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Galgani A, Lombardo F, Frijia F, Martini N, Tognoni G, Pavese N, Giorgi FS. The degeneration of locus coeruleus occurring during Alzheimer's disease clinical progression: a neuroimaging follow-up investigation. Brain Struct Funct 2024; 229:1317-1325. [PMID: 38625557 PMCID: PMC11147916 DOI: 10.1007/s00429-024-02797-1] [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: 01/16/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024]
Abstract
The noradrenergic nucleus Locus Coeruleus (LC) is precociously involved in Alzheimer's Disease (AD) pathology, and its degeneration progresses during the course of the disease. Using Magnetic Resonance Imaging (MRI), researchers showed also in vivo in patients the disruption of LC, which can be observed both in Mild Cognitively Impaired individuals and AD demented patients. In this study, we report the results of a follow-up neuroradiological assessment, in which we evaluated the LC degeneration overtime in a group of cognitively impaired patients, submitted to MRI both at baseline and at the end of a 2.5-year follow-up. We found that a progressive LC disruption can be observed also in vivo, involving the entire nucleus and associated with clinical diagnosis. Our findings parallel neuropathological ones, which showed a continuous increase of neuronal death and volumetric atrophy within the LC with the progression of Braak's stages for neurofibrillary pathology. This supports the reliability of MRI as a tool for exploring the integrity of the central noradrenergic system in neurodegenerative disorders.
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Affiliation(s)
- Alessandro Galgani
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Via Roma 55, Pisa, 56126, Italy
| | | | - Francesca Frijia
- Bioengineering Unit, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Nicola Martini
- Bioengineering Unit, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Gloria Tognoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, UK
- Institute of Clinical Medicine, PET Centre, Aarhus University, Aarhus, Denmark
| | - Filippo Sean Giorgi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Via Roma 55, Pisa, 56126, Italy.
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2
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Stouffer KM, Grande X, Düzel E, Johansson M, Creese B, Witter MP, Miller MI, Wisse LEM, Berron D. Amidst an amygdala renaissance in Alzheimer's disease. Brain 2024; 147:816-829. [PMID: 38109776 PMCID: PMC10907090 DOI: 10.1093/brain/awad411] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/03/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
The amygdala was highlighted as an early site for neurofibrillary tau tangle pathology in Alzheimer's disease in the seminal 1991 article by Braak and Braak. This knowledge has, however, only received traction recently with advances in imaging and image analysis techniques. Here, we provide a cross-disciplinary overview of pathology and neuroimaging studies on the amygdala. These studies provide strong support for an early role of the amygdala in Alzheimer's disease and the utility of imaging biomarkers of the amygdala in detecting early changes and predicting decline in cognitive functions and neuropsychiatric symptoms in early stages. We summarize the animal literature on connectivity of the amygdala, demonstrating that amygdala nuclei that show the earliest and strongest accumulation of neurofibrillary tangle pathology are those that are connected to brain regions that also show early neurofibrillary tangle accumulation. Additionally, we propose an alternative pathway of neurofibrillary tangle spreading within the medial temporal lobe between the amygdala and the anterior hippocampus. The proposed existence of this pathway is strengthened by novel experimental data on human functional connectivity. Finally, we summarize the functional roles of the amygdala, highlighting the correspondence between neurofibrillary tangle accumulation and symptomatic profiles in Alzheimer's disease. In summary, these findings provide a new impetus for studying the amygdala in Alzheimer's disease and a unique perspective to guide further study on neurofibrillary tangle spreading and the occurrence of neuropsychiatric symptoms in Alzheimer's disease.
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Affiliation(s)
- Kaitlin M Stouffer
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, MD, 21218, USA
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Xenia Grande
- German Center for Neurodegenerative Diseases (DZNE), 39120, Magdeburg, Germany
- Institute for Cognitive Neurology and Dementia Research, Otto-von-Guericke University, 39106, Magdeburg, Germany
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), 39120, Magdeburg, Germany
- Institute for Cognitive Neurology and Dementia Research, Otto-von-Guericke University, 39106, Magdeburg, Germany
| | - Maurits Johansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, 205 02, Lund, Sweden
- Division of Clinical Sciences, Helsingborg, Department of Clinical Sciences Lund, Lund University, 221 84, Lund, Sweden
- Department of Psychiatry, Helsingborg Hospital, 252 23, Helsingborg, Sweden
| | - Byron Creese
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, EX4 4PY, Exeter, UK
- Division of Psychology, Department of Life Sciences, Brunel University London, UB8 3PH, Uxbridge, UK
| | - Menno P Witter
- Kavli Institute for Systems Neuroscience, NTNU Norwegian University of Science and Technology, 7491, Trondheim, Norway
- KG. Jebsen Centre for Alzheimer’s Disease, NTNU Norwegian University of Science and Technology, 7491, Trondheim, Norway
| | - Michael I Miller
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, MD, 21218, USA
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Laura E M Wisse
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, 211 84, Lund, Sweden
| | - David Berron
- German Center for Neurodegenerative Diseases (DZNE), 39120, Magdeburg, Germany
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, 205 02, Lund, Sweden
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3
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Ducharme S, Pijnenburg Y, Rohrer JD, Huey E, Finger E, Tatton N. Identifying and Diagnosing TDP-43 Neurodegenerative Diseases in Psychiatry. Am J Geriatr Psychiatry 2024; 32:98-113. [PMID: 37741764 PMCID: PMC11270911 DOI: 10.1016/j.jagp.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/25/2023]
Abstract
Neuropsychiatric symptoms (NPS) are common manifestations of neurodegenerative disorders and are often early signs of those diseases. Among those neurodegenerative diseases, TDP-43 proteinopathies are an increasingly recognized cause of early neuropsychiatric manifestations. TDP-43-related diseases include frontotemporal dementia (FTD), amyotrophic lateral sclerosis (ALS), and Limbic-Predominant Age-Related TDP-43 Encephalopathy (LATE). The majority of TDP-43-related diseases are sporadic, but a significant proportion is hereditary, with progranulin (GRN) mutations and C9orf72 repeat expansions as the most common genetic etiologies. Studies reveal that NPS can be the initial manifestation of those diseases or can complicate disease course, but there is a lack of awareness among clinicians about TDP-43-related diseases, which leads to common diagnostic mistakes or delays. There is also emerging evidence that TDP-43 accumulations could play a role in late-onset primary psychiatric disorders. In the absence of robust biomarkers for TDP-43, the diagnosis remains primarily based on clinical assessment and neuroimaging. Given the association with psychiatric symptoms, clinical psychiatrists have a key role in the early identification of patients with TDP-43-related diseases. This narrative review provides a comprehensive overview of the pathobiology of TDP-43, resulting clinical presentations, and associated neuropsychiatric manifestations to help guide clinical practice.
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Affiliation(s)
- Simon Ducharme
- Department of Psychiatry (SD), Douglas Mental Health University Institute, McGill University, Montreal, Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada.
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience (YP), Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease (JDR), UCL Queen Square Institute of Neurology, London, UK
| | - Edward Huey
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Psychiatry (EH), Columbia University, New York, NY
| | - Elizabeth Finger
- London Health Sciences Centre Parkwood Institute (EF), London, ON, Canada
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4
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Hiya S, Maldonado-Díaz C, Walker JM, Richardson TE. Cognitive symptoms progress with limbic-predominant age-related TDP-43 encephalopathy stage and co-occurrence with Alzheimer disease. J Neuropathol Exp Neurol 2023; 83:2-10. [PMID: 37966908 PMCID: PMC10746699 DOI: 10.1093/jnen/nlad098] [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] [Indexed: 11/17/2023] Open
Abstract
Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is a neuropathologic entity characterized by transactive response DNA-binding protein of 43-kDa (TDP-43)-immunoreactive inclusions that originate in the amygdala and then progress to the hippocampi and middle frontal gyrus. LATE-NC may mimic Alzheimer disease clinically and often co-occurs with Alzheimer disease neuropathologic change (ADNC). This report focuses on the cognitive effects of isolated and concomitant LATE-NC and ADNC. Cognitive/neuropsychological, neuropathologic, genetic, and demographic variables were analyzed in 28 control, 31 isolated LATE-NC, 244 isolated ADNC, and 172 concurrent LATE-NC/ADNC subjects from the National Alzheimer's Coordinating Center. Cases with LATE-NC and ADNC were significantly older than controls; cases with ADNC had a significantly higher proportion of cases with at least one APOE ε4 allele. Both LATE-NC and ADNC exhibited deleterious effects on overall cognition proportional to their neuropathological stages; concurrent LATE-NC/ADNC exhibited the worst overall cognitive effect. Multivariate logistic regression analysis determined an independent risk of cognitive impairment for progressive LATE-NC stages (OR 1.66; p = 0.0256) and ADNC levels (OR 3.41; p < 0.0001). These data add to the existing knowledge on the clinical consequences of LATE-NC pathology and the growing literature on the effects of multiple concurrent neurodegenerative pathologies.
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Affiliation(s)
- Satomi Hiya
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Carolina Maldonado-Díaz
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jamie M Walker
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Neuropathology Brain Bank & Research CoRE, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Timothy E Richardson
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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5
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Zhang M, Ganz AB, Rohde S, Lorenz L, Rozemuller AJM, van Vliet K, Graat M, Sikkes SAM, Reinders MJT, Scheltens P, Hulsman M, Hoozemans JJM, Holstege H. The correlation between neuropathology levels and cognitive performance in centenarians. Alzheimers Dement 2023; 19:5036-5047. [PMID: 37092333 DOI: 10.1002/alz.13087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Neuropathological substrates associated with neurodegeneration occur in brains of the oldest old. How does this affect cognitive performance? METHODS The 100-plus Study is an ongoing longitudinal cohort study of centenarians who self-report to be cognitively healthy; post mortem brain donation is optional. In 85 centenarian brains, we explored the correlations between the levels of 11 neuropathological substrates with ante mortem performance on 12 neuropsychological tests. RESULTS Levels of neuropathological substrates varied: we observed levels up to Thal-amyloid beta phase 5, Braak-neurofibrillary tangle (NFT) stage V, Consortium to Establish a Registry for Alzheimer's Disease (CERAD)-neuritic plaque score 3, Thal-cerebral amyloid angiopathy stage 3, Tar-DNA binding protein 43 (TDP-43) stage 3, hippocampal sclerosis stage 1, Braak-Lewy bodies stage 6, atherosclerosis stage 3, cerebral infarcts stage 1, and cerebral atrophy stage 2. Granulovacuolar degeneration occurred in all centenarians. Some high performers had the highest neuropathology scores. DISCUSSION Only Braak-NFT stage and limbic-predominant age-related TDP-43 encephalopathy (LATE) pathology associated significantly with performance across multiple cognitive domains. Of all cognitive tests, the clock-drawing test was particularly sensitive to levels of multiple neuropathologies.
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Affiliation(s)
- Meng Zhang
- Department of Human Genetics, Genomics of Neurodegenerative Diseases and Aging, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Delft Bioinformatics Lab, Delft Technical University, Van, The Netherlands
| | - Andrea B Ganz
- Department of Human Genetics, Genomics of Neurodegenerative Diseases and Aging, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Alzheimer Center Amsterdam, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Molecular and Cellular Neuroscience, Center for Neurogenomics and Cognitive Research, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Pathology, Neuroscience, Amsterdam, The Netherlands
| | - Susan Rohde
- Department of Human Genetics, Genomics of Neurodegenerative Diseases and Aging, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Alzheimer Center Amsterdam, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Pathology, Neuroscience, Amsterdam, The Netherlands
| | - Linda Lorenz
- Department of Human Genetics, Genomics of Neurodegenerative Diseases and Aging, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Alzheimer Center Amsterdam, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemieke J M Rozemuller
- Department of Pathology, Neuroscience, Amsterdam, The Netherlands
- Netherlands Institute for Neuroscience, The Netherlands
| | - Kimberley van Vliet
- Department of Human Genetics, Genomics of Neurodegenerative Diseases and Aging, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marieke Graat
- Department of Human Genetics, Genomics of Neurodegenerative Diseases and Aging, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sietske A M Sikkes
- Department of Human Genetics, Genomics of Neurodegenerative Diseases and Aging, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology & Biostatistics, Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences, Clinical Developmental Psychology and Clinical Neuropsychology, Vrije Universiteit Amsterdam, The Netherlands
| | | | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marc Hulsman
- Department of Human Genetics, Genomics of Neurodegenerative Diseases and Aging, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Delft Bioinformatics Lab, Delft Technical University, Van, The Netherlands
| | | | - Henne Holstege
- Department of Human Genetics, Genomics of Neurodegenerative Diseases and Aging, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Alzheimer Center Amsterdam, Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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6
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Perna A, Montine KS, White LR, Montine TJ, Cholerton BA. Paradigm Shift: Multiple Potential Pathways to Neurodegenerative Dementia. Neurotherapeutics 2023; 20:1641-1652. [PMID: 37733209 PMCID: PMC10684852 DOI: 10.1007/s13311-023-01441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 09/22/2023] Open
Abstract
Neurodegenerative dementia can result from multiple underlying abnormalities, including neurotransmitter imbalances, protein aggregation, and other neurotoxic events. A major complication in identifying effective treatment targets is the frequent co-occurrence of multiple neurodegenerative processes, occurring either in parallel or sequentially. The path towards developing effective treatments for Alzheimer's disease (AD) and other dementias has been relatively slow and until recently has focused on disease symptoms. Aducanumab and lecanemab, recently approved by the FDA, are meant to target disease structures but have only modest benefit on symptom progression and remain unproven in reversing or preventing dementia. A third, donanemab, appears more promising but awaits FDA approval. Ongoing trials include potential cognition enhancers, new combinations of known drugs for synergistic effects, prodrugs with less toxicity, and increasing interest in drugs targeting neuroinflammation or microbiome. Scientific and technological advances offer the opportunity to move in new therapy directions, such as modifying microglia to prevent or suppress underlying disease. A major challenge, however, is that underlying comorbidities likely influence the effectiveness of therapies. Indeed, the full range of comorbidity, today only definitively identified postmortem, likely contributes to failed clinical trials and overmedication of older adults, since it is difficult to exclude (during life) people unlikely to respond. Our current knowledge thus signals that a paradigm shift towards individualized and multimodal treatments is necessary to effectively advance the field of dementia therapeutics.
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Affiliation(s)
- Amalia Perna
- Department of Pathology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA.
| | - Kathleen S Montine
- Department of Pathology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA
| | - Lon R White
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | - Thomas J Montine
- Department of Pathology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA
| | - Brenna A Cholerton
- Department of Pathology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA
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Nelson RS, Abner EL, Jicha GA, Schmitt FA, Di J, Wilcock DM, Barber JM, Van Eldik LJ, Katsumata Y, Fardo DW, Nelson PT. Neurodegenerative pathologies associated with behavioral and psychological symptoms of dementia in a community-based autopsy cohort. Acta Neuropathol Commun 2023; 11:89. [PMID: 37269007 PMCID: PMC10236713 DOI: 10.1186/s40478-023-01576-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/30/2023] [Indexed: 06/04/2023] Open
Abstract
In addition to the memory disorders and global cognitive impairment that accompany neurodegenerative diseases, behavioral and psychological symptoms of dementia (BPSD) commonly impair quality of life and complicate clinical management. To investigate clinical-pathological correlations of BPSD, we analyzed data from autopsied participants from the community-based University of Kentucky Alzheimer's Disease Research Center longitudinal cohort (n = 368 research volunteers met inclusion criteria, average age at death 85.4 years). Data assessing BPSD were obtained approximately annually, including parameters for agitation, anxiety, apathy, appetite problems, delusions, depression, disinhibition, hallucinations, motor disturbance, and irritability. Each BPSD was scored on a severity scale (0-3) via the Neuropsychiatric Inventory Questionnaire (NPI-Q). Further, Clinical Dementia Rating (CDR)-Global and -Language evaluations (also scored on 0-3 scales) were used to indicate the degree of global cognitive and language impairment. The NPI-Q and CDR ratings were correlated with neuropathology findings at autopsy: Alzheimer's disease neuropathological changes (ADNC), neocortical and amygdala-only Lewy bodies (LBs), limbic predominant age-related TDP-43 encephalopathy neuropathologic changes (LATE-NC), primary age-related tauopathy (PART), hippocampal sclerosis, and cerebrovascular pathologies. Combinations of pathologies included the quadruple misfolding proteinopathy (QMP) phenotype with co-occurring ADNC, neocortical LBs, and LATE-NC. Statistical models were used to estimate the associations between BPSD subtypes and pathologic patterns. Individuals with severe ADNC (particularly those with Braak NFT stage VI) had more BPSD, and the QMP phenotype was associated with the highest mean number of BPSD symptoms: > 8 different BPSD subtypes per individual. Disinhibition and language problems were common in persons with severe ADNC but were not specific to any pathology. "Pure" LATE-NC was associated with global cognitive impairment, apathy, and motor disturbance, but again, these were not specific associations. In summary, Braak NFT stage VI ADNC was strongly associated with BPSD, but no tested BPSD subtype was a robust indicator of any particular "pure" or mixed pathological combination.
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Affiliation(s)
| | - Erin L Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, KY, USA
| | - Gregory A Jicha
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Frederick A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Jing Di
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, USA
| | - Donna M Wilcock
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Justin M Barber
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Linda J Van Eldik
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Yuriko Katsumata
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - David W Fardo
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Peter T Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA.
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, USA.
- University of Kentucky, Rm 575 Todd Building, Lexington, KY, 40536, USA.
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8
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I F. The unique neuropathological vulnerability of the human brain to aging. Ageing Res Rev 2023; 87:101916. [PMID: 36990284 DOI: 10.1016/j.arr.2023.101916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
Alzheimer's disease (AD)-related neurofibrillary tangles (NFT), argyrophilic grain disease (AGD), aging-related tau astrogliopathy (ARTAG), limbic predominant TDP-43 proteinopathy (LATE), and amygdala-predominant Lewy body disease (LBD) are proteinopathies that, together with hippocampal sclerosis, progressively appear in the elderly affecting from 50% to 99% of individuals aged 80 years, depending on the disease. These disorders usually converge on the same subject and associate with additive cognitive impairment. Abnormal Tau, TDP-43, and α-synuclein pathologies progress following a pattern consistent with an active cell-to-cell transmission and abnormal protein processing in the host cell. However, cell vulnerability and transmission pathways are specific for each disorder, albeit abnormal proteins may co-localize in particular neurons. All these alterations are unique or highly prevalent in humans. They all affect, at first, the archicortex and paleocortex to extend at later stages to the neocortex and other regions of the telencephalon. These observations show that the phylogenetically oldest areas of the human cerebral cortex and amygdala are not designed to cope with the lifespan of actual humans. New strategies aimed at reducing the functional overload of the human telencephalon, including optimization of dream repair mechanisms and implementation of artificial circuit devices to surrogate specific brain functions, appear promising.
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Affiliation(s)
- Ferrer I
- Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain; Emeritus Researcher of the Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain; Biomedical Research Network of Neurodegenerative Diseases (CIBERNED), Barcelona, Spain; Institute of Neurosciences, University of Barcelona, Barcelona, Spain; Hospitalet de Llobregat, Barcelona, Spain.
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Ramírez-Salazar SA, MacRae C, Feany MB, Miller M, Yang HS, Meadows ME, McGinnis SM, Silbersweig D, Gale SA, Daffner KR. Case Study 6: The Diagnostic Challenge of a 75-Year-Old Man Who Had, Then Didn't Have, Then Did Have Alzheimer's Disease. J Neuropsychiatry Clin Neurosci 2023; 35:325-332. [PMID: 37840261 DOI: 10.1176/appi.neuropsych.20230097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Affiliation(s)
- Sergio A Ramírez-Salazar
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Cassie MacRae
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Mel B Feany
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Michael Miller
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Hyun-Sik Yang
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Mary-Ellen Meadows
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Scott M McGinnis
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - David Silbersweig
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Seth A Gale
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
| | - Kirk R Daffner
- Departments of Neurology (Ramírez-Salazar, Yang, Meadows, McGinnis, Gale, Daffner) and Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (MacRae, Feany, Miller), Brigham and Women's Hospital, Harvard Medical School
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Gauthreaux K, Mock C, Teylan MA, Culhane JE, Chen YC, Chan KCG, Katsumata Y, Nelson PT, Kukull WA. Symptomatic Profile and Cognitive Performance in Autopsy-Confirmed Limbic-Predominant Age-Related TDP-43 Encephalopathy With Comorbid Alzheimer Disease. J Neuropathol Exp Neurol 2022; 81:975-987. [PMID: 36264254 PMCID: PMC9677237 DOI: 10.1093/jnen/nlac093] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Transactive response DNA-binding protein 43 kDa (TDP-43) proteinopathy is the hallmark of limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC). LATE-NC is a common copathology with Alzheimer disease neuropathologic change (ADNC). Data from the National Alzheimer's Coordinating Center were analyzed to compare clinical features and copathologies of autopsy-confirmed ADNC with versus without comorbid LATE-NC. A total of 735 participants with ADNC alone and 365 with ADNC with LATE-NC were included. Consistent with prior work, brains with LATE-NC had more severe ADNC, more hippocampal sclerosis, and more brain arteriolosclerosis copathologies. Behavioral symptoms and cognitive performance on neuropsychological tests were compared, stratified by ADNC severity (low/intermediate vs high). Participants with ADNC and LATE-NC were older, had higher ADNC burden, and had worse cognitive performance than participants with ADNC alone. In the low/intermediate ADNC strata, participants with comorbid LATE-NC had higher prevalence of behavioral symptoms (apathy, disinhibition, agitation, personality change). They also had worsened performance in episodic memory and language/semantic memory. Differences narrowed in the high ADNC strata, with worsened performance in only episodic memory in the comorbid LATE-NC group. The co-occurrence of LATE-NC with ADNC is associated with a different pattern of behavioral and cognitive performance than ADNC alone, particularly in people with low/intermediate ADNC burden.
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Affiliation(s)
- Kathryn Gauthreaux
- From the Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington, USA
| | - Charles Mock
- From the Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington, USA
| | - Merilee A Teylan
- From the Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington, USA
| | - Jessica E Culhane
- From the Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington, USA
| | - Yen-Chi Chen
- From the Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Kwun C G Chan
- From the Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Yuriko Katsumata
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
| | - Peter T Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
- Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, Kentucky, USA
| | - Walter A Kukull
- From the Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington, USA
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11
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Wu X, Peng C, Nelson PT, Cheng Q. Deep learning algorithm reveals probabilities of stage-specific time to conversion in individuals with neurodegenerative disease LATE. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12363. [PMID: 36348767 PMCID: PMC9632667 DOI: 10.1002/trc2.12363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/27/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
Introduction Limbic-predominant age-related TAR DNA-binding protein 43 (TDP-43) encephalopathy (LATE) is a recently defined neurodegenerative disease. Currently, there is no effective way to make a prognosis of time to stage-specific future conversions at an individual level. Methods After using the Kaplan-Meier estimation and log-rank test to confirm the heterogeneity of LATE progression, we developed a deep learning-based approach to assess the stage-specific probabilities of time to LATE conversions for different subjects. Results Our approach could accurately estimate the disease incidence and transition to next stages: the concordance index was at least 82% and the integrated Brier score was less than 0.14. Moreover, we identified the top 10 important predictors for each disease conversion scenario to help explain the estimation results, which were clinicopathologically meaningful and most were also statistically significant. Discussion Our study has the potential to provide individualized assessment for future time courses of LATE conversions years before their actual occurrence.
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Affiliation(s)
- Xinxing Wu
- Institute for Biomedical InformaticsUniversity of KentuckyLexingtonKentuckyUSA
| | - Chong Peng
- Department of Computer Science and EngineeringQingdao UniversityShandongChina
| | - Peter T. Nelson
- Sanders‐Brown Aging Center and Department of PathologyUniversity of KentuckyLexingtonKentuckyUSA
| | - Qiang Cheng
- Institute for Biomedical InformaticsUniversity of KentuckyLexingtonKentuckyUSA
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12
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Ruthirakuhan M, Ismail Z, Herrmann N, Gallagher D, Lanctot KL. Mild behavioral impairment is associated with progression to Alzheimer's disease: A clinicopathological study. Alzheimers Dement 2022; 18:2199-2208. [PMID: 35103400 PMCID: PMC9339594 DOI: 10.1002/alz.12519] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Mild behavioral impairment (MBI) is characterized by later-life emergence of neuropsychiatric symptoms. Investigating its relationship with progression to Alzheimer's disease (AD) would provide insight on its importance as a predictor of AD. METHODS Cognitively normal participants (N = 11,372) from the National Alzheimer's Coordinating Center were stratified by MBI status, using the Neuropsychiatric Inventory-Questionnaire. We investigated whether MBI and its domains were predictors of progression to clinically-diagnosed AD. MBI as a predictor of progression to neuropathology-confirmed AD was also investigated in those with neuropathological data. RESULTS Six percent (N = 671) of participants progressed to AD. MBI (N = 2765) was a significant predictor of progression to clinically-diagnosed (hazard ratio [HR] = 1.75) and neuropathology-confirmed AD (HR = 1.59). MBI domains were also associated with clinically-diagnosed AD, with psychosis having the greatest effect (HR = 6.49). DISCUSSION These findings support the biological underpinnings of MBI, emphasizing the importance of later life behavioral changes in dementia detection and prognostication.
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Affiliation(s)
- Myuri Ruthirakuhan
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute and O’Brien Institute for Public Health University of Calgary, Calgary, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Damien Gallagher
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Krista L. Lanctot
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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13
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Duong MT, Wolk DA. Limbic-Predominant Age-Related TDP-43 Encephalopathy: LATE-Breaking Updates in Clinicopathologic Features and Biomarkers. Curr Neurol Neurosci Rep 2022; 22:689-698. [PMID: 36190653 PMCID: PMC9633415 DOI: 10.1007/s11910-022-01232-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Limbic-predominant age-related TDP-43 encephalopathy (LATE) is a recently defined neurodegenerative disease characterized by amnestic phenotype and pathological inclusions of TAR DNA-binding protein 43 (TDP-43). LATE is distinct from rarer forms of TDP-43 diseases such as frontotemporal lobar degeneration with TDP-43 but is also a common copathology with Alzheimer's disease (AD) and cerebrovascular disease and accelerates cognitive decline. LATE contributes to clinicopathologic heterogeneity in neurodegenerative diseases, so it is imperative to distinguish LATE from other etiologies. RECENT FINDINGS Novel biomarkers for LATE are being developed with magnetic resonance imaging (MRI) and positron emission tomography (PET). When cooccurring with AD, LATE exhibits identifiable patterns of limbic-predominant atrophy on MRI and hypometabolism on 18F-fluorodeoxyglucose PET that are greater than expected relative to levels of local AD pathology. Efforts are being made to develop TDP-43-specific radiotracers, molecularly specific biofluid measures, and genomic predictors of TDP-43. LATE is a highly prevalent neurodegenerative disease distinct from previously characterized cognitive disorders.
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Affiliation(s)
- Michael Tran Duong
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Alzheimer's Disease Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Institute On Aging, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.
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14
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Hussain H, Djurin T, Rodriguez J, Daneelian L, Sundi S, Fadel A, Saadoon Z. Transactivation Response DNA-Binding Protein of 43 (TDP-43) and Glial Cell Roles in Neurological Disorders. Cureus 2022; 14:e30639. [DOI: 10.7759/cureus.30639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/07/2022] Open
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15
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Jellinger KA. Recent update on the heterogeneity of the Alzheimer’s disease spectrum. J Neural Transm (Vienna) 2021; 129:1-24. [DOI: 10.1007/s00702-021-02449-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/25/2021] [Indexed: 02/03/2023]
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16
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Abellaneda-Pérez K, Vaqué-Alcázar L, Perellón-Alfonso R, Solé-Padullés C, Bargalló N, Salvador R, Ruffini G, Nitsche MA, Pascual-Leone A, Bartrés-Faz D. Multifocal Transcranial Direct Current Stimulation Modulates Resting-State Functional Connectivity in Older Adults Depending on the Induced Current Density. Front Aging Neurosci 2021; 13:725013. [PMID: 34899266 PMCID: PMC8662695 DOI: 10.3389/fnagi.2021.725013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/02/2021] [Indexed: 02/02/2023] Open
Abstract
Combining non-invasive brain stimulation (NIBS) with resting-state functional magnetic resonance imaging (rs-fMRI) is a promising approach to characterize and potentially optimize the brain networks subtending cognition that changes as a function of age. However, whether multifocal NIBS approaches are able to modulate rs-fMRI brain dynamics in aged populations, and if these NIBS-induced changes are consistent with the simulated electric current distribution on the brain remains largely unknown. In the present investigation, thirty-one cognitively healthy older adults underwent two different multifocal real transcranial direct current stimulation (tDCS) conditions (C1 and C2) and a sham condition in a crossover design during a rs-fMRI acquisition. The real tDCS conditions were designed to electrically induce two distinct complex neural patterns, either targeting generalized frontoparietal cortical overactivity (C1) or a detachment between the frontal areas and the posteromedial cortex (C2). Data revealed that the two tDCS conditions modulated rs-fMRI differently. C1 increased the coactivation of multiple functional couplings as compared to sham, while a smaller number of connections increased in C1 as compared to C2. At the group level, C1-induced changes were topographically consistent with the calculated electric current density distribution. At the individual level, the extent of tDCS-induced rs-fMRI modulation in C1 was related with the magnitude of the simulated electric current density estimates. These results highlight that multifocal tDCS procedures can effectively change rs-fMRI neural functioning in advancing age, being the induced modulation consistent with the spatial distribution of the simulated electric current on the brain. Moreover, our data supports that individually tailoring NIBS-based interventions grounded on subject-specific structural data might be crucial to increase tDCS potential in future studies amongst older adults.
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Affiliation(s)
- Kilian Abellaneda-Pérez
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Lídia Vaqué-Alcázar
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ruben Perellón-Alfonso
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Solé-Padullés
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Núria Bargalló
- Section of Neuroradiology, Department of Radiology, Diagnostic Image Center, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Magnetic Resonance Image Core Facility (IDIBAPS), Barcelona, Spain
| | - Ricardo Salvador
- Neuroelectrics, Cambridge, MA, United States.,Neuroelectrics, Barcelona, Spain
| | - Giulio Ruffini
- Neuroelectrics, Cambridge, MA, United States.,Neuroelectrics, Barcelona, Spain
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States.,Department of Neurology, Harvard Medical School, Boston, MA, United States.,Guttmann Brain Health Institute, Guttmann University Institute of Neurorehabilitation, Autonomous University of Barcelona, Badalona, Spain
| | - David Bartrés-Faz
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Guttmann Brain Health Institute, Guttmann University Institute of Neurorehabilitation, Autonomous University of Barcelona, Badalona, Spain
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17
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Teylan MA, Mock C, Gauthreaux K, Culhane JE, Jicha G, Chen YC, Chan KCG, Kukull WA, Nelson PT, Katsumata Y. Differences in Symptomatic Presentation and Cognitive Performance Among Participants With LATE-NC Compared to FTLD-TDP. J Neuropathol Exp Neurol 2021; 80:1024–1032. [PMID: 34597386 DOI: 10.1093/jnen/nlab098] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Transactive response DNA-binding protein 43 kDa (TDP-43) is aberrantly aggregated and phosphorylated in frontotemporal lobar degeneration of the TDP-43 type (FTLD-TDP), and in limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC). We examined data from the National Alzheimer's Coordinating Center to compare clinical features of autopsy-confirmed LATE-NC and FTLD-TDP. A total of 265 LATE-NC and 92 FTLD-TDP participants were included. Cognitive and behavioral symptoms were compared, stratified by level of impairment based on global clinical dementia rating (CDR) score. LATE-NC participants were older at death, more likely to carry APOE ε4, more likely to have Alzheimer disease neuropathology, and had lower (i.e. less severe) final CDR global scores than those with FTLD-TDP. Participants with FTLD-TDP were more likely to present with primary progressive aphasia, or behavior problems such as apathy, disinhibition, and personality changes. Among participants with final CDR score of 2-3, those with LATE-NC were more likely to have visuospatial impairment, delusions, and/or visual hallucinations. These differences were robust after sensitivity analyses excluding older (≥80 years at death), LATE-NC stage 3, or severe Alzheimer cases. Overall, FTLD-TDP was more globally severe, and affected younger participants, whereas psychoses were more common in LATE-NC.
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Affiliation(s)
- Merilee A Teylan
- From the National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, USA (MAT, CM, KG, JEC, Y-CC, KCGC, WAK); Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA (GJ, PTN, YK); Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, Kentucky, USA (PTN); Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA (YK)
| | - Charles Mock
- From the National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, USA (MAT, CM, KG, JEC, Y-CC, KCGC, WAK); Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA (GJ, PTN, YK); Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, Kentucky, USA (PTN); Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA (YK)
| | - Kathryn Gauthreaux
- From the National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, USA (MAT, CM, KG, JEC, Y-CC, KCGC, WAK); Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA (GJ, PTN, YK); Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, Kentucky, USA (PTN); Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA (YK)
| | - Jessica E Culhane
- From the National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, USA (MAT, CM, KG, JEC, Y-CC, KCGC, WAK); Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA (GJ, PTN, YK); Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, Kentucky, USA (PTN); Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA (YK)
| | - Gregory Jicha
- From the National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, USA (MAT, CM, KG, JEC, Y-CC, KCGC, WAK); Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA (GJ, PTN, YK); Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, Kentucky, USA (PTN); Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA (YK)
| | - Yen-Chi Chen
- From the National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, USA (MAT, CM, KG, JEC, Y-CC, KCGC, WAK); Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA (GJ, PTN, YK); Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, Kentucky, USA (PTN); Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA (YK)
| | - Kwun C G Chan
- From the National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, USA (MAT, CM, KG, JEC, Y-CC, KCGC, WAK); Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA (GJ, PTN, YK); Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, Kentucky, USA (PTN); Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA (YK)
| | - Walter A Kukull
- From the National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, USA (MAT, CM, KG, JEC, Y-CC, KCGC, WAK); Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA (GJ, PTN, YK); Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, Kentucky, USA (PTN); Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA (YK)
| | - Peter T Nelson
- From the National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, USA (MAT, CM, KG, JEC, Y-CC, KCGC, WAK); Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA (GJ, PTN, YK); Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, Kentucky, USA (PTN); Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA (YK)
| | - Yuriko Katsumata
- From the National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, USA (MAT, CM, KG, JEC, Y-CC, KCGC, WAK); Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA (GJ, PTN, YK); Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, Kentucky, USA (PTN); Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA (YK)
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18
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Buciuc M, Tosakulwong N, Machulda MM, Whitwell JL, Weigand SD, Murray ME, Reichard RR, Parisi JE, Dickson DW, Boeve BF, Knopman DS, Petersen RC, Josephs KA. TAR DNA-Binding Protein 43 Is Associated with Rate of Memory, Functional and Global Cognitive Decline in the Decade Prior to Death. J Alzheimers Dis 2021; 80:683-693. [PMID: 33579840 PMCID: PMC8020877 DOI: 10.3233/jad-201166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Transactive response DNA-binding protein of 43 kDa (TDP-43) is associated with memory impairment and overall cognitive decline. It is unclear how TDP-43 contributes to the rate of clinical decline. Objective: To determine whether cross-sectional and longitudinal cognitive and functional decline are associated with anatomical distribution of TDP-43 in the brain. Methods: Longitudinal clinical-neuropathologic autopsy cohort study of 385 initially cognitively normal/mildly impaired older adults prospectively followed until death. We investigated how TDP-43, amyloid-β (Aβ), tau neurofibrillary tangles (NFT), Lewy body disease (LBD), age, sex, and genetics are associated with clinical scores and rates of their longitudinal decline. Results: Of 385 participants, 260 (68%) had no TDP-43, 32 (8%) had TDP-43 limited to amygdala, and 93 (24%) had TDP-43 in the hippocampus and beyond. Higher TDP-43 and Braak NFT stages independently were associated with faster decline in global cognition, functional performance measured by Clinical Dementia Rating scale, and naming and episodic memory, whereas older age was associated with slower rate of cognitive, psychiatric, and functional decline. Cross-sectionally the following associations were found: higher TDP-43 and Braak NFT - worse performance; higher Aβ burden - worse global cognition, more behavioral changes, the latter also with higher LBD; older age - worse naming, lower frequency of behavioral changes; female sex - more impaired naming and better preserved episodic memory. There were no genetic associations. Conclusion: The association of TDP-43 distribution with decline in cognitive and functional performance suggests that TDP-43 is playing a role in the clinical progression to dementia. Further characterization of clinical features associated with TDP-43 can facilitate establishment of antemortem diagnosis.
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Affiliation(s)
- Marina Buciuc
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Stephen D Weigand
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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