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Hoshi H, Hirata Y, Fukasawa K, Kobayashi M, Shigihara Y. Oscillatory characteristics of resting-state magnetoencephalography reflect pathological and symptomatic conditions of cognitive impairment. Front Aging Neurosci 2024; 16:1273738. [PMID: 38352236 PMCID: PMC10861731 DOI: 10.3389/fnagi.2024.1273738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024] Open
Abstract
Background Dementia and mild cognitive impairment are characterised by symptoms of cognitive decline, which are typically assessed using neuropsychological assessments (NPAs), such as the Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB). Magnetoencephalography (MEG) is a novel clinical assessment technique that measures brain activities (summarised as oscillatory parameters), which are associated with symptoms of cognitive impairment. However, the relevance of MEG and regional cerebral blood flow (rCBF) data obtained using single-photon emission computed tomography (SPECT) has not been examined using clinical datasets. Therefore, this study aimed to investigate the relationships among MEG oscillatory parameters, clinically validated biomarkers computed from rCBF, and NPAs using outpatient data retrieved from hospital records. Methods Clinical data from 64 individuals with mixed pathological backgrounds were retrieved and analysed. MEG oscillatory parameters, including relative power (RP) from delta to high gamma bands, mean frequency, individual alpha frequency, and Shannon's spectral entropy, were computed for each cortical region. For SPECT data, three pathological parameters-'severity', 'extent', and 'ratio'-were computed using an easy z-score imaging system (eZIS). As for NPAs, the MMSE and FAB scores were retrieved. Results MEG oscillatory parameters were correlated with eZIS parameters. The eZIS parameters associated with Alzheimer's disease pathology were reflected in theta power augmentation and slower shift of the alpha peak. Moreover, MEG oscillatory parameters were found to reflect NPAs. Global slowing and loss of diversity in neural oscillatory components correlated with MMSE and FAB scores, whereas the associations between eZIS parameters and NPAs were sparse. Conclusion MEG oscillatory parameters correlated with both SPECT (i.e. eZIS) parameters and NPAs, supporting the clinical validity of MEG oscillatory parameters as pathological and symptomatic indicators. The findings indicate that various components of MEG oscillatory characteristics can provide valuable pathological and symptomatic information, making MEG data a rich resource for clinical examinations of patients with cognitive impairments. SPECT (i.e. eZIS) parameters showed no correlations with NPAs. The results contributed to a better understanding of the characteristics of electrophysiological and pathological examinations for patients with cognitive impairments, which will help to facilitate their co-use in clinical application, thereby improving patient care.
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Affiliation(s)
- Hideyuki Hoshi
- Precision Medicine Centre, Hokuto Hospital, Obihiro, Japan
| | - Yoko Hirata
- Department of Neurosurgery, Kumagaya General Hospital, Kumagaya, Japan
| | | | - Momoko Kobayashi
- Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, Japan
| | - Yoshihito Shigihara
- Precision Medicine Centre, Hokuto Hospital, Obihiro, Japan
- Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, Japan
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2
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Chu KT, Lei WC, Wu MH, Fuh JL, Wang SJ, French IT, Chang WS, Chang CF, Huang NE, Liang WK, Juan CH. A holo-spectral EEG analysis provides an early detection of cognitive decline and predicts the progression to Alzheimer's disease. Front Aging Neurosci 2023; 15:1195424. [PMID: 37674782 PMCID: PMC10477374 DOI: 10.3389/fnagi.2023.1195424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/25/2023] [Indexed: 09/08/2023] Open
Abstract
Aims Our aim was to differentiate patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) from cognitively normal (CN) individuals and predict the progression from MCI to AD within a 3-year longitudinal follow-up. A newly developed Holo-Hilbert Spectral Analysis (HHSA) was applied to resting state EEG (rsEEG), and features were extracted and subjected to machine learning algorithms. Methods A total of 205 participants were recruited from three hospitals, with CN (n = 51, MMSE > 26), MCI (n = 42, CDR = 0.5, MMSE ≥ 25), AD1 (n = 61, CDR = 1, MMSE < 25), AD2 (n = 35, CDR = 2, MMSE < 16), and AD3 (n = 16, CDR = 3, MMSE < 16). rsEEG was also acquired from all subjects. Seventy-two MCI patients (CDR = 0.5) were longitudinally followed up with two rsEEG recordings within 3 years and further subdivided into an MCI-stable group (MCI-S, n = 36) and an MCI-converted group (MCI-C, n = 36). The HHSA was then applied to the rsEEG data, and features were extracted and subjected to machine-learning algorithms. Results (a) At the group level analysis, the HHSA contrast of MCI and different stages of AD showed augmented amplitude modulation (AM) power of lower-frequency oscillations (LFO; delta and theta bands) with attenuated AM power of higher-frequency oscillations (HFO; beta and gamma bands) compared with cognitively normal elderly controls. The alpha frequency oscillation showed augmented AM power across MCI to AD1 with a reverse trend at AD2. (b) At the individual level of cross-sectional analysis, implementation of machine learning algorithms discriminated between groups with good sensitivity (Sen) and specificity (Spec) as follows: CN elderly vs. MCI: 0.82 (Sen)/0.80 (Spec), CN vs. AD1: 0.94 (Sen)/0.80 (Spec), CN vs. AD2: 0.93 (Sen)/0.90 (Spec), and CN vs. AD3: 0.75 (Sen)/1.00 (Spec). (c) In the longitudinal MCI follow-up, the initial contrasted HHSA between MCI-S and MCI-C groups showed significantly attenuated AM power of alpha and beta band oscillations. (d) At the individual level analysis of longitudinal MCI groups, deploying machine learning algorithms with the best seven features resulted in a sensitivity of 0.9 by the support vector machine (SVM) classifier, with a specificity of 0.8 yielded by the decision tree classifier. Conclusion Integrating HHSA into EEG signals and machine learning algorithms can differentiate between CN and MCI as well as also predict AD progression at the MCI stage.
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Affiliation(s)
- Kwo-Ta Chu
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
- Yang-Ming Hospital, Taoyuan, Taiwan
| | - Weng-Chi Lei
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
- Cognitive Intelligence and Precision Healthcare Center, National Central University, Taoyuan, Taiwan
| | - Ming-Hsiu Wu
- Division of Neurology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Long-Term Care and Health Promotion, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Isobel T. French
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
- Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Central University and Academia Sinica, Taipei, Taiwan
| | - Wen-Sheng Chang
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
| | - Chi-Fu Chang
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
| | - Norden E. Huang
- Cognitive Intelligence and Precision Healthcare Center, National Central University, Taoyuan, Taiwan
- Key Laboratory of Data Analysis and Applications, First Institute of Oceanography, SOA, Qingdao, China
| | - Wei-Kuang Liang
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
- Cognitive Intelligence and Precision Healthcare Center, National Central University, Taoyuan, Taiwan
| | - Chi-Hung Juan
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
- Cognitive Intelligence and Precision Healthcare Center, National Central University, Taoyuan, Taiwan
- Department of Psychology, Kaohsiung Medical University, Kaohsiung, Taiwan
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3
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Lista S, Vergallo A, Teipel SJ, Lemercier P, Giorgi FS, Gabelle A, Garaci F, Mercuri NB, Babiloni C, Gaire BP, Koronyo Y, Koronyo-Hamaoui M, Hampel H, Nisticò R. Determinants of approved acetylcholinesterase inhibitor response outcomes in Alzheimer's disease: relevance for precision medicine in neurodegenerative diseases. Ageing Res Rev 2023; 84:101819. [PMID: 36526257 DOI: 10.1016/j.arr.2022.101819] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/11/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Acetylcholinesterase inhibitors (ChEI) are the global standard of care for the symptomatic treatment of Alzheimer's disease (AD) and show significant positive effects in neurodegenerative diseases with cognitive and behavioral symptoms. Although experimental and large-scale clinical evidence indicates the potential long-term efficacy of ChEI, primary outcomes are generally heterogeneous across outpatient clinics and regional healthcare systems. Sub-optimal dosing or slow tapering, heterogeneous guidelines about the timing for therapy initiation (prodromal versus dementia stages), healthcare providers' ambivalence to treatment, lack of disease awareness, delayed medical consultation, prescription of ChEI in non-AD cognitive disorders, contribute to the negative outcomes. We present an evidence-based overview of determinants, spanning genetic, molecular, and large-scale networks, involved in the response to ChEI in patients with AD and other neurodegenerative diseases. A comprehensive understanding of cerebral and retinal cholinergic system dysfunctions along with ChEI response predictors in AD is crucial since disease-modifying therapies will frequently be prescribed in combination with ChEI. Therapeutic algorithms tailored to genetic, biological, clinical (endo)phenotypes, and disease stages will help leverage inter-drug synergy and attain optimal combined response outcomes, in line with the precision medicine model.
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Affiliation(s)
- Simone Lista
- Memory Resources and Research Center (CMRR), Neurology Department, Gui de Chauliac University Hospital, Montpellier, France; School of Pharmacy, University of Rome "Tor Vergata", Rome, Italy.
| | - Andrea Vergallo
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Stefan J Teipel
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medicine Rostock, Rostock, Germany
| | - Pablo Lemercier
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Filippo Sean Giorgi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Audrey Gabelle
- Memory Resources and Research Center (CMRR), Neurology Department, Gui de Chauliac University Hospital, Montpellier, France
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy; Casa di Cura "San Raffaele Cassino", Cassino, Italy
| | - Nicola B Mercuri
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; IRCCS Santa Lucia Foundation, Rome, Italy
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "Erspamer", Sapienza University of Rome, Rome, Italy; Hospital San Raffaele Cassino, Cassino, Italy
| | - Bhakta Prasad Gaire
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yosef Koronyo
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Biomedical Sciences, Division of Applied Cell Biology and Physiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Harald Hampel
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Robert Nisticò
- School of Pharmacy, University of Rome "Tor Vergata", Rome, Italy; Laboratory of Pharmacology of Synaptic Plasticity, EBRI Rita Levi-Montalcini Foundation, Rome, Italy.
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Kamal F, Campbell K, Taler V. Effects of the Duration of a Resting-State EEG Recording in Healthy Aging and Mild Cognitive Impairment. Clin EEG Neurosci 2022; 53:443-451. [PMID: 33370162 DOI: 10.1177/1550059420983624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The recording of resting-state EEG may provide a means to predict early cognitive decline associated with mild cognitive impairment (MCI). Previous studies have typically used very short recording times to avoid a confound with drowsiness that may occur in longer recordings. The effects of a longer recording have not however been systematically examined. METHODS Eyes-closed resting-state EEG activity was recorded in 40 older adult participants (20 healthy older adults and 20 people with MCI). The recording period was a relatively long 6 minutes, divided into two equal 3-minute halves to determine if drowsiness will be more apparent as the recording progresses. The participants also completed standardized neuropsychological tasks that assessed global cognition (Montreal Cognitive Assessment) and memory (California Verbal Learning Test, Second Edition). A spectral analysis was performed on both short (2 seconds) and long (8 seconds) segments in both 3-minute halves. RESULTS No differences in power density for any of the EEG frequency bands were found between the 2 halves of the study for either group. There was little evidence of increased drowsiness in the second half of the study even when frequency resolution was increased with the 8-second segmentation. Theta power density was overall larger for people with MCI compared to healthy older adults. A negative correlation was also observed between theta power and global cognition in healthy older adults. CONCLUSIONS The present results indicate that longer resting-state EEG recording can be reliably employed without increased risk of drowsiness.
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Affiliation(s)
- Farooq Kamal
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Kenneth Campbell
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Vanessa Taler
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
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Fide E, Yerlikaya D, Öz D, Öztura İ, Yener G. Normalized Theta but Increased Gamma Activity after Acetylcholinesterase Inhibitor Treatment in Alzheimer's Disease: Preliminary qEEG Study. Clin EEG Neurosci 2022; 54:305-315. [PMID: 35957592 DOI: 10.1177/15500594221120723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acetylcholinesterase inhibitors (AChE-I) are the core treatment of mild to severe Alzheimer's disease (AD). However, the efficacy of AChE-I treatment on electroencephalography (EEG) and cognition remains unclear. We aimed to investigate the EEG power and coherence changes, in addition to neuropsychological performance, following a one-year treatment. Nine de-novo AD patients and demographically-matched healthy controls (HC) were included. After baseline assessments, all AD participants started cholinergic therapy. We found that baseline and follow-up gamma power analyzes were similar between groups. Yet, within the AD group after AChE-I intake, individuals with AD displayed higher gamma power compared to their baselines (P < .039). Also, baseline gamma coherence analysis showed lower values in the AD than in HC (P < .048), while these differences disappeared with increased gamma values of AD patients at the follow-up. Within the AD group after AChE-I intake, individuals with AD displayed higher theta and alpha coherence compared to their baselines (all, P < .039). These increased results within the AD group may result from a subclinical epileptiform activity. Even though AChE-I is associated with lower mortality, our results showed a significant effect on EEG power yet can increase the subclinical epileptiform activity. It is essential to be conscious of the seizure risk that treatment may cause.
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Affiliation(s)
- Ezgi Fide
- Department of Neurosciences, Institute of Health Sciences, 37508Dokuz Eylül University, Izmir, Turkey
| | - Deniz Yerlikaya
- Department of Neurosciences, Institute of Health Sciences, 37508Dokuz Eylül University, Izmir, Turkey
| | - Didem Öz
- Department of Neurosciences, Institute of Health Sciences, 37508Dokuz Eylül University, Izmir, Turkey.,Department of Neurology, 37508Dokuz Eylül University Medical School, Izmir, Turkey.,Global Brain Health Institute, 8785University of California San Francisco, San Francisco, CA, USA.,Brain Dynamics Multidisciplinary Research Center, 37508Dokuz Eylül University, Izmir, Turkey
| | - İbrahim Öztura
- Department of Neurosciences, Institute of Health Sciences, 37508Dokuz Eylül University, Izmir, Turkey.,Department of Neurology, 37508Dokuz Eylül University Medical School, Izmir, Turkey.,Brain Dynamics Multidisciplinary Research Center, 37508Dokuz Eylül University, Izmir, Turkey
| | - Görsev Yener
- Brain Dynamics Multidisciplinary Research Center, 37508Dokuz Eylül University, Izmir, Turkey.,Faculty of Medicine, 605730Izmir University of Economics, Izmir, Turkey.,Izmir Biomedicine and Genome Center, Izmir, Turkey
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Han SH, Chul Youn Y. Quantitative electroencephalography changes in patients with mild cognitive impairment after choline alphoscerate administration. J Clin Neurosci 2022; 102:42-48. [PMID: 35714391 DOI: 10.1016/j.jocn.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
There is limited evidence on the effectiveness of choline alphoscerate for mild cognitive impairment (MCI) in studies using neuropsychological markers. The aim of this study was to evaluate the spectral change at a source level using quantitative electroencephalography (qEEG) as a biomarker for cognitive function after choline alphoscerate administration to patients with MCI. This study used the qEEG data of patients with MCI who visited the Department of Neurology of the Chung-Ang University Hospital between April 2017 and December 2018. Resting-state EEG studies were performed on 33 patients with MCI at baseline and compared with those of the 18 normal controls selected from the community. After baseline qEEG, choline alphoscerate 400 mg was administered twice daily for 2 months to the patients with MCI. Follow-up qEEG was performed in 20 subjects. Baseline qEEG of patients with MCI was compared to qEEG after choline alphoscerate administration. We found that the MCI group exhibited a decreased alpha power compared to that of the control group. Patients with MCI treated with choline alphoscerate exhibited a decrease in the theta and delta power of the parietal and temporal lobe and an increase in the alpha power spectrum of the occipital lobes. We also identified the trend of default mode network enhancement after choline alphoscerate administration. Our results suggest that choline alphoscerate may have a positive effect in patients with MCI and support the usefulness of qEEG for monitoring the therapeutic effect of nootropics.
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Affiliation(s)
- Su-Hyun Han
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Young Chul Youn
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea.
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Resting-state electroencephalographic delta rhythms may reflect global cortical arousal in healthy old seniors and patients with Alzheimer's disease dementia. Int J Psychophysiol 2020; 158:259-270. [DOI: 10.1016/j.ijpsycho.2020.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/23/2022]
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Babiloni C, Lopez S, Del Percio C, Noce G, Pascarelli MT, Lizio R, Teipel SJ, González-Escamilla G, Bakardjian H, George N, Cavedo E, Lista S, Chiesa PA, Vergallo A, Lemercier P, Spinelli G, Grothe MJ, Potier MC, Stocchi F, Ferri R, Habert MO, Fraga FJ, Dubois B, Hampel H. Resting-state posterior alpha rhythms are abnormal in subjective memory complaint seniors with preclinical Alzheimer's neuropathology and high education level: the INSIGHT-preAD study. Neurobiol Aging 2020; 90:43-59. [DOI: 10.1016/j.neurobiolaging.2020.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 01/05/2023]
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9
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Hampel H, Toschi N, Babiloni C, Baldacci F, Black KL, Bokde AL, Bun RS, Cacciola F, Cavedo E, Chiesa PA, Colliot O, Coman CM, Dubois B, Duggento A, Durrleman S, Ferretti MT, George N, Genthon R, Habert MO, Herholz K, Koronyo Y, Koronyo-Hamaoui M, Lamari F, Langevin T, Lehéricy S, Lorenceau J, Neri C, Nisticò R, Nyasse-Messene F, Ritchie C, Rossi S, Santarnecchi E, Sporns O, Verdooner SR, Vergallo A, Villain N, Younesi E, Garaci F, Lista S. Revolution of Alzheimer Precision Neurology. Passageway of Systems Biology and Neurophysiology. J Alzheimers Dis 2018; 64:S47-S105. [PMID: 29562524 PMCID: PMC6008221 DOI: 10.3233/jad-179932] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The Precision Neurology development process implements systems theory with system biology and neurophysiology in a parallel, bidirectional research path: a combined hypothesis-driven investigation of systems dysfunction within distinct molecular, cellular, and large-scale neural network systems in both animal models as well as through tests for the usefulness of these candidate dynamic systems biomarkers in different diseases and subgroups at different stages of pathophysiological progression. This translational research path is paralleled by an "omics"-based, hypothesis-free, exploratory research pathway, which will collect multimodal data from progressing asymptomatic, preclinical, and clinical neurodegenerative disease (ND) populations, within the wide continuous biological and clinical spectrum of ND, applying high-throughput and high-content technologies combined with powerful computational and statistical modeling tools, aimed at identifying novel dysfunctional systems and predictive marker signatures associated with ND. The goals are to identify common biological denominators or differentiating classifiers across the continuum of ND during detectable stages of pathophysiological progression, characterize systems-based intermediate endophenotypes, validate multi-modal novel diagnostic systems biomarkers, and advance clinical intervention trial designs by utilizing systems-based intermediate endophenotypes and candidate surrogate markers. Achieving these goals is key to the ultimate development of early and effective individualized treatment of ND, such as Alzheimer's disease. The Alzheimer Precision Medicine Initiative (APMI) and cohort program (APMI-CP), as well as the Paris based core of the Sorbonne University Clinical Research Group "Alzheimer Precision Medicine" (GRC-APM) were recently launched to facilitate the passageway from conventional clinical diagnostic and drug development toward breakthrough innovation based on the investigation of the comprehensive biological nature of aging individuals. The APMI movement is gaining momentum to systematically apply both systems neurophysiology and systems biology in exploratory translational neuroscience research on ND.
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Affiliation(s)
- Harald Hampel
- AXA Research Fund & Sorbonne Université Chair, Paris, France
- Sorbonne Université, AP-HP, GRC n° 21, Alzheimer Precision Medicine (APM), Hôpital de la Pitié-Salpêtrière, Boulevard de l’hôpital, F-75013, Paris, France
- Institut du Cerveau et de la Moelle Épinière (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, F-75013, Paris, France
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Boulevard de l’hôpital, F-75013, Paris, France
| | - 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
| | - Claudio Babiloni
- Department of Physiology and Pharmacology “Vittorio Erspamer”, University of Rome “La Sapienza”, Rome, Italy
- Institute for Research and Medical Care, IRCCS “San Raffaele Pisana”, Rome, Italy
| | - Filippo Baldacci
- AXA Research Fund & Sorbonne Université Chair, Paris, France
- Sorbonne Université, AP-HP, GRC n° 21, Alzheimer Precision Medicine (APM), Hôpital de la Pitié-Salpêtrière, Boulevard de l’hôpital, F-75013, Paris, France
- Institut du Cerveau et de la Moelle Épinière (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, F-75013, Paris, France
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Boulevard de l’hôpital, F-75013, Paris, France
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Keith L. Black
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Arun L.W. Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland
| | - René S. Bun
- AXA Research Fund & Sorbonne Université Chair, Paris, France
- Sorbonne Université, AP-HP, GRC n° 21, Alzheimer Precision Medicine (APM), Hôpital de la Pitié-Salpêtrière, Boulevard de l’hôpital, F-75013, Paris, France
- Institut du Cerveau et de la Moelle Épinière (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, F-75013, Paris, France
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Boulevard de l’hôpital, F-75013, Paris, France
| | - Francesco Cacciola
- Unit of Neurosurgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Enrica Cavedo
- AXA Research Fund & Sorbonne Université Chair, Paris, France
- Sorbonne Université, AP-HP, GRC n° 21, Alzheimer Precision Medicine (APM), Hôpital de la Pitié-Salpêtrière, Boulevard de l’hôpital, F-75013, Paris, France
- Institut du Cerveau et de la Moelle Épinière (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, F-75013, Paris, France
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Boulevard de l’hôpital, F-75013, Paris, France
- IRCCS “San Giovanni di Dio-Fatebenefratelli”, Brescia, Italy
| | - Patrizia A. Chiesa
- AXA Research Fund & Sorbonne Université Chair, Paris, France
- Sorbonne Université, AP-HP, GRC n° 21, Alzheimer Precision Medicine (APM), Hôpital de la Pitié-Salpêtrière, Boulevard de l’hôpital, F-75013, Paris, France
- Institut du Cerveau et de la Moelle Épinière (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, F-75013, Paris, France
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Boulevard de l’hôpital, F-75013, Paris, France
| | - Olivier Colliot
- Inserm, U1127, Paris, France; CNRS, UMR 7225 ICM, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Paris, France; Institut du Cerveau et de la Moelle Épinière (ICM) Paris, France; Inria, Aramis project-team, Centre de Recherche de Paris, France; Department of Neuroradiology, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France; Department of Neurology, AP-HP, Hôpital de la Pitié-Salpêtrière, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Paris, France
| | - Cristina-Maria Coman
- AXA Research Fund & Sorbonne Université Chair, Paris, France
- Sorbonne Université, AP-HP, GRC n° 21, Alzheimer Precision Medicine (APM), Hôpital de la Pitié-Salpêtrière, Boulevard de l’hôpital, F-75013, Paris, France
- Institut du Cerveau et de la Moelle Épinière (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, F-75013, Paris, France
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Boulevard de l’hôpital, F-75013, Paris, France
| | - Bruno Dubois
- Sorbonne Université, Inserm, CNRS, Institut du Cerveau et de la Moelle Épinière (ICM), Département de Neurologie, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Hôpital Pitié-Salpêtrière, Boulevard de l’hôpital, F-75013, Paris, France
| | - Andrea Duggento
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Stanley Durrleman
- Inserm, U1127, Paris, France; CNRS, UMR 7225 ICM, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Paris, France; Institut du Cerveau et de la Moelle Épinière (ICM) Paris, France; Inria, Aramis project-team, Centre de Recherche de Paris, France
| | - Maria-Teresa Ferretti
- IREM, Institute for Regenerative Medicine, University of Zurich, Zürich, Switzerland
- ZNZ Neuroscience Center Zurich, Zürich, Switzerland
| | - Nathalie George
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle Épinière, ICM, Ecole Normale Supérieure, ENS, Centre MEG-EEG, F-75013, Paris, France
| | - Remy Genthon
- Sorbonne Université, Inserm, CNRS, Institut du Cerveau et de la Moelle Épinière (ICM), Département de Neurologie, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Hôpital Pitié-Salpêtrière, Boulevard de l’hôpital, F-75013, Paris, France
| | - Marie-Odile Habert
- Département de Médecine Nucléaire, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
- Laboratoire d’Imagerie Biomédicale, Sorbonne Universités, UPMC Univ Paris 06, Inserm U 1146, CNRS UMR 7371, Paris, France
| | - Karl Herholz
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Wolfson Molecular Imaging Centre, Manchester, UK
| | - Yosef Koronyo
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Foudil Lamari
- AP-HP, UF Biochimie des Maladies Neuro-métaboliques, Service de Biochimie Métabolique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Stéphane Lehéricy
- Centre de NeuroImagerie de Recherche - CENIR, Institut du Cerveau et de la Moelle Épinière - ICM, F-75013, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, F-75013, Paris, France
| | - Jean Lorenceau
- Institut de la Vision, INSERM, Sorbonne Universités, UPMC Univ Paris 06, UMR_S968, CNRS UMR7210, Paris, France
| | - Christian Neri
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Paris 06, CNRS UMR 8256, Institut de Biologie Paris-Seine (IBPS), Place Jussieu, F-75005, Paris, France
| | - Robert Nisticò
- Department of Biology, University of Rome “Tor Vergata” & Pharmacology of Synaptic Disease Lab, European Brain Research Institute (E.B.R.I.), Rome, Italy
| | - Francis Nyasse-Messene
- Sorbonne Université, Inserm, CNRS, Institut du Cerveau et de la Moelle Épinière (ICM), Département de Neurologie, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Hôpital Pitié-Salpêtrière, Boulevard de l’hôpital, F-75013, Paris, France
| | - Craig Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Simone Rossi
- Department of Medicine, Surgery and Neurosciences, Unit of Neurology and Clinical Neurophysiology, Brain Investigation & Neuromodulation Lab. (Si-BIN Lab.), University of Siena, Siena, Italy
- Department of Medicine, Surgery and Neurosciences, Section of Human Physiology University of Siena, Siena, Italy
| | - Emiliano Santarnecchi
- Department of Medicine, Surgery and Neurosciences, Unit of Neurology and Clinical Neurophysiology, Brain Investigation & Neuromodulation Lab. (Si-BIN Lab.), University of Siena, Siena, Italy
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Olaf Sporns
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
- IU Network Science Institute, Indiana University, Bloomington, IN, USA
| | | | - Andrea Vergallo
- AXA Research Fund & Sorbonne Université Chair, Paris, France
- Sorbonne Université, AP-HP, GRC n° 21, Alzheimer Precision Medicine (APM), Hôpital de la Pitié-Salpêtrière, Boulevard de l’hôpital, F-75013, Paris, France
- Institut du Cerveau et de la Moelle Épinière (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, F-75013, Paris, France
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Boulevard de l’hôpital, F-75013, Paris, France
| | - Nicolas Villain
- Sorbonne Université, AP-HP, GRC n° 21, Alzheimer Precision Medicine (APM), Hôpital de la Pitié-Salpêtrière, Boulevard de l’hôpital, F-75013, Paris, France
- Institut du Cerveau et de la Moelle Épinière (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, F-75013, Paris, France
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Boulevard de l’hôpital, F-75013, Paris, France
| | | | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- Casa di Cura “San Raffaele Cassino”, Cassino, Italy
| | - Simone Lista
- AXA Research Fund & Sorbonne Université Chair, Paris, France
- Sorbonne Université, AP-HP, GRC n° 21, Alzheimer Precision Medicine (APM), Hôpital de la Pitié-Salpêtrière, Boulevard de l’hôpital, F-75013, Paris, France
- Institut du Cerveau et de la Moelle Épinière (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, F-75013, Paris, France
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Boulevard de l’hôpital, F-75013, Paris, France
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10
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Ilhan Algin D, Dagli Atalay S, Ozkan S, Ozbabalik Adapinar D, Ak Sivrioz I. Memantine improves semantic memory in patients with amnestic mild cognitive impairment: A single-photon emission computed tomography study. J Int Med Res 2017; 45:2053-2064. [PMID: 28661262 PMCID: PMC5805216 DOI: 10.1177/0300060517715166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 05/23/2017] [Indexed: 12/20/2022] Open
Abstract
Objective This study was performed to assess the efficacy of memantine in patients with amnestic mild cognitive impairment (aMCI). Methods Thirty healthy controls and 45 patients diagnosed with aMCI based on the Petersen criteria were classified into 3 groups. Group 1 comprised patients who received a single memantine dose following examination (n = 25), Group 2 comprised patients who did not receive memantine treatment following examination (n = 20), and Group 3 comprised healthy age-matched volunteers (n = 30). Neuropsychological testing was performed, and the response to memantine was examined at baseline and at 12, 24, and 48 weeks. Single-photon emission computed tomography was performed at baseline and at 48 weeks in patients who received memantine treatment. Results Memantine treatment significantly improved the symptoms of aMCI according to the Wechsler Adult Intelligence Scale-Revised vocabulary subtest, backward digit span, and Blessed Dementia Rating Scale, all of which were recorded for the duration of the study. Conclusion These data indicate that patients with aMCI receiving memantine develop an improved semantic memory compared with no treatment. Further studies including larger patient cohorts are necessary to validate these findings.
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Affiliation(s)
- Demet Ilhan Algin
- Assistant Professor, Eskişehir Osmangazi
University Faculty of Medicine Department of Neurology, Eskişehir, Turkey
| | - Suna Dagli Atalay
- Assistant Professor, Eskişehir Osmangazi
University Faculty of Medicine Department of Neurology, Eskişehir, Turkey
| | - Serhat Ozkan
- Assistant Professor, Eskişehir Osmangazi
University Faculty of Medicine Department of Neurology, Eskişehir, Turkey
| | - Demet Ozbabalik Adapinar
- Assistant Professor, Eskişehir Osmangazi
University Faculty of Medicine Department of Neurology, Eskişehir, Turkey
| | - Ilknur Ak Sivrioz
- Professor, Eskişehir Osmangazi
University Faculty of Medicine Department of Nuclear Medicine, Eskişehir,
Turkey
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11
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Babiloni C, Del Percio C, Caroli A, Salvatore E, Nicolai E, Marzano N, Lizio R, Cavedo E, Landau S, Chen K, Jagust W, Reiman E, Tedeschi G, Montella P, De Stefano M, Gesualdo L, Frisoni GB, Soricelli A. Cortical sources of resting state EEG rhythms are related to brain hypometabolism in subjects with Alzheimer's disease: an EEG-PET study. Neurobiol Aging 2016; 48:122-134. [DOI: 10.1016/j.neurobiolaging.2016.08.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/05/2016] [Accepted: 08/24/2016] [Indexed: 11/24/2022]
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12
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Babiloni C, Pennica A, Del Percio C, Noce G, Cordone S, Lopez S, Berry K, Muratori C, Ferracuti S, Roma P, Correr V, Di Campli F, Gianserra L, Ciullini L, Aceti A, Soricelli A, Teti E, Viscione M, Limatola C, Onorati P, Capotosto P, Andreoni M. Antiretroviral therapy affects the z-score index of deviant cortical EEG rhythms in naïve HIV individuals. Neuroimage Clin 2016; 12:144-56. [PMID: 27408799 PMCID: PMC4933036 DOI: 10.1016/j.nicl.2016.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/12/2016] [Accepted: 06/06/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Here we tested the effect of combined antiretroviral therapy (cART) on deviant electroencephalographic (EEG) source activity in treatment-naïve HIV individuals. METHODS Resting state eyes-closed EEG data were recorded before and after 5 months of cART in 48 male HIV subjects, who were naïve at the study start. The EEG data were also recorded in 59 age- and sex-matched healthy subjects as a control group. Frequency bands of interest included delta, theta, alpha1, alpha2 and alpha3, based on alpha frequency peak specific to each individual. They also included beta1 (13-20 Hz) and beta2 (20-30 Hz). Low-resolution brain electromagnetic tomography (LORETA) estimated EEG cortical source activity in frontal, central, temporal, parietal, and occipital regions. RESULTS Before the therapy, the HIV group showed greater parietal delta source activity and lower spatially diffuse alpha source activity compared to the control group. Thus, the ratio of parietal delta and alpha3 source activity served as an EEG marker. The z-score showed a statistically deviant EEG marker (EEG +) in 50% of the HIV individuals before therapy (p < 0.05). After 5 months of cART, delta source activity decreased, and alpha3 source activity increased in the HIV subjects with EEG + (about 50% of them showed a normalized EEG marker). CONCLUSIONS This procedure detected a deviant EEG marker before therapy and its post-therapy normalization in naïve HIV single individuals. SIGNIFICANCE The parietal delta/alpha3 EEG marker may be used to monitor cART effects on brain function in such individuals.
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Affiliation(s)
- Claudio Babiloni
- Department of Physiology and Pharmacology, University of Rome “La Sapienza”, Rome, Italy
- IRCCS S. Raffaele Pisana, Rome, Italy
| | - Alfredo Pennica
- Infectious Diseases, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy
| | | | | | - Susanna Cordone
- Department of Physiology and Pharmacology, University of Rome “La Sapienza”, Rome, Italy
| | - Susanna Lopez
- Department of Physiology and Pharmacology, University of Rome “La Sapienza”, Rome, Italy
| | - Ketura Berry
- Department of Physiology and Pharmacology, University of Rome “La Sapienza”, Rome, Italy
| | | | - Stefano Ferracuti
- Psychiatry, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy
| | - Paolo Roma
- Psychiatry, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy
| | - Valentina Correr
- Psychiatry, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy
| | - Francesco Di Campli
- Infectious Diseases, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy
| | - Laura Gianserra
- Infectious Diseases, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy
| | - Lorenzo Ciullini
- Infectious Diseases, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy
| | - Antonio Aceti
- Infectious Diseases, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy
| | - Andrea Soricelli
- IRCCS SDN, Naples, Italy
- Department of Motor Sciences and Healthiness, University of Naples Parthenope, Naples, Italy
| | - Elisabetta Teti
- Clinical Infectious Diseases, University of Rome “Tor Vergata”, Rome, Italy
| | - Magdalena Viscione
- Clinical Infectious Diseases, University of Rome “Tor Vergata”, Rome, Italy
| | - Cristina Limatola
- Department of Physiology and Pharmacology, University of Rome “La Sapienza”, Rome, Italy
| | - Paolo Onorati
- Department of Physiology and Pharmacology, University of Rome “La Sapienza”, Rome, Italy
- IRCCS S. Raffaele Pisana, Rome, Italy
| | | | - Massimo Andreoni
- Clinical Infectious Diseases, University of Rome “Tor Vergata”, Rome, Italy
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13
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Babiloni C, Lizio R, Marzano N, Capotosto P, Soricelli A, Triggiani AI, Cordone S, Gesualdo L, Del Percio C. Brain neural synchronization and functional coupling in Alzheimer's disease as revealed by resting state EEG rhythms. Int J Psychophysiol 2016; 103:88-102. [PMID: 25660305 DOI: 10.1016/j.ijpsycho.2015.02.008] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Heo JH, Park MH, Lee JH. Effect of Korean Red Ginseng on Cognitive Function and Quantitative EEG in Patients with Alzheimer's Disease: A Preliminary Study. J Altern Complement Med 2016; 22:280-5. [PMID: 26974484 DOI: 10.1089/acm.2015.0265] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Korean red ginseng (KRG) has a nootropic effect. This study assessed the efficacy of KRG on cognitive function and quantitative electroencephalography (EEG) in patients with Alzheimer's disease (AD). METHODS Fourteen patients with AD (mean age, 74.93 years; 11 women and 3 men) were recruited and treated with KRG (4.5 g per day) for 12 weeks. Cognitive function was assessed by the Korean Mini-Mental State Examination (K-MMSE) and the Frontal Assessment Battery (FAB). EEG performed before and after treatment were analyzed with quantitative spectral analysis. RESULTS The FAB score improved significantly after 12 weeks of treatment. In the relative power spectrum analysis performed according to responsiveness, alpha power increased significantly in the right temporal area of the responders. The increments of relative alpha power in the right temporal, parietal, and occipital areas were significantly higher in the responders than the nonresponders. CONCLUSIONS This study indicates the efficacy of KRG on frontal lobe function in AD, related to increasing relative alpha power.
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Affiliation(s)
- Jae-Hyeok Heo
- Department of Neurology, Seoul Medical Center , Seoul, South Korea
| | - Min-Ho Park
- Department of Neurology, Seoul Medical Center , Seoul, South Korea
| | - Jeong-Heon Lee
- Department of Neurology, Seoul Medical Center , Seoul, South Korea
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15
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A Novel Application of Multiscale Entropy in Electroencephalography to Predict the Efficacy of Acetylcholinesterase Inhibitor in Alzheimer's Disease. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:953868. [PMID: 26120358 PMCID: PMC4450304 DOI: 10.1155/2015/953868] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/02/2015] [Indexed: 11/30/2022]
Abstract
Alzheimer's disease (AD) is the most common form of dementia. According to one hypothesis, AD is caused by the reduced synthesis of the neurotransmitter acetylcholine. Therefore, acetylcholinesterase (AChE) inhibitors are considered to be an effective therapy. For clinicians, however, AChE inhibitors are not a predictable treatment for individual patients. We aimed to disclose the difference by biosignal processing. In this study, we used multiscale entropy (MSE) analysis, which can disclose the embedded information in different time scales, in electroencephalography (EEG), in an attempt to predict the efficacy of AChE inhibitors. Seventeen newly diagnosed AD patients were enrolled, with an initial minimental state examination (MMSE) score of 18.8 ± 4.5. After 12 months of AChE inhibitor therapy, 7 patients were responsive and 10 patients were nonresponsive. The major difference between these two groups is Slope 2 (MSE6 to 20). The area below the receiver operating characteristic (ROC) curve of Slope 2 is 0.871 (95% CI = 0.69–1). The sensitivity is 85.7% and the specificity is 60%, whereas the cut-off value of Slope 2 is −0.024. Therefore, MSE analysis of EEG signals, especially Slope 2, provides a potential tool for predicting the efficacy of AChE inhibitors prior to therapy.
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16
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van Straaten EC, Scheltens P, Gouw AA, Stam CJ. Eyes-closed task-free electroencephalography in clinical trials for Alzheimer's disease: an emerging method based upon brain dynamics. ALZHEIMERS RESEARCH & THERAPY 2014; 6:86. [PMID: 25621017 PMCID: PMC4304266 DOI: 10.1186/s13195-014-0086-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Electroencephalography (EEG) is a longstanding technique to measure electrical brain activity and thereby an indirect measure of synaptic activity. Synaptic dysfunction accompanies Alzheimer’s disease (AD) and EEG can be regarded as a potentially useful biomarker in this disease. Lately, emerging analysis techniques of time series have become available for EEG, such as functional connectivity and network analysis, which have increased the possibilities for use in AD clinical trials. In this review, we report the EEG changes in the course of AD, including slowing of the EEG oscillations, decreased functional connectivity in the higher-frequency bands, and decline in optimal functional network organization. We discuss the use of EEG in clinical trials and provide directions for future research.
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Affiliation(s)
- Elisabeth Cw van Straaten
- Department of Clinical Neurophysiology, VU University Medical Center, de Bolelaan 1118, P.O. box 7057, 1007 MB Amsterdam, The Netherlands ; Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht Science Park, Uppsalalaan 12, 3584 CT Utrecht, The Netherlands
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, VU University Medical Center, de Boelelaan 1118, P.O. box 7057, 1007 MB Amsterdam, the Netherlands
| | - Alida A Gouw
- Department of Clinical Neurophysiology, VU University Medical Center, de Bolelaan 1118, P.O. box 7057, 1007 MB Amsterdam, The Netherlands ; Alzheimer Center & Department of Neurology, VU University Medical Center, de Boelelaan 1118, P.O. box 7057, 1007 MB Amsterdam, the Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology, VU University Medical Center, de Bolelaan 1118, P.O. box 7057, 1007 MB Amsterdam, The Netherlands
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17
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Tsolaki A, Kazis D, Kompatsiaris I, Kosmidou V, Tsolaki M. Electroencephalogram and Alzheimer's disease: clinical and research approaches. Int J Alzheimers Dis 2014; 2014:349249. [PMID: 24868482 PMCID: PMC4020452 DOI: 10.1155/2014/349249] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/16/2014] [Indexed: 01/08/2023] Open
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder that is characterized by cognitive deficits, problems in activities of daily living, and behavioral disturbances. Electroencephalogram (EEG) has been demonstrated as a reliable tool in dementia research and diagnosis. The application of EEG in AD has a wide range of interest. EEG contributes to the differential diagnosis and the prognosis of the disease progression. Additionally such recordings can add important information related to the drug effectiveness. This review is prepared to form a knowledge platform for the project entitled "Cognitive Signal Processing Lab," which is in progress in Information Technology Institute in Thessaloniki. The team tried to focus on the main research fields of AD via EEG and recent published studies.
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Affiliation(s)
- Anthoula Tsolaki
- Medical Physics Laboratory, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Dimitrios Kazis
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Exochi, 57010 Thessaloniki, Greece
| | - Ioannis Kompatsiaris
- Centre of Research and Technology, Information Technologies Institute, 6th Klm Charilaou-Thermi Road, P.O. Box 60361, Thermi, 57001 Thessaloniki, Greece
| | - Vasiliki Kosmidou
- Centre of Research and Technology, Information Technologies Institute, 6th Klm Charilaou-Thermi Road, P.O. Box 60361, Thermi, 57001 Thessaloniki, Greece
| | - Magda Tsolaki
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Exochi, 57010 Thessaloniki, Greece
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18
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Moretti DV, Prestia A, Binetti G, Zanetti O, Frisoni GB. Increase of theta frequency is associated with reduction in regional cerebral blood flow only in subjects with mild cognitive impairment with higher upper alpha/low alpha EEG frequency power ratio. Front Behav Neurosci 2013; 7:188. [PMID: 24367305 PMCID: PMC3851738 DOI: 10.3389/fnbeh.2013.00188] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/17/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several biomarkers have been proposed for detecting Alzheimer's disease (AD) in its earliest stages, that is, in the predementia stage. In an attempt to find noninvasive biomarkers, researchers have investigated the feasibility of neuroimaging tools, such as MRI, SPECT as well as neurophysiological measurements using EEG. Moreover, the increase of EEG alpha3/alpha2 frequency power ratio has been associated with AD-converters subjects with mild cognitive impairment (MCI). OBJECTIVE To study the association of alpha3/alpha2 frequency power ratio with regional cerebral blood flow (rCBF) changes in subjects with MCI. METHODS Twenty-seven adult subjects with MCI underwent EEG recording and perfusion single-photon emission computed tomography (SPECT) evaluation. The alpha3/alpha2 frequency power ratio was computed for each subject. Two groups were obtained according to the median values of alpha3/alpha2, at a cut-off of 1.17. Correlation between brain perfusion and EEG markers were detected. RESULTS Subjects with higher alpha3/alpha2 frequency power ratio showed a constant trend to a lower perfusion than low alpha3/alpha2 group. The two groups were significantly different as about the hippocampal volume and correlation with the theta frequency activity. CONCLUSION There is a complex interplay between cerebral blood flow, theta frequency activity, and hippocampal volume in MCI patients with prodromal Alzheimer's disease, characterized by higher EEG alpha3/alpha2 frequency power ratio.
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Affiliation(s)
- Davide V. Moretti
- Alzheimer Unit, IRCCS San Giovanni di Dio FatebenefratelliBrescia, Italy
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19
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Babiloni C, Del Percio C, Bordet R, Bourriez JL, Bentivoglio M, Payoux P, Derambure P, Dix S, Infarinato F, Lizio R, Triggiani AI, Richardson JC, Rossini PM. Effects of acetylcholinesterase inhibitors and memantine on resting-state electroencephalographic rhythms in Alzheimer’s disease patients. Clin Neurophysiol 2013; 124:837-50. [DOI: 10.1016/j.clinph.2012.09.017] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 09/21/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
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20
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Vecchio F, Babiloni C, Lizio R, Fallani FDV, Blinowska K, Verrienti G, Frisoni G, Rossini PM. Resting state cortical EEG rhythms in Alzheimer's disease: toward EEG markers for clinical applications: a review. SUPPLEMENTS TO CLINICAL NEUROPHYSIOLOGY 2013; 62:223-36. [PMID: 24053043 DOI: 10.1016/b978-0-7020-5307-8.00015-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The human brain contains an intricate network of about 100 billion neurons. Aging of the brain is characterized by a combination of synaptic pruning, loss of cortico-cortical connections, and neuronal apoptosis that provoke an age-dependent decline of cognitive functions. Neural/synaptic redundancy and plastic remodeling of brain networking, also secondary to mental and physical training, promote maintenance of brain activity and cognitive status in healthy elderly subjects for everyday life. However, age is the main risk factor for neurodegenerative disorders such as Alzheimer's disease (AD) that impact on cognition. Growing evidence supports the idea that AD targets specific and functionally connected neuronal networks and that oscillatory electromagnetic brain activity might be a hallmark of the disease. In this line, digital electroencephalography (EEG) allows noninvasive analysis of cortical neuronal synchronization, as revealed by resting state brain rhythms. This review provides an overview of the studies on resting state eyes-closed EEG rhythms recorded in amnesic mild cognitive impairment (MCI) and AD subjects. Several studies support the idea that spectral markers of these EEG rhythms, such as power density, spectral coherence, and other quantitative features, differ among normal elderly, MCI, and AD subjects, at least at group level. Regarding the classification of these subjects at individual level, the most previous studies showed a moderate accuracy (70-80%) in the classification of EEG markers relative to normal and AD subjects. In conclusion, resting state EEG makers are promising for large-scale, low-cost, fully noninvasive screening of elderly subjects at risk of AD.
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Affiliation(s)
- Fabrizio Vecchio
- A.Fa.R., Dipartimento di Neuroscienze, Ospedale Fatebenefratelli, Isola Tiberina, 00186 Rome, Italy
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Empirical mode decomposition based detrended sample entropy in electroencephalography for Alzheimer's disease. J Neurosci Methods 2012; 210:230-7. [PMID: 22878177 DOI: 10.1016/j.jneumeth.2012.07.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/12/2012] [Accepted: 07/10/2012] [Indexed: 11/21/2022]
Abstract
Quantitative electroencephalographs (qEEG) provide a potential method to objectively quantify the cortical activations in Alzheimer's disease (AD), but they are too insensitive to probe the alteration of EEG in the early AD. The sample entropy (SaEn) attempts to quantify the complex information embedded in EEG non-linearly, which fits in that EEG originates from non-linear interactions. However, a technical issue which has been ignored by most researchers is that the signal should be stationary. In order to resolve the non-stationarity of SaEn in EEG to improve the sensitivity, an empirical mode decomposition (EMD) was applied for detrending in this study. Twenty-seven AD patients (9M/18F; mean age 74.0±1.5 years) were included. Their initial Minimal Mental Status Examination was 19.3±0.7. They received the first resting-awake 30-mine EEG before the therapy. Five of them received a follow-up examination within 6 months after the therapy. The 30-s EEG data without artifacts were selected and analyzed with a new proposed method, "EMD-based detrended-SaEn" to attenuate the influence of intrinsic non-stationarity. The correlation factors in 27 AD patients showed a moderate correlation (0.361-0.523, p<0.05) between MMSE and EMD-based detrended SaEn in Fp1, Fp2, F4 and T3. There was a high correlation (Correlation coefficient=0.975, p<0.05) between the changes of MMSE and the changes of EMD-based detrended-SaEn in F7 in 5 follow-up patients. The dynamic complexity of EEG fluctuations is degraded by pathological degeneration, and EMD-based detrended SaEn provides an objective, non-invasive and non-expensive tool for evaluating and following AD patients.
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Lizio R, Vecchio F, Frisoni GB, Ferri R, Rodriguez G, Babiloni C. Electroencephalographic rhythms in Alzheimer's disease. Int J Alzheimers Dis 2011; 2011:927573. [PMID: 21629714 PMCID: PMC3100729 DOI: 10.4061/2011/927573] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 03/13/2011] [Indexed: 11/20/2022] Open
Abstract
Physiological brain aging is characterized by synapses loss and neurodegeneration that slowly lead to an age-related decline of cognition. Neural/synaptic redundancy and plastic remodelling of brain networking, also due to mental and physical training, promotes maintenance of brain activity in healthy elderly subjects for everyday life and good social behaviour and intellectual capabilities. However, age is the major risk factor for most common neurodegenerative disorders that impact on cognition, like Alzheimer's disease (AD). Brain electromagnetic activity is a feature of neuronal network function in various brain regions. Modern neurophysiological techniques, such as electroencephalography (EEG) and event-related potentials (ERPs), are useful tools in the investigation of brain cognitive function in normal and pathological aging with an excellent time resolution. These techniques can index normal and abnormal brain aging analysis of corticocortical connectivity and neuronal synchronization of rhythmic oscillations at various frequencies. The present review suggests that discrimination between physiological and pathological brain aging clearly emerges at the group level, with suggested applications also at the level of single individual. The possibility of combining the use of EEG together with biological/neuropsychological markers and structural/functional imaging is promising for a low-cost, non-invasive, and widely available assessment of groups of individuals at-risk.
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Snyder SM, Hall JR, Cornwell SL, Falk JD. Addition of EEG improves accuracy of a logistic model that uses neuropsychological and cardiovascular factors to identify dementia and MCI. Psychiatry Res 2011; 186:97-102. [PMID: 20817309 DOI: 10.1016/j.psychres.2010.04.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 12/21/2009] [Accepted: 04/30/2010] [Indexed: 11/29/2022]
Abstract
To investigate whether addition of EEG would improve accuracy of a logistic model that uses neuropsychological assessment and cardiovascular history to identify dementia and mild cognitive impairment (MCI) as a single group, we collected data and constructed logistic models from a sample of 78 normal adults and 33 patients (aged 50-85 years). To determine accuracy, we compared logistic regression results to a geriatrician's diagnosis of MCI or dementia that included Alzheimer's disease, vascular dementia or mixed dementia. We found that the addition of EEG (non-linear complexity) to a logistic model that included both neuropsychological assessment (ADAS-Cog) and cardiovascular history increased overall accuracy from 80% to 92%. The logistic model identified dementia and MCI as a single group comprised of the following subgroups (with accuracies): Alzheimer's disease (92%; 12/13), vascular dementia (73%; 8/11), mixed dementia (100%; 4/4), and mild cognitive impairment (80%; 4/5). Whereas the analysis is limited by small sample sizes and mixing of diverse pathologies, the findings do provide support that the subgroups may share changes in neuropsychological, cardiovascular, and electroencephalographic factors (specifically ADAS-Cog total score, cardiovascular history, and EEG complexity). Taken together, the study results provide support that EEG might complement the clinician's evaluation of dementia and MCI.
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Affiliation(s)
- Steven Michael Snyder
- Department of Psychiatry and Neuroscience, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas 76107, USA.
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Yoshida Y, Sugiyama T, Utsunomiya K, Ogura Y, Ikeda T. A pilot study for the effects of donepezil therapy on cerebral and optic nerve head blood flow, visual field defect in normal-tension glaucoma. J Ocul Pharmacol Ther 2010; 26:187-92. [PMID: 20415624 DOI: 10.1089/jop.2009.0117] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To evaluate the effect of donepezil hydrochloride, an agent for the treatment of Alzheimer's disease (AD), on the cerebral and optic nerve head (ONH) blood flow, visual field defect in normal-tension glaucoma (NTG) patients with decreased cerebral blood flow (CBF) that demonstrates an AD-like perfusion pattern. METHODS The subjects were 5 NTG patients who exhibited AD-like decreased CBF upon (123)I-iodoamphetamine single photon emission computed tomography ((123)I-IMP SPECT). Donepezil hydrochloride (5 mg/day) was prescribed for each patient during a period of 12 months. Intraocular pressure (IOP), mean deviation (MD) of the Humphrey visual field, ONH blood flow determined by a laser speckle flowgraphy, and regional CBF (rCBF) determined by (123)I-IMP SPECT were measured before and every 6 months during the treatment. RESULTS MD, ONH blood flow, and rCBF were improved significantly after 6 months of the treatment, although IOP did not change significantly. No deterioration of NTG morbidity was found in any of the measured parameters after 12 months of the treatment. CONCLUSIONS Oral administration of donepezil hydrochloride in NTG patients might prevent deterioration of visual field defect, ONH blood flow, and rCBF in the temporal, parietal, and posterior lobes. This pilot study suggested the possibility that donepezil hydrochloride might ameliorate glaucomatous optic neuropathy in NTG.
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Affiliation(s)
- Yukiko Yoshida
- Department of Ophthalmology, Ujigawa Hospital, vji, Kyoto, Japan
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25
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Van Beek AHEA, Claassen JAHR. The cerebrovascular role of the cholinergic neural system in Alzheimer's disease. Behav Brain Res 2010; 221:537-42. [PMID: 20060023 DOI: 10.1016/j.bbr.2009.12.047] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/26/2009] [Indexed: 10/20/2022]
Abstract
The intrinsic cholinergic innervation of the cortical microvessels contains both subcortical pathways and local cortical interneurons mediated by muscarinic and nicotinic acetylcholine receptors. Stimulation of this system leads to vasodilatation. In the extrinsic innervation, choline acts as a selective agonist for the α7-nicoticinic acetylcholine receptor on the sympathetic nerves to cause vasodilatation, and through this mechanism, cholinergic modulation may affect this sympathetic vasodilatation. Alzheimer's disease is characterized by a cerebral cholinergic deficit and cerebral blood flow is diminished. Cholinesterase inhibitors, important drugs in the treatment of Alzheimer's disease, could influence the cerebral blood flow through stimulation of the intrinsic cholinergic cerebrovascular innervation. Indeed, cholinesterase inhibitors improve cerebral blood flow in Alzheimer patients who respond to treatment. Further, cerebrovascular reactivity and neurovascular coupling are impaired in Alzheimer's disease and both can be improved by cholinesterase inhibitors. Conversely, cholinesterase inhibitors inhibit the α7-nicoticinic acetylcholine receptor on extrinsic sympathetic nerves and thus may impair vasodilatation. The net outcome of these opposing effects in clinical practice remains unknown. Moreover, it is uncertain whether the regulation of cerebral blood flow during blood pressure changes (cerebral autoregulation) is impaired in patients with Alzheimer's disease. Technological developments now allow us to dynamically measure blood pressure, cerebral blood flow, and cerebral cortical oxygenation. Using simple maneuvers like single sit-stand and repeated sit-stand maneuvers, the regulation of cerebral perfusion in patients with Alzheimer's disease can easily be measured. Sit-stand maneuvers can be considered as a provocation test for cerebral autoregulation, and provide excellent opportunities to study the cerebrovascular effects of cholinesterase inhibitors.
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Affiliation(s)
- Arenda H E A Van Beek
- Radboud University Nijmegen Medical Centre, Department of Geriatric Medicine and Alzheimer Centre Nijmegen, The Netherlands
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26
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Gispen-de Wied CC, Kritsidima M, Elferink AJA. The validity of biomarkers as surrogate endpoints in Alzheimer's disease by means of the Quantitative Surrogate Validation Level of Evidence Scheme (QSVLES). J Nutr Health Aging 2009; 13:376-87. [PMID: 19300886 DOI: 10.1007/s12603-009-0049-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the validity of biomarkers that are currently being proposed as potential surrogate endpoints in AD clinical trials with the aid of the "Quantitative Surrogate Validation Level of Evidence Schema" (QSVLES) proposed by Lassere et.al. (1). PROCEDURE A Pubmed literature search was conducted to identify AD biomarkers with SEP potential, and the QSVLES was applied to determine the extent of the SEP validity. RESULTS MRI, PET and MRS measures attained a total validity score of 4, NAA/Cre a total score of 5, and cerebral blood flow (SPECT), Abeta , Tau and APP a total score of 2. None of these biomarkers could fall into the rank of Levels 1 or 2, reserved for SEPs, according to the QSVLES criteria. This was mainly attributed to the lack of sufficient evidence that was derived from high ranking studies (RCT, prospective observational studies). CONCLUSION Though residing on SEPs as sole determinants of the benefit/risk ratio of AD medications seems to be pretty far, there could be certain cases where the use of SEPs may be beneficial, making efficient therapies available faster when there is a major public health interest involved. However, the potential risks of relying on invalid SEPs should not be underestimated and therefore the research on SEP validation and the development of specific validation guidance should be encouraged. The QSVLES, though not devoid of criticism, may be proposed as a starting point.
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Rossini PM, Rossi S, Babiloni C, Polich J. Clinical neurophysiology of aging brain: from normal aging to neurodegeneration. Prog Neurobiol 2007; 83:375-400. [PMID: 17870229 DOI: 10.1016/j.pneurobio.2007.07.010] [Citation(s) in RCA: 333] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 05/03/2007] [Accepted: 07/26/2007] [Indexed: 02/06/2023]
Abstract
Physiological brain aging is characterized by a loss of synaptic contacts and neuronal apoptosis that provokes age-dependent decline of sensory processing, motor performance, and cognitive function. Neural redundancy and plastic remodelling of brain networking, also secondary to mental and physical training, promotes maintenance of brain activity in healthy elderly for everyday life and fully productive affective and intellectual capabilities. However, age is the main risk factor for neurodegenerative disorders such as Alzheimer's disease (AD) that impact on cognition. Oscillatory electromagnetic brain activity is a hallmark of neuronal network function in various brain regions. Modern neurophysiological techniques including electroencephalography (EEG), event-related potential (ERP), magnetoencephalography (MEG), and transcranial magnetic stimulation (TMS) can accurately index normal and abnormal brain aging to facilitate non-invasive analysis of cortico-cortical connectivity and neuronal synchronization of firing and coherence of rhythmic oscillations at various frequencies. The present review provides a perspective of these issues by assaying different neurophysiological methods and integrating the results with functional brain imaging findings. It is concluded that discrimination between physiological and pathological brain aging clearly emerges at the group level, with applications at the individual level also suggested. Integrated approaches utilizing neurophysiological techniques together with biological markers and structural and functional imaging are promising for large-scale, low-cost and non-invasive evaluation of at-risk populations. Practical implications of the methods are emphasized.
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Affiliation(s)
- Paolo M Rossini
- Clinica Neurologica University Campus Bio-Medico, Rome, Italy.
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28
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Irving EA, Upton N. Symptomatic treatment of Alzheimer’s disease: identification of biomarkers to aid translation from bench to bedside. Biomark Med 2007; 1:93-110. [DOI: 10.2217/17520363.1.1.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the absence of robust pharmacodynamic markers, the potential success of novel therapeutic agents for the symptomatic relief of Alzheimer’s disease is largely unknown until the drugs enter relatively large studies, assessing clinical outcome over a 6-month period. In order to increase the efficiency of future clinical development there is, therefore, a need to identify pharmacodynamic markers of drug response, pharmacodynamic models that allow early prediction of efficacy and markers to aid the stratification of the patient population. Using literature available from cholinesterase inhibitors, memantine and Ginkgo biloba, this review focuses on the identification of potential pharmacodynamic markers/models and highlights the utility of these end points throughout the drug discovery process, from preclinical to clinical development.
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Affiliation(s)
- Elaine A Irving
- GlaxoSmithKline, Neurology and GI CEDD, New Frontiers Science Park North, Third Avenue, Harlow, Essex, CM19 5AW, UK
| | - Neil Upton
- GlaxoSmithKline, Neurology and GI CEDD, New Frontiers Science Park North, Third Avenue, Harlow, Essex, CM19 5AW, UK
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Abstract
Alzheimer's disease (AD) is the commonest form of degenerative dementia and is characterised by progressive cognitive decline. Despite extensive research, the cause of AD is unknown and there is no cure at present. Of the deficits found in AD, that affecting the cholinergic neurotransmitter system is the best established and the only one translated into symptomatic treatment. Cholinergic enhancement with cholinesterase inhibitor (ChEI) drugs has been achieved and their efficacy and safety ascertained by conventional clinical trials. The mechanism of action of these drugs, however, is not well understood. Imaging with SPECT, PET, MRI and fMRI after treatment has clarified what happens in the brains of those AD patients treated with ChEI drugs. Studies with these techniques have identified increases in brain blood flow and glucose metabolism, restoration of nicotinic receptor function and re-establishment of task-related regional brain activation in response to cognitive stimulation after treatment. Structural MRI studies have explained, to some degree, why only a proportion of patients benefits from ChEI treatment and there is some evidence that some ChEI drugs might be neuroprotective. There are, however, many unsolved problems. Timing of treatment intervention to obtain maximum response and the determinants of treatment response are mostly unknown. It is also unclear whether administration of treatment in those patients who have no potential for response accelerates disease progression. These issues cannot be solved by conventional clinical trials. Pharmacoimaging studies could assist the development and refinement of drugs to treat those diseases, such as AD, which affect the central nervous system.
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Affiliation(s)
- Annalena Venneri
- Clinical Neuroscience Centre, University of Hull, HU6 7RX Hull, UK.
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30
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Shanks MF, McGeown WJ, Forbes-McKay KE, Waiter GD, Ries M, Venneri A. Regional brain activity after prolonged cholinergic enhancement in early Alzheimer's disease. Magn Reson Imaging 2007; 25:848-59. [PMID: 17442521 DOI: 10.1016/j.mri.2007.02.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2007] [Indexed: 11/29/2022]
Abstract
This functional magnetic resonance imaging (fMRI) study examined changes in brain activation after prolonged (20 weeks) and stabilized treatment with the cholinesterase inhibitor galantamine in a small group of patients with very mild Alzheimer's disease (AD). Two cognitive activation paradigms were chosen: one requiring semantic association and the other relying on attention and requiring target detection. A group of age- and education-matched healthy controls was also scanned for comparison. A modest (but not statistically significant) improvement in behavioral scores after treatment was observed in both fMRI tasks. There were brain activation increases in the semantic association task after treatment, and the differences in brain activation present in the comparison of AD patients' baseline images with those of controls were not detectable after treatment. In the target detection task, regions that were activated in the elderly controls but not in the baseline images of the AD group also showed significant activation after treatment. Overall, however, the increases were modest and might reflect the heterogeneity of clinical response to treatment in this small group. Future pharmacological fMRI studies should include clinical response as a factor in the analysis of cholinergic enhancement effects in AD patients.
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Affiliation(s)
- Michael F Shanks
- Clinical Neuroscience Centre, University of Hull, HU6 7RX Hull, UK
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Zhu X, Smith MA, Honda K, Aliev G, Moreira PI, Nunomura A, Casadesus G, Harris PL, Siedlak SL, Perry G. Vascular oxidative stress in Alzheimer disease. J Neurol Sci 2007; 257:240-6. [PMID: 17337008 PMCID: PMC1952687 DOI: 10.1016/j.jns.2007.01.039] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Alzheimer disease and cerebrovascular dementia are two common causes of dementia and, by present diagnostic criteria, are mutually exclusive using vascular pathology as an arbitrary demarcation in differential diagnosis. However, evidence from epidemiological, neuropathological, clinical, pharmacological, and functional studies suggest considerable overlap in risk factors and pathological changes suggesting shared common pathogenic mechanisms between these two diseases such that vascular factors play a vital role in the pathogenesis of Alzheimer disease. A high energy demand and lack of an endogenous fuel reserve make the brain highly dependent upon a continuous blood supply where disruption of cerebral blood vessels and blood flow can have serious consequences on neural activities. Indeed, many studies implicate metabolic defects in Alzheimer disease, such a reduced brain metabolism is one of the best documented abnormalities in the disease. Notably, since endothelial reactive oxygen species such as nitric oxide act as vasodilators at low concentrations, increased production coupled with elevated reactive oxygen species scavenging of nitric oxide, can lead to reduced bioavailability of nitric oxide and increased oxidative stress that damage sensitive vascular cells. In this respect, we and others have demonstrated that oxidative stress is one of the earliest pathological changes in the brain of Alzheimer disease patients and plays a critical role in the vascular abnormalities underlying metabolic defects in Alzheimer disease. Here, we discuss vascular factors in relation to Alzheimer disease and review hypoperfusion as a potential cause by triggering mitochondrial dysfunction and increased oxidative stress initiating the pathogenic process.
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Affiliation(s)
- Xiongwei Zhu
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio 44106, USA
| | - Mark A. Smith
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio 44106, USA
| | - Kazuhiro Honda
- Department of Internal Medicine, Shinmatsudo Central General Hospital, Chiba 270-0034, Japan
| | - Gjumrakch Aliev
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio 44106, USA
| | - Paula I. Moreira
- Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, 3004-517 Coimbra, Portugal
| | - Akihiko Nunomura
- Department of Psychiatry and Neurology, Asahikawa Medical College, Asahikawa 078-8510, Japan
| | - Gemma Casadesus
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio 44106, USA
| | - Peggy L.R. Harris
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio 44106, USA
| | - Sandra L. Siedlak
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio 44106, USA
| | - George Perry
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio 44106, USA
- College of Sciences, University of Texas at San Antonio, San Antonio, Texas 78249-0661, USA
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Mueller SG, Schuff N, Weiner MW. Evaluation of treatment effects in Alzheimer's and other neurodegenerative diseases by MRI and MRS. NMR IN BIOMEDICINE 2006; 19:655-68. [PMID: 16986115 PMCID: PMC1820857 DOI: 10.1002/nbm.1062] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Neurodegeneration refers to a large clinically and pathologically heterogeneous disease entity associated with slowly progressive neuronal loss in different anatomical and functional systems of the brain. Neurodegenerative diseases often affect cognition, e.g. Alzheimer's disease (AD), dementia with Lewy bodies and vascular dementia, or different aspects of the motor system, e.g., amyotrophic lateral sclerosis, Parkinson's disease and ataxic disorders. Owing to increasing knowledge about the mechanisms leading to neurodegeneration, the development of treatments able to modify the neurodegenerative process becomes possible for the first time. Currently, clinical outcome measures are used to assess the efficacy of such treatments. However, most clinical outcome measures have a low test-retest reliability and thus considerable measurement variance. Therefore, large patient populations and long observation times are needed to detect treatment effects. Furthermore, clinical outcome measures cannot distinguish between symptomatic and disease-modifying treatment effects. Therefore, alternative biomarkers including neuroimaging may take on a more important role in this process. Because MR scanners are widely available and allow for non-invasive detection and quantification of changes in brain structure and metabolism, there is increasing interest in the use of MRI/MRS to monitor objectively treatment effects in clinical trials of neurodegenerative diseases. Particularly volumetric MRI has been used to measure atrophy rates in treatment trials of AD because the relationship between atrophic changes and neuron loss is well established and correlates well with clinical measures. More research is needed to determine the value of other MR modalities, i.e. diffusion, perfusion and functional MRI and MR spectroscopy, for clinical trials with neuroprotective drugs.
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Affiliation(s)
- S. G. Mueller
- Center of Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, Department of Radiology, University of California San Francisco, San Francisco, CA 94121, USA
| | - N. Schuff
- Center of Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, Department of Radiology, University of California San Francisco, San Francisco, CA 94121, USA
| | - M. W. Weiner
- Center of Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, Department of Radiology, University of California San Francisco, San Francisco, CA 94121, USA
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Braverman ER, Chen TJH, Schoolfield J, Martinez-Pons M, Arcuri V, Varshavskiy M, Gordon CA, Mengucci J, Blum SH, Meshkin B, Downs BW, Blum K. Delayed P300 latency correlates with abnormal Test of Variables of Attention (TOVA) in adults and predicts early cognitive decline in a clinical setting. Adv Ther 2006; 23:582-600. [PMID: 17050501 DOI: 10.1007/bf02850047] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Delayed P300 latency identifies dementia better than the Mini-Mental Status Exam and, in some cases, the Wechsler Memory Scale (WMS-III). The purpose of this study was to determine whether the outcome of an objective Test of Variables of Attention (TOVA) correlates with the findings of an electrophysiologic test-P300 latency-in patients 40 y of age or older. Adult attention deficit disorder may be an important premorbid marker of memory dysfunction or dementia. In males, the means for P300 latency and age-adjusted P300 latency were significantly greater for patients classified as SD-BL (significantly deviant or borderline: TOVA<-1.0) than for those categorized as normal (TOVA(3)0) for attention failure (ie, omissions [P<.010] and commissions [P<.005]) but not for response time or for variability. Males with >2 SD-BL quarters had significantly delayed P300 latency and age-adjusted P300 latency compared with males who had 0 SD-BL quarters (P<.020) and 1 SD-BL quarter (P<.005). In females, the means for P300 latency and age-adjusted P300 latency were significantly delayed for those grouped as SD-BL than for those labeled normal for response time (P<.001) and variability (P<.010), but not for omissions or for commissions. Females with >2 SD-BL quarters had significantly delayed P300 latency and age-adjusted P300 latency compared with females who had 0 SD-BL quarters (P<.005) and 1 SD-BL quarter (P<.010). Results suggest that TOVA abnormalities may be an indicator of delayed P300 and attention disorder. Recent research correlates TOVA abnormalities with impaired WMS scores of early dementia. Coupling of TOVA assessment findings with results of P300, Mini-Mental Status Exam, and WMS-III may allow for enhanced accuracy in the diagnosis and evaluation of the complex pathway of failing attention, memory, and cognition that leads to dementia.
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Babiloni C, Cassetta E, Dal Forno G, Del Percio C, Ferreri F, Ferri R, Lanuzza B, Miniussi C, Moretti DV, Nobili F, Pascual-Marqui RD, Rodriguez G, Luca Romani G, Salinari S, Zanetti O, Rossini PM. Donepezil effects on sources of cortical rhythms in mild Alzheimer's disease: Responders vs. Non-Responders. Neuroimage 2006; 31:1650-65. [PMID: 16600641 DOI: 10.1016/j.neuroimage.2006.02.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 02/01/2006] [Accepted: 02/03/2006] [Indexed: 11/20/2022] Open
Abstract
Acetylcholinesterase inhibitors (AChEI) such as donepezil act in mild Alzheimer's disease (AD) by increasing cholinergic tone. Differences in the clinical response in patients who do or do not benefit from therapy may be due to different functional features of the central neural systems. We tested this hypothesis using cortical electroencephalographic (EEG) rhythmicity. Resting eyes-closed EEG data were recorded in 58 mild AD patients (Mini Mental State Examination [MMSE] range 17-24) before and approximately 1 year after standard donepezil treatment. Based on changes of MMSE scores between baseline and follow-up, 28 patients were classified as "Responders" (MMSEvar >or=0) and 30 patients as "Non-Responders" (MMSEvar <0). EEG rhythms of interest were delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), and beta 2 (20-30 Hz). Cortical EEG sources were studied with low-resolution brain electromagnetic tomography (LORETA). Before treatment, posterior sources of delta, alpha 1 and alpha 2 frequencies were greater in amplitude in Non-Responders. After treatment, a lesser magnitude reduction of occipital and temporal alpha 1 sources characterized Responders. These results suggest that Responders and Non-Responders had different EEG cortical rhythms. Donepezil could act by reactivating existing yet functionally silent cortical synapses in Responders, restoring temporal and occipital alpha rhythms.
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Affiliation(s)
- Claudio Babiloni
- Dip. Fisiologia Umana e Farmacologia, Univ. La Sapienza, Rome, Italy.
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Abstract
In spite of its origins deeply rooted in the discipline, pharmaco-EEG applications in psychiatry remain limited to its achievements in the field of psychotropic drugs classification and, in few instances, discovery. In the present paper two attempts to transfer pharmaco-EEG methods to psychiatric clinical routine will be described: 1) monitoring of psychotropic drug toxicity at the central nervous system level, and 2) prediction of clinical response to treatment with psychotropic drugs. Both applications have been the object of several investigations providing promising and sometimes consistent findings which, however, had no impact on clinical practice. For the first topic, the review is limited to antipsychotics, lithium and recreational drugs, as for other psychotropic drugs mostly case studies are available, while for the response prediction it will include antipsychotics, antidepressants, anxiolytics, psychostimulants and nootropics. In spite of several methodological limitations, pharmaco-EEG studies dealing with monitoring of antipsychotic- and lithium-induced EEG abnormalities went close to, but never became, a clinical routine. EEG studies of recreational drugs are flawed by several limitations, and failed, so far, to identify reliable indices of CNS toxicity to be used in clinical settings. Several QEEG studies on early predictors of treatment response to first generation antipsychotics have produced consistent findings, but had no clinical impact. For other psychotropic drug classes few and inconsistent reports have appeared. Pharmaco-EEG had the potential for important clinical applications, but so far none of them entered clinical routine. The ability to upgrade theories and methods and promote large scale studies represent the future challenge.
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Affiliation(s)
- Armida Mucci
- Department of Psychiatry, University of Naples SUN, Naples, Italy.
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Claassen JAHR, Jansen RWMM. Cholinergically Mediated Augmentation of Cerebral Perfusion in Alzheimer's Disease and Related Cognitive Disorders: The Cholinergic-Vascular Hypothesis. J Gerontol A Biol Sci Med Sci 2006; 61:267-71. [PMID: 16567376 DOI: 10.1093/gerona/61.3.267] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The treatment of Alzheimer's disease (AD) with cholinesterase inhibitors (ChEIs) is based on the cholinergic hypothesis. This hypothesis fails to account for the global nature of the clinical effects of ChEIs, for the replication of these effects in other dementias, and for the strong and unpredictable intraindividual variation in response to treatment. These findings may be better explained by the premise that ChEIs primarily act by augmenting cerebral perfusion: the cholinergic-vascular hypothesis. This article will review the evidence from preclinical and clinical investigations on the vascular role of the cholinergic neural system. The clinical relevance of this hypothesis is discussed with respect to its interactions with the vascular and amyloid hypotheses of AD. Implications for treatment are indicated. Finally, we propose that the role of the cholinergic system in neurovascular regulation and functional hyperemia elucidates how the cholinergic deficit in AD contributes to the clinical and pathological features of this disease.
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Affiliation(s)
- Jurgen A H R Claassen
- Department of Geriatric Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Firbank MJ, Burn DJ, McKeith IG, O'Brien JT. Longitudinal study of cerebral blood flow SPECT in Parkinson's disease with dementia, and dementia with Lewy bodies. Int J Geriatr Psychiatry 2005; 20:776-82. [PMID: 16035122 DOI: 10.1002/gps.1359] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND People with Parkinson's disease (PD) have an increased risk of developing dementia (PDD), which often has clinical features similar to dementia with Lewy bodies (DLB). Whilst perfusion studies have shown parieto-occipital hypoperfusion in DLB and PDD relative to controls, there have not been any longitudinal studies of perfusion changes in PDD and DLB. METHODS In this study, we measured brain perfusion using Tc99m HMPAO SPECT over one year in 17 PDD, 18 DLB and 34 healthy subjects. We used SPM99 to compare perfusion changes in the two dementia groups against the control group. RESULTS We did not see any reductions in perfusion in either of the dementia groups. However, in the DLB, but not PDD group, there was a significant increase in putamen perfusion relative to controls over the year. In both DLB and PDD groups, there was a correlation between striatal perfusion increase over the year, and worsening of parkinsonism. Perfusion changes were not secondary to changes in antiparkinsonian medication. CONCLUSION The increase in striatal perfusion may be a compensatory change related to decreasing striatal dopaminergic input from the substantia nigra in PDD and DLB, consistent with the increased predominance of rigidity over tremor symptoms in these groups compared with non-demented PD.
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Affiliation(s)
- Michael J Firbank
- The Institute for Ageing and Health, University of Newcastle upon Tyne, UK.
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O'Brien JT, Firbank MJ, Mosimann UP, Burn DJ, McKeith IG. Change in perfusion, hallucinations and fluctuations in consciousness in dementia with Lewy bodies. Psychiatry Res 2005; 139:79-88. [PMID: 15964748 DOI: 10.1016/j.pscychresns.2005.04.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Revised: 04/22/2005] [Accepted: 04/26/2005] [Indexed: 10/25/2022]
Abstract
Fluctuations in consciousness and visual hallucinations are common neuropsychiatric features of dementia with Lewy bodies and Parkinson's disease dementia. To investigate potential neural correlates, we compared how changes in brain perfusion over a 1-year period were related to changes in the severity of these key clinical features. We recruited 29 subjects with either Parkinson's disease with dementia (15 subjects) or dementia with Lewy bodies (14 subjects). Cerebral perfusion was measured using HMPAO SPECT at baseline, and repeated 1 year later. The presence of hallucinations (Neuropsychiatric Inventory), severity of fluctuations in consciousness (fluctuation assessment scale) and cognitive ability (CAMCOG) were assessed at both time points. After controlling for changes in cognitive ability and effect of cholinesterase medication, we found a significant correlation between an increase in perfusion in midline posterior cingulate and decrease in hallucination severity. There was also a significant correlation between increased fluctuations of consciousness and increased thalamic and decreased inferior occipital perfusion. We have identified important neural correlates of key clinical features in Lewy body dementia and postulate that the associations can be understood through the influence of the cholinergic system on attention.
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Affiliation(s)
- John T O'Brien
- Institute for Ageing and Health, University of Newcastle upon Tyne, Wolfson Research Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
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Stefanova E, Wall A, Almkvist O, Nilsson A, Forsberg A, Långström B, Nordberg A. Longitudinal PET evaluation of cerebral glucose metabolism in rivastigmine treated patients with mild Alzheimer’s disease. J Neural Transm (Vienna) 2005; 113:205-18. [PMID: 16049637 DOI: 10.1007/s00702-005-0312-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2004] [Accepted: 03/25/2005] [Indexed: 10/25/2022]
Abstract
In this study 11 patients with mild Alzheimer's disease (AD) were treated with the cholinesterase inhibitor rivastigmine (mean dose 8.6 +/- 1.3'mg) for 12 months and underwent positron emission tomography (PET) studies of cerebral glucose metabolism (CMRglc) and neuropsychological testing at baseline and after 12 months. An untreated group of 10 AD patients served as control group. While the untreated AD patients showed a significant decline of CMRglc in the temporo-parietal and frontal cortical regions after 12 months follow-up the rivastigmine-treated patients showed no decline in CMRglc in corresponding cortical brain regions. Furthermore, a significant dose-related increase in CMRglc was recorded in the right frontal association region after 12 months rivastigmine treatment. A positive correlation was observed between changes in CMRglc and several cognitive tests in patients receiving higher doses (10.5-12'mg) of rivastigmine. These results suggest a stabilization effect of rivastigmine on CMRglc in mild AD patients receiving long-term rivastigmine treatment.
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Affiliation(s)
- E Stefanova
- Division of Molecular Neuropharmacology, Neurotec Department, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Nobili F, Brugnolo A, Calvini P, Copello F, De Leo C, Girtler N, Morbelli S, Piccardo A, Vitali P, Rodriguez G. Resting SPECT-neuropsychology correlation in very mild Alzheimer's disease. Clin Neurophysiol 2005; 116:364-75. [PMID: 15661114 DOI: 10.1016/j.clinph.2004.09.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2004] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the relationships between brain function and some of the most frequently impaired cognitive domains in the first stages of Alzheimer's disease (AD), we searched for correlation between the scores on 3 neuropsychological tests and brain perfusion, assessed by single photon emission computed tomography (SPECT) in patients with very mild AD. METHODS Twenty-nine consecutive outpatients (mean age 78.2+/-5.5) affected by probable AD in the very mild phase (i.e. with a score > or =20 on the mini-mental state examination, MMSE) underwent brain SPECT with (99m)Tc-ethylcisteinate dimer. For correlative purposes, word list learning (by the selective reminding test, SRT), constructional praxis test (CPT) and visual search test (VST) were chosen a priori out of an extended battery employed to diagnose AD at first patient evaluation. Voxel-based correlation analysis was achieved by statistical parametric mapping (SPM99) with a height threshold of P=0.005. Age, years of education and the MMSE score were inserted in the correlative analysis as confounding variables. RESULTS The SRT score showed correlation with brain perfusion in 3 clusters of the left hemisphere, including the post-central gyrus, the parietal precuneus, the inferior parietal lobule and the middle temporal gyrus, and in one cluster in the right hemisphere including the middle temporal gyrus and the middle occipital gyrus. The CPT score was significantly correlated with brain perfusion in the parietal precuneus and the posterior cingulate gyrus in the left hemisphere, whereas the VST score gave a significant correlation with brain perfusion in a left cluster including the parietal precuneus and the superior temporal gyrus. CONCLUSIONS Cognitive impairment in very mild AD is reflected by brain dysfunction in posterior associative areas, with peculiar topographical differences proper of each domain. The parietal precuneus was a common site of correlation of all 3 neuropsychological tests. This region, together with the posterior cingulate and the superficial posterior temporal-parietal cortex, is thought to be affected by disconnection from the mesial temporal lobe, besides being directly affected by increased oxidative stress and by atrophy as well. The impairment of these areas is thought to contribute to cognitive decline in verbal memory, constructional praxis and visual sustained attention which are indeed among the earliest signs of cognitive impairment in AD. SIGNIFICANCE Assessing the relationships between neuropsychology and brain functional imaging is a key approach to clarify the pathophysiology of cognitive failure in AD; the specificity of these findings in AD remains to be proven through comparison with correlation achieved in matched controls.
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Affiliation(s)
- Flavio Nobili
- Section of Clinical Neurophysiology (DISEM), Department of Endocrinological and Metabolic Sciences, University of Genoa, Viale Benedetto XV, 6, I-16132 Genoa, Italy.
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Yao D, Wang L, Oostenveld R, Nielsen KD, Arendt-Nielsen L, Chen ACN. A comparative study of different references for EEG spectral mapping: the issue of the neutral reference and the use of the infinity reference. Physiol Meas 2005; 26:173-84. [PMID: 15798293 DOI: 10.1088/0967-3334/26/3/003] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Based on EEG data recorded from 11 subjects with eyes open and the left mastoid (M) reference, three data sets were generated by re-referencing to the conventional linked mastoids (L), average (A) and the new 'infinity' (I) reference provided by the reference electrode standardization technique (REST, Yao 2001 Physiol. Meas. 22 693-711). The EEG power in the alpha frequency band with the four different references was calculated and compared with respect to the total energy and spatial amplitude weight centre (AWC) coordinates, to compare the effects of different references on power mapping in the frequency domain. Compared with the I reference, the AWCs of the EEG with the M reference show significant shifts to the right, frontal and superficial positions, the L reference significant shifts to frontal and superficial positions, and the A reference shifts the AWC significantly to a deeper position. Furthermore, the power maps of the M and L references have larger total power than the I reference, while that of the A reference has the smallest total power. These results confirm that different choices of reference electrodes result in systematic changes in the distribution of EEG frequency power, and in order to reduce the effect of such systematic shifts on the explanation of EEG mappings, a common reference is necessary for EEG research. We recommend the I reference for objective use in cross-laboratory studies and clinical practices, as it is far from all the other electrodes and can act as a neutral reference.
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Affiliation(s)
- Dezhong Yao
- Human Brain Mapping and Cortical Imaging Laboratory, Centre for Sensory Motor Interaction, Aalborg University, Fredrik Bajers Vej 7D3, Aalborg 9220, Denmark.
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