterized. We reviewed the literature for studies that measured cerebrospinal fluid or plasma amyloid-β and tau, or took magnetic resonance image or fluorodeoxyglucose/Pittsburgh compound B-positron electron tomography scans, in longitudinal cohort studies. We summarized the properties of the major cohort studies in various countries, commonly used diagnosis methods and study designs. We have concluded that additional studies with repeat measures over time in a representative population cohort are needed to address the gap in knowledge of AD progression. Based on our analysis, we suggest directions in which research could move in order to advance our understanding of this complex disease, including repeat biomarker measurements, standardization and increased sample sizes.
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Affiliation(s)
- Emma Lawrence
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Carolin Vegvari
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Alison Ower
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | | | - Frank De Wolf
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.,Janssen Prevention Center, Leiden, The Netherlands
| | - Roy M Anderson
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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22
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Cerebrospinal Biomarker Cut-off Methods Defined Only by Alzheimer's Disease Predict More Precisely Conversions of Mild Cognitive Impairment. Dement Neurocogn Disord 2017; 16:114-120. [PMID: 30906382 PMCID: PMC6428002 DOI: 10.12779/dnd.2017.16.4.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/06/2017] [Accepted: 12/06/2017] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose The cerebrospinal fluid (CSF) biomarkers play an important supportive role as diagnostic and predictive indicators of Alzheimer's disease (AD). About 30% of controls in old age show abnormal values of CSF biomarkers and display a higher risk for AD compared with those showing normal values. The cut-off values are determined by their diagnostic accuracy. However, the current cut-off values may be less accurate, because controls include high-risk groups of AD. We sought to develop models of patients with AD, who are homogenous for CSF biomarkers. Methods We included participants who had CSF biomarker data in the Alzheimer's Disease Neuroimaging Initiative database. We investigated the factors related to CSF biomarkers in patients with AD using linear mixed models. Using the factors, we developed models corresponding to CSF biomarkers to classify patients with mild cognitive impairment (MCI) into high risk and low risk and analyzed the conversion from MCI to AD using the Cox proportional hazards model. Results APOE ε4 status and age were significantly related to CSF Aβ1-42. CSF t-tau, APOE ε2 status and sex were significant factors. The CSF p-tau181 was associated with age and frequency of diagnosis. Accordingly, we modeled the three CSF biomarkers of AD. In MCI without APOE ε4, our models were better predictors of conversion. Conclusions We can interpret CSF biomarkers based on the models derived from the data obtained from patients with AD.
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23
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Ferreira D, Machado A, Molina Y, Nieto A, Correia R, Westman E, Barroso J. Cognitive Variability during Middle-Age: Possible Association with Neurodegeneration and Cognitive Reserve. Front Aging Neurosci 2017. [PMID: 28649200 PMCID: PMC5465264 DOI: 10.3389/fnagi.2017.00188] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective: Increased variability in cognition with age has been argued as an indication of pathological processes. Focusing on early detection of neurodegenerative disorders, we investigated variability in cognition in healthy middle-aged adults. In order to understand possible determinants of this variability, we also investigated associations with cognitive reserve, neuroimaging markers, subjective memory complaints, depressive symptomatology, and gender. Method: Thirty-one 50 ± 2 years old individuals were investigated as target group and deviation was studied in comparison to a reference younger group of 30 individuals 40 ± 2 years old. Comprehensive neuropsychological and structural imaging protocols were collected. Brain regional volumes and cortical thickness were calculated with FreeSurfer, white matter hyperintensities with CASCADE, and mean diffusivity with FSL. Results: Across-individuals variability showed greater dispersion in lexical access, processing speed, executive functions, and memory. Variability in global cognition correlated with, reduced cortical thickness in the right parietal-temporal-occipital association cortex, and increased mean diffusivity in the cingulum bundle and right inferior fronto-occipital fasciculus. A trend was also observed for the correlation between global cognition and hippocampal volume and female gender. All these associations were influenced by cognitive reserve. No correlations were found with subjective memory complaints, white matter hyperintensities and depressive symptomatology. Across-domains and across-tasks variability was greater in several executive components and cognitive processing speed. Conclusion: Variability in cognition during middle-age is associated with neurodegeneration in the parietal–temporal–occipital association cortex and white matter tracts connecting this to the prefrontal dorsolateral cortex and the hippocampus. Moreover, this effect is influenced by cognitive reserve. Studying variability offers valuable information showing that differences do not occur in the same magnitude and direction across individuals, cognitive domains and tasks. These findings may have important implications for early detection of subtle cognitive impairment and clinical interpretation of deviation from normality.
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Affiliation(s)
- Daniel Ferreira
- Division of Clinical Geriatrics-Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetStockholm, Sweden.,Faculty of Psychology, University of La LagunaLa Laguna, Spain
| | - Alejandra Machado
- Division of Clinical Geriatrics-Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetStockholm, Sweden.,Faculty of Psychology, University of La LagunaLa Laguna, Spain
| | - Yaiza Molina
- Faculty of Psychology, University of La LagunaLa Laguna, Spain.,Faculty of Health Sciences, University Fernando Pessoa CanariasLas Palmas, Spain
| | - Antonieta Nieto
- Faculty of Psychology, University of La LagunaLa Laguna, Spain
| | - Rut Correia
- Faculty of Psychology, University of La LagunaLa Laguna, Spain.,Facultad de Educación, Universidad Diego PortalesSantiago, Chile
| | - Eric Westman
- Division of Clinical Geriatrics-Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetStockholm, Sweden
| | - José Barroso
- Faculty of Psychology, University of La LagunaLa Laguna, Spain
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24
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Ferreira D, Hansson O, Barroso J, Molina Y, Machado A, Hernández-Cabrera JA, Muehlboeck JS, Stomrud E, Nägga K, Lindberg O, Ames D, Kalpouzos G, Fratiglioni L, Bäckman L, Graff C, Mecocci P, Vellas B, Tsolaki M, Kłoszewska I, Soininen H, Lovestone S, Ahlström H, Lind L, Larsson EM, Wahlund LO, Simmons A, Westman E. The interactive effect of demographic and clinical factors on hippocampal volume: A multicohort study on 1958 cognitively normal individuals. Hippocampus 2017; 27:653-667. [DOI: 10.1002/hipo.22721] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Daniel Ferreira
- Division of Clinical Geriatrics; Centre for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet; Stockholm 14157 Sweden
| | - Oskar Hansson
- Department of Clinical Sciences; Clinical Memory Research Unit, Lund University; Malmö 20502 Sweden
| | - José Barroso
- Department of Clinical Psychology; Psychobiology and Methodology, University of La Laguna; La Laguna 38071 Spain
| | - Yaiza Molina
- Department of Clinical Psychology; Psychobiology and Methodology, University of La Laguna; La Laguna 38071 Spain
- Faculty of Health Sciences; University Fernando Pessoa Canarias, Las Palmas de Gran Canaria; Spain
| | - Alejandra Machado
- Department of Clinical Psychology; Psychobiology and Methodology, University of La Laguna; La Laguna 38071 Spain
| | | | - J-Sebastian Muehlboeck
- Division of Clinical Geriatrics; Centre for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet; Stockholm 14157 Sweden
| | - Erik Stomrud
- Department of Clinical Sciences; Clinical Memory Research Unit, Lund University; Malmö 20502 Sweden
| | - Katarina Nägga
- Department of Clinical Sciences; Clinical Memory Research Unit, Lund University; Malmö 20502 Sweden
| | - Olof Lindberg
- Division of Clinical Geriatrics; Centre for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet; Stockholm 14157 Sweden
- Department of Clinical Sciences; Clinical Memory Research Unit, Lund University; Malmö 20502 Sweden
| | - David Ames
- National Ageing Research Institute; Parkville; Victoria 3050 Australia
- University of Melbourne Academic Unit for Psychiatry of Old Age; St George's Hospital, Kew; Victoria 3101 Australia
| | - Grégoria Kalpouzos
- Aging Research Center (ARC); Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University; 113 30 Stockholm Sweden
| | - Laura Fratiglioni
- Aging Research Center (ARC); Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University; 113 30 Stockholm Sweden
- Stockholm Gerontology Research Centre; Stockholm 11330 Sweden
| | - Lars Bäckman
- Aging Research Center (ARC); Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University; 113 30 Stockholm Sweden
- Stockholm Gerontology Research Centre; Stockholm 11330 Sweden
| | - Caroline Graff
- Division of Neurogeriatrics; Department of Neurobiology Care Sciences and Society, Centre for Alzheimer Research, Karolinska Institutet; Stockholm 14157 Sweden
- Department of Geriatric Medicine; Karolinska University Hospital Huddinge; Stockholm 14186 Sweden
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics; University of Perugia; Perugia 06100 Italy
| | - Bruno Vellas
- INSERM U 558; University of Toulouse; Toulouse 31024 France
| | - Magda Tsolaki
- 3rd Department of Neurology; Aristoteleion Panepistimeion Thessalonikis; Thessaloniki 54124 Greece
| | | | - Hilkka Soininen
- University of Eastern Finland and Kuopio University Hospital; Kuopio 70211 Finland
| | - Simon Lovestone
- Department of Psychiatry; Warneford Hospital University of Oxford; Oxford OX37JX United Kingdom
| | - Håkan Ahlström
- Department of Surgical Sciences; Radiology, Uppsala University; Uppsala 75185 Sweden
| | - Lars Lind
- Department of Medical Sciences; Uppsala University; Uppsala 75185 Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences; Radiology, Uppsala University; Uppsala 75185 Sweden
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics; Centre for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet; Stockholm 14157 Sweden
| | - Andrew Simmons
- Division of Clinical Geriatrics; Centre for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet; Stockholm 14157 Sweden
- NIHR Biomedical Research Centre for Mental Health; London SE58AF United Kingdom
- NIHR Biomedical Research Unit for Dementia; London SE58AF United Kingdom
- Institute of Psychiatry; King's College London; London SE58AF United Kingdom
| | - Eric Westman
- Division of Clinical Geriatrics; Centre for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet; Stockholm 14157 Sweden
- Institute of Psychiatry; King's College London; London SE58AF United Kingdom
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25
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Classifying anatomical subtypes of subjective memory impairment. Neurobiol Aging 2016; 48:53-60. [DOI: 10.1016/j.neurobiolaging.2016.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/18/2016] [Accepted: 08/10/2016] [Indexed: 11/22/2022]
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26
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Ruan Q, D'Onofrio G, Sancarlo D, Greco A, Yu Z. Potential fluid biomarkers for pathological brain changes in Alzheimer's disease: Implication for the screening of cognitive frailty. Mol Med Rep 2016; 14:3184-98. [PMID: 27511317 PMCID: PMC5042792 DOI: 10.3892/mmr.2016.5618] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022] Open
Abstract
Cognitive frailty (CF) overlaps with early neuropathological alterations associated with aging-related major neurocognitive disorders, including Alzheimer's disease (AD). Fluid biomarkers for these pathological brain alterations allow for early diagnosis in the preclinical stages of AD, and for objective prognostic assessments in clinical intervention trials. These biomarkers may also be helpful in the screening of CF. The present study reviewed the literature and identified systematic reviews of cohort studies and other authoritative reports. The selection criteria for potentially suitable fluid biomarkers included: i) Frequent use in studies of fluid-derived markers and ii) evidence of novel measurement techniques for fluid-derived markers. The present study focused on studies that assessed these biomarkers in AD, mild cognitive impairment and non-AD demented subjects. At present, widely used fluid biomarkers include cerebrospinal fluid (CSF), total tau, phosphorylated tau and amyloid-β levels. With the development of novel measurement techniques and improvements in understanding regarding the mechanisms underlying aging-related major neurocognitive disorders, numerous novel biomarkers associated with various aspects of AD neuropathology are being explored. These include specific measurements of Aβ oligomer or monomer forms, tau proteins in the peripheral plasma and CSF, and novel markers of synaptic dysfunction, neuronal damage and apoptosis, neuronal activity alteration, neuroinflammation, blood brain barrier dysfunction, oxidative stress, metabolites, mitochondrial function and aberrant lipid metabolism. The proposed panels of fluid biomarkers may be useful in the early diagnosis of AD, prediction of the progression of AD from preclinical stages to the dementia stage, and the differentiation of AD from non-AD dementia. In combination with physical frailty, the present study surmised that these biomarkers may also be used as biomarkers for CF, thus contribute to discovering causes and informing interventions for cognitive impairment in individuals with CF.
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Affiliation(s)
- Qingwei Ruan
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai 200040, P.R. China
| | - Grazia D'Onofrio
- Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, I‑71013 Foggia, Italy
| | - Daniele Sancarlo
- Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, I‑71013 Foggia, Italy
| | - Antonio Greco
- Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, I‑71013 Foggia, Italy
| | - Zhuowei Yu
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai 200040, P.R. China
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27
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Racine AM, Koscik RL, Berman SE, Nicholas CR, Clark LR, Okonkwo OC, Rowley HA, Asthana S, Bendlin BB, Blennow K, Zetterberg H, Gleason CE, Carlsson CM, Johnson SC. Biomarker clusters are differentially associated with longitudinal cognitive decline in late midlife. Brain 2016; 139:2261-74. [PMID: 27324877 DOI: 10.1093/brain/aww142] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/05/2016] [Indexed: 11/12/2022] Open
Abstract
The ability to detect preclinical Alzheimer's disease is of great importance, as this stage of the Alzheimer's continuum is believed to provide a key window for intervention and prevention. As Alzheimer's disease is characterized by multiple pathological changes, a biomarker panel reflecting co-occurring pathology will likely be most useful for early detection. Towards this end, 175 late middle-aged participants (mean age 55.9 ± 5.7 years at first cognitive assessment, 70% female) were recruited from two longitudinally followed cohorts to undergo magnetic resonance imaging and lumbar puncture. Cluster analysis was used to group individuals based on biomarkers of amyloid pathology (cerebrospinal fluid amyloid-β42/amyloid-β40 assay levels), magnetic resonance imaging-derived measures of neurodegeneration/atrophy (cerebrospinal fluid-to-brain volume ratio, and hippocampal volume), neurofibrillary tangles (cerebrospinal fluid phosphorylated tau181 assay levels), and a brain-based marker of vascular risk (total white matter hyperintensity lesion volume). Four biomarker clusters emerged consistent with preclinical features of (i) Alzheimer's disease; (ii) mixed Alzheimer's disease and vascular aetiology; (iii) suspected non-Alzheimer's disease aetiology; and (iv) healthy ageing. Cognitive decline was then analysed between clusters using longitudinal assessments of episodic memory, semantic memory, executive function, and global cognitive function with linear mixed effects modelling. Cluster 1 exhibited a higher intercept and greater rates of decline on tests of episodic memory. Cluster 2 had a lower intercept on a test of semantic memory and both Cluster 2 and Cluster 3 had steeper rates of decline on a test of global cognition. Additional analyses on Cluster 3, which had the smallest hippocampal volume, suggest that its biomarker profile is more likely due to hippocampal vulnerability and not to detectable specific volume loss exceeding the rate of normal ageing. Our results demonstrate that pathology, as indicated by biomarkers, in a preclinical timeframe is related to patterns of longitudinal cognitive decline. Such biomarker patterns may be useful for identifying at-risk populations to recruit for clinical trials.
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Affiliation(s)
- Annie M Racine
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 2 Institute on Aging, University of Wisconsin-Madison, USA, Madison, WI 53706, USA 3 Neuroscience and Public Policy Program, University of Wisconsin-Madison, USA, Madison, WI 53705, USA
| | - Rebecca L Koscik
- 4 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA
| | - Sara E Berman
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA
| | - Christopher R Nicholas
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 5 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, USA, Madison WI 53705, USA
| | - Lindsay R Clark
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 4 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 5 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, USA, Madison WI 53705, USA
| | - Ozioma C Okonkwo
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 4 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA
| | - Howard A Rowley
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 6 Department of Radiology, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA
| | - Sanjay Asthana
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 5 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, USA, Madison WI 53705, USA
| | - Barbara B Bendlin
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 4 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA
| | - Kaj Blennow
- 7 Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden 8 Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- 7 Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden 8 Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden 9 Institute of Neurology, University College London, London, UK
| | - Carey E Gleason
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 5 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, USA, Madison WI 53705, USA
| | - Cynthia M Carlsson
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 4 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 5 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, USA, Madison WI 53705, USA
| | - Sterling C Johnson
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 4 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 5 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, USA, Madison WI 53705, USA 10 Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, USA, Madison, WI 53705, USA
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28
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Ruan Q, D'Onofrio G, Sancarlo D, Bao Z, Greco A, Yu Z. Potential neuroimaging biomarkers of pathologic brain changes in Mild Cognitive Impairment and Alzheimer's disease: a systematic review. BMC Geriatr 2016; 16:104. [PMID: 27184250 PMCID: PMC4869390 DOI: 10.1186/s12877-016-0281-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/09/2016] [Indexed: 12/16/2022] Open
Abstract
Background Neuroimaging-biomarkers of Mild Cognitive Impairment (MCI) allow an early diagnosis in preclinical stages of Alzheimer’s disease (AD). The goal in this paper was to review of biomarkers for Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD), with emphasis on neuroimaging biomarkers. Methods A systematic review was conducted from existing literature that draws on markers and evidence for new measurement techniques of neuroimaging in AD, MCI and non-demented subjects. Selection criteria included: 1) age ≥ 60 years; 2) diagnosis of AD according to NIAAA criteria, 3) diagnosis of MCI according to NIAAA criteria with a confirmed progression to AD assessed by clinical follow-up, and 4) acceptable clinical measures of cognitive impairment, disability, quality of life, and global clinical assessments. Results Seventy-two articles were included in the review. With the development of new radioligands of neuroimaging, today it is possible to measure different aspects of AD neuropathology, early diagnosis of MCI and AD become probable from preclinical stage of AD to AD dementia and non-AD dementia. Conclusions The panel of noninvasive neuroimaging-biomarkers reviewed provides a set methods to measure brain structural and functional pathophysiological changes in vivo, which are closely associated with preclinical AD, MCI and non-AD dementia. The dynamic measures of these imaging biomarkers are used to predict the disease progression in the early stages and improve the assessment of therapeutic efficacy in these diseases in future clinical trials.
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Affiliation(s)
- Qingwei Ruan
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Grazia D'Onofrio
- Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.
| | - Daniele Sancarlo
- Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Zhijun Bao
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Antonio Greco
- Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Zhuowei Yu
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, 200040, China. .,Huadong Hospital, Shanghai Medical College, Fudan University, 221 West Yan An Road, Shanghai, 200040, P.R. China.
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Chung JK, Plitman E, Nakajima S, Chakravarty MM, Caravaggio F, Gerretsen P, Iwata Y, Graff-Guerrero A. Cortical Amyloid β Deposition and Current Depressive Symptoms in Alzheimer Disease and Mild Cognitive Impairment. J Geriatr Psychiatry Neurol 2016; 29:149-59. [PMID: 26400248 PMCID: PMC4870393 DOI: 10.1177/0891988715606230] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/29/2015] [Indexed: 01/18/2023]
Abstract
Depressive symptoms are frequently seen in patients with dementia and mild cognitive impairment (MCI). Evidence suggests that there may be a link between current depressive symptoms and Alzheimer disease (AD)-associated pathological changes, such as an increase in cortical amyloid-β (Aβ). However, limited in vivo studies have explored the relationship between current depressive symptoms and cortical Aβ in patients with MCI and AD. Our study, using a large sample of 455 patients with MCI and 153 patients with AD from the Alzheimer's disease Neuroimaging Initiatives, investigated whether current depressive symptoms are related to cortical Aβ deposition. Depressive symptoms were assessed using the Geriatric Depression Scale and Neuropsychiatric Inventory-depression/dysphoria. Cortical Aβ was quantified using positron emission tomography with the Aβ probe(18)F-florbetapir (AV-45).(18)F-florbetapir standardized uptake value ratio (AV-45 SUVR) from the frontal, cingulate, parietal, and temporal regions was estimated. A global AV-45 SUVR, defined as the average of frontal, cingulate, precuneus, and parietal cortex, was also used. We observed that current depressive symptoms were not related to cortical Aβ, after controlling for potential confounds, including history of major depression. We also observed that there was no difference in cortical Aβ between matched participants with high and low depressive symptoms, as well as no difference between matched participants with the presence and absence of depressive symptoms. The association between depression and cortical Aβ deposition does not exist, but the relationship is highly influenced by stressful events in the past, such as previous depressive episodes, and complex interactions of different pathways underlying both depression and dementia.
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Affiliation(s)
- Jun Ku Chung
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada Multimodal Imaging Group-Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Eric Plitman
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada Multimodal Imaging Group-Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group-Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health Institute, McGill University, Montreal, Quebec, Canada Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Fernando Caravaggio
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada Multimodal Imaging Group-Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group-Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group-Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Ariel Graff-Guerrero
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada Multimodal Imaging Group-Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Jack CR, Barnes J, Bernstein MA, Borowski BJ, Brewer J, Clegg S, Dale AM, Carmichael O, Ching C, DeCarli C, Desikan RS, Fennema-Notestine C, Fjell AM, Fletcher E, Fox NC, Gunter J, Gutman BA, Holland D, Hua X, Insel P, Kantarci K, Killiany RJ, Krueger G, Leung KK, Mackin S, Maillard P, Malone IB, Mattsson N, McEvoy L, Modat M, Mueller S, Nosheny R, Ourselin S, Schuff N, Senjem ML, Simonson A, Thompson PM, Rettmann D, Vemuri P, Walhovd K, Zhao Y, Zuk S, Weiner M. Magnetic resonance imaging in Alzheimer's Disease Neuroimaging Initiative 2. Alzheimers Dement 2016; 11:740-56. [PMID: 26194310 DOI: 10.1016/j.jalz.2015.05.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/28/2015] [Accepted: 05/05/2015] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Alzheimer's Disease Neuroimaging Initiative (ADNI) is now in its 10th year. The primary objective of the magnetic resonance imaging (MRI) core of ADNI has been to improve methods for clinical trials in Alzheimer's disease (AD) and related disorders. METHODS We review the contributions of the MRI core from present and past cycles of ADNI (ADNI-1, -Grand Opportunity and -2). We also review plans for the future-ADNI-3. RESULTS Contributions of the MRI core include creating standardized acquisition protocols and quality control methods; examining the effect of technical features of image acquisition and analysis on outcome metrics; deriving sample size estimates for future trials based on those outcomes; and piloting the potential utility of MR perfusion, diffusion, and functional connectivity measures in multicenter clinical trials. DISCUSSION Over the past decade the MRI core of ADNI has fulfilled its mandate of improving methods for clinical trials in AD and will continue to do so in the future.
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Affiliation(s)
| | - Josephine Barnes
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | | | | | - James Brewer
- Department of Neuroscience, University of California at San Diego, La Jolla, CA, USA
| | - Shona Clegg
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Anders M Dale
- Department of Neuroscience, University of California at San Diego, La Jolla, CA, USA
| | - Owen Carmichael
- Department of Neurology, University of California at Davis, Davis, CA, USA
| | - Christopher Ching
- Department of Neurology, Imaging Genetics Center, Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, Davis, CA, USA; Center for Neuroscience, University of California at Davis, Davis, CA, USA
| | - Rahul S Desikan
- Department of Radiology, University of California at San Diego, La Jolla, CA, USA
| | - Christine Fennema-Notestine
- Department of Radiology, University of California at San Diego, La Jolla, CA, USA; Department of Psychiatry, University of California at San Diego, La Jolla, CA, USA
| | - Anders M Fjell
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Evan Fletcher
- Department of Neurology, University of California at Davis, Davis, CA, USA; Center for Neuroscience, University of California at Davis, Davis, CA, USA
| | - Nick C Fox
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Jeff Gunter
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Boris A Gutman
- Department of Neurology, Imaging Genetics Center, Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - Dominic Holland
- Department of Neuroscience, University of California at San Diego, La Jolla, CA, USA
| | - Xue Hua
- Department of Neurology, Imaging Genetics Center, Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - Philip Insel
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ron J Killiany
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | | | - Kelvin K Leung
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Scott Mackin
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | - Pauline Maillard
- Department of Neurology, University of California at Davis, Davis, CA, USA; Center for Neuroscience, University of California at Davis, Davis, CA, USA
| | - Ian B Malone
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Niklas Mattsson
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
| | - Linda McEvoy
- Department of Radiology, University of California at San Diego, La Jolla, CA, USA
| | - Marc Modat
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, UK; Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Susanne Mueller
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Radiology, University of California at San Francisco, San Francisco, CA, USA
| | - Rachel Nosheny
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Radiology, University of California at San Francisco, San Francisco, CA, USA
| | - Sebastien Ourselin
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, UK; Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Norbert Schuff
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Radiology, University of California at San Francisco, San Francisco, CA, USA
| | | | - Alix Simonson
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Paul M Thompson
- Department of Neurology, Imaging Genetics Center, Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - Dan Rettmann
- MR Applications and Workflow, GE Healthcare, Rochester, MN, USA
| | | | | | | | - Samantha Zuk
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Michael Weiner
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA; Department of Radiology, University of California at San Francisco, San Francisco, CA, USA; Department of Medicine, University of California at San Francisco, San Francisco, CA, USA; Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
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Minkova L, Scheller E, Peter J, Abdulkadir A, Kaller CP, Roos RA, Durr A, Leavitt BR, Tabrizi SJ, Klöppel S. Detection of Motor Changes in Huntington's Disease Using Dynamic Causal Modeling. Front Hum Neurosci 2015; 9:634. [PMID: 26635585 PMCID: PMC4658414 DOI: 10.3389/fnhum.2015.00634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/06/2015] [Indexed: 11/17/2022] Open
Abstract
Deficits in motor functioning are one of the hallmarks of Huntington's disease (HD), a genetically caused neurodegenerative disorder. We applied functional magnetic resonance imaging (fMRI) and dynamic causal modeling (DCM) to assess changes that occur with disease progression in the neural circuitry of key areas associated with executive and cognitive aspects of motor control. Seventy-seven healthy controls, 62 pre-symptomatic HD gene carriers (preHD), and 16 patients with manifest HD symptoms (earlyHD) performed a motor finger-tapping fMRI task with systematically varying speed and complexity. DCM was used to assess the causal interactions among seven pre-defined regions of interest, comprising primary motor cortex, supplementary motor area (SMA), dorsal premotor cortex, and superior parietal cortex. To capture heterogeneity among HD gene carriers, DCM parameters were entered into a hierarchical cluster analysis using Ward's method and squared Euclidian distance as a measure of similarity. After applying Bonferroni correction for the number of tests, DCM analysis revealed a group difference that was not present in the conventional fMRI analysis. We found an inhibitory effect of complexity on the connection from parietal to premotor areas in preHD, which became excitatory in earlyHD and correlated with putamen atrophy. While speed of finger movements did not modulate the connection from caudal to pre-SMA in controls and preHD, this connection became strongly negative in earlyHD. This second effect did not survive correction for multiple comparisons. Hierarchical clustering separated the gene mutation carriers into three clusters that also differed significantly between these two connections and thereby confirmed their relevance. DCM proved useful in identifying group differences that would have remained undetected by standard analyses and may aid in the investigation of between-subject heterogeneity.
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Affiliation(s)
- Lora Minkova
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany ; Freiburg Brain Imaging Center, University Medical Center Freiburg Freiburg, Germany ; Laboratory for Biological and Personality Psychology, Department of Psychology, University of Freiburg Freiburg, Germany
| | - Elisa Scheller
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany ; Freiburg Brain Imaging Center, University Medical Center Freiburg Freiburg, Germany
| | - Jessica Peter
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany ; Freiburg Brain Imaging Center, University Medical Center Freiburg Freiburg, Germany
| | - Ahmed Abdulkadir
- Freiburg Brain Imaging Center, University Medical Center Freiburg Freiburg, Germany ; Department of Computer Science, University of Freiburg Freiburg, Germany
| | - Christoph P Kaller
- Freiburg Brain Imaging Center, University Medical Center Freiburg Freiburg, Germany ; Department of Neurology, University Medical Center Freiburg Freiburg, Germany ; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg Freiburg, Germany
| | - Raymund A Roos
- Department of Neurology, Leiden University Medical Centre Leiden, Netherlands
| | - Alexandra Durr
- Department of Genetics and Cytogenetics, Pitié-Salpêtrière University Hospital Paris, France
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia Vancouver, Canada
| | - Sarah J Tabrizi
- Department of Neurodegenerative Disease, Institute of Neurology, University College London London, UK
| | - Stefan Klöppel
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany ; Freiburg Brain Imaging Center, University Medical Center Freiburg Freiburg, Germany ; Department of Neurology, University Medical Center Freiburg Freiburg, Germany
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Weiner MW, Veitch DP, Aisen PS, Beckett LA, Cairns NJ, Cedarbaum J, Donohue MC, Green RC, Harvey D, Jack CR, Jagust W, Morris JC, Petersen RC, Saykin AJ, Shaw L, Thompson PM, Toga AW, Trojanowski JQ. Impact of the Alzheimer's Disease Neuroimaging Initiative, 2004 to 2014. Alzheimers Dement 2015; 11:865-84. [PMID: 26194320 PMCID: PMC4659407 DOI: 10.1016/j.jalz.2015.04.005] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/04/2015] [Accepted: 04/23/2015] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The Alzheimer's Disease Neuroimaging Initiative (ADNI) was established in 2004 to facilitate the development of effective treatments for Alzheimer's disease (AD) by validating biomarkers for AD clinical trials. METHODS We searched for ADNI publications using established methods. RESULTS ADNI has (1) developed standardized biomarkers for use in clinical trial subject selection and as surrogate outcome measures; (2) standardized protocols for use across multiple centers; (3) initiated worldwide ADNI; (4) inspired initiatives investigating traumatic brain injury and post-traumatic stress disorder in military populations, and depression, respectively, as an AD risk factor; (5) acted as a data-sharing model; (6) generated data used in over 600 publications, leading to the identification of novel AD risk alleles, and an understanding of the relationship between biomarkers and AD progression; and (7) inspired other public-private partnerships developing biomarkers for Parkinson's disease and multiple sclerosis. DISCUSSION ADNI has made myriad impacts in its first decade. A competitive renewal of the project in 2015 would see the use of newly developed tau imaging ligands, and the continued development of recruitment strategies and outcome measures for clinical trials.
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Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Paul S Aisen
- Department of Neurosciences, University of California- San Diego, La Jolla, CA, USA
| | - Laurel A Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Nigel J Cairns
- Department of Neurology, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA; Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jesse Cedarbaum
- Neurology Early Clinical Development, Biogen Idec, Cambridge, MA, USA
| | - Michael C Donohue
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | | | - William Jagust
- Helen Wills Neuroscience Institute and the School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Andrew J Saykin
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Institute for Neuroimaging and Informatics, University of Southern California, Marina Del Rey, CA, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, Keck School of Medicine of University of Southern California Los Angeles, CA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Alzheimer's Disease Core Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Udall Parkinson's Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Beckett LA, Donohue MC, Wang C, Aisen P, Harvey DJ, Saito N. The Alzheimer's Disease Neuroimaging Initiative phase 2: Increasing the length, breadth, and depth of our understanding. Alzheimers Dement 2015; 11:823-31. [PMID: 26194315 PMCID: PMC4510463 DOI: 10.1016/j.jalz.2015.05.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The Alzheimer's Disease Neuroimaging Initiative (ADNI) is a multisite study designed to characterize the trajectories of biomarkers across the aging process. We present ADNI Biostatistics Core analyses that integrate data over the length, breadth, and depth of ADNI. METHODS Relative progression of key imaging, fluid, and clinical measures was assessed. Individuals with subjective memory complaints (SMC) and early mild cognitive impairment (eMCI) were compared with normal controls (NC), MCI, and individuals with Alzheimer's disease. Amyloid imaging and magnetic resonance imaging (MRI) summaries were assessed as predictors of disease progression. RESULTS Relative progression of markers supports parts of the amyloid cascade hypothesis, although evidence of earlier occurrence of cognitive change exists. SMC are similar to NC, whereas eMCI fall between the cognitively normal and MCI groups. Amyloid leads to faster conversion and increased cognitive impairment. DISCUSSION Analyses support features of the amyloid hypothesis, but also illustrate the considerable heterogeneity in the aging process.
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Affiliation(s)
- Laurel A Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA.
| | - Michael C Donohue
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Cathy Wang
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Paul Aisen
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Danielle J Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Naomi Saito
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
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Weiner MW, Veitch DP, Aisen PS, Beckett LA, Cairns NJ, Cedarbaum J, Green RC, Harvey D, Jack CR, Jagust W, Luthman J, Morris JC, Petersen RC, Saykin AJ, Shaw L, Shen L, Schwarz A, Toga AW, Trojanowski JQ. 2014 Update of the Alzheimer's Disease Neuroimaging Initiative: A review of papers published since its inception. Alzheimers Dement 2015; 11:e1-120. [PMID: 26073027 PMCID: PMC5469297 DOI: 10.1016/j.jalz.2014.11.001] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/18/2013] [Indexed: 01/18/2023]
Abstract
The Alzheimer's Disease Neuroimaging Initiative (ADNI) is an ongoing, longitudinal, multicenter study designed to develop clinical, imaging, genetic, and biochemical biomarkers for the early detection and tracking of Alzheimer's disease (AD). The initial study, ADNI-1, enrolled 400 subjects with early mild cognitive impairment (MCI), 200 with early AD, and 200 cognitively normal elderly controls. ADNI-1 was extended by a 2-year Grand Opportunities grant in 2009 and by a competitive renewal, ADNI-2, which enrolled an additional 550 participants and will run until 2015. This article reviews all papers published since the inception of the initiative and summarizes the results to the end of 2013. The major accomplishments of ADNI have been as follows: (1) the development of standardized methods for clinical tests, magnetic resonance imaging (MRI), positron emission tomography (PET), and cerebrospinal fluid (CSF) biomarkers in a multicenter setting; (2) elucidation of the patterns and rates of change of imaging and CSF biomarker measurements in control subjects, MCI patients, and AD patients. CSF biomarkers are largely consistent with disease trajectories predicted by β-amyloid cascade (Hardy, J Alzheimer's Dis 2006;9(Suppl 3):151-3) and tau-mediated neurodegeneration hypotheses for AD, whereas brain atrophy and hypometabolism levels show predicted patterns but exhibit differing rates of change depending on region and disease severity; (3) the assessment of alternative methods of diagnostic categorization. Currently, the best classifiers select and combine optimum features from multiple modalities, including MRI, [(18)F]-fluorodeoxyglucose-PET, amyloid PET, CSF biomarkers, and clinical tests; (4) the development of blood biomarkers for AD as potentially noninvasive and low-cost alternatives to CSF biomarkers for AD diagnosis and the assessment of α-syn as an additional biomarker; (5) the development of methods for the early detection of AD. CSF biomarkers, β-amyloid 42 and tau, as well as amyloid PET may reflect the earliest steps in AD pathology in mildly symptomatic or even nonsymptomatic subjects and are leading candidates for the detection of AD in its preclinical stages; (6) the improvement of clinical trial efficiency through the identification of subjects most likely to undergo imminent future clinical decline and the use of more sensitive outcome measures to reduce sample sizes. Multimodal methods incorporating APOE status and longitudinal MRI proved most highly predictive of future decline. Refinements of clinical tests used as outcome measures such as clinical dementia rating-sum of boxes further reduced sample sizes; (7) the pioneering of genome-wide association studies that leverage quantitative imaging and biomarker phenotypes, including longitudinal data, to confirm recently identified loci, CR1, CLU, and PICALM and to identify novel AD risk loci; (8) worldwide impact through the establishment of ADNI-like programs in Japan, Australia, Argentina, Taiwan, China, Korea, Europe, and Italy; (9) understanding the biology and pathobiology of normal aging, MCI, and AD through integration of ADNI biomarker and clinical data to stimulate research that will resolve controversies about competing hypotheses on the etiopathogenesis of AD, thereby advancing efforts to find disease-modifying drugs for AD; and (10) the establishment of infrastructure to allow sharing of all raw and processed data without embargo to interested scientific investigators throughout the world.
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Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA.
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Paul S Aisen
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Laurel A Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Nigel J Cairns
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA; Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jesse Cedarbaum
- Neurology Early Clinical Development, Biogen Idec, Cambridge, MA, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - William Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - Johan Luthman
- Neuroscience Clinical Development, Neuroscience & General Medicine Product Creation Unit, Eisai Inc., Philadelphia, PA, USA
| | - John C Morris
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | | | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Li Shen
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Adam Schwarz
- Tailored Therapeutics, Eli Lilly and Company, Indianapolis, IN, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - John Q Trojanowski
- Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Alzheimer's Disease Core Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Udall Parkinson's Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Sirály E, Szabó Á, Szita B, Kovács V, Fodor Z, Marosi C, Salacz P, Hidasi Z, Maros V, Hanák P, Csibri É, Csukly G. Monitoring the early signs of cognitive decline in elderly by computer games: an MRI study. PLoS One 2015; 10:e0117918. [PMID: 25706380 PMCID: PMC4338307 DOI: 10.1371/journal.pone.0117918] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 12/31/2014] [Indexed: 11/18/2022] Open
Abstract
Background It is anticipated that current and future preventive therapies will likely be more effective in the early stages of dementia, when everyday functioning is not affected. Accordingly the early identification of people at risk is particularly important. In most cases, when subjects visit an expert and are examined using neuropsychological tests, the disease has already been developed. Contrary to this cognitive games are played by healthy, well functioning elderly people, subjects who should be monitored for early signs. Further advantages of cognitive games are their accessibility and their cost-effectiveness. Purpose The aim of the investigation was to show that computer games can help to identify those who are at risk. In order to validate games analysis was completed which measured the correlations between results of the 'Find the Pairs' memory game and the volumes of the temporal brain regions previously found to be good predictors of later cognitive decline. Participants and Methods 34 healthy elderly subjects were enrolled in the study. The volume of the cerebral structures was measured by MRI. Cortical reconstruction and volumetric segmentation were performed by Freesurfer. Results There was a correlation between the number of attempts and the time required to complete the memory game and the volume of the entorhinal cortex, the temporal pole, and the hippocampus. There was also a correlation between the results of the Paired Associates Learning (PAL) test and the memory game. Conclusions The results gathered support the initial hypothesis that healthy elderly subjects achieving lower scores in the memory game have increased level of atrophy in the temporal brain structures and showed a decreased performance in the PAL test. Based on these results it can be concluded that memory games may be useful in early screening for cognitive decline.
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Affiliation(s)
- Enikő Sirály
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Ádám Szabó
- Semmelweis University, Magnetic Resonance Imaging Research Center, Budapest, Hungary
- * E-mail:
| | - Bernadett Szita
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Vivienne Kovács
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Fodor
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Csilla Marosi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Pál Salacz
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Zoltán Hidasi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Viktor Maros
- Healthcare Technologies Knowledge Center, Budapest University of Technology and Economics, Budapest, Hungary
| | - Péter Hanák
- Healthcare Technologies Knowledge Center, Budapest University of Technology and Economics, Budapest, Hungary
| | - Éva Csibri
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Gábor Csukly
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
- * E-mail:
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Nasrallah IM, Wolk DA. Multimodality imaging of Alzheimer disease and other neurodegenerative dementias. J Nucl Med 2014; 55:2003-11. [PMID: 25413136 DOI: 10.2967/jnumed.114.141416] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Neurodegenerative diseases, such as Alzheimer disease, result in cognitive decline and dementia and are a leading cause of mortality in the growing elderly population. These progressive diseases typically have an insidious onset, with overlapping clinical features early in the disease course that make diagnosis challenging. The neurodegenerative diseases are associated with characteristic, although not completely understood, changes in the brain: abnormal protein deposition, synaptic dysfunction, neuronal injury, and neuronal death. Neuroimaging biomarkers-principally regional atrophy on structural MR imaging, patterns of hypometabolism on (18)F-FDG PET, and detection of cerebral amyloid plaque on amyloid PET--are able to evaluate the patterns of these abnormalities in the brain to improve early diagnosis and help predict the disease course. These techniques have unique strengths and synergies in multimodality evaluation of the patient with cognitive decline or dementia. This review discusses the key imaging biomarkers from MR imaging, (18)F-FDG PET, and amyloid PET; the imaging features of the most common neurodegenerative dementias; the role of various neuroimaging studies in differential diagnosis and prognosis; and some promising imaging techniques under development.
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Affiliation(s)
- Ilya M Nasrallah
- Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David A Wolk
- Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania
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Bertens D, Knol DL, Scheltens P, Visser PJ. Temporal evolution of biomarkers and cognitive markers in the asymptomatic, MCI, and dementia stage of Alzheimer's disease. Alzheimers Dement 2014; 11:511-22. [PMID: 25150730 DOI: 10.1016/j.jalz.2014.05.1754] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 05/10/2014] [Accepted: 05/30/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated the pattern of disease progression in the asymptomatic, mild cognitive impairment (MCI), and dementia stage of Alzheimer's disease (AD). METHODS We selected 284 subjects with AD pathology, defined as abnormal levels of amyloid beta 1-42 (Aβ1-42) in cerebrospinal fluid (CSF). Disease outcome measures included six biomarkers and five cognitive markers. We compared differences in baseline measures and decline over 4 years between the AD stages and tested whether these changes differed from subjects, without AD pathology (N = 132). RESULTS CSF Aβ1-42 reached the maximum abnormality level in the asymptomatic stage and tau in the MCI stage. The imaging and cognitive markers started to decline in the asymptomatic stage, and decline accelerated with advancing clinical stage. CONCLUSION This study provides further evidence for a temporal evolution of AD biomarkers. Our findings may be helpful to determine stage specific outcome measures for clinical trials.
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Affiliation(s)
- Daniela Bertens
- Department of Neurology/Alzheimer Centre, VU Medical Centre, Amsterdam, The Netherlands.
| | - Dirk L Knol
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology/Alzheimer Centre, VU Medical Centre, Amsterdam, The Netherlands
| | - Pieter Jelle Visser
- Department of Neurology/Alzheimer Centre, VU Medical Centre, Amsterdam, The Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, University Medical Centre, Maastricht, The Netherlands
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Tang W, Huang Q, Wang Y, Wang ZY, Yao YY. Assessment of CSF Aβ42 as an aid to discriminating Alzheimer's disease from other dementias and mild cognitive impairment: a meta-analysis of 50 studies. J Neurol Sci 2014; 345:26-36. [PMID: 25086857 DOI: 10.1016/j.jns.2014.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/27/2014] [Accepted: 07/07/2014] [Indexed: 01/08/2023]
Abstract
Mild Alzheimer's disease (AD) is usually difficult to differentiate from other dementias or mild cognitive impairment (MCI). The aim of our study is to evaluate the clinical importance of cerebrospinal fluid (CSF) β-amyloid 42 (Aβ42) in MCI, AD and other dementias, more specifically: frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), Parkinson's disease (PD) with dementia (PDD) and vascular dementia (VaD). Fifty eligible articles were identified by search of databases including PubMed, EMBASE, Elsevier, Springer Link and the Cochrane Library, from January 1990 to May 2014. The random effects model was used to calculate the standardized mean difference (SMD) with corresponding 95% CI by STATA 9.0 software. The subgroup analyses were made on the method (ELISA, xMAP). We found that CSF Aβ42 concentrations were significantly lower in AD compared to MCI (SMD: -0.68, 95% CI: [-0.80, -0.56], z=11.34, P<0.001), FTD (SMD: -1.09, 95% CI: [-1.41, -0.76], z=6.62, P<0.001), PDD (SMD: -0.75, 95% CI: [-1.39, -0.10], z=2.27, P=0.023), VaD (SMD: -0.95, 95% CI: [-1.30, -0.61], z=5.43, P<0.001). In addition, compared to DLB, Aβ42 concentrations are moderately lower in AD (SMD: -0.27, 95% CI: [-0.51, -0.03], z=2.20, P=0.028). Results from this meta-analysis hinted that CSF Aβ42 is a good biomarker for discriminating Alzheimer's disease from other dementias and MCI.
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Affiliation(s)
- Wei Tang
- Department of Clinical Laboratory Medicine, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Qiong Huang
- AnQing City Affiliated Hospital of Anhui Medical University, No. 352 Renmin Road, AnQing 246003, Anhui, China
| | - Yan Wang
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei 230601, Anhui, China
| | - Zheng-Yu Wang
- Department of Clinical Laboratory Medicine, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yu-You Yao
- Department of Clinical Laboratory Medicine, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China.
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Tang W, Huang Q, Yao YY, Wang Y, Wu YL, Wang ZY. Does CSF p-tau181 help to discriminate Alzheimer's disease from other dementias and mild cognitive impairment? A meta-analysis of the literature. J Neural Transm (Vienna) 2014; 121:1541-53. [PMID: 24817210 DOI: 10.1007/s00702-014-1226-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/20/2014] [Indexed: 12/11/2022]
Abstract
To evaluate the clinical importance of cerebrospinal fluid (CSF) phosphorylated tau 181 (p-tau181) in mild cognitive impairment (MCI), Alzheimer's disease (AD) and other dementias, more specifically: frontotemporal degeneration (FTD), dementia with Lewy bodies (DLB), vascular dementia (VaD) and Parkinson's disease (PD) with dementia (PDD). Fifty eligible articles were identified by search of databases including PubMed, EMBASE, Elsevier, Springer Link and the Cochrane Library, up to December 2013. The random effects model was used to calculate the standardized mean difference (SMD) with corresponding 95% CI by STATA 9.0 software. The subgroup analyses were made on the methods or PD with dementia. We found that CSF p-tau181 concentrations were significantly higher in AD compared to MCI [SMD: 0.61, 95% CI: (0.46, 0.76), z = 8.07, P < 0.001], FTD [SMD: 1.23, 95% CI: (0.89, 1.56), z = 7.19, P < 0.001], DLB [SMD: 1.08, 95% CI: (0.80, 1.37), z = 7.41, P < 0.001], PDD [SMD: 1.05, 95% CI: (0.02, 2.07), z = 2.00, P = 0.045] and VaD [SMD: 1.28, 95% CI: (0.68, 1.88), z = 4.19, P < 0.001]. Results from this meta-analysis implied that CSF p-tau181 is a good biomarker for discriminating Alzheimer's disease from other dementias and mild cognitive impairment.
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Affiliation(s)
- Wei Tang
- Department of Clinical Laboratory Medicine, School of Public Health, Anhui Medical University, No. 81 Meishan road, Hefei, 230032, Anhui, China
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Braskie MN, Thompson PM. A focus on structural brain imaging in the Alzheimer's disease neuroimaging initiative. Biol Psychiatry 2014; 75:527-33. [PMID: 24367935 PMCID: PMC4019004 DOI: 10.1016/j.biopsych.2013.11.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 01/18/2023]
Abstract
In recent years, numerous laboratories and consortia have used neuroimaging to evaluate the risk for and progression of Alzheimer's disease (AD). The Alzheimer's Disease Neuroimaging Initiative is a longitudinal, multicenter study that is evaluating a range of biomarkers for use in diagnosis of AD, prediction of patient outcomes, and clinical trials. These biomarkers include brain metrics derived from magnetic resonance imaging (MRI) and positron emission tomography scans as well as metrics derived from blood and cerebrospinal fluid. We focus on Alzheimer's Disease Neuroimaging Initiative studies published between 2011 and March 2013 for which structural MRI was a major outcome measure. Our main goal was to review key articles offering insights into progression of AD and the relationships of structural MRI measures to cognition and to other biomarkers in AD. In Supplement 1, we also discuss genetic and environmental risk factors for AD and exciting new analysis tools for the efficient evaluation of large-scale structural MRI data sets such as the Alzheimer's Disease Neuroimaging Initiative data.
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Affiliation(s)
- Meredith N Braskie
- Imaging Genetics Center, Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, California; Department of Neurology, University of Southern California, Los Angeles, California
| | - Paul M Thompson
- Imaging Genetics Center, Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, California; Department of Neurology, University of Southern California, Los Angeles, California; Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, California; Department of Radiology, University of Southern California, Los Angeles, California; Department of Pediatrics, University of Southern California, Los Angeles, California; Department of Ophthalmology, University of Southern California, Los Angeles, California; Keck School of Medicine, and Viterbi School of Engineering, University of Southern California, Los Angeles, California.
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Ferreira D, Perestelo-Pérez L, Westman E, Wahlund LO, Sarría A, Serrano-Aguilar P. Meta-Review of CSF Core Biomarkers in Alzheimer's Disease: The State-of-the-Art after the New Revised Diagnostic Criteria. Front Aging Neurosci 2014; 6:47. [PMID: 24715863 PMCID: PMC3970033 DOI: 10.3389/fnagi.2014.00047] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/02/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Current research criteria for Alzheimer's disease (AD) include cerebrospinal fluid (CSF) biomarkers into the diagnostic algorithm. However, spreading their use to the clinical routine is still questionable. OBJECTIVE To provide an updated, systematic and critical review on the diagnostic utility of the CSF core biomarkers for AD. DATA SOURCES MEDLINE, PreMedline, EMBASE, PsycInfo, CINAHL, Cochrane Library, and CRD. ELIGIBILITY CRITERIA (1a) Systematic reviews with meta-analysis; (1b) Primary studies published after the new revised diagnostic criteria; (2) Evaluation of the diagnostic performance of at least one CSF core biomarker. RESULTS The diagnostic performance of CSF biomarkers is generally satisfactory. They are optimal for discriminating AD patients from healthy controls. Their combination may also be suitable for mild cognitive impairment (MCI) prognosis. However, CSF biomarkers fail to distinguish AD from other forms of dementia. LIMITATIONS (1) Use of clinical diagnosis as standard instead of pathological postmortem confirmation; (2) variability of methodological aspects; (3) insufficiently long follow-up periods in MCI studies; and (4) lower diagnostic accuracy in primary care compared with memory clinics. CONCLUSION Additional work needs to be done to validate the application of CSF core biomarkers as they are proposed in the new revised diagnostic criteria. The use of CSF core biomarkers in clinical routine is more likely if these limitations are overcome. Early diagnosis is going to be of utmost importance when effective pharmacological treatment will be available and the CSF core biomarkers can also be implemented in clinical trials for drug development.
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Affiliation(s)
- Daniel Ferreira
- Section of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
| | - Lilisbeth Perestelo-Pérez
- Evaluation Unit of the Canary Islands Health Service , Santa Cruz de Tenerife , Spain ; Red de Investigación en Servicios de Salud en Enfermedades Crónicas , Santa Cruz de Tenerife , Spain
| | - Eric Westman
- Section of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
| | - Lars-Olof Wahlund
- Section of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
| | - Antonio Sarría
- Evaluation Unit of the Canary Islands Health Service , Santa Cruz de Tenerife , Spain ; Agency for Health Technology Assessment, Institute of Health Carlos III , Madrid , Spain
| | - Pedro Serrano-Aguilar
- Evaluation Unit of the Canary Islands Health Service , Santa Cruz de Tenerife , Spain ; Red de Investigación en Servicios de Salud en Enfermedades Crónicas , Santa Cruz de Tenerife , Spain
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Nettiksimmons J, DeCarli C, Landau S, Beckett L. Biological heterogeneity in ADNI amnestic mild cognitive impairment. Alzheimers Dement 2014; 10:511-521.e1. [PMID: 24418061 DOI: 10.1016/j.jalz.2013.09.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 07/25/2013] [Accepted: 09/16/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous work examining normal controls from the Alzheimer's Disease Neuroimaging Initiative (ADNI) identified substantial biological heterogeneity. We hypothesized that ADNI mild cognitive impairment (MCI) subjects would also exhibit heterogeneity with possible clinical implications. METHODS ADNI subjects diagnosed with amnestic MCI (n=138) were clustered based on baseline magnetic resonance imaging, cerebrospinal fluid, and serum biomarkers. The clusters were compared with respect to longitudinal atrophy, cognitive trajectory, and time to conversion. RESULTS Four clusters emerged with distinct biomarker patterns: The first cluster was biologically similar to normal controls and rarely converted to Alzheimer's disease (AD) during follow-up. The second cluster had characteristics of early Alzheimer's pathology. The third cluster showed the most severe atrophy but barely abnormal tau levels and a substantial proportion converted to clinical AD. The fourth cluster appeared to be pre-AD and nearly all converted to AD. CONCLUSIONS Subjects with MCI who were clinically similar showed substantial heterogeneity in biomarkers.
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Affiliation(s)
- Jasmine Nettiksimmons
- Department of Psychiatry, University of California-San Francisco, San Francisco, CA, USA.
| | - Charles DeCarli
- Department of Neurology and Center for Neuroscience, University of California-Davis, Sacramento, CA, USA
| | - Susan Landau
- Helen Wills Neuroscience Institute, University of California-Berkeley, Berkeley, CA, USA
| | - Laurel Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California-Davis, Davis, CA, USA
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Suk HI, Lee SW, Shen D. Latent feature representation with stacked auto-encoder for AD/MCI diagnosis. Brain Struct Funct 2013; 220:841-59. [PMID: 24363140 DOI: 10.1007/s00429-013-0687-3] [Citation(s) in RCA: 245] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 11/14/2013] [Indexed: 01/10/2023]
Abstract
Recently, there have been great interests for computer-aided diagnosis of Alzheimer's disease (AD) and its prodromal stage, mild cognitive impairment (MCI). Unlike the previous methods that considered simple low-level features such as gray matter tissue volumes from MRI, and mean signal intensities from PET, in this paper, we propose a deep learning-based latent feature representation with a stacked auto-encoder (SAE). We believe that there exist latent non-linear complicated patterns inherent in the low-level features such as relations among features. Combining the latent information with the original features helps build a robust model in AD/MCI classification, with high diagnostic accuracy. Furthermore, thanks to the unsupervised characteristic of the pre-training in deep learning, we can benefit from the target-unrelated samples to initialize parameters of SAE, thus finding optimal parameters in fine-tuning with the target-related samples, and further enhancing the classification performances across four binary classification problems: AD vs. healthy normal control (HC), MCI vs. HC, AD vs. MCI, and MCI converter (MCI-C) vs. MCI non-converter (MCI-NC). In our experiments on ADNI dataset, we validated the effectiveness of the proposed method, showing the accuracies of 98.8, 90.7, 83.7, and 83.3 % for AD/HC, MCI/HC, AD/MCI, and MCI-C/MCI-NC classification, respectively. We believe that deep learning can shed new light on the neuroimaging data analysis, and our work presented the applicability of this method to brain disease diagnosis.
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Affiliation(s)
- Heung-Il Suk
- Biomedical Research Imaging Center (BRIC) and Department of Radiology, University of North Carolina, Chapel Hill, NC, 27599, USA,
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Nettiksimmons J, Beckett L, Schwarz C, Carmichael O, Fletcher E, Decarli C. Subgroup of ADNI normal controls characterized by atrophy and cognitive decline associated with vascular damage. Psychol Aging 2013; 28:191-201. [PMID: 23527743 DOI: 10.1037/a0031063] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Previous work examining Alzheimer's Disease Neuroimaging Initiative (ADNI) normal controls using cluster analysis identified a subgroup characterized by substantial brain atrophy and white matter hyperintensities (WMH). We hypothesized that these effects could be related to vascular damage. Fifty-three individuals in the suspected vascular cluster (Normal 2) were compared with 31 individuals from the cluster characterized as healthy/typical (Normal 1) on a variety of outcomes, including magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) biomarkers, vascular risk factors and outcomes, cognitive trajectory, and medications for vascular conditions. Normal 2 was significantly older but did not differ on ApoE4+ prevalence. Normal 2 differed significantly from Normal 1 on all MRI measures but not on Amyloid-Beta1-42 or total tau protein. Normal 2 had significantly higher body mass index (BMI), Hachinksi score, and creatinine levels, and took significantly more medications for vascular conditions. Normal 2 had marginally significantly higher triglycerides and blood glucose. Normal 2 had a worse cognitive trajectory on the Rey's Auditory Verbal Learning Test (RAVLT) 30-min delay test and the Functional Activity Questionnaire (FAQ). Cerebral atrophy associated with multiple vascular risks is common among cognitively normal individuals, forming a distinct subgroup with significantly increased cognitive decline. Further studies are needed to determine the clinical impact of these findings.
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Affiliation(s)
- Jasmine Nettiksimmons
- Clinical and Translational Science Center, University of California, Davis, School of Medicine, Sacramento, CA 95817, USA.
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45
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Understanding cognitive deficits in Alzheimer's disease based on neuroimaging findings. Trends Cogn Sci 2013; 17:510-6. [PMID: 24029445 DOI: 10.1016/j.tics.2013.08.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 08/07/2013] [Indexed: 01/21/2023]
Abstract
Brain amyloid can be measured using positron emission tomography (PET). There are mixed reports regarding whether amyloid measures are correlated with measures of cognition (in particular memory), depending on the cohorts and cognitive domains assessed. In Alzheimer's disease (AD) patients and those at heightened risk for AD, cognitive performance may be related to the level and extent of classical AD pathology (amyloid plaques and neurofibrillary angles), but it is also influenced by neurodegeneration, neurocognitive reserve, and vascular health. We discuss what recent neuroimaging research has discovered about cognitive deficits in AD and offer suggestions for future research.
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Chen G, Zhang HY, Xie C, Chen G, Zhang ZJ, Teng GJ, Li SJ. Modular reorganization of brain resting state networks and its independent validation in Alzheimer's disease patients. Front Hum Neurosci 2013; 7:456. [PMID: 23950743 PMCID: PMC3739061 DOI: 10.3389/fnhum.2013.00456] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/22/2013] [Indexed: 12/05/2022] Open
Abstract
Previous studies have demonstrated disruption in structural and functional connectivity occurring in the Alzheimer's Disease (AD). However, it is not known how these disruptions alter brain network reorganization. With the modular analysis method of graph theory, and datasets acquired by the resting-state functional connectivity MRI (R-fMRI) method, we investigated and compared the brain organization patterns between the AD group and the cognitively normal control (CN) group. Our main finding is that the largest homotopic module (defined as the insula module) in the CN group was broken down to the pieces in the AD group. Specifically, it was discovered that the eight pairs of the bilateral regions (the opercular part of inferior frontal gyrus, area triangularis, insula, putamen, globus pallidus, transverse temporal gyri, superior temporal gyrus, and superior temporal pole) of the insula module had lost symmetric functional connection properties, and the corresponding gray matter concentration (GMC) was significant lower in AD group. We further quantified the functional connectivity changes with an index (index A) and structural changes with the GMC index in the insula module to demonstrate their great potential as AD biomarkers. We further validated these results with six additional independent datasets (271 subjects in six groups). Our results demonstrated specific underlying structural and functional reorganization from young to old, and for diseased subjects. Further, it is suggested that by combining the structural GMC analysis and functional modular analysis in the insula module, a new biomarker can be developed at the single-subject level.
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Affiliation(s)
- Guangyu Chen
- Department of Biophysics, Medical College of Wisconsin Milwaukee, WI, USA
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Weiner MW, Veitch DP, Aisen PS, Beckett LA, Cairns NJ, Green RC, Harvey D, Jack CR, Jagust W, Liu E, Morris JC, Petersen RC, Saykin AJ, Schmidt ME, Shaw L, Shen L, Siuciak JA, Soares H, Toga AW, Trojanowski JQ. The Alzheimer's Disease Neuroimaging Initiative: a review of papers published since its inception. Alzheimers Dement 2013; 9:e111-94. [PMID: 23932184 DOI: 10.1016/j.jalz.2013.05.1769] [Citation(s) in RCA: 308] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/18/2013] [Indexed: 01/19/2023]
Abstract
The Alzheimer's Disease Neuroimaging Initiative (ADNI) is an ongoing, longitudinal, multicenter study designed to develop clinical, imaging, genetic, and biochemical biomarkers for the early detection and tracking of Alzheimer's disease (AD). The study aimed to enroll 400 subjects with early mild cognitive impairment (MCI), 200 subjects with early AD, and 200 normal control subjects; $67 million funding was provided by both the public and private sectors, including the National Institute on Aging, 13 pharmaceutical companies, and 2 foundations that provided support through the Foundation for the National Institutes of Health. This article reviews all papers published since the inception of the initiative and summarizes the results as of February 2011. The major accomplishments of ADNI have been as follows: (1) the development of standardized methods for clinical tests, magnetic resonance imaging (MRI), positron emission tomography (PET), and cerebrospinal fluid (CSF) biomarkers in a multicenter setting; (2) elucidation of the patterns and rates of change of imaging and CSF biomarker measurements in control subjects, MCI patients, and AD patients. CSF biomarkers are consistent with disease trajectories predicted by β-amyloid cascade (Hardy, J Alzheimers Dis 2006;9(Suppl 3):151-3) and tau-mediated neurodegeneration hypotheses for AD, whereas brain atrophy and hypometabolism levels show predicted patterns but exhibit differing rates of change depending on region and disease severity; (3) the assessment of alternative methods of diagnostic categorization. Currently, the best classifiers combine optimum features from multiple modalities, including MRI, [(18)F]-fluorodeoxyglucose-PET, CSF biomarkers, and clinical tests; (4) the development of methods for the early detection of AD. CSF biomarkers, β-amyloid 42 and tau, as well as amyloid PET may reflect the earliest steps in AD pathology in mildly symptomatic or even nonsymptomatic subjects, and are leading candidates for the detection of AD in its preclinical stages; (5) the improvement of clinical trial efficiency through the identification of subjects most likely to undergo imminent future clinical decline and the use of more sensitive outcome measures to reduce sample sizes. Baseline cognitive and/or MRI measures generally predicted future decline better than other modalities, whereas MRI measures of change were shown to be the most efficient outcome measures; (6) the confirmation of the AD risk loci CLU, CR1, and PICALM and the identification of novel candidate risk loci; (7) worldwide impact through the establishment of ADNI-like programs in Europe, Asia, and Australia; (8) understanding the biology and pathobiology of normal aging, MCI, and AD through integration of ADNI biomarker data with clinical data from ADNI to stimulate research that will resolve controversies about competing hypotheses on the etiopathogenesis of AD, thereby advancing efforts to find disease-modifying drugs for AD; and (9) the establishment of infrastructure to allow sharing of all raw and processed data without embargo to interested scientific investigators throughout the world. The ADNI study was extended by a 2-year Grand Opportunities grant in 2009 and a renewal of ADNI (ADNI-2) in October 2010 through to 2016, with enrollment of an additional 550 participants.
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Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA.
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Braskie MN, Toga AW, Thompson PM. Recent advances in imaging Alzheimer's disease. J Alzheimers Dis 2013; 33 Suppl 1:S313-27. [PMID: 22672880 DOI: 10.3233/jad-2012-129016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Advances in brain imaging technology in the past five years have contributed greatly to the understanding of Alzheimer's disease (AD). Here, we review recent research related to amyloid imaging, new methods for magnetic resonance imaging analyses, and statistical methods. We also review research that evaluates AD risk factors and brain imaging, in the context of AD prediction and progression. We selected a variety of illustrative studies, describing how they advanced the field and are leading AD research in promising new directions.
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Affiliation(s)
- Meredith N Braskie
- Laboratory of Neuro Imaging, Department of Neurology, UCLA School of Medicine, Los Angeles, CA 90095-7334, USA
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Sato JR, Rondina JM, Mourão-Miranda J. Measuring abnormal brains: building normative rules in neuroimaging using one-class support vector machines. Front Neurosci 2012; 6:178. [PMID: 23248579 PMCID: PMC3521128 DOI: 10.3389/fnins.2012.00178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/24/2012] [Indexed: 12/29/2022] Open
Abstract
Pattern recognition methods have demonstrated to be suitable analyses tools to handle the high dimensionality of neuroimaging data. However, most studies combining neuroimaging with pattern recognition methods focus on two-class classification problems, usually aiming to discriminate patients under a specific condition (e.g., Alzheimer’s disease) from healthy controls. In this perspective paper we highlight the potential of the one-class support vector machines (OC-SVM) as an unsupervised or exploratory approach that can be used to create normative rules in a multivariate sense. In contrast with the standard SVM that finds an optimal boundary separating two classes (discriminating boundary), the OC-SVM finds the boundary enclosing a specific class (characteristic boundary). If the OC-SVM is trained with patterns of healthy control subjects, the distance to the boundary can be interpreted as an abnormality score. This score might allow quantification of symptom severity or provide insights about subgroups of patients. We provide an intuitive description of basic concepts in one-class classification, the foundations of OC-SVM, current applications, and discuss how this tool can bring new insights to neuroimaging studies.
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Affiliation(s)
- João Ricardo Sato
- Center of Mathematics, Computation and Cognition, Universidade Federal do ABC Santo André, Brazil
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Nho K, Risacher SL, Crane PK, DeCarli C, Glymour MM, Habeck C, Kim S, Lee GJ, Mormino E, Mukherjee S, Shen L, West JD, Saykin AJ. Voxel and surface-based topography of memory and executive deficits in mild cognitive impairment and Alzheimer's disease. Brain Imaging Behav 2012; 6:551-67. [PMID: 23070747 PMCID: PMC3532574 DOI: 10.1007/s11682-012-9203-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Mild cognitive impairment (MCI) and Alzheimer's disease (AD) are associated with a progressive loss of cognitive abilities. In the present report, we assessed the relationship of memory and executive function with brain structure in a sample of 810 Alzheimer's Disease Neuroimaging Initiative (ADNI) participants, including 188 AD, 396 MCI, and 226 healthy older adults (HC). Composite scores of memory (ADNI-Mem) and executive function (ADNI-Exec) were generated by applying modern psychometric theory to item-level data from ADNI's neuropsychological battery. We performed voxel-based morphometry (VBM) and surface-based association (SurfStat) analyses to evaluate relationships of ADNI-Mem and ADNI-Exec with grey matter (GM) density and cortical thickness across the whole brain in the combined sample and within diagnostic groups. We observed strong associations between ADNI-Mem and medial and lateral temporal lobe atrophy. Lower ADNI-Exec scores were associated with advanced GM and cortical atrophy across broadly distributed regions, most impressively in the bilateral parietal and temporal lobes. We also evaluated ADNI-Exec adjusted for ADNI-Mem, and found associations with GM density and cortical thickness primarily in the bilateral parietal, temporal, and frontal lobes. Within-group analyses suggest these associations are strongest in patients with MCI and AD. The present study provides insight into the spatially unbiased associations between brain atrophy and memory and executive function, and underscores the importance of structural brain changes in early cognitive decline.
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Affiliation(s)
- Kwangsik Nho
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shannon L. Risacher
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Paul K. Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Charles DeCarli
- Department of Neurology and the Center for Neuroscience, School of Medicine, University of California Davis, Davis, CA, USA
| | - M. Maria Glymour
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Christian Habeck
- Cognitive Neuroscience Division of Taub Institute for the Study of Alzheimer’s Disease and Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Sungeun Kim
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Grace J. Lee
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Elizabeth Mormino
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | | | - Li Shen
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John D. West
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew J. Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
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