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Mackay GA, Gall C, Jampana R, Sleith C, Lip GYH. Scottish Intercollegiate Guidelines Network Guidance on Dementia: The Investigation of Suspected Dementia (SIGN 168) with Focus on Biomarkers-Executive Summary. Thromb Haemost 2024. [PMID: 38788775 DOI: 10.1055/a-2332-6426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
This is an executive summary of the recent guidance produced by the Scottish Intercollegiate Guidelines Network (SIGN) dementia guideline group with regards to the investigation of suspected dementia. This is a sub-section of the broader SIGN 168 guideline released in November 2023. The guideline group included clinicians with expertise in Old Age Psychiatry, Neurology, Radiology, and Nuclear Medicine supported by colleagues from the SIGN and Healthcare Improvement Scotland teams. There was representation from carers and support organizations with experience of dementia, to ensure the recommendations were appropriate from the perspective of the people being assessed for possible dementia and their carers. As the 2018 National Institute for Health and Clinical Excellence (NICE) dementia review included a review of the evidenced investigation of dementia, the SIGN guideline development group decided to focus on a review on the up-to-date evidence regarding the role of imaging and fluid biomarkers in the diagnosis of dementia. To give context to the consideration of more advanced diagnostic biomarker investigations, the guideline and this summary include the NICE guidance on the use of standard investigations as well as more specialist investigations. The evidence review supports consideration of the use of structural imaging, nuclear medicine imaging, and established Alzheimer's cerebrospinal fluid biomarkers (amyloid and tau) in the diagnosis of dementia. Although routine use of amyloid positron emission tomography imaging was not recommended, its potential use, under specialist direction, in patients with atypical or young-onset presentations of suspected Alzheimer's dementia was included as a clinical good practice point.
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Affiliation(s)
- Graham Andrew Mackay
- Department of Neurology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, United Kingdom
| | - Claire Gall
- Department of Neurology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Ravi Jampana
- Department of Neuroradiology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Carolyn Sleith
- Healthcare Improvement Scotland, Edinburgh, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
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2
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van Kraaij SJW, Borghans L, Klaassen ES, Gal P, van der Grond J, Tripp K, Winrow C, Glasser C, Groeneveld GJ. Randomized placebo-controlled crossover study to assess tolerability and pharmacodynamics of zagociguat, a soluble guanylyl cyclase stimulator, in healthy elderly. Br J Clin Pharmacol 2023; 89:3606-3617. [PMID: 37488930 DOI: 10.1111/bcp.15861] [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: 03/13/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023] Open
Abstract
AIMS Dysfunction of nitric oxide-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate signalling is implicated in the pathophysiology of cognitive impairment. Zagociguat is a central nervous system (CNS) penetrant sGC stimulator designed to amplify nitric oxide-cyclic guanosine monophosphate signalling in the CNS. This article describes a phase 1b study evaluating the safety and pharmacodynamic effects of zagociguat. METHODS In this randomized crossover study, 24 healthy participants aged ≥65 years were planned to receive 15 mg zagociguat or placebo once daily for 2 15-day periods separated by a 27-day washout. Adverse events, vital signs, electrocardiograms and laboratory tests were conducted to assess safety. Pharmacokinetics of zagociguat were evaluated in blood and cerebrospinal fluid (CSF). Pharmacodynamic assessments included evaluation of cerebral blood flow, CNS tests, pharmaco-electroencephalography, passive leg movement and biomarkers in blood, CSF and brain. RESULTS Twenty-four participants were enrolled; 12 participants completed both treatment periods, while the other 12 participants completed only 1 treatment period. Zagociguat was well-tolerated and penetrated the blood-brain barrier, with a CSF/free plasma concentration ratio of 0.45 (standard deviation 0.092) measured 5 h after the last dose of zagociguat on Day 15. Zagociguat induced modest decreases in blood pressure. No consistent effects of zagociguat on other pharmacodynamic parameters were detected. CONCLUSION Zagociguat was well-tolerated and induced modest blood pressure reductions consistent with other sGC stimulators. No clear pharmacodynamic effects of zagociguat were detected. Studies in participants with proven reduced cerebral blood flow or CNS function may be an avenue for further evaluation of the compound.
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Affiliation(s)
- Sebastiaan J W van Kraaij
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Pim Gal
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ken Tripp
- Cyclerion Therapeutics, Cambridge, Massachusetts, USA
| | | | - Chad Glasser
- Cyclerion Therapeutics, Cambridge, Massachusetts, USA
| | - Geert Jan Groeneveld
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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3
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Kreple CJ, Gajagowni S, Jockel-Balsaratti J, Bucelli RC, Miller TM. Lumbar punctures are safe in patients with ALS and have a risk profile similar to that in the non-ALS population. Muscle Nerve 2023; 68:771-775. [PMID: 37566385 DOI: 10.1002/mus.27956] [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: 05/03/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION/AIMS Analysis of biofluids, especially cerebrospinal fluid (CSF), is critically important for amyotrophic lateral sclerosis (ALS) research. Collection of CSF is typically performed by lumbar puncture (LP). Previous studies have demonstrated the safety of LPs in patients with other neurodegenerative diseases, such as Alzheimer's disease, although there are no published studies of the safety of LPs in patients with ALS. We performed a retrospective analysis of complications resulting from LPs. METHODS This is a retrospective study of LPs performed between 2015 and 2021 on a total of 233 participants (healthy controls [n = 63], ALS [n = 154], and disease controls [n = 16]) as part of clinical research studies at the Washington University ALS Center. We used bivariate logistical analyses looking for associations between participant characteristics and adverse events (AEs), and likelihood ratio tests were used for significance testing. RESULTS We found an overall AE rate of 21.03%. AEs included headache, back pain, vasovagal syncope, and severe headache requiring epidural blood patch. Participants with ALS were not more likely to experience post-LP AEs compared to controls (odds ratio [OR] 0.61 [0.32-1.18]). Post-LP headaches were significantly less likely in participants with ALS (OR 0.36 [0.15-0.83]). DISCUSSION Our findings demonstrate that LP is a safe procedure for participants with ALS, with a similar or lower rate of AEs than in participants without ALS.
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Affiliation(s)
- Collin J Kreple
- Department of Neurology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Jennifer Jockel-Balsaratti
- Department of Neurology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri, USA
| | - Robert C Bucelli
- Department of Neurology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri, USA
| | - Timothy M Miller
- Department of Neurology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri, USA
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Hu WT, Nayyar A, Kaluzova M. Charting the Next Road Map for CSF Biomarkers in Alzheimer's Disease and Related Dementias. Neurotherapeutics 2023; 20:955-974. [PMID: 37378862 PMCID: PMC10457281 DOI: 10.1007/s13311-023-01370-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 06/29/2023] Open
Abstract
Clinical prediction of underlying pathologic substrates in people with Alzheimer's disease (AD) dementia or related dementia syndromes (ADRD) has limited accuracy. Etiologic biomarkers - including cerebrospinal fluid (CSF) levels of AD proteins and cerebral amyloid PET imaging - have greatly modernized disease-modifying clinical trials in AD, but their integration into medical practice has been slow. Beyond core CSF AD biomarkers (including beta-amyloid 1-42, total tau, and tau phosphorylated at threonine 181), novel biomarkers have been interrogated in single- and multi-centered studies with uneven rigor. Here, we review early expectations for ideal AD/ADRD biomarkers, assess these goals' future applicability, and propose study designs and performance thresholds for meeting these ideals with a focus on CSF biomarkers. We further propose three new characteristics: equity (oversampling of diverse populations in the design and testing of biomarkers), access (reasonable availability to 80% of people at risk for disease, along with pre- and post-biomarker processes), and reliability (thorough evaluation of pre-analytical and analytical factors influencing measurements and performance). Finally, we urge biomarker scientists to balance the desire and evidence for a biomarker to reflect its namesake function, indulge data- as well as theory-driven associations, re-visit the subset of rigorously measured CSF biomarkers in large datasets (such as Alzheimer's disease neuroimaging initiative), and resist the temptation to favor ease over fail-safe in the development phase. This shift from discovery to application, and from suspended disbelief to cogent ingenuity, should allow the AD/ADRD biomarker field to live up to its billing during the next phase of neurodegenerative disease research.
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Affiliation(s)
- William T Hu
- Department of Neurology, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, USA.
- Center for Innovation in Health and Aging Research, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA.
| | - Ashima Nayyar
- Department of Neurology, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, USA
| | - Milota Kaluzova
- Department of Neurology, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, USA
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Arnold MR, Coughlin DG, Brumbach BH, Smirnov DS, Concha-Marambio L, Farris CM, Ma Y, Kim Y, Wilson EN, Kaye JA, Hiniker A, Woltjer RL, Galasko DR, Quinn JF. α-Synuclein Seed Amplification in CSF and Brain from Patients with Different Brain Distributions of Pathological α-Synuclein in the Context of Co-Pathology and Non-LBD Diagnoses. Ann Neurol 2022; 92:650-662. [PMID: 35808984 PMCID: PMC9489647 DOI: 10.1002/ana.26453] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the sensitivity and specificity of α-synuclein seed amplification assay (αSyn-SAA) in antemortem and postmortem cerebrospinal fluid (CSF) of autopsy-confirmed patients with different distributions of pathological αSyn, co-pathologies, and clinical diagnoses. METHODS The αSyn-SAA was used to test antemortem CSF samples from 119 subjects with a variety of clinical syndromes and standardized neuropathological examinations from Oregon Health and Science University (OHSU) and University of California San Diego (UCSD; 56 additional postmortem CSF samples available). The αSyn-SAA was also applied to frontal cortex and amygdala homogenates. Sensitivity and specificity were compared across distributions of αSyn pathology. Clinical data and co-pathologies were compared across αSyn-SAA positive and negative groups. RESULTS Fifty-three individuals without and 66 with αSyn-pathology (neocortical [n = 38], limbic [n = 7], and amygdala-predominant [n = 21]) were included. There was a sensitivity of 97.8% and specificity of 98.1% of the αSyn-SAA to identify patients with limbic/neocortical pathology from antemortem CSF. Sensitivity to detect amygdala-predominant pathology was only 14.3%. Postmortem CSF and brain tissue αSyn-SAA analyses also showed higher assay positivity in samples from limbic/neocortical cases. INTERPRETATION CSF αSyn-SAA reliably identifies αSyn seeds in patients with diffuse αSyn pathology in the context of co-pathology and non-Lewy body disease (LBD) diagnoses. The analysis of brain homogenates suggests that pathological αSyn in the amygdala might differ from pathological αSyn in the frontal cortex. The αSyn-SAA might facilitate the differential diagnosis of dementias with mixed pathologies. ANN NEUROL 2022;92:650-662.
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Affiliation(s)
- Moriah R. Arnold
- Medical Scientist Training Program, Oregon Health and Science University
| | | | | | | | | | | | | | | | - Yongya Kim
- Department of Neurosciences, University of California San Diego
| | - Edward N. Wilson
- Department of Neurology & Neurological Sciences, Stanford University
| | - Jeffrey A. Kaye
- Department of Neurology, Oregon Health and Science University
| | - Annie Hiniker
- Department of Pathology, University of California San Diego
| | | | - Doug R. Galasko
- Department of Neurosciences, University of California San Diego
| | - Joseph F. Quinn
- Department of Neurology, Oregon Health and Science University
- Portland VA Medical Center, Parkinson’s Disease Research Education and Clinical Care Center (PADRECC)
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Umemura Y, Khan B, Weill BJ, Buthorn JJ, Skakodub A, Ridder AJ, Nevel KS, Sun Y, Boire A. Discordance Between Perceptions and Experience of Lumbar Puncture: A Prospective Study. Neurol Clin Pract 2022; 12:344-351. [PMID: 36380890 PMCID: PMC9647808 DOI: 10.1212/cpj.0000000000200061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/26/2022] [Indexed: 01/13/2023]
Abstract
Background and Objectives Novel diagnostic techniques and neurologic biomarkers have greatly expanded clinical indications for CSF studies. CSF is most commonly obtained via lumbar puncture (LP). Although it is generally believed that LPs are well tolerated, there is a lack of supportive data for this claim, and patients anticipate LP to be painful. The objective of this study was to prospectively investigate discordance between patient perception and tolerability of LP. Methods Adult patients were surveyed before and after LP regarding their perceptions and experience of LP. Physician perceptions were gathered through a web-based survey. Relative risk and Spearman correlation were used to assess the relationship between responses. Paired binomial and paired ordinal responses were compared by McNemar and paired Wilcoxon rank-sum tests. Results A total of 178 patients completed the surveys. About half of the patients (58%) reported anxiety pre-LP, at median 3.0 of 10. Physicians overpredicted patients' pre-LP anxiety (median score 5.0, p < 0.001). Experienced pain was significantly less than predicted pain (median scores 0 and 3.0, respectively, p < 0.001). Patients who predicted pain were more likely to report pain from LP (relative risk [RR] 1.3). Predicting pain was also correlated with anxiety before LP (p < 0.001). Discussion LP was generally well tolerated. The majority of patients experienced minimal pain. Anticipation of pain was correlated with both feeling anxious and experiencing pain. The results of this study can be used to reassure patients and providers that LP is indeed not as painful as imagined, which may both reduce pre-LP anxiety and improve LP tolerability.
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Affiliation(s)
- Yoshie Umemura
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Baber Khan
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Benjamin J Weill
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Justin J Buthorn
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Anna Skakodub
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Andrew J Ridder
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Kathryn S Nevel
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Yilun Sun
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Adrienne Boire
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
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Carlyle BC, Kitchen RR, Mattingly Z, Celia AM, Trombetta BA, Das S, Hyman BT, Kivisäkk P, Arnold SE. Technical Performance Evaluation of Olink Proximity Extension Assay for Blood-Based Biomarker Discovery in Longitudinal Studies of Alzheimer's Disease. Front Neurol 2022; 13:889647. [PMID: 35734478 PMCID: PMC9207419 DOI: 10.3389/fneur.2022.889647] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022] Open
Abstract
The core Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers; amyloid-β (Aß), total tau (t-tau), and phosphorylated tau (p-tau181), are strong indicators of the presence of AD pathology, but do not correlate well with disease progression, and can be difficult to implement in longitudinal studies where repeat biofluid sampling is required. As a result, blood-based biomarkers are increasingly being sought as alternatives. In this study, we aimed to evaluate a promising blood biomarker discovery technology, Olink Proximity Extension Assays for technical reproducibility characteristics in order to highlight the advantages and disadvantages of using this technology in biomarker discovery in AD. We evaluated the performance of five Olink Proteomic multiplex proximity extension assays (PEA) in plasma samples. Three technical control samples included on each plate allowed calculation of technical variability. Biotemporal stability was measured in three sequential annual samples from 54 individuals with and without AD. Coefficients of variation (CVs), analysis of variance (ANOVA), and variance component analyses were used to quantify technical and individual variation over time. We show that overall, Olink assays are technically robust, with the largest experimental variation stemming from biological differences between individuals for most analytes. As a powerful illustration of one of the potential pitfalls of using a multi-plexed technology for discovery, we performed power calculations using the baseline samples to demonstrate the size of study required to overcome the need for multiple test correction with this technology. We show that the power of moderate effect size proteins was strongly reduced, and as a result investigators should strongly consider pooling resources to perform larger studies using this multiplexed technique where possible.
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Affiliation(s)
- Becky C. Carlyle
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Robert R. Kitchen
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Zoe Mattingly
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Amanda M. Celia
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Bianca A. Trombetta
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sudeshna Das
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Bradley T. Hyman
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Pia Kivisäkk
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Steven E. Arnold
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- *Correspondence: Steven E. Arnold
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Rodrigues FB, Owen G, Sathe S, Pak E, Kaur D, Ehrhardt AG, Lifer S, Townhill J, Schubert K, Leavitt BR, Guttman M, Bang J, Lewerenz J, Levey J, Sampaio C, Wild EJ. Safety and Feasibility of Research Lumbar Puncture in Huntington's Disease: The HDClarity Cohort and Bioresource. J Huntingtons Dis 2022; 11:59-69. [PMID: 35253773 DOI: 10.3233/jhd-210508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Biomarkers are needed to monitor disease progression, target engagement and efficacy in Huntington's disease (HD). Cerebrospinal fluid (CSF) is an ideal medium to research such biomarkers due to its proximity to the brain. OBJECTIVE To investigate the safety and feasibility of research lumbar punctures (LP) in HD. METHODS HDClarity is an ongoing international biofluid collection initiative built on the Enroll-HD platform, where clinical assessments are recorded. It aims to recruit 1,200 participants. Biosamples are collected following an overnight fast: blood via venipuncture and CSF via LP. Participants are healthy controls and HD gene expansion carriers across the disease spectrum. We report on monitored data from February 2016 to September 2019. RESULTS Of 448 participants screened, 398 underwent at least 1 sampling visit, of which 98.24% were successful (i.e., CSF was collected), amounting to 10,610 mL of CSF and 8,200 mL of plasma. In the total 572 sampling visits, adverse events were reported in 24.13%, and headaches of any kind and post-LP headaches in 14.86% and 12.24%, respectively. Frequencies were less in manifest HD; gender, age, body mass index and disease burden score were not associated with the occurrence of the events in gene expansion carriers. Headaches and back pain were the most frequent adverse events. CONCLUSION HDClarity is the largest CSF collection initiative to support scientific research into HD and is now stablished as a leading resource for HD research. Our data confirm that research LP in HD are feasible and acceptable to the community, and have a manageable safety profile.
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Affiliation(s)
- Filipe B Rodrigues
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Gail Owen
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Swati Sathe
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | - Elena Pak
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | | | | | - Sherry Lifer
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | - Jenny Townhill
- Enroll-HD platform, European Huntington's Disease Network, University Hospital of Ulm, Ulm, Germany
| | - Katarzyna Schubert
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Mark Guttman
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jee Bang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jan Lewerenz
- Department of Neurology, Ulm University, Ulm, Germany
| | - Jamie Levey
- CHDI Management/CHDI Foundation, Princeton, NJ, USA.,Enroll-HD platform, European Huntington's Disease Network, University Hospital of Ulm, Ulm, Germany
| | | | | | - Edward J Wild
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
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9
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Soo SA, Zailan FZ, Tan JY, Sandhu GK, Wong BYX, Wang BZ, Ng ASL, Chiew HJ, Ng KP, Kandiah N. Safety and Usefulness of Lumbar Puncture for the Diagnosis and Management of Young-Onset Cognitive Disorders. J Alzheimers Dis 2022; 87:479-488. [PMID: 35275537 DOI: 10.3233/jad-215453] [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: 12/31/2022]
Abstract
BACKGROUND Young-onset cognitive disorders (YOCD) often manifests with complex and atypical presentations due to underlying heterogenous pathologies. Therefore, a biomarker-based evaluation will allow for timely diagnosis and definitive management. OBJECTIVE Here, we evaluated the safety and usefulness of cerebrospinal fluid (CSF) sampling through lumbar puncture (LP) in YOCD patients in a tertiary clinical setting. METHODS Patients with mild cognitive impairment (MCI) and mild dementia with age of onset between 45-64 years were evaluated. Patients underwent magnetic resonance imaging and their medial temporal lobe atrophy (MTA) was rated. LP side-effects and the impact of the CSF findings on diagnosis and management were analyzed. RESULTS 142 patients (53 (37.32%) MCI, 51 (35.92%) dementia of the Alzheimer's disease [DAT] type, and 38 (26.76%) non-AD type dementia) who underwent LP between 2015 to 2021 were analyzed. Using post-LP results and MTA ratings, 74 (52.11%) patients met the AT(N) criteria for AD. 56 (39.44%) patients (28 out of 53 (50.0%) MCI, 12 out of 51 (21.43%) DAT, and 16 out of 38 (28.57%) non-AD dementia) had a change in diagnosis following LP. 13 (9.15%) patients developed side-effects post-LP (11 (84.62%) patients had headache, 1 (7.69%) patient had backache, and 1 (7.69%) patient had headache and backache). 32 (22.54%) patients had a change in management post-LP, 24 (75.0%) had medication changes, 10 (31.30%) had referrals to other specialists, and 3 (9.40%) was referred for clinical trial with disease modifying interventions. CONCLUSION LP is well-tolerated in YOCD and can bring about relevant clinical decisions with regards to the diagnosis and management of this complex clinical condition.
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Affiliation(s)
- See Ann Soo
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Jayne Yi Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | | | | | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke NUS Medical School, Singapore.,Lee Kong Chian School of Medicine-NTU, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke NUS Medical School, Singapore.,Lee Kong Chian School of Medicine-NTU, Singapore
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10
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Eigenbehaviour as an Indicator of Cognitive Abilities. SENSORS 2022; 22:s22072769. [PMID: 35408381 PMCID: PMC9003060 DOI: 10.3390/s22072769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 02/01/2023]
Abstract
With growing use of machine learning algorithms and big data in health applications, digital measures, such as digital biomarkers, have become highly relevant in digital health. In this paper, we focus on one important use case, the long-term continuous monitoring of cognitive ability in older adults. Cognitive ability is a factor both for long-term monitoring of people living alone as well as a relevant outcome in clinical studies. In this work, we propose a new potential digital biomarker for cognitive abilities based on location eigenbehaviour obtained from contactless ambient sensors. Indoor location information obtained from passive infrared sensors is used to build a location matrix covering several weeks of measurement. Based on the eigenvectors of this matrix, the reconstruction error is calculated for various numbers of used eigenvectors. The reconstruction error in turn is used to predict cognitive ability scores collected at baseline, using linear regression. Additionally, classification of normal versus pathological cognition level is performed using a support-vector machine. Prediction performance is strong for high levels of cognitive ability but grows weaker for low levels of cognitive ability. Classification into normal and older adults with mild cognitive impairment, using age and the reconstruction error, shows high discriminative performance with an ROC AUC of 0.94. This is an improvement of 0.08 as compared with a classification with age only. Due to the unobtrusive method of measurement, this potential digital biomarker of cognitive ability can be obtained entirely unobtrusively—it does not impose any patient burden. In conclusion, the usage of the reconstruction error is a strong potential digital biomarker for binary classification and, to a lesser extent, for more detailed prediction of inter-individual differences in cognition.
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11
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Gregory S, Linz N, König A, Langel K, Pullen H, Luz S, Harrison J, Ritchie CW. Remote data collection speech analysis and prediction of the identification of Alzheimer's disease biomarkers in people at risk for Alzheimer's disease dementia: the Speech on the Phone Assessment (SPeAk) prospective observational study protocol. BMJ Open 2022; 12:e052250. [PMID: 35292490 PMCID: PMC8928245 DOI: 10.1136/bmjopen-2021-052250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Identifying cost-effective, non-invasive biomarkers of Alzheimer's disease (AD) is a clinical and research priority. Speech data are easy to collect, and studies suggest it can identify those with AD. We do not know if speech features can predict AD biomarkers in a preclinical population. METHODS AND ANALYSIS The Speech on the Phone Assessment (SPeAk) study is a prospective observational study. SPeAk recruits participants aged 50 years and over who have previously completed studies with AD biomarker collection. Participants complete a baseline telephone assessment, including spontaneous speech and cognitive tests. A 3-month visit will repeat the cognitive tests with a conversational artificial intelligence bot. Participants complete acceptability questionnaires after each visit. Participants are randomised to receive their cognitive test results either after each visit or only after they have completed the study. We will combine SPeAK data with AD biomarker data collected in a previous study and analyse for correlations between extracted speech features and AD biomarkers. The outcome of this analysis will inform the development of an algorithm for prediction of AD risk based on speech features. ETHICS AND DISSEMINATION This study has been approved by the Edinburgh Medical School Research Ethics Committee (REC reference 20-EMREC-007). All participants will provide informed consent before completing any study-related procedures, participants must have capacity to consent to participate in this study. Participants may find the tests, or receiving their scores, causes anxiety or stress. Previous exposure to similar tests may make this more familiar and reduce this anxiety. The study information will include signposting in case of distress. Study results will be disseminated to study participants, presented at conferences and published in a peer reviewed journal. No study participants will be identifiable in the study results.
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Affiliation(s)
- Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Nicklas Linz
- ki elements, ki elements, Saarbrucken, Saarland, Germany
| | - Alexandra König
- Stars Team, National Institute for Research in Computer Science and Automation, Nice, France
| | - Kai Langel
- Janssen Healthcare Innovation, Beerse, Belgium
| | - Hannah Pullen
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Saturnino Luz
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - John Harrison
- Metis Cognition Ltd, Kilmington Common, UK
- Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
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12
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Thomas-Black G, Dumitrascu A, Garcia-Moreno H, Vallortigara J, Greenfield J, Hunt B, Walther S, Wells M, Lynch DR, Montgomery H, Giunti P. The attitude of patients with progressive ataxias towards clinical trials. Orphanet J Rare Dis 2022; 17:1. [PMID: 34983593 PMCID: PMC8729009 DOI: 10.1186/s13023-021-02091-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/17/2021] [Indexed: 12/17/2022] Open
Abstract
Background The development of new therapies may rely on the conduct of human experimentation as well as later clinical trials of therapeutic interventions. Ethical considerations seek to protect the patient from risk but few have sought to ascertain the attitude to such risk of patients with progressive debilitating or terminal conditions, for which no mitigating or curative therapies exist. Such understanding is also important if recruitment is to be maximized. We therefore sought to define the motivations for and barriers to trial participation amongst patients with progressive ataxias, as well as their condition-specific trial preferences. Methods We conducted an online survey consisting of 29 questions covering four key domains (demographics, personal motivation, drug therapy and study design) relating to the design of clinical trials. Two major ataxia charities, Ataxia UK and the Friedreich’s Ataxia Research Alliance (FARA) sent the survey to their members. Responses were analysed by disease and by ambulatory status. Results Of 342 respondents, 204 reported a diagnosis of Friedreich’s ataxia (FRDA), 55 inherited cerebellar ataxia (CA) and 70 idiopathic CA. The most important symptoms to be addressed by a trial were considered to be balance problems and ambulation, although these were superseded by speech problems in wheelchair users. Common motivations for participation were potential benefits to self and others. Reasons for non-participation included concerns about side effects, and the burden and cost of travel. Financial reimbursement for expenses was reported to be likely to increase trial engagement, Phase two trials were the most popular to participate in, and the use of a placebo arm was seen as a disincentive. Across all disease subgroups, drug repurposing trials proved popular and just under 70% of participants would be prepared to undergo intrathecal drug administration. Conclusions Knowledge of motivations for and barriers to trial participation as well as the acceptability of investigations, time commitments and routes of drug administration should inform better, more patient focused trial design. This in turn may improve recruitment and retention of participants to future trials. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02091-x.
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Affiliation(s)
- Gilbert Thomas-Black
- Department of Clinical and Movement Neurosciences, The Ataxia Centre, UCL Queen Square Institute of Neurology, University College London, London, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals Foundation NHS Trust, London, UK
| | - Andrada Dumitrascu
- Department of Clinical and Movement Neurosciences, The Ataxia Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Hector Garcia-Moreno
- Department of Clinical and Movement Neurosciences, The Ataxia Centre, UCL Queen Square Institute of Neurology, University College London, London, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals Foundation NHS Trust, London, UK
| | - Julie Vallortigara
- Department of Clinical and Movement Neurosciences, The Ataxia Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Barry Hunt
- Ataxia UK, 12 Broadbent Close, N6 5JW, London, UK
| | - Susan Walther
- Friedreich'S Ataxia Research Alliance, 533 W Uwchlan Ave, Downingtown, PA, 19335, USA
| | - Mackenzie Wells
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - David R Lynch
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Hugh Montgomery
- Institute of Sport Exercise and Health, University College London, London, UK
| | - Paola Giunti
- Department of Clinical and Movement Neurosciences, The Ataxia Centre, UCL Queen Square Institute of Neurology, University College London, London, UK. .,National Hospital for Neurology and Neurosurgery, University College London Hospitals Foundation NHS Trust, London, UK.
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13
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Ullah R, Park TJ, Huang X, Kim MO. Abnormal amyloid beta metabolism in systemic abnormalities and Alzheimer's pathology: Insights and therapeutic approaches from periphery. Ageing Res Rev 2021; 71:101451. [PMID: 34450351 DOI: 10.1016/j.arr.2021.101451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023]
Abstract
Alzheimer's disease (AD) is an age-associated, multifactorial neurodegenerative disorder that is incurable. Despite recent success in treatments that partially improve symptomatic relief, they have failed in most clinical trials. Re-holding AD for accurate diagnosis and treatment is widely known as a challenging task. Lack of knowledge of basic molecular pathogenesis might be a possible reason for ineffective AD treatment. Historically, a majority of therapy-based studies have investigated the role of amyloid-β (Aβ peptide) in the central nervous system (CNS), whereas less is known about Aβ peptide in the periphery in AD. In this review, we provide a comprehensive summary of the current understanding of Aβ peptide metabolism (anabolism and catabolism) in the brain and periphery. We show that the abnormal metabolism of Aβ peptide is significantly linked with central-brain and peripheral abnormalities; the interaction between peripheral Aβ peptide metabolism and peripheral abnormalities affects central-brain Aβ peptide metabolism, suggesting the existence of significant communication between these two pathways of Aβ peptide metabolism. This close interaction between the central brain and periphery in abnormal Aβ peptide metabolism plays a key role in the development and progression of AD. In conclusion, we need to obtain a full understanding of the dynamic roles of Aβ peptide at the molecular level in both the brain and periphery in relation to the pathology of AD. This will not only provide new information regarding the complex disease pathology, but also offer potential new clues to improve therapeutic strategies and diagnostic biomarkers for the successful treatment of AD.
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14
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Lusardi TA, Sandau US, Sakhanenko NA, Baker SCB, Wiedrick JT, Lapidus JA, Raskind MA, Li G, Peskind ER, Galas DJ, Quinn JF, Saugstad JA. Cerebrospinal Fluid MicroRNA Changes in Cognitively Normal Veterans With a History of Deployment-Associated Mild Traumatic Brain Injury. Front Neurosci 2021; 15:720778. [PMID: 34580583 PMCID: PMC8463659 DOI: 10.3389/fnins.2021.720778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/27/2021] [Indexed: 01/09/2023] Open
Abstract
A history of traumatic brain injury (TBI) increases the odds of developing Alzheimer's disease (AD). The long latent period between injury and dementia makes it difficult to study molecular changes initiated by TBI that may increase the risk of developing AD. MicroRNA (miRNA) levels are altered in TBI at acute times post-injury (<4 weeks), and in AD. We hypothesized that miRNA levels in cerebrospinal fluid (CSF) following TBI in veterans may be indicative of increased risk for developing AD. Our population of interest is cognitively normal veterans with a history of one or more mild TBI (mTBI) at a chronic time following TBI. We measured miRNA levels in CSF from three groups of participants: (1) community controls with no lifetime history of TBI (ComC); (2) deployed Iraq/Afghanistan veterans with no lifetime history of TBI (DepC), and (3) deployed Iraq/Afghanistan veterans with a history of repetitive blast mTBI (DepTBI). CSF samples were collected at the baseline visit in a longitudinal, multimodal assessment of Gulf War veterans, and represent a heterogenous group of male veterans and community controls. The average time since the last blast mTBI experienced was 4.7 ± 2.2 years [1.5 - 11.5]. Statistical analysis of TaqManTM miRNA array data revealed 18 miRNAs with significant differential expression in the group comparisons: 10 between DepTBI and ComC, 7 between DepC and ComC, and 8 between DepTBI and DepC. We also identified 8 miRNAs with significant differential detection in the group comparisons: 5 in DepTBI vs. ComC, 3 in DepC vs. ComC, and 2 in DepTBI vs. DepC. When we applied our previously developed multivariable dependence analysis, we found 13 miRNAs (6 of which are altered in levels or detection) that show dependencies with participant phenotypes, e.g., ApoE. Target prediction and pathway analysis with miRNAs differentially expressed in DepTBI vs. either DepC or ComC identified canonical pathways highly relevant to TBI including senescence and ephrin receptor signaling, respectively. This study shows that both TBI and deployment result in persistent changes in CSF miRNA levels that are relevant to known miRNA-mediated AD pathology, and which may reflect early events in AD.
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Affiliation(s)
- Theresa A Lusardi
- Knight Cancer Institute, Cancer Early Detection Advanced Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Ursula S Sandau
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, United States
| | | | - Sarah Catherine B Baker
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Jack T Wiedrick
- Biostatistics & Design Program, Oregon Health & Science University, Portland, OR, United States
| | - Jodi A Lapidus
- Biostatistics & Design Program, Oregon Health & Science University, Portland, OR, United States
| | - Murray A Raskind
- Northwest Mental Illness, Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Ge Li
- Northwest Mental Illness, Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States.,Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Elaine R Peskind
- Northwest Mental Illness, Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - David J Galas
- Pacific Northwest Research Institute, Seattle, WA, United States
| | - Joseph F Quinn
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States.,Parkinson Center and Movement Disorders Program, School of Medicine, Oregon Health & Science University, Portland, OR, United States.,Portland VAMC Parkinson's Disease Research, Education, and Clinical Center, Portland, OR, United States
| | - Julie A Saugstad
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, United States
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15
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Trammell AR, McDaniel DJ, Obideen M, Okafor M, Thomas TL, Goldstein FC, Shaw LM, Hajjar IM. Perceived Stress is Associated with Alzheimer's Disease Cerebrospinal Fluid Biomarkers in African Americans with Mild Cognitive Impairment. J Alzheimers Dis 2021; 77:843-853. [PMID: 32741810 DOI: 10.3233/jad-200089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND African Americans (AA) have a higher Alzheimer's disease (AD) prevalence and report more perceived stress than White Americans. The biological basis of the stress-AD link is unclear. This study investigates the connection between stress and AD biomarkers in a biracial cohort. OBJECTIVE Establish biomarker evidence for the observed association between stress and AD, especially in AA. METHODS A cross-sectional study (n = 364, 41.8% AA) administering cognitive tests and the perceived stress scale (PSS) questionnaire. A subset (n = 309) provided cerebrospinal fluid for measurement of Aβ42, Tau, Ptau, Tau/Aβ42 (TAR), and Ptau/Aβ42 (PTAR). Multivariate linear regression, including factors that confound racial differences in AD, was performed. RESULTS Higher PSS scores were associated with higher Ptau (β= 0.43, p = 0.01) and PTAR (β= 0.005, p = 0.03) in AA with impaired cognition (mild cognitive impairment). CONCLUSION Higher PSS scores were associated with Tau-related AD biomarker indices in AA/MCI, suggesting a potential biological connection for stress with AD and its racial disparity.
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Affiliation(s)
- Antoine R Trammell
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Darius J McDaniel
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Malik Obideen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Maureen Okafor
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Tiffany L Thomas
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia C Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Ihab M Hajjar
- Department of Medicine and Neurology, Emory University School of Medicine, Atlanta, GA, USA
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16
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Hampel H, Shaw LM, Aisen P, Chen C, Lleó A, Iwatsubo T, Iwata A, Yamada M, Ikeuchi T, Jia J, Wang H, Teunissen CE, Peskind E, Blennow K, Cummings J, Vergallo A. State-of-the-art of lumbar puncture and its place in the journey of patients with Alzheimer's disease. Alzheimers Dement 2021; 18:159-177. [PMID: 34043269 PMCID: PMC8626532 DOI: 10.1002/alz.12372] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/24/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023]
Abstract
Recent advances in developing disease‐modifying therapies (DMT) for Alzheimer's disease (AD), and the recognition that AD pathophysiology emerges decades before clinical symptoms, necessitate a paradigm shift of health‐care systems toward biomarker‐guided early detection, diagnosis, and therapeutic decision‐making. Appropriate incorporation of cerebrospinal fluid biomarker analysis in clinical practice is an essential step toward system readiness for accommodating the demand of AD diagnosis and proper use of DMTs—once they become available. However, the use of lumbar puncture (LP) in individuals with suspected neurodegenerative diseases such as AD is inconsistent, and the perception of its utility and safety differs considerably among medical specialties as well as among regions and countries. This review describes the state‐of‐the‐art evidence concerning the safety profile of LP in older adults, discusses the risk factors for LP‐associated adverse events, and provides recommendations and an outlook for optimized use and global implementation of LP in individuals with suspected AD.
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Affiliation(s)
- Harald Hampel
- Eisai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
| | - Leslie M Shaw
- Perelman School of Medicine, Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Aisen
- USC Alzheimer's Therapeutic Research Institute, San Diego, California, USA
| | - Christopher Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alberto Lleó
- Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau-Biomedical Research Institute Sant Pau-Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Takeshi Iwatsubo
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsushi Iwata
- Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Asahimachi, Niigata, Japan
| | - Jianping Jia
- Innovation Center for Neurological Disorders, Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Elaine Peskind
- VA Northwest Mental Illness Research, Education and Clinical Center, VA Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - 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, Nevada, USA
| | - Andrea Vergallo
- Eisai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
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17
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2020 update on the clinical validity of cerebrospinal fluid amyloid, tau, and phospho-tau as biomarkers for Alzheimer's disease in the context of a structured 5-phase development framework. Eur J Nucl Med Mol Imaging 2021; 48:2121-2139. [PMID: 33674895 PMCID: PMC8175301 DOI: 10.1007/s00259-021-05258-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
Purpose In the last decade, the research community has focused on defining reliable biomarkers for the early detection of Alzheimer’s disease (AD) pathology. In 2017, the Geneva AD Biomarker Roadmap Initiative adapted a framework for the systematic validation of oncological biomarkers to cerebrospinal fluid (CSF) AD biomarkers—encompassing the 42 amino-acid isoform of amyloid-β (Aβ42), phosphorylated-tau (P-tau), and Total-tau (T-tau)—with the aim to accelerate their development and clinical implementation. The aim of this work is to update the current validation status of CSF AD biomarkers based on the Biomarker Roadmap methodology. Methods A panel of experts in AD biomarkers convened in November 2019 at a 2-day workshop in Geneva. The level of maturity (fully achieved, partly achieved, preliminary evidence, not achieved, unsuccessful) of CSF AD biomarkers was assessed based on the Biomarker Roadmap methodology before the meeting and presented and discussed during the workshop. Results By comparison to the previous 2017 Geneva Roadmap meeting, the primary advances in CSF AD biomarkers have been in the area of a unified protocol for CSF sampling, handling and storage, the introduction of certified reference methods and materials for Aβ42, and the introduction of fully automated assays. Additional advances have occurred in the form of defining thresholds for biomarker positivity and assessing the impact of covariates on their discriminatory ability. Conclusions Though much has been achieved for phases one through three, much work remains in phases four (real world performance) and five (assessment of impact/cost). To a large degree, this will depend on the availability of disease-modifying treatments for AD, given these will make accurate and generally available diagnostic tools key to initiate therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05258-7.
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18
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Darrow JA, Calabro A, Gannon S, Orusakwe A, Esquivel R, Traynham C, Rao A, Gulyani S, Khingelova K, Bandeen-Roche K, Albert M, Moghekar A. Effect of Patient-Specific Preanalytic Variables on CSF Aβ1-42 Concentrations Measured on an Automated Chemiluminescent Platform. J Appl Lab Med 2021; 6:397-408. [PMID: 33249440 PMCID: PMC8482291 DOI: 10.1093/jalm/jfaa145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/28/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) biomarkers are increasingly used to confirm the accuracy of a clinical diagnosis of mild cognitive impairment or dementia due to Alzheimer disease (AD). Recent evidence suggests that fully automated assays reduce the impact of some preanalytical factors on the variability of these measures. This study evaluated the effect of several preanalytical variables common in clinical settings on the variability of CSF β-amyloid 1-42 (Aβ1-42) concentrations. METHODS Aβ1-42 concentrations were measured using the LUMIPULSE G1200 from both freshly collected and frozen CSF samples. Preanalytic variables examined were: (1) patient fasting prior to CSF collection, (2) blood contamination of specimens, and (3) aliquoting specimens sequentially over the course of collection (i.e., CSF gradients). RESULTS Patient fasting did not significantly affect CSF Aβ1-42 levels. While assessing gradient effects, Aβ1-42 concentrations remained stable within the first 5 1-mL aliquots. However, there is evidence of a gradient effect toward higher concentrations over successive aliquots. Aβ1-42 levels were stable when fresh CSF samples were spiked with up to 2.5% of blood. However, in frozen CSF samples, even 0.25% blood contamination significantly decreased Aβ1-42 concentrations. CONCLUSIONS The preanalytical variables examined here do not have significant effects on Aβ1-42 concentrations if fresh samples are processed within 2 h. However, a gradient effect can be observed on Aβ1-42 concentrations after the first 5 mL of collection and blood contamination has a significant impact on Aβ1-42 concentrations once specimens have been frozen.
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Affiliation(s)
| | | | | | | | | | | | - Aruna Rao
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Seema Gulyani
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
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19
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Happo S, Keränen T, Halkoaho A, Lehto SM. Risk Assessment of Medical Study Procedures in the Documents Submitted to a Research Ethics Committee. J Empir Res Hum Res Ethics 2020; 15:396-406. [PMID: 32036724 PMCID: PMC7604935 DOI: 10.1177/1556264620903563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several frameworks assist research ethics committees (RECs) in risk assessment of medical studies. However, little is known about how researchers describe risks of the procedures in study protocols and participant information sheets. We examined 349 study protocols and participant information sheets submitted to an REC and evaluated the risk assessments performed for 1,510 study procedures. Risks had been assessed for 399 (26%) procedures in study protocols and for 425 (28%) procedures in participant information sheets. Physical risks were assessed six times more frequently than psychological risks. Risks of medical procedures are not always detailed in study protocols or participant information sheets. Risk descriptions of procedures believed to be familiar to potential participants may be omitted.
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Affiliation(s)
- Saara Happo
- University of Eastern Finland, Kuopio, Finland
| | | | | | - Soili M. Lehto
- University of Eastern Finland, Kuopio, Finland
- University of Helsinki, Finland
- Helsinki University Hospital, Finland
- Kuopio University Hospital, Finland
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20
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Shaffer RM, Sheppard L, Peskind ER, Zhang J, Adar SD, Li G. Fine Particulate Matter Exposure and Cerebrospinal Fluid Markers of Vascular Injury. J Alzheimers Dis 2020; 71:1015-1025. [PMID: 31476158 DOI: 10.3233/jad-190563] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cerebrovascular diseases play an important role in dementia. Air pollution is associated with cardiovascular disease, with growing links to neurodegeneration. Prior studies demonstrate associations between fine particulate matter (PM2.5) and biomarkers of endothelial injury in the blood; however, no studies have evaluated these biomarkers in cerebrospinal fluid (CSF). OBJECTIVE We evaluate associations between short-term and long-term PM2.5 exposure with CSF vascular cell adhesion molecule-1 (VCAM-1) and e-selectin in cognitively normal and mild cognitive impairment (MCI)/Alzheimer's disease (AD) individuals. METHODS We collected CSF from 133 community volunteers at VA Puget Sound between 2001-2012. We assigned short-term PM2.5 from central monitors and long-term PM2.5 based on annual average exposure predictions linked to participant addresses. We performed analyses stratified by cognitive status and adjusted for key covariates with tiered models. Our primary exposure windows for the short-term and long-term analyses were 7-day and 1-year averages, respectively. RESULTS Among cognitively normal individuals, a 5 μg/m3 increase in 7-day and 1-year average PM2.5 was associated with elevated VCAM-1 (7-day: 35.4 (9.7, 61.1) ng/ml; 1-year: 51.8 (6.5, 97.1) ng/ml). A 5 μg/m3 increase in 1-year average PM2.5, but not 7-day average, was associated with elevated e-selectin (53.3 (11.0, 95.5) pg/ml). We found no consistent associations among MCI/AD individuals. CONCLUSIONS We report associations between short-term and long term PM2.5 and CSF biomarkers of vascular damage in cognitively normal adults. These results are aligned with prior research linking PM2.5 to vascular damage in other biofluids as well as emerging evidence of the role of PM2.5 in neurodegeneration.
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Affiliation(s)
- Rachel M Shaffer
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Elaine R Peskind
- VA Northwest Network Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jing Zhang
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Sara D Adar
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, WA, USA
| | - Ge Li
- VA Northwest Network Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
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21
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Meabon JS, Cook DG, Yagi M, Terry GE, Cross DJ, Muzi M, Pagulayan KF, Logsdon AF, Schindler AG, Ghai V, Wang K, Fallen S, Zhou Y, Kim TK, Lee I, Banks WA, Carlson ES, Mayer C, Hendrickson RC, Raskind MA, Marshall DA, Perl DP, Keene CD, Peskind ER. Chronic elevation of plasma vascular endothelial growth factor-A (VEGF-A) is associated with a history of blast exposure. J Neurol Sci 2020; 417:117049. [PMID: 32758764 PMCID: PMC7492467 DOI: 10.1016/j.jns.2020.117049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 06/23/2020] [Accepted: 07/15/2020] [Indexed: 02/02/2023]
Abstract
Mounting evidence points to the significance of neurovascular-related dysfunction in veterans with blast-related mTBI, which is also associated with reduced [18F]-fluorodeoxyglucose (FDG) uptake. The goal of this study was to determine whether plasma VEGF-A is altered in veterans with blast-related mTBI and address whether VEGF-A levels correlate with FDG uptake in the cerebellum, a brain region that is vulnerable to blast-related injury 72 veterans with blast-related mTBI (mTBI) and 24 deployed control (DC) veterans with no lifetime history of TBI were studied. Plasma VEGF-A was significantly elevated in mTBIs compared to DCs. Plasma VEGF-A levels in mTBIs were significantly negatively correlated with FDG uptake in cerebellum. In addition, performance on a Stroop color/word interference task was inversely correlated with plasma VEGF-A levels in blast mTBI veterans. Finally, we observed aberrant perivascular VEGF-A immunoreactivity in postmortem cerebellar tissue and not cortical or hippocampal tissues from blast mTBI veterans. These findings add to the limited number of plasma proteins that are chronically elevated in veterans with a history of blast exposure associated with mTBI. It is likely the elevated VEGF-A levels are from peripheral sources. Nonetheless, increasing plasma VEGF-A concentrations correlated with chronically decreased cerebellar glucose metabolism and poorer performance on tasks involving cognitive inhibition and set shifting. These results strengthen an emerging view that cognitive complaints and functional brain deficits caused by blast exposure are associated with chronic blood-brain barrier injury and prolonged recovery in affected regions.
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Affiliation(s)
- James S Meabon
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - David G Cook
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA; Department of Pharmacology, University of Washington, Seattle, WA, USA
| | - Mayumi Yagi
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Garth E Terry
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Radiology, University of Washington, Seattle, WA, USA
| | - Donna J Cross
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Kathleen F Pagulayan
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Aric F Logsdon
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA
| | - Abigail G Schindler
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Vikas Ghai
- Institute for Systems Biology, Seattle, WA, USA
| | - Kai Wang
- Institute for Systems Biology, Seattle, WA, USA
| | | | - Yong Zhou
- Institute for Systems Biology, Seattle, WA, USA
| | | | - Inyoul Lee
- Institute for Systems Biology, Seattle, WA, USA
| | - William A Banks
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA
| | - Erik S Carlson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Cynthia Mayer
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA
| | - Rebecca C Hendrickson
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Murray A Raskind
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | - Daniel P Perl
- Department of Pathology, Center for Neuroscience and Regenerative Medicine, School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Elaine R Peskind
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
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22
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Witbracht MG, Bernstein OM, Lin V, Salazar CR, Sajjadi SA, Hoang D, Cox CG, Gillen DL, Grill JD. Education and Message Framing Increase Willingness to Undergo Research Lumbar Puncture: A Randomized Controlled Trial. Front Med (Lausanne) 2020; 7:493. [PMID: 33043024 PMCID: PMC7530193 DOI: 10.3389/fmed.2020.00493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/20/2020] [Indexed: 12/26/2022] Open
Abstract
Reluctance to undergo lumbar puncture (LP) is a barrier to neurological disease biomarker research. We assessed whether an educational intervention increased willingness to consider research LP and whether message framing modified intervention effectiveness. We randomly assigned 851 recruitment registry enrollees who had previously indicated they were unwilling to be contacted about studies requiring LP to gain or loss framed video educational interventions describing the procedure and the probability of experiencing adverse events. The gain framed intervention emphasized the proportion of individuals free of adverse events; the loss frame emphasized the proportion experiencing adverse events. The primary outcome for the study was the participant's post-intervention agreement to be contacted about studies requiring LP. Participants were mean (SD) age 60.1 years (15.7), 69% female (n = 591), and mostly college educated and white. Among the 699 participants who completed the study, 43% (95% CI: 0.39, 0.47; n = 301) changed their response to agree to be contacted about studies requiring LP. We estimated that participants randomized to the gain framed intervention had 67% higher odds of changing their response compared to those randomized to the loss frame (Odds Ratio = 1.67; 95% CI: 1.24, 2.26; p < 0.001). A classification and regression tree model identified participants' pre-intervention willingness as the strongest predictor of changing response. Education, in particular education that alerts participants to the probability of not experiencing adverse events, may be an effective tool to increase participation rates in research requiring LP.
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Affiliation(s)
- Megan G Witbracht
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Olivia M Bernstein
- Department of Statistics, University of California, Irvine, Irvine, CA, United States
| | - Vanessa Lin
- Graduate Medical Sciences, Boston University School of Medicine, Boston, MA, United States
| | - Christian R Salazar
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - S Ahmad Sajjadi
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States.,Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Dan Hoang
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Chelsea G Cox
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Daniel L Gillen
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States.,Department of Statistics, University of California, Irvine, Irvine, CA, United States
| | - Joshua D Grill
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States.,Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, United States.,Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States.,Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, United States
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23
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Yakhine-Diop SM, Morales-García JA, Niso-Santano M, González-Polo RA, Uribe-Carretero E, Martinez-Chacon G, Durand S, Maiuri MC, Aiastui A, Zulaica M, Ruíz-Martínez J, López de Munain A, Pérez-Tur J, Pérez-Castillo A, Kroemer G, Bravo-San Pedro JM, Fuentes JM. Metabolic alterations in plasma from patients with familial and idiopathic Parkinson's disease. Aging (Albany NY) 2020; 12:16690-16708. [PMID: 32903216 PMCID: PMC7521510 DOI: 10.18632/aging.103992] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/15/2020] [Indexed: 01/24/2023]
Abstract
The research of new biomarkers for Parkinson's disease is essential for accurate and precocious diagnosis, as well as for the discovery of new potential disease mechanisms and drug targets. The main objective of this work was to identify metabolic changes that might serve as biomarkers for the diagnosis of this neurodegenerative disorder. For this, we profiled the plasma metabolome from mice with neurotoxin-induced Parkinson's disease as well as from patients with familial or sporadic Parkinson's disease. By using mass spectrometry technology, we analyzed the complete metabolome from healthy volunteers compared to patients with idiopathic or familial (carrying the G2019S or R1441G mutations in the LRRK2 gene) Parkinson's disease, as well as, from mice treated with 6-hydroxydopamine to induce Parkinson disease. Both human and murine Parkinson was accompanied by an increase in plasma levels of unconjugated bile acids (cholic acid, deoxycholic acid and lithocholic acid) and purine base intermediary metabolites, in particular hypoxanthine. The comprehensive metabolomic analysis of plasma from Parkinsonian patients underscores the importance of bile acids and purine metabolism in the pathophysiology of this disease. Therefore, plasma measurements of certain metabolites related to these pathways might contribute to the diagnosis of Parkinson's Disease.
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Affiliation(s)
- Sokhna M.S. Yakhine-Diop
- Departamento de Bioquímica y Biología Molecular y Genética, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - José A. Morales-García
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Instituto de Investigaciones Biomédicas (CSIC-UAM) “Alberto Sols” (CSIC-UAM), Madrid, Spain,Departamento de Biología Celular, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Mireia Niso-Santano
- Departamento de Bioquímica y Biología Molecular y Genética, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - Rosa A. González-Polo
- Departamento de Bioquímica y Biología Molecular y Genética, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - Elisabet Uribe-Carretero
- Departamento de Bioquímica y Biología Molecular y Genética, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - Guadalupe Martinez-Chacon
- Departamento de Bioquímica y Biología Molecular y Genética, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - Sylvere Durand
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
| | - Maria Chiara Maiuri
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France,Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université de Paris, Sorbonne Université, Paris, France
| | - Ana Aiastui
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Cell Culture Platform, Biodonostia Health Research Institute, San Sebastián, Spain,Neuroscience Area of Biodonostia Health Research Institute, Donostia University Hospital, San Sebastián, Spain
| | - Miren Zulaica
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Neuroscience Area of Biodonostia Health Research Institute, Donostia University Hospital, San Sebastián, Spain
| | - Javier Ruíz-Martínez
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Neuroscience Area of Biodonostia Health Research Institute, Donostia University Hospital, San Sebastián, Spain,Donostia University Hospital, Department of Neurology, OSAKIDETZA, Spain,Ilundain Foundation, San Sebastian, Spain
| | - Adolfo López de Munain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Neuroscience Area of Biodonostia Health Research Institute, Donostia University Hospital, San Sebastián, Spain,Donostia University Hospital, Department of Neurology, OSAKIDETZA, Spain,Ilundain Foundation, San Sebastian, Spain,Department of Neurosciences, University of the Basque Country UPV-EHU, San Sebastián, Spain
| | - Jordi Pérez-Tur
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Instituto de Biomedicina de Valencia-CSIC, Unidad de Genética Molecular, Valencia, Spain,Unidad Mixta de Genética y Neurología, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Ana Pérez-Castillo
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Instituto de Investigaciones Biomédicas (CSIC-UAM) “Alberto Sols” (CSIC-UAM), Madrid, Spain
| | - Guido Kroemer
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France,Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université de Paris, Sorbonne Université, Paris, France,Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, France,Suzhou Institute for Systems Medicine, Chinese Academy of Medical Sciences, Suzhou, China,Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - José M. Bravo-San Pedro
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Departamento de Fisiología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - José M. Fuentes
- Departamento de Bioquímica y Biología Molecular y Genética, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
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24
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Significance of Blood and Cerebrospinal Fluid Biomarkers for Alzheimer's Disease: Sensitivity, Specificity and Potential for Clinical Use. J Pers Med 2020; 10:jpm10030116. [PMID: 32911755 PMCID: PMC7565390 DOI: 10.3390/jpm10030116] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 12/16/2022] Open
Abstract
Alzheimer's disease (AD) is the most common type of dementia, affecting more than 5 million Americans, with steadily increasing mortality and incredible socio-economic burden. Not only have therapeutic efforts so far failed to reach significant efficacy, but the real pathogenesis of the disease is still obscure. The current theories are based on pathological findings of amyloid plaques and tau neurofibrillary tangles that accumulate in the brain parenchyma of affected patients. These findings have defined, together with the extensive neurodegeneration, the diagnostic criteria of the disease. The ability to detect changes in the levels of amyloid and tau in cerebrospinal fluid (CSF) first, and more recently in blood, has allowed us to use these biomarkers for the specific in-vivo diagnosis of AD in humans. Furthermore, other pathological elements of AD, such as the loss of neurons, inflammation and metabolic derangement, have translated to the definition of other CSF and blood biomarkers, which are not specific of the disease but, when combined with amyloid and tau, correlate with the progression from mild cognitive impairment to AD dementia, or identify patients who will develop AD pathology. In this review, we discuss the role of current and hypothetical biomarkers of Alzheimer's disease, their specificity, and the caveats of current high-sensitivity platforms for their peripheral detection.
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25
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Hwang J, Lim YH, Eun MY, Jeon JY, Ko PW, Kim SH, Kang K, Lee HW, Park JS. Lower Glucose Level Associated With Increased Risk for Post-Dural Puncture Headache. Headache 2020; 60:1901-1909. [PMID: 32463126 DOI: 10.1111/head.13850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE AND BACKGROUND Post-dural puncture headache is the most common significant adverse event following lumbar puncture. In this study, we investigated the possible systemic factors associated with risk for post-dural puncture headache (PDPH). METHODS We performed a retrospective cohort study in 969 patients who underwent diagnostic lumbar puncture following a standardized protocol. We compared the clinical and laboratory profiles of the post-dural puncture headache group and non-headache group. We also identified independent factors associated with the incidence of post-dural puncture headache. RESULTS A total of 48 patients (5%) reported headache; 12 of these patients (25%) received a therapeutic epidural blood patch and the remaining 36 patients improved with conservative treatment. After adjusting for other variables that could be related to PDPH, we found that the development of post lumbar puncture headache was independently associated with age (OR: 0.97, 95% CI: 0.95-0.99, P = .001) and serum glucose levels (OR: 0.98, 95% CI: 0.97-0.99, P = .008).When the patients were classified by age, serum glucose levels were persistently lower in patients with PDPH vs those patients without PDPH in all age groups, with more clearly significant differences observed in the elderly (age <30 years, 103.4 mg/dL vs 106.3 mg/dL, P = .716; >60 years, 111.8 mg/dL vs 137.3 mg/dL, P = .023). CONCLUSIONS Low glucose levels were inversely associated with risk for post-dural puncture headache. Patients with low serum glucose should be carefully monitored for headache after lumbar puncture.
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Affiliation(s)
- Jaechun Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Yong-Hyun Lim
- Center of Self-Organizing Software-Platform, Kyungpook National University, Daegu, South Korea
| | - Mi-Yeon Eun
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Ji-Ye Jeon
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Pan-Woo Ko
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Sung-Hee Kim
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Kyunghun Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Ho-Won Lee
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
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26
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Wiedrick JT, Phillips JI, Lusardi TA, McFarland TJ, Lind B, Sandau US, Harrington CA, Lapidus JA, Galasko DR, Quinn JF, Saugstad JA. Validation of MicroRNA Biomarkers for Alzheimer's Disease in Human Cerebrospinal Fluid. J Alzheimers Dis 2020; 67:875-891. [PMID: 30689565 DOI: 10.3233/jad-180539] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We previously discovered microRNAs (miRNAs) in cerebrospinal fluid (CSF) that differentiate Alzheimer's disease (AD) patients from Controls. Here we examined the performance of 37 candidate AD miRNA biomarkers in a new and independent cohort of CSF from 47 AD patients and 71 Controls on custom TaqMan arrays. We employed a consensus ranking approach to provide an overall priority score for each miRNA, then used multimarker models to assess the relative contributions of the top-ranking miRNAs to differentiate AD from Controls. We assessed classification performance of the top-ranking miRNAs when combined with apolipoprotein E4 (APOE4) genotype status or CSF amyloid-β42 (Aβ42):total tau (T-tau) measures. We also assessed whether miRNAs that ranked higher as AD markers correlate with Mini-Mental State Examination (MMSE) scores. We show that of 37 miRNAs brought forth from the discovery study, 26 miRNAs remained viable as candidate biomarkers for AD in the validation study. We found that combinations of 6-7 miRNAs work better to identify AD than subsets of fewer miRNAs. Of 26 miRNAs that contribute most to the multimarker models, 14 have higher potential than the others to predict AD. Addition of these 14 miRNAs to APOE4 status or CSF Aβ42:T-tau measures significantly improved classification performance for AD. We further show that individual miRNAs that ranked higher as AD markers correlate more strongly with changes in MMSE scores. Our studies validate that a set of CSF miRNAs serve as biomarkers for AD, and support their advancement toward development as biomarkers in the clinical setting.
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Affiliation(s)
- Jack T Wiedrick
- Biostatistics & Design Program, Oregon Health & Science University, Portland, OR, USA
| | - Jay I Phillips
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Theresa A Lusardi
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Trevor J McFarland
- Integrated Genomics Laboratory, Oregon Health & Science University, Portland, OR, USA
| | - Babett Lind
- Department of Neurology, Layton Aging and Alzheimer's Center, Oregon Health & Science University, Portland, OR, USA
| | - Ursula S Sandau
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Jodi A Lapidus
- Biostatistics & Design Program, Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University - Portland State University School of Public Health, Portland, OR, USA
| | - Douglas R Galasko
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Joseph F Quinn
- Department of Neurology, Layton Aging and Alzheimer's Center, Oregon Health & Science University, Portland, OR, USA.,Portland Veterans Affairs Medical Center, Portland, OR, USA
| | - Julie A Saugstad
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
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Moore EE, Gifford KA, Khan OA, Liu D, Pechman KR, Acosta LMY, Bell SP, Turchan M, Landman BA, Blennow K, Zetterberg H, Hohman TJ, Jefferson AL. Cerebrospinal fluid biomarkers of neurodegeneration, synaptic dysfunction, and axonal injury relate to atrophy in structural brain regions specific to Alzheimer's disease. Alzheimers Dement 2020; 16:883-895. [PMID: 32378327 DOI: 10.1002/alz.12087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Patterns of atrophy can distinguish normal cognition from Alzheimer's disease (AD), but neuropathological drivers of this pattern are unknown. This study examined associations between cerebrospinal fluid biomarkers of AD pathology, synaptic dysfunction, and neuroaxonal injury with two AD imaging signatures. METHODS Signatures were calculated using published guidelines. Linear regressions related each biomarker to both signatures, adjusting for demographic factors. Bootstrapped analyses tested if associations were stronger with one signature versus the other. RESULTS Increased phosphorylated tau (p-tau), total tau, and neurofilament light (P-values <.045) related to smaller signatures (indicating greater atrophy). Diagnosis and sex modified associations between p-tau and neurogranin (P-values<.05) and signatures, such that associations were stronger among participants with mild cognitive impairment and female participants. The strength of associations did not differ between signatures. DISCUSSION Increased evidence of neurodegeneration, axonopathy, and tau phosphorylation relate to greater AD-related atrophy. Tau phosphorylation and synaptic dysfunction may be more prominent in AD-affected regions in females.
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Affiliation(s)
- Elizabeth E Moore
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine A Gifford
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Omair A Khan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kimberly R Pechman
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lealani Mae Y Acosta
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Susan P Bell
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Maxim Turchan
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bennett A Landman
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Lab, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Lab, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Timothy J Hohman
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Angela L Jefferson
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Day GS, Rappai T, Sathyan S, Morris JC. Deciphering the factors that influence participation in studies requiring serial lumbar punctures. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12003. [PMID: 32211499 PMCID: PMC7085282 DOI: 10.1002/dad2.12003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/15/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Cerebrospinal fluid biomarkers increasingly inform the causes of dementia and may provide objective markers of disease progression. There is a need to decipher participant and procedural factors that promote participation in studies incorporating longitudinal biomarker measures. METHODS Participant and procedural factors associated with participation in longitudinal biomarker studies were determined in individuals enrolled in studies of memory and aging at the Knight Alzheimer Disease Research Center (Saint Louis, MO, USA). RESULTS Complications were encountered following 331 of 1484 lumbar punctures (22.3%; LPs), affecting 280 of 929 participants (30.1%); in >95% complications were minor. Three hundred fifteen of 679 eligible participants (46.4%) completed multiple LPs. Younger age (odds ratio [OR] 2.08 per decade [95% confidence interval (CI) 1.61-2.94]), normal cognition (OR 21.4 [2.85-160.1]), and the absence of heart disease (OR 2.0 [1.01-3.85]) or seizures at study entry identified participants with increased odds of completing three or more LPs. DISCUSSION Factors influencing participation may be leveraged to improve recruitment and retention within observational and therapeutic studies requiring serial LPs.
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Affiliation(s)
- Gregory S Day
- The Charles F. and Joanne Knight Alzheimer Disease Research Center Washington University School of Medicine St. Louis Missouri USA
- Washington University School of Medicine St. Louis Missouri USA
| | - Tracy Rappai
- The Charles F. and Joanne Knight Alzheimer Disease Research Center Washington University School of Medicine St. Louis Missouri USA
- Washington University School of Medicine St. Louis Missouri USA
| | - Sushila Sathyan
- The Charles F. and Joanne Knight Alzheimer Disease Research Center Washington University School of Medicine St. Louis Missouri USA
- Washington University School of Medicine St. Louis Missouri USA
| | - John C Morris
- The Charles F. and Joanne Knight Alzheimer Disease Research Center Washington University School of Medicine St. Louis Missouri USA
- Washington University School of Medicine St. Louis Missouri USA
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Decourt B, Wilson J, Ritter A, Dardis C, DiFilippo FP, Zhuang X, Cordes D, Lee G, Fulkerson ND, St Rose T, Hartley K, Sabbagh MN. MCLENA-1: A Phase II Clinical Trial for the Assessment of Safety, Tolerability, and Efficacy of Lenalidomide in Patients with Mild Cognitive Impairment Due to Alzheimer's Disease. OPEN ACCESS JOURNAL OF CLINICAL TRIALS 2020; 12:1-13. [PMID: 32123490 PMCID: PMC7051033 DOI: 10.2147/oajct.s221914] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
With the general population reaching higher ages, a surge in Alzheimer's disease (AD) incidence will happen in the coming decades, putting a heavy burden on families and healthcare systems Worldwide. This emphasizes the pressing need for AD therapeutic interventions. Accumulating evidence indicates that inflammation is prominent both in the blood and central nervous system of AD sufferers. These data suggest that systemic inflammation plays a crucial role in the cause and effects of AD neuropathology. Capitalizing on our experience from a previous clinical trial with thalidomide, we hypothesize that modulating inflammation via the pleiotropic immunomodulator lenalidomide may alter AD if administered during a proper time window in the course of the disease. Thus, in this Phase II, proof-of mechanism study, 30 amnestic mild cognitive impairment (aMCI) subjects will be treated with lenalidomide at 10 mg/day for 12 months on a 1:1 ratio, followed by a 6 months washout period. The primary objective of this study is to investigate the effect of lenalidomide on cognition, which is assessed at regular intervals. The secondary objective is to assess the safety and tolerability of lenalidomide in aMCI patients evaluated through adverse events, vital signs, clinical biochemistry, and physical and neurological examinations. Tertiary objectives are to analyze the effects of lenalidomide on brain amyloid loads (Florbetapir PET imaging) and neurodegeneration (volumetric MRI) by comparing pre- and post-dosing data. Finally, exploratory objectives will investigate whether blood inflammatory markers can serve as surrogate markers of therapeutic efficacy. Our study should determine whether lenalidomide is safe in AD subjects and whether it can alter the clinical progression of AD when administered before dementia onset. If effective, lenalidomide would become the first drug capable of delaying the trajectory of AD, which could lead the way to find additional, less toxic treatments in the near future.
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Affiliation(s)
- Boris Decourt
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Jeffrey Wilson
- Department of Economics W. P. Carey School of Business, Arizona State University, Tempe, AZ, USA
| | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | | | | | - Xiaowei Zhuang
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Dietmar Cordes
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Garam Lee
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Nadia D Fulkerson
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Tessa St Rose
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Katurah Hartley
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Marwan N Sabbagh
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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Peña-Bautista C, Durand T, Oger C, Baquero M, Vento M, Cháfer-Pericás C. Assessment of lipid peroxidation and artificial neural network models in early Alzheimer Disease diagnosis. Clin Biochem 2019; 72:64-70. [PMID: 31319065 DOI: 10.1016/j.clinbiochem.2019.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/11/2019] [Accepted: 07/13/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Lipid peroxidation constitutes a molecular mechanism involved in early Alzheimer Disease (AD) stages, and artificial neural network (ANN) analysis is a promising non-linear regression model, characterized by its high flexibility and utility in clinical diagnosis. ANN simulates neuron learning procedures and it could provide good diagnostic performances in this complex and heterogeneous disease compared with linear regression analysis. DESIGN AND METHODS In our study, a new set of lipid peroxidation compounds were determined in urine and plasma samples from patients diagnosed with early Alzheimer Disease (n = 70) and healthy controls (n = 26) by means of ultra-performance liquid chromatography coupled with tandem mass-spectrometry. Then, a model based on ANN was developed to classify groups of participants. RESULTS The diagnostic performances obtained using an ANN model for each biological matrix were compared with the corresponding linear regression model based on partial least squares (PLS), and with the non-linear (radial and polynomial) support vector machine (SVM) models. Better accuracy, in terms of receiver operating characteristic-area under curve (ROC-AUC), was obtained for the ANN models (ROC-AUC 0.882 in plasma and 0.839 in urine) than for PLS and SVM models. CONCLUSION Lipid peroxidation and ANN constitute a useful approach to establish a reliable diagnosis when the prognosis is complex, multidimensional and non-linear.
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Affiliation(s)
| | - Thierry Durand
- Institut des Biomolécules Max Mousseron, IBMM, University of Montpellier, CNRS ENSCM, Montpellier, France
| | - Camille Oger
- Institut des Biomolécules Max Mousseron, IBMM, University of Montpellier, CNRS ENSCM, Montpellier, France
| | - Miguel Baquero
- Neurology Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Máximo Vento
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
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Antibody-free detection of amyloid beta peptides biomarkers in cerebrospinal fluid using capillary isotachophoresis coupled with mass spectrometry. J Chromatogr A 2019; 1601:350-356. [PMID: 31101465 DOI: 10.1016/j.chroma.2019.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 12/14/2022]
Abstract
This study reports a capillary isotachophoresis (ITP) - electrospray ionization mass spectrometry (ESI-MS) method for the determination of several amyloid β (Aβ) peptides, which are biomarkers of Alzheimer's disease (AD) in cerebrospinal fluids (CSF). For the first time, these peptides have been detected directly from CSF by MS without recourse to an immunocapture-based sample pre-treatment. The antibody-free approach is based on the marriage between capillary ITP, a powerful on-line electrokinetic preconcentration technique, and MS for simultaneous detection of different Aβ peptides. To ensure a good performance, the ITP process of fluorescently labelled Aβ peptides was for the first time implemented and verified with laser induced fluorescent detection, prior to methodology transfer to MS detection. Better detection sensitivity was achieved with labelled Aβ peptides for both detection modes. Using hydroxyl ions as the terminating and acetate as the leading ions, our method allows efficient ITP preconcentration under alkaline conditions of the slowly migrating Aβ peptides to reach quantifiable concentration down to 50 pM. The developed ITP-MS approach allows reliable quantification of different fluorescently derivatized Aβ peptides, i.e. Aβ 1-42, Aβ 1-40 and Aβ 1-38 down to sub nM ranges in CSF samples from AD and non-demented (healthy control) patients. Good agreement (<20% deviation) for the determination of Aβ 1-42/Aβ 1-40 ratio in CSF was achieved between results obtained with this new ITP-MS and our recently developed method based on large volume sample stacking coupled to CE. Discrimination of one AD patient from two healthy controls was successfully made with the Aβ 1-42/Aβ 1-40 ratio obtained by the developed ITP-MS method for the tested cerebrospinal fluid samples.
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32
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Hansson O, Lehmann S, Otto M, Zetterberg H, Lewczuk P. Advantages and disadvantages of the use of the CSF Amyloid β (Aβ) 42/40 ratio in the diagnosis of Alzheimer's Disease. ALZHEIMERS RESEARCH & THERAPY 2019; 11:34. [PMID: 31010420 PMCID: PMC6477717 DOI: 10.1186/s13195-019-0485-0] [Citation(s) in RCA: 282] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The cerebrospinal fluid (CSF) biochemical markers (biomarkers) Amyloidβ 42 (Aβ42), total Tau (T-tau) and Tau phosphorylated at threonine 181 (P-tau181) have proven diagnostic accuracy for mild cognitive impairment and dementia due to Alzheimer’s Disease (AD). In an effort to improve the accuracy of an AD diagnosis, it is important to be able to distinguish between AD and other types of dementia (non-AD). The concentration ratio of Aβ42 to Aβ40 (Aβ42/40 Ratio) has been suggested to be superior to the concentration of Aβ42 alone when identifying patients with AD. This article reviews the available evidence on the use of the CSF Aβ42/40 ratio in the diagnosis of AD. Based on the body of evidence presented herein, it is the conclusion of the current working group that the CSF Aβ42/40 ratio, rather than the absolute value of CSF Aβ42, should be used when analysing CSF AD biomarkers to improve the percentage of appropriately diagnosed patients.
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Affiliation(s)
- Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Sylvain Lehmann
- Center of Excellence for Neurodegenerative disorders (COEN) of Montpellier, Montpellier University, CHU Montpellier, INSERM, Montpellier, France
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.,UK Dementia Research Institute, London, UK
| | - Piotr Lewczuk
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany. .,Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Bialystok, Poland. .,Lab for Clinical Neurochemistry and Neurochemical Dementia Diagnostics, Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
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33
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Prakash N, Caspell-Garcia C, Coffey C, Siderowf A, Tanner CM, Kieburtz K, Mollenhauer B, Galasko D, Merchant K, Foroud T, Chahine LM, Weintraub D, Casaceli C, Dorsey R, Wilson R, Herzog M, Daegele N, Arnedo V, Frasier M, Sherer T, Marek K, Frank S, Jennings D, Simuni T. Feasibility and safety of lumbar puncture in the Parkinson's disease research participants: Parkinson's Progression Marker Initiative (PPMI). Parkinsonism Relat Disord 2019; 62:201-209. [PMID: 30738748 DOI: 10.1016/j.parkreldis.2018.12.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/11/2018] [Accepted: 12/19/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the feasibility, safety and tolerability of lumbar punctures (LPs) in research participants with early Parkinson disease (PD), subjects without evidence of dopaminergic deficiency (SWEDDs) and healthy volunteers (HC). BACKGROUND Cerebrospinal fluid (CSF) analysis is becoming an essential part of the biomarkers discovery effort in PD with still limited data on safety and feasibility of serial LPs in PD participants. DESIGN/METHODS Parkinson's Progression Marker Initiative (PPMI) is a longitudinal observation study designed to identify PD progression biomarkers. All PPMI participants undergo LP at baseline, 6, 12 months and yearly thereafter. CSF collection is performed by a trained investigator using predominantly atraumatic needles. Adverse events (AEs) are monitored by phone one week after LP completion. We analyzed safety data from baseline LPs. RESULTS PPMI enrolled 683 participants (423 PD/196 HC/64 SWEDDs) from 23 study sites. CSF was collected at baseline in 97.5% of participants, of whom 5.4% underwent collection under fluoroscopy. 23% participants reported any related AEs, 68% of all AE were mild while 5.6% were severe. The most common AEs were headaches (13%) and low back pain (6.5%) and both occurred more commonly in HC and SWEDDs compared to PD participants. Factors associated with higher incidence of AEs across the cohorts included female gender, younger age and use of traumatic needles with larger diameter. AEs largely did not impact compliance with the future LPs. CONCLUSIONS LPs are safe and feasible in PD research participants. Specific LP techniques (needle type and gauge) may reduce the overall incidence of AEs.
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Affiliation(s)
- Neha Prakash
- Northwestern University Feinberg School of Medicine, USA.
| | | | | | | | | | | | - Brit Mollenhauer
- Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Goettingen, Germany.
| | | | | | | | | | | | | | - Ray Dorsey
- University of Rochester Medical Center, USA.
| | - Renee Wilson
- Clinical Trial Coordination Center, University of Rochester Medical Center, USA.
| | | | | | | | | | | | - Ken Marek
- Institute for Neurodegenerative Disorders, USA.
| | - Samuel Frank
- Harvard Medical School, Beth Israel Deaconess Medical Center, Parkinson's Disease and Movement Disorders Center, Director of the HDSA Center of Excellence, USA.
| | | | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, USA.
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Abstract
Cerebrospinal fluid (CSF) is a physiologically essential fluid produced by the brain that is involved in protecting the brain and in the exchange of nutrients and waste products. CSF has long been utilized to confirm clinical suspicion of various infectious and inflammatory disorders, such as meningitis and multiple sclerosis. However, there has been increasing interest in collecting CSF in order to study the clinical significance of additional biomarkers. This chapter outlines the procedures necessary to collect, process, store, and utilize CSF obtained for the purposes of biobanking from both living and deceased patients.
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Affiliation(s)
- Randy S Tashjian
- Division of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Harry V Vinters
- Division of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William H Yong
- Division of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- Brain Tumor Translational Resource, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Abstract
Recent advance in high-throughput proteome analysis has enabled genome-wide and proteome-wide analyses of associations between single nucleotide polymorphisms and protein expression levels. Protein quantitative trait locus (pQTL) studies using cerebrospinal fluid (CSF) and DNA samples may provide valuable insights into the genetic basis and molecular mechanisms regulating protein expression in the central nervous system. In this chapter, we describe a step-by-step procedures of CSF collection and pQTL analysis, by using PLINK and R software.
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Shaw LM, Arias J, Blennow K, Galasko D, Molinuevo JL, Salloway S, Schindler S, Carrillo MC, Hendrix JA, Ross A, Illes J, Ramus C, Fifer S. Appropriate use criteria for lumbar puncture and cerebrospinal fluid testing in the diagnosis of Alzheimer's disease. Alzheimers Dement 2018; 14:1505-1521. [PMID: 30316776 PMCID: PMC10013957 DOI: 10.1016/j.jalz.2018.07.220] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/17/2018] [Accepted: 07/31/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The Alzheimer's Association convened a multidisciplinary workgroup to develop appropriate use criteria to guide the safe and optimal use of the lumbar puncture procedure and cerebrospinal fluid (CSF) testing for Alzheimer's disease pathology detection in the diagnostic process. METHODS The workgroup, experienced in the ethical use of lumbar puncture and CSF analysis, developed key research questions to guide the systematic review of the evidence and developed clinical indications commonly encountered in clinical practice based on key patient groups in whom the use of lumbar puncture and CSF may be considered as part of the diagnostic process. Based on their expertise and interpretation of the evidence from systematic review, members rated each indication as appropriate or inappropriate. RESULTS The workgroup finalized 14 indications, rating 6 appropriate and 8 inappropriate. DISCUSSION In anticipation of the emergence of more reliable CSF analysis platforms, the manuscript offers important guidance to health-care practitioners and suggestions for implementation and future research.
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Affiliation(s)
- Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Jalayne Arias
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, University of Gothenberg, Molndal, Sweden
| | - Douglas Galasko
- Department of Neuroscience, University of California, San Diego, CA, USA
| | | | - Stephen Salloway
- Butler Hospital Memory and Aging Program, The Warren Alpert Medical School of Brown University, Brown University, Providence, RI, USA
| | | | | | | | - April Ross
- Alzheimer's Association, Chicago, IL, USA
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Wen HJ. Acute bilateral vision deficit as the initial symptom in Guillain-Barre syndrome: A case report. Exp Ther Med 2018; 16:2712-2716. [PMID: 30186502 PMCID: PMC6122450 DOI: 10.3892/etm.2018.6465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/08/2018] [Indexed: 01/12/2023] Open
Abstract
Guillain-Barre syndrome (GBS) is a rare autoimmune-mediated peripheral neuropathy with an acute onset. GBS is associated with posterior cranial nerve injury including the facial, oculomotor, glossopharyngeal and vagus nerves. A 43-year-old female presented with worsening blurred binocular vision accompanied by diplopia, bilateral ptosis, speech difficulties, dysphagia, extremity numbness and weakness of the limbs. A neurological examination was conducted along with magnetic resonance imaging of the brain and spinal cord, electromyography, cerebrospinal fluid analysis and visual evoked potential tests, which led to a diagnosis of GBS. Following immunoglobulin administration, the patient's neurological deficiencies were markedly relieved and they were discharged following a 3-week observation period. To the best of our knowledge, this is the first reported case of GBS associated with cranial nerve damage presenting with bilateral visual deterioration as the initial symptom. It is necessary to emphasize that early diagnosis and commencing the immunological treatment in a timely manner resulted in a favorable prognosis for the patient.
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Affiliation(s)
- Hui-Jun Wen
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, P.R. China
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38
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Michaud TL, Kane RL, McCarten JR, Gaugler JE, Nyman JA, Kuntz KM. Using Cerebrospinal Fluid Biomarker Testing to Target Treatment to Patients with Mild Cognitive Impairment: A Cost-Effectiveness Analysis. PHARMACOECONOMICS - OPEN 2018; 2:309-323. [PMID: 29623628 PMCID: PMC6103924 DOI: 10.1007/s41669-017-0054-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Cerebrospinal fluid (CSF) biomarkers are shown to facilitate a risk identification of patients with mild cognitive impairment (MCI) into different risk levels of progression to Alzheimer's disease (AD). Knowing a patient's risk level provides an opportunity for earlier interventions, which could result in potential greater benefits. We assessed the cost effectiveness of the use of CSF biomarkers in MCI patients where the treatment decision was based on patients' risk level. METHODS We developed a state-transition model to project lifetime quality-adjusted life-years (QALYs) and costs for a cohort of 65-year-old MCI patients from a US societal perspective. We compared four test-and-treat strategies where the decision to treat was based on a patient's risk level (low, intermediate, high) of progressing to AD with two strategies without testing, one where no patients were treated during the MCI phase and in the other all patients were treated. We performed deterministic and probabilistic sensitivity analyses to evaluate parameter uncertainty. RESULTS Testing and treating low-risk MCI patients was the most cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of US$37,700 per QALY. Our results were most sensitive to the level of treatment effectiveness for patients with mild AD and for MCI patients. Moreover, the ICERs for this strategy at the 2.5th and 97.5th percentiles were US$18,900 and US$50,100 per QALY, respectively. CONCLUSION Based on the best available evidence regarding the treatment effectiveness for MCI, this study suggests the potential value of performing CSF biomarker testing for early targeted treatments among MCI patients with a narrow range for the ICER.
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Affiliation(s)
- Tzeyu L Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Robert L Kane
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - J Riley McCarten
- Geriatric Research, Education and Clinical Center, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA
- Department of Neurology and Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Joseph E Gaugler
- School of Nursing and Center on Aging, University of Minnesota, Minneapolis, MN, USA
| | - John A Nyman
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Karen M Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Abstract
OBJECTIVE Lumbar puncture (LP) is increasingly common in Alzheimer disease research; however, agreement to undergo LP varies. We sought to determine factors influencing LP consent at Alzheimer's Disease Centers (ADCs) in the United States. METHODS A 3-part survey was distributed to each ADC: (1) ADC LP Experience; (2) LP Requestor Experience; and (3) Patient LP Experience (both Initial and Follow-up). In all, 64 LP Requestor, 579 Patient/Initial, and 404 Patient/Follow-up surveys were collected. Logistic regression analyses with generalized estimating equations were used to assess factors associated with LP agreement and post-LP complications. RESULTS Asians and those viewing LP negatively were less likely to agree to LP. Three hundred fifty-two participants had an LP; LP headache occurred in 11.9% (blood patch required in 1.4%) and 9.9% reported other complications. Younger individuals, women, those diagnosed with mild cognitive impairment, use of a Quincke needle, ≤20 mL cerebrospinal fluid drawn, and hemorrhage during LP were associated with LP headache. Use of gravity flow during LP was associated with fewer other complications (nausea, dizziness, vasovagal response, back pain, neck stiffness, and/or nerve root pain). CONCLUSIONS LP in Alzheimer disease research is generally safe and well tolerated. Factors influencing LP agreement potentially could be studied to advance participant acceptance of the procedure.
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Hendrickson RC, Raskind MA, Millard SP, Sikkema C, Terry GE, Pagulayan KF, Li G, Peskind ER. Evidence for altered brain reactivity to norepinephrine in Veterans with a history of traumatic stress. Neurobiol Stress 2018; 8:103-111. [PMID: 29888305 PMCID: PMC5991318 DOI: 10.1016/j.ynstr.2018.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 12/22/2022] Open
Abstract
Background Increases in the quantity or impact of noradrenergic signaling have been implicated in the pathophysiology of posttraumatic stress disorder (PTSD). This increased signaling may result from increased norepinephrine (NE) release, from altered brain responses to NE, or from a combination of both factors. Here, we tested the hypothesis that Veterans reporting a history of trauma exposure would show an increased association between brain NE and mental health symptoms commonly observed after trauma, as compared to Veterans who did not report a history of trauma exposure, consistent with the possibility of increased brain reactivity to NE after traumatic stress. Methods Using a convenience sample of 69 male Veterans with a history of combat-theater deployment, we examined the relationship between trauma-related mental health symptoms and the concentration of NE in cerebrospinal fluid (CSF). CSF NE levels were measured by HPLC in CSF from morning lumbar puncture. Behavioral symptoms associated with diagnoses of PTSD, depression, insomnia, or post-concussive syndrome (PCS), which together cover a wide variety of symptoms associated with alterations in arousal systems, such as sleep, mood, concentration, and anxiety, were assessed via self-report (PTSD Checklist [PCL] for PTSD, Patient Health Questionnaire 9 [PHQ9] for depression, Pittsburgh Sleep Quality Index [PSQI] for sleep problems including insomnia, and Neurobehavioral Symptom Inventory [NSI] for PCS) and structured clinical interview (Clinician-Administered PSTD Scale [CAPS]). Individuals meeting criterion A of the DSM-IV diagnostic criteria for PTSD were considered trauma-exposed. Linear regression models were used to quantify the association between CSF NE and symptom intensity in participants with and without a history of trauma exposure, as well as in participants with a history of trauma exposure who were currently taking the noradrenergic receptor antagonist prazosin. Results Fifty-two Veterans met criteria for a history of trauma exposure; of these, 36 met criteria for PTSD. CSF NE levels were not significantly different in Veterans with a history of trauma compared to those without, nor in Veterans with PTSD as compared to those without. Veterans with a history of trauma and who were not using the medication prazosin demonstrated a significantly more positive correlation between CSF NE and behavioral symptom expression than Veterans who had not experienced traumatic stress. No relationship between CSF NE and behavioral symptom expression was found in Veterans who had experienced traumatic stress and were taking prazosin at the time of the assessments. Conclusions These results are consistent with increased central nervous system responsiveness to noradrenergic signaling in individuals with a history of traumatic exposure, raising the possibility that there may be long-lasting physiologic effects of trauma-exposure that exist independently of whether an individual meets criteria for PTSD at any given point in time. Exploration of the mechanism by which brain responsiveness to NE is modulated following trauma holds the possibility of finding new strategies for both preventing and treating PTSD. CSF Norepinephrine (NE) and common mental health symptoms were assessed in Veterans. In Veterans without trauma exposure, CSF NE was inversely associated with symptoms. In those with trauma exposure, CSF NE was more positively associated with symptoms. Trauma exposure may alter central reactivity to NE. PTSD may occur when there is both increased release of, and reactivity to, NE.
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Affiliation(s)
- Rebecca C. Hendrickson
- VISN 20 Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, USA
- Corresponding author. VA Puget Sound Health Care System, 1660 S. Columbian Way, S182 GRECC, Seattle, WA 98108, USA.
| | - Murray A. Raskind
- VISN 20 Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, USA
| | - Steven P. Millard
- VISN 20 Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
| | - Carl Sikkema
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
| | - Garth E. Terry
- VISN 20 Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, USA
| | - Kathleen F. Pagulayan
- VISN 20 Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, USA
| | - Ge Li
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, USA
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
| | - Elaine R. Peskind
- VISN 20 Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, USA
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Hu W, Lin X, Zhang H, Zhao N. ATP Binding Cassette Subfamily A Member 2 (ABCA2) Expression and Methylation are Associated with Alzheimer's Disease. Med Sci Monit 2017; 23:5851-5861. [PMID: 29224028 PMCID: PMC5733562 DOI: 10.12659/msm.905524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background ABCA2 has been genetically linked to Alzheimer’s disease (AD) risk, but its mRNA expression and epigenetics in AD have not been investigated. Material/Method To explore the diagnosis value of ABCA2 mRNA expression in AD, 2 datasets GES15222 and GSE33000 containing expression profile of brain cortex tissues and 2 datasets GSE63063 (Cohort 1) and GSE63063 (Cohort 2) containing expression profile of blood were downloaded from the NCBI GEO database and analyzed by receiver operating characteristic curve (ROC) analyses and logistic regression. The ABCA2 co-expressed genes were also analyzed by GO annotation to investigate the potential molecular mechanisms. Results The analyses results suggested ABCA2 mRNA expression was upregulated significantly in AD compared with controls in all datasets. ROC analysis suggested that ABCA2 was associated with AD in all datasets, which were also proved by univariate and multivariate analyses. Next, the dataset GSE80970 containing methylation profiles of prefrontal cortex tissues from AD patients were downloaded and analyzed. Methylation of 2 of 36 CpG islands in ABCA2 gene with high diagnostic accuracy of AD from controls in ROC analyses were found to be negatively associated with AD risk in univariate analysis. One was still associated with AD risk after adjustment of confounding factors. Additional analyses indicated that ACBA2 mRNA expression could be used to diagnose mild cognitive impairment (MCI) and Huntington’s disease (HD) from controls and to distinguish HD from AD, but not AD from MCI. Furthermore, the genes involved in AD during ABCA2 alteration were analyzed by GO analysis. Conclusions ABCA2 mRNA expression and methylation is associated AD risk. ABCA2 may be used as a biomarker for AD diagnosis and may be a potential therapeutic target of AD.
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Affiliation(s)
- Wanhua Hu
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China (mainland)
| | - Xiaodong Lin
- Department of Traditional Chinese Internal Medicine, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, China (mainland)
| | - Huihe Zhang
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China (mainland)
| | - Na Zhao
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China (mainland)
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Cerebrospinal fluid levels of coenzyme Q10 are reduced in multiple system atrophy. Parkinsonism Relat Disord 2017; 46:16-23. [PMID: 29107645 DOI: 10.1016/j.parkreldis.2017.10.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/20/2017] [Accepted: 10/17/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The finding of mutations of the COQ2 gene and reduced coenzyme Q10 levels in the cerebellum in multiple system atrophy (MSA) suggest that coenzyme Q10 is relevant to MSA pathophysiology. Two recent studies have reported reduced coenzyme Q10 levels in plasma and serum (respectively) of MSA patients compared to Parkinson's disease and/or control subjects, but with largely overlapping values, limited comparison with other parkinsonisms, or dependence on cholesterol levels. We hypothesized that cerebrospinal fluid (CSF) is reliable to assess reductions in coenzyme Q10 as a candidate biomarker of MSA. METHODS In this preliminary cross-sectional study we assessed CSF coenzyme Q10 levels in 20 patients with MSA from the multicenter Catalan MSA Registry and of 15 PD patients, 10 patients with progressive supranuclear palsy (PSP), and 15 control subjects from the Movement Disorders Unit Biosample Collection of Hospital Clinic de Barcelona. A specific ELISA kit was used to determine CSF coenzyme Q10 levels. CSF coenzyme Q10 levels were compared in MSA vs. the other groups globally, pair-wise, and by binary logistic regression models adjusted for age, sex, disease severity, disease duration, and dopaminergic treatment. RESULTS CSF coenzyme Q10 levels were significantly lower in MSA than in other groups in global and pair-wise comparisons, as well as in multivariate regression models. Receiver operating characteristic curve analyses yielded significant areas under the curve for MSA vs. PD, PSP and controls. CONCLUSIONS These findings support coenzyme Q10 relevance in MSA. Low CSF coenzyme Q10 levels deserve further consideration as a biomarker of MSA.
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Kimmelman J, Resnik DB, Peppercorn J, Ratain MJ. Burdensome Research Procedures in Trials: Why Less Is More. J Natl Cancer Inst 2017; 109:3003033. [PMID: 28376159 DOI: 10.1093/jnci/djw315] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 11/29/2016] [Indexed: 01/10/2023] Open
Abstract
A large volume of trials involve invasive, nontherapeutic research procedures, like organ biopsy or sham surgeries, that can pose risks comparable with the experimental treatment itself but that have no direct benefit for volunteers. Though such procedures can enhance the value of clinical investigations, recent studies suggest that many studies involving invasive, nontherapeutic research procedures are not well planned and reported; some studies suggest that their results are often not utilized in the planning of new investigations. This commentary offers recommendations for how investigators, sponsors, and ethics committees might improve evaluation and implementation of studies involving invasive nontherapeutic procedures. We conclude by urging more demanding scientific standards for the rationale, design, and reporting of burdensome, nontherapeutic research procedures-particularly where they involve risk of serious complications.
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Affiliation(s)
- Jonathan Kimmelman
- Studies of Translation, Ethics and Medicine (STREAM), Biomedical Ethics Unit, Social Studies of Medicine, McGill University, Montréal, Canada
| | - David B Resnik
- National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Jeffrey Peppercorn
- MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark J Ratain
- Department of Medicine, Comprehensive Cancer Center, and Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA
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Li G, Shofer JB, Petrie EC, Yu CE, Wilkinson CW, Figlewicz DP, Shutes-David A, Zhang J, Montine TJ, Raskind MA, Quinn JF, Galasko DR, Peskind ER. Cerebrospinal fluid biomarkers for Alzheimer's and vascular disease vary by age, gender, and APOE genotype in cognitively normal adults. ALZHEIMERS RESEARCH & THERAPY 2017; 9:48. [PMID: 28673336 PMCID: PMC5496132 DOI: 10.1186/s13195-017-0271-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/31/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study sought to evaluate gender and APOE genotype-related differences in the concentrations of cerebrospinal fluid (CSF) biomarkers for Alzheimer's disease (AD) and cerebrovascular injury across the life span of cognitively normal adults. METHODS CSF amyloid beta1-42 (Aβ42), phospho-tau-181 (p-tau181), and total tau were measured in 331 participants who were between the ages of 21 and 100. CSF E-selectin and vascular cell adhesion protein 1 (VCAM1) were measured in 249 participants who were between the ages of 50 and 100. RESULTS CSF total tau and p-tau181 increased with age over the adult life span (p < 0.01) with no gender differences in those increases. CSF Aβ42 concentration varied according to age, gender, and APOE genotype (interaction of age × gender × ε4, p = 0.047). CSF VCAM1, but not E-selectin, increased with age (p < 0.01), but both were elevated in men compared to women (p < 0.01). CONCLUSIONS Female APOE-ε4 carriers appear at higher risk for AD after age 50. In contrast, men may experience a relatively higher rate of cerebrovascular injury in middle and early old age.
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Affiliation(s)
- Ge Li
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA. .,Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA, 98195, USA. .,Northwest Network (VISN-20) Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.
| | - Jane B Shofer
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA, 98195, USA
| | - Eric C Petrie
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA, 98195, USA.,Northwest Network (VISN-20) Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
| | - Chang-En Yu
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
| | - Charles W Wilkinson
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA, 98195, USA
| | - Dianne P Figlewicz
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA, 98195, USA.,BSR&D Program, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
| | - Andrew Shutes-David
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Northwest Network (VISN-20) Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
| | - Jing Zhang
- Department of Pathology, University of Washington School of Medicine, 1959 NE Pacific St, Box 357470, Seattle, WA, 98195, USA
| | - Thomas J Montine
- Department of Pathology, Stanford University, 300 Pasteur Drive, Lane 235, Stanford, CA, 94305, USA
| | - Murray A Raskind
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA, 98195, USA.,Northwest Network (VISN-20) Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
| | - Joseph F Quinn
- Parkinson's Disease Research, Education, and Clinical Care Center, Portland VA Medical Center, 3710 SW Veterans Hospital Rd, Portland, OR, 97239, USA.,Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L226, Portland, OR, 97239, USA
| | - Douglas R Galasko
- Department of Neurosciences, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Elaine R Peskind
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA, 98195, USA.,Northwest Network (VISN-20) Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
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Saugstad JA, Lusardi TA, Van Keuren-Jensen KR, Phillips JI, Lind B, Harrington CA, McFarland TJ, Courtright AL, Reiman RA, Yeri AS, Kalani MYS, Adelson PD, Arango J, Nolan JP, Duggan E, Messer K, Akers JC, Galasko DR, Quinn JF, Carter BS, Hochberg FH. Analysis of extracellular RNA in cerebrospinal fluid. J Extracell Vesicles 2017; 6:1317577. [PMID: 28717417 PMCID: PMC5505019 DOI: 10.1080/20013078.2017.1317577] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Indexed: 12/12/2022] Open
Abstract
We examined the extracellular vesicle (EV) and RNA composition of pooled normal cerebrospinal fluid (CSF) samples and CSF from five major neurological disorders: Alzheimer’s disease (AD), Parkinson’s disease (PD), low-grade glioma (LGG), glioblastoma multiforme (GBM), and subarachnoid haemorrhage (SAH), representing neurodegenerative disease, cancer, and severe acute brain injury. We evaluated: (I) size and quantity of EVs by nanoparticle tracking analysis (NTA) and vesicle flow cytometry (VFC), (II) RNA yield and purity using four RNA isolation kits, (III) replication of RNA yields within and between laboratories, and (IV) composition of total and EV RNAs by reverse transcription–quantitative polymerase chain reaction (RT-qPCR) and RNA sequencing (RNASeq). The CSF contained ~106 EVs/μL by NTA and VFC. Brain tumour and SAH CSF contained more EVs and RNA relative to normal, AD, and PD. RT-qPCR and RNASeq identified disease-related populations of microRNAs and messenger RNAs (mRNAs) relative to normal CSF, in both total and EV fractions. This work presents relevant measures selected to inform the design of subsequent replicative CSF studies. The range of neurological diseases highlights variations in total and EV RNA content due to disease or collection site, revealing critical considerations guiding the selection of appropriate approaches and controls for CSF studies.
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Affiliation(s)
- Julie A Saugstad
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Theresa A Lusardi
- Bioinformatics Core, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Jay I Phillips
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Babett Lind
- Department of Neurology, Layton Aging and Alzheimer's Center, Oregon Health & Science University, Portland, OR, USA
| | | | - Trevor J McFarland
- Integrated Genomics Laboratory, Oregon Health & Science University, Portland, OR, USA
| | | | - Rebecca A Reiman
- Neurogenomics, Translational Genomics Research Institute,Phoenix, AZ, USA
| | - Ashish S Yeri
- Neurogenomics, Translational Genomics Research Institute,Phoenix, AZ, USA
| | - M Yashar S Kalani
- Department of Neurosurgery, Radiology, Anatomy and Neurobiology, University of Utah School of Medicine and the Barrow Neurological Institute, Salt Lake City, UT, USA
| | - P David Adelson
- Barrow Neurological Institute at Phoenix Children's Hospital, Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Jorge Arango
- Barrow Neurological Institute at Phoenix Children's Hospital, Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | | | - Karen Messer
- Division of Biostatistics and Bioinformatics, University of California, San Diego, CA, USA
| | - Johnny C Akers
- Department of Neurosurgery, University of California, San Diego, CA, USA
| | - Douglas R Galasko
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Joseph F Quinn
- Department of Neurology, Portland VA Medical Center, Oregon Health & Science University, Portland, OR, USA
| | - Bob S Carter
- Department of Neurosurgery, University of California, San Diego, CA, USA
| | - Fred H Hochberg
- Department of Neurosurgery, University of California, San Diego, CA, USA
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Engelborghs S, Niemantsverdriet E, Struyfs H, Blennow K, Brouns R, Comabella M, Dujmovic I, van der Flier W, Frölich L, Galimberti D, Gnanapavan S, Hemmer B, Hoff E, Hort J, Iacobaeus E, Ingelsson M, Jan de Jong F, Jonsson M, Khalil M, Kuhle J, Lleó A, de Mendonça A, Molinuevo JL, Nagels G, Paquet C, Parnetti L, Roks G, Rosa-Neto P, Scheltens P, Skårsgard C, Stomrud E, Tumani H, Visser PJ, Wallin A, Winblad B, Zetterberg H, Duits F, Teunissen CE. Consensus guidelines for lumbar puncture in patients with neurological diseases. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 8:111-126. [PMID: 28603768 PMCID: PMC5454085 DOI: 10.1016/j.dadm.2017.04.007] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction Cerebrospinal fluid collection by lumbar puncture (LP) is performed in the diagnostic workup of several neurological brain diseases. Reluctance to perform the procedure is among others due to a lack of standards and guidelines to minimize the risk of complications, such as post-LP headache or back pain. Methods We provide consensus guidelines for the LP procedure to minimize the risk of complications. The recommendations are based on (1) data from a large multicenter LP feasibility study (evidence level II-2), (2) systematic literature review on LP needle characteristics and post-LP complications (evidence level II-2), (3) discussion of best practice within the Joint Programme Neurodegenerative Disease Research Biomarkers for Alzheimer's disease and Parkinson's Disease and Biomarkers for Multiple Sclerosis consortia (evidence level III). Results Our consensus guidelines address contraindications, as well as patient-related and procedure-related risk factors that can influence the development of post-LP complications. Discussion When an LP is performed correctly, the procedure is well tolerated and accepted with a low complication rate.
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Affiliation(s)
- Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Ellis Niemantsverdriet
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Hanne Struyfs
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Raf Brouns
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Receca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irena Dujmovic
- Clinic of Neurology, Clinical Centre of Serbia, Department of Neurology, Faculty of Medicine, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Wiesje van der Flier
- Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty, Mannheim/Heidelberg University, Mannheim, Germany
| | - Daniela Galimberti
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione Ca' Granda, IRCCS Ospedale Policlinico, Milan, Italy
| | - Sharmilee Gnanapavan
- Department of Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Bernhard Hemmer
- Department of Neurology, Technische Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Erik Hoff
- Department of Neurology, Atrium Medisch Centrum Parkstad, Heerlen, The Netherlands
| | - Jakub Hort
- Memory Disorders Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ellen Iacobaeus
- Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Frank Jan de Jong
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michael Jonsson
- Memory Clinic, Department of Neuropsychiatry, Sahlgrenska University Hospital, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Michael Khalil
- Department of Neurology, Medical University Graz, Graz, Austria
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red en enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Alexandre de Mendonça
- Laboratory of Neurosciences, Department of Molecular Medicine and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - José Luis Molinuevo
- Alzheimer's disease and other cognitive disorders unit, Neurology Service, Hospital Clinic i Universitari, IDIBAPS, Barcelona, Spain
| | - Guy Nagels
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Faculté de Psychologie et des sciences de l'éducation, UMons, Mons, Belgium.,National MS Center Melsbroek, Brussels, Belgium
| | - Claire Paquet
- Research Memory Center Lariboisière Hospital University Paris Diderot INSERMU942, Paris, France
| | - Lucilla Parnetti
- Section of Neurology, Centre for Memory Disturbances, Department of Medicine, University of Perugia, Perugia, Italy
| | - Gerwin Roks
- Department of Neurology, St Elisabeth Ziekenhuis, Tilburg, The Netherlands
| | - Pedro Rosa-Neto
- Departments of Neurology & Neurosurgery and Psychiatry, McGill Centre for Studies in Aging, Douglas Hospital Research Center, McGill University, Montreal, Canada.,Departments of Psychiatry, McGill Centre for Studies in Aging, Douglas Hospital Research Center, McGill University, Montreal, Canada
| | - Philip Scheltens
- Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Hayrettin Tumani
- CSF Laboratory and Multiple Sclerosis Outpatient Unit, Department of Neurology, University of Ulm, Ulm, Germany
| | - Pieter Jelle Visser
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Anders Wallin
- Memory Clinic, Department of Neuropsychiatry, Sahlgrenska University Hospital, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Bengt Winblad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,UCL Institute of Neurology, Department of Molecular Neuroscience, London, United Kingdom
| | - Flora Duits
- Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Tsvetkova DZ, Bergquist SH, Parker MW, Jarrett TL, Howell JC, Watts KD, Kollhoff A, Roberts DL, Hu WT. Fear and Uncertainty Do Not Influence Reported Willingness to Undergo Lumbar Punctures in a U.S. Multi-Cultural Cohort. Front Aging Neurosci 2017; 9:22. [PMID: 28239349 PMCID: PMC5300987 DOI: 10.3389/fnagi.2017.00022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/27/2017] [Indexed: 12/03/2022] Open
Abstract
Cerebrospinal fluid (CSF) biomarkers for Alzheimer’s disease and related disorders can provide early and accurate prediction of underlying neuropathology even when the clinical symptoms are mild, but lumbar punctures (LP) to obtain CSF can be perceived as frightening and invasive. We previously demonstrated that this negative perception of the LP is strongly associated with a negative LP experience in terms of discomfort and complications, but it is not known what factors can lead to a negative perception of the LP. It has also been proposed that LP is less well-perceived by adults in the U.S. compared to Europe and elsewhere, although there is a paucity of primary data to support this. To address these knowledge gaps, we conducted a survey of 237 younger and older adults in the Atlanta area including a significant number born outside of the U.S. (n = 82, 34%) to determine demographic, medical, and experiential factors associated with the perception of LP as well as the willingness to undergo LP for medical or research purposes. Our results show that one in four respondents in this cohort with limited first-hand LP experience viewed the LP as a frightening invasive procedure, but the majority (89%) were willing to undergo LP for medical reasons. General awareness of the LP was associated with both standard and negative views of the LP, but perception did not influence willingness to undergo the procedure. Multi-variate models showed that higher annual household income, not place of birth or past experience, was associated with greater willingness to undergo LPs. We conclude that Americans (born in the U.S. or abroad) are not resistant to LPs if there is useful information to improve their health, although there is limited enthusiasm to undergo LPs solely for research purposes. At the same time, we failed to find modifiable factors to improve the perception of LP among those who already perceive it as frightening and invasive. Future recruitment effort should target adults with no preconceived notion of the LP with emphasis on data related to safety and tolerability.
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Affiliation(s)
- Dobromira Z Tsvetkova
- Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Center for Neurodegenerative Diseases Research, Emory University School of Medicine, AtlantaGA, USA
| | - Sharon H Bergquist
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta GA, USA
| | - Monica W Parker
- Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Alzheimer's Disease Research Center, Emory University School of Medicine, AtlantaGA, USA
| | - Thomas L Jarrett
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta GA, USA
| | - Jennifer C Howell
- Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Center for Neurodegenerative Diseases Research, Emory University School of Medicine, AtlantaGA, USA; Alzheimer's Disease Research Center, Emory University School of Medicine, AtlantaGA, USA
| | - Kelly D Watts
- Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Center for Neurodegenerative Diseases Research, Emory University School of Medicine, AtlantaGA, USA; Alzheimer's Disease Research Center, Emory University School of Medicine, AtlantaGA, USA
| | - Alexander Kollhoff
- Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Center for Neurodegenerative Diseases Research, Emory University School of Medicine, AtlantaGA, USA; Alzheimer's Disease Research Center, Emory University School of Medicine, AtlantaGA, USA
| | - David L Roberts
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta GA, USA
| | - William T Hu
- Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Center for Neurodegenerative Diseases Research, Emory University School of Medicine, AtlantaGA, USA; Alzheimer's Disease Research Center, Emory University School of Medicine, AtlantaGA, USA
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49
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Johar I, Mollenhauer B, Aarsland D. Cerebrospinal Fluid Biomarkers of Cognitive Decline in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:275-294. [PMID: 28554411 DOI: 10.1016/bs.irn.2016.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Among the nonmotor symptoms in Parkinson's disease (PD), cognitive impairment is one of the most common and devastating. Over recent years, mild cognitive impairment (MCI) has become a recognized feature of PD (PD-MCI). The underlying mechanisms which influence onset, rate of decline, and conversion to dementia (PDD) are largely unknown. Adding to this uncertainty is the heterogeneity of cognitive domains affected. Currently there are no disease-modifying treatments that can slow or reverse this process. Identification of biomarkers that can predict rate and risk of cognitive decline is therefore an unmet need. Cerebrospinal fluid (CSF) is an ideal biomarker candidate as its constituents reflect the metabolic processes underlying the functioning of brain parenchyma. The pathological hallmark of PD is the presence of aggregated α-synuclein (α-Syn) in intracellular Lewy inclusions. In addition, there is concomitant Alzheimer's disease (AD) pathology. In AD, decreased CSF β-amyloid 1-42 (Aβ42) and increased CSF tau levels are predictive of future cognitive decline, setting a precedent for such studies to be carried out in PD. CSF studies in PD have focused on the classical AD biomarkers and α-Syn. Longitudinal studies indicate that low levels of CSF Aβ42 are predictive of cognitive decline; however, results for tau and α-Syn were not consistent. This chapter summarizes recent findings of CSF biomarker studies and cognitive dysfunction in PD.
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Affiliation(s)
- Iskandar Johar
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany; University Medical Center, Göttingen, Germany
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
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50
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Carmona-Iragui M, Santos T, Videla S, Fernández S, Benejam B, Videla L, Alcolea D, Blennow K, Blesa R, Lleó A, Fortea J. Feasibility of Lumbar Puncture in the Study of Cerebrospinal Fluid Biomarkers for Alzheimer’s Disease in Subjects with Down Syndrome. J Alzheimers Dis 2016; 55:1489-1496. [PMID: 27858714 DOI: 10.3233/jad-160827] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- María Carmona-Iragui
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Telma Santos
- Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Sebastián Videla
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Department of Experimental and Health Sciences, Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Susana Fernández
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Bessy Benejam
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Laura Videla
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Daniel Alcolea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, University of Göteborg, Göteborg, Sweden
| | - Rafael Blesa
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
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