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Lee LH, Wu SC, Ho CF, Liang WL, Liu YC, Chou CJ. White matter hyperintensities in cholinergic pathways may predict poorer responsiveness to acetylcholinesterase inhibitor treatment for Alzheimer's disease. PLoS One 2023; 18:e0283790. [PMID: 37000849 PMCID: PMC10065432 DOI: 10.1371/journal.pone.0283790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/19/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Acetylcholinesterase inhibitor (AChEI) drug regimens are the mainstay treatment options for patients with Alzheimer's disease (AD). Herein, We examined the association between clinical response to AChEI and white matter hyperintensities on magnetic resonance imaging (MRI) scan at baseline. METHODS Between 2020 and 2021, we recruited 101 individuals with a clinical diagnosis of probable AD. Each participant underwent complete neuropsychological testing and 3T (Telsa) brain magnetic resonance imaging. Responsiveness to AChEI, as assessed after 12 months, was designated as less than two points of regression in Mini-Mental State Examination scores (MMSE) and stable clinical dementia rating scale. We also evaluated MRI images by examining scores on the Cholinergic Pathways Hyperintensities Scale (CHIPS), Fazekas scale, and medial temporal atrophy (MTA) scale. RESULTS In our cohort, 52 patients (51.4%) were classified as responders. We observed significantly higher CHIPS scores in the nonresponder group (21.1 ± 12.9 vs. 14.9 ± 9.2, P = 0.007). Age at baseline, education level, sex, Clinical Dementia Rating sum of boxes scores, and three neuroimaging parameters were tested in regression models. Only CHIPS scores predicted clinical response to AChEI treatment. CONCLUSION WMHs in the cholinergic pathways, not diffuse white matter lesions or hippocampal atrophy, correlated with poorer responsiveness to AChEI treatment. Therefore, further investigation into the role of the cholinergic pathway in AD is warranted.
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Affiliation(s)
- Li-Hua Lee
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
| | - Shu-Ching Wu
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
| | - Cheng-Feng Ho
- Department of Radiology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
| | - Wan-Lin Liang
- Department of Medical Research, Far Eastern Hospital, New Taipei City, Taipei, Taiwan
| | - Yi-Chien Liu
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
- Department of Education and Research, Medical school of Fu-Jen University, New Taipei City, Taipei, Taiwan
- Geriatric Behavioral Neurology Project, Tohoku University New Industry Hatchery Center (NICHe), Sendai, Japan
- * E-mail:
| | - Chia-Ju Chou
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
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Bentham C, De Marco M, Venneri A. Cerebrovascular Pathology and Responsiveness to Treatment in Alzheimer's Disease: A Systematic Review. Curr Alzheimer Res 2021; 18:103-124. [PMID: 33855943 DOI: 10.2174/1567205018666210414121227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 02/12/2021] [Accepted: 03/31/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Responsiveness to treatment with cholinesterase inhibitors (ChEIs) is difficult to predict in Alzheimer's disease (AD). In the current review, vascular burden is considered as a potential moderator of treatment responsiveness. Cerebrovascular burden co-occurs in at least 30% of AD brains, although it is debated if vascular pathology plays a causal or synergistic role in AD pathogenesis. Vascular burden, therefore, could potentially limit response to treatment due to limited brain reserve or foster treatment efficacy as those with vascular pathology may represent a subgroup with comparable clinical expression but less progressed AD neurodegeneration. METHODS A systematic search of Web of Science, Pubmed, Scopus and EthoS identified 32 papers which met the criteria for inclusion. Association of treatment response and vascular burden across five broad markers are discussed: cerebral hypoperfusion, intima-media thickness, white matter changes, cerebral microbleeds and co-existing diagnosis of cerebrovascular disease. RESULTS Analysis of frontal regional cerebral blood flow and intima-media thickness may have predictive ability to distinguish those with AD who may respond optimally to short-term treatment with ChEIs. The impact of white matter changes is less consistent; the majority of studies demonstrates no association with treatment response and those that do implicate changes in executive functioning. There is preliminary evidence that deep cerebral microbleeds limit treatment response in subcortical cognitive domains, but this finding requires replication. The use of diagnosis of co-occurring cerebrovascular disease yields no robust variability in response to ChEIs in AD. CONCLUSION There is limited evidence that markers of cerebral hypoperfusion, intima-media thickness and cerebral microbleeds moderate response to ChEIs. Findings for other markers of vascular burden are less consistent and do not support any moderating effect.
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Affiliation(s)
- Charlotte Bentham
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Matteo De Marco
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
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Asano T, Wang CW, Tsugaruya M, Ishikawa T. Effectiveness of high-frequency individual reminiscence interventions using life story books on persons with dementia. Br J Occup Ther 2020. [DOI: 10.1177/0308022620945932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Reminiscence therapy, using life story books, is a non-pharmacological treatment and helps promote psychosocial benefits in people with dementia. This research thus aimed to determine the effects of life story books among participants with dementia of different severities. Method The experimental group ( n = 36) underwent three semi-structured interviews over 10 weeks. After a 2-week life story books-production interval, the experimental group received the intervention over 4 weeks, five times weekly. The following 12 weeks were the follow-up period. The control group ( n = 30) underwent the first and last assessments, with a 6-month interval, while receiving their usual care services. Results Participants’ cognitive functioning was mostly maintained at follow-up in the experimental group, but significantly declined in the control group. The experimental group showed no significant change in cognition among participants with severe dementia during all periods, assessed using the behavioural and psychological symptoms of dementia, and the caregivers’ burden decreased significantly from before to after the intervention. Conclusion These results demonstrate that life story book interventions are an effective tool in improving the relationship between caregivers and people with dementia, and could help people with dementia maintain cognitive function, even those with severe dementia.
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Affiliation(s)
- Tomoaki Asano
- Department of Occupational Therapy, Akita University, Akita, Japan
| | - Chih-Wen Wang
- Department of Rehabilitation, Tohoku Bunka Gakuen University, Sendai, Japan
| | - Megumi Tsugaruya
- Department of Occupational Therapy, Akita University, Akita, Japan
| | - Takashi Ishikawa
- Department of Occupational Therapy, Akita University, Akita, Japan
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Prevention of Cognitive Decline in Alzheimer's Disease by Novel Antioxidative Supplements. Int J Mol Sci 2020; 21:ijms21061974. [PMID: 32183152 PMCID: PMC7139972 DOI: 10.3390/ijms21061974] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Abstract
Oxidative stress plays a crucial role in Alzheimer’s disease (AD) from its prodromal stage of mild cognitive impairment. There is an interplay between oxidative stress and the amyloid β (Aβ) cascade via various mechanisms including mitochondrial dysfunction, lipid peroxidation, protein oxidation, glycoxidation, deoxyribonucleotide acid damage, altered antioxidant defense, impaired amyloid clearance, inflammation and chronic cerebral hypoperfusion. Based on findings that indicate that oxidative stress plays a major role in AD, oxidative stress has been considered as a therapeutic target of AD. In spite of favorable preclinical study outcomes, previous antioxidative components, including a single antioxidative supplement such as vitamin C, vitamin E or their mixtures, did not clearly show any therapeutic effect on cognitive decline in AD. However, novel antioxidative supplements can be beneficial for AD patients. In this review, we summarize the interplay between oxidative stress and the Aβ cascade, and introduce novel antioxidative supplements expected to prevent cognitive decline in AD.
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Rao T, Tan Z, Peng J, Guo Y, Chen Y, Zhou H, Ouyang D. The pharmacogenetics of natural products: A pharmacokinetic and pharmacodynamic perspective. Pharmacol Res 2019; 146:104283. [PMID: 31129178 DOI: 10.1016/j.phrs.2019.104283] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 11/19/2022]
Abstract
Natural products have represented attractive alternatives for disease prevention and treatment over the course of human history and have contributed to the development of modern drugs. These natural products possess beneficial efficacies as well as adverse efffects, which vary largely among individuals because of genetic variations in their pharmacokinetics and pharmacodynamics. As with other synthetic chemical drugs, the dosing of natural products can be optimized to improve efficacy and reduce toxicity according to the pharmacogenetic properties. With the emergence and development of pharmacogenomics, it is possible to discover and identify the targets/mechanisms of pharmacological effects and therapeutic responses of natural products effectively and efficiently on the whole genome level. This review covers the effects of genetic variations in drug metabolizing enzymes, drug transporters, and direct and indirect interactions with the pharmacological targets/pathways on the individual response to natural products, and provides suggestions on dosing regimen adjustments of natural products based on their pharmacokinetic and pharmacogenetic paratmeters. Finally, we provide our viewpoints on the importance and necessity of pharmacogenetic and pharmacogenomic research of natural products in natural medicine's rational development and clinical application of precision medicine.
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Affiliation(s)
- Tai Rao
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, PR China; Institute of Clinical Pharmacology, Central South University, Changsha, PR China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, Changsha, PR China; National Clinical Research Center for Geriatric Disorders, Changsha, Hunan, PR China
| | - Zhirong Tan
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, PR China; Institute of Clinical Pharmacology, Central South University, Changsha, PR China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, Changsha, PR China; National Clinical Research Center for Geriatric Disorders, Changsha, Hunan, PR China
| | - Jingbo Peng
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, PR China; Institute of Clinical Pharmacology, Central South University, Changsha, PR China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, Changsha, PR China; National Clinical Research Center for Geriatric Disorders, Changsha, Hunan, PR China
| | - Ying Guo
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, PR China; Institute of Clinical Pharmacology, Central South University, Changsha, PR China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, Changsha, PR China; National Clinical Research Center for Geriatric Disorders, Changsha, Hunan, PR China
| | - Yao Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, PR China; Institute of Clinical Pharmacology, Central South University, Changsha, PR China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, Changsha, PR China; National Clinical Research Center for Geriatric Disorders, Changsha, Hunan, PR China
| | - Honghao Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, PR China; Institute of Clinical Pharmacology, Central South University, Changsha, PR China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, Changsha, PR China; National Clinical Research Center for Geriatric Disorders, Changsha, Hunan, PR China
| | - Dongsheng Ouyang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, PR China; Institute of Clinical Pharmacology, Central South University, Changsha, PR China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, Changsha, PR China; National Clinical Research Center for Geriatric Disorders, Changsha, Hunan, PR China.
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