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Bermejo-Pareja F, del Ser T. Controversial Past, Splendid Present, Unpredictable Future: A Brief Review of Alzheimer Disease History. J Clin Med 2024; 13:536. [PMID: 38256670 PMCID: PMC10816332 DOI: 10.3390/jcm13020536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Background: The concept of Alzheimer disease (AD)-since its histological discovery by Alzheimer to the present day-has undergone substantial modifications. Methods: We conducted a classical narrative review of this field with a bibliography selection (giving preference to Medline best match). Results: The following subjects are reviewed and discussed: Alzheimer's discovery, Kraepelin's creation of a new disease that was a rare condition until the 1970's, the growing interest and investment in AD as a major killer in a society with a large elderly population in the second half of the 20th century, the consolidation of the AD clinicopathological model, and the modern AD nosology based on the dominant amyloid hypothesis among many others. In the 21st century, the development of AD biomarkers has supported a novel biological definition of AD, although the proposed therapies have failed to cure this disease. The incidence of dementia/AD has shown a decrease in affluent countries (possibly due to control of risk factors), and mixed dementia has been established as the most frequent etiology in the oldest old. Conclusions: The current concept of AD lacks unanimity. Many hypotheses attempt to explain its complex physiopathology entwined with aging, and the dominant amyloid cascade has yielded poor therapeutic results. The reduction in the incidence of dementia/AD appears promising but it should be confirmed in the future. A reevaluation of the AD concept is also necessary.
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Affiliation(s)
- Félix Bermejo-Pareja
- CIBERNED, Institute of Health Carlos III, 28029 Madrid, Spain
- Institute of Research i+12, University Hospital “12 de Octubre”, 28041 Madrid, Spain
| | - Teodoro del Ser
- Alzheimer’s Centre Reina Sofia—CIEN Foundation, Institute of Health Carlos III, 28031 Madrid, Spain;
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Shorey CL, Mulla RT, Mielke JG. The effects of synthetic glucocorticoid treatment for inflammatory disease on brain structure, function, and dementia outcomes: A systematic review. Brain Res 2022; 1798:148157. [DOI: 10.1016/j.brainres.2022.148157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/31/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
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Vives‐Rodriguez AL, Schiloski KA, Marin A, Wang R, Hajos GP, Powsner R, DeCaro R, Budson AE, Turk KW. Impact of amyloid PET in the clinical care of veterans in a tertiary memory disorders clinic. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12320. [PMID: 35992216 PMCID: PMC9382691 DOI: 10.1002/trc2.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/31/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
Introduction We aimed to characterize the clinical impact of amyloid PET (APET) in a veteran population with cognitive decline by comparing differences in management between those who did and did not have an APET. Methods This was a retrospective observational study. Poisson regressions and logistic regression were used for comparisons. Results Out of 565 veterans, 197 underwent APET; positivity rate was 36.55%. Having an APET was associated with longer follow-up, and increased diagnostic variability; it was not associated with number of additional studies, cholinesterase inhibitors prescription, or referrals to research. A positive APET was associated with less diagnostic variability, fewer additional tests, greater cholinesterase inhibitor prescriptions, and more research referrals. Discussion In a medically complex, real-world population, APET yielded lower positivity rates and was not associated with classical clinical utility variables when comparing patients with and without an APET. APET may be used more to "rule out" rather than to confirm Alzheimer's disease. Highlights Amyloid PET was associated with longer follow-up, and higher diagnostic variability.No association was seen with cholinesterase inhibitors prescription, or referrals to research.In complex patients, expected amyloid PET positivity rates are lower than previously described.Amyloid PETs were used to "rule out" AD than to confirm the diagnosis of AD.
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Affiliation(s)
- Ana Laura Vives‐Rodriguez
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Kylie A. Schiloski
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Anna Marin
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Neuroscience DepartmentBoston University School of Medicine BostonMassachusettsUSA
| | - Ryan Wang
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Gabor P. Hajos
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Rachel Powsner
- Department of RadiologyVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Renée DeCaro
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Andrew E. Budson
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- Alzheimer's Disease Research CenterDepartment of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Katherine W. Turk
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- Alzheimer's Disease Research CenterDepartment of NeurologyBoston University School of MedicineBostonMassachusettsUSA
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4
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Abstract
PURPOSE OF REVIEW This article discusses the application of neuropsychological evaluation to the workup of individuals with age-related cognitive impairment and suspected dementia. Referral questions, principles of evaluation, and common instruments to detect abnormalities in cognition and behavior in this population are reviewed. The integration of neuropsychological test findings with other clinical and biomarker information enhances early detection, differential diagnosis, and care planning. RECENT FINDINGS Life expectancy is increasing in the United States, and, accordingly, the prevalence and incidence of dementia associated with age-related neurodegenerative brain disease are rising. Age is the greatest risk factor for the dementia associated with Alzheimer disease, the most common neurodegenerative cause of dementia in people over 65 years of age; other etiologies, such as the class of frontotemporal lobar degenerations, are increasingly recognized in individuals both younger and older than 65 years of age. The clinical dementia diagnosis, unfortunately, is imperfectly related to disease etiology; however, probabilistic relationships can aid in diagnosis. Further, mounting evidence from postmortem brain autopsies points to multiple etiologies. The case examples in this article illustrate how the neuropsychological evaluation increases diagnostic accuracy and, most important, identifies salient cognitive and behavioral symptoms to target for nonpharmacologic intervention and caregiver education and support. Sharing the diagnosis with affected individuals is also discussed with reference to prognosis and severity of illness. SUMMARY The clinical neuropsychological examination facilitates early detection of dementia, characterizes the level of severity, defines salient clinical features, aids in differential diagnosis, and points to a pathway for care planning and disease education.
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Zhou Q, Xie D, Chen T, Gao Y, Lin L, Lin X. The effects of dexmedetomidine on the cognitive function of mild cognitive impairment (MCI) rats. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:667. [PMID: 35845519 PMCID: PMC9279787 DOI: 10.21037/atm-22-2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/08/2022] [Indexed: 12/02/2022]
Abstract
Background The study sought to investigate the effects of dexmedetomidine (DEX) on cognitive function after anesthesia and to examine its actual mechanism. Methods A total of 48 rats were injected with d-galactose (D-gal) 1,000 mg·kg−1·d−1 and normal saline at the neck and back for 1 week to establish rats with mild cognitive impairment (MCI) and conduct behavioral tests. Sevoflurane was inhaled and DEX was pumped into each group respectively. Morris water maze (MWM) test was conducted 24 hours later. The inflammatory factors interleukin (IL)-1, interleukin (IL)-6, and a tumor necrosis factor (TNF)-α in brain homogenate were quantitatively measured by enzyme-linked immunosorbent assay (ELISA) on the next day. The apoptosis of hippocampal cells was observed by hematoxylin-eosin staining (HE staining). Results In relation to the model establishment, we found that there was no significant difference in body weight and swimming speed before and after modeling. There was no statistically significant difference in the escape latency between Groups A, B, C, and D before modeling. After modeling, there was no statistical difference in the escape latency between Groups A, B, and C, but the difference was statistically significant when compared to Group D (P<0.05). In relation to the DEX intervention, we found that compared to Group C, MWM test performance in Groups A and B was considerably worse longer escape latencies and fewer platform crossings within 90 seconds), and were more significant in Group A. Compared with Group D, the levels of inflammatory cytokines of the brain homogenates were elevated, and this elevation was highest in Group A, followed by Group B; the pathological changes were consistent with changes in behavioral tests. In Group A, there were obvious disorders of glial cell arrangement, apoptosis and deletion. There was no significant change in Group D. And the changes of vertebral cells in Group B and Group C were slight, with orderly arrangement and intact cell structure. Conclusions DEX inhibits the apoptosis of hippocampal cells and reduces the cognitive dysfunction of rats with MCI induced by D-gal via the inhibition of the release of inflammatory cytokines.
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Affiliation(s)
- Qian Zhou
- Department of Anesthesiology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Institute of Anesthesiology, Fujian Medical University, Fuzhou, China
| | | | - Ting Chen
- Department of Anesthesiology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Institute of Anesthesiology, Fujian Medical University, Fuzhou, China
| | - Youguang Gao
- Department of Anesthesiology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Institute of Anesthesiology, Fujian Medical University, Fuzhou, China
| | - Lanying Lin
- Department of Anesthesiology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Institute of Anesthesiology, Fujian Medical University, Fuzhou, China
| | - Xianzhong Lin
- Department of Anesthesiology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Institute of Anesthesiology, Fujian Medical University, Fuzhou, China
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Beach TG. A History of Senile Plaques: From Alzheimer to Amyloid Imaging. J Neuropathol Exp Neurol 2022; 81:387-413. [PMID: 35595841 DOI: 10.1093/jnen/nlac030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Senile plaques have been studied in postmortem brains for more than 120 years and the resultant knowledge has not only helped us understand the etiology and pathogenesis of Alzheimer disease (AD), but has also pointed to possible modes of prevention and treatment. Within the last 15 years, it has become possible to image plaques in living subjects. This is arguably the single greatest advance in AD research since the identification of the Aβ peptide as the major plaque constituent. The limitations and potentialities of amyloid imaging are still not completely clear but are perhaps best glimpsed through the perspective gained from the accumulated postmortem histological studies. The basic morphological classification of plaques into neuritic, cored and diffuse has been supplemented by sophisticated immunohistochemical and biochemical analyses and increasingly detailed mapping of plaque brain distribution. Changes in plaque classification and staging have in turn contributed to changes in the definition and diagnostic criteria for AD. All of this information continues to be tested by clinicopathological correlations and it is through the insights thereby gained that we will best be able to employ the powerful tool of amyloid imaging.
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Affiliation(s)
- Thomas G Beach
- From the Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA
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7
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Poloni KM, Ferrari RJ. Automated detection, selection and classification of hippocampal landmark points for the diagnosis of Alzheimer's disease. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 214:106581. [PMID: 34923325 DOI: 10.1016/j.cmpb.2021.106581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 11/12/2021] [Accepted: 12/04/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Alzheimer's disease (AD) is a neurodegenerative, progressive, and irreversible disease that accounts for up to 80% of all dementia cases. AD predominantly affects older adults, and its clinical diagnosis is a challenging evaluation process, with imprecision rates between 12 and 23%. Structural magnetic resonance (MR) imaging has been widely used in studies related to AD because this technique provides images with excellent anatomical details and information about structural changes induced by the disease in the brain. Current studies are focused on detecting AD in its initial stage, i.e., mild cognitive impairment (MCI), since treatments for preventing or delaying the onset of symptoms is more effective when administered at the early stages of the disease. This study proposes a new technique to perform MR image classification in AD diagnosis using discriminative hippocampal point landmarks among the cognitively normal (CN), MCI, and AD populations. METHODS Our approach, based on a two-level classification, first detects and selects discriminative landmark points from two diagnosis populations based on their matching distance compared to a probabilistic atlas of 3-D labeled landmark points. The points are classified using attributes computed in a spherical support region around each point using information from brain probability image tissues of gray matter, white matter, and cerebrospinal fluid as sources of information. Next, at the second level, the images are classified based on a quantitative evaluation obtained from the first-level classifier outputs. RESULTS For the CN×MCI experiment, we achieved an AUC of 0.83, an accuracy of 75.58%, with 72.9% of sensitivity and 77.81% of specificity. For the MCI×AD experiment, we achieved an AUC value of 0.73, an accuracy of 69.8%, a sensitivity of 74.09% and specificity of 64.57%. Finally, for the CN×AD, we achieved an AUC of 0.95, an accuracy of 89.24%, with 85.58% of sensitivity and 92.71% of specificity. CONCLUSIONS The obtained classification results are similar to (or even higher than) other studies that classify AD compared to CN individuals and comparable to those classified patients with MCI.
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Affiliation(s)
- Katia M Poloni
- Department of Computing, Federal University of São Carlos, Rod. Washington Luis, Km 235, São Carlos, 13565-905, SP, Brazil
| | - Ricardo J Ferrari
- Department of Computing, Federal University of São Carlos, Rod. Washington Luis, Km 235, São Carlos, 13565-905, SP, Brazil.
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Lloret A, Esteve D, Lloret MA, Cervera-Ferri A, Lopez B, Nepomuceno M, Monllor P. When Does Alzheimer's Disease Really Start? The Role of Biomarkers. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:355-364. [PMID: 34690605 DOI: 10.1176/appi.focus.19305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Appeared originally in Int J Mol Sci 2019, 20 5536).
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Affiliation(s)
- Ana Lloret
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
| | - Daniel Esteve
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
| | - Maria-Angeles Lloret
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
| | - Ana Cervera-Ferri
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
| | - Begoña Lopez
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
| | - Mariana Nepomuceno
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
| | - Paloma Monllor
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
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9
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Howlett SE, Rutenberg AD, Rockwood K. The degree of frailty as a translational measure of health in aging. NATURE AGING 2021; 1:651-665. [PMID: 37117769 DOI: 10.1038/s43587-021-00099-3] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 07/06/2021] [Indexed: 04/30/2023]
Abstract
Frailty is a multiply determined, age-related state of increased risk for adverse health outcomes. We review how the degree of frailty conditions the development of late-life diseases and modifies their expression. The risks for frailty range from subcellular damage to social determinants. These risks are often synergistic-circumstances that favor damage also make repair less likely. We explore how age-related damage and decline in repair result in cellular and molecular deficits that scale up to tissue, organ and system levels, where they are jointly expressed as frailty. The degree of frailty can help to explain the distinction between carrying damage and expressing its usual clinical manifestations. Studying people-and animals-who live with frailty, including them in clinical trials and measuring the impact of the degree of frailty are ways to better understand the diseases of old age and to establish best practices for the care of older adults.
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Affiliation(s)
- Susan E Howlett
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew D Rutenberg
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia, Canada.
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10
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Lee CS, Lee ML, Gibbons LE, Yanagihara RT, Blazes M, Kam JP, McCurry SM, Bowen JD, McCormick WC, Lee AY, Larson EB, Crane PK. Associations Between Retinal Artery/Vein Occlusions and Risk of Vascular Dementia. J Alzheimers Dis 2021; 81:245-253. [PMID: 33749651 DOI: 10.3233/jad-201492] [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: 11/15/2022]
Abstract
BACKGROUND Vascular disease is a risk factor for Alzheimer's disease (AD) and related dementia in older adults. Retinal artery/vein occlusion (RAVO) is an ophthalmic complication of systemic vascular pathology. Whether there are associations between RAVO and dementia risk is unknown. OBJECTIVE To determine whether RAVOs are associated with an increased risk of developing vascular dementia or AD. METHODS Data from Adult Changes in Thought (ACT) study participants were analyzed. This prospective, population-based cohort study followed older adults (age ≥65 years) who were dementia-free at enrollment for development of vascular dementia or AD based on research criteria. RAVO diagnoses were extracted from electronic medical records. Cox-regression survival analyses were stratified by APOEɛ4 genotype and adjusted for demographic and clinical factors. RESULTS On review of 41,216 person-years (4,743 participants), 266 (5.6%) experienced RAVO. APOEɛ4 carriers who developed RAVO had greater than four-fold higher risk for developing vascular dementia (Hazard Ratio [HR] 4.54, 95% Confidence Interval [CI] 1.86, 11.10, p = 0.001). When including other cerebrovascular disease (history of carotid endarterectomy or transient ischemic attack) in the model, the risk was three-fold higher (HR 3.06, 95% CI 1.23, 7.62). No other conditions evaluated in the secondary analyses were found to confound this relationship. There was no effect in non-APOEɛ4 carriers (HR 1.03, 95% CI 0.37, 2.80). There were no significant associations between RAVO and AD in either APOE group. CONCLUSION Older dementia-free patients who present with RAVO and carry the APOEɛ4 allele appear to be at higher risk for vascular dementia.
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Affiliation(s)
- Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Michael L Lee
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Laura E Gibbons
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ryan T Yanagihara
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Marian Blazes
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Jason P Kam
- Kaiser Permanente Washington, Seattle, WA, USA
| | - Susan M McCurry
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - James D Bowen
- Department of Neurology, Swedish Medical Center, Seattle, WA, USA
| | | | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
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11
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Ye LQ, Gao PR, Zhang YB, Cheng HR, Tao QQ, Wu ZY, Li HL. Application of Cerebrospinal Fluid AT(N) Framework on the Diagnosis of AD and Related Cognitive Disorders in Chinese Han Population. Clin Interv Aging 2021; 16:311-323. [PMID: 33654388 PMCID: PMC7910151 DOI: 10.2147/cia.s294756] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Studies concerning the impact of the AT(N) framework on diagnostic capability in the dementia population are lacking. We aimed to explore the diagnostic application of CSF AT(N) framework in clinical routines of Alzheimer's disease (AD) as well as differential diagnosis of other cognitive diseases in the Chinese Han population. Patients and Methods A total of 137 patients with cognitive disorders received CSF tests of Aβ42, t-tau and p-tau181. Their CSF biomarker results were categorized and interpreted by the AT(N) framework. Neurologists provided a diagnosis both pre- and post-CSF biomarker disclosure with corresponding diagnostic confidence. Results The total initial diagnosis included 79 patients with AD and 58 patients with non-AD (NAD). The results of CSF biomarkers led to a diagnostic change of 28% in the cohort. Approximately 81.5% (n=53) of 65 patients whose CSF biomarker showed an underlying AD pathology were finally diagnosed as AD, with an increase of 17.5% in diagnostic confidence. Thirty-seven CSF results indicating NAD pathologic changes contributed to an exclusion of AD in 56.8% (n=21) of the patients along with a modest increase of 9.8% in average confidence. Thirty-five patients with normal CSF biomarkers maintained the diagnosis of NAD in 68.6% (n=24) of the group, leading to a slight elevation of 7.6% in confidence. Conclusion We found that the presence of amyloid pathology (A+) is contributable to diagnosing AD and improving confidence. On occasion of negative amyloid pathology (A-), with or without tau pathology, gaining uncertainty of the primary AD diagnosis would diminish the corresponding confidence. To the best of our knowledge, this is the first study performed in the Chinese Han population with cognitive disorders that explores the clinical capability of CSF AT(N) framework in a quantitative way.
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Affiliation(s)
- Ling-Qi Ye
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Rehabilitation Medicine and Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, People's Republic of China
| | - Pei-Rong Gao
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yan-Bin Zhang
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Neurology and Institute of Neurology in First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Hong-Rong Cheng
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Neurology in Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, People's Republic of China
| | - Qing-Qing Tao
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Zhi-Ying Wu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Hong-Lei Li
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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12
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Therriault J, Pascoal TA, Benedet AL, Tissot C, Savard M, Chamoun M, Lussier F, Kang MS, Berzgin G, Wang T, Fernandes-Arias J, Massarweh G, Soucy JP, Vitali P, Saha-Chaudhuri P, Gauthier S, Rosa-Neto P. Frequency of Biologically Defined Alzheimer Disease in Relation to Age, Sex, APOE ε4, and Cognitive Impairment. Neurology 2021; 96:e975-e985. [PMID: 33443136 PMCID: PMC8055338 DOI: 10.1212/wnl.0000000000011416] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To assess the frequency of biologically defined Alzheimer disease (AD) in relation to age, sex, APOE ε4, and clinical diagnosis in a prospective cohort study evaluated with amyloid-PET and tau-PET. METHODS We assessed cognitively unimpaired (CU) elderly (n = 166), patients with amnestic mild cognitive impairment (n = 77), and patients with probable AD dementia (n = 62) who underwent evaluation by dementia specialists and neuropsychologists in addition to amyloid-PET with [18F]AZD4694 and tau-PET with [18F]MK6240. Individuals were grouped according to their AD biomarker profile. Positive predictive value for biologically defined AD was assessed in relation to clinical diagnosis. Frequency of AD biomarker profiles was assessed using logistic regressions with odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The clinical diagnosis of probable AD dementia demonstrated good agreement with biologically defined AD (positive predictive value 85.2%). A total of 7.88% of CU were positive for both amyloid-PET and tau-PET. Frequency of biologically defined AD increased with age (OR 1.14; p < 0.0001) and frequency of APOE ε4 allele carriers (single ε4: OR 3.82; p < 0.0001; double ε4: OR 17.55, p < 0.0001). CONCLUSION Whereas we observed strong, but not complete, agreement between clinically defined probable AD dementia and biomarker positivity for both β-amyloid and tau, we also observed that biologically defined AD was not rare in CU elderly. Abnormal tau-PET was almost exclusively observed in individuals with abnormal amyloid-PET. Our results highlight that even in tertiary care memory clinics, detailed evaluation by dementia specialists systematically underestimates the frequency of biologically defined AD and related entities. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that biologically defined AD (abnormal amyloid PET and tau PET) was observed in 85.2% of people with clinically defined AD and 7.88% of CU elderly.
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Affiliation(s)
- Joseph Therriault
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Tharick A Pascoal
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Andrea L Benedet
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Cecile Tissot
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Melissa Savard
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Mira Chamoun
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Firoza Lussier
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Min Su Kang
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Gleb Berzgin
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Tina Wang
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Jaime Fernandes-Arias
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Gassan Massarweh
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Jean-Paul Soucy
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Paolo Vitali
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Paramita Saha-Chaudhuri
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Serge Gauthier
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada
| | - Pedro Rosa-Neto
- From the Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital (J.T., T.A.P., A.L.B., C.T., M.S., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., S.G., P.R.-N.), and the Departments of Neurology and Neurosurgery (J.T., T.A.P., A.L.B., C.T., M.C., F.L., M.S.K., G.B., T.W., J.F.-A., J.-P.S., P.V., S.G., P.R.-N.), Psychiatry (S.G., P.R.-N.), Radiochemistry (G.M.), and Epidemiology and Biostatistics (P.S.-C.), McGill University, Montreal; and Montreal Neurological Institute (J.T., T.A.P., A.L.B., C.T., F.L., M.S.K., G.B., T.W., J.F.-A., G.M., J.-P.S., P.R.-N.), Canada.
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Kameyama M, Ishibashi K, Toyohara J, Wagatsuma K, Umeda-Kameyama Y, Shimoji K, Kanemaru K, Murayama S, Ogawa S, Tokumaru AM, Ishii K. Voxel-based morphometry focusing on medial temporal lobe structures has a limited capability to detect amyloid β, an Alzheimer's disease pathology. Aging (Albany NY) 2020; 12:19701-19710. [PMID: 33024054 PMCID: PMC7732322 DOI: 10.18632/aging.104012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/30/2020] [Indexed: 01/24/2023]
Abstract
Voxel-based morphometry (VBM) analysis of nuclear Magnetic Resonance Imaging (MRI) data allows the identification of medial temporal lobe (MTL) atrophy and is widely used to assist the diagnosis of Alzheimer's disease (AD). However, its reliability in the clinical environment has not yet been confirmed. To determine the credibility of VBM, amyloid positron emission tomography (PET) and VBM studies were compared retrospectively. Patients who underwent Pittsburgh Compound B (PiB) PET were retrospectively recruited. Ninety-seven patients were found to be amyloid negative and 116 were amyloid positive. MTL atrophy in the PiB positive group, as quantified by thin sliced 3D MRI and VBM software, was significantly more severe (p =0.0039) than in the PiB negative group. However, data histogram showed a vast overlap between the two groups. The area under the ROC curve (AUC) was 0.646. MMSE scores of patients in the amyloid negative and positive groups were also significantly different (p = 0.0028), and the AUC was 0.672. Thus, MTL atrophy could not reliably differentiate between amyloid positive and negative patients in a clinical setting, possibly due to the wide array of dementia-type diseases that exist other than AD.
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Affiliation(s)
- Masashi Kameyama
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo 173-0015, Japan
| | - Kenji Ishibashi
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | - Jun Toyohara
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | - Kei Wagatsuma
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | - Yumi, Umeda-Kameyama
- Department of Geriatric Medicine, The University of Tokyo School of Medicine, Tokyo 113-8655, Japan
| | - Keigo Shimoji
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo 173-0015, Japan
| | - Kazutomi Kanemaru
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, 113-0015, Japan
| | - Shigeo Murayama
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, 113-0015, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, The University of Tokyo School of Medicine, Tokyo 113-8655, Japan
| | - Aya M. Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo 173-0015, Japan
| | - Kenji Ishii
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
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Hwang PH, Longstreth W, Brenowitz WD, Thielke SM, Lopez OL, Francis CE, DeKosky ST, Fitzpatrick AL. Dual sensory impairment in older adults and risk of dementia from the GEM Study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12054. [PMID: 32671180 PMCID: PMC7340796 DOI: 10.1002/dad2.12054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hearing and vision loss are independently associated with dementia, but the impact of dual sensory impairment (DSI) on dementia risk is not well understood. METHODS Self-reported measures of hearing and vision were taken from 2051 participants at baseline from the Gingko Evaluation of Memory Study. Dementia status was ascertained using standardized criteria. Cox models were used to estimate risk of dementia associated with number of sensory impairments (none, one, or two). RESULTS DSI was significantly associated with higher risk of all-cause dementia (hazard ratio [HR] = 1.86; 95% confidence interval [CI] = 1.25-2.76) and Alzheimer's disease (HR = 2.12; 95% CI = 1.34-3.36). Individually only visual impairment was independently associated with an increased risk of all-cause dementia (HR = 1.32; 95% CI = 1.02-1.71). DISCUSSION Older adults with DSI are at a significantly increased risk for dementia. Further studies are needed to evaluate whether treatments can modify this risk.
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Affiliation(s)
- Phillip H. Hwang
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - W.T. Longstreth
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Willa D. Brenowitz
- Department of PsychiatryUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Stephen M. Thielke
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWashingtonUSA
- Geriatric ResearchEducationand Clinical CenterPuget Sound VA Medical CenterSeattleWashingtonUSA
| | - Oscar L. Lopez
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | | | - Annette L. Fitzpatrick
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of Family MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
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Guerreiro R, Gibbons E, Tábuas-Pereira M, Kun-Rodrigues C, Santo GC, Bras J. Genetic architecture of common non-Alzheimer's disease dementias. Neurobiol Dis 2020; 142:104946. [PMID: 32439597 PMCID: PMC8207829 DOI: 10.1016/j.nbd.2020.104946] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023] Open
Abstract
Frontotemporal dementia (FTD), dementia with Lewy bodies (DLB) and vascular dementia (VaD) are the most common forms of dementia after Alzheimer’s disease (AD). The heterogeneity of these disorders and/or the clinical overlap with other diseases hinder the study of their genetic components. Even though Mendelian dementias are rare, the study of these forms of disease can have a significant impact in the lives of patients and families and have successfully brought to the fore many of the genes currently known to be involved in FTD and VaD, starting to give us a glimpse of the molecular mechanisms underlying these phenotypes. More recently, genome-wide association studies have also pointed to disease risk-associated loci. This has been particularly important for DLB where familial forms of disease are very rarely described. In this review we systematically describe the Mendelian and risk genes involved in these non-AD dementias in an effort to contribute to a better understanding of their genetic architecture, find differences and commonalities between different dementia phenotypes, and uncover areas that would benefit from more intense research endeavors.
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Affiliation(s)
- Rita Guerreiro
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA; Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| | - Elizabeth Gibbons
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | - Miguel Tábuas-Pereira
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Celia Kun-Rodrigues
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | - Gustavo C Santo
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Jose Bras
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA; Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
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Investigating APOE, APP-Aβ metabolism genes and Alzheimer's disease GWAS hits in brain small vessel ischemic disease. Sci Rep 2020; 10:7103. [PMID: 32345996 PMCID: PMC7188838 DOI: 10.1038/s41598-020-63183-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/13/2020] [Indexed: 12/24/2022] Open
Abstract
Alzheimer’s disease and small vessel ischemic disease frequently co-exist in the aging brain. However, pathogenic links between these 2 disorders are yet to be identified. Therefore we used Taqman genotyping, exome and RNA sequencing to investigate Alzheimer’s disease known pathogenic variants and pathways: APOE ε4 allele, APP-Aβ metabolism and late-onset Alzheimer’s disease main genome-wide association loci (APOE, BIN1, CD33, MS4A6A, CD2AP, PICALM, CLU, CR1, EPHA1, ABCA7) in 96 early-onset small vessel ischemic disease Caucasian patients and 368 elderly neuropathologically proven controls (HEX database) and in a mouse model of cerebral hypoperfusion. Only a minority of patients (29%) carried APOE ε4 allele. We did not detect any pathogenic mutation in APP, PSEN1 and PSEN2 and report a burden of truncating mutations in APP-Aß degradation genes. The single-variant association test identified 3 common variants with a likely protective effect on small vessel ischemic disease (0.54>OR > 0.32, adj. p-value <0.05) (EPHA1 p.M900V and p.V160A and CD33 p.A14V). Moreover, 5/17 APP-Aß catabolism genes were significantly upregulated (LogFC > 1, adj. p-val<0.05) together with Apoe, Ms4a cluster and Cd33 during brain hypoperfusion and their overexpression correlated with the ischemic lesion size. Finally, the detection of Aβ oligomers in the hypoperfused hippocampus supported the link between brain ischemia and Alzheimer’s disease pathology.
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17
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Ebrahimighahnavieh MA, Luo S, Chiong R. Deep learning to detect Alzheimer's disease from neuroimaging: A systematic literature review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 187:105242. [PMID: 31837630 DOI: 10.1016/j.cmpb.2019.105242] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 06/10/2023]
Abstract
Alzheimer's Disease (AD) is one of the leading causes of death in developed countries. From a research point of view, impressive results have been reported using computer-aided algorithms, but clinically no practical diagnostic method is available. In recent years, deep models have become popular, especially in dealing with images. Since 2013, deep learning has begun to gain considerable attention in AD detection research, with the number of published papers in this area increasing drastically since 2017. Deep models have been reported to be more accurate for AD detection compared to general machine learning techniques. Nevertheless, AD detection is still challenging, and for classification, it requires a highly discriminative feature representation to separate similar brain patterns. This paper reviews the current state of AD detection using deep learning. Through a systematic literature review of over 100 articles, we set out the most recent findings and trends. Specifically, we review useful biomarkers and features (personal information, genetic data, and brain scans), the necessary pre-processing steps, and different ways of dealing with neuroimaging data originating from single-modality and multi-modality studies. Deep models and their performance are described in detail. Although deep learning has achieved notable performance in detecting AD, there are several limitations, especially regarding the availability of datasets and training procedures.
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Affiliation(s)
| | - Suhuai Luo
- The University of Newcastle, University Drive, Callaghan 2308, Australia
| | - Raymond Chiong
- The University of Newcastle, University Drive, Callaghan 2308, Australia.
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Wu J, Hasselgren C, Zettergren A, Zetterberg H, Blennow K, Skoog I, Halleröd B. The impact of social networks and APOE ε4 on dementia among older adults: tests of possible interactions. Aging Ment Health 2020; 24:395-404. [PMID: 30587010 DOI: 10.1080/13607863.2018.1531368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Emerging evidence suggests that social networks may protect against the development of dementia among older adults. In this study we analysed the association between social networks, the apolipoprotein E (APOE) ε4 allele, and dementia. We also investigated whether there were gender-specific patterns in this respect.Method: The analyses used population-based longitudinal data from Gothenburg, Sweden: the H70 Birth Cohort Study and the Prospective Population Study on Women (PPSW). A total of 580 individuals born in 1930 underwent semi-structured neuropsychiatric examinations in 2000-2001. Follow-up examinations were carried out in 2005-2006 and 2009-2010. The timing of dementia onset was analysed using Cox proportional hazards regression.Results: The presence of the APOE ε4 allele affected the risk of developing dementia in both genders. Among women, distant social networks had a protective effect on dementia, while among men the significant associations between close social networks and dementia did not remain after controlling for covariates. Significant interactions between social networks and the APOE ε4 allele were not found.Conclusion: Strong social networks do not seem to moderate the increased risk of dementia implied by the APOE ε4 allele. Nevertheless, our results underline the importance of strong social networks in postponing dementia onset and indicate that their impact may differ among men and women.
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Affiliation(s)
- Jing Wu
- Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Mölndal, Sweden
| | - Caroline Hasselgren
- Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Mölndal, Sweden
| | - Anna Zettergren
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK.,UK Dementia Research Institute, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Ingmar Skoog
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Mölndal, Sweden
| | - Björn Halleröd
- Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Mölndal, Sweden
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19
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When Does Alzheimer's Disease Really Start? The Role of Biomarkers. Int J Mol Sci 2019; 20:ijms20225536. [PMID: 31698826 PMCID: PMC6888399 DOI: 10.3390/ijms20225536] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022] Open
Abstract
While Alzheimer’s disease (AD) classical diagnostic criteria rely on clinical data from a stablished symptomatic disease, newer criteria aim to identify the disease in its earlier stages. For that, they incorporated the use of AD’s specific biomarkers to reach a diagnosis, including the identification of Aβ and tau depositions, glucose hypometabolism, and cerebral atrophy. These biomarkers created a new concept of the disease, in which AD’s main pathological processes have already taken place decades before we can clinically diagnose the first symptoms. Therefore, AD is now considered a dynamic disease with a gradual progression, and dementia is its final stage. With that in mind, new models were proposed, considering the orderly increment of biomarkers and the disease as a continuum, or the variable time needed for the disease’s progression. In 2011, the National Institute on Aging and the Alzheimer’s Association (NIA-AA) created separate diagnostic recommendations for each stage of the disease continuum—preclinical, mild cognitive impairment, and dementia. However, new scientific advances have led them to create a unifying research framework in 2018 that, although not intended for clinical use as of yet, is a step toward shifting the focus from the clinical symptoms to the biological alterations and toward changing the future diagnostic and treatment possibilities. This review aims to discuss the role of biomarkers in the onset of AD.
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Bretag-Norris R, Gallur L, Flynn P. Heterogeneity in the psychiatric presentation of behavioural variant frontotemporal dementia (bvFTD). Australas Psychiatry 2019; 27:491-495. [PMID: 31310153 DOI: 10.1177/1039856219860031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This article describes how the onset of bvFTD can be heralded by psychiatric symptoms. METHOD Case reports are described with reference to the relevant literature review. RESULTS Three patients were admitted with psychiatric symptoms, including depression, mania, psychosis and catatonia. Two had been previously diagnosed with a psychiatric disorder. All three were diagnosed with probable bvFTD. CONCLUSION bvFTD is an important differential diagnosis to consider when patients present with atypical psychiatric symptoms.
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Affiliation(s)
- Reece Bretag-Norris
- Central Adelaide Local Health Network, Adelaide, SA, and; School of Medicine, Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Lara Gallur
- Northern Adelaide Local Health Network, Adelaide, SA, and; School of Medicine, Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Patrick Flynn
- Central Adelaide Local Health Network, Adelaide, SA, Australia
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21
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Wolk DA, Sadowsky C, Safirstein B, Rinne JO, Duara R, Perry R, Agronin M, Gamez J, Shi J, Ivanoiu A, Minthon L, Walker Z, Hasselbalch S, Holmes C, Sabbagh M, Albert M, Fleisher A, Loughlin P, Triau E, Frey K, Høgh P, Bozoki A, Bullock R, Salmon E, Farrar G, Buckley CJ, Zanette M, Sherwin PF, Cherubini A, Inglis F. Use of Flutemetamol F 18-Labeled Positron Emission Tomography and Other Biomarkers to Assess Risk of Clinical Progression in Patients With Amnestic Mild Cognitive Impairment. JAMA Neurol 2019; 75:1114-1123. [PMID: 29799984 DOI: 10.1001/jamaneurol.2018.0894] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Patients with amnestic mild cognitive impairment (aMCI) may progress to clinical Alzheimer disease (AD), remain stable, or revert to normal. Earlier progression to AD among patients who were β-amyloid positive vs those who were β-amyloid negative has been previously observed. Current research now accepts that a combination of biomarkers could provide greater refinement in the assessment of risk for clinical progression. Objective To evaluate the ability of flutemetamol F 18 and other biomarkers to assess the risk of progression from aMCI to probable AD. Design, Setting, and Participants In this multicenter cohort study, from November 11, 2009, to January 16, 2014, patients with aMCI underwent positron emission tomography (PET) at baseline followed by local clinical assessments every 6 months for up to 3 years. Patients with aMCI (365 screened; 232 were eligible) were recruited from 28 clinical centers in Europe and the United States. Physicians remained strictly blinded to the results of PET, and the standard of truth was an independent clinical adjudication committee that confirmed or refuted local assessments. Flutemetamol F 18-labeled PET scans were read centrally as either negative or positive by 5 blinded readers with no knowledge of clinical status. Statistical analysis was conducted from February 19, 2014, to January 26, 2018. Interventions Flutemetamol F 18-labeled PET at baseline followed by up to 6 clinical visits every 6 months, as well as magnetic resonance imaging and multiple cognitive measures. Main Outcomes and Measures Time from PET to probable AD or last follow-up was plotted as a Kaplan-Meier survival curve; PET scan results, age, hippocampal volume, and aMCI stage were entered into Cox proportional hazards logistic regression analyses to identify variables associated with progression to probable AD. Results Of 232 patients with aMCI (118 women and 114 men; mean [SD] age, 71.1 [8.6] years), 98 (42.2%) had positive results detected on PET scan. By 36 months, the rates of progression to probable AD were 36.2% overall (81 of 224 patients), 53.6% (52 of 97) for patients with positive results detected on PET scan, and 22.8% (29 of 127) for patients with negative results detected on PET scan. Hazard ratios for association with progression were 2.51 (95% CI, 1.57-3.99; P < .001) for a positive β-amyloid scan alone (primary outcome measure), 5.60 (95% CI, 3.14-9.98; P < .001) with additional low hippocampal volume, and 8.45 (95% CI, 4.40-16.24; P < .001) when poorer cognitive status was added to the model. Conclusions and Relevance A combination of positive results of flutemetamol F 18-labeled PET, low hippocampal volume, and cognitive status corresponded with a high probability of risk of progression from aMCI to probable AD within 36 months.
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Affiliation(s)
- David A Wolk
- Department of Neurology, Penn Memory Center, University of Pennsylvania, Philadelphia
| | - Carl Sadowsky
- Division of Neurology, Nova Southeastern University, Fort Lauderdale, Florida
| | - Beth Safirstein
- Division of Neurology, MD Clinical, Hallandale Beach, Florida
| | - Juha O Rinne
- Turku PET Centre, University of Turku, Turku, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Ranjan Duara
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Florida
| | - Richard Perry
- Imperial College Healthcare National Health Service Trust Charing Cross Hospital, London, United Kingdom
| | - Marc Agronin
- Mental Health and Clinical Research, Miami Jewish Health Systems, Miami, Florida
| | | | - Jiong Shi
- Barrows Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Adrian Ivanoiu
- Department of Neurology, Cliniques Universitaires St Luc, Brussels, Belgium
| | - Lennart Minthon
- Memory Clinic, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, United Kingdom.,Specialist Dementia and Frailty Service, Essex Partnership University Foundation Trust, Essex, United Kingdom
| | - Steen Hasselbalch
- Danish Dementia Research Centre, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Clive Holmes
- Memory Assessment and Research Centre, Moorgreen Hospital, Southampton, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | | | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adam Fleisher
- Banner Alzheimer's Institute, Phoenix, Arizona.,Now with Eli Lilly and Company, Indianapolis, Indiana
| | - Paul Loughlin
- The Princess Margaret Hospital, Windsor, United Kingdom
| | - Eric Triau
- Neurologie Tervuursevest, Leuven, Belgium
| | - Kirk Frey
- Department of Nuclear Medicine and Molecular Imaging, University of Michigan Health System, Ann Arbor
| | - Peter Høgh
- Department of Neurology, Regional Dementia Research Centre, Copenhagen University Hospital, Roskilde, Denmark
| | - Andrea Bozoki
- Department of Neurology, Michigan State University, East Lansing
| | | | - Eric Salmon
- Cyclotron Research Centre, University of Liège, Liège, Belgium
| | - Gillian Farrar
- GE Healthcare Life Sciences, Amersham, Buckinghamshire, United Kingdom
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Exploring diseases and syndromes in neurology case reports from 1955 to 2017 with text mining. Comput Biol Med 2019; 109:322-332. [PMID: 31128466 DOI: 10.1016/j.compbiomed.2019.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND A large number of neurology case reports have been published, but it is a challenging task for human medical experts to explore all of these publications. Text mining offers a computational approach to investigate neurology literature and capture meaningful patterns. The overarching goal of this study is to provide a new perspective on case reports of neurological disease and syndrome analysis over the last six decades using text mining. METHODS We extracted diseases and syndromes (DsSs) from more than 65,000 neurology case reports from 66 journals in PubMed over the last six decades from 1955 to 2017. Text mining was applied to reports on the detected DsSs to investigate high-frequency DsSs, categorize them, and explore the linear trends over the 63-year time frame. RESULTS The text mining methods explored high-frequency neurologic DsSs and the relationships between them from 1955 to 2017. We detected more than 18,000 unique DsSs and found 10 categories of neurologic DsSs. While the trend analysis showed the increasing trends in the case reports for top-10 high-frequency DsSs, the categories had mixed trends. CONCLUSION Our study provided new insights into the application of text mining methods to investigate DsSs in a large number of medical case reports that occur over several decades. The proposed approach can be used to provide a macro level analysis of medical literature by discovering interesting patterns and tracking them over several years to help physicians explore these case reports more efficiently.
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23
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Knopman DS, Petersen RC, Jack CR. A brief history of "Alzheimer disease": Multiple meanings separated by a common name. Neurology 2019; 92:1053-1059. [PMID: 31028129 DOI: 10.1212/wnl.0000000000007583] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/25/2019] [Indexed: 12/16/2022] Open
Abstract
The field of Alzheimer disease (AD) has a nosologic problem: The diagnostic label "Alzheimer disease" has several distinctive meanings. The term probable AD was introduced in 1984 to designate a clinically diagnosed acquired and progressive amnestic dementia for which there was no evidence for another etiology. Probable AD represented a clinicopathologic entity that assumed a specific and sensitive linkage between amnestic dementia and the neuropathology of β-amyloid-containing neuritic plaques and tau-containing neurofibrillary tangles. The clinicopathologic model represented by probable AD was adapted in abbreviated form for population-based studies and general clinical practice, although the uncertainty connoted by "probable" was often overlooked. Representing the growing public awareness of later life cognitive impairment, a vernacular meaning of AD arose out of the clinicopathologic model in which AD represented all dementia not due to another clinically apparent cause. In contrast, by the 1990s, neuropathologists settled on a definition of AD based entirely on a sufficient burden of neuritic plaques and neurofibrillary tangles at postmortem examination, regardless of antemortem clinical status. In the last decade, the availability of fluid and imaging biomarkers that measure β-amyloid and tau abnormalities has enabled antemortem pathobiological diagnoses, highlighting the divide between the clinicopathologic model, the vernacular usage, and the pathobiological models. Each definition has value. However, the meanings of AD as defined by each of these models are not interchangeable. The pathobiological one is the only one that is unambiguous.
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Affiliation(s)
- David S Knopman
- From the Departments of Neurology (D.S.K., R.C.P.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN.
| | - Ronald C Petersen
- From the Departments of Neurology (D.S.K., R.C.P.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Departments of Neurology (D.S.K., R.C.P.) and Radiology (C.R.J.), Mayo Clinic, Rochester, MN
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24
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Cilento EM, Jin L, Stewart T, Shi M, Sheng L, Zhang J. Mass spectrometry: A platform for biomarker discovery and validation for Alzheimer's and Parkinson's diseases. J Neurochem 2019; 151:397-416. [PMID: 30474862 DOI: 10.1111/jnc.14635] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 12/16/2022]
Abstract
Accurate, reliable, and objective biomarkers for Alzheimer's disease (AD), Parkinson's disease (PD), and related age-associated neurodegenerative disorders are urgently needed to assist in both diagnosis, particularly at early stages, and monitoring of disease progression. Technological advancements in protein detection platforms over the last few decades have resulted in a plethora of reported molecular biomarker candidates for both AD and PD; however, very few of these candidates are developed beyond the discovery phase of the biomarker development pipeline, a reflection of the current bottleneck within the field. In this review, the expanded use of selected reaction monitoring (SRM) targeted mass spectrometry will be discussed in detail as a platform for systematic verification of large panels of protein biomarker candidates prior to costly validation testing. We also advocate for the coupling of discovery-based proteomics with modern targeted MS-based approaches (e.g., SRM) within a single study in future workflows to expedite biomarker development and validation for AD and PD. It is our hope that improving the efficiency within the biomarker development process by use of an SRM pipeline may ultimately hasten the development of biomarkers that both decrease misdiagnosis of AD and PD and ultimately lead to detection at early stages of disease and objective assessment of disease progression. This article is part of the special issue "Proteomics".
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Affiliation(s)
- Eugene M Cilento
- Department of Pathology, University of Washington, School of Medicine, Seattle, Washington, USA
| | - Lorrain Jin
- Department of Pathology, University of Washington, School of Medicine, Seattle, Washington, USA
| | - Tessandra Stewart
- Department of Pathology, University of Washington, School of Medicine, Seattle, Washington, USA
| | - Min Shi
- Department of Pathology, University of Washington, School of Medicine, Seattle, Washington, USA
| | - Lifu Sheng
- Department of Pathology, University of Washington, School of Medicine, Seattle, Washington, USA
| | - Jing Zhang
- Department of Pathology, University of Washington, School of Medicine, Seattle, Washington, USA.,Department of Pathology, School of Basic Medicine, Peking University Health Science Center, Peking University Third Hospital and Peking Key Laboratory for Early Diagnosis of Neurodegenerative Disorders, Beijing, China
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25
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Godoy MDCL, Fornazieri MA, Doty RL, Pinna FDR, Farfel JM, Santos GBD, Molina M, Ferretti-Rebustini REL, Leite REP, Suemoto CK, Grinberg LT, Pasqualucci CAG, Voegels RL, Nitrini R, Jacob Filho W. Is Olfactory Epithelium Biopsy Useful for Confirming Alzheimer's Disease? Ann Otol Rhinol Laryngol 2018; 128:184-192. [PMID: 30501500 DOI: 10.1177/0003489418814865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The clinical symptoms of Alzheimer's disease (AD) are preceded by a long asymptomatic period associated with "silent" deposition of aberrant paired helical filament (PHF)-tau and amyloid-beta proteins in brain tissue. Similar depositions have been reported within the olfactory epithelium (OE), a tissue that can be biopsied in vivo. The degree to which such biopsies are useful in identifying AD is controversial. This postmortem study had 3 main goals: first, to quantify the relative densities of AD-related proteins in 3 regions of the olfactory neuroepithelium, namely, the nasal septum, middle turbinate, and superior turbinate; second, to establish whether such densities are correlated among these epithelial regions as well as with semi-quantitative ratings of general brain cortex pathology; and third, to evaluate correlations between the protein densities and measures of antemortem cognitive function. METHODS Postmortem blocks of olfactory mucosa were obtained from 12 AD cadavers and 24 controls and subjected to amyloid-beta and PHF-tau immunohistochemistry. RESULTS We observed marked heterogeneity in the presence of the biomarkers of tau and amyloid-beta among the targeted olfactory epithelial regions. No significant difference was observed between the cadavers with AD and the controls regarding the concentration of these proteins in any of these epithelial regions. Only one correlation significant was evident, namely, that between the tau protein densities of the middle and the upper turbinate (r = .58, P = .002). CONCLUSION AD-related biomarker heterogeneity, which has not been previously demonstrated, makes comparisons across studies difficult and throws into question the usefulness of OE amyloid-beta and PHF-tau biopsies in detecting AD.
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Affiliation(s)
| | - Marco Aurélio Fornazieri
- Department of Surgery, Londrina State University, Londrina, Brazil, and Pontifical Catholic University of Paraná, Londrina, PR, Brazil
| | - Richard L Doty
- Smell and Taste Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
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26
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Kim Y, Suh YL, Kim SJ, Bae MH, Kim JB, Kim Y, Choi KC, Huh GY, Kim EJ, Lee JS, Kang HW, Shim SM, Lim HJ, Koh YH, Kim BC, Lee KH, Lee MC, Lee HW, Lim TS, Seeley WW, Kim HJ, Na DL, Lee KH, Seo SW. The Brain Donation Program in South Korea. Yonsei Med J 2018; 59:1197-1204. [PMID: 30450854 PMCID: PMC6240560 DOI: 10.3349/ymj.2018.59.10.1197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/05/2018] [Accepted: 10/11/2018] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Obtaining brain tissue is critical to definite diagnosis and to furthering understanding of neurodegenerative diseases. The present authors have maintained the National Neuropathology Reference and Diagnostic Laboratories for Dementia in South Korea since 2016. We have built a nationwide brain bank network and are collecting brain tissues from patients with neurodegenerative diseases. We are aiming to facilitate analyses of clinic-pathological and image-pathological correlations of neurodegenerative disease and to broaden understanding thereof. MATERIALS AND METHODS We recruited participants through two routes: from memory clinics and the community. As a baseline evaluation, clinical interviews, a neurological examination, laboratory tests, neuropsychological tests, and MRI were undertaken. Some patients also underwent amyloid PET. RESULTS We recruited 105 participants, 70 from clinics and 35 from the community. Among them, 11 died and were autopsied. The clinical diagnoses of the autopsied patients included four with Alzheimer's disease (AD), two with subcortical vascular dementia, two with non-fluent variant primary progressive aphasia, one with leukoencephalopathy, one with frontotemporal dementia (FTD), and one with Creutzfeldt-Jakob disease (CJD). Five patients underwent amyloid PET: two with AD, one with mixed dementia, one with FTD, and one with CJD. CONCLUSION The clinical and neuropathological information to be obtained from this cohort in the future will provide a deeper understanding of the neuropathological mechanisms of cognitive impairment in Asia, especially Korea.
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Affiliation(s)
- Yeshin Kim
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Yeon Lim Suh
- Department of Pathology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
| | - Seung Joo Kim
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Moon Hwan Bae
- Department of Pathology, Samsung Medical Center, Seoul, Korea
| | - Jae Bum Kim
- Administarative Office, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Yuna Kim
- Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Kyung Chan Choi
- Department of Pathology, College of Medicine, Hallym University, Chuncheon, Korea
| | - Gi Yeong Huh
- Department of Forensic Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Eun Joo Kim
- Department of Neurology, Pusan National University Hospital, Busan, Korea
| | - Jung Seok Lee
- Department of Neurology, Jeju National University College of Medicine, Jeju, Korea
| | - Hyun Wook Kang
- Department of Forensic Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Sung Mi Shim
- Division of Brain Diseases, Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Korea
| | - Hyun Joung Lim
- Division of Brain Diseases, Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Korea
| | - Young Ho Koh
- Division of Brain Diseases, Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Korea
| | - Byeong Chae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Hwa Lee
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Min Cheol Lee
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Won Lee
- Department of Neurology, School of Medicine, Brain Science and Engineering Institute, Kyungpook National University, Daegu, Korea
| | - Tae Sung Lim
- Department of Neurology, School of Medicine, Ajou University, Suwon, Korea
| | - William W Seeley
- Memory and Aging Center, Departments of Neurology and Pathology, University of California, San Francisco, CA, USA
| | - Hee Jin Kim
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Duk L Na
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyung Hoon Lee
- Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Sang Won Seo
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
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Soria JA, Huisa BN, Edland SD, Litvan I, Peavy GM, Salmon DP, Hansen LA, Galasko DR, Brewer JB, González HM, Rissman RA. Clinical-Neuropathological Correlations of Alzheimer's Disease and Related Dementias in Latino Volunteers. J Alzheimers Dis 2018; 66:1539-1548. [PMID: 30412501 DOI: 10.3233/jad-180789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Clinical, neuropsychological, and neurological procedures used to diagnose Alzheimer's disease (AD) and related dementias were largely developed and validated in well-educated, non-Latino, English-speaking populations. Sociocultural and genetic differences in Latinos might influence the accuracy of clinical diagnosis of AD and other dementias. We aim to compare the accuracy of the clinical diagnosis of AD and related dementias in Latinos with the corresponding neuropathological diagnosis. From the UCSD Alzheimer's Disease Research Center longitudinal cohort, we selected all Latino participants who had autopsy neuropathological studies from 1991 to 2017. Participants underwent annual neurological clinical evaluations, standard neuropsychological tests, neuroimaging, and genotyping of Apolipoprotein E. We calculated the sensitivity and specificity of the clinical diagnosis of AD against the primary pathological diagnosis. Of the 34 participants with a primary neuropathological diagnosis of AD, 33 (97.1%) were correctly clinically diagnosed as having AD at the last clinical evaluation, and 1 was incorrectly diagnosed with dementia with Lewy bodies. Of the 19 participants without a primary neuropathological diagnosis of AD, 8 were incorrectly clinically diagnosed with probable AD at the last clinic evaluation. The clinical diagnosis of AD at the last clinical evaluation had 97.1% sensitivity and 57.9% specificity for autopsy-verified AD. In this Latino cohort, clinicians predicted AD pathological findings with high sensitivity but moderate specificity. Tangle-only dementia was the most common misdiagnosis. Our study suggests that current procedures and instruments to clinically determine AD in Latinos have high sensitivity compared with neuropathology, but specificity needs to be improved.
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Affiliation(s)
- Jose A Soria
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Branko N Huisa
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Steven D Edland
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Guerry M Peavy
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - David P Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Lawrence A Hansen
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Department of Pathology, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Douglas R Galasko
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - James B Brewer
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Department of Radiology, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Hector M González
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Robert A Rissman
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA.,VA San Diego Health Care System, La Jolla, CA, USA
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28
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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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29
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Voxel-wise deviations from healthy aging for the detection of region-specific atrophy. NEUROIMAGE-CLINICAL 2018; 20:851-860. [PMID: 30278372 PMCID: PMC6169102 DOI: 10.1016/j.nicl.2018.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 08/14/2018] [Accepted: 09/16/2018] [Indexed: 12/19/2022]
Abstract
The identification of pathological atrophy in MRI scans requires specialized training, which is scarce outside dedicated centers. We sought to investigate the clinical usefulness of computer-generated representations of local grey matter (GM) loss or increased volume of cerebral fluids (CSF) as normalized deviations (z-scores) from healthy aging to either aid human visual readings or directly detect pathological atrophy. Two experienced neuroradiologists rated atrophy in 30 patients with Alzheimer's disease (AD), 30 patients with frontotemporal dementia (FTD), 30 with dementia due to Lewy-body disease (LBD) and 30 healthy controls (HC) on a three-point scale in 10 anatomical regions as reference gold standard. Seven raters, varying in their experience with MRI diagnostics rated all cases on the same scale once with and once without computer-generated volume deviation maps that were overlaid on anatomical slices. In addition, we investigated the predictive value of the computer generated deviation maps on their own for the detection of atrophy as identified by the gold standard raters. Inter and intra-rater agreements of the two gold standard raters were substantial (Cohen's kappa κ > 0.62). The intra-rater agreement of the other raters ranged from fair (κ = 0.37) to substantial (κ = 0.72) and improved on average by 0.13 (0.57 < κ < 0.87) when volume deviation maps were displayed. The seven other raters showed good agreement with the gold standard in regions including the hippocampus but agreement was substantially lower in e.g. the parietal cortex and did not improve with the display of atrophy scores. Rating speed increased over the course of the study and irrespective of the presentation of voxel-wise deviations. Automatically detected large deviations of local volume were consistently associated with gold standard atrophy reading as shown by an area under the receiver operator characteristic of up to 0.95 for the hippocampus region. When applying these test characteristics to prevalences typically found in a memory clinic, we observed a positive or negative predictive value close to or above 0.9 in the hippocampus for almost all of the expected cases. The volume deviation maps derived from CSF volume increase were generally better in detecting atrophy. Our study demonstrates an agreement of visual ratings among non-experts not further increased by displaying, region-specific deviations of volume. The high predictive value of computer generated local deviations independent from human interaction and the consistent advantages of CSF-over GM-based estimations should be considered in the development of diagnostic tools and indicate clinical utility well beyond aiding visual assessments. The visual identification of atrophy is most accurate in the temporal lobe. Voxel-wise deviations of tissue volume from normal aging is easy to implement. Displaying voxel-wise deviations subjectively but not objectively aids readers. Voxel-wise deviations themselves show high agreement with expert readings. Information on tissue deviations should be provided with cerebral MRI scans.
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30
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Trujillo Diaz D, Hernandez NC, Cortes EP, Faust PL, Vonsattel JPG, Louis ED. Banking brains: a pre-mortem "how to" guide to successful donation. Cell Tissue Bank 2018; 19:473-488. [PMID: 30220002 DOI: 10.1007/s10561-018-9720-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/13/2018] [Indexed: 11/29/2022]
Abstract
A review of the brain banking literature reveals a primary focus either on the factors that influence the decision to become a future donor or on the brain tissue processing that takes place after the individual has died (i.e., the front-end or back-end processes). What has not been sufficiently detailed, however, is the complex and involved process that takes place after this decision to become a future donor is made yet before post-mortem processing occurs (i.e., the large middle-ground). This generally represents a period of many years during which the brain bank is actively engaged with donors to ensure that valuable clinical information is prospectively collected and that their donation is eventually completed. For the past 15 years, the Essential Tremor Centralized Brain Repository has been actively involved in brain banking, and our experience has provided us valuable insights that may be useful for researchers interested in establishing their own brain banking efforts. In this piece, we fill a gap in the literature by detailing the processes of enrolling participants, creating individualized brain donation plans, collecting clinical information and regularly following-up with donors to update that information, and efficiently coordinating the brain harvest when death finally arrives.
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Affiliation(s)
- Daniel Trujillo Diaz
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Nora C Hernandez
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Etty P Cortes
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Jean Paul G Vonsattel
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA. .,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA. .,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.
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31
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Hanfelt JJ, Peng L, Goldstein FC, Lah JJ. Latent classes of mild cognitive impairment are associated with clinical outcomes and neuropathology: Analysis of data from the National Alzheimer's Coordinating Center. Neurobiol Dis 2018; 117:62-71. [PMID: 29859866 DOI: 10.1016/j.nbd.2018.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 04/20/2018] [Accepted: 05/30/2018] [Indexed: 01/26/2023] Open
Abstract
Given the importance of identifying prodromes of dementia with specific etiologies, we assessed whether seven latent classes of mild cognitive impairment (MCI), defined empirically based on cognitive, functional, and neuropsychiatric information at initial visit, are associated with distinct clinical outcomes and neuropathological features. We separated 6034 participants with a baseline diagnosis of MCI into seven latent classes using previously defined criteria. We found that these latent classes of MCI differed significantly in their clinical outcomes, survival time, and neuropathology. Two amnestic multi-domain subgroups, as well as two other subgroups with functional impairments and neuropsychiatric disturbances, were at higher risk of not only a 'pure' form of Alzheimer's disease (AD) pathology, but also a 'mixed' pathology consisting of both AD and vascular features. Moreover, the seven latent classes had different risks of Lewy bodies, hippocampal sclerosis, and frontotemporal lobar degeneration (FTLD). This study indicates that data-driven subgroups of MCI are clinicopathologically informative and, with refinement, could lead to targeted interventions focused on each etiology.
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Affiliation(s)
- John J Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, United States; Emory Alzheimer's Disease Research Center, United States.
| | - Limin Peng
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, United States
| | - Felicia C Goldstein
- Department of Neurology, Emory University School of Medicine, United States; Emory Alzheimer's Disease Research Center, United States
| | - James J Lah
- Department of Neurology, Emory University School of Medicine, United States; Emory Alzheimer's Disease Research Center, United States.
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32
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Tolonen A, Rhodius-Meester HFM, Bruun M, Koikkalainen J, Barkhof F, Lemstra AW, Koene T, Scheltens P, Teunissen CE, Tong T, Guerrero R, Schuh A, Ledig C, Baroni M, Rueckert D, Soininen H, Remes AM, Waldemar G, Hasselbalch SG, Mecocci P, van der Flier WM, Lötjönen J. Data-Driven Differential Diagnosis of Dementia Using Multiclass Disease State Index Classifier. Front Aging Neurosci 2018; 10:111. [PMID: 29922145 PMCID: PMC5996907 DOI: 10.3389/fnagi.2018.00111] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 04/03/2018] [Indexed: 01/18/2023] Open
Abstract
Clinical decision support systems (CDSSs) hold potential for the differential diagnosis of neurodegenerative diseases. We developed a novel CDSS, the PredictND tool, designed for differential diagnosis of different types of dementia. It combines information obtained from multiple diagnostic tests such as neuropsychological tests, MRI and cerebrospinal fluid samples. Here we evaluated how the classifier used in it performs in differentiating between controls with subjective cognitive decline, dementia due to Alzheimer's disease, vascular dementia, frontotemporal lobar degeneration and dementia with Lewy bodies. We used the multiclass Disease State Index classifier, which is the classifier used by the PredictND tool, to differentiate between controls and patients with the four different types of dementia. The multiclass Disease State Index classifier is an extension of a previously developed two-class Disease State Index classifier. As the two-class Disease State Index classifier, the multiclass Disease State Index classifier also offers a visualization of its decision making process, which makes it especially suitable for medical decision support where interpretability of the results is highly important. A subset of the Amsterdam Dementia cohort, consisting of 504 patients (age 65 ± 8 years, 44% females) with data from neuropsychological tests, cerebrospinal fluid samples and both automatic and visual MRI quantifications, was used for the evaluation. The Disease State Index classifier was highly accurate in separating the five classes from each other (balanced accuracy 82.3%). Accuracy was highest for vascular dementia and lowest for dementia with Lewy bodies. For the 50% of patients for which the classifier was most confident on the classification the balanced accuracy was 93.6%. Data-driven CDSSs can be of aid in differential diagnosis in clinical practice. The decision support system tested in this study was highly accurate in separating the different dementias and controls from each other. In addition to the predicted class, it also provides a confidence measure for the classification.
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Affiliation(s)
- Antti Tolonen
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Hanneke F M Rhodius-Meester
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Marie Bruun
- Danish Dementia Research Centre, Rigshospitalet, Copenhagen, Denmark
| | | | - Frederik Barkhof
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, United Kingdom
| | - Afina W Lemstra
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Teddy Koene
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Philip Scheltens
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Charlotte E Teunissen
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Tong Tong
- Imperial College London, London, United Kingdom
| | | | | | | | - Marta Baroni
- Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | | | - Hilkka Soininen
- Institute of Clinical Medicine and Department of Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology, Neurocenter, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Institute of Clinical Medicine and Department of Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology, Neurocenter, Kuopio University Hospital, Kuopio, Finland
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, Copenhagen, Denmark
| | | | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Wiesje M van der Flier
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
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Paraskevaidi M, Martin-Hirsch PL, Martin FL. Progress and Challenges in the Diagnosis of Dementia: A Critical Review. ACS Chem Neurosci 2018; 9:446-461. [PMID: 29390184 DOI: 10.1021/acschemneuro.8b00007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Longer life expectancies have led to an increased number of neurodegenerative disease cases globally. Accurate diagnosis of this devastating disorder is of crucial importance but is still feasible only by a brain biopsy after death. An enormous amount of attention and research has been in place over the years toward the better understanding of the mechanisms, as well as the early diagnosis, of neurodegeneration. However, numerous studies have been contradictory from time to time, while new diagnostic methods are constantly developed in a tireless effort to tackle the disease. Nonetheless, there is not yet a conclusive report covering a broader range of techniques for the diagnosis of different types of dementia. In this paper, we critically review current knowledge on the different hypotheses about the pathogenesis of distinct types of dementia, as well as risk factors and current diagnostic approaches in a clinical setting, including neuroimaging, cerebrospinal (CSF), and blood tests. Encouraging research results for the diagnosis and investigation of neurodegenerative disorders are also reported. Particular attention is given to the field of spectroscopy as an emerging tool to detect dementias, follow-up patients, and potentially monitor the patients' response to a therapeutic approach. Spectroscopic techniques, such as infrared and Raman spectroscopy, have facilitated numerous disease-related studies, including neurodegenerative disorders, and are currently undergoing trials for clinical implementation. This review constitutes a comprehensive report with an in-depth focus on promising imaging, molecular biomarker and spectroscopic tests in the field of dementive diseases.
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Affiliation(s)
- Maria Paraskevaidi
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, United Kingdon
| | - Pierre L. Martin-Hirsch
- Department of Obstetrics and Gynaecology, Central Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, United Kingdom
| | - Francis L. Martin
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, United Kingdon
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Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, Ballard C, Banerjee S, Burns A, Cohen-Mansfield J, Cooper C, Fox N, Gitlin LN, Howard R, Kales HC, Larson EB, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care. Lancet 2017; 390:2673-2734. [PMID: 28735855 DOI: 10.1016/s0140-6736(17)31363-6] [Citation(s) in RCA: 3419] [Impact Index Per Article: 488.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | | | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Sergi G Costafreda
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK; Department of Old Age Psychiatry, King's College London, London, UK
| | - David Ames
- National Ageing Research Institute, Parkville, VIC, Australia; Academic Unit for Psychiatry of Old Age, University of Melbourne, Kew, VIC, Australia
| | | | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Alistair Burns
- Centre for Dementia Studies, University of Manchester, Manchester, UK
| | - Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Heczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Nick Fox
- Dementia Research Centre, University College London, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Karen Ritchie
- Inserm, Unit 1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kenneth Rockwood
- Centre for the Health Care of Elderly People, Geriatric Medicine Dalhousie University, Halifax, NS, Canada
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, MD, USA
| | - Lon S Schneider
- Department of Neurology and Department of Psychiatry and the Behavioural Sciences, Keck School of Medicine, Leonard Davis School of Gerontology of the University of Southern California, Los Angeles, CA, USA
| | - Geir Selbæk
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Linda Teri
- Department Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK
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35
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Custodio N, Montesinos R, Lira D, Herrera-Pérez E, Bardales Y, Valeriano-Lorenzo L. Mixed dementia: A review of the evidence. Dement Neuropsychol 2017; 11:364-370. [PMID: 29354216 PMCID: PMC5769994 DOI: 10.1590/1980-57642016dn11-040005] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Mixed dementia is the coexistence of Alzheimer's disease and cerebrovascular disease (CVD) in the same demented patient. Currently, its diagnosis and treatment remains a challenge for practitioners. To provide an overview of the epidemiology, pathogenesis, natural history, diagnosis, and therapy of Mixed Vascular-Alzheimer Dementia (MVAD). The literature was reviewed for articles published between 1990-2016 by using the keywords linked to MVAD. Neuropathological studies indicate that MVAD is a very common pathological finding in the elderly with a prevalence about of 22%. The distinction between Alzheimer's dementia and vascular dementia (VD) is complex because their clinical presentation can overlap. There are international criteria for the MVAD diagnosis. The pharmacologic therapy shows modest clinical benefits that are similar among all drugs used in patients with Alzheimer's dementia and VD. The non-pharmacologic therapy includes the rigorous management of cardiovascular risk factors (especially hypertension) and the promotion of a healthy diet. The diagnosis and treatment of MVAD cannot be improved without further studies. Currently available medications provide only modest clinical benefits once a patient has developed MVAD. In subjects at risk, the antihypertensive therapy and healthy diet should be recommend for preventing or slowing the progression of MVAD.
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Affiliation(s)
- Nilton Custodio
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Neurología. Instituto Peruano de Neurociencias. Lima, Perú
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Medicina de Rehabilitación. Instituto Peruano de Neurociencias. Lima, Perú
| | - David Lira
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Neurología. Instituto Peruano de Neurociencias. Lima, Perú
| | - Eder Herrera-Pérez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Unidad de Diseño y Elaboración de Proyectos de Investigación. Instituto Nacional de Salud del Niño. Lima, Perú.,GESID. Lima, Peru
| | - Yadira Bardales
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Unidad de Geriatría. Instituto Peruano de neurociencias. Lima, Perú
| | - Lucía Valeriano-Lorenzo
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Unidad de Neuropsicología. Instituto Peruano de Neurociencias. Lima. Perú
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36
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Fields JA, Garovic VD, Mielke MM, Kantarci K, Jayachandran M, White WM, Butts AM, Graff-Radford J, Lahr BD, Bailey KR, Miller VM. Preeclampsia and cognitive impairment later in life. Am J Obstet Gynecol 2017; 217:74.e1-74.e11. [PMID: 28322777 DOI: 10.1016/j.ajog.2017.03.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/07/2016] [Accepted: 03/10/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hypertension is a risk factor for cerebrovascular disease and cognitive impairment. Women with hypertensive episodes during pregnancy report variable neurocognitive changes within the first decade following the affected pregnancy. However, long-term follow-up of these women into their postmenopausal years has not been conducted. OBJECTIVE The aim of this study was to examine whether women with a history of preeclampsia were at increased risk of cognitive decline 35-40 years after the affected pregnancy. STUDY DESIGN Women were identified and recruited through the medical linkage, population-based Rochester Epidemiologic Project. Forty women with a history of preeclampsia were age- and parity-matched to 40 women with a history of normotensive pregnancy. All women underwent comprehensive neuropsychological assessment and completed self-report inventories measuring mood, ie, depression, anxiety, and other symptoms related to emotional state. Scores were compared between groups. In addition, individual cognitive scores were examined by neuropsychologists and a neurologist blinded to pregnancy status, and a clinical consensus diagnosis of normal, mild cognitive impairment, or dementia for each participant was conferred. RESULTS Age at time of consent did not differ between preeclampsia (59.2 [range 50.9-71.5] years) and normotensive (59.6 [range 52.1-72.2] years) groups, nor did time from index pregnancy (34.9 [range 32.0-47.2] vs 34.5 [range 32.0-46.4] years, respectively). There were no statistically significant differences in raw scores on tests of cognition and mood between women with histories of preeclampsia compared to women with histories of normotensive pregnancy. However, a consensus diagnosis of mild cognitive impairment or dementia trended toward greater frequency in women with histories of preeclampsia compared to those with normotensive pregnancies (20% vs 8%, P = .10) and affected more domains among the preeclampsia group (P = .03), most strongly related to executive dysfunction (d = 1.96) and verbal list learning impairment (d = 1.93). CONCLUSION These findings suggest a trend for women with a history of preeclampsia to exhibit more cognitive impairment later in life than those with a history of normotensive pregnancy. Furthermore, the pattern of cognitive changes is consistent with that observed with vascular disease/white matter pathology.
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Affiliation(s)
- Julie A Fields
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | | | | | - Wendy M White
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Alissa M Butts
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | - Brian D Lahr
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN
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Barbay M, Taillia H, Nedelec-Ciceri C, Arnoux A, Puy L, Wiener E, Canaple S, Lamy C, Godefroy O, Roussel M. Vascular cognitive impairment: Advances and trends. Rev Neurol (Paris) 2017; 173:473-480. [DOI: 10.1016/j.neurol.2017.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/15/2017] [Indexed: 10/18/2022]
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Identification and classification of traditional Chinese medicine syndrome types among senior patients with vascular mild cognitive impairment using latent tree analysis. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2017; 15:186-200. [DOI: 10.1016/s2095-4964(17)60335-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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39
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Brenowitz WD, Keene CD, Hawes SE, Hubbard RA, Longstreth WT, Woltjer RL, Crane PK, Larson EB, Kukull WA. Alzheimer's disease neuropathologic change, Lewy body disease, and vascular brain injury in clinic- and community-based samples. Neurobiol Aging 2017; 53:83-92. [PMID: 28236716 PMCID: PMC5385292 DOI: 10.1016/j.neurobiolaging.2017.01.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/02/2017] [Accepted: 01/22/2017] [Indexed: 02/02/2023]
Abstract
We examined the relationships between Alzheimer's disease neuropathologic change (ADNC), Lewy body disease (LBD), and vascular brain injury (VBI) in 2 large autopsy samples. Because findings may differ between study populations, data came from U.S. Alzheimer's Disease Centers contributing to the National Alzheimer's Coordinating Center (n = 2742) and from the population-based Adult Changes in Thought study (n = 499). Regardless of study population, over 50% of participants with ADNC had co-occurring LBD or VBI; the majority of whom had a clinical AD dementia diagnosis prior to death. Overlap of pathologies was similar between studies, especially after standardizing to the distribution of age and dementia status in the Adult Changes in Thought population. LBD, but not VBI, was positively associated with ADNC in both studies. Interestingly, cortical LBD was more common in those with intermediate ADNC compared to low or high ADNC, especially in the National Alzheimer's Coordinating Center (p < 0.001). High prevalence of co-occurring neuropathologies among older adults with dementia has implications for accurate diagnosis of dementia etiologies and development of disease-modifying strategies.
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Affiliation(s)
- Willa D Brenowitz
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - W T Longstreth
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Randy L Woltjer
- Department of Pathology, Health Sciences University of Oregon, Portland, OR, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- Department of Medicine, University of Washington, Seattle, WA, USA; Group Health Research Institute, Seattle, WA, USA
| | - Walter A Kukull
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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40
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Zwan MD, Bouwman FH, Konijnenberg E, van der Flier WM, Lammertsma AA, Verhey FRJ, Aalten P, van Berckel BNM, Scheltens P. Diagnostic impact of [ 18F]flutemetamol PET in early-onset dementia. ALZHEIMERS RESEARCH & THERAPY 2017; 9:2. [PMID: 28093088 PMCID: PMC5240413 DOI: 10.1186/s13195-016-0228-4] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/08/2016] [Indexed: 12/20/2022]
Abstract
Background Early-onset dementia patients often present with atypical clinical symptoms, hampering an accurate clinical diagnosis. The purpose of the present study was to assess the diagnostic impact of the amyloid-positron emission tomography (PET) imaging agent [18F]flutemetamol in early-onset dementia patients, in terms of change in (confidence in) diagnosis and patient management plan. Methods This prospective bi-center study included 211 patients suspected of early-onset dementia who visited a tertiary memory clinic. Patients were eligible with Mini Mental State Examination ≥ 18 and age at diagnosis ≤ 70 years and in whom the diagnostic confidence was <90% after routine diagnostic work-up. All patients underwent [18F]flutemetamol PET, which was interpreted as amyloid-negative or amyloid-positive based on visual rating. Before and after disclosing the PET results, we assessed the diagnostic confidence (using a visual analog scale of 0–100%) and clinical diagnosis. The impact of [18F]flutemetamol PET on the patient management plan was also evaluated. Results [18F]flutemetamol PET scans were positive in 133 out of 211 (63%) patients, of whom 110 out of 144 (76%) patients had a pre-PET Alzheimer’s disease (AD) diagnosis and 23 out of 67 (34%) patients had a non-AD diagnosis. After disclosure of PET results, 41/211 (19%) diagnoses changed. Overall, diagnostic confidence increased from 69 ± 12% to 88 ± 15% after disclosing PET results (P < 0.001; in 87% of patients). In 79 (37%) patients, PET results led to a change in patient management and predominantly the initiation of AD medication when PET showed evidence for amyloid pathology. Conclusions [18F]flutemetamol PET changed clinical diagnosis, increased overall diagnostic confidence, and altered the patient management plan. Our results suggest that amyloid PET may have added value over the standardized diagnostic work-up in early-onset dementia patients with uncertain clinical diagnosis. This study provides evidence for the recommendations put forward in the appropriate use criteria for amyloid PET in clinical practice. Trial registration Nederlands Trial Register NTR3743. Registered 7 December 2012.
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Affiliation(s)
- Marissa D Zwan
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands.
| | - Femke H Bouwman
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Elles Konijnenberg
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Frans R J Verhey
- School for Mental Health and Neuroscience, Alzheimer Centre Limburg, European Graduate School of Neuroscience EURON, Maastricht University, Maastricht, The Netherlands
| | - Pauline Aalten
- School for Mental Health and Neuroscience, Alzheimer Centre Limburg, European Graduate School of Neuroscience EURON, Maastricht University, Maastricht, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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Pasquier F, Sadowsky C, Holstein A, Leterme GLP, Peng Y, Jackson N, Fox NC, Ketter N, Liu E, Ryan JM. Two Phase 2 Multiple Ascending-Dose Studies of Vanutide Cridificar (ACC-001) and QS-21 Adjuvant in Mild-to-Moderate Alzheimer's Disease. J Alzheimers Dis 2016; 51:1131-43. [PMID: 26967206 DOI: 10.3233/jad-150376] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Vanutide cridificar (ACC-001), an immunotherapeutic vaccine, is a potentially disease-modifying therapy that aims to reduce brain amyloid-β (Aβ) plaques in patients with Alzheimer's disease (AD). ACC-001 was evaluated in two phase 2a, multicenter, randomized, third party-unblinded, placebo-controlled, multiple ascending-dose studies of ACC-001 (3μg, 10μg, 30μg) with and without QS-21 adjuvant that enrolled patients with mild-to-moderate AD (n = 245). Patients were treated with up to five doses of study vaccine or placebo and followed for safety and tolerability (primary objective) and anti-Aβ IgG immunogenicity (secondary objective) up to 12 months after the last vaccination. Exploratory assessments included cognitive/functional measures, brain magnetic resonance imaging (MRI) volumetry, and pharmacodynamic markers in plasma and cerebrospinal fluid (CSF). The most frequent treatment-emergent adverse events (≥10%) were local injection reactions and headache. Amyloid-related imaging abnormalities with vasogenic edema occurred in two (0.8%) patients (ACC-001 30μg + QS-21; ACC-001 10μg). ACC-001 + QS-21 elicited consistently higher peak and sustained anti-Aβ IgG titers compared with ACC-001 alone. Plasma Aβx-40 was significantly higher in all ACC-001 + QS-21 groups versus placebo (weeks 16-56), with no evidence of dose response. Exploratory cognitive evaluations, volumetric brain MRI, and CSF biomarkers did not show differences or trends between treatment groups and placebo. ACC-001 with or without QS-21 adjuvant has an acceptable safety profile in patients with mild-to-moderate AD.
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Affiliation(s)
- Florence Pasquier
- Inserm U1171, Memory clinic of CHU and University of Lille, Lille, France
| | - Carl Sadowsky
- Premiere Research Institute, Palm Beach Neurology, Nova SE University, West Palm Beach, FL, USA
| | | | | | | | | | - Nick C Fox
- Dementia Research Centre, Department of Neurodegeneration, UCL Institute of Neurology, London, UK
| | - Nzeera Ketter
- Janssen Research and Development, San Diego, CA, USA
| | - Enchi Liu
- Janssen Research and Development, San Diego, CA, USA
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42
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Bermejo-Pareja F, Llamas-Velasco S, Villarejo-Galende A. Alzheimer's disease prevention: A way forward. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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43
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Abstract
Amyloid plaques, along with neurofibrillary tangles, are a neuropathologic hallmark of Alzheimer disease (AD). Recently, amyloid PET radiotracers have been developed and approved for clinical use in the evaluation of suspected neurodegenerative disorders. In both research and clinical settings, amyloid PET imaging has provided important diagnostic and prognostic information for the management of patients with possible AD, mild cognitive impairment (MCI), and other challenging diagnostic presentations. Although the overall impact of amyloid imaging is still being evaluated, the Society of Nuclear Medicine and Molecular Imaging and Alzheimer's Association Amyloid Imaging Task Force have created appropriate use criteria for the standard clinical use of amyloid PET imaging. By the appropriate use criteria, amyloid imaging is appropriate for patients with (1) persistent or unexplained MCI, (2) AD as a possible but still uncertain diagnosis after expert evaluation and (3) atypically early-age-onset progressive dementia. To better understand the clinical and economic effect of amyloid imaging, the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) study is an ongoing large multicenter study in the United States, which is evaluating how amyloid imaging affects diagnosis, management, and outcomes for cognitively impaired patients who cannot be completely evaluated by clinical assessment alone. Multiple other large-scale studies are evaluating the prognostic role of amyloid PET imaging for predicting MCI progression to AD in general and high-risk populations. At the same time, amyloid imaging is an important tool for evaluating potential disease-modifying therapies for AD. Overall, the increased use of amyloid PET imaging has led to a better understanding of the strengths and limitations of this imaging modality and how it may best be used with other clinical, molecular, and imaging assessment techniques for the diagnosis and management of neurodegenerative disorders.
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Affiliation(s)
- Atul Mallik
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT.
| | - Alex Drzezga
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Satoshi Minoshima
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
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44
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Kang HS, Kwon JH, Kim S, Na DL, Kim SY, Lee JH, Han SH, Choi SH, Kim S, Carroll BJ, Kim DK. Comparison of neuropsychological profiles in patients with Alzheimer's disease and mixed dementia. J Neurol Sci 2016; 369:134-138. [PMID: 27653879 DOI: 10.1016/j.jns.2016.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/15/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022]
Abstract
OBJECTS We designed this study to extensively compare the neuropsychological profiles of Alzheimer's disease (AD) and mixed dementia (MD) in a large multicenter cohort of patients. Specifically, we performed subgroup analyses to examine group differences associated with dementia severity. METHODS A total of 1021 AD patients and 577 MD patients were included from the Clinical Research Center for Dementia of South Korea (CREDOS) Study. All patients underwent comprehensive neuropsychological and functional ratings, as well as complete physical and neurological examinations. To avoid floor confounds, only patients with Clinical Dementia Rating (CDR) scores of 0.5-2.0 were included. RESULTS Overall, MD patients showed worse performance in frontal/executive function than those with AD. Stratification by dementia severity revealed a significant difference in global cognitive function scores between AD and MD patients only in the low severity groups (CDR 0.5). Also, MD patients showed worse performance in frontal/executive function domains in the CDR 0.5 groups whereas they had better performance in the memory domain in the CDR 1 groups than did AD patients. Additionally, AD patients showed better performance than MD patients with respect to activities of daily living at CDR levels 0.5 and 1. All differences had disappeared at the CDR 2 level of global dementia severity. CONCLUSION This study suggests that there are significant differences in neuropsychological profiles between AD and MD patients, with the pattern of this difference varying distinctively according to dementia severity.
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Affiliation(s)
- Hyo Shin Kang
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea; Department of Clinical and Counseling Psychology, Korea University, Seoul, Republic of Korea
| | - Jung Hye Kwon
- Department of Clinical and Counseling Psychology, Korea University, Seoul, Republic of Korea
| | - Sangha Kim
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Yoon Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Doh Kwan Kim
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea; Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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45
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Klöppel S, Peter J, Ludl A, Pilatus A, Maier S, Mader I, Heimbach B, Frings L, Egger K, Dukart J, Schroeter ML, Perneczky R, Häussermann P, Vach W, Urbach H, Teipel S, Hüll M, Abdulkadir A. Applying Automated MR-Based Diagnostic Methods to the Memory Clinic: A Prospective Study. J Alzheimers Dis 2016; 47:939-54. [PMID: 26401773 PMCID: PMC4923764 DOI: 10.3233/jad-150334] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Several studies have demonstrated that fully automated pattern recognition methods applied to structural magnetic resonance imaging (MRI) aid in the diagnosis of dementia, but these conclusions are based on highly preselected samples that significantly differ from that seen in a dementia clinic. At a single dementia clinic, we evaluated the ability of a linear support vector machine trained with completely unrelated data to differentiate between Alzheimer’s disease (AD), frontotemporal dementia (FTD), Lewy body dementia, and healthy aging based on 3D-T1 weighted MRI data sets. Furthermore, we predicted progression to AD in subjects with mild cognitive impairment (MCI) at baseline and automatically quantified white matter hyperintensities from FLAIR-images. Separating additionally recruited healthy elderly from those with dementia was accurate with an area under the curve (AUC) of 0.97 (according to Fig. 4). Multi-class separation of patients with either AD or FTD from other included groups was good on the training set (AUC > 0.9) but substantially less accurate (AUC = 0.76 for AD, AUC = 0.78 for FTD) on 134 cases from the local clinic. Longitudinal data from 28 cases with MCI at baseline and appropriate follow-up data were available. The computer tool discriminated progressive from stable MCI with AUC = 0.73, compared to AUC = 0.80 for the training set. A relatively low accuracy by clinicians (AUC = 0.81) illustrates the difficulties of predicting conversion in this heterogeneous cohort. This first application of a MRI-based pattern recognition method to a routine sample demonstrates feasibility, but also illustrates that automated multi-class differential diagnoses have to be the focus of future methodological developments and application studies
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Affiliation(s)
- Stefan Klöppel
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.,Freiburg Brain Imaging, University Medical Center Freiburg, Germany.,Departments of Psychiatry and Psychotherapy, Section of Gerontopsychiatry and Neuropsychology, University Medical Center Freiburg, Freiburg, Germany.,Department of Neurology, University Medical Center Freiburg, Freiburg, Germany
| | - Jessica Peter
- Freiburg Brain Imaging, University Medical Center Freiburg, Germany.,Departments of Psychiatry and Psychotherapy, Section of Gerontopsychiatry and Neuropsychology, University Medical Center Freiburg, Freiburg, Germany.,Department of Neurology, University Medical Center Freiburg, Freiburg, Germany
| | - Anna Ludl
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany
| | - Anne Pilatus
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany
| | - Sabrina Maier
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany
| | - Irina Mader
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Bernhard Heimbach
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany
| | - Lars Frings
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.,Department of Nuclear Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Karl Egger
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Juergen Dukart
- F. Hoffmann-La Roche, pRED, Pharma Research and Early Development, DTA Neuroscience, Basel, Switzerland.,Max Planck Institute for Human Cognitive and Brain Sciences & Clinic for Cognitive Neurology, University of Leipzig, and German Consortium for Frontotemporal Lobar Degeneration, Ulm, Germany
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences & Clinic for Cognitive Neurology, University of Leipzig, and German Consortium for Frontotemporal Lobar Degeneration, Ulm, Germany
| | - Robert Perneczky
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College of Science, Technology and Medicine London, United Kingdom.,Cognitive Impairment and Dementia Services, Lakeside Mental Health Unit, West London Mental Health NHS Trust, London, UK.,Departments of Psychiatry and Psychotherapy, Technical University München, Germany
| | | | - Werner Vach
- Center for Medical Biometry and Medical Informatics, University of Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Stefan Teipel
- Departments of Psychosomatic Medicine, University of Rostock, and German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Michael Hüll
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg, Freiburg, Germany.,Clinics for Geronto- and Neuropsychiatry, ZfP Emmendingen, Emmendingen, Germany
| | - Ahmed Abdulkadir
- Freiburg Brain Imaging, University Medical Center Freiburg, Germany.,Department of Computer Science and BIOSS Centre for Biological Signaling Studies, University of Freiburg, Germany
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46
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Li QX, Villemagne VL, Doecke JD, Rembach A, Sarros S, Varghese S, McGlade A, Laughton KM, Pertile KK, Fowler CJ, Rumble RL, Trounson BO, Taddei K, Rainey-Smith SR, Laws SM, Robertson JS, Evered LA, Silbert B, Ellis KA, Rowe CC, Macaulay SL, Darby D, Martins RN, Ames D, Masters CL, Collins S. Alzheimer's Disease Normative Cerebrospinal Fluid Biomarkers Validated in PET Amyloid-β Characterized Subjects from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study. J Alzheimers Dis 2016; 48:175-87. [PMID: 26401938 DOI: 10.3233/jad-150247] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The cerebrospinal fluid (CSF) amyloid-β (Aβ)(1-42), total-tau (T-tau), and phosphorylated-tau (P-tau181P) profile has been established as a valuable biomarker for Alzheimer's disease (AD). OBJECTIVE The current study aimed to determine CSF biomarker cut-points using positron emission tomography (PET) Aβ imaging screened subjects from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study of aging, as well as correlate CSF analyte cut-points across a range of PET Aβ amyloid ligands. METHODS Aβ pathology was determined by PET imaging, utilizing ¹¹C-Pittsburgh Compound B, ¹⁸F-flutemetamol, or ¹⁸F-florbetapir, in 157 AIBL participants who also underwent CSF collection. Using an INNOTEST assay, cut-points were established (Aβ(1-42) >544 ng/L, T-tau <407 ng/L, and P-tau181P <78 ng/L) employing a rank based method to define a "positive" CSF in the sub-cohort of amyloid-PET negative healthy participants (n = 97), and compared with the presence of PET demonstrated AD pathology. RESULTS CSF Aβ(1-42) was the strongest individual biomarker, detecting cognitively impaired PET positive mild cognitive impairment (MCI)/AD with 85% sensitivity and 91% specificity. The ratio of P-tau181P or T-tau to Aβ(1-42) provided greater accuracy, predicting MCI/AD with Aβ pathology with ≥92% sensitivity and specificity. Cross-validated accuracy, using all three biomarkers or the ratio of P-tau or T-tau to Aβ(1-42) to predict MCI/AD, reached ≥92% sensitivity and specificity. CONCLUSIONS CSF Aβ(1-42) levels and analyte combination ratios demonstrated very high correlation with PET Aβ imaging. Our study offers additional support for CSF biomarkers in the early and accurate detection of AD pathology, including enrichment of patient cohorts for treatment trials even at the pre-symptomatic stage.
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Affiliation(s)
- Qiao-Xin Li
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Victor L Villemagne
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia.,Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, VIC, Australia
| | - James D Doecke
- CSIRO Digital Productivity/Australian e-Health Research Centre and Cooperative Research Centre for Mental Health, Brisbane, QLD, Australia
| | - Alan Rembach
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Shannon Sarros
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Shiji Varghese
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Amelia McGlade
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Katrina M Laughton
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Kelly K Pertile
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Christopher J Fowler
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Rebecca L Rumble
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Brett O Trounson
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Kevin Taddei
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), Perth, WA, Australia
| | - Stephanie R Rainey-Smith
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), Perth, WA, Australia
| | - Simon M Laws
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), Perth, WA, Australia
| | - Joanne S Robertson
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Lisbeth A Evered
- Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, and Department of Surgery, St. Vincent's Hospital, The University of Melbourne, VIC, Australia
| | - Brendan Silbert
- Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, and Department of Surgery, St. Vincent's Hospital, The University of Melbourne, VIC, Australia
| | - Kathryn A Ellis
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia.,The University of Melbourne Academic Unit for Psychiatry of Old Age, St George's Hospital, Kew, VIC, Australia
| | - Christopher C Rowe
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia.,Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, VIC, Australia
| | | | - David Darby
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Ralph N Martins
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), Perth, WA, Australia.,School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia
| | - David Ames
- The University of Melbourne Academic Unit for Psychiatry of Old Age, St George's Hospital, Kew, VIC, Australia.,National Ageing Research Institute, Parkville, VIC, Australia
| | - Colin L Masters
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia
| | - Steven Collins
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, VIC, Australia.,Department of Pathology, The University of Melbourne, Parkville, Australia
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Bermejo-Pareja F, Llamas-Velasco S, Villarejo-Galende A. Alzheimer's disease prevention: A way forward. Rev Clin Esp 2016; 216:495-503. [PMID: 27325510 DOI: 10.1016/j.rce.2016.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 01/22/2023]
Abstract
This review proposes a more optimistic view of Alzheimer's disease (AD), in contrast to that contributed by the ageing of the population and the failure of potentially curative therapies (vaccines and others). Treatment failure is likely due to the fact that AD gestates in the brain for decades but manifests in old age. This review updates the concept of AD and presents the results of recent studies that show that primary prevention can reduce the incidence and delay the onset of the disease. Half of all cases of AD are potentially preventable through education, the control of cardiovascular risk factors, the promotion of healthy lifestyles and specific drug treatments. These approaches could substantially reduce the future incidence rate of this disease.
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Affiliation(s)
- F Bermejo-Pareja
- Imas12 (Instituto de Investigación Hospital Universitario 12 de Octubre), Madrid, España; Cátedra Extraordinaria de Alzheimer y enfermedades Neurodegenerativas, Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España; CIBERNED, Instituto de Investigación Carlos III, Madrid, España
| | - S Llamas-Velasco
- Imas12 (Instituto de Investigación Hospital Universitario 12 de Octubre), Madrid, España; Departamento de Neurología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - A Villarejo-Galende
- CIBERNED, Instituto de Investigación Carlos III, Madrid, España; Departamento de Neurología, Hospital Universitario 12 de Octubre, Madrid, España
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48
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Preventive geriatrics the cross-talk between arterial and brain aging: A lifelong condition. Exp Gerontol 2016; 87:148-150. [PMID: 27311517 DOI: 10.1016/j.exger.2016.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 05/11/2016] [Accepted: 06/06/2016] [Indexed: 11/23/2022]
Abstract
Arterial aging - clinically evaluable noninvasively as carotid-femoral Pulse Wave Velocity (PWV), an index of arterial stiffness - has emerged as a risky condition for cardiovascular events and cognitive decline. With advancing age, arterial aging is less and less dependent on blood pressure levels. We propose a life-course approach to the cross-talking between arterial and brain aging aimed at preventing disabling conditions at older ages. This vision is supported by growing evidence that "silent" alteration in large artery as well as in brain structure and function are already detectable at young ages.
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49
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Paquet C, Magnin E, Wallon D, Troussière AC, Dumurgier J, Jager A, Bellivier F, Bouaziz-Amar E, Blanc F, Beaufils E, Miguet-Alfonsi C, Quillard M, Schraen S, Pasquier F, Hannequin D, Robert P, Hugon J, Mouton-Liger F. Utility of CSF biomarkers in psychiatric disorders: a national multicentre prospective study. ALZHEIMERS RESEARCH & THERAPY 2016; 8:27. [PMID: 27357952 PMCID: PMC4928321 DOI: 10.1186/s13195-016-0192-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/16/2016] [Indexed: 12/27/2022]
Abstract
Background Affective and psychotic disorders are mental or behavioural patterns resulting in an inability to cope with life’s ordinary demands and routines. These conditions can be a prodromal event of Alzheimer’s disease (AD). The prevalence of underlying AD lesions in psychiatric diseases is unknown, and it would be helpful to determine them in patients. AD cerebrospinal fluid (CSF) biomarkers (amyloid β, tau and phosphorylated tau) have high diagnostic accuracy, both for AD with dementia and to predict incipient AD (mild cognitive impairment due to AD), and they are sometimes used to discriminate psychiatric diseases from AD. Our objective in the present study was to evaluate the clinical utility of CSF biomarkers in a group of patients with psychiatric disease as the main diagnosis. Methods In a multicentre prospective study, clinicians filled out an anonymous questionnaire about all of their patients who had undergone CSF biomarker evaluation. Before and after CSF biomarker results were obtained, clinicians provided a diagnosis with their level of confidence and information about the treatment. We included patients with a psychiatric disorder as the initial diagnosis. In a second part of the study conducted retrospectively in a followed subgroup, clinicians detailed the psychiatric history and we classified patients into three categories: (1) psychiatric symptoms associated with AD, (2) dual diagnosis and (3) cognitive decline not linked to a neurodegenerative disorder. Results Of 957 patients, 69 had an initial diagnosis of a psychiatric disorder. Among these 69 patients, 14 (20.2 %) had a CSF AD profile, 5 (7.2 %) presented with an intermediate CSF profile and 50 (72.4 %) had a non-AD CSF profile. Ultimately, 13 (18.8 %) patients were diagnosed with AD. We show that in the AD group psychiatric symptoms occurred later and the delay between the first psychiatric symptoms and the cognitive decline was shorter. Conclusions This study revealed that about 20 % of patients with a primary psychiatric disorder diagnosis before undergoing a CSF exploration for cognitive disorder displayed a CSF biomarker AD profile. In memory clinics, it seems important to consider AD as a possible diagnosis before finalizing a diagnosis of a psychiatric disorder.
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Affiliation(s)
- Claire Paquet
- INSERM UMR-S942 Université Paris Diderot, 75010, Paris, France. .,Centre Mémoire (CMRR) Paris Nord Ile de France, Groupe Hospitalier Lariboisiere FW Saint-Louis, APHP, Université Paris Diderot, 200, rue du Faubourg Saint Denis, 75010, Paris, France. .,Unité d'Histologie et de Biologie du Vieillissement, Groupe Hospitalier Lariboisiere FW Saint Louis APHP, Université Paris Diderot, 75010, Paris, France.
| | - Eloi Magnin
- Centre Mémoire (CMRR) de Besançon, Hôpital Universitaire de Besançon, 25000, Besançon, France
| | - David Wallon
- Centre Mémoire (CMRR) and INSERM UMR1079, Hôpital Universitaire de Rouen, 76000, Rouen, France
| | - Anne-Cécile Troussière
- Centre Mémoire (CMRR) de Lille, Université Lille Nord de France, UDSL, 59000, Lille, France
| | - Julien Dumurgier
- INSERM UMR-S942 Université Paris Diderot, 75010, Paris, France.,Centre Mémoire (CMRR) Paris Nord Ile de France, Groupe Hospitalier Lariboisiere FW Saint-Louis, APHP, Université Paris Diderot, 200, rue du Faubourg Saint Denis, 75010, Paris, France.,Unité d'Histologie et de Biologie du Vieillissement, Groupe Hospitalier Lariboisiere FW Saint Louis APHP, Université Paris Diderot, 75010, Paris, France
| | - Alain Jager
- Centre de Neurologie, 6 place Luxembourg, 57100, Thionville, France
| | - Frank Bellivier
- INSERM UMR-S1144 and Service de Psychiatrie, Groupe Hospitalier Lariboisiere FW Saint-Louis, APHP, Université Paris Diderot, 75010, Paris, France
| | - Elodie Bouaziz-Amar
- Service de Biochimie, Groupe Hospitalier Lariboisiere FW Saint-Louis, APHP, Université Paris Diderot, 75010, Paris, France
| | - Frédéric Blanc
- Université de Strasbourg, CNRS, Laboratoire ICube UMR 7357 and Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000, Strasbourg, France.,Centre Mémoire (CMRR), Hôpital Universitaire de Strasbourg, Département de Gériatrie, Hôpital de Jour Gériatrique, 67000, Strasbourg, France
| | - Emilie Beaufils
- Centre Mémoire (CMRR) de Tours, Hôpital Universitaire Tours, 37000, Tours, France
| | | | - Muriel Quillard
- Service de Biochimie, Hôpital Universitaire de Rouen, 76000, Rouen, France
| | - Susanna Schraen
- Université Lille, CHU-Lille, Inserm, UF de Neurobiologie, CBPG, Lille, France
| | - Florence Pasquier
- Centre Mémoire (CMRR) de Lille, Université Lille Nord de France, UDSL, 59000, Lille, France
| | - Didier Hannequin
- Centre Mémoire (CMRR) and INSERM UMR1079, Hôpital Universitaire de Rouen, 76000, Rouen, France
| | - Philippe Robert
- CMRR COBTEK research unit, Université de Nice Sophia Antipolis, 06100, Nice, France
| | - Jacques Hugon
- INSERM UMR-S942 Université Paris Diderot, 75010, Paris, France.,Centre Mémoire (CMRR) Paris Nord Ile de France, Groupe Hospitalier Lariboisiere FW Saint-Louis, APHP, Université Paris Diderot, 200, rue du Faubourg Saint Denis, 75010, Paris, France.,Unité d'Histologie et de Biologie du Vieillissement, Groupe Hospitalier Lariboisiere FW Saint Louis APHP, Université Paris Diderot, 75010, Paris, France
| | - François Mouton-Liger
- INSERM UMR-S942 Université Paris Diderot, 75010, Paris, France.,Centre Mémoire (CMRR) Paris Nord Ile de France, Groupe Hospitalier Lariboisiere FW Saint-Louis, APHP, Université Paris Diderot, 200, rue du Faubourg Saint Denis, 75010, Paris, France
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Eisenmenger LB, Huo EJ, Hoffman JM, Minoshima S, Matesan MC, Lewis DH, Lopresti BJ, Mathis CA, Okonkwo DO, Mountz JM. Advances in PET Imaging of Degenerative, Cerebrovascular, and Traumatic Causes of Dementia. Semin Nucl Med 2016; 46:57-87. [DOI: 10.1053/j.semnuclmed.2015.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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