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Shafiei SB, Shadpour S, Shafqat A. Mental workload evaluation using weighted phase lag index and coherence features extracted from EEG data. Brain Res Bull 2024; 214:110992. [PMID: 38825253 DOI: 10.1016/j.brainresbull.2024.110992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/26/2024] [Accepted: 05/30/2024] [Indexed: 06/04/2024]
Abstract
Electroencephalogram (EEG) represents an effective, non-invasive technology to study mental workload. However, volume conduction, a common EEG artifact, influences functional connectivity analysis of EEG data. EEG coherence has been used traditionally to investigate functional connectivity between brain areas associated with mental workload, while weighted Phase Lag Index (wPLI) is a measure that improves on coherence by reducing susceptibility to volume conduction, a common EEG artifact. The goal of this study was to compare two methods of functional connectivity analysis, wPLI and coherence, in the context of mental workload evaluation. The study involved model development for mental workload domains and comparing their performance using coherence-based features, wPLI-based features, and a combination of both. Generalized linear mixed-effects model (GLMM) with the least absolute shrinkage and selection operator (LASSO) feature selection method was used for model development. Results indicated that the model developed using a combination of both feature types demonstrated improved predictive performance across all mental workload domains, compared to models that used each feature type individually. The R2 values were 0.82 for perceived task complexity, 0.71 for distraction, 0.91 for mental demand, 0.85 for physical demand, 0.74 for situational stress, and 0.74 for temporal demand. Furthermore, task complexity and functional connectivity patterns in different brain areas were identified as significant contributors to perceived mental workload (p-value<0.05). Findings showed the potential of using EEG data for mental workload evaluation which suggests that combination of coherence and wPLI can improve the accuracy of mental workload domains prediction. Future research should aim to validate these results on larger, diverse datasets to confirm their generalizability and refine the predictive models.
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Affiliation(s)
- Somayeh B Shafiei
- the Intelligent Cancer Care Laboratory, the Department of Urology, Roswell Park Comprehensive Cancer Center in Buffalo, NY 14263, USA.
| | - Saeed Shadpour
- the Department of Animal Biosciences, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Ambreen Shafqat
- the Intelligent Cancer Care Laboratory, the Department of Urology, Roswell Park Comprehensive Cancer Center in Buffalo, NY 14263, USA
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2
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Deng J, Sun B, Kavcic V, Liu M, Giordani B, Li T. Novel methodology for detection and prediction of mild cognitive impairment using resting-state EEG. Alzheimers Dement 2024; 20:145-158. [PMID: 37496373 PMCID: PMC10811294 DOI: 10.1002/alz.13411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Early discrimination and prediction of cognitive decline are crucial for the study of neurodegenerative mechanisms and interventions to promote cognitive resiliency. METHODS Our research is based on resting-state electroencephalography (EEG) and the current dataset includes 137 consensus-diagnosed, community-dwelling Black Americans (ages 60-90 years, 84 healthy controls [HC]; 53 mild cognitive impairment [MCI]) recruited through Wayne State University and Michigan Alzheimer's Disease Research Center. We conducted multiscale analysis on time-varying brain functional connectivity and developed an innovative soft discrimination model in which each decision on HC or MCI also comes with a connectivity-based score. RESULTS The leave-one-out cross-validation accuracy is 91.97% and 3-fold accuracy is 91.17%. The 9 to 18 months' progression trend prediction accuracy over an availability-limited subset sample is 84.61%. CONCLUSION The EEG-based soft discrimination model demonstrates high sensitivity and reliability for MCI detection and shows promising capability in proactive prediction of people at risk of MCI before clinical symptoms may occur.
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Affiliation(s)
- Jinxian Deng
- Department of Electrical and Computer EngineeringMichigan State UniversityEast LansingMichiganUSA
| | - Boxin Sun
- Department of Electrical and Computer EngineeringMichigan State UniversityEast LansingMichiganUSA
| | - Voyko Kavcic
- Institute of GerontologyWayne State UniversityDetroitMichiganUSA
- International Institute of Applied GerontologyLjubljanaSlovenia
| | - Mingyan Liu
- Department of Electrical Engineering and Computer ScienceUniversity of MichiganAnn ArborMichiganUSA
| | - Bruno Giordani
- Departments of PsychiatryNeurologyPsychology and School of NursingUniversity of MichiganAnn ArborMichiganUSA
- Michigan Alzheimer's Disease Research CenterAnn ArborMichiganUSA
| | - Tongtong Li
- Department of Electrical and Computer EngineeringMichigan State UniversityEast LansingMichiganUSA
- Michigan Alzheimer's Disease Research CenterAnn ArborMichiganUSA
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3
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Chino B, Torres-Simón L, Żelwetro A, Rodríguez-Rojo IC, Carnes-Vendrell A, Piñol-Ripoll G, Yubero R, Paúl N, Maestú F. Understanding the Episodic Memory and Executive Functioning Axis Impairment in MCI Patients: A Multicenter Study in Comparison with CSF Biomarkers. Biomedicines 2023; 11:3147. [PMID: 38137368 PMCID: PMC10741228 DOI: 10.3390/biomedicines11123147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/06/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND This study aimed to explore the association between a verbal learning task that evaluates the potential mutual dependency between memory and executive functions (i.e., the Test of Memory Strategies, TMS) and cerebrospinal fluid (CSF) Alzheimer's Disease (AD) biomarkers. METHODS A sample of 47 mild cognitive impairment (MCI) participants from Poland and Spain were classified according to the Erlangen Score Diagnostic Algorithm (ESA) into CSF- (n = 16) and CSF+ (n = 31) groups. Correlation analyses between TMS word-list conditions and CSF biomarkers were conducted. Additionally, an analysis of covariance was performed to define the effect on ESA classification in the sample, using as a covariable the country of origin of the participants. RESULTS Significant associations between the TMS-3 condition and Aβ42, t-tau, and p-tau were observed for the whole sample. In addition, the CSF- participants obtained higher cognitive performance in TMS-3 compared to the CSF+ group. This outcome persisted if the groups were based on Aβ42 scores, but not t-tau or p-tau values. CONCLUSIONS These findings could indicate that poor performance on verbal learning tests may be affected by executive dysfunctions. Therefore, future intervention plans focused on training executive functions would be of interest to improve the ability of MCI patients to encode and organize information.
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Affiliation(s)
- Brenda Chino
- Institute of Neuroscience, Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain;
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.T.-S.); (F.M.)
| | - Lucía Torres-Simón
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.T.-S.); (F.M.)
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Agnieszka Żelwetro
- Interdisciplinary Doctoral School, SWPS University of Social Sciences and Humanities, 53-238 Wrocław, Poland;
- Alzheimer’s Disease Research, Center in Ścinawa, 59-330 Ścinawa, Poland
| | - Inmaculada Concepción Rodríguez-Rojo
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.T.-S.); (F.M.)
- Department of Nursing and Physiotherapy, Faculty of Medicine and Health Sciences, Universidad de Alcalá, 28801 Madrid, Spain
| | - Anna Carnes-Vendrell
- Unitat de Trastorns Cognitius, Cognition and Behavior Study Group, Universitat de Lleida, IRBLleida, 25198 Lleida, Spain; (A.C.-V.); (G.P.-R.)
| | - Gerard Piñol-Ripoll
- Unitat de Trastorns Cognitius, Cognition and Behavior Study Group, Universitat de Lleida, IRBLleida, 25198 Lleida, Spain; (A.C.-V.); (G.P.-R.)
| | - Raquel Yubero
- Neurology Department, Hospital Quirónsalud Madrid, 28223 Madrid, Spain;
| | - Nuria Paúl
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Fernando Maestú
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.T.-S.); (F.M.)
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Instituto de Investigación del Hospital Clínico San Carlos, 28040 Madrid, Spain
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4
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Mazzeo S, Lassi M, Padiglioni S, Vergani AA, Moschini V, Scarpino M, Giacomucci G, Burali R, Morinelli C, Fabbiani C, Galdo G, Amato LG, Bagnoli S, Emiliani F, Ingannato A, Nacmias B, Sorbi S, Grippo A, Mazzoni A, Bessi V. PRedicting the EVolution of SubjectIvE Cognitive Decline to Alzheimer's Disease With machine learning: the PREVIEW study protocol. BMC Neurol 2023; 23:300. [PMID: 37573339 PMCID: PMC10422810 DOI: 10.1186/s12883-023-03347-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND As disease-modifying therapies (DMTs) for Alzheimer's disease (AD) are becoming a reality, there is an urgent need to select cost-effective tools that can accurately identify patients in the earliest stages of the disease. Subjective Cognitive Decline (SCD) is a condition in which individuals complain of cognitive decline with normal performances on neuropsychological evaluation. Many studies demonstrated a higher prevalence of Alzheimer's pathology in patients diagnosed with SCD as compared to the general population. Consequently, SCD was suggested as an early symptomatic phase of AD. We will describe the study protocol of a prospective cohort study (PREVIEW) that aim to identify features derived from easily accessible, cost-effective and non-invasive assessment to accurately detect SCD patients who will progress to AD dementia. METHODS We will include patients who self-referred to our memory clinic and are diagnosed with SCD. Participants will undergo: clinical, neurologic and neuropsychological examination, estimation of cognitive reserve and depression, evaluation of personality traits, APOE and BDNF genotyping, electroencephalography and event-related potential recording, lumbar puncture for measurement of Aβ42, t-tau, and p-tau concentration and Aβ42/Aβ40 ratio. Recruited patients will have follow-up neuropsychological examinations every two years. Collected data will be used to train a machine learning algorithm to define the risk of being carriers of AD and progress to dementia in patients with SCD. DISCUSSION This is the first study to investigate the application of machine learning to predict AD in patients with SCD. Since all the features we will consider can be derived from non-invasive and easily accessible assessments, our expected results may provide evidence for defining cost-effective and globally scalable tools to estimate the risk of AD and address the needs of patients with memory complaints. In the era of DMTs, this will have crucial implications for the early identification of patients suitable for treatment in the initial stages of AD. TRIAL REGISTRATION NUMBER (TRN) NCT05569083.
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Affiliation(s)
- Salvatore Mazzeo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michael Lassi
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sonia Padiglioni
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Regional Referral Centre for Relational Criticalities - Tuscany Region, Florence, Italy
| | - Alberto Arturo Vergani
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Valentina Moschini
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Giulia Giacomucci
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy
| | | | - Carmen Morinelli
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Giulia Galdo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy
| | - Lorenzo Gaetano Amato
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy
| | - Filippo Emiliani
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy
| | - Assunta Ingannato
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Alberto Mazzoni
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Valentina Bessi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy.
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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5
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Tăuƫan AM, Casula EP, Pellicciari MC, Borghi I, Maiella M, Bonni S, Minei M, Assogna M, Palmisano A, Smeralda C, Romanella SM, Ionescu B, Koch G, Santarnecchi E. TMS-EEG perturbation biomarkers for Alzheimer's disease patients classification. Sci Rep 2023; 13:7667. [PMID: 37169900 PMCID: PMC10175269 DOI: 10.1038/s41598-022-22978-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/21/2022] [Indexed: 05/13/2023] Open
Abstract
The combination of TMS and EEG has the potential to capture relevant features of Alzheimer's disease (AD) pathophysiology. We used a machine learning framework to explore time-domain features characterizing AD patients compared to age-matched healthy controls (HC). More than 150 time-domain features including some related to local and distributed evoked activity were extracted from TMS-EEG data and fed into a Random Forest (RF) classifier using a leave-one-subject out validation approach. The best classification accuracy, sensitivity, specificity and F1 score were of 92.95%, 96.15%, 87.94% and 92.03% respectively when using a balanced dataset of features computed globally across the brain. The feature importance and statistical analysis revealed that the maximum amplitude of the post-TMS signal, its Hjorth complexity and the amplitude of the TEP calculated in the window 45-80 ms after the TMS-pulse were the most relevant features differentiating AD patients from HC. TMS-EEG metrics can be used as a non-invasive tool to further understand the AD pathophysiology and possibly contribute to patients' classification as well as longitudinal disease tracking.
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Affiliation(s)
- Alexandra-Maria Tăuƫan
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- AI Multimedia Lab, Research Center CAMPUS, University Politehnica of Bucharest, 061344, Bucharest, Romania
| | - Elias P Casula
- Santa Lucia Foundation, 00179, Rome, Italy
- Department of Psychology, La Sapienza University, Via dei Marsi 78, 00185, Rome, Italy
| | | | | | | | | | | | | | - Annalisa Palmisano
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Carmelo Smeralda
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
| | - Sara M Romanella
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
| | - Bogdan Ionescu
- AI Multimedia Lab, Research Center CAMPUS, University Politehnica of Bucharest, 061344, Bucharest, Romania
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, Section of Human Physiology, University of Ferrara, 44121, Ferrara, Italy
- Santa Lucia Foundation, 00179, Rome, Italy
| | - Emiliano Santarnecchi
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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6
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Lassi M, Fabbiani C, Mazzeo S, Burali R, Vergani AA, Giacomucci G, Moschini V, Morinelli C, Emiliani F, Scarpino M, Bagnoli S, Ingannato A, Nacmias B, Padiglioni S, Micera S, Sorbi S, Grippo A, Bessi V, Mazzoni A. Degradation of EEG microstates patterns in subjective cognitive decline and mild cognitive impairment: Early biomarkers along the Alzheimer's Disease continuum? Neuroimage Clin 2023; 38:103407. [PMID: 37094437 PMCID: PMC10149415 DOI: 10.1016/j.nicl.2023.103407] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/29/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
Alzheimer's disease (AD) pathological changes may begin up to decades earlier than the appearance of the first symptoms of cognitive decline. Subjective cognitive decline (SCD) could be the first pre-clinical sign of possible AD, which might be followed by mild cognitive impairment (MCI), the initial stage of clinical cognitive decline. However, the neural correlates of these prodromic stages are not completely clear yet. Recent studies suggest that EEG analysis tools characterizing the cortical activity as a whole, such as microstates and cortical regions connectivity, might support a characterization of SCD and MCI conditions. Here we test this approach by performing a broad set of analyses to identify the prominent EEG markers differentiating SCD (n = 57), MCI (n = 46) and healthy control subjects (HC, n = 19). We found that the salient differences were in the temporal structure of the microstates patterns, with MCI being associated with less complex sequences due to the altered transition probability, frequency and duration of canonic microstate C. Spectral content of EEG, network connectivity, and spatial arrangement of microstates were instead largely similar in the three groups. Interestingly, comparing properties of EEG microstates in different cerebrospinal fluid (CSF) biomarkers profiles, we found that canonic microstate C displayed significant differences in topography in AD-like profile. These results show that the progression of dementia might be associated with a degradation of the cortical organization captured by microstates analysis, and that this leads to altered transitions between cortical states. Overall, our approach paves the way for the use of non-invasive EEG recordings in the identification of possible biomarkers of progression to AD from its prodromal states.
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Affiliation(s)
- Michael Lassi
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Sant'Anna School of Advanced Studies, viale Rinaldo Piaggio 34, 56025 Pisa, Italy
| | - Carlo Fabbiani
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci, 269, 50143 Florence, Italy
| | - Salvatore Mazzeo
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci, 269, 50143 Florence, Italy; Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Careggi University Hospital, viale Gaetano Pieraccini, 6, 50139 Florence, Italy
| | - Rachele Burali
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci, 269, 50143 Florence, Italy
| | - Alberto Arturo Vergani
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Sant'Anna School of Advanced Studies, viale Rinaldo Piaggio 34, 56025 Pisa, Italy
| | - Giulia Giacomucci
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Careggi University Hospital, viale Gaetano Pieraccini, 6, 50139 Florence, Italy
| | - Valentina Moschini
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Careggi University Hospital, viale Gaetano Pieraccini, 6, 50139 Florence, Italy
| | - Carmen Morinelli
- Dipartimento Neuromuscolo-scheletrico e degli organi di senso, Careggi University Hospital, 50134 Florence, Italy
| | - Filippo Emiliani
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Careggi University Hospital, viale Gaetano Pieraccini, 6, 50139 Florence, Italy
| | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci, 269, 50143 Florence, Italy
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Careggi University Hospital, viale Gaetano Pieraccini, 6, 50139 Florence, Italy
| | - Assunta Ingannato
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Careggi University Hospital, viale Gaetano Pieraccini, 6, 50139 Florence, Italy
| | - Benedetta Nacmias
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci, 269, 50143 Florence, Italy; Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Careggi University Hospital, viale Gaetano Pieraccini, 6, 50139 Florence, Italy
| | - Sonia Padiglioni
- Regional Referral Centre for Relational Criticalities - Tuscany Region, 50139 Florence, Italy
| | - Silvestro Micera
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Sant'Anna School of Advanced Studies, viale Rinaldo Piaggio 34, 56025 Pisa, Italy; Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci, 269, 50143 Florence, Italy; Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Careggi University Hospital, viale Gaetano Pieraccini, 6, 50139 Florence, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci, 269, 50143 Florence, Italy
| | - Valentina Bessi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Careggi University Hospital, viale Gaetano Pieraccini, 6, 50139 Florence, Italy
| | - Alberto Mazzoni
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Sant'Anna School of Advanced Studies, viale Rinaldo Piaggio 34, 56025 Pisa, Italy.
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7
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Hampel H, Gao P, Cummings J, Toschi N, Thompson PM, Hu Y, Cho M, Vergallo A. The foundation and architecture of precision medicine in neurology and psychiatry. Trends Neurosci 2023; 46:176-198. [PMID: 36642626 PMCID: PMC10720395 DOI: 10.1016/j.tins.2022.12.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/18/2022] [Accepted: 12/14/2022] [Indexed: 01/15/2023]
Abstract
Neurological and psychiatric diseases have high degrees of genetic and pathophysiological heterogeneity, irrespective of clinical manifestations. Traditional medical paradigms have focused on late-stage syndromic aspects of these diseases, with little consideration of the underlying biology. Advances in disease modeling and methodological design have paved the way for the development of precision medicine (PM), an established concept in oncology with growing attention from other medical specialties. We propose a PM architecture for central nervous system diseases built on four converging pillars: multimodal biomarkers, systems medicine, digital health technologies, and data science. We discuss Alzheimer's disease (AD), an area of significant unmet medical need, as a case-in-point for the proposed framework. AD can be seen as one of the most advanced PM-oriented disease models and as a compelling catalyzer towards PM-oriented neuroscience drug development and advanced healthcare practice.
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Affiliation(s)
- Harald Hampel
- Alzheimer's Disease & Brain Health, Eisai Inc., Nutley, NJ, USA.
| | - Peng Gao
- Alzheimer's Disease & Brain Health, Eisai Inc., Nutley, NJ, USA
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, NV, USA
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yan Hu
- Alzheimer's Disease & Brain Health, Eisai Inc., Nutley, NJ, USA
| | - Min Cho
- Alzheimer's Disease & Brain Health, Eisai Inc., Nutley, NJ, USA
| | - Andrea Vergallo
- Alzheimer's Disease & Brain Health, Eisai Inc., Nutley, NJ, USA
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8
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Azarafrouz F, Farhangian M, Chavoshinezhad S, Dargahi S, Nassiri-Asl M, Dargahi L. Interferon beta attenuates recognition memory impairment and improves brain glucose uptake in a rat model of Alzheimer's disease: Involvement of mitochondrial biogenesis and PI3K pathway. Neuropeptides 2022; 95:102262. [PMID: 35709657 DOI: 10.1016/j.npep.2022.102262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/10/2022] [Accepted: 05/30/2022] [Indexed: 11/15/2022]
Abstract
Interferon beta (IFNβ) is a cytokine with anti-apoptotic and anti-inflammatory properties, and its beneficial effects on Alzheimer's disease (AD) have been recently shown. The alterations in cerebral glucose uptake are closely linked to memory deficit and AD progression. The current study was designed to determine if IFNβ can improve recognition memory and brain glucose uptake in a rat model of AD. The lentiviruses expressing mutant human amyloid precursor protein were injected bilaterally to the rat hippocampus. From day 23 after virus injection, rats were intranasally treated with recombinant IFNβ protein (68,000 IU/rat) every other day until day 50. Recognition memory performance was evaluated by novel object recognition test on days 46-49. The 18F-2- fluoro-deoxy-d-glucose positron emission tomography (18F-FDG-PET) was used to determine changes in brain glucose metabolism on day 50. The expression of the PI3K/Akt pathway components, neurotrophins and mitochondrial biogenesis factors were also measured by qPCR in the hippocampus. Our results showed that IFNβ treatment improves recognition memory performance in parallel with increased glucose uptake and neuronal survival in the hippocampus of the AD rats. The neuroprotective effect of IFNβ could be attributed, at least partly, to activation of PI3K-Akt-mTOR signaling pathway, increased expression of NGF, and mitochondrial biogenesis. Taken together, our findings suggest the therapeutic potential of IFNβ for AD.
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Affiliation(s)
- Forouzan Azarafrouz
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Farhangian
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Chavoshinezhad
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Saina Dargahi
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marjan Nassiri-Asl
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Neurobiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Dargahi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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9
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Black SAG, Stepanchuk AA, Templeton GW, Hernandez Y, Ota T, Roychoudhury S, Smith EE, Barber PA, Ismail Z, Fischer K, Zwiers A, Poulin MJ, Blennow K, Zetterberg H, Stys PK, Tsutsui S. Diagnosing Alzheimer's Disease from Circulating Blood Leukocytes Using a Fluorescent Amyloid Probe. J Alzheimers Dis 2021; 85:1721-1734. [PMID: 34958041 DOI: 10.3233/jad-215402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Toxic amyloid-β (Aβ) peptides aggregate into higher molecular weight assemblies and accumulate not only in the extracellular space, but also in the walls of blood vessels in the brain, increasing their permeability, and promoting immune cell migration and activation. Given the prominent role of the immune system, phagocytic blood cells may contact pathological brain materials. OBJECTIVE To develop a novel method for early Alzheimer's disease (AD) detection, we used blood leukocytes, that could act as "sentinels" after trafficking through the brain microvasculature, to detect pathological amyloid by labelling with a conformationally-sensitive fluorescent amyloid probe and imaging with confocal spectral microscopy. METHODS Formalin-fixed peripheral blood mononuclear cells (PBMCs) from cognitively healthy control (HC) subjects, mild cognitive impairment (MCI) and AD patients were stained with the fluorescent amyloid probe K114, and imaged. Results were validated against cerebrospinal fluid (CSF) biomarkers and clinical diagnosis. RESULTS K114-labeled leukocytes exhibited distinctive fluorescent spectral signatures in MCI/AD subjects. Comparing subjects with single CSF biomarker-positive AD/MCI to negative controls, our technique yielded modest AUCs, which improved to the 0.90 range when only MCI subjects were included in order to measure performance in an early disease state. Combining CSF Aβ 42 and t-Tau metrics further improved the AUC to 0.93. CONCLUSION Our method holds promise for sensitive detection of AD-related protein misfolding in circulating leukocytes, particularly in the early stages of disease.
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Affiliation(s)
- Stefanie A G Black
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada.,Amira Medical Technologies Inc., Calgary, AB, Canada
| | - Anastasiia A Stepanchuk
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | | | - Yda Hernandez
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, Faculty of Kinesiology, University of Calgary, Calgary AB, Canada
| | - Tomoko Ota
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Shyamosree Roychoudhury
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Eric E Smith
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Philip A Barber
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada.,Calgary Stroke Program, Seaman Family MR Center, Departments of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary AB, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada.,Department of Psychiatry, and the Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary AB, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary AB, Canada
| | - Karyn Fischer
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Angela Zwiers
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Marc J Poulin
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary AB, Canada.,Department of Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, Faculty of Kinesiology, University of Calgary, Calgary AB, Canada
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, UK.,UK Dementia Research Institute, University College London, London, UK
| | - Peter K Stys
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Shigeki Tsutsui
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB, Canada.,Amira Medical Technologies Inc., Calgary, AB, Canada
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10
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Ford JN, Sweeney EM, Skafida M, Glynn S, Amoashiy M, Lange DJ, Lin E, Chiang GC, Osborne JR, Pahlajani S, de Leon MJ, Ivanidze J. Heuristic scoring method utilizing FDG-PET statistical parametric mapping in the evaluation of suspected Alzheimer disease and frontotemporal lobar degeneration. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2021; 11:313-326. [PMID: 34513285 PMCID: PMC8414399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
Distinguishing frontotemporal lobar degeneration (FTLD) and Alzheimer Disease (AD) on FDG-PET based on qualitative review alone can pose a diagnostic challenge. SPM has been shown to improve diagnostic performance in research settings, but translation to clinical practice has been lacking. Our purpose was to create a heuristic scoring method based on statistical parametric mapping z-scores. We aimed to compare the performance of the scoring method to the initial qualitative read and a machine learning (ML)-based method as benchmarks. FDG-PET/CT or PET/MRI of 65 patients with suspected dementia were processed using SPM software, yielding z-scores from either whole brain (W) or cerebellar (C) normalization relative to a healthy cohort. A non-ML, heuristic scoring system was applied using region counts below a preset z-score cutoff. W z-scores, C z-scores, or WC z-scores (z-scores from both W and C normalization) served as features to build random forest models. The neurological diagnosis was used as the gold standard. The sensitivity of the non-ML scoring system and the random forest models to detect AD was higher than the initial qualitative read of the standard FDG-PET [0.89-1.00 vs. 0.22 (95% CI, 0-0.33)]. A categorical random forest model to distinguish AD, FTLD, and normal cases had similar accuracy than the non-ML scoring model (0.63 vs. 0.61). Our non-ML-based scoring system of SPM z-scores approximated the diagnostic performance of a ML-based method and demonstrated higher sensitivity in the detection of AD compared to qualitative reads. This approach may improve the diagnostic performance.
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Affiliation(s)
- Jeremy N Ford
- Department of Radiology, Massachusetts General HospitalBoston, MA, United States
| | - Elizabeth M Sweeney
- Department of Population Health Sciences, Division of Biostatistics and Epidemiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Myrto Skafida
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Shannon Glynn
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Michael Amoashiy
- Department of Neurology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Dale J Lange
- Department of Neurology, Hospital for Special SurgeryNew York, NY, United States
| | - Eaton Lin
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Gloria C Chiang
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Joseph R Osborne
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Mony J de Leon
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Jana Ivanidze
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
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11
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Strom A, Iaccarino L, Edwards L, Lesman-Segev OH, Soleimani-Meigooni DN, Pham J, Baker SL, Landau S, Jagust WJ, Miller BL, Rosen HJ, Gorno-Tempini ML, Rabinovici GD, La Joie R. Cortical hypometabolism reflects local atrophy and tau pathology in symptomatic Alzheimer's disease. Brain 2021; 145:713-728. [PMID: 34373896 PMCID: PMC9014741 DOI: 10.1093/brain/awab294] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 11/14/2022] Open
Abstract
Posterior cortical hypometabolism measured with [18F]-Fluorodeoxyglucose (FDG)-PET is a well-known marker of Alzheimer's disease-related neurodegeneration, but its associations with underlying neuropathological processes are unclear. We assessed cross-sectionally the relative contributions of three potential mechanisms causing hypometabolism in the retrosplenial and inferior parietal cortices: local molecular (amyloid and tau) pathology and atrophy, distant factors including contributions from the degenerating medial temporal lobe or molecular pathology in functionally connected regions, and the presence of the apolipoprotein E (APOE) ε4 allele. Two hundred and thirty-two amyloid-positive cognitively impaired patients from two cohorts (University of California, San Francisco, UCSF, and Alzheimer's Disease Neuroimaging Initiative, ADNI) underwent MRI and PET with FDG, amyloid-PET using [11C]-Pittsburgh Compound B, [18F]-Florbetapir, or [18F]-Florbetaben, and [18F]-Flortaucipir tau-PET within one year. Standard uptake value ratios (SUVR) were calculated using tracer-specific reference regions. Regression analyses were run within cohorts to identify variables associated with retrosplenial or inferior parietal FDG SUVR. On average, ADNI patients were older and were less impaired than UCSF patients. Regional patterns of hypometabolism were similar between cohorts, though there were cohort differences in regional gray matter atrophy. Local cortical thickness and tau-PET (but not amyloid-PET) were independently associated with both retrosplenial and inferior parietal FDG SUVR (ΔR2 = .09 to .21) across cohorts in models that also included age and disease severity (local model). Including medial temporal lobe volume improved the retrosplenial FDG model in ADNI (ΔR2 = .04, p = .008) but not UCSF (ΔR2 < .01, p = .52), and did not improve the inferior parietal models (ΔR2s < .01, ps > .37). Interaction analyses revealed that medial temporal volume was more strongly associated with retrosplenial FDG SUVR at earlier disease stages (p = .06 in UCSF, p = .046 in ADNI). Exploratory analyses across the cortex confirmed overall associations between hypometabolism and local tau pathology and thickness and revealed associations between medial temporal degeneration and hypometabolism in retrosplenial, orbitofrontal, and anterior cingulate cortices. Finally, our data did not support hypotheses of a detrimental effect of pathology in connected regions or of an effect of the APOE ε4 allele in impaired participants. Overall, in two independent groups of patients at symptomatic stages of Alzheimer's disease, cortical hypometabolism mainly reflected structural neurodegeneration and tau, but not amyloid, pathology.
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Affiliation(s)
- Amelia Strom
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Lauren Edwards
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Orit H Lesman-Segev
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - David N Soleimani-Meigooni
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Julie Pham
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Suzanne L Baker
- Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Susan Landau
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA
| | - William J Jagust
- Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.,Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.,Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
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12
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Guo Y, Dang G, Hordacre B, Su X, Yan N, Chen S, Ren H, Shi X, Cai M, Zhang S, Lan X. Repetitive Transcranial Magnetic Stimulation of the Dorsolateral Prefrontal Cortex Modulates Electroencephalographic Functional Connectivity in Alzheimer's Disease. Front Aging Neurosci 2021; 13:679585. [PMID: 34305567 PMCID: PMC8293898 DOI: 10.3389/fnagi.2021.679585] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Increasing evidence demonstrates that repetitive transcranial magnetic stimulation (rTMS) treatment of the dorsolateral prefrontal cortex is beneficial for improving cognitive function in patients with Alzheimer’s disease (AD); however, the underlying mechanism of its therapeutic effect remains unclear. Objectives/Hypothesis: The aim of this study was to investigate the impact of rTMS to the dorsolateral prefrontal cortex on functional connectivity along with treatment response in AD patients with different severity of cognitive impairment. Methods: We conducted a 2-week treatment course of 10-Hz rTMS over the left dorsolateral prefrontal cortex in 23 patients with AD who were split into the mild or moderate cognitive impairment subgroup. Resting state electroencephalography and general cognition was assessed before and after rTMS. Power envelope connectivity was used to calculate functional connectivity at the source level. The functional connectivity of AD patients and 11 cognitively normal individuals was compared. Results: Power envelope connectivity was higher in the delta and theta bands but lower in the beta band in the moderate cognitive impairment group, compared to the cognitively normal controls, at baseline (p < 0.05). The mild cognitive impairment group had no significant abnormities. Montreal Cognitive Assessment scores improved after rTMS in the moderate and mild cognitive impairment groups. Power envelope connectivity in the beta band post-rTMS was increased in the moderate group (p < 0.05) but not in the mild group. No significant changes in the delta and theta band were found after rTMS in both the moderate and mild group. Conclusion: High-frequency rTMS to the dorsolateral prefrontal cortex modulates electroencephalographic functional connectivity while improving cognitive function in patients with AD. Increased beta connectivity may have an important mechanistic role in rTMS therapeutic effects.
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Affiliation(s)
- Yi Guo
- Department of Neurology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.,Shenzhen Bay Laboratory, Shenzhen, China
| | - Ge Dang
- Department of Neurology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Brenton Hordacre
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Xiaolin Su
- Department of Neurology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Nan Yan
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Siyan Chen
- Department of Neurology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Huixia Ren
- Department of Neurology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Xue Shi
- Department of Neurology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Min Cai
- Department of Neurology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Sirui Zhang
- Department of Neurology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Xiaoyong Lan
- Department of Neurology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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