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Moussa M, Falfoul Y, Nasri A, El Matri K, Kacem I, Mrabet S, Chebil A, Gharbi A, Gouider R, El Matri L. Optical coherence tomography and angiography in Alzheimer's disease and other cognitive disorders. Eur J Ophthalmol 2023:11206721221148952. [PMID: 36617984 DOI: 10.1177/11206721221148952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS The aims of this study were to analyze retinal and choroidal changes on optical coherence tomography (OCT) and OCT-Angiography (OCT-A) in Alzheimer's disease (AD) patients and compare them to other forms of major dementia. We also aimed to analyze the correlation between clinical severity of global cognitive deficiency assessed by the mini-mental state exam (MMSE) score and OCT/OCT-A parameters. METHODS Retrospective cross-sectional evaluative study of AD, and age-and gender-matched patients with other dementias. Fundus examination, OCT and OCT-A were compared. RESULTS Ninety-one eyes of AD patients and 53 eyes of patients with other dementias were included. Retinal deposits were found in 6.59% of AD cases. OCT highlighted the presence of hyperreflective deposits and localized areas of outer retina and ellipsoid zone disruption, respectively in 20.87% and 15.38% of AD cases. Hyperreflective foci were noted within inner retinal layers in 4.39% of AD cases. Quantitative analysis revealed a thicker nasal retinal nerve fiber layer (p = 0.001) and ganglion cell complex in superior (p = 0.011) and temporal quadrants (p = 0.009) in eyes of AD patients, compared to other dementias. OCT-A showed a significantly higher fractal dimension of both superficial and deep capillary plexus (p = 0.005), with lower choriocapillaris density (p = 0.003) in AD patients. CONCLUSIONS Structural OCT could highlight the presence of hyperreflective deposits in AD, probably reflecting beta-amyloid deposits, associated to outer retinal disruptions. Quantitative OCT analysis showed structural differences between AD patients and other dementias, and combined OCT-A could identify microvascular changes in AD patients representing new potential differential diagnosis criteria.
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Affiliation(s)
- Mohamed Moussa
- Department of Ophthalmology B, 383447Hedi Raies Institute of Ophthalmology, Tunis, Tunisia
- Faculty of Medicine of Tunis, 37964University of Tunis El Manar, Tunis, Tunisia
| | - Yousra Falfoul
- Department of Ophthalmology B, 383447Hedi Raies Institute of Ophthalmology, Tunis, Tunisia
- Faculty of Medicine of Tunis, 37964University of Tunis El Manar, Tunis, Tunisia
| | - Amina Nasri
- Faculty of Medicine of Tunis, 37964University of Tunis El Manar, Tunis, Tunisia
- Department of Neurology, LR18SP03, Clinical Investigation Center "Neurosciences and Mental Health", Razi University Hospital, Tunis, Manouba, Tunisia
| | - Khaled El Matri
- Department of Ophthalmology B, 383447Hedi Raies Institute of Ophthalmology, Tunis, Tunisia
- Faculty of Medicine of Tunis, 37964University of Tunis El Manar, Tunis, Tunisia
| | - Imen Kacem
- Faculty of Medicine of Tunis, 37964University of Tunis El Manar, Tunis, Tunisia
- Department of Neurology, LR18SP03, Clinical Investigation Center "Neurosciences and Mental Health", Razi University Hospital, Tunis, Manouba, Tunisia
| | - Saloua Mrabet
- Faculty of Medicine of Tunis, 37964University of Tunis El Manar, Tunis, Tunisia
- Department of Neurology, LR18SP03, Clinical Investigation Center "Neurosciences and Mental Health", Razi University Hospital, Tunis, Manouba, Tunisia
| | - Ahmed Chebil
- Department of Ophthalmology B, 383447Hedi Raies Institute of Ophthalmology, Tunis, Tunisia
- Faculty of Medicine of Tunis, 37964University of Tunis El Manar, Tunis, Tunisia
| | - Alya Gharbi
- Faculty of Medicine of Tunis, 37964University of Tunis El Manar, Tunis, Tunisia
- Department of Neurology, LR18SP03, Clinical Investigation Center "Neurosciences and Mental Health", Razi University Hospital, Tunis, Manouba, Tunisia
| | - Riadh Gouider
- Faculty of Medicine of Tunis, 37964University of Tunis El Manar, Tunis, Tunisia
- Department of Neurology, LR18SP03, Clinical Investigation Center "Neurosciences and Mental Health", Razi University Hospital, Tunis, Manouba, Tunisia
| | - Leila El Matri
- Department of Ophthalmology B, 383447Hedi Raies Institute of Ophthalmology, Tunis, Tunisia
- Faculty of Medicine of Tunis, 37964University of Tunis El Manar, Tunis, Tunisia
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Rifai OM, McGrory S, Robbins CB, Grewal DS, Liu A, Fekrat S, MacGillivray TJ. The application of optical coherence tomography angiography in Alzheimer's disease: A systematic review. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12149. [PMID: 33718582 PMCID: PMC7927164 DOI: 10.1002/dad2.12149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/12/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Discovering non-invasive and easily acquired biomarkers that are conducive to the accurate diagnosis of dementia is an urgent area of ongoing clinical research. One promising approach is retinal imaging, as there is homology between retinal and cerebral vasculature. Recently, optical coherence tomography angiography (OCT-A) has emerged as a promising new technology for imaging the microvasculature of the retina. METHODS A systematic review and meta-analysis was conducted to examine the application of OCT-A in dementia. RESULTS Fourteen studies assessing OCT-A in preclinical Alzheimer's disease (AD), mild cognitive impairment, or AD were included. Exploratory meta-analyses revealed a significant increase in the foveal avascular zone area and a significant decrease in superficial parafoveal and whole vessel density in AD, although there was significant heterogeneity between studies. DISCUSSION Although certain OCT-A metrics may have the potential to serve as biomarkers for AD, the field requires further standardization to allow conclusions to be reached regarding their clinical utility.
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Affiliation(s)
- Olivia M. Rifai
- Translational Neuroscience PhD ProgrammeUniversity of EdinburghEdinburghUK
- Centre for Clinical Brain SciencesCollege of Medicine and Veterinary MedicineUniversity of EdinburghEdinburghUK
| | - Sarah McGrory
- Centre for Clinical Brain SciencesCollege of Medicine and Veterinary MedicineUniversity of EdinburghEdinburghUK
| | - Cason B. Robbins
- Department of OphthalmologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Dilraj S. Grewal
- Department of OphthalmologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Andy Liu
- Department of NeurologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Sharon Fekrat
- Department of OphthalmologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Thomas J. MacGillivray
- Centre for Clinical Brain SciencesCollege of Medicine and Veterinary MedicineUniversity of EdinburghEdinburghUK
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Changes in retinal microvasculature and retinal layer thickness in association with apolipoprotein E genotype in Alzheimer's disease. Sci Rep 2021; 11:1847. [PMID: 33469106 PMCID: PMC7815838 DOI: 10.1038/s41598-020-80892-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022] Open
Abstract
Biomarker tests of Alzheimer’s disease (AD) are invasive and expensive. Recent developments in optical coherence tomography (OCT) and OCT angiography (OCTA) have enabled noninvasive, cost-effective characterization of retinal layer vasculature and thickness. Using OCTA and OCT, we characterized retinal microvascular changes in the mild cognitive impairment (MCI) stage of AD and assessed their correlation with structural changes in each retinal neuronal layer. We also evaluated the effect of the APOE-ε4 genotype on retinal microvasculature and layer thickness. Retinal layer thickness did not differ between MCI patients (40 eyes) and controls (37 eyes, all p > 0.05). MCI patients had lower vessel density (VD) (p = 0.003) of the superficial capillary plexus (SCP) and larger foveal avascular zone area (p = 0.01) of the deep capillary plexus (DCP) than those of controls. VD of the SCP correlated with the ganglion cell layer (r = 0.358, p = 0.03) and inner plexiform layer thickness (r = 0.437, p = 0.007) in MCI patients. APOE-ε4-carrying MCI patients had a lower VD of the DCP than non-carriers (p = 0.03). In conclusion, retinal microvasculature was reduced in patients with AD-associated MCI, but retinal thickness was not changed; these changes might be affected by the APOE genotype. OCTA of the retinal microvasculature may be useful to detect vascular changes in AD.
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Abstract
Dementia poses important medical and societal challenges, and of all health risks people face in life, dementia is one of the most feared. Recent research indicates that up to about 40% of all cases of dementia might be preventable. A series of environmental, social, and medical risk-factors have been identified that should be targeted from midlife onwards when people are still cognitively healthy. At first glance, this seems not merely advisable, but even imperative. However, these new developments trigger a series of new ethical questions and concerns which have hardly been addressed to date. Pro-active ethical reflection, however, is crucial to ensure that the interests and well-being of those affected, ultimately all of us, are adequately respected. This is the goal of the current contribution. Against the background of a concrete case in primary dementia prevention, it provides a systematic overview of the current ethical literature and sketches an ethical research agenda. First, possible benefits of increased well-being must be balanced with the burdens of being engaged in particularly long-term interventions for which it is unclear whether they will ever pay out on a personal level. Second, while knowledge about one's options to maintain brain health might empower people, it might also undermine autonomy, put high social pressure on people, medicalize healthy adults, and stigmatize those who still develop dementia. Third, while synergistic effects might occur, the ideals of dementia prevention might also conflict with other health and non-health related values people hold in life.
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Affiliation(s)
- Dorothee Horstkötter
- MHeNS School for Mental Health and Neuroscience, Department of Health, Ethics and Society, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Smedinga M, Tromp K, Schermer MHN, Richard E. Ethical Arguments Concerning the Use of Alzheimer's Disease Biomarkers in Individuals with No or Mild Cognitive Impairment: A Systematic Review and Framework for Discussion. J Alzheimers Dis 2019; 66:1309-1322. [PMID: 30507575 DOI: 10.3233/jad-180638] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The shift to defining Alzheimer's disease (AD) as a biological continuum, which is characterized by the presence of biomarkers instead of clinical symptoms, has sparked a widespread debate. Insight into the given arguments and their underlying moral values is crucial to ensure well-considered and appropriate AD biomarker testing in the future. OBJECTIVE To critically review the arguments in favor of or against AD biomarker testing in people with no or mild cognitive impairment and to explicate their underlying moral values. METHODS Seven databases were systematically searched for publications mentioning arguments of interest. Arguments are identified using qualitative data-analysis and evaluated within an ethical framework. RESULTS Our search yielded 3,657 articles of which 34 met the inclusion criteria. We discuss the clusters of arguments separate from their evaluation and the assessment of the debate as a whole. The right to know, which derives from the moral value of respect for autonomy, is a central argument in favor of biomarker testing. On the other hand, fear of the disease and lack of a disease-modifying treatment may result in a negative balance of good over inflicted harms, which argues against its use. CONCLUSION Critical evaluation and weighing of the given arguments in a specific context, within an ethical framework, demonstrates the necessity to differentiate between what we hope or expect from research and where we currently stand. While AD biomarkers may have an indispensable value for research, the current advantage for clinical practice appears limited.
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Affiliation(s)
- Marthe Smedinga
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands.,Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Krista Tromp
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Maartje H N Schermer
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
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Naveed M, Mubeen S, Khan A, Ibrahim S, Meer B. Plasma Biomarkers: Potent Screeners of Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2019; 34:290-301. [PMID: 31072117 PMCID: PMC10852434 DOI: 10.1177/1533317519848239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD), a neurological disorder, is as a complex chronic disease of brain cell death that usher to cognitive decline and loss of memory. Its prevalence differs according to risk factors associated with it and necropsy performs vital role in its definite diagnosis. The stages of AD vary from preclinical to severe that proceeds to death of patient with no availability of treatment. Biomarker may be a biochemical change that can be recognized by different emerging technologies such as proteomics and metabolomics. Plasma biomarkers, 5-protein classifiers, are readily being used for the diagnosis of AD and can also predict its progression with a great accuracy, specificity, and sensitivity. In this review, upregulation or downregulation of few plasma proteins in patients with AD has also been discussed, when juxtaposed with control, and thus serves as potent biomarker in the diagnosis of AD.
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Affiliation(s)
- Muhammad Naveed
- Department of Biotechnology, Faculty of Life Sciences, University of Central Punjab, Lahore, Pakistan
| | - Shamsa Mubeen
- Department of Biochemistry and Molecular Biology, University of Gujrat, Gujrat, Pakistan
| | - Abeer Khan
- Department of Biotechnology, University of Gujrat, Gujrat, Pakistan
| | - Sehrish Ibrahim
- Department of Biotechnology, University of Gujrat, Gujrat, Pakistan
| | - Bisma Meer
- Department of Biotechnology, University of Gujrat, Gujrat, Pakistan
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Chan VTT, Sun Z, Tang S, Chen LJ, Wong A, Tham CC, Wong TY, Chen C, Ikram MK, Whitson HE, Lad EM, Mok VCT, Cheung CY. Spectral-Domain OCT Measurements in Alzheimer's Disease: A Systematic Review and Meta-analysis. Ophthalmology 2018; 126:497-510. [PMID: 30114417 DOI: 10.1016/j.ophtha.2018.08.009] [Citation(s) in RCA: 204] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023] Open
Abstract
TOPIC OCT is a noninvasive tool to measure specific retinal layers in the eye. The relationship of retinal spectral-domain (SD) OCT measurements with Alzheimer's disease (AD) and mild cognitive impairment (MCI) remains unclear. Hence, we conducted a systematic review and meta-analysis to examine the SD OCT measurements in AD and MCI. CLINICAL RELEVANCE Current methods of diagnosing early AD are expensive and invasive. Retinal measurements of SD OCT, which are noninvasive, technically simple, and inexpensive, are potential biomarkers of AD. METHODS We conducted a literature search in PubMed and Excerpta Medica Database to identify studies published before December 31, 2017, that assessed the associations between AD, MCI, and measurements of SD OCT: ganglion cell-inner plexiform layer (GC-IPL), ganglion cell complex (GCC), macular volume, and choroidal thickness, in addition to retinal nerve fiber layer (RNFL) and macular thickness. We used a random-effects model to examine these relationships. We also conducted meta-regression and assessed heterogeneity, publication bias, and study quality. RESULTS We identified 30 eligible studies, involving 1257 AD patients, 305 MCI patients, and 1460 controls, all of which were cross-sectional studies. In terms of the macular structure, AD patients showed significant differences in GC-IPL thickness (standardized mean difference [SMD], -0.46; 95% confidence interval [CI], -0.80 to -0.11; I2 = 71%), GCC thickness (SMD, -0.84; 95% CI, -1.10 to -0.57; I2 = 0%), macular volume (SMD, -0.58; 95% CI, -1.03 to -0.14; I2 = 80%), and macular thickness of all inner and outer sectors (SMD range, -0.52 to -0.74; all P < 0.001) when compared with controls. Peripapillary RNFL thickness (SMD, -0.67; 95% CI, -0.95 to -0.38; I2 = 89%) and choroidal thickness (SMD range, -0.88 to -1.03; all P < 0.001) also were thinner in AD patients. CONCLUSIONS Our results confirmed the associations between retinal measurements of SD OCT and AD, highlighting the potential usefulness of SD OCT measurements as biomarkers of AD.
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Affiliation(s)
- Victor T T Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Zihan Sun
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Shumin Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore, Republic of Singapore; Department of Pharmacology, National University of Singapore, Singapore, Republic of Singapore
| | - M Kamran Ikram
- Departments of Neurology and Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Heather E Whitson
- Duke University Medical Center, Durham, North Carolina; Geriatrics Research Education and Clinical Center (GRECC), Durham VA Medical Center, Durham, North Carolina
| | | | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
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Vanderschaeghe G, Dierickx K, Vandenberghe R. Review of the Ethical Issues of a Biomarker-Based Diagnoses in the Early Stage of Alzheimer's Disease. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:219-230. [PMID: 29532386 DOI: 10.1007/s11673-018-9844-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 10/02/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Today, many healthcare or dementia organizations, clinicians, and companies emphasize the importance of detection of Alzheimer's disease in an early phase. This idea has gained considerable momentum due to the development of biomarkers, the recent FDA and EMA approval of three amyloid tracers, and the failure of a number of recent therapeutic trials conducted in the early dementia phase. On the one hand, an early etiological diagnosis can lead to early and more efficacious intervention. On the other hand, it is questioned how early an etiological diagnosis is beneficial to the patient. Here we consider ethical issues related to the process of biomarker testing and the impact on the diagnostic disclosure to patients with mild cognitive impairment due to prodromal Alzheimer's disease. METHODS A systematic review of the theoretical bioethics literature was performed by using electronic databases. The review was limited to articles published in English between 2003 and 2016. RESULTS A total of twenty articles were included in our effort to make an analysis of the ethical challenges. One of the biggest challenges was the uncertainty and the predictive value of the biomarker-based diagnosis where patients can be amyloid positive without full certainty whether or when they will develop symptomatic decline due to Alzheimer's disease. Another challenge was the tension between the right to know versus the wish not to know, the limited efficacy of currently available treatment options, and the opportunities and consequences after receiving such an early diagnosis. CONCLUSION Based on the results and the additional comments in the discussion, several unanswered questions emerged. Therefore, careful consideration of all these ethical issues is required before the disclosure of a biomarker-based diagnosis to the patient with mild cognitive impairment due to Alzheimer's disease.
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Affiliation(s)
- Gwendolien Vanderschaeghe
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurology, KU Leuven BELGIUM; Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neurodegenerative Disorders KU Leuven and Neurology Department of UZ Leuven Hospitals (Campus Gasthuisberg), UZ Leuven / KU Leuven, Leuven, Belgium
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Vanderschaeghe G, Schaeverbeke J, Bruffaerts R, Vandenberghe R, Dierickx K. Amnestic MCI patients' experiences after disclosure of their amyloid PET result in a research context. ALZHEIMERS RESEARCH & THERAPY 2017; 9:92. [PMID: 29197423 PMCID: PMC5712105 DOI: 10.1186/s13195-017-0321-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Biomarkers such as amyloid imaging are increasingly used for diagnosis in the early stages of Alzheimer's disease. Very few studies have examined this from the perspective of the patient. To date, there is only limited evidence about how patients experience and value disclosure in an early disease stage. METHODS Semistructured interviews were carried out with 38 patients with amnestic mild cognitive impairment as part of an investigator-driven diagnostic trial (EudraCT, 2013-004671-12; registered on 20 June 2014) in which participants could opt to know the binary outcome (positive/negative) result of their amyloid positron emission tomography (PET) scan. Verbatim transcripts of the interviews were evaluated using qualitative content analysis and NVivo 11 software. RESULTS Eight of 38 patients received a positive amyloid PET scan result, and the remaining 30 patients received a negative amyloid PET scan result. After disclosure of the result to the patients, we interviewed each patient twice: 2 weeks after disclosure and 6 months after disclosure. Patients had difficulties in repeating the exact words used during disclosure of their amyloid PET scan result by the neurologist; yet, they could recall the core message of the result in their own words. Some patients were confused by the terminology of an amyloid-positive/negative test result. At 6 months, two of eight patients with a positive amyloid PET scan result experienced emotional difficulties (sadness, feeling worried). Three of 30 patients with a negative amyloid PET scan result started to doubt whether they had received the correct result. Patients reported that they experienced advantages after the disclosure, such as information about their health status, the possibility of making practical arrangements, medication, enjoying life more, and a positive impact on relationships. They also reported disadvantages following disclosure, such as having emotional difficulties, feeling worried about when their symptoms might worsen, the risk of a more patronizing attitude by relatives, and the possibility of a wrong diagnosis. CONCLUSIONS This exploratory study shows that the majority of patients can accurately recall the information received during disclosure. The experienced advantages and disadvantages reported by our patients depended on the outcome of the result (positive or negative) and the interval of the conducted interview (2 weeks or 6 months after amyloid PET disclosure). Discrepancies were found between patients' expectations according to the interview prior to amyloid PET disclosure (Vanderschaeghe et al. [Neuroethics. 2017;10:281-97]) and their actual experiences after their amyloid PET disclosure.
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Affiliation(s)
- Gwendolien Vanderschaeghe
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 Blok D, Box 7001, 3000, Leuven, Belgium.
| | - Jolien Schaeverbeke
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, O&N II, Herestraat 49, Box 1021, 3000, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven research Institute for Neuroscience and Disease, KU Leuven, Leuven, Belgium
| | - Rose Bruffaerts
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, O&N II, Herestraat 49, Box 1021, 3000, Leuven, Belgium.,Neurology Department, University Hospitals Leuven (UZ Leuven, Campus Gasthuisberg), Leuven, Belgium
| | - Rik Vandenberghe
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, O&N II, Herestraat 49, Box 1021, 3000, Leuven, Belgium. .,Alzheimer Research Centre KU Leuven, Leuven research Institute for Neuroscience and Disease, KU Leuven, Leuven, Belgium. .,Neurology Department, University Hospitals Leuven (UZ Leuven, Campus Gasthuisberg), Leuven, Belgium.
| | - Kris Dierickx
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 Blok D, Box 7001, 3000, Leuven, Belgium
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10
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McGrory S, Cameron JR, Pellegrini E, Warren C, Doubal FN, Deary IJ, Dhillon B, Wardlaw JM, Trucco E, MacGillivray TJ. The application of retinal fundus camera imaging in dementia: A systematic review. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 6:91-107. [PMID: 28229127 PMCID: PMC5312461 DOI: 10.1016/j.dadm.2016.11.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction The ease of imaging the retinal vasculature, and the evolving evidence suggesting this microvascular bed might reflect the cerebral microvasculature, presents an opportunity to investigate cerebrovascular disease and the contribution of microvascular disease to dementia with fundus camera imaging. Methods A systematic review and meta-analysis was carried out to assess the measurement of retinal properties in dementia using fundus imaging. Results Ten studies assessing retinal properties in dementia were included. Quantitative measurement revealed significant yet inconsistent pathologic changes in vessel caliber, tortuosity, and fractal dimension. Retinopathy was more prevalent in dementia. No association of age-related macular degeneration with dementia was reported. Discussion Inconsistent findings across studies provide tentative support for the application of fundus camera imaging as a means of identifying changes associated with dementia. The potential of fundus image analysis in differentiating between dementia subtypes should be investigated using larger well-characterized samples. Future work should focus on refining and standardizing methods and measurements.
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Affiliation(s)
- Sarah McGrory
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - James R Cameron
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; Anne Rowling Regenerative Neurology Clinic, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Enrico Pellegrini
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Claire Warren
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK; Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network: A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE Project and Computer Vision and Image Processing Group School of Science and Engineering (Computing), University of Dundee, Dundee, UK
| | - Thomas J MacGillivray
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; VAMPIRE Project and Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh, UK
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St John PD, Tyas SL, Montgomery PR. Cognition, even in the normal range, predicts disability: cross-sectional and prospective analyses of a population-based sample. Int J Geriatr Psychiatry 2015; 30:1008-16. [PMID: 25640203 DOI: 10.1002/gps.4254] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/26/2014] [Accepted: 12/03/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine if the modified mini-mental state examination (3MS) predicts functional status and if any effect on function is observed within the normal range of cognition. DESIGN Cohort study. SETTING Community-dwelling older adults in the Canadian province of Manitoba sampled in 1991 and followed in 1996. PARTICIPANTS Baseline sample of 1751 adults aged 65+ from a representative registry. Five years later, 1028 participants remained in the community and had no missing data. MEASUREMENTS The 3MS, age, gender, education, living arrangements, self-rated health, and depressive symptoms were self-reported. Functional status was assessed using the Older Americans Resource Survey, which was dichotomized into no/mild disability versus moderate/severe disability. RESULTS Baseline 3MS score predicted baseline functional status. This effect was a gradient across the entire 3MS score, extending into the normal range with no apparent threshold. In logistic regression models, the unadjusted odds ratio (OR, 95% confidence interval) for the association of 3MS score with disability was 0.94 (0.93, 0.95); the adjusted OR was 0.96 (0.95, 0.98) in models including age, gender, education, and other covariates. Baseline 3MS score also predicted functional status 5 years later: The unadjusted OR for disability was 0.94 (0.92, 0.95); the adjusted OR was 0.97 (0.95, 0.99). Again, the risk of functional impairment at time 2 was a gradient effect, extending into the normal range of baseline 3MS score. CONCLUSIONS The 3MS predicts functional decline, and this effect is a gradient effect. These results support the hypothesis that cognition is a continuum in risk.
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Affiliation(s)
- Philip D St John
- Section of Geriatric Medicine, Department of Medicine, and the Centre on Aging, University of Manitoba, Canada
| | - Suzanne L Tyas
- School of Public Health and Health Systems, University of Waterloo, Canada
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12
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Peters KR, Katz S. Voices from the field: Expert reflections on mild cognitive impairment. DEMENTIA 2015; 14:285-97. [DOI: 10.1177/1471301214562135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kevin R Peters
- Department of Psychology, Trent University, Peterborough, Canada
| | - Stephen Katz
- Department of Sociology, Trent University, Peterborough, Canada
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Brayne C, Katz S, Peters KR. Interview with Dr Carol Brayne, 5 April 2013. DEMENTIA 2014; 14:351-60. [PMID: 25502352 DOI: 10.1177/1471301214562137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schicktanz S, Schweda M, Ballenger JF, Fox PJ, Halpern J, Kramer JH, Micco G, Post SG, Thompson C, Knight RT, Jagust WJ. Before it is too late: professional responsibilities in late-onset Alzheimer's research and pre-symptomatic prediction. Front Hum Neurosci 2014; 8:921. [PMID: 25477802 PMCID: PMC4238325 DOI: 10.3389/fnhum.2014.00921] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/28/2014] [Indexed: 12/03/2022] Open
Abstract
The development of a wide array of molecular and neuroscientific biomarkers can provide the possibility to visualize the course of Alzheimer's disease (AD) at early stages. Many of these biomarkers are aimed at detecting not only a preclinical, but also a pre-symptomatic state. They are supposed to facilitate clinical trials aiming at treatments that attack the disease at its earliest stage or even prevent it. The increasing number of such biomarkers currently tested and now partly proposed for clinical implementation calls for critical reflection on their aims, social benefits, and risks. This position paper summarizes major challenges and responsibilities. Its focus is on the ethical and social problems involved in the organization and application of dementia research, as well as in healthcare provision from a cross-national point of view. The paper is based on a discussion of leading dementia experts from neuroscience, neurology, social sciences, and bioethics in the United States and Europe. It thus reflects a notable consensus across various disciplines and national backgrounds. We intend to initiate a debate on the need for actions within the researchers' national and international communities.
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Affiliation(s)
- Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center GöttingenGöttingen, Germany
| | - Mark Schweda
- Department of Medical Ethics and History of Medicine, University Medical Center GöttingenGöttingen, Germany
- Lichtenberg Kolleg, University of GöttingenGöttingen, Germany
| | - Jesse F. Ballenger
- Health Administration Department, Drexel UniversityPhiladelphia, PA, USA
| | - Patrick J. Fox
- Institute for Health & Aging, University of CaliforniaSan Francisco, San Francisco, CA, USA
| | - Jodi Halpern
- UC Berkeley-UCSF Joint Medical Program, School of Public Health, University of CaliforniaBerkeley, Berkeley, CA, USA
| | - Joel H. Kramer
- Memory and Aging Center, Sandler Neurosciences Center, University of CaliforniaSan Francisco, San Francisco, CA, USA
| | - Guy Micco
- UC Berkeley-UCSF Joint Medical Program, School of Public Health, University of CaliforniaBerkeley, Berkeley, CA, USA
| | - Stephen G. Post
- Compassionate Care & Bioethics, Stony Brook MedicineStony Brook, NY, USA
| | - Charis Thompson
- Department of Gender and Women’s Studies, University of CaliforniaBerkeley, Berkeley, CA, USA
- Department of Sociology, London School of EconomicsLondon, UK
| | - Robert T. Knight
- Department of Psychology, University of California, BerkeleyBerkeley, CA, USA
- Helen Wills Neuroscience Institute, University of CaliforniaBerkeley, Berkeley, CA, USA
| | - William J. Jagust
- UC Berkeley-UCSF Joint Medical Program, School of Public Health, University of CaliforniaBerkeley, Berkeley, CA, USA
- Helen Wills Neuroscience Institute, University of CaliforniaBerkeley, Berkeley, CA, USA
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Oh J, Lee HJ, Song JH, Park SI, Kim H. Plasminogen activator inhibitor-1 as an early potential diagnostic marker for Alzheimer's disease. Exp Gerontol 2014; 60:87-91. [PMID: 25304332 DOI: 10.1016/j.exger.2014.10.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/29/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
Alzheimer's disease (AD) is the most common cause of dementia in individuals over 65 years old. However, to date, no useful early diagnostic markers for AD have been discovered. We examined the utility of plasminogen activator inhibitor-1 (PAI-1) as a potential biomarker for AD in subjects with mild cognitive impairment (MCI) or AD, as well as in nondemented healthy controls. Plasma PAI-1 levels were measured by enzyme-linked immunosorbent assays (ELISAs) in samples collected from 76 patients with MCI, 74 patients with AD, and 76 healthy controls. Our results show that plasma PAI-1 levels gradually increased as dementia progressed. The mean levels of plasma PAI-1 in patients with MCI and AD patients were significantly higher than those of in healthy controls. Consistently, neuropsychological examination (e.g., MMSE, CDR) also demonstrated significant correlations between the plasma PAI-1 levels and cognitive function. In conclusion, the level of plasma PAI-1 is a potential biomarker for the early detection and diagnosis of AD.
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Affiliation(s)
- Jaeho Oh
- Division of Brain Diseases, Center for Biomedical Science, Korea National Institute of Health, Osong, Chungcheongbuk-do 361-951, South Korea
| | - Hye-Ja Lee
- Division of Metabolic Diseases, Center for Biomedical Science, Korea National Institute of Health, Osong, Chungcheongbuk-do 361-951, South Korea
| | - Ji-Hyun Song
- Division of Brain Diseases, Center for Biomedical Science, Korea National Institute of Health, Osong, Chungcheongbuk-do 361-951, South Korea
| | - Sang Ick Park
- Division of Brain Diseases, Center for Biomedical Science, Korea National Institute of Health, Osong, Chungcheongbuk-do 361-951, South Korea.
| | - Hyunyoung Kim
- Division of Brain Diseases, Center for Biomedical Science, Korea National Institute of Health, Osong, Chungcheongbuk-do 361-951, South Korea.
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Sohma H, Imai SI, Takei N, Honda H, Matsumoto K, Utsumi K, Matsuki K, Hashimoto E, Saito T, Kokai Y. Evaluation of annexin A5 as a biomarker for Alzheimer's disease and dementia with lewy bodies. Front Aging Neurosci 2013; 5:15. [PMID: 23576984 PMCID: PMC3617410 DOI: 10.3389/fnagi.2013.00015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 03/19/2013] [Indexed: 01/27/2023] Open
Abstract
Background: Alzheimer's disease (AD) differs from other forms of dementia in its relation to amyloid beta peptide (Aβ42). Using a cell culture model we previously identified annexin A5, a Ca2+, and phospholipid binding protein, as an AD biomarker. Plasma level of annexin A5 was significantly higher in AD patients compared to that in a control group. On the other hand, AD has been identified to share a number of clinical and pathological features with Dementia with Lewy bodies (DLB). The present study was done to examine whether or not plasma annexin A5 is a specific marker for AD, when being compared with the levels of DLB patients. As Apolipoprotein E (ApoE) gene subtype ε4 (ApoE-ε4) has been noticed as the probable genetic factor for AD, we also examined and compared ApoE genotype in both AD and DLB. Methods: Blood samples were obtained from 150 patients with AD (aged 77.6 ± 6.5 years), 50 patients of DLB (79.4 ± 5.0) and 279 community-dwelling healthy elderly individuals of comparable age and sex (75.6 ± 8.1). All AD patients met NINCDS-ADRDA criteria and all DLB patients were diagnosed as probable DLB according to the latest consensus diagnostic criteria. Quantification was done using the Chemiluminescent Enzyme Immunoassay (CLEIA) Technique (SphereLight assay) using the monoclonal antibodies against annexin A5. DNA genotyping of ApoE was performed by distinguishing unique combinations of Hha1 fragments of PCR-amplified genomic DNA products. Results: The plasma level of annexin A5 was significantly higher in AD patients than in the healthy individuals (control) (P < 0.0001). The plasma annexin A5 level was also significantly higher in DLB patients than in the control group (P < 0.0001). From the ROC curves with plasma annexin A5 concentrations, the mean areas under the curve were 0.863 and 0.838 for the AD/control and DLB/control, respectively. The rate of ApoE4 carrier status and the frequency of the ε4 allele were significantly higher in AD or DLB than in control and there was no significant difference between AD and DLB. Conclusions: These results suggest that both annexin A5 and ApoE4 are common markers for AD and DLB.
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Affiliation(s)
- Hitoshi Sohma
- Department of Educational Development, Center for Medical Education, Sapporo Medical University Sapporo, Japan ; Department of Biomedical Engineering, School of Medicine, Sapporo Medical University Sapporo, Japan
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Yener GG, Başar E. Brain oscillations as biomarkers in neuropsychiatric disorders: following an interactive panel discussion and synopsis. SUPPLEMENTS TO CLINICAL NEUROPHYSIOLOGY 2013; 62:343-63. [PMID: 24053048 DOI: 10.1016/b978-0-7020-5307-8.00016-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This survey covers the potential use of neurophysiological changes as a biomarker in four neuropsychiatric diseases (attention deficit hyperactivity disorder (ADHD), Alzheimer's disease (AD), bipolar disorder (BD), and schizophrenia (SZ)). Great developments have been made in the search of biomarkers in these disorders, especially in AD. Nevertheless, there is a tremendous need to develop an efficient, low-cost, potentially portable, non-invasive biomarker in the diagnosis, course, or treatment of the above-mentioned disorders. Electrophysiological methods would provide a tool that would reflect functional brain dynamic changes within milliseconds and also may be used as an ensemble of biomarkers that is greatly needed in the evaluation of cognitive changes seen in these disorders. The strategies for measuring cognitive changes include spontaneous electroencephalography (EEG), sensory evoked oscillation (SEO), and event-related oscillations (ERO). Further selective connectivity deficit in sensory or cognitive networks is reflected by coherence measurements. Possible candidate biomarkers discussed in an interactive panel can be summarized as follows: for ADHD: (a) elevation of delta and theta, (b) diminished alpha and beta responses in spontaneous EEG; for SZ: (a) decrease of ERO gamma responses, (b) decreased ERO in all other frequency ranges, (c) invariant ERO gamma response in relation to working memory demand; for euthymic BD: (a) decreased event-related gamma coherence, (b) decreased alpha in ERO and in spontaneous EEG; for manic BD: (a) lower alpha and higher beta in ERO, (b) decreased event-related gamma coherence, (c) lower alpha and beta in ERO after valproate; and for AD: (a) decreased alpha and beta, and increased theta and delta in spontaneous EEG, (b) hyperexcitability of motor cortices as shown by transcortical magnetic stimulation, (c) hyperexcitability of visual sensory cortex as indicated by increased SEO theta responses, (d) lower delta ERO, (e) lower delta, theta, and alpha event-related coherence, (f) higher theta synchrony and higher alpha event-related coherence in cholinergically treated AD subjects. In further research in the search for biomarkers, multimodal methods should be introduced to electrophysiology for validation purposes. Also, providing the protocols for standardization and harmonization of user-friendly acquisition or analysis methods that would be applied in larger cohort populations should be used to incorporate these electrophysiologic methods into the clinical criteria. In an extension to conventional anatomical, biochemical and brain imaging biomarkers, the use of neurophysiologic markers may lead to new applications for functional interpretrations and also the possibility to monitor treatments tailored for individuals.
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Affiliation(s)
- Görsev G Yener
- Brain Dynamics Multidisciplinary Research Center, Dokuz Eylül University, Izmir 35340, Turkey.
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Biomarkers in Alzheimer's disease with a special emphasis on event-related oscillatory responses. APPLICATION OF BRAIN OSCILLATIONS IN NEUROPSYCHIATRIC DISEASES - SELECTED PAPERS FROM “BRAIN OSCILLATIONS IN COGNITIVE IMPAIRMENT AND NEUROTRANSMITTERS” CONFERENCE, ISTANBUL, TURKEY, 29 APRIL–1 MAY 2011 2013; 62:237-73. [DOI: 10.1016/b978-0-7020-5307-8.00020-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Rabin LA, Wang C, Katz MJ, Derby CA, Buschke H, Lipton RB. Predicting Alzheimer's disease: neuropsychological tests, self-reports, and informant reports of cognitive difficulties. J Am Geriatr Soc 2012; 60:1128-34. [PMID: 22690986 DOI: 10.1111/j.1532-5415.2012.03956.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To investigate the independent and combined contributions to the risk of Alzheimer's disease (AD) of three important domains of cognitive assessment: neuropsychological measurement, self-reports, and informant reports. DESIGN Longitudinal, community-based sample. SETTING Einstein Aging Study. PARTICIPANTS Six hundred twenty-seven individuals without dementia aged 70 and older systematically recruited from the Bronx, New York. MEASUREMENTS Comprehensive assessment included neurological examination, behavioral questions, and neuropsychological testing. AD diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria assigned at a multidisciplinary consensus case conference. The major statistical analyses used Cox proportional hazards models (with age as the time scale) adjusted for sex, education, and depressive symptoms. RESULTS Forty-eight participants developed incident AD during a median of 3.3 years of follow-up. Self- and informant reports of cognitive status and baseline scores on tests of episodic memory and psychomotor speed predicted the onset of AD, but in models examining all the variables simultaneously, only the episodic memory tests and informant reports were associated with risk of AD. A likelihood ratio test confirmed the incremental effect of informant reports in addition to the neuropsychological test scores (P = .03). CONCLUSION Informant ratings improved the prediction of AD conversion in addition to objective memory impairment in older adults without dementia. Combining these cognitive measures may provide a useful, empirical method for identifying individuals at high risk of future AD.
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Affiliation(s)
- Laura A Rabin
- Department of Psychology, Brooklyn College and The Graduate Center, City University of New York, Brooklyn, New York 11210, USA.
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Abstract
BACKGROUND The use of informant rating scales in older adults at risk of dementia may assist with early detection and intervention strategies. This study aims to evaluate whether informants rate greater cognitive change in patients with mild cognitive impairment (MCI) compared to cognitively intact individuals, and to determine the relationship between informant ratings of cognitive change and neuropsychological performance. METHODS One hundred and nine health-seeking older adults underwent clinical and neuropsychological assessments, and informants completed the Cambridge Behavioral Inventory-Revised (CBI-R). Patients were rated according to MCI criteria, including amnestic and non-amnestic subtypes, or as being cognitively intact. CBI-R ratings were evaluated with respect to MCI diagnosis and neuropsychological performance. RESULTS Compared to cognitively intact individuals, informants rated patients with MCI as having significantly more change in overall functioning (p < 0.05) as well as in specific domains of memory and orientation (p < 0.01), everyday skills (p < 0.05), and motivation (p < 0.05), even after controlling for depressive symptom severity. In further analyses, the non-amnestic MCI subgroup only had more informant-rated mood changes compared to the amnestic subgroup. In relation to neuropsychological performance, informant ratings were related to poorer visual memory, verbal learning and memory, language, and psychomotor speed, with correlations ranging from -0.19 to -0.43 (p < 0.05). CONCLUSIONS These findings indicate that informants are sensitive to subtle early cognitive change in individuals with MCI, and that their ratings are related to objectively measured neuropsychological performance. Thus, the CBI-R may be valuable in assisting early screening and intervention processes.
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Quinn TJ, Gallacher J, Deary IJ, Lowe GDO, Fenton C, Stott DJ. Association between circulating hemostatic measures and dementia or cognitive impairment: systematic review and meta-analyzes. J Thromb Haemost 2011; 9:1475-82. [PMID: 21676170 DOI: 10.1111/j.1538-7836.2011.04403.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Hemostasis and thrombosis may be important contributors to cognitive decline and dementia. Certain blood markers may assist in diagnosis or management. OBJECTIVES To collate evidence for the association of circulating hemostatic variables and dementia or cognitive impairment. METHODS A systematic review of studies describing blood markers of hemostatic function and cognition/dementia. Abstracts were reviewed by two independent assessors and studies selected based on pre-specified criteria. We described methodological quality and performed meta-analyzes where data allowed. RESULTS From 7103 titles, 485 abstracts and included 21 studies (n = 32,773) were assessed. In two longitudinal studies, the incident of vascular dementia risk was greater for higher D-dimer [hazard ratio (HR): 1.50, 95% confidence interval (CI): 1.15-1.96]. For case-control data, we calculated standardized mean differences (SMD) and 95% CI. Higher levels of: factor (F)VII (SMD: 0.93; 95% CI: 0.60-1.26), fibrinogen (SMD: 1.53; 95% CI: 1.17-1.87), prothrombin fragment 1 and 2 (SMD: 0.64; 95% CI: 0.32-0.96), plasminogen activator inhibitor (SMD: 0.68; 95% CI: 0.26-1.10), D-dimer (SMD: 2.00; 95% CI: 1.59-2.40) and von Willebrand factor (VWF) (SMD: 1.68; 95% CI: 1.30-2.06) showed modest but significant associations with vascular dementia. For patients with any dementia diagnosis, associations were with higher D-dimer (SMD: 0.36; 95% CI: 0.15-0.56) and VWF (SMD: 0.31; 95% CI: 0.11-0.51). For specific cognitive domains, significant (P < 0.001) positive correlations were fibrinogen and speed of processing (0.76; 95% CI: 0.67-0.84), verbal memory (0.69; 95% CI: 0.59-0.79) and non-verbal reasoning (0.57; 95% CI: 0.49-0.65). CONCLUSIONS The present results suggest a modest association between hemostasis and vascular dementia including increased levels of thrombin generation markers (D-dimer and prothrombin fragment 1 + 2) and endothelial dysfunction (VWF and plasminogen activator inhibitor). Associations are weaker for specific cognitive tests and when all dementias are combined.
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Affiliation(s)
- T J Quinn
- Institute Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
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Galvin JE. Dementia screening, biomarkers and protein misfolding: Implications for public health and diagnosis. Prion 2011; 5:16-21. [PMID: 21164279 PMCID: PMC3038001 DOI: 10.4161/pri.5.1.14439] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 12/08/2010] [Indexed: 01/15/2023] Open
Abstract
Misfolded proteins are at the core of many neurodegenerative diseases, nearly all of them associated with cognitive impairment. For example Creutzfeldt-Jacob disease is associated with aggregation of prion protein, Lewy body dementia and Parkinson disease with α-synuclein and forms of frontotemporal dementia with tau, TDP 43 and host of other proteins, Alzheimer disease (AD), the most common cause of dementia, and its prodromal syndrome mild cognitive impairment (MCI) are an increasing public health problem and a diagnostic challenge to may clinicians. AD is characterized pathologically by the accumulation of amyloid β protein (Aβ) as senile plaques and in the walls of blood vessels as amyloid angiopathy. Additionally, there are accumulations of tau-protein as neurofibrillary tangles and dystrophic neurites. Biological markers of AD and MCI can serve as in vivo diagnostic indicators of underlying pathology, particularly when clinical symptoms are mild and are likely present years before the onset of clinical symptoms. Research to discover and refine fluid and imaging biomarkers of protein aggregation has undergone a rapid evolution and combined analysis of different modalities may further increase diagnostic sensitivity and specificity. Multi-center trials are now investigating whether imaging and/or cerebrospinal fluid (CSF) biomarker candidates can be used as outcome measures for use in phase III clinical trials for AD.
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Affiliation(s)
- James E Galvin
- Center of Excellence on Brain Aging, Department of Neurology, New York University Langone Medical Center, New York, NY, USA.
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