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Pilloni G, Casper TC, Mar S, Ness J, Schreiner T, Waltz M, Waubant E, Weinstock-Guttman B, Wheeler Y, Krupp L, Charvet L. Increased intraindividual variability (IIV) in reaction time is the earliest indicator of cognitive change in MS: A two-year observational study. Int J Clin Health Psychol 2024; 24:100486. [PMID: 39105175 PMCID: PMC11299566 DOI: 10.1016/j.ijchp.2024.100486] [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: 04/02/2024] [Accepted: 07/03/2024] [Indexed: 08/07/2024] Open
Abstract
Background Cognitive decline in multiple sclerosis (MS) is common, but unpredictable, and increases with disease duration. As such, early detection of cognitive decline may improve the effectiveness of interventions. To that end, the Symbol Digit Modalities Test (SDMT) is effective in detecting slow processing speed as it relates to cognitive impairment, and intraindividual variability (IIV) observed in trials assessing continuous reaction time (RT) may be a useful indicator of early cognitive changes. Here, we will assess cognitive IIV changes in adults with early MS. Methods Adults with relapsing-remitting MS (RRMS), <11 years since diagnosis, were recruited nationally. Baseline and two-year follow-up assessments included Brief International Cognitive Assessment in MS (BICAMS) and Cogstate computerized tests. Intraindividual variability in RT was calculated from psychomotor tasks and data were age-normalized. Results A total of 44 of the 66 participants completed follow-up (mean age, 34.0 ± 5.5 years; 66 % female; mean disease duration, 4.1 ± 2.9 years; median Expanded Disability Status Scale (EDSS) score, 1.5 [0 to 6.0]). Participants were grouped by SDMT z-score median split. Groups did not differ in demographics or clinical features. The higher baseline SDMT group was faster (p = 0.05) in RT and less variable (lower IIV, p = 0.001). At the two-year follow-up, the higher SDMT group showed increased variability (p = 0.05) compared to the lower SDMT group, with no significant RT or BICAMS changes. Conclusions In early MS, higher SDMT performance at baseline is associated with less cognitive variability but may indicate susceptibility to increased variability over time, highlighting the importance of monitoring IIV for early cognitive changes.
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Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Parekh Center for Interdisciplinary Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Soe Mar
- Washington University, St. Louis, MO, USA
| | - Jayne Ness
- University of Alabama, Birmingham, AL, USA
| | | | | | | | | | | | - Lauren Krupp
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Parekh Center for Interdisciplinary Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Leigh Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Parekh Center for Interdisciplinary Neurology, NYU Grossman School of Medicine, New York, NY, USA
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Podger L, Stewart WF, Serrano D, Lipton RB, Gomez-Ulloa D, Ayasse ND, Barnes FB, Davis EA, Runken MC. Application of a Novel Endpoint Staging Framework: Proof of Concept in the AMBAR Study. J Alzheimers Dis 2024; 98:1079-1094. [PMID: 38489186 DOI: 10.3233/jad-231197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Background A theoretical endpoint staging framework was previously developed and published, aligning outcomes (i.e., memory) to the stage of Alzheimer's disease (AD) in which a given outcome is most relevant (i.e., has the greatest risk of degradation). The framework guides the selection of endpoints measuring outcomes relevant within a target AD population. Here, a proof of concept is presented via post-hoc analyses of the Alzheimer Management by Albumin Replacement (AMBAR) Phase 2b clinical trial in patients with AD (NCT01561053, 2012). Objective To evaluate whether aligning endpoints measuring cognition, function, and quality of life to hypothesized 'target' stages of AD yields magnitudes of treatment efficacy greater than those reported in the AMBAR full analysis set (FAS). Methods Three endpoints were tested: ADAS-Cog 12, ADCS-ADL, and QoL-AD. The magnitude of treatment efficacy was hypothesized to be maximized in the target stages of mild, mild-to-moderate, and very mild AD, respectively, compared to the full analysis set (FAS) and non-target stages. Results For ADAS-Cog 12, the magnitude of treatment efficacy was largest in the non-target stage (-4.0, p = 0.0760) compared to target stage and FAS. For ADCS-ADL and QoL-AD, the magnitude of treatment efficacy was largest in the target stage (14.2, p = 0.0003; 2.4, p < 0.0001, respectively) compared to non-target stage and FAS. Conclusions Findings indicated that evaluating endpoints in the most relevant AD stage can increase the magnitude of the observed treatment efficacy. Evidence provides preliminary proof of concept for the endpoint staging framework.
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Affiliation(s)
| | | | | | | | | | | | | | - E Anne Davis
- Formerly Grifols SSNA, Research Triangle Park, NC, USA
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Goossens J, Cervantes González A, Dewit N, Lidón L, Fortea J, Alcolea D, Lleó A, Belbin O, Vanmechelen E. Evaluation of cerebrospinal fluid levels of synaptic vesicle protein, VAMP-2, across the sporadic Alzheimer's disease continuum. Alzheimers Res Ther 2023; 15:186. [PMID: 37898760 PMCID: PMC10612328 DOI: 10.1186/s13195-023-01336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Synapse loss is an early event that precedes neuronal death and symptom onset and is considered the best neuropathological correlate of cognitive decline in Alzheimer's disease (AD). Vesicle-associated membrane protein 2 (VAMP-2) has emerged as a promising biomarker of AD-related synapse degeneration in cerebrospinal fluid (CSF). The aim of this study was to explore the CSF profile of VAMP-2 across the AD continuum in relation to core AD biomarkers, other synaptic proteins, neurogranin (Ng) and synaptosomal-associated Protein-25 kDa (SNAP-25) and cognitive performance. METHODS We developed a digital immunoassay on the Single Molecule Array platform to quantify VAMP-2 in CSF and used existing immunoassays to quantify Ng, SNAP-25 and core CSF AD biomarkers. The clinical study included 62 cognitively unimpaired AD biomarker-negative subjects and 152 participants across the AD continuum from the SPIN cohort (Sant Pau Initiative on Neurodegeneration). Cognitive measures of episodic, semantic, executive and visuospatial domains and global cognition were included. Statistical methods included χ2 tests, spearman correlation, and ANCOVA analyses. RESULTS The VAMP-2 assay had a good analytical performance (repeatability 8.9%, intermediate precision 10.3%). Assay antibodies detected native VAMP-2 protein in human brain homogenates. CSF concentrations of VAMP-2, neurogranin and SNAP-25 were lower in preclinical AD stage 1 compared to controls and higher at later AD stages compared to AD stage 1 and were associated with core AD biomarkers, particularly total tau (adj. r2 = 0.62 to 0.78, p < 0.001). All three synaptic proteins were associated with all cognitive domains in individuals on the AD continuum (adj. r2 = 0.04 to 0.19, p < 0.05). CONCLUSIONS Our novel digital immunoassay accurately measures VAMP-2 changes in CSF, which reflect AD biomarkers and cognitive performance across multiple domains.
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Affiliation(s)
| | - Alba Cervantes González
- Sant Pau Memory Unit, Neurology Department and IIB-Sant Pau, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Nele Dewit
- Medpace Reference Laboratories (A.A.), Flow Cytometry Unit, Louvain, Belgium
| | - Laia Lidón
- Sant Pau Memory Unit, Neurology Department and IIB-Sant Pau, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Neurology Department and IIB-Sant Pau, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Daniel Alcolea
- Sant Pau Memory Unit, Neurology Department and IIB-Sant Pau, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Neurology Department and IIB-Sant Pau, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Olivia Belbin
- Sant Pau Memory Unit, Neurology Department and IIB-Sant Pau, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain.
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain.
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del Ser T, Valeriano-Lorenzo E, Jáñez-Escalada L, Ávila-Villanueva M, Frades B, Zea MA, Valentí M, Zhang L, Fernández-Blázquez MA. Dimensions of cognitive reserve and their predictive power of cognitive performance and decline in the elderly. FRONTIERS IN DEMENTIA 2023; 2:1099059. [PMID: 39081990 PMCID: PMC11285562 DOI: 10.3389/frdem.2023.1099059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 08/03/2023] [Indexed: 08/02/2024]
Abstract
Background The relative importance of different components of cognitive reserve (CR), as well as their differences by gender, are poorly established. Objective To explore several dimensions of CR, their differences by gender, and their effects on cognitive performance and trajectory in a cohort of older people without relevant psychiatric, neurologic, or systemic conditions. Methods Twenty-one variables related to the education, occupation, social activities, and life habits of 1,093 home-dwelling and cognitively healthy individuals, between 68 and 86 years old, were explored using factorial analyses to delineate several dimensions of CR. These dimensions were contrasted with baseline cognitive performance, follow-up over 5 years of participants' cognitive trajectory, conversion to mild cognitive impairment (MCI), and brain volumes using regression and growth curve models, controlling for gender, age, marital status, number of medications, trait anxiety, depression, and ApoE genotype. Results Five highly intercorrelated dimensions of CR were identified, with some differences in their structure and effects based on gender. Three of them, education/occupation, midlife cognitive activities, and leisure activities, were significantly associated with late-life cognitive performance, accounting for more than 20% of its variance. The education/occupation had positive effect on the rate of cognitive decline during the 5-year follow up in individuals with final diagnosis of MCI but showed a reduced risk for MCI in men. None of these dimensions showed significant relationships with gray or white matter volumes. Conclusion Proxy markers of CR can be represented by five interrelated dimensions. Education/occupation, midlife cognitive activities, and leisure activities are associated with better cognitive performance in old age and provide a buffer against cognitive impairment. Education/occupation may delay the clinical onset of MCI and is also associated with the rate of change in cognitive performance.
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Affiliation(s)
- Teodoro del Ser
- Clinical Department, Alzheimer's Center Reina Sofia—CIEN Foundation, Madrid, Spain
| | | | - Luis Jáñez-Escalada
- Clinical Department, Alzheimer's Center Reina Sofia—CIEN Foundation, Madrid, Spain
- Institute of Knowledge Technology, Complutense University, Madrid, Spain
| | | | - Belén Frades
- Clinical Department, Alzheimer's Center Reina Sofia—CIEN Foundation, Madrid, Spain
| | - María-Ascensión Zea
- Clinical Department, Alzheimer's Center Reina Sofia—CIEN Foundation, Madrid, Spain
| | - Meritxell Valentí
- Clinical Department, Alzheimer's Center Reina Sofia—CIEN Foundation, Madrid, Spain
| | - Linda Zhang
- Neuroimaging Department, Alzheimer's Center Reina Sofia—CIEN Foundation, Madrid, Spain
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Jutten RJ, Papp KV, Hendrix S, Ellison N, Langbaum JB, Donohue MC, Hassenstab J, Maruff P, Rentz DM, Harrison J, Cummings J, Scheltens P, Sikkes SAM. Why a clinical trial is as good as its outcome measure: A framework for the selection and use of cognitive outcome measures for clinical trials of Alzheimer's disease. Alzheimers Dement 2023; 19:708-720. [PMID: 36086926 PMCID: PMC9931632 DOI: 10.1002/alz.12773] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/29/2022] [Accepted: 07/22/2022] [Indexed: 11/11/2022]
Abstract
A crucial aspect of any clinical trial is using the right outcome measure to assess treatment efficacy. Compared to the rapidly evolved understanding and measurement of pathophysiology in preclinical and early symptomatic stages of Alzheimer's disease (AD), relatively less progress has been made in the evolution of clinical outcome assessments (COAs) for those stages. The current paper aims to provide a benchmark for the design and evaluation of COAs for use in early AD trials. We discuss lessons learned on capturing cognitive changes in predementia stages of AD, including challenges when validating novel COAs for those early stages and necessary evidence for their implementation in clinical trials. Moving forward, we propose a multi-step framework to advance the use of more effective COAs to assess clinically meaningful changes in early AD, which will hopefully contribute to the much-needed consensus around more appropriate outcome measures to assess clinical efficacy of putative treatments. HIGHLIGHTS: We discuss lessons learned on capturing cognitive changes in predementia stages of AD. We propose a framework for the design and evaluation of performance based cognitive tests for use in early AD trials. We provide recommendations to facilitate the implementation of more effective cognitive outcome measures in AD trials.
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Affiliation(s)
- Roos J. Jutten
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn V. Papp
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Michael C. Donohue
- Alzheimer’s Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego, California, USA
| | - Jason Hassenstab
- Knight Alzheimer Disease Research Center, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Paul Maruff
- Cogstate Ltd., Melbourne, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Dorene M. Rentz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John Harrison
- Metis Cognition Ltd., Kilmington, UK
- Department of Psychiatry, Psychology & Neuroscience, King’s College London, UK
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, location VUmc, VU University, Amsterdam, The Netherlands
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, Nevada, USA
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, location VUmc, VU University, Amsterdam, The Netherlands
| | - Sietske A. M. Sikkes
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, location VUmc, VU University, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Movement and Behavioral Sciences, VU University, Amsterdam, The Netherlands
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Guevara JE, Kurniadi NE, Duff K. Assessing Longitudinal Cognitive Change in Mild Cognitive Impairment Using Estimated Standardized Regression-Based Formulas. J Alzheimers Dis 2023; 95:509-521. [PMID: 37545235 DOI: 10.3233/jad-230160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Cognitive change in mild cognitive impairment (MCI), a likely prodrome to Alzheimer's disease, can be tracked with repeated neuropsychological assessments, but there has been little work quantifying these changes over time. Cognitive change can be statistically examined using standardized regression-based (SRB) formulas, which yield a z-score indicating amount of change compared to a normative group. OBJECTIVE To use SRB z-scores to quantify cognitive change in a sample of patients classified as MCI at baseline, and to compare cognitive change in those who remained MCI on follow-up (MCI-Stable) and those who progressed to dementia (MCI-Decline). METHODS Using 283 MCI patients from a cognitive disorders clinic who were re-assessed after approximately one- and one-half years, SRB z-scores were calculated for each test in a comprehensive neuropsychological battery for each participant. RESULTS There was a significant decline between timepoints across all cognitive tests, with the greatest amount of decline on tests of learning and memory. Group differences were seen on nearly all cognitive tests, with the MCI-Decline group showing more decline (i.e., significantly larger and negative z-scores) than the MCI-Stable participants. Notable cognitive decline was also observed in the MCI-Stable group, with z-scores ranging from -0.01 - -2.24 compared to normative data. CONCLUSION This study highlights the amount of cognitive decline that occurs in MCI, including for those who remain "stable" and those who progress to dementia. It also demonstrates the value of the SRB method in more clearly quantifying cognitive decline, which may help identify individuals most vulnerable to MCI progression.
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Affiliation(s)
- Jasmin E Guevara
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Natalie E Kurniadi
- Advanced Neurobehavioral Health of Southern California, San Diego, CA, USA
| | - Kevin Duff
- Department of Neurology, Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
- Department of Neurology, Center for Alzheimer's Care, Imaging, and Research, University of Utah, Salt Lake City, UT, USA
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Li P, Ma S, Ma X, Ding D, Zhu X, Zhang H, Liu J, Mu J, Zhang M. Reversal of neurovascular decoupling and cognitive impairment in patients with end-stage renal disease during a hemodialysis session: Evidence from a comprehensive fMRI analysis. Hum Brain Mapp 2022; 44:989-1001. [PMID: 36269166 PMCID: PMC9875915 DOI: 10.1002/hbm.26122] [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: 05/22/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 01/28/2023] Open
Abstract
Neurovascular (NV) decoupling is a potential neuropathologic mechanism of cognitive impairment in patients with end-stage renal disease (ESRD). Hemodialysis improves cognitive impairment at 24 h post-dialysis, which suggests a potential neuroprotective effect of hemodialysis treatment on the brain. We investigated the effects of hemodialysis treatment on the reversal of NV decoupling associated with cognitive improvement. A total of 39 patients with ESRD and 39 healthy controls were enrolled. All patients were imaged twice during a dialysis session: before hemodialysis (T1pre-dialysis ) and at 24 h after dialysis (T2post-dialysis ). The healthy controls were imaged once. NV coupling was characterized based on correlation coefficients between four types of blood oxygen level-dependent signals and cerebral blood flow (CBF). A battery of neuropsychological and blood tests was performed before the imaging. Patients with ESRD showed improvements in memory and executive function at T2post-dialysis compared with that at T1pre-dialysis . At both T1pre-dialysis and T2post-dialysis , patients with ESRD had lower amplitude of low-frequency fluctuation (ALFF)-CBF coupling than healthy controls. Additionally, patients with ESRD had higher ALFF-CBF coupling at T2post-dialysis than at T1pre-dialysis . Higher memory scores, higher hemoglobin level, lower total plasma homocysteine level, lower systolic blood pressure variance, and lower ultrafiltration volume were associated with higher ALFF-CBF coupling in patients with ESRD after a hemodialysis session. These findings indicate that partial correction of anemia and hyperhomocysteinemia, stable systolic blood pressure, and fluid restriction may be closely linked to the reversal of NV decoupling and improvement in cognition in patients with ESRD.
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Affiliation(s)
- Peng Li
- Department of Medical ImagingFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina,Department of Medical ImagingNuclear Industry 215 Hospital of Shaanxi ProvinceXianyangShaanxiChina
| | - Shaohui Ma
- Department of Medical ImagingFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Xueying Ma
- Department of Medical ImagingThe Affiliated Hospital of Inner Mongolia Medical UniversityHohhotInner MongoliaChina
| | - Dun Ding
- Department of Medical ImagingSecond Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Xinyi Zhu
- Department of Medical ImagingFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Huawen Zhang
- Department of Medical ImagingNuclear Industry 215 Hospital of Shaanxi ProvinceXianyangShaanxiChina
| | - Jixin Liu
- Center for Brain ImagingSchool of Life Science and Technology, Xidian UniversityXi'anChina
| | - Junya Mu
- Department of Medical ImagingFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Ming Zhang
- Department of Medical ImagingFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
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Zhang X, Wu Y, He Y, Ge X, Cui J, Han H, Luo Y, Liu L, Wang Z, Yu H. Metrological properties of neuropsychological tests for measuring cognitive change in individuals with prodromal Alzheimer's disease. Aging Ment Health 2022; 26:1988-1996. [PMID: 34409904 DOI: 10.1080/13607863.2021.1966746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES In Alzheimer's Disease (AD) research, choosing appropriate method for measuring change in cognitive function over time can be challenging. The aim for this study was to examine the sensitivity of four neuropsychological tests used to measure cognition during the transition from mild cognitive impairment (MCI) to AD, and the impacts of associated covariates. METHODS We enrolled 223 patients with MCI who progressed to AD and had completed multiple follow-up assessments in the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. We constructed nonlinear mixed model for multivariate longitudinal data assuming that multiple neuropsychological tests would exhibit nonlinear transformation of a common factor in the latent cognitive process underlying the progression from MCI to AD. RESULTS The Clinical Dementia Rating-Sum of the Boxes (CDR-SB) and Alzheimer's Disease Assessment Scale (11 items; ADAS-11) were more sensitive to cognitive changes in individuals with higher cognitive function, the Functional Activities Questionnaire (FAQ) was more sensitive to cognitive changes in individuals with middle cognitive function, and the Mini-Mental State Examination (MMSE) was more sensitive to cognitive changes in individuals with lower cognitive function. Gender (p = 0.0139) and educational level (p = 0.0094) had varying effects on different tests, such that men performed better on the FAQ and CDR-SB, and individuals with higher educational level tended to perform better on the FAQ and MMSE. CONCLUSIONS When choosing appropriate neuropsychological tests in cognitive measurements, the cognitive functional level of the patient as well as the impacts of covariates should be considered.
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Affiliation(s)
- Xinnan Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yan Wu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yao He
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xiaoyan Ge
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jing Cui
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Hongjuan Han
- bDepartment of Mathematics, School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Yanhong Luo
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Long Liu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Zhixin Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Hongmei Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China.,Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, China
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Flo BK, Matziorinis AM, Skouras S, Sudmann TT, Gold C, Koelsch S. Study protocol for the Alzheimer and music therapy study: An RCT to compare the efficacy of music therapy and physical activity on brain plasticity, depressive symptoms, and cognitive decline, in a population with and at risk for Alzheimer's disease. PLoS One 2022; 17:e0270682. [PMID: 35771851 PMCID: PMC9246122 DOI: 10.1371/journal.pone.0270682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There is anecdotal evidence for beneficial effects of music therapy in patients with Alzheimer's Disease (AD). However, there is a lack of rigorous research investigating this issue. The aim of this study is to evaluate the effects of music therapy and physical activity on brain plasticity, mood, and cognition in a population with AD and at risk for AD. METHODS One-hundred and thirty-five participants with memory complaints will be recruited for a parallel, three-arm Randomized Controlled Trial (RCT). Inclusion criteria are a diagnosis of mild (early) AD or mild cognitive impairment (MCI), or memory complaints without other neuropsychiatric pathology. Participants are randomised into either a music therapy intervention (singing lessons), an active control group (physical activity) or a passive control group (no intervention) for 12 months. The primary outcomes are the brain age gap, measured via magnetic resonance imaging (MRI), and depressive symptoms. Secondary outcomes include cognitive performance, activities of daily living, brain structure (voxel-based morphometry and diffusion tensor imaging), and brain function (resting-state functional MRI). TRIAL STATUS Screening of participants began in April 2018. A total of 84 participants have been recruited and started intervention, out of which 48 participants have completed 12 months of intervention and post-intervention assessment. DISCUSSION Addressing the need for rigorous longitudinal data for the effectiveness of music therapy in people with and at risk for developing AD, this trial aims to enhance knowledge regarding cost-effective interventions with potentially high clinical applicability. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03444181, registered on February 23, 2018.
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Affiliation(s)
- Birthe K. Flo
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | | | - Stavros Skouras
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | | | - Christian Gold
- NORCE Norwegian Research Centre AS, Bergen, Norway
- Grieg Academy Department of Music, University of Bergen, Bergen, Norway
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - Stefan Koelsch
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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Behl T, Kaur D, Sehgal A, Singh S, Makeen HA, Albratty M, Abdellatif AAH, Dachani SR, Bungau S. Exploring the potential role of rab5 protein in endo-lysosomal impairment in Alzheimer's disease. Biomed Pharmacother 2022; 148:112773. [PMID: 35245734 DOI: 10.1016/j.biopha.2022.112773] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/18/2022] [Accepted: 02/27/2022] [Indexed: 11/02/2022] Open
Abstract
Growing evidence suggests that neuronal dysfunction in the endo-lysosomal and autophagic processes contributes to the onset and progression of neurodegenerative diseases such as Alzheimer's disease (AD). Since they are the primary cellular systems involved in the production and clearance of aggregated amyloid plaques, endo-lysosomal or autophagic equilibrium must be maintained throughout life. As a result, variations in the autophagic and endo-lysosomal torrent, as a measure of degenerative function in these sections or pathways, may have a direct impact on disease-related processes, such as Aß clearance from the brain and interneuronal deposition of Aß and tau aggregates, thus disrupting synaptic plasticity. The discovery of several chromosomal factors for Alzheimer's disease that are clinically linked to regulation of the endocytic pathway, including protein aggregation and removal, supports the theory that the endo-lysosomal/autophagic torrent is more susceptible to impairment, especially as people age, thus catalysing the onset of disease. Although the role of endo-lysosomal/autophagic dysfunction in neurodegeneration has progressed in recent years, the field remains underdeveloped. Because of its possible therapeutic implications in Alzheimer's disease, further study is needed to explain the possibilities for effective autophagy regulation.
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Affiliation(s)
- Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India.
| | - Dapinder Kaur
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India
| | - Aayush Sehgal
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India
| | - Sukhbir Singh
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India
| | - Hafiz A Makeen
- Pharmacy Practice Research Unit, Clinical Pharmacy, Department, College of Pharmacy, Jazan University, P.O. Box-114, Jazan 45142, Saudi Arabia
| | - Mohammed Albratty
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jazan University, P.O. Box 114, Jazan 45142, Saudi Arabia
| | - Ahmed A H Abdellatif
- Department of Pharmaceutics, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt
| | - Sudharshan Reddy Dachani
- Department of Pharmacy Practice & Pharmacology, College of Pharmacy, Shaqra University, Al-Dawadmi Campus, Al-Dawadmi 11961, Saudi Arabia
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.
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11
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De Simone MS, Perri R, Rodini M, Fadda L, De Tollis M, Caltagirone C, Carlesimo GA. A Lack of Practice Effects on Memory Tasks Predicts Conversion to Alzheimer Disease in Patients With Amnestic Mild Cognitive Impairment. J Geriatr Psychiatry Neurol 2021; 34:582-593. [PMID: 32734799 DOI: 10.1177/0891988720944244] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The aim of the current study was to test the accuracy of practice effects, that is, improvement in test performance due to repeated neuropsychological evaluations, in identifying patients with amnestic mild cognitive impairment (a-MCI) at greater risk of conversion to Alzheimer disease (AD). For this purpose, we conducted a longitudinal study of 54 patients diagnosed with a-MCI at the first assessment and followed-up for 4 years. During this time, 18 patients converted to AD. Baseline and 6- to 12-month follow-up performances on a large set of neuropsychological tests were analyzed to determine their diagnostic ability to predict later conversion to dementia. Results demonstrate that a lack of practice effects on episodic memory tests is an accurate prognostic indicator of late conversion to AD in a-MCI patients. In fact, even though the performance of both groups was substantially comparable at the baseline evaluation, stable a-MCI patients greatly improved their memory performance at retest after 6 to 12 months; instead, scores of converter a-MCI remained stable or decreased passing from baseline to follow-up. Standardized z-change scores on memory tasks, which were computed as a reliable measure of performance change, classified group membership with very good overall accuracy, which was higher than the classification of converter and stable a-MCIs provided by baseline or follow-up scores. We hypothesize that the lack of practice effects on memory tasks mirrors the early involvement of medial temporal lobe areas in converter a-MCI that are fundamental for the consolidation of new memory traces.
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Affiliation(s)
| | - Roberta Perri
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Marta Rodini
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Lucia Fadda
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Massimo De Tollis
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Carlo Caltagirone
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni Augusto Carlesimo
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, Tor Vergata University, Rome, Italy
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12
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Mura T, Coley N, Amieva H, Berr C, Gabelle A, Ousset PJ, Vellas B, Andrieu S. Cognitive decline as an outcome and marker of progression toward dementia, in early preventive trials. Alzheimers Dement 2021; 18:676-687. [PMID: 34482607 DOI: 10.1002/alz.12431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 05/05/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Recent Food and Drug Administration guidance endorses cognitive assessment as a possible primary endpoint for early trials for Alzheimer's disease but emphasizes the need for certainty regarding the relationship with progression to dementia. METHODS We compared the validity of the 2-year change (Y0-Y2) of 11 markers of neuropsychological and functional abilities for the prediction of incident dementia over the following 3 years (Y2-Y5), in 860 subjects aged 70 years or older, who consulted for memory loss and were included in the "GuidAge" prevention trial. RESULTS The Free and Cued Selective Reminding Test-Free Recall (FCSRT-FR) score showed the most predictive 2-year change (area under the curve = 0.72 95% confidence interval = 0.64;0.81). Changes in other subscores of the FCSRT, verbal fluencies tasks, and composite cognitive score were also significantly predictive. Conversely, 2-year change of Mini-Mental State Examination, Trail Making test (TMT)-A, TMT-B, Clinical Dementia Rating Sum of Boxes, and Instrumental Activities of Daily Living scores did not significantly predict occurrence of dementia. CONCLUSION The FCSRT, the Fluency Task, and the composite cognitive score appear to be good cognitive markers of progression toward dementia in early prevention trials.
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Affiliation(s)
- Thibault Mura
- INSERM-University of Toulouse, UMR1027, Toulouse, France.,Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France.,Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, University of Montpellier, Nimes, France
| | - Nicola Coley
- INSERM-University of Toulouse, UMR1027, Toulouse, France.,Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France
| | - Hélène Amieva
- Inserm U1219 Bordeaux Population Health Center, Université de Bordeaux, Bordeaux, France
| | - Claudine Berr
- INSERM-University of Montpellier, U1061, Montpellier, France.,Memory Resources and Research Center, Department of Neurology, Gui de Chauliac University Hospital, Montpellier, France
| | - Audrey Gabelle
- INSERM-University of Montpellier, U1061, Montpellier, France.,Memory Resources and Research Center, Department of Neurology, Gui de Chauliac University Hospital, Montpellier, France
| | - Pierre-Jean Ousset
- INSERM-University of Toulouse, UMR1027, Toulouse, France.,Department of Geriatric Medicine, CHU Toulouse, Gerontopole, Toulouse, France
| | - Bruno Vellas
- INSERM-University of Toulouse, UMR1027, Toulouse, France.,Department of Geriatric Medicine, CHU Toulouse, Gerontopole, Toulouse, France
| | - Sandrine Andrieu
- INSERM-University of Toulouse, UMR1027, Toulouse, France.,Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France
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13
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Piccininni C, Quaranta D, Gainotti G, Lacidogna G, Guglielmi V, Giovannini S, Marra C. The Destiny of Multiple Domain Amnesic Mild Cognitive Impairment: Effect of Alternative Neuropsychological Definitions and Their Adjunctive Role in Respect of Memory Impairment. Arch Clin Neuropsychol 2021; 36:702-710. [PMID: 33313637 DOI: 10.1093/arclin/acaa094] [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] [Received: 09/13/2019] [Revised: 05/19/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Mild cognitive impairment is the main risk factor of dementia. Previous evidence has claimed that subjects with memory disturbances associated with impairment of other cognitive domains (multiple domain amnesic MCI) are at the highest risk of developing dementia. To date, a shared definition of amnesic MCI multiple domain (aMCI-MD) is still lacking. METHOD 163 subjects with aMCI were enrolled and followed-up for 2 years. They underwent a baseline comprehensive neuropsychological battery. The cut-off point for each test was set at 1, 1.5, and 2 SD below the mean obtained in normative studies; aMCI-MD was defined as the occurrence of abnormal scores on at least one, two, or three tests not assessing memory. The Episodic Memory Score (EMS), that measures the severity of memory impairment, was determined. Logistic regressionand Cox's proportional hazard risk models were carried out. The adjunctive effect of the definitions of aMCI-MD on the severity of memory impairment was assessed. RESULTS Fifty-four subjects progressed to dementia. Only restrictive definitions of aMCI-MD (at least three tests below 1.5 SD; at least two tests below 2 SD) predicted conversion to dementia in both logistic regression and survival analysis. None of the conditions showed a significant adjunctive effect on the EMS. CONCLUSIONS The predictive effect of impairment in tests assessing cognitive domains other than memory depends on its psychometric definition. The use of a restrictive definition would be of some usefulness, but the adjunctive effect of such a definition on an integrated analysis of memory impairment may be questionable.
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Affiliation(s)
- Chiara Piccininni
- Departement of Neuroscience, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Davide Quaranta
- Institute of Neurology, IRCCS Policlinico Universitario "A. Gemelli", Roma, Italy
| | - Guido Gainotti
- Institute of Neurology, IRCCS Policlinico Universitario "A. Gemelli", Roma, Italy
| | - Giordano Lacidogna
- Institute of Neurology, IRCCS Policlinico Universitario "A. Gemelli", Roma, Italy
| | - Valeria Guglielmi
- Departement of Neuroscience, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Silvia Giovannini
- Institute of Geriatrics, IRCCS Policlinico Universitario "A. Gemelli", Roma, Italy
| | - Camillo Marra
- Departement of Neuroscience, Università Cattolica del Sacro Cuore, Roma, Italy.,Institute of Neurology, IRCCS Policlinico Universitario "A. Gemelli", Roma, Italy
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14
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Grober E, Qi Q, Kuo L, Hassenstab J, Perrin RJ, Lipton RB. Stages of Objective Memory Impairment Predict Alzheimer's Disease Neuropathology: Comparison with the Clinical Dementia Rating Scale-Sum of Boxes. J Alzheimers Dis 2021; 80:185-195. [PMID: 33492286 PMCID: PMC8075392 DOI: 10.3233/jad-200946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The ultimate validation of a clinical marker for Alzheimer's disease (AD) is its association with AD neuropathology. OBJECTIVE To examine how well the Stages of Objective Memory Impairment (SOMI) system predicts intermediate/high AD neuropathologic change and extent of neurofibrillary tangle (NFT) pathology defined by Braak stage, in comparison to the Clinical Dementia Rating (CDR) Scale sum of boxes (CDR-SB). METHODS 251 well-characterized participants from the Knight ADRC clinicopathologic series were classified into SOMI stage at their last assessment prior to death using the free recall and total recall scores from the picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT + IR). Logistic regression models assessed the predictive validity of SOMI and CDR-SB for intermediate/high AD neuropathologic change. Receiver operating characteristics (ROC) analysis evaluated the discriminative validity of SOMI and CDR-SB for AD pathology. Ordinal logistic regression was used to predict Braak stage using SOMI and CDR-SB in separate and joint models. RESULTS The diagnostic accuracy of SOMI for AD diagnosis was similar to that of the CDR-SB (AUC: 85%versus 83%). In separate models, both SOMI and CDR-SB predicted Braak stage. In a joint model SOMI remained a significant predictor of Braak stage but CDR-SB did not. CONCLUSION SOMI provides a neuropathologically validated staging system for episodic memory impairment in the AD continuum and should be useful in predicting tau positivity based on its association with Braak stage.
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Affiliation(s)
- Ellen Grober
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Qi Qi
- Department of Statistics, University of Connecticut, CT, USA
| | - Lynn Kuo
- Department of Statistics, University of Connecticut, CT, USA
| | - Jason Hassenstab
- Knight Alzheimer Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard J Perrin
- Knight Alzheimer Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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15
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Grober E, Qi Q, Kuo L, Hassenstab J, Perrin RJ, Lipton RB. The Free and Cued Selective Reminding Test Predicts Braak Stage. J Alzheimers Dis 2021; 80:175-183. [PMID: 33492287 PMCID: PMC8075386 DOI: 10.3233/jad-200980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: The ultimate validation of a clinical marker for Alzheimer’s disease (AD) is its association with AD neuropathology. Objective: To identify clinical measures that predict pathology, we evaluated the relationships of the picture version of the Free and Cued Selective Reminding Test (pFCSRT + IR), the Mini-Mental State Exam (MMSE), and the Clinical Dementia Rating scale Sum of Boxes (CDR-SB) to Braak stage. Methods: 315 cases from the clinicopathologic series at the Knight Alzheimer’s Disease Research Center were classified according to Braak stage. Boxplots of each predictor were compared to identify the earliest stage at which decline was observed and ordinal logistic regression was used to predict Braak stage. Results: Looking at the assessment closest to death, free recall scores were lower in individuals at Braak stage III versus Braak stages 0 and I (combined) while MMSE and CDR scores for individuals did not differ from Braak stages 0/I until Braak stage IV. The sum of free recall and total recall scores independently predicted Braak stage and had higher predictive validity than MMSE and CDR-SB in models including all three. Conclusion: pFCSRT + IR scores may be more sensitive to early pathological changes than either the CDR-SB or the MMSE.
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Affiliation(s)
- Ellen Grober
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Qi Qi
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Lynn Kuo
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Jason Hassenstab
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard J Perrin
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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16
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Dubbelman MA, Jutten RJ, Tomaszewski Farias SE, Amariglio RE, Buckley RF, Visser PJ, Rentz DM, Johnson KA, Properzi MJ, Schultz A, Donovan N, Gatchell JR, Teunissen CE, Van Berckel BNM, Van der Flier WM, Sperling RA, Papp KV, Scheltens P, Marshall GA, Sikkes SAM. Decline in cognitively complex everyday activities accelerates along the Alzheimer's disease continuum. Alzheimers Res Ther 2020; 12:138. [PMID: 33121534 PMCID: PMC7597034 DOI: 10.1186/s13195-020-00706-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Impairment in daily functioning is a clinical hallmark of dementia. Difficulties with "instrumental activities of daily living" (IADL) seem to increase gradually over the course of Alzheimer's disease (AD), before dementia onset. However, it is currently not well established how difficulties develop along the preclinical and prodromal stages of AD. We aimed to investigate the trajectories of decline in IADL performance, as reported by a study partner, along the early stages of AD. METHODS In a longitudinal multicenter study, combining data from community-based and memory clinic cohorts, we included 1555 individuals (mean age 72.5 ± 7.8 years; 50% female) based on availability of amyloid biomarkers, longitudinal IADL data, and clinical information at baseline. Median follow-up duration was 2.1 years. All amyloid-positive participants (n = 982) were classified into the National Institute on Aging-Alzheimer's Association (NIA-AA) clinical stages ranging from preclinical AD (1) to overt dementia (4+). Cognitively normal amyloid-negative individuals (n = 573) served as a comparison group. The total scores of three study-partner reported IADL questionnaires were standardized. RESULTS The rate of decline in cognitively normal (stage 1) individuals with and without abnormal amyloid did not differ (p = .453). However, from stage 2 onwards, decline was significantly faster in individuals on the AD continuum (B [95%CI] = - 0.32 [- 0.55, - 0.09], p = .007). The rate of decline increased with each successive stage: one standard deviation (SD) unit per year in stage 3 (- 1.06 [- 1.27, - 0.85], p < .001) and nearly two SD units per year in stage 4+ (1.93 [- 2.19, - 1.67], p < .001). Overall, results were similar between community-based and memory clinic study cohorts. CONCLUSIONS Our results suggest that the rate of functional decline accelerates along the AD continuum, as shown by steeper rates of decline in each successive NIA-AA clinical stage. These results imply that incremental changes in function are a meaningful measure for early disease monitoring. Combined with the low-cost assessment, this advocates the use of these functional questionnaires for capturing the effects of early AD-related cognitive decline on daily life.
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Affiliation(s)
- Mark A Dubbelman
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Roos J Jutten
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | | | - Rebecca E Amariglio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel F Buckley
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Pieter Jelle Visser
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Dorene M Rentz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J Properzi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron Schultz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nancy Donovan
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer R Gatchell
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bart N M Van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wiesje M Van der Flier
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathryn V Papp
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Philip Scheltens
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Gad A Marshall
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sietske A M Sikkes
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Clinical, Neuro- & Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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17
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O'Connor A, Weston PSJ, Pavisic IM, Ryan NS, Collins JD, Lu K, Crutch SJ, Alexander DC, Fox NC, Oxtoby NP. Quantitative detection and staging of presymptomatic cognitive decline in familial Alzheimer's disease: a retrospective cohort analysis. Alzheimers Res Ther 2020; 12:126. [PMID: 33023653 PMCID: PMC7539456 DOI: 10.1186/s13195-020-00695-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/17/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Understanding the earliest manifestations of Alzheimer's disease (AD) is key to realising disease-modifying treatments. Advances in neuroimaging and fluid biomarkers have improved our ability to identify AD pathology in vivo. The critical next step is improved detection and staging of early cognitive change. We studied an asymptomatic familial Alzheimer's disease (FAD) cohort to characterise preclinical cognitive change. METHODS Data included 35 asymptomatic participants at 50% risk of carrying a pathogenic FAD mutation. Participants completed a multi-domain neuropsychology battery. After accounting for sex, age and education, we used event-based modelling to estimate the sequence of cognitive decline in presymptomatic FAD, and uncertainty in the sequence. We assigned individuals to their most likely model stage of cumulative cognitive decline, given their data. Linear regression of estimated years to symptom onset against model stage was used to estimate the timing of preclinical cognitive decline. RESULTS Cognitive change in mutation carriers was first detected in measures of accelerated long-term forgetting, up to 10 years before estimated symptom onset. Measures of subjective cognitive decline also revealed early abnormalities. Our data-driven model demonstrated subtle cognitive impairment across multiple cognitive domains in clinically normal individuals on the AD continuum. CONCLUSIONS Data-driven modelling of neuropsychological test scores has potential to differentiate cognitive decline from cognitive stability and to estimate a fine-grained sequence of decline across cognitive domains and functions, in the preclinical phase of Alzheimer's disease. This can improve the design of future presymptomatic trials by informing enrichment strategies and guiding the selection of outcome measures.
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Affiliation(s)
- Antoinette O'Connor
- Dementia Research Centre, UCL Queen Square Institute Of Neurology, 8-11 Queen Square, London, WC1N 3AR, UK. antoinette.o'
- UK Dementia Research Institute at UCL, UCL, London, UK. antoinette.o'
| | - Philip S J Weston
- Dementia Research Centre, UCL Queen Square Institute Of Neurology, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Ivanna M Pavisic
- Dementia Research Centre, UCL Queen Square Institute Of Neurology, 8-11 Queen Square, London, WC1N 3AR, UK
- UK Dementia Research Institute at UCL, UCL, London, UK
| | - Natalie S Ryan
- Dementia Research Centre, UCL Queen Square Institute Of Neurology, 8-11 Queen Square, London, WC1N 3AR, UK
- UK Dementia Research Institute at UCL, UCL, London, UK
| | - Jessica D Collins
- Dementia Research Centre, UCL Queen Square Institute Of Neurology, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Kirsty Lu
- Dementia Research Centre, UCL Queen Square Institute Of Neurology, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute Of Neurology, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Daniel C Alexander
- Department of Computer Science, UCL Centre for Medical Image Computing, 1st Floor, 90 High Holborn, London, WC1V 6LJ, UK
| | - Nick C Fox
- Dementia Research Centre, UCL Queen Square Institute Of Neurology, 8-11 Queen Square, London, WC1N 3AR, UK
- UK Dementia Research Institute at UCL, UCL, London, UK
| | - Neil P Oxtoby
- Department of Computer Science, UCL Centre for Medical Image Computing, 1st Floor, 90 High Holborn, London, WC1V 6LJ, UK.
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18
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Brice S, Jabouley A, Reyes S, Machado C, Rogan C, Dias-Gastellier N, Chabriat H, du Montcel ST. Modeling the Cognitive Trajectory in CADASIL. J Alzheimers Dis 2020; 77:291-300. [PMID: 32804128 DOI: 10.3233/jad-200310] [Citation(s) in RCA: 4] [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 For developing future clinical trials in Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), it seems crucial to study the long-term changes of cognition. OBJECTIVE We aimed to study the global trajectory of cognition, measured by the Mini-Mental State Examination (MMSE) and the Mattis Dementia Rating Scale (MDRS), along the course of CADASIL. METHODS Follow-up data of 185 CADASIL patients, investigated at the French National Referral center CERVCO from 2003, were considered for analysis based on strict inclusion criteria. Assuming that the MMSE and the MDRS provide imprecise measures of cognition, the trajectory of a common cognitive latent process during follow-up was delineated using a multivariate latent process mixed model. After adjustment of this model for sex and education, the sensitivities of the two scales to cognitive change were compared. RESULTS Analysis of the cognitive trajectory over a time frame of 60 years of age showed a decrease of performances with aging, especially after age of 50 years. This decline was not altered by sex or education but patients who graduated from high school had a higher mean cognitive level at baseline. The sensitivities of MMSE and MDRS scales were similar and the two scales suffered from a ceiling effect and curvilinearity. CONCLUSION These data support that cognitive decline is not linear and mainly occurs after the age of 50 years during the course of CADASIL. They also showed that MMSE and MDRS scales are hampered by major limitations for longitudinal studies.
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Affiliation(s)
- Sandrine Brice
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Aude Jabouley
- Département de Neurologie, Centre de référence CERVCO, Hôpital Lariboisière, AP-HP, Université Paris 7 Denis Diderot, Paris, France
| | - Sonia Reyes
- Département de Neurologie, Centre de référence CERVCO, Hôpital Lariboisière, AP-HP, Université Paris 7 Denis Diderot, Paris, France
| | - Carla Machado
- Département de Neurologie, Centre de référence CERVCO, Hôpital Lariboisière, AP-HP, Université Paris 7 Denis Diderot, Paris, France
| | - Christina Rogan
- Département de Neurologie, Centre de référence CERVCO, Hôpital Lariboisière, AP-HP, Université Paris 7 Denis Diderot, Paris, France
| | - Nathalie Dias-Gastellier
- Département de Neurologie, Centre de référence CERVCO, Hôpital Lariboisière, AP-HP, Université Paris 7 Denis Diderot, Paris, France
| | - Hugues Chabriat
- Département de Neurologie, Centre de référence CERVCO, Hôpital Lariboisière, AP-HP, Université Paris 7 Denis Diderot, Paris, France.,INSERM, Unité Mixte de Recherche 1161, Paris, France
| | - Sophie Tezenas du Montcel
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
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19
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Mowrey WB, Lipton RB, Katz MJ, Ramratan WS, Loewenstein DA, Zimmerman ME, Buschke H. Memory Binding Test Predicts Incident Dementia: Results from the Einstein Aging Study. J Alzheimers Dis 2019; 62:293-304. [PMID: 29439336 DOI: 10.3233/jad-170714] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Memory Binding Test (MBT) demonstrated good cross-sectional discriminative validity and predicted incident aMCI. OBJECTIVE To assess whether the MBT predicts incident dementia better than a conventional list learning test in a longitudinal community-based study. METHODS As a sub-study in the Einstein Aging Study, 309 participants age≥70 initially free of dementia were administered the MBT and followed annually for incident dementia for up to 13 years. Based on previous work, poor memory binding was defined using an optimal empirical cut-score of≤17 on the binding measure of the MBT, Total Items in the Paired condition (TIP). Cox proportional hazards models were used to assess predictive validity adjusting for covariates. We compared the predictive validity of MBT TIP to that of the free and cued selective reminding test free recall score (FCSRT-FR; cut-score:≤24) and the single list recall measure of the MBT, Cued Recalled from List 1 (CR-L1; cut-score:≤12). RESULTS Thirty-five of 309 participants developed incident dementia. When assessing each test alone, the hazard ratio (HR) for dementia was significant for MBT TIP (HR = 8.58, 95% CI: (3.58, 20.58), p < 0.0001), FCSRT-FR (HR = 4.19, 95% CI: (1.94, 9.04), p = 0.0003) and MBT CR-L1 (HR = 2.91, 95% CI: (1.37, 6.18), p = 0.006). MBT TIP remained a significant predictor of dementia (p = 0.0002) when adjusting for FCSRT-FR or CR-L1. CONCLUSIONS Older adults with poor memory binding as measured by the MBT TIP were at increased risk for incident dementia. This measure outperforms conventional episodic memory measures of free and cued recall, supporting the memory binding hypothesis.
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Affiliation(s)
- Wenzhu B Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mindy J Katz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wendy S Ramratan
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA
| | - Molly E Zimmerman
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Herman Buschke
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
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20
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Grande G, Vanacore N, Vetrano DL, Cova I, Rizzuto D, Mayer F, Maggiore L, Ghiretti R, Cucumo V, Mariani C, Cappa SF, Pomati S. Free and cued selective reminding test predicts progression to Alzheimer’s disease in people with mild cognitive impairment. Neurol Sci 2018; 39:1867-1875. [DOI: 10.1007/s10072-018-3507-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
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21
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Neural correlates of episodic memory in the Memento cohort. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:224-233. [PMID: 29955665 PMCID: PMC6021546 DOI: 10.1016/j.trci.2018.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction The free and cued selective reminding test is used to identify memory deficits in mild cognitive impairment and demented patients. It allows assessing three processes: encoding, storage, and recollection of verbal episodic memory. Methods We investigated the neural correlates of these three memory processes in a large cohort study. The Memento cohort enrolled 2323 outpatients presenting either with subjective cognitive decline or mild cognitive impairment who underwent cognitive, structural MRI and, for a subset, fluorodeoxyglucose–positron emission tomography evaluations. Results Encoding was associated with a network including parietal and temporal cortices; storage was mainly associated with entorhinal and parahippocampal regions, bilaterally; retrieval was associated with a widespread network encompassing frontal regions. Discussion The neural correlates of episodic memory processes can be assessed in large and standardized cohorts of patients at risk for Alzheimer's disease. Their relation to pathophysiological markers of Alzheimer's disease remains to be studied. This is the largest cohort ever to be used in the study of the morpho-metabolic correlates of episodic memory in human, ensuring the validity of the obtained results. We found that encoding of information is linked to a posterior network previously evidenced to support working memory. The storage process was mainly supported in our study by medial temporal regions. Spontaneous retrieval of stimuli implicated broad neural networks including the frontal regions. These associations were particularly strong in APOE ε4 carriers suggesting that the free and selective reminding test is useful to detect Alzheimer's disease at an early stage.
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22
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Koval I, Schiratti JB, Routier A, Bacci M, Colliot O, Allassonnière S, Durrleman S. Spatiotemporal Propagation of the Cortical Atrophy: Population and Individual Patterns. Front Neurol 2018; 9:235. [PMID: 29780348 PMCID: PMC5945895 DOI: 10.3389/fneur.2018.00235] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 03/26/2018] [Indexed: 01/19/2023] Open
Abstract
Repeated failures in clinical trials for Alzheimer’s disease (AD) have raised a strong interest for the prodromal phase of the disease. A better understanding of the brain alterations during this early phase is crucial to diagnose patients sooner, to estimate an accurate disease stage, and to give a reliable prognosis. According to recent evidence, structural alterations in the brain are likely to be sensitive markers of the disease progression. Neuronal loss translates in specific spatiotemporal patterns of cortical atrophy, starting in the enthorinal cortex and spreading over other cortical regions according to specific propagation pathways. We developed a digital model of the cortical atrophy in the left hemisphere from prodromal to diseased phases, which is built on the temporal alignment and combination of several short-term observation data to reconstruct the long-term history of the disease. The model not only provides a description of the spatiotemporal patterns of cortical atrophy at the group level but also shows the variability of these patterns at the individual level in terms of difference in propagation pathways, speed of propagation, and age at propagation onset. Longitudinal MRI datasets of patients with mild cognitive impairments who converted to AD are used to reconstruct the cortical atrophy propagation across all disease stages. Each observation is considered as a signal spatially distributed on a network, such as the cortical mesh, each cortex location being associated to a node. We consider how the temporal profile of the signal varies across the network nodes. We introduce a statistical mixed-effect model to describe the evolution of the cortex alterations. To ensure a spatiotemporal smooth propagation of the alterations, we introduce a constrain on the propagation signal in the model such that neighboring nodes have similar profiles of the signal changes. Our generative model enables the reconstruction of personalized patterns of the neurodegenerative spread, providing a way to estimate disease progression stages and predict the age at which the disease will be diagnosed. The model shows that, for instance, APOE carriers have a significantly higher pace of cortical atrophy but not earlier atrophy onset.
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Affiliation(s)
- Igor Koval
- Inria Paris-Rocquencourt, INSERM U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMRS 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,INSERM UMRS 1138, Centre de Recherche des Cordeliers, Université Paris Descartes, Paris, France
| | - Jean-Baptiste Schiratti
- Inria Paris-Rocquencourt, INSERM U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMRS 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,INSERM UMRS 1138, Centre de Recherche des Cordeliers, Université Paris Descartes, Paris, France
| | - Alexandre Routier
- Inria Paris-Rocquencourt, INSERM U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMRS 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Michael Bacci
- Inria Paris-Rocquencourt, INSERM U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMRS 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Olivier Colliot
- Inria Paris-Rocquencourt, INSERM U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMRS 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,AP-HP, Pitié-Salpétriere Hospital, Department of Neurology, Paris, France.,AP-HP, Pitié-Salpétriere Hospital, Department of Neuroradiology, Paris, France
| | - Stéphanie Allassonnière
- INSERM UMRS 1138, Centre de Recherche des Cordeliers, Université Paris Descartes, Paris, France
| | - Stanley Durrleman
- Inria Paris-Rocquencourt, INSERM U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMRS 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
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23
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Vaughan RM, Coen RF, Kenny R, Lawlor BA. Semantic and Phonemic Verbal Fluency Discrepancy in Mild Cognitive Impairment: Potential Predictor of Progression to Alzheimer's Disease. J Am Geriatr Soc 2018; 66:755-759. [DOI: 10.1111/jgs.15294] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Roisin M. Vaughan
- Mercer's Institute for Research on Ageing; St. James's Hospital; Dublin Ireland
| | - Robert F. Coen
- Mercer's Institute for Research on Ageing; St. James's Hospital; Dublin Ireland
| | - RoseAnne Kenny
- The Irish Longitudinal Study on Ageing; Trinity College; Dublin Ireland
| | - Brian A. Lawlor
- Mercer's Institute for Research on Ageing; St. James's Hospital; Dublin Ireland
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24
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Sala I, Illán-Gala I, Alcolea D, Sánchez-Saudinós MB, Salgado SA, Morenas-Rodríguez E, Subirana A, Videla L, Clarimón J, Carmona-Iragui M, Ribosa-Nogué R, Blesa R, Fortea J, Lleó A. Diagnostic and Prognostic Value of the Combination of Two Measures of Verbal Memory in Mild Cognitive Impairment due to Alzheimer's Disease. J Alzheimers Dis 2018; 58:909-918. [PMID: 28527215 DOI: 10.3233/jad-170073] [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: 01/05/2023]
Abstract
BACKGROUND Episodic memory impairment is the core feature of typical Alzheimer's disease. OBJECTIVE To evaluate the performance of two commonly used verbal memory tests to detect mild cognitive impairment due to Alzheimer's disease (MCI-AD) and to predict progression to Alzheimer's disease dementia (AD-d). METHODS Prospective study of MCI patients in a tertiary memory disorder unit. Patients underwent an extensive neuropsychological battery including two tests of declarative verbal memory: The Free and Cued Selective Reminding Test (FCSRT) and the word list learning task from the Consortium to Establish a Registry for Alzheimer's disease (CERAD-WL). Cerebrospinal fluid (CSF) was obtained from all patients and MCI-AD was defined by means of the t-Tau/Aβ1-42 ratio. Logistic regression analyses tested whether the combination of FCSRT and CERAD-WL measures significantly improved the prediction of MCI-AD. Progression to AD-d was analyzed in a Cox regression model. RESULTS A total of 202 MCI patients with a mean follow-up of 34.2±24.2 months were included and 98 (48.5%) met the criteria for MCI-AD. The combination of FCSRT and CERAD-WL measures improved MCI-AD classification accuracy based on CSF biomarkers. Both tests yielded similar global predictive values (59.9-65.3% and 59.4-62.8% for FCSRT and CERAD-WL, respectively). MCI-AD patients with deficits in both FCSRT and CERAD-WL had a faster progression to AD-d than patients with deficits in only one test. CONCLUSIONS The combination of FCSRT and CERAD-WL improves the classification of MCI-AD and defines different prognostic profiles. These findings have important implications for clinical practice and the design of clinical trials.
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Affiliation(s)
- Isabel Sala
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Ignacio Illán-Gala
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Daniel Alcolea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Ma Belén Sánchez-Saudinós
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Sergio Andrés Salgado
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Estrella Morenas-Rodríguez
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Andrea Subirana
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Laura Videla
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Jordi Clarimón
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - María Carmona-Iragui
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Roser Ribosa-Nogué
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Rafael Blesa
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Spain
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Jenkins C, Feldman G. Recognition of preclinical signs of dementia: A qualitative study exploring the experiences of family carers and professional care assistants. J Clin Nurs 2018; 27:1931-1940. [PMID: 29495091 DOI: 10.1111/jocn.14333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 01/24/2023]
Abstract
AIMS AND OBJECTIVES To identify preclinical signs of dementia by exploring the experiences of family caregivers and professional care assistants. BACKGROUND Dementia results in disability, emotional strain and financial loss for people with dementia, family members and nations. Informal identification of social and behavioural risk signifiers could facilitate timely interventions with potential to delay onset of serious disability. DESIGN A retrospective qualitative approach using a naturalistic interpretive design was used. Focus groups enabled in-depth understanding of the participants' experiences of life or work with people who subsequently developed dementia. METHODS Purposive sampling was used to recruit family carers and professional carers who had cared for people who later developed dementia. The data from focus groups were fully transcribed and anonymised, and transcripts were analysed by two researchers. These researchers coded and analysed the transcripts independently; subsequently, overlapping and similar themes were identified and consensus reached on final themes. A third researcher was invited to review the analysis and ensure trustworthiness of the study findings. RESULTS Findings revealed that preclinical signs of dementia were identifiable in retrospect Participants' accounts resulted in four themes, "Lowered Threshold of Frustration", "Insight and Coping Strategies," "Early signs of poor memory" and "Alarming Events." CONCLUSIONS Earlier recognition of preclinical signs of dementia would allow affected individuals to follow health promotion advice and plan for the future. Identification of social exclusion prior to diagnosis has implications for antistigma campaigns and development of "dementia-friendly communities." RELEVANCE TO CLINICAL PRACTICE Healthcare professionals could work with those at risk, facilitating lifestyle changes to postpone symptoms and advance planning for improved autonomy. Predementia should be viewed as a disability for which reasonable adjustments can be made at a community level, to enhance and extend emotional well-being and social inclusion.
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26
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De Marco M, Duzzi D, Meneghello F, Venneri A. Cognitive Efficiency in Alzheimer's Disease is Associated with Increased Occipital Connectivity. J Alzheimers Dis 2018; 57:541-556. [PMID: 28269781 DOI: 10.3233/jad-161164] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There are cognitive domains which remain fully functional in a proportion of Alzheimer's disease (AD) patients. It is unknown, however, what distinctive mechanisms sustain such efficient processing. The concept of "cognitive efficiency" was investigated in these patients by operationalizing it as a function of the level of performance shown on the Letter Fluency test, on which, very often, patients in the early stages of AD show unimpaired performance. Forty-five individuals at the prodromal/early stage of AD (diagnosis supported by subsequent clinical follow-ups) and 45 healthy controls completed a battery of neuropsychological tests and an MRI protocol which included resting state acquisitions. The Letter Fluency test was the only task on which no between-group difference in performance was found. Participants were divided into "low-performing" and "high-performing" according to the global median. Dual-regression methods were implemented to compute six patterns of network connectivity. The diagnosis-by-level of performance interaction was inferred on each pattern to determine the network distinctiveness of efficient performance in AD. Significant interactions were found in the anterior default mode network, and in both left and right executive control networks. For all three circuits, high-performing patients showed increased connectivity within the ventral and dorsal part of BA19, as confirmed by post hoc t tests. Peristriate remapping is suggested to play a compensatory role. Since the occipital lobe is the neurophysiological source of long-range cortical connectivity, it is speculated that the physiological mechanisms of functional connectivity might sustain occipital functional remapping in early AD, particularly for those functions which are sustained by areas not excessively affected by the prodromal disease.
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Affiliation(s)
- Matteo De Marco
- Department of Neuroscience, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK.,IRCCS Fondazione Ospedale San Camillo, Venice Lido, Italy
| | - Davide Duzzi
- IRCCS Fondazione Ospedale San Camillo, Venice Lido, Italy
| | | | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK.,IRCCS Fondazione Ospedale San Camillo, Venice Lido, Italy
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27
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Anblagan D, Valdés Hernández MC, Ritchie SJ, Aribisala BS, Royle NA, Hamilton IF, Cox SR, Gow AJ, Pattie A, Corley J, Starr JM, Muñoz Maniega S, Bastin ME, Deary IJ, Wardlaw JM. Coupled changes in hippocampal structure and cognitive ability in later life. Brain Behav 2018; 8:e00838. [PMID: 29484252 PMCID: PMC5822578 DOI: 10.1002/brb3.838] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/07/2017] [Accepted: 08/07/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction The hippocampus plays an important role in cognitive abilities which often decline with advancing age. Methods In a longitudinal study of community-dwelling adults, we investigated whether there were coupled changes in hippocampal structure and verbal memory, working memory, and processing speed between the ages of 73 (N = 655) and 76 years (N = 469). Hippocampal structure was indexed by hippocampal volume, hippocampal volume as a percentage of intracranial volume (H_ICV), fractional anisotropy (FA), mean diffusivity (MD), and longitudinal relaxation time (T1). Results Mean levels of hippocampal volume, H_ICV, FA, T1, and all three cognitive abilities domains decreased, whereas MD increased, from age 73 to 76. At baseline, higher hippocampal volume was associated with better working memory and verbal memory, but none of these correlations survived correction for multiple comparisons. Higher FA, lower MD, and lower T1 at baseline were associated with better cognitive abilities in all three domains; only the correlation between baseline hippocampal MD and T1, and change in the three cognitive domains, survived correction for multiple comparisons. Individuals with higher hippocampal MD at age 73 experienced a greater decline in all three cognitive abilities between ages 73 and 76. However, no significant associations with changes in cognitive abilities were found with hippocampal volume, FA, and T1 measures at baseline. Similarly, no significant associations were found between cognitive abilities at age 73 and changes in the hippocampal MRI biomarkers between ages 73 and 76. Conclusion Our results provide evidence to better understand how the hippocampus ages in healthy adults in relation to the cognitive domains in which it is involved, suggesting that better hippocampal MD at age 73 predicts less relative decline in three important cognitive domains across the next 3 years. It can potentially assist in diagnosing early stages of aging-related neuropathologies, because in some cases, accelerated decline could predict pathologies.
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Affiliation(s)
- Devasuda Anblagan
- Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
- Department of Neuroimaging SciencesCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- Scottish Imaging NetworkA Platform for Scientific Excellence (SINAPSE) CollaborationEdinburghUK
- Edinburgh Dementia Research CentreUK Dementia Research InstituteEdinburghUK
| | - Maria C. Valdés Hernández
- Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
- Department of Neuroimaging SciencesCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- Scottish Imaging NetworkA Platform for Scientific Excellence (SINAPSE) CollaborationEdinburghUK
- Edinburgh Dementia Research CentreUK Dementia Research InstituteEdinburghUK
| | - Stuart J. Ritchie
- Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
- Department of PsychologyUniversity of EdinburghEdinburghUK
| | - Benjamin S. Aribisala
- Department of Neuroimaging SciencesCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- Department of Computer ScienceLagos State UniversityLagosNigeria
| | - Natalie A. Royle
- Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
- Department of Neuroimaging SciencesCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- Scottish Imaging NetworkA Platform for Scientific Excellence (SINAPSE) CollaborationEdinburghUK
| | - Iona F. Hamilton
- Department of Neuroimaging SciencesCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- Edinburgh Dementia Research CentreUK Dementia Research InstituteEdinburghUK
| | - Simon R. Cox
- Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
- Scottish Imaging NetworkA Platform for Scientific Excellence (SINAPSE) CollaborationEdinburghUK
- Department of PsychologyUniversity of EdinburghEdinburghUK
| | - Alan J. Gow
- Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
- Department of PsychologySchool of Social SciencesHeriot‐Watt UniversityEdinburghUK
| | - Alison Pattie
- Department of PsychologyUniversity of EdinburghEdinburghUK
| | - Janie Corley
- Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
- Department of PsychologyUniversity of EdinburghEdinburghUK
| | - John M. Starr
- Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
| | - Susana Muñoz Maniega
- Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
- Department of Neuroimaging SciencesCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- Scottish Imaging NetworkA Platform for Scientific Excellence (SINAPSE) CollaborationEdinburghUK
- Edinburgh Dementia Research CentreUK Dementia Research InstituteEdinburghUK
| | - Mark E. Bastin
- Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
- Department of Neuroimaging SciencesCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- Scottish Imaging NetworkA Platform for Scientific Excellence (SINAPSE) CollaborationEdinburghUK
- Edinburgh Dementia Research CentreUK Dementia Research InstituteEdinburghUK
| | - Ian J. Deary
- Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
- Department of PsychologyUniversity of EdinburghEdinburghUK
| | - Joanna M. Wardlaw
- Centre for Cognitive Ageing and Cognitive EpidemiologyUniversity of EdinburghEdinburghUK
- Department of Neuroimaging SciencesCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- Scottish Imaging NetworkA Platform for Scientific Excellence (SINAPSE) CollaborationEdinburghUK
- Edinburgh Dementia Research CentreUK Dementia Research InstituteEdinburghUK
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28
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Grober E, Veroff AE, Lipton RB. Temporal unfolding of declining episodic memory on the Free and Cued Selective Reminding Test in the predementia phase of Alzheimer's disease: Implications for clinical trials. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:161-171. [PMID: 29552631 PMCID: PMC5852329 DOI: 10.1016/j.dadm.2017.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction Free and Cued Selective Reminding Test (FCSRT) performance identifies patients with preclinical disease at elevated risk for developing Alzheimer's dementia, predicting diagnosis better than other memory tests. Methods Based on literature mapping FCSRT performance to clinical outcomes and biological markers, and on longitudinal preclinical data from the Baltimore Longitudinal Study of Aging, we developed the Stages of Objective Memory Impairment (SOMI) model. Five sequential stages of episodic memory decline are defined by Free Recall (FR) and Total Recall (TR) score ranges and years prior to dementia diagnosis. We sought to replicate the SOMI model using longitudinal assessments of 142 Einstein Aging Study participants who developed AD over 10 years. Results Time to diagnosis was at least seven years if FR was intact, at least four years if TR was intact, and two years if TR was impaired, consistent with SOMI model predictions. The SOMI identified incipient dementia with excellent sensitivity and specificity. Discussion The SOMI model provides an efficient approach for clinical trial cognitive screening in advance of more costly biomarker studies and ultimately in clinical practice, and provides a vocabulary for understanding AD biomarker patterns and for re-analysis of existing clinical trial data.
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Affiliation(s)
- Ellen Grober
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | | | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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Cerami C, Dubois B, Boccardi M, Monsch AU, Demonet JF, Cappa SF. Clinical validity of delayed recall tests as a gateway biomarker for Alzheimer's disease in the context of a structured 5-phase development framework. Neurobiol Aging 2017; 52:153-166. [PMID: 28317646 DOI: 10.1016/j.neurobiolaging.2016.03.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/05/2016] [Accepted: 03/22/2016] [Indexed: 11/27/2022]
Abstract
Although Alzheimer's disease criteria promote the use of biomarkers, their maturity in clinical routine still needs to be assessed. In the light of the oncology framework, we conducted a literature review on measures used to assess delayed recall impairment due to medial temporal lobe dysfunction (i.e., free and cued word list recall tests). Ample evidence is available for phases 1 (rationale for use), 2 (discriminative ability), and 3 (early detection ability) for many of the tests in routine use. Evidence about phase 4 (performance in real world) and phase 5 (quantify impact and costs) is yet to come. Administration procedures have been standardized and cutoff scores are well validated in large Alzheimer's disease and mild cognitive impaired series. Some aspects (e.g., different task formats), however, hamper the comparability of results among different populations and the reproducibility between laboratories. No definite guideline for their use can thus be proposed at the moment. Accordingly, the maturity of such markers is not yet sufficient and requires future investigation to promote the proper use of memory measures in clinical settings.
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Mura T, Baramova M, Gabelle A, Artero S, Dartigues JF, Amieva H, Berr C. Predicting dementia using socio-demographic characteristics and the Free and Cued Selective Reminding Test in the general population. Alzheimers Res Ther 2017; 9:21. [PMID: 28335796 PMCID: PMC5364571 DOI: 10.1186/s13195-016-0230-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/21/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Our study aimed to determine whether the consideration of socio-demographic features improves the prediction of Alzheimer's dementia (AD) at 5 years when using the Free and Cued Selective Reminding Test (FCSRT) in the general older population. METHODS Our analyses focused on 2558 subjects from the prospective Three-City Study, a cohort of community-dwelling individuals aged 65 years and over, with FCSRT scores. Four "residual scores" and "risk scores" were built that included the FCSRT scores and socio-demographic variables. The predictive performance of crude, residual and risk scores was analyzed by comparing the areas under the ROC curve (AUC). RESULTS In total, 1750 subjects were seen 5 years after completing the FCSRT. AD was diagnosed in 116 of them. Compared with the crude free-recall score, the predictive performances of the residual score and of the risk score were not significantly improved (AUC: 0.83 vs 0.82 and 0.88 vs 0.89 respectively). CONCLUSION Using socio-demographic features in addition to the FCSRT does not improve its predictive performance for dementia or AD.
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Affiliation(s)
- Thibault Mura
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, 34093 Montpellier, Cedex 5 France
- University of Montpellier, Montpellier, France
- Medical Information Department, University Hospital of Montpellier, Montpellier, France
| | - Marieta Baramova
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, 34093 Montpellier, Cedex 5 France
| | - Audrey Gabelle
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, 34093 Montpellier, Cedex 5 France
- University of Montpellier, Montpellier, France
- Memory Consultation, Centre Mémoire de Ressource et de Recherche, Gui de Chauliac University Hospital, Montpellier, France
| | - Sylvaine Artero
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, 34093 Montpellier, Cedex 5 France
| | - Jean-François Dartigues
- Memory Consultation, Centre Mémoire de Ressource et de Recherche, University Hospital, Bordeaux, France
- ISPED, Centre INSERM U1219, Bordeaux Population Health Research Center, Bordeaux, France
- University of Bordeaux,, Centre INSERM U1219, Bordeaux Population Health Research Center, Bordeaux, France
| | - Hélène Amieva
- ISPED, Centre INSERM U1219, Bordeaux Population Health Research Center, Bordeaux, France
- University of Bordeaux,, Centre INSERM U1219, Bordeaux Population Health Research Center, Bordeaux, France
| | - Claudine Berr
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, 34093 Montpellier, Cedex 5 France
- University of Montpellier, Montpellier, France
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Jutten RJ, Harrison J, de Jong FJ, Aleman A, Ritchie CW, Scheltens P, Sikkes SAM. A composite measure of cognitive and functional progression in Alzheimer's disease: Design of the Capturing Changes in Cognition study. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:130-138. [PMID: 29067324 PMCID: PMC5651369 DOI: 10.1016/j.trci.2017.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cognitive testing in Alzheimer's disease (AD) is essential for establishing diagnosis, monitoring progression, and evaluating treatments. Assessments should ideally be brief, reliable, valid, and reflect clinically meaningful changes. There is a lack of instruments that meet all these criteria. In the Capturing Changes in Cognition (Catch-Cog) study, we seek to correct these deficiencies through the development and validation of a composite measure combining cognition and function: the cognitive-functional composite (CFC). We expect that the CFC is able to detect clinically relevant changes over time in early dementia stages of AD. METHODS/DESIGN We will include patients (n = 350) with mild cognitive impairment or mild dementia due to AD from memory clinics in the Netherlands and the United Kingdom. We will include cognitively healthy volunteers (n = 30) as a control group. The CFC is based on the "cognitive composite" and the Amsterdam instrumental activities of daily living questionnaire. We will investigate test-retest reliability with baseline and 2- to 3-week follow-up assessments (n = 50 patients and n = 30 healthy controls). We will involve experts and participants to evaluate the initial feasibility and refine the CFC if needed. Subsequently, we will perform a longitudinal construct validation study in a prospective cohort (n = 300) with baseline, 3-, 6-, and 12-month follow-up assessments. The main outcome is cognitive and functional progression measured by the CFC. Reference measures for progression include traditional cognitive and functional tests, disease burden measures, and brain imaging methods. Using linear mixed modeling, we will investigate longitudinal changes on the CFC and relate these to the reference measures. Using linear regression analyses, we will evaluate the influence of possible confounders such as age, gender, and education on the CFC. DISCUSSION By performing an independent longitudinal construct validation, the Catch-Cog study of the novel CFC will contribute to the improvement of disease monitoring and treatment evaluation in early dementia stages of AD.
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Affiliation(s)
- Roos J Jutten
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - John Harrison
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Metis Cognition Ltd, Kilmington Common, Warminster, United Kingdom
| | - Frank Jan de Jong
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André Aleman
- Department of Neurosciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Craig W Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip Scheltens
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Sietske A M Sikkes
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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Gramunt N, Sánchez-Benavides G, Buschke H, Lipton RB, Masramon X, Gispert JD, Peña-Casanova J, Fauria K, Molinuevo JL. Psychometric Properties of the Memory Binding Test: Test-Retest Reliability and Convergent Validity. J Alzheimers Dis 2016; 50:999-1010. [PMID: 26836167 DOI: 10.3233/jad-150776] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Episodic memory testing is fundamental for the diagnosis of Alzheimer's disease (AD). Although the Free and Cued Selective Reminding Test (FCSRT) is widely used for this purpose, it may not be sensitive enough for early detection of subtle decline in preclinical AD. The Memory Binding Test (MBT) intends to overcome this limitation. OBJECTIVES To analyze the test-retest reliability of the MBT and its convergent validity with the FCRST. METHODS 36 cognitively healthy participants of the ALFA Study, aged 45 to 65, were included for the test-retest study and 69 for the convergent analysis. They were visited twice in a period of 6 ± 2 weeks. Test-retest reliability was determined by the calculation of the intra-class correlation coefficient (ICC). Score differences were studied by computing the mean percentage of score variation between visits and visualized by Bland-Altman plots. Convergent validity was determined by Pearson's correlations. RESULTS ICC values in the test-retest reliability analysis of the MBT direct scores ranged from 0.64 to 0.76. Subjects showed consistent practice effects, with mean amounts of score increasing between 10% and 26%. Pearson correlation between MBT and FCSRT direct scores showed r values between 0.40 and 0.53. The FCSRT displayed ceiling effects not observed in the MBT. CONCLUSIONS The MBT shows adequate test-retest reliability and overall moderate convergent validity with the FCSRT. Unlike the FCSRT, the MBT does not have ceiling effects and it may therefore be especially useful in longitudinal studies, facilitating the measurement of subtle memory performance decline and the detection of very early AD.
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Affiliation(s)
- Nina Gramunt
- Clinical Research Program, Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Gonzalo Sánchez-Benavides
- Clinical Research Program, Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Herman Buschke
- Department of Neurology, Albert Einstein College of Medicine. Bronx, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine. Bronx, NY, USA
| | | | - Juan D Gispert
- Clinical Research Program, Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Jordi Peña-Casanova
- Department of Behavioral Neurology, Service of Neurology, Hospital del Mar, Parc Salut Mar, Barcelona, Spain
| | - Karine Fauria
- Clinical Research Program, Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - José L Molinuevo
- Clinical Research Program, Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
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de Diego-Balaguer R, Schramm C, Rebeix I, Dupoux E, Durr A, Brice A, Charles P, Cleret de Langavant L, Youssov K, Verny C, Damotte V, Azulay JP, Goizet C, Simonin C, Tranchant C, Maison P, Rialland A, Schmitz D, Jacquemot C, Fontaine B, Bachoud-Lévi AC. COMT Val158Met Polymorphism Modulates Huntington's Disease Progression. PLoS One 2016; 11:e0161106. [PMID: 27657697 PMCID: PMC5033325 DOI: 10.1371/journal.pone.0161106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/29/2016] [Indexed: 11/19/2022] Open
Abstract
Little is known about the genetic factors modulating the progression of Huntington's disease (HD). Dopamine levels are affected in HD and modulate executive functions, the main cognitive disorder of HD. We investigated whether the Val158Met polymorphism of the catechol-O-methyltransferase (COMT) gene, which influences dopamine (DA) degradation, affects clinical progression in HD. We carried out a prospective longitudinal multicenter study from 1994 to 2011, on 438 HD gene carriers at different stages of the disease (34 pre-manifest; 172 stage 1; 130 stage 2; 80 stage 3; 17 stage 4; and 5 stage 5), according to Total Functional Capacity (TFC) score. We used the Unified Huntington's Disease Rating Scale to evaluate motor, cognitive, behavioral and functional decline. We genotyped participants for COMT polymorphism (107 Met-homozygous, 114 Val-homozygous and 217 heterozygous). 367 controls of similar ancestry were also genotyped. We compared clinical progression, on each domain, between groups of COMT polymorphisms, using latent-class mixed models accounting for disease duration and number of CAG (cytosine adenine guanine) repeats. We show that HD gene carriers with fewer CAG repeats and with the Val allele in COMT polymorphism displayed slower cognitive decline. The rate of cognitive decline was greater for Met/Met homozygotes, which displayed a better maintenance of cognitive capacity in earlier stages of the disease, but had a worse performance than Val allele carriers later on. COMT polymorphism did not significantly impact functional and behavioral performance. Since COMT polymorphism influences progression in HD, it could be used for stratification in future clinical trials. Moreover, DA treatments based on the specific COMT polymorphism and adapted according to disease duration could potentially slow HD progression.
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Affiliation(s)
- Ruth de Diego-Balaguer
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
- ICREA, 08010, Barcelona, Spain
- Universitat de Barcelona, Departament de Cognició, Desenvolupament i Psicologia de L’Educació, 08035, Barcelona, Spain
- IDIBELL, Unitat de Cognició i Plasticitat Cerebral, 08907, L’Hospitalet de Llobregat, Spain
- Institut de Neurociència, Universitat de Barcelona, Barcelona, Spain
| | - Catherine Schramm
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
| | - Isabelle Rebeix
- INSERM-UPMC-CNRS, UMR 7225–1127, Institut Cerveau Moelle-ICM, Hôpital Pitié-Salpêtrière, 74013, Paris, France
- Assistance Publique-Hôpitaux de Paris, Département des Maladies du Système Nerveux, Hôpital Pitié-Salpêtrière, 74013, Paris, France
| | - Emmanuel Dupoux
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Laboratoire de Sciences Cognitives et Psycholinguistique, ENS-EHESS-CNRS, Paris, 75005, France
| | - Alexandra Durr
- INSERM-UPMC-CNRS, UMR 7225–1127, Institut Cerveau Moelle-ICM, Hôpital Pitié-Salpêtrière, 74013, Paris, France
- Assistance Publique-Hôpitaux de Paris, Département de Génétique, Hôpital Pitié-Salpêtrière, 74013, Paris, France
| | - Alexis Brice
- INSERM-UPMC-CNRS, UMR 7225–1127, Institut Cerveau Moelle-ICM, Hôpital Pitié-Salpêtrière, 74013, Paris, France
- Assistance Publique-Hôpitaux de Paris, Département de Génétique, Hôpital Pitié-Salpêtrière, 74013, Paris, France
| | - Perrine Charles
- Assistance Publique-Hôpitaux de Paris, Département de Génétique, Hôpital Pitié-Salpêtrière, 74013, Paris, France
| | - Laurent Cleret de Langavant
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladie de Huntington, Service de Neurologie, Hôpital Henri Mondor-Albert Chenevier, 94000, Créteil, France
| | - Katia Youssov
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladie de Huntington, Service de Neurologie, Hôpital Henri Mondor-Albert Chenevier, 94000, Créteil, France
| | - Christophe Verny
- CHU d'Angers, Centre de Référence des Maladies Neurogénétiques, Service de Neurologie, 49933, Angers, France
| | - Vincent Damotte
- INSERM-UPMC-CNRS, UMR 7225–1127, Institut Cerveau Moelle-ICM, Hôpital Pitié-Salpêtrière, 74013, Paris, France
- Assistance Publique-Hôpitaux de Paris, Département des Maladies du Système Nerveux, Hôpital Pitié-Salpêtrière, 74013, Paris, France
| | - Jean-Philippe Azulay
- CHU de Marseille—Hôpital de la Timone, Service de Neurologie et Pathologie du Mouvement, 13385, Marseille, France
| | - Cyril Goizet
- CHU de Bordeaux-GH Sud—Hôpital Haut-Lévêque, Service de Neurologie, 33604, Pessac, France
| | - Clémence Simonin
- CHRU de Lille, Service de Neurologie et Pathologie du Mouvement, 59000, Lille, France
- INSERM UMR-S 1172, JPArc, centre de recherche Jean-Pierre-Aubert neurosciences et cancer, Université de Lille, 59000, Lille, France
| | - Christine Tranchant
- CHU de Strasbourg—Hôpital de Hautepierre, Service de Neurologie, 67098, Strasbourg, France
| | - Patrick Maison
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique, 94000, Créteil, France
| | - Amandine Rialland
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique, 94000, Créteil, France
| | - David Schmitz
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique, 94000, Créteil, France
| | - Charlotte Jacquemot
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
| | - Bertrand Fontaine
- Assistance Publique-Hôpitaux de Paris, Département des Maladies du Système Nerveux, Hôpital Pitié-Salpêtrière, 74013, Paris, France
- Assistance Publique-Hôpitaux de Paris, Département de Génétique, Hôpital Pitié-Salpêtrière, 74013, Paris, France
| | - Anne-Catherine Bachoud-Lévi
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladie de Huntington, Service de Neurologie, Hôpital Henri Mondor-Albert Chenevier, 94000, Créteil, France
- * E-mail:
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Pierrot N, Lhommel R, Quenon L, Hanseeuw B, Dricot L, Sindic C, Maloteaux JM, Octavea JN, Ivanoiu A. Targretin Improves Cognitive and Biological Markers in a Patient with Alzheimer's Disease. J Alzheimers Dis 2016; 49:271-6. [PMID: 26444777 DOI: 10.3233/jad-150405] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present the effects of Targretin® (bexarotene) on cognition and biomarkers in a patient with mild Alzheimer's disease (AD). Targretin® is a Retinoic X Receptor (RXR) agonist shown to improve synaptic and cognitive functions in animal models of AD by increasing neuronal cholesterol efflux. After 6 months of treatment with Targretin® 300 mg/day, memory improved by about 40% and the tau protein in the cerebrospinal fluid decreased by about 20% . No significant side effects were noticed. This observation in a single patient indicates that Targretin® may improve memory performance and biological markers at an early stage of AD.
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Affiliation(s)
- Nathalie Pierrot
- Université catholique de Louvain, Brussels, Belgium.,Institute of Neuroscience, Brussels, Belgium
| | - Renaud Lhommel
- Université catholique de Louvain, Brussels, Belgium.,Institute of Neuroscience, Brussels, Belgium.,Cliniques universitaires Saint Luc, Nuclear Medicine department, Brussels, Belgium
| | - Lisa Quenon
- Université catholique de Louvain, Brussels, Belgium.,Institute of Neuroscience, Brussels, Belgium
| | - Bernard Hanseeuw
- Université catholique de Louvain, Brussels, Belgium.,Cliniques universitaires Saint Luc, Neurology department, Brussels, Belgium
| | - Laurence Dricot
- Université catholique de Louvain, Brussels, Belgium.,Institute of Neuroscience, Brussels, Belgium
| | - Christian Sindic
- Université catholique de Louvain, Brussels, Belgium.,Institute of Neuroscience, Brussels, Belgium
| | - Jean-Marie Maloteaux
- Université catholique de Louvain, Brussels, Belgium.,Institute of Neuroscience, Brussels, Belgium.,Cliniques universitaires Saint Luc, Neurology department, Brussels, Belgium
| | - Jean-Noël Octavea
- Université catholique de Louvain, Brussels, Belgium.,Institute of Neuroscience, Brussels, Belgium
| | - Adrian Ivanoiu
- Université catholique de Louvain, Brussels, Belgium.,Institute of Neuroscience, Brussels, Belgium.,Cliniques universitaires Saint Luc, Neurology department, Brussels, Belgium
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Philippi N, Noblet V, Duron E, Cretin B, Boully C, Wisniewski I, Seux ML, Martin-Hunyadi C, Chaussade E, Demuynck C, Kremer S, Lehéricy S, Gounot D, Armspach JP, Hanon O, Blanc F. Exploring anterograde memory: a volumetric MRI study in patients with mild cognitive impairment. ALZHEIMERS RESEARCH & THERAPY 2016; 8:26. [PMID: 27473839 PMCID: PMC4967326 DOI: 10.1186/s13195-016-0190-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/29/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this volumetric study was to explore the neuroanatomical correlates of the Free and Cued Selective Reminding Test (FCSRT) and the Delayed Matching-to-Sample-48 items (DMS-48), two tests widely used in France to assess verbal and visual anterograde memory. We wanted to determine to what extent the two tests rely on the medial temporal lobe, and could therefore be predictive of Alzheimer's disease, in which pathological changes typically start in this region. METHODS We analysed data from a cohort of 138 patients with mild cognitive impairment participating in a longitudinal multicentre clinical research study. Verbal memory was assessed using the FCSRT and visual recognition memory was evaluated using the DMS-48. Performances on these two tests were correlated to local grey matter atrophy via structural MRI using voxel-based morphometry. RESULTS Our results confirm the existence of a positive correlation between the volume of the medial temporal lobe and the performance on the FCSRT, prominently on the left, and the performance on the DMS-48, on the right, for the whole group of patients (family-wise error, P < 0.05). Interestingly, this region remained implicated only in the subgroup of patients who had deficient scores on the cued recall of the FCSRT, whereas the free recall was associated with prefrontal aspects. For the DMS-48, it was only implicated for the group of patients whose performances declined between the immediate and delayed trial. Conversely, temporo-parietal cortices were implicated when no decline was observed. Within the medial temporal lobe, the parahippocampal gyrus was prominently involved for the FCSRT and the immediate trial of the DMS-48, whereas the hippocampus was solely involved for the delayed trial of the DMS-48. CONCLUSIONS The two tests are able to detect an amnestic profile of the medial temporal type, under the condition that the scores remain deficient after the cued recall of the FCSRT or decline on the delayed recognition trial of the DMS-48. Strategic retrieval as well as perceptual/attentional processes, supported by prefrontal and temporo-parietal cortices, were also found to have an impact on the performances. Finally, the implication of the hippocampus appears time dependent, triggered by a longer delay than the parahippocampus, rather than determined by the sense of recollection or the encoding strength associated with the memory trace.
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Affiliation(s)
- N Philippi
- Department of Neurology, University Hospital of Strasbourg, Neuropsychology Unit, Strasbourg, France. .,University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France. .,University Hospital of Strasbourg, Centre Mémoire Ressources et Recherche, Strasbourg, France. .,Department of Geriatrics, University Hospital of Strasbourg, Strasbourg, France.
| | - V Noblet
- University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France
| | - E Duron
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - B Cretin
- Department of Neurology, University Hospital of Strasbourg, Neuropsychology Unit, Strasbourg, France.,University Hospital of Strasbourg, Centre Mémoire Ressources et Recherche, Strasbourg, France
| | - C Boully
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - I Wisniewski
- University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France
| | - M L Seux
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Martin-Hunyadi
- University Hospital of Strasbourg, Centre Mémoire Ressources et Recherche, Strasbourg, France.,Department of Geriatrics, University Hospital of Strasbourg, Strasbourg, France
| | - E Chaussade
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Demuynck
- University Hospital of Strasbourg, Centre Mémoire Ressources et Recherche, Strasbourg, France.,Department of Geriatrics, University Hospital of Strasbourg, Strasbourg, France
| | - S Kremer
- University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France.,Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - S Lehéricy
- Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,UPMC Paris 6-Inserm U1127, CNRS 7225, Institut du Cerveau et de la Moelle (ICM), Centre de NeuroImagerie de Recherche (CENIR), Paris, France
| | - D Gounot
- University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France
| | - J P Armspach
- University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France
| | - O Hanon
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, EA4468, Paris, France
| | - F Blanc
- Department of Neurology, University Hospital of Strasbourg, Neuropsychology Unit, Strasbourg, France.,University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France.,University Hospital of Strasbourg, Centre Mémoire Ressources et Recherche, Strasbourg, France.,Department of Geriatrics, University Hospital of Strasbourg, Strasbourg, France
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36
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Grober E, Mowrey WB, Ehrlich AR, Mabie P, Hahn S, Lipton RB. Two-stage screening for early dementia in primary care. J Clin Exp Neuropsychol 2016; 38:1038-49. [PMID: 27270103 DOI: 10.1080/13803395.2016.1187117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective was to compare two screening strategies for dementia in an urban primary care clinic, serving a low-education, minority community composed largely of Latino and African American patients. METHOD Two hundred and fifty-seven patients underwent two-stage patient-based screening (PBS) and informant-based screening (IBS) followed by a diagnostic evaluation. In the first stage, PBS included brief tests of episodic memory (Memory Impairment Screen), semantic memory (Animal Fluency), and executive function (Reciting Months Backwards). For IBS, the first stage consisted of the short Informant Questionnaire on Cognitive Decline in the Elderly, administered to a family member or friend. Patients who screened positive in the first stage of either strategy underwent testing with the picture version of the Free and Cued Selective Reminding Test with Immediate Recall to identify memory impairment. Sensitivity, specificity, and positive and negative predictive values were computed for various cutoffs of each test and combination of tests. Dementia was diagnosed using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria without access to the screening test results. RESULTS We identified 66 patients (25.7%) with previously undiagnosed dementia. Sensitivity was the same (77%) for both strategies but specificity was higher for IBS than for PBS (92% versus 83%). IBS's higher specificity makes it the preferred strategy if a knowledgeable informant is available. CONCLUSION Unrecognized dementia is common in primary care. Case-finding can be improved using either PBS or IBS two-stage screening strategies.
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Affiliation(s)
- Ellen Grober
- a Department of Neurology , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| | - Wenzhu Bi Mowrey
- b Department of Epidemiology and Population Health , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| | - Amy R Ehrlich
- c Division of Geriatrics of the Department of Medicine , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| | - Peter Mabie
- a Department of Neurology , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| | - Steven Hahn
- d Department of Medicine , Albert Einstein College of Medicine and Jacobi Medical Center , Bronx , NY , USA
| | - Richard B Lipton
- a Department of Neurology , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.,b Department of Epidemiology and Population Health , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
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37
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Anderson-Mooney AJ, Schmitt FA, Head E, Lott IT, Heilman KM. Gait dyspraxia as a clinical marker of cognitive decline in Down syndrome: A review of theory and proposed mechanisms. Brain Cogn 2016; 104:48-57. [PMID: 26930369 PMCID: PMC4801771 DOI: 10.1016/j.bandc.2016.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/13/2016] [Accepted: 02/21/2016] [Indexed: 12/15/2022]
Abstract
Down syndrome (DS) is the most common genetic cause of intellectual disability in children. With aging, DS is associated with an increased risk for Alzheimer's disease (AD). The development of AD neuropathology in individuals with DS can result in further disturbances in cognition and behavior and may significantly exacerbate caregiver burden. Early detection may allow for appropriate preparation by caregivers. Recent literature suggests that declines in gait may serve as an early marker of AD-related cognitive disorders; however, this relationship has not been examined in individuals with DS. The theory regarding gait dyspraxia and cognitive decline in the general population is reviewed, and potential applications to the population with individuals with DS are highlighted. Challenges and benefits in the line of inquiry are discussed. In particular, it appears that gait declines in aging individuals with DS may be associated with known declines in frontoparietal gray matter, development of AD-related pathology, and white matter losses in tracts critical to motor control. These changes are also potentially related to the cognitive and functional changes often observed during the same chronological period as gait declines in adults with DS. Gait declines may be an early marker of cognitive change, related to the development of underlying AD-related pathology, in individuals with DS. Future investigations in this area may provide insight into the clinical changes associated with development of AD pathology in both the population with DS and the general population, enhancing efforts for optimal patient and caregiver support and propelling investigations regarding safety/quality of life interventions and disease-modifying interventions.
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Affiliation(s)
- Amelia J Anderson-Mooney
- University of Kentucky College of Medicine, Department of Neurology, 740 S. Limestone, Suite B-101, Lexington, KY 40536, United States.
| | - Frederick A Schmitt
- University of Kentucky College of Medicine, Department of Neurology and Sanders-Brown Center on Aging, 800 S. Limestone, Room 312, Lexington, KY 40536, United States.
| | - Elizabeth Head
- University of Kentucky, Department of Molecular & Biomedical Pharmacology and Sanders-Brown Center on Aging, 800 S. Limestone, Room 203, Lexington, KY 40536, United States.
| | - Ira T Lott
- University of California - Irvine School of Medicine, Department of Pediatrics, Bldg 2 3rd Floor Rt 81, 101 The City Drive, Mail Code: 4482, Orange, CA 92668, United States.
| | - Kenneth M Heilman
- University of Florida College of Medicine, Department of Neurology, Room L3-100, McKnight Brain Institute, 1149 Newell Drive, Gainesville, FL 32611, United States.
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38
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Luchsinger JA, Perez T, Chang H, Mehta P, Steffener J, Pradabhan G, Ichise M, Manly J, Devanand DP, Bagiella E. Metformin in Amnestic Mild Cognitive Impairment: Results of a Pilot Randomized Placebo Controlled Clinical Trial. J Alzheimers Dis 2016; 51:501-14. [PMID: 26890736 PMCID: PMC5079271 DOI: 10.3233/jad-150493] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diabetes and hyperinsulinemia may be risk factors for Alzheimer's disease (AD). We conducted a pilot study of metformin, a medication efficacious in treating and preventing diabetes while reducing hyperinsulinemia, among persons with amnestic mild cognitive impairment (aMCI) with the goal of collecting preliminary data on feasibility, safety, and efficacy. Participants were 80 men and women aged 55 to 90 years with aMCI, overweight or obese, without treated diabetes. We randomized participants to metformin 1000 mg twice a day or matching placebo for 12 months. The co-primary clinical outcomes were changes from baseline to 12 months in total recall of the Selective Reminding Test (SRT) and the score of the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog). The secondary outcome was change in relative glucose uptake in the posterior cingulate-precuneus in brain fluorodeoxyglucose positron emission tomography. Change in plasma Aβ42 was an exploratory outcome. The mean age of participants was 65 years. Fifty percent of participants were women. The only baseline variable that was different between the arms was the ADAS-Cog. Metformin could not be tolerated by 7.5% of participants; 15% tolerated 500 mg/day, 35% tolerated 1000 mg/day, 32.5% tolerated 1500 mg/day, and only 10% tolerated the maximum dose. There were no serious adverse events related to metformin. The 7.5% of persons who did not tolerate metformin reported gastrointestinal symptoms. After adjusting for baseline ADAS-cog, changes in total recall of the SRT favored the metformin group (9.7±8.5 versus 5.3±8.5; p = 0.02). Differences for other outcomes were not significant. A larger trial seems warranted to evaluate the efficacy and cognitive safety of metformin in prodromal AD.
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Affiliation(s)
- José A. Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Medical Center, 630 West 168 street, New York, NY 10032. USA
| | - Thania Perez
- Deparment of Medicine, Columbia University Medical Center, 630 West 168 street, New York, NY 10032. USA
| | - Helena Chang
- Department of Statistics, Mt. Sinai Medical Center, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Pankaj Mehta
- New York Institute for Basic Research, 1050 Forest Hill Road, Staten Island, NY 10314, USA
| | - Jason Steffener
- Gertrude H. Sergievsky Center, Columbia University, 630 West 168 Street, New York, NY 10032, USA
| | - Gnanavalli Pradabhan
- Department of Psychiatry, Columbia University Medical Center, and Division of Geriatric Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Masanori Ichise
- Department of Radiology, Columbia University Medical Center, 622 West 168 street, New York, NY 10032, USA
| | - Jennifer Manly
- Gertrude H. Sergievsky Center, Columbia University, 630 West 168 Street, New York, NY 10032, USA
| | - Devangere P. Devanand
- Department of Psychiatry, Columbia University Medical Center, and Division of Geriatric Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Emilia Bagiella
- Department of Statistics, Mt. Sinai Medical Center, 1425 Madison Avenue, New York, NY, 10029, USA
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Di Stefano F, Epelbaum S, Coley N, Cantet C, Ousset PJ, Hampel H, Bakardjian H, Lista S, Vellas B, Dubois B, Andrieu S. Prediction of Alzheimer’s Disease Dementia: Data from the GuidAge Prevention Trial. J Alzheimers Dis 2015; 48:793-804. [DOI: 10.3233/jad-150013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Francesca Di Stefano
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Neurologie, Institut de la mémoire et de la maladie d’Alzheimer, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Stephane Epelbaum
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Neurologie, Institut de la mémoire et de la maladie d’Alzheimer, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- ICM, CNRS UMR 7225, Inserm U 1127, UPMC-P6 UMR S 1127, GH Pitié-Salpêtrière, 47 Bd de l’Hôpital, Paris, France
| | - Nicola Coley
- INSERM U1027, Toulouse, France
- Faculté de Médecine Université Toulouse III, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Christelle Cantet
- INSERM U1027, Toulouse, France
- Faculté de Médecine Université Toulouse III, Toulouse, France
- Department of Internal Medicine and Geriatrics, CHU Toulouse, Toulouse, France
| | - Pierre-Jean Ousset
- INSERM U1027, Toulouse, France
- Faculté de Médecine Université Toulouse III, Toulouse, France
- Gérontopole, Toulouse University Hospital, Toulouse, France
| | - Harald Hampel
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Neurologie, Institut de la mémoire et de la maladie d’Alzheimer, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- ICM, CNRS UMR 7225, Inserm U 1127, UPMC-P6 UMR S 1127, GH Pitié-Salpêtrière, 47 Bd de l’Hôpital, Paris, France
- AXA Research Fund & UPMC Chair, Paris, France
| | - Hovagim Bakardjian
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Neurologie, Institut de la mémoire et de la maladie d’Alzheimer, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- IHU-A-ICM - Paris Institute of Translational Neurosciences, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Simone Lista
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Neurologie, Institut de la mémoire et de la maladie d’Alzheimer, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- IHU-A-ICM - Paris Institute of Translational Neurosciences, Hôpital de la Pitié-Salpêtrière, Paris, France
- AXA Research Fund & UPMC Chair, Paris, France
| | - Bruno Vellas
- INSERM U1027, Toulouse, France
- Faculté de Médecine Université Toulouse III, Toulouse, France
- Gérontopole, Toulouse University Hospital, Toulouse, France
| | - Bruno Dubois
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Neurologie, Institut de la mémoire et de la maladie d’Alzheimer, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- ICM, CNRS UMR 7225, Inserm U 1127, UPMC-P6 UMR S 1127, GH Pitié-Salpêtrière, 47 Bd de l’Hôpital, Paris, France
| | - Sandrine Andrieu
- INSERM U1027, Toulouse, France
- Faculté de Médecine Université Toulouse III, Toulouse, France
- Gérontopole, Toulouse University Hospital, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
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40
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Abstract
Understanding aging-related cognitive decline is of growing importance in aging societies, but relatively little is known about its neural substrates. Measures of white matter microstructure are known to correlate cross-sectionally with cognitive ability measures, but only a few small studies have tested for longitudinal relations among these variables. We tested whether there were coupled changes in brain white matter microstructure indexed by fractional anisotropy (FA) and three broad cognitive domains (fluid intelligence, processing speed, and memory) in a large cohort of human participants with longitudinal diffusion tensor MRI and detailed cognitive data taken at ages 73 years (n = 731) and 76 years (n = 488). Longitudinal changes in white matter microstructure were coupled with changes in fluid intelligence, but not with processing speed or memory. Individuals with higher baseline white matter FA showed less subsequent decline in processing speed. Our results provide evidence for a longitudinal link between changes in white matter microstructure and aging-related cognitive decline during the eighth decade of life. They are consistent with theoretical perspectives positing that a corticocortical "disconnection" partly explains cognitive aging.
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41
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Lawrence AJ, Brookes RL, Zeestraten EA, Barrick TR, Morris RG, Markus HS. Pattern and Rate of Cognitive Decline in Cerebral Small Vessel Disease: A Prospective Study. PLoS One 2015; 10:e0135523. [PMID: 26273828 PMCID: PMC4537104 DOI: 10.1371/journal.pone.0135523] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/22/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives Cognitive impairment, predominantly affecting processing speed and executive function, is an important consequence of cerebral small vessel disease (SVD). To date, few longitudinal studies of cognition in SVD have been conducted. We determined the pattern and rate of cognitive decline in SVD and used the results to determine sample size calculations for clinical trials of interventions reducing cognitive decline. Methods 121 patients with MRI confirmed lacunar stroke and leukoaraiosis were enrolled into the prospective St George’s Cognition And Neuroimaging in Stroke (SCANS) study. Patients attended one baseline and three annual cognitive assessments providing 36 month follow-up data. Neuropsychological assessment comprised a battery of tests assessing working memory, long-term (episodic) memory, processing speed and executive function. We calculated annualized change in cognition for the 98 patients who completed at least two time-points. Results Task performance was heterogeneous, but significant cognitive decline was found for the executive function index (p<0.007). Working memory and processing speed decreased numerically, but not significantly. The executive function composite score would require the smallest samples sizes for a treatment trial with an aim of halting decline, but this would still require over 2,000 patients per arm to detect a 30% difference with power of 0.8 over a three year follow-up. Conclusions The pattern of cognitive decline seen in SVD over three years is consistent with the pattern of impairments at baseline. Rates of decline were slow and sample sizes would need to be large for clinical trials aimed at halting decline beyond initial diagnosis using cognitive scores as an outcome measure. This emphasizes the importance of more sensitive surrogate markers in this disease.
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Affiliation(s)
- Andrew J. Lawrence
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Rebecca L. Brookes
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Eva A. Zeestraten
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George’s University of London, London, United Kingdom
| | - Thomas R. Barrick
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George’s University of London, London, United Kingdom
| | - Robin G. Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology and Neurosciences, London, United Kingdom
| | - Hugh S. Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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42
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Lemos R, Marôco J, Simões MR, Santiago B, Tomás J, Santana I. The free and cued selective reminding test for predicting progression to Alzheimer's disease in patients with mild cognitive impairment: A prospective longitudinal study. J Neuropsychol 2015; 11:40-55. [PMID: 26058529 DOI: 10.1111/jnp.12075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/06/2015] [Indexed: 12/01/2022]
Abstract
Amnestic mild cognitive impairment (aMCI) patients carry a greater risk of conversion to Alzheimer's disease (AD). Therefore, the International Working Group (IWG) on AD aims to consider some cases of aMCI as symptomatic prodromal AD. The core diagnostic marker of AD is a significant and progressive memory deficit, and the Free and Cued Selective Reminding Test (FCSRT) was recommended by the IWG to test memory in cases of possible prodromal AD. This study aims to investigate whether the performance on the FCSRT would enhance the ability to predict conversion to AD in an aMCI group. A longitudinal study was conducted on 88 aMCI patients, and neuropsychological tests were analysed on the relative risk of conversion to AD. During follow-up (23.82 months), 33% of the aMCI population converted to AD. An impaired FCSRT TR was significantly associated with the risk of conversion to dementia, with a mean time to conversion of 25 months. The FCSRT demonstrates utility for detecting AD at its prodromal stage, thus supporting its use as a valid clinical marker.
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Affiliation(s)
- Raquel Lemos
- Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal.,Visual Neuroscience Laboratory, Institute of Biomedical Research in Light and Image, Faculty of Medicine, University of Coimbra, Portugal
| | - João Marôco
- Psychology and Health Research Unit (UIPES), Department of Psychological Sciences, ISPA - Instituto Universitário, Lisboa, Portugal
| | - Mário R Simões
- Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Beatriz Santiago
- Neurology Department of the Coimbra Hospital and University Center, Portugal
| | - José Tomás
- Neurology Department of the Coimbra Hospital and University Center, Portugal
| | - Isabel Santana
- Neurology Department of the Coimbra Hospital and University Center, Portugal.,Faculty of Medicine, University of Coimbra, Portugal
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43
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Early neuropsychological detection of Alzheimer's disease. Eur J Clin Nutr 2014; 68:1192-9. [PMID: 25182019 DOI: 10.1038/ejcn.2014.176] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/28/2014] [Indexed: 02/08/2023]
Abstract
Lifestyle modification offers a promising way of preventing or delaying Alzheimer's disease (AD). In particular, nutritional interventions can contribute to decrease the risk of dementia. The efficacy of such interventions should be assessed in individuals thought to be prone to AD. It is therefore necessary to identify markers that may help detecting AD as early as possible. This review will focus on subtle neuropsychological changes that may already exist in the predementia phase, and that could point to individuals at risk of dementia. Episodic memory decline appears consistently as the earliest sign of incipient typical AD. An episodic memory test that ensures deep encoding of information and assesses retrieval with free as well as cued recall appears as a useful tool to detect patients at an early stage of AD. Beyond the memory domain, category verbal fluency has been shown to decline early and to predict progression to AD. Moreover, in line with current diagnosis criteria for prodromal AD, combining neuropsychological scores and neuroimaging data allows a better discrimination of future AD patients than neuroimaging or neuropsychological data alone. Altogether, the detection of cognitive changes that are predictive of the typical form of probable AD already in the predementia stage points to at risk people who are the best target for therapeutic interventions, such as nutrition or physical exercise counseling or dietary interventions.
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44
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Dubois B, Feldman HH, Jacova C, Hampel H, Molinuevo JL, Blennow K, DeKosky ST, Gauthier S, Selkoe D, Bateman R, Cappa S, Crutch S, Engelborghs S, Frisoni GB, Fox NC, Galasko D, Habert MO, Jicha GA, Nordberg A, Pasquier F, Rabinovici G, Robert P, Rowe C, Salloway S, Sarazin M, Epelbaum S, de Souza LC, Vellas B, Visser PJ, Schneider L, Stern Y, Scheltens P, Cummings JL. Advancing research diagnostic criteria for Alzheimer's disease: the IWG-2 criteria. Lancet Neurol 2014; 13:614-29. [PMID: 24849862 DOI: 10.1016/s1474-4422(14)70090-0] [Citation(s) in RCA: 2227] [Impact Index Per Article: 222.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the past 8 years, both the International Working Group (IWG) and the US National Institute on Aging-Alzheimer's Association have contributed criteria for the diagnosis of Alzheimer's disease (AD) that better define clinical phenotypes and integrate biomarkers into the diagnostic process, covering the full staging of the disease. This Position Paper considers the strengths and limitations of the IWG research diagnostic criteria and proposes advances to improve the diagnostic framework. On the basis of these refinements, the diagnosis of AD can be simplified, requiring the presence of an appropriate clinical AD phenotype (typical or atypical) and a pathophysiological biomarker consistent with the presence of Alzheimer's pathology. We propose that downstream topographical biomarkers of the disease, such as volumetric MRI and fluorodeoxyglucose PET, might better serve in the measurement and monitoring of the course of disease. This paper also elaborates on the specific diagnostic criteria for atypical forms of AD, for mixed AD, and for the preclinical states of AD.
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Affiliation(s)
- Bruno Dubois
- Centre des Maladies Cognitives et Comportementales, Institut du Cerveau et de la Moelle épinière, Paris, France; Université Pierre et Marie Curie-Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France.
| | - Howard H Feldman
- Division of Neurology, University of British Columbia and Vancouver Coastal Health, Vancouver, BC, Canada
| | - Claudia Jacova
- UBC Division of Neurology, S152 UBC Hospital, BC, Canada
| | - Harald Hampel
- Centre des Maladies Cognitives et Comportementales, Institut du Cerveau et de la Moelle épinière, Paris, France; Université Pierre et Marie Curie-Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France
| | - José Luis Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, IDIBAPS Hospital Clinici Universitari, Barcelona, Spain; BarcelonaBeta Brain Research Centre, Fundació Pasqual Maragall, Barcelona, Spain
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Steven T DeKosky
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Serge Gauthier
- McGill Center for Studies in Aging, Douglas Hospital, Montreal, Quebec, QC, Canada
| | - Dennis Selkoe
- Harvard Medical School Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Randall Bateman
- Washington University School of Medicine, St Louis, Missouri, MO, USA
| | - Stefano Cappa
- Vita-Salute San Raffaele University, Milan, Italy; Department of Clinical Neurosciences, Cognitive Neurorehabilitation, Milan, Italy
| | - Sebastian Crutch
- Dementia Research Centre, Department of Neurodegeneration, Institute of Neurology, University College London, London, UK; Dementia Research Centre, National Hospital, London, UK
| | - Sebastiaan Engelborghs
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA), Middelheim and Hoge Beuken, Antwerp, Belgium; Reference Centre for Biological Markers of Dementia, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Giovanni B Frisoni
- Hopitaux Universitaires et Université de Genève, Geneva, Switzerland; IRCCS Fatebenefratelli, Brescia, Italy; HUG Belle-Idée, bâtiment les Voirons, Chêne-Bourg, France
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegeneration, Institute of Neurology, University College London, London, UK
| | - Douglas Galasko
- Department of Neurosciences, -University of California, San Diego, CA, USA
| | - Marie-Odile Habert
- INSERM UMR, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Nucléaire, Paris, France
| | - Gregory A Jicha
- University of Kentucky Alzheimer's Disease Center, Lexington, KY, USA
| | - Agneta Nordberg
- Karolinska Institutet, Karolinska University Hospital Huddinge, Alzheimer Neurobiology Center, Stockholm, Sweden
| | - Florence Pasquier
- Université Lille Nord de France, Lille, France; CHRU, Clinique Neurologique, Hôpital Roger Salengro, Lille, France
| | - Gil Rabinovici
- UCSF Memory & Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Philippe Robert
- EA CoBTeK and Memory Center, CHU University of Nice, UNSA, Hôpital de Cimiez 4 av Victoria, Nice, France
| | - Christopher Rowe
- FRACP, Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, Melbourne, VIC, Australia
| | - Stephen Salloway
- Neurology and the Memory and Aging Program, Butler Hospital, Department of Neurology and Psychiatry, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Marie Sarazin
- Neurologie de la Mémoire et du Langage, Centre Hospitalier Sainte-Anne, Paris Cedex, France; Université Paris 5, Paris, France
| | - Stéphane Epelbaum
- Centre des Maladies Cognitives et Comportementales, Institut du Cerveau et de la Moelle épinière, Paris, France; Université Pierre et Marie Curie-Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France
| | - Leonardo C de Souza
- Centre des Maladies Cognitives et Comportementales, Institut du Cerveau et de la Moelle épinière, Paris, France; Université Pierre et Marie Curie-Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France; Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Bruno Vellas
- Gerontopole, Pavillon Junod, University Toulouse 3, Toulouse, France
| | - Pieter J Visser
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Neurology and Alzheimer Center, Amsterdam, Netherlands
| | - Lon Schneider
- Department of Psychiatry, Neurology, and Gerontology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Taub Institute, Presbyterian Hospital, New York, NY, USA
| | - Philip Scheltens
- Alzheimer Centrum Vrije Universiteit Medical Center, VU University, Amsterdam, Netherlands
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Dion M, Potvin O, Belleville S, Ferland G, Renaud M, Bherer L, Joubert S, Vallet GT, Simard M, Rouleau I, Lecomte S, Macoir J, Hudon C. Normative Data for the Rappel libre/Rappel indicé à 16 items (16-item Free and Cued Recall) in the Elderly Quebec-French Population. Clin Neuropsychol 2014; 28 Suppl 1:S1-19. [DOI: 10.1080/13854046.2014.915058] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Mélissa Dion
- Centre de recherche de l’Institut universitaire en santé mentale de Québec , Québec (QC), Canada
- École de psychologie, Université Laval , Québec (QC), Canada
| | - Olivier Potvin
- Centre de recherche de l’Institut universitaire en santé mentale de Québec , Québec (QC), Canada
| | - Sylvie Belleville
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal , Montréal (QC), Canada
- Département de psychologie, Université de Montréal , Montréal (QC), Canada
| | - Guylaine Ferland
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal , Montréal (QC), Canada
- Faculté de médecine, Université de Montréal , Montréal (QC), Canada
| | - Mélanie Renaud
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal , Montréal (QC), Canada
| | - Louis Bherer
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal , Montréal (QC), Canada
- Département de psychologie, Université Concordia , Montréal (QC), Canada
| | - Sven Joubert
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal , Montréal (QC), Canada
- Département de psychologie, Université de Montréal , Montréal (QC), Canada
| | - Guillaume T. Vallet
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal , Montréal (QC), Canada
| | - Martine Simard
- École de psychologie, Université Laval , Québec (QC), Canada
| | - Isabelle Rouleau
- Département de psychologie, Université du Québec à Montréal , Montréal (QC), Canada
| | - Sarah Lecomte
- Centre de réadaptation physique Le Bouclier , Montréal (QC), Canada
| | - Joël Macoir
- Centre de recherche de l’Institut universitaire en santé mentale de Québec , Québec (QC), Canada
- Département de réadaptation, Université Laval , Québec (QC), Canada
| | - Carol Hudon
- Centre de recherche de l’Institut universitaire en santé mentale de Québec , Québec (QC), Canada
- École de psychologie, Université Laval , Québec (QC), Canada
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Davtyan H, Bacon A, Petrushina I, Zagorski K, Cribbs DH, Ghochikyan A, Agadjanyan MG. Immunogenicity of DNA- and recombinant protein-based Alzheimer disease epitope vaccines. Hum Vaccin Immunother 2014; 10:1248-55. [PMID: 24525778 DOI: 10.4161/hv.27882] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Alzheimer disease (AD) process involves the accumulation of amyloid plaques and tau tangles in the brain, nevertheless the attempts at targeting the main culprits, neurotoxic β-amyloid (Aβ) peptides, have thus far proven unsuccessful for improving cognitive function. Important lessons about anti-Aβ immunotherapeutic strategies were learned from the first active vaccination clinical trials. AD progression could be safely prevented or delayed if the vaccine (1) induces high titers of antibodies specific to toxic forms of Aβ; (2) does not activate the harmful autoreactive T cells that may induce inflammation; (3) is initiated before or at least at the early stages of the accumulation of toxic forms of Aβ. Data from the recent passive vaccination trials with bapineuzumab and solanezumab also indicated that anti-Aβ immunotherapy might be effective in reduction of the AD pathology and even improvement of cognitive and/or functional performance in patients when administered early in the course of the disease. For the prevention of AD the active immunization strategy may be more desirable than passive immunotherapy protocol and it can offer the potential for sustainable clinical and commercial advantages. Here we discuss the active vaccine approaches, which are still in preclinical development and vaccines that are already in clinical trials.
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Affiliation(s)
- Hayk Davtyan
- Department of Molecular Immunology; Institute for Molecular Medicine; Huntington Beach, CA USA
| | | | - Irina Petrushina
- Institute for Memory Impairments and Neurological Disorders; University of California at Irvine; Irvine, CA USA
| | - Karen Zagorski
- Department of Molecular Immunology; Institute for Molecular Medicine; Huntington Beach, CA USA
| | - David H Cribbs
- Institute for Memory Impairments and Neurological Disorders; University of California at Irvine; Irvine, CA USA; Department of Neurology; University of California at Irvine; Irvine, CA USA
| | - Anahit Ghochikyan
- Department of Molecular Immunology; Institute for Molecular Medicine; Huntington Beach, CA USA
| | - Michael G Agadjanyan
- Department of Molecular Immunology; Institute for Molecular Medicine; Huntington Beach, CA USA; Institute for Memory Impairments and Neurological Disorders; University of California at Irvine; Irvine, CA USA
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