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Shi M, Tang L, Toledo JB, Ginghina C, Wang H, Aro P, Jensen PH, Weintraub D, Chen-Plotkin AS, Irwin DJ, Grossman M, McCluskey L, Elman LB, Wolk DA, Lee EB, Shaw LM, Trojanowski JQ, Zhang J. Cerebrospinal fluid α-synuclein contributes to the differential diagnosis of Alzheimer's disease. Alzheimers Dement 2018; 14:1052-1062. [PMID: 29604263 DOI: 10.1016/j.jalz.2018.02.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/08/2017] [Accepted: 02/07/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The ability of Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers (amyloid β peptide 1-42, total tau, and phosphorylated tau) to discriminate AD from related disorders is limited. Biomarkers for other concomitant pathologies (e.g., CSF α-synuclein [α-syn] for Lewy body pathology) may be needed to further improve the differential diagnosis. METHODS CSF total α-syn, phosphorylated α-syn at Ser129, and AD CSF biomarkers were evaluated with Luminex immunoassays in 367 participants, followed by validation in 74 different neuropathologically confirmed cases. RESULTS CSF total α-syn, when combined with amyloid β peptide 1-42 and either total tau or phosphorylated tau, improved the differential diagnosis of AD versus frontotemporal dementia, Lewy body disorders, or other neurological disorders. The diagnostic accuracy of the combined models attained clinical relevance (area under curve ∼0.9) and was largely validated in neuropathologically confirmed cases. DISCUSSION Combining CSF biomarkers representing AD and Lewy body pathologies may have clinical value in the differential diagnosis of AD.
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Affiliation(s)
- Min Shi
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Lu Tang
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA; Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Jon B Toledo
- Departments of Pathology and Laboratory Medicine, Psychiatry, Neurology and Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carmen Ginghina
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Hua Wang
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA; Department of Pathology, Peking University Health Science Centre and Third Hospital, Beijing, China
| | - Patrick Aro
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Poul H Jensen
- DANDRITE-Danish Research Institute of Translational Neuroscience & Department of Biomedicine, University of Aarhus, Aarhus, Denmark
| | - Daniel Weintraub
- Departments of Pathology and Laboratory Medicine, Psychiatry, Neurology and Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alice S Chen-Plotkin
- Departments of Pathology and Laboratory Medicine, Psychiatry, Neurology and Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David J Irwin
- Departments of Pathology and Laboratory Medicine, Psychiatry, Neurology and Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Murray Grossman
- Departments of Pathology and Laboratory Medicine, Psychiatry, Neurology and Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Leo McCluskey
- Departments of Pathology and Laboratory Medicine, Psychiatry, Neurology and Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren B Elman
- Departments of Pathology and Laboratory Medicine, Psychiatry, Neurology and Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Departments of Pathology and Laboratory Medicine, Psychiatry, Neurology and Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Edward B Lee
- Departments of Pathology and Laboratory Medicine, Psychiatry, Neurology and Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Leslie M Shaw
- Departments of Pathology and Laboratory Medicine, Psychiatry, Neurology and Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John Q Trojanowski
- Departments of Pathology and Laboratory Medicine, Psychiatry, Neurology and Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jing Zhang
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA; Department of Pathology, Peking University Health Science Centre and Third Hospital, Beijing, China.
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Ranasinghe KG, Rankin KP, Lobach IV, Kramer JH, Sturm VE, Bettcher BM, Possin K, Christine You S, Lamarre AK, Shany-Ur T, Stephens ML, Perry DC, Lee SE, Miller ZA, Gorno-Tempini ML, Rosen HJ, Boxer A, Seeley WW, Rabinovici GD, Vossel KA, Miller BL. Cognition and neuropsychiatry in behavioral variant frontotemporal dementia by disease stage. Neurology 2016; 86:600-10. [PMID: 26802093 DOI: 10.1212/wnl.0000000000002373] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/19/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To characterize the cognitive and neuropsychiatric symptoms of patients with behavioral variant frontotemporal dementia (bvFTD) over the natural course of the disease. METHODS We examined the initial and subsequent neuropsychological test performance and neuropsychiatric symptoms in a large cohort of patients with bvFTD (n = 204) across progressive stages of disease as measured by the Clinical Dementia Rating (CDR). We also compared cognitive and neuropsychiatric impairments of patients with bvFTD to those of an age-matched cohort with Alzheimer disease (AD) dementia (n = 674). RESULTS At the earliest stage (CDR = 0.5), patients with bvFTD had profound neuropsychiatric disturbances, insensitivity to errors, slower response times, and poor naming, with intact attention span, memory, and facial affect naming. Tests continuing to show progressive, statistically significant stepwise declines after the CDR = 1 stage included free recall, visuoconstruction, set-shifting, error insensitivity, semantic fluency, design fluency, emotion naming, calculations, confrontation naming, syntax comprehension, and verbal agility. At CDR = 0.5, patients with bvFTD significantly outperformed patients with AD in episodic memory and were faster in set-shifting, while scoring quantitatively worse in lexical fluency, emotion naming, and error sensitivity. The overall rate of disease progression in bvFTD was more rapid than in AD. CONCLUSION There are distinct patterns of cognitive deficits differentiating the earlier and later disease stages in bvFTD, with the pattern of cognitive decline revealing in greater detail the natural history of the disease. These cognitive symptoms are readily apparent clinical markers of dysfunction in the principal brain networks known to undergo molecular and anatomical changes in bvFTD, thus are important indicators of the evolving pathology in individual patients.
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Affiliation(s)
- Kamalini G Ranasinghe
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Katherine P Rankin
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA.
| | - Iryna V Lobach
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Joel H Kramer
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Virginia E Sturm
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Brianne M Bettcher
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Katherine Possin
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - S Christine You
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Amanda K Lamarre
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Tal Shany-Ur
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Melanie L Stephens
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - David C Perry
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Suzee E Lee
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Zachary A Miller
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Maria L Gorno-Tempini
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Howard J Rosen
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Adam Boxer
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - William W Seeley
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Gil D Rabinovici
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Keith A Vossel
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
| | - Bruce L Miller
- From the Memory and Aging Center (K.G.R., K.P.R., I.V.L., J.H.K., V.E.S., B.M.B., K.P., S.C.Y., A.K.L., T.S.-U., M.L.S., D.C.P., S.E.L., Z.A.M., M.L.G.-T., H.J.R., A.B., W.W.S., G.D.R., K.A.V., B.L.M.), Department of Neurology, University of California, San Francisco; Departments of Neurosurgery and Neurology (B.M.B.), University of Colorado Anschutz School of Medicine, Aurora; and Gladstone Institute of Neurological Disease (K.A.V.), CA
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