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Muñoz-Lopetegi A, Baiardi S, Balasa M, Mammana A, Mayà G, Rossi M, Serradell M, Zenesini C, Ticca A, Santamaria J, Dellavalle S, Gaig C, Iranzo A, Parchi P. CSF markers of neurodegeneration Alzheimer's and Lewy body pathology in isolated REM sleep behavior disorder. NPJ Parkinsons Dis 2024; 10:157. [PMID: 39147825 PMCID: PMC11327307 DOI: 10.1038/s41531-024-00770-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/26/2024] [Indexed: 08/17/2024] Open
Abstract
We investigated the biomarker profile of neurodegeneration, Alzheimer's and Lewy body pathology in the CSF of 148 polysomnography-confirmed patients with isolated REM sleep behavior disorder (IRBD), a condition that precedes Parkinson's disease (PD) and dementia with Lewy bodies (DLB). We assessed misfolded α-synuclein (AS) by RT-QuIC assay, amyloid-beta peptides (Aβ42 and Aβ40), phosphorylated tau (p-tau), and total tau (t-tau) by CLEIA and neurofilament light chain (NfL) by ELISA. We detected AS in 75.3% of patients, pathologically decreased Aβ42/Aβ40 ratio in 22.5%, increased p-tau in 15.5%, increased t-tau in 14.9%, and elevated NfL in 14.7%. After a mean follow-up of 2.48 ± 2.75 years, 47 (38.1%) patients developed PD (n = 24) or DLB (n = 23). At CSF collection, AS positivity [HR 4.05 (1.26-12.99), p = 0.019], mild cognitive impairment [3.86 (1.96-7.61), p < 0.001], and abnormal DAT-SPECT [2.31 (1.09-4.91), p < 0.030] were independent predictors of conversion to PD and DLB. Among the other CSF markers, only elevated p-tau/Aβ42 was predictive of conversion, although only to DLB and not as an independent variable. In IRBD, CSF AS assessment by RT-QuIC provides an added value in defining the risk of short-term conversion to PD and DLB independent of clinical and instrumental investigations. Positive Alzheimer's disease (AD) pathology markers and elevated NfL occur in a subgroup of patients, but p-tau/Aβ42 is the only marker that predicts short-term conversion to DLB. Longer follow-up is needed to assess if AD biomarkers predict the later development of PD and DLB in IRBD.
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Affiliation(s)
- Amaia Muñoz-Lopetegi
- Neurology Service, Sleep Unit, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Simone Baiardi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Mircea Balasa
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Angela Mammana
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Gerard Mayà
- Neurology Service, Sleep Unit, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Marcello Rossi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Mónica Serradell
- Neurology Service, Sleep Unit, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Corrado Zenesini
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Alice Ticca
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Joan Santamaria
- Neurology Service, Sleep Unit, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Sofia Dellavalle
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Carles Gaig
- Neurology Service, Sleep Unit, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Alex Iranzo
- Neurology Service, Sleep Unit, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain.
| | - Piero Parchi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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Shantaraman A, Dammer EB, Ugochukwu O, Duong DM, Yin L, Carter EK, Gearing M, Chen-Plotkin A, Lee EB, Trojanowski JQ, Bennett DA, Lah JJ, Levey AI, Seyfried NT, Higginbotham L. Network proteomics of the Lewy body dementia brain reveals presynaptic signatures distinct from Alzheimer's disease. Mol Neurodegener 2024; 19:60. [PMID: 39107789 PMCID: PMC11302177 DOI: 10.1186/s13024-024-00749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 07/24/2024] [Indexed: 08/10/2024] Open
Abstract
Lewy body dementia (LBD), a class of disorders comprising Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB), features substantial clinical and pathological overlap with Alzheimer's disease (AD). The identification of biomarkers unique to LBD pathophysiology could meaningfully advance its diagnosis, monitoring, and treatment. Using quantitative mass spectrometry (MS), we measured over 9,000 proteins across 138 dorsolateral prefrontal cortex (DLPFC) tissues from a University of Pennsylvania autopsy collection comprising control, Parkinson's disease (PD), PDD, and DLB diagnoses. We then analyzed co-expression network protein alterations in those with LBD, validated these disease signatures in two independent LBD datasets, and compared these findings to those observed in network analyses of AD cases. The LBD network revealed numerous groups or "modules" of co-expressed proteins significantly altered in PDD and DLB, representing synaptic, metabolic, and inflammatory pathophysiology. A comparison of validated LBD signatures to those of AD identified distinct differences between the two diseases. Notably, synuclein-associated presynaptic modules were elevated in LBD but decreased in AD relative to controls. We also found that glial-associated matrisome signatures consistently elevated in AD were more variably altered in LBD, ultimately stratifying those LBD cases with low versus high burdens of concurrent beta-amyloid deposition. In conclusion, unbiased network proteomic analysis revealed diverse pathophysiological changes in the LBD frontal cortex distinct from alterations in AD. These results highlight the LBD brain network proteome as a promising source of biomarkers that could enhance clinical recognition and management.
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Affiliation(s)
- Anantharaman Shantaraman
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric B Dammer
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Obiadada Ugochukwu
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Duc M Duong
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Luming Yin
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - E Kathleen Carter
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Marla Gearing
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Alice Chen-Plotkin
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - James J Lah
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Allan I Levey
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicholas T Seyfried
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Lenora Higginbotham
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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Bolsewig K, van Unnik AAJM, Blujdea ER, Gonzalez MC, Ashton NJ, Aarsland D, Zetterberg H, Padovani A, Bonanni L, Mollenhauer B, Schade S, Vandenberghe R, Poesen K, Kramberger MG, Paquet C, Bousiges O, Cretin B, Willemse EAJ, Teunissen CE, Lemstra AW. Association of Plasma Amyloid, P-Tau, GFAP, and NfL With CSF, Clinical, and Cognitive Features in Patients With Dementia With Lewy Bodies. Neurology 2024; 102:e209418. [PMID: 38830138 PMCID: PMC11244745 DOI: 10.1212/wnl.0000000000209418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/19/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Plasma β-amyloid-1-42/1-40 (Aβ42/40), phosphorylated-tau (P-tau), glial fibrillary acidic protein (GFAP), and neurofilament light (NfL) have been widely examined in Alzheimer disease (AD), but little is known about their reflection of copathologies, clinical importance, and predictive value in dementia with Lewy bodies (DLB). We aimed to evaluate associations of these biomarkers with CSF amyloid, cognition, and core features in DLB. METHODS This cross-sectional multicenter cohort study with prospective component included individuals with DLB, AD, and healthy controls (HCs), recruited from 2002 to 2020 with an annual follow-up of up to 5 years, from the European-Dementia With Lewy Bodies consortium. Plasma biomarkers were measured by single-molecule array (Neurology 4-Plex E kit). Amyloid status was determined by CSF Aβ42 concentrations, and cognition was assessed by Mini-Mental State Examination (MMSE). Biomarker differences across groups, associations with amyloid status, and clinical core features were assessed by analysis of covariance. Associations with cognitive impairment and decline were assessed by linear regression and linear mixed-effects models. RESULTS In our cohort consisting of 562 individuals (HC n = 89, DLB n = 342, AD n = 131; 250 women [44.5%], mean [SD] age of 71 [8] years), sex distribution did not differ between groups. Patients with DLB were significantly older, and had less years of education and worse baseline cognition than HC, but not AD. DLB participants stratified for amyloid status differed significantly in plasma Aβ42/40 ratio (decreased in amyloid abnormal: β = -0.008, 95% CI -0.016 to -0.0003, p = 0.01) and P-tau (increased in amyloid abnormal, P-tau181: β = 0.246, 95% CI 0.011-0.481; P-tau231: β = 0.227, 95% CI 0.035-0.419, both p < 0.05), but not in GFAP (β = 0.068, 95% CI -0.018 to 0.153, p = 0.119), and NfL (β = 0.004, 95% CI -0.087 to 0.096, p = 0.923) concentrations. Higher baseline GFAP, NfL, and P-tau concentrations were associated with lower MMSE scores in DLB, and GFAP and NfL were associated with a faster cognitive decline (GFAP: annual change of -2.11 MMSE points, 95% CI -2.88 to -1.35 MMSE points, p < 0.001; NfL: annual change of -2.13 MMSE points, 95% CI -2.97 to -1.29 MMSE points, p < 0.001). DLB participants with parkinsonism had higher concentrations of NfL (β = 0.08, 95% CI 0.02-0.14, p = 0.006) than those without. DISCUSSION Our study suggests a possible utility of plasma Aβ42/40, P-tau181, and P-tau231 as a noninvasive biomarkers to assess amyloid copathology in DLB, and plasma GFAP and NfL as monitoring biomarkers for cognitive symptoms in DLB.
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Affiliation(s)
- Katharina Bolsewig
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Annemartijn A J M van Unnik
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Elena R Blujdea
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Maria C Gonzalez
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Nicholas J Ashton
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Dag Aarsland
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Henrik Zetterberg
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Alessandro Padovani
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Laura Bonanni
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Brit Mollenhauer
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Sebastian Schade
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Rik Vandenberghe
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Koen Poesen
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Milica G Kramberger
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Claire Paquet
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Olivier Bousiges
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Benjamin Cretin
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Eline A J Willemse
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Charlotte E Teunissen
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
| | - Afina W Lemstra
- From the Department of Laboratory Medicine (K.B., E.R.B., E.A.J.W., C.E.T.) and Alzheimer Center Amsterdam (A.A.J.M.U., A.W.L.), Amsterdam UMC, the Netherlands; Department of Quality and Health Technology (M.C.G.), University of Stavanger; The Norwegian Centre for Movement Disorders (M.C.G.) and the Centre for Age-Related Medicine (M.C.G., N.J.A., D.A.), Stavanger University Hospital, Norway; Department of Psychiatry and Neurochemistry (N.J.A., H.Z.), the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Department of Old Age Psychiatry (N.J.A., D.A.), King's College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; UK Dementia Research Institute at UCL (H.Z.), London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.), Hong Kong, China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin School of Medicine and Public Health, Madison; Neurology Unit (A.P.), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Medicine and Aging Sciences (L.B.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Neurology (B.M.), University Medical Center Göttingen; Paracelsus-Elena-Klinik (B.M., S.S.), Germany; Department of Neurosciences (R.V., K.P.), KU Leuven, Belgium; Department of Neurology and Medical Faculty (M.G.K.), University Medical Center Ljubljana, Slovenia; Department of Neurobiology (M.G.K.), Karolinska Institutet, Huddinge, Sweden; Université de Paris Cité (C.P.), Centre de Neurologie Cognitive, Paris; Laboratory of Biochemistry and Molecular Biology (O.B.), University Hospital of Strasbourg; University of Strasbourg and CNRS (O.B., B.C.); Memory Resource and Research Centre (B.C.), University Hospital of Strasbourg, France; Department of Neurology (E.A.J.W.), Multiple Sclerosis Center; Research Center for Clinical Neuroimmunology and Neuroscience Basel (E.A.J.W.); and Departments of Biomedicine and Clinical Research (E.A.J.W.), University Hospital Basel and University of Basel, Switzerland
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Geng C, Tan L, Chen C. Neuropsychiatric symptoms profile and markers of Alzheimer disease-type pathology in patients with Lewy body dementias. Brain Res 2024; 1833:148881. [PMID: 38519009 DOI: 10.1016/j.brainres.2024.148881] [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] [Received: 01/19/2024] [Revised: 02/20/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND To determine whether Lewy body dementia (LBD) patients with likely copathology of Alzheimer's disease (AD) exhibit greater neuropsychiatric symptom (NPS) compared to those without likely AD-type copathology. METHODS We enrolled 69 individuals diagnosed with Lewy body dementia (LBD), comprising both dementia with Lewy bodies (DLB) (n = 36) and Parkinson's disease dementia (PDD) (n = 33). These participants had accessible cerebrospinal fluid (CSF) markers related to Alzheimer's disease (AD) and cognitive data. We assessed CSF levels of β-amyloid 42 (Aβ42), phosphorylated tau (p-tau), and total tau (t-tau). Employing autopsy-validated CSF thresholds (t-tau/Aβ42 ratio > 0.3, n = 69), we categorized individuals into LBD with AD pathology (LBD + AD, n = 31) and LBD without apparent AD co-pathology (LBD - AD, n = 38). Moreover, the Hamilton Depression Scale (HAMD24), Hamilton Anxiety Scale (HAMA14), and Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to assess the NPS. Spearman correlations were utilized to explore links between NPS and CSF marker profiles. RESULTS In terms of neuropsychiatric symptoms, LBD + AD patients demonstrated notably elevated levels of depressive symptoms (HAMD24) in comparison to LBD - AD patients (P < 0.001). However, based on PDD and DLB groups, no significant variations were noted in the neuropsychiatric symptoms(P>0.05). Moreover, CSF-derived biomarkers of Aβ42, and t-tau/Aβ42 were also associated with HAMD24 total scores in the LBD + AD subsample (P < 0.05). CONCLUSION There is an association between AD pathological markers and the NPS of LBD. The biologically based classification of LBD may be more advantageous in elucidating clinical heterogeneity than clinically defined syndromes.
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Affiliation(s)
- Chaofan Geng
- Department of Neurology & Innovation Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China
| | - Leilei Tan
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Chen Chen
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
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5
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Wetering JV, Geut H, Bol JJ, Galis Y, Timmermans E, Twisk JWR, Hepp DH, Morella ML, Pihlstrom L, Lemstra AW, Rozemuller AJM, Jonkman LE, van de Berg WDJ. Neuroinflammation is associated with Alzheimer's disease co-pathology in dementia with Lewy bodies. Acta Neuropathol Commun 2024; 12:73. [PMID: 38715119 PMCID: PMC11075309 DOI: 10.1186/s40478-024-01786-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Neuroinflammation and Alzheimer's disease (AD) co-pathology may contribute to disease progression and severity in dementia with Lewy bodies (DLB). This study aims to clarify whether a different pattern of neuroinflammation, such as alteration in microglial and astroglial morphology and distribution, is present in DLB cases with and without AD co-pathology. METHODS The morphology and load (% area of immunopositivity) of total (Iba1) and reactive microglia (CD68 and HLA-DR), reactive astrocytes (GFAP) and proteinopathies of alpha-synuclein (KM51/pser129), amyloid-beta (6 F/3D) and p-tau (AT8) were assessed in a cohort of mixed DLB + AD (n = 35), pure DLB (n = 15), pure AD (n = 16) and control (n = 11) donors in limbic and neocortical brain regions using immunostaining, quantitative image analysis and confocal microscopy. Regional and group differences were estimated using a linear mixed model analysis. RESULTS Morphologically, reactive and amoeboid microglia were common in mixed DLB + AD, while homeostatic microglia with a small soma and thin processes were observed in pure DLB cases. A higher density of swollen astrocytes was observed in pure AD cases, but not in mixed DLB + AD or pure DLB cases. Mixed DLB + AD had higher CD68-loads in the amygdala and parahippocampal gyrus than pure DLB cases, but did not differ in astrocytic loads. Pure AD showed higher Iba1-loads in the CA1 and CA2, higher CD68-loads in the CA2 and subiculum, and a higher astrocytic load in the CA1-4 and subiculum than mixed DLB + AD cases. In mixed DLB + AD cases, microglial load associated strongly with amyloid-beta (Iba1, CD68 and HLA-DR), and p-tau (CD68 and HLA-DR), and minimally with alpha-synuclein load (CD68). In addition, the highest microglial activity was found in the amygdala and CA2, and astroglial load in the CA4. Confocal microscopy demonstrated co-localization of large amoeboid microglia with neuritic and classic-cored plaques of amyloid-beta and p-tau in mixed DLB + AD cases. CONCLUSIONS In conclusion, microglial activation in DLB was largely associated with AD co-pathology, while astrocytic response in DLB was not. In addition, microglial activity was high in limbic regions, with prevalent AD pathology. Our study provides novel insights into the molecular neuropathology of DLB, highlighting the importance of microglial activation in mixed DLB + AD.
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Affiliation(s)
- Janna van Wetering
- Department of Anatomy and Neurosciences, Section Clinical Neuroanatomy and Biobanking and Life Sciences O|2 building 13e55, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HV, The Netherlands
- Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Hanne Geut
- Department of Anatomy and Neurosciences, Section Clinical Neuroanatomy and Biobanking and Life Sciences O|2 building 13e55, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HV, The Netherlands
- Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - John J Bol
- Department of Anatomy and Neurosciences, Section Clinical Neuroanatomy and Biobanking and Life Sciences O|2 building 13e55, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HV, The Netherlands
| | - Yvon Galis
- Department of Anatomy and Neurosciences, Section Clinical Neuroanatomy and Biobanking and Life Sciences O|2 building 13e55, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HV, The Netherlands
| | - Evelien Timmermans
- Department of Anatomy and Neurosciences, Section Clinical Neuroanatomy and Biobanking and Life Sciences O|2 building 13e55, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HV, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Dagmar H Hepp
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Martino L Morella
- Department of Anatomy and Neurosciences, Section Clinical Neuroanatomy and Biobanking and Life Sciences O|2 building 13e55, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HV, The Netherlands
- Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Lasse Pihlstrom
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Afina W Lemstra
- Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, De Boelelaan 1117, The Netherlands
- Alzheimer Center, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Annemieke J M Rozemuller
- Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Pathology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Laura E Jonkman
- Department of Anatomy and Neurosciences, Section Clinical Neuroanatomy and Biobanking and Life Sciences O|2 building 13e55, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HV, The Netherlands
- Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Wilma D J van de Berg
- Department of Anatomy and Neurosciences, Section Clinical Neuroanatomy and Biobanking and Life Sciences O|2 building 13e55, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HV, The Netherlands.
- Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands.
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Shantaraman A, Dammer EB, Ugochukwu O, Duong DM, Yin L, Carter EK, Gearing M, Chen-Plotkin A, Lee EB, Trojanowski JQ, Bennett DA, Lah JJ, Levey AI, Seyfried NT, Higginbotham L. Network Proteomics of the Lewy Body Dementia Brain Reveals Presynaptic Signatures Distinct from Alzheimer's Disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.23.576728. [PMID: 38328211 PMCID: PMC10849701 DOI: 10.1101/2024.01.23.576728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Lewy body dementia (LBD), a class of disorders comprising Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB), features substantial clinical and pathological overlap with Alzheimer's disease (AD). The identification of biomarkers unique to LBD pathophysiology could meaningfully advance its diagnosis, monitoring, and treatment. Using quantitative mass spectrometry (MS), we measured over 9,000 proteins across 138 dorsolateral prefrontal cortex (DLPFC) tissues from a University of Pennsylvania autopsy collection comprising control, Parkinson's disease (PD), PDD, and DLB diagnoses. We then analyzed co-expression network protein alterations in those with LBD, validated these disease signatures in two independent LBD datasets, and compared these findings to those observed in network analyses of AD cases. The LBD network revealed numerous groups or "modules" of co-expressed proteins significantly altered in PDD and DLB, representing synaptic, metabolic, and inflammatory pathophysiology. A comparison of validated LBD signatures to those of AD identified distinct differences between the two diseases. Notably, synuclein-associated presynaptic modules were elevated in LBD but decreased in AD relative to controls. We also found that glial-associated matrisome signatures consistently elevated in AD were more variably altered in LBD, ultimately stratifying those LBD cases with low versus high burdens of concurrent beta-amyloid deposition. In conclusion, unbiased network proteomic analysis revealed diverse pathophysiological changes in the LBD frontal cortex distinct from alterations in AD. These results highlight the LBD brain network proteome as a promising source of biomarkers that could enhance clinical recognition and management.
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Affiliation(s)
- Anantharaman Shantaraman
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric B. Dammer
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Obiadada Ugochukwu
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Duc M. Duong
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Luming Yin
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - E. Kathleen Carter
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Marla Gearing
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Alice Chen-Plotkin
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Edward B. Lee
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - James J. Lah
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Allan I. Levey
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicholas T. Seyfried
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Lenora Higginbotham
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Kobayashi R, Morioka D, Kawakatsu S, Sakamoto K, Suzuki A. Application of Suggestive Biomarkers in Dementia With Lewy Bodies With Masking of Typical Clinical Symptoms by Alzheimer Disease-type Pathology. Alzheimer Dis Assoc Disord 2024; 38:95-97. [PMID: 38227857 DOI: 10.1097/wad.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
Dementia with Lewy bodies (DLB) is strongly associated with Alzheimer disease (AD)-type pathology and tends to mask the core clinical features of DLB. Therefore, there may be cases of undiagnosed DLB without suggestive biomarkers of DLB. We describe the case of a 63-year-old woman who was initially diagnosed as having AD and later diagnosed with DLB based on suggestive biomarkers of DLB. In this case, transient sleep talking with physical movements for several days led to the assessment of suggestive biomarkers for DLB in the absence of the core clinical features of DLB. For clinicians, diagnosing DLB in patients with AD-type pathology is challenging. However, the application of biomarkers suggestive of DLB to all patients with dementia is not realistic. To overcome the difficulties of clinical diagnosis of DLB, further research is needed regarding strategies for the application of suggestive biomarkers for DLB to appropriately diagnose DLB.
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Affiliation(s)
- Ryota Kobayashi
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
| | - Daichi Morioka
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
| | - Shinobu Kawakatsu
- Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Kazutaka Sakamoto
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
| | - Akihito Suzuki
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
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Tolea MI, Ezzeddine R, Camacho S, Galvin JE. Emerging drugs for dementia with Lewy Bodies: a review of Phase II & III trials. Expert Opin Emerg Drugs 2023; 28:167-180. [PMID: 37531299 DOI: 10.1080/14728214.2023.2244425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Despite faster cognitive decline and greater negative impact on patients and family caregivers, drug development efforts in Dementia with Lewy Bodies (DLB) fall behind those for Alzheimer's Disease (AD). Current off-label drug DLB treatment options are limited to symptomatic agents developed to address cognitive deficits in AD, motor deficits in Parkinson's Disease, or behavioral symptoms in psychiatric disease. Aided by recent improvements in DLB diagnosis, a new focus on the development of disease-modifying agents (DMA) is emerging. AREAS COVERED Driven by evidence supporting different pathological mechanisms in DLB and PDD, this review assesses the evidence on symptomatic drug treatments and describes current efforts in DMA development in DLB. Specifically, our goals were to: (1) review evidence supporting the use of symptomatic drug treatments in DLB; (2) review the current DMA pipeline in DLB with a focus on Phase II and III clinical trials; and (3) identify potential issues with the development of DMA in DLB. Included in this review were completed and ongoing drug clinical trials in DLB registered on ClinicalTrials.gov (no time limits set for the search) or disseminated at the 2023 international conference on Clinical Trials in AD. Drug clinical trials registered in non-US clinical trial registries were not included. EXPERT OPINION Adoption of current symptomatic drug treatments used off-label in DLB relied on efficacy of benefits in other disorders rather than evidence from randomized controlled clinical trials. Symptoms remain difficult to manage. Several DMA drugs are currently being evaluated as either repurposing candidates or novel small molecules. Continued improvement in methodological aspects including development of DLB-specific outcome measures and biomarkers is needed to move the field of DMA drug development forward.
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Affiliation(s)
- Magdalena I Tolea
- Comprehensive Center for Brain Health, Lewy Body Dementia Research Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Reem Ezzeddine
- Comprehensive Center for Brain Health, Lewy Body Dementia Research Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Simone Camacho
- Comprehensive Center for Brain Health, Lewy Body Dementia Research Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Lewy Body Dementia Research Center of Excellence, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Gharbi A, Nasri A, Sghaier I, Kacem I, Mrabet S, Souissi A, Ben Djebara M, Gargouri A, Gouider R. Subtypes of Dementia with Lewy Bodies: Clinical Features, Survival, and Apolipoprotein E Effect. J Alzheimers Dis Rep 2023; 7:1277-1288. [PMID: 38143772 PMCID: PMC10741894 DOI: 10.3233/adr-230064] [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: 07/11/2023] [Accepted: 11/01/2023] [Indexed: 12/26/2023] Open
Abstract
Background Dementia with Lewy bodies (DLB) is a progressive neurodegenerative disease with various clinical symptoms. Limited data have described the clinical subtypes of DLB. Objective We aimed to compare clinical subtypes of DLB according to initial symptoms and to study the effect of Apolipoprotein E (APOE) gene in DLB. Methods We included DLB patients classified into three groups based on initial symptoms: non-motor onset (cognitive and/or psychiatric) (NMO-DLB), motor onset (parkinsonism and/or gait disorders) (MO-DLB), and mixed onset (non-motor and motor symptoms) (MXO-DLB). Clinical and APOE genotype associations and survival were analyzed. Results A total of 268 patients were included (NMO-DLB = 75%, MXO-DLB = 15.3%, MO-DLB = 9.7%). Visual hallucinations were more frequent (p = 0.025), and attention was less commonly impaired in MXO-DLB (p = 0.047). When adjusting with APOE ɛ4 status (APOE genotype performed in 155 patients), earlier falls and frontal lobe syndrome were more common in MXO-DLB (p = 0.044 and p = 0.023, respectively). The median MMSE decline was 2.1 points/year and the median FAB decline was 1.9 points/year, with no effect of clinical subtypes. Median survival was 6 years. It was similar in DLB subtypes (p = 0.62), but shorter for patients with memory symptoms at onset (p = 0.04) and for males (p = 0.0058). Conclusions Our study revealed a few differences between DLB clinical subtypes. APOE ɛ4 appears to be associated with earlier falls and a higher prevalence of frontal syndrome in MXO-DLB. However, DLB clinical subtypes did not impact on survival. Nevertheless, survival analysis identified other poor prognosis factors, notably inaugural memory impairment and male gender.
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Affiliation(s)
- Alya Gharbi
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Amina Nasri
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Ikram Sghaier
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Imen Kacem
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Saloua Mrabet
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Amira Souissi
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Mouna Ben Djebara
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Amina Gargouri
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Riadh Gouider
- Neurology Department, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
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Collij LE, Farrar G, Zwan M, van de Giessen E, Ossenkoppele R, Barkhof F, Rozemuller AJM, Pijnenburg YAL, van der Flier WM, Bouwman F. Clinical outcomes up to 9 years after [ 18F]flutemetamol amyloid-PET in a symptomatic memory clinic population. Alzheimers Res Ther 2023; 15:207. [PMID: 38012799 PMCID: PMC10680192 DOI: 10.1186/s13195-023-01351-1] [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: 06/27/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Previous studies demonstrated increases in diagnostic confidence and change in patient management after amyloid-PET. However, studies investigating longitudinal outcomes over an extended period of time are limited. Therefore, we aimed to investigate clinical outcomes up to 9 years after amyloid-PET to support the clinical validity of the imaging technique. METHODS We analyzed longitudinal data from 200 patients (Mage = 61.8, 45.5% female, MMMSE = 23.3) suspected of early-onset dementia that underwent [18F]flutemetamol-PET. Baseline amyloid status was determined through visual read (VR). Information on mortality was available with a mean follow-up of 6.7 years (range = 1.1-9.3). In a subset of 108 patients, longitudinal cognitive scores and clinical etiological diagnosis (eDx) at least 1 year after amyloid-PET acquisition were available (M = 3.06 years, range = 1.00-7.02). VR - and VR + patients were compared on mortality rates with Cox Hazard's model, prevalence of stable eDx using chi-square test, and longitudinal cognition with linear mixed models. Neuropathological data was available for 4 patients (mean delay = 3.59 ± 1.82 years, range = 1.2-6.3). RESULTS At baseline, 184 (92.0%) patients were considered to have dementia. The majority of VR + patients had a primary etiological diagnosis of AD (122/128, 95.3%), while the VR - group consisted mostly of non-AD etiologies, most commonly frontotemporal lobar degeneration (30/72, 40.2%). Overall mortality rate was 48.5% and did not differ between VR - and VR + patients. eDx at follow-up was consistent with baseline diagnosis for 92/108 (85.2%) patients, with most changes observed in VR - cases (VR - = 14/35, 40% vs VR + = 2/73, 2.7%, χ2 = 26.03, p < 0.001), who at no time received an AD diagnosis. VR + patients declined faster than VR - patients based on MMSE (β = - 1.17, p = 0.004), episodic memory (β = - 0.78, p = 0.003), fluency (β = - 1.44, p < 0.001), and attention scores (β = 16.76, p = 0.03). Amyloid-PET assessment was in line with post-mortem confirmation in all cases; two cases were VR + and showed widespread AD pathology, while the other two cases were VR - and showed limited amyloid pathology. CONCLUSION In a symptomatic population, we observed that amyloid-status did not impact mortality rates, but is predictive of cognitive functioning over time across several domains. Also, we show particular validity for a negative amyloid-PET assessment, as these patients did not receive an AD diagnosis at follow-up.
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Affiliation(s)
- Lyduine E Collij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands.
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
| | | | - Marissa Zwan
- Alzheimer Center and Department of Neurology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Alzheimer Center and Department of Neurology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
- Centre for Medical Image Computing, and Queen Square Institute of Neurology, UCL, London, UK
| | | | - Yolande A L Pijnenburg
- Alzheimer Center and Department of Neurology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center and Department of Neurology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
| | - Femke Bouwman
- Alzheimer Center and Department of Neurology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
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Alam JJ, Maruff P, Doctrow SR, Chu HM, Conway J, Gomperts SN, Teunissen C. Association of Plasma Phosphorylated Tau With the Response to Neflamapimod Treatment in Patients With Dementia With Lewy Bodies. Neurology 2023; 101:e1708-e1717. [PMID: 37657939 PMCID: PMC10624490 DOI: 10.1212/wnl.0000000000207755] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In a proportion of patients, dementia with Lewy bodies (DLB) is associated with Alzheimer disease (AD) copathology, which is linked to accelerated cognitive decline and more extensive cortical atrophy. The objective was to evaluate the relationship between a biomarker of AD copathology, plasma tau phosphorylated at residue 181 (ptau181), and the treatment effects of the p38α kinase inhibitor neflamapimod, which targets the cholinergic degenerative process in DLB. METHODS The AscenD-LB study was a phase 2a, randomized (1:1), 16-week, placebo-controlled clinical trial of neflamapimod in DLB, the main results of which have been published. After the study was completed (i.e., post hoc), pretreatment plasma ptau181 levels were determined and participants were grouped based on a cutoff for AD pathology of 2.2 pg/mL (established in a separate cohort to identify AD from healthy controls). Clinical outcomes for the comparison of placebo with neflamapimod 40 mg three times daily (TID; the higher and more clinically active of 2 doses studied) were analyzed using mixed models for repeated measures within each subgroup (baseline plasma ptau181 < and ≥2.2 pg/mL). RESULTS Pretreatment plasma ptau181 levels were determined in eighty-five participants with mild-to-moderate DLB receiving cholinesterase inhibitors, with 45 participants below and 40 above the 2.2 pg/mL cutoff at baseline. In the 16-week treatment period, in the comparison of placebo with neflamapimod 40 mg TID, for all end points evaluated, improvements with neflamapimod treatment were greater in participants below the cutoff, compared with those above the cutoff. In addition, participants below the ptau181 cutoff at baseline showed significant improvement over placebo in an attention composite measure (+0.42, 95% CI 0.07-0.78, p = 0.023, d = 0.78), the Clinical Dementia Rating Scale Sum of Boxes (-0.60, 95% CI -1.04 to -0.06, p = 0.031, d = 0.70), the Timed Up and Go test (-3.1 seconds, 95% CI -4.7 to -1.6, p < 0.001, d = 0.74), and International Shopping List Test-Recognition (+1.4, 95% CI 0.2-2.5, p = 0.024, d = 1.00). DISCUSSION Exclusion of patients with elevated plasma ptau181, potentially through excluding patients with extensive cortical neurodegeneration, enriches for a patient with DLB population that is more responsive to neflamapimod. More generally, plasma biomarkers of AD copathology at study entry should be considered as stratification variables in DLB clinical trials. TRIAL REGISTRATION INFORMATION NCT04001517 at ClinicalTrials.gov.
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Affiliation(s)
- John J Alam
- From the CervoMed (formerly EIP Pharma) (J.J.A., S.R.D., J.C.), Inc., Boston, MA; CogState Ltd London (P.M.), United Kingdom; Anoixis Corporation (H.-M.C.), Natick; Massachusetts Alzheimer's Disease Research Center (S.N.G.), Department of Neurology, Massachusetts General Hospital, Charlestown; and Neurochemistry Lab (C.T.), Department of Laboratory Medicine, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.
| | - Paul Maruff
- From the CervoMed (formerly EIP Pharma) (J.J.A., S.R.D., J.C.), Inc., Boston, MA; CogState Ltd London (P.M.), United Kingdom; Anoixis Corporation (H.-M.C.), Natick; Massachusetts Alzheimer's Disease Research Center (S.N.G.), Department of Neurology, Massachusetts General Hospital, Charlestown; and Neurochemistry Lab (C.T.), Department of Laboratory Medicine, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Susan R Doctrow
- From the CervoMed (formerly EIP Pharma) (J.J.A., S.R.D., J.C.), Inc., Boston, MA; CogState Ltd London (P.M.), United Kingdom; Anoixis Corporation (H.-M.C.), Natick; Massachusetts Alzheimer's Disease Research Center (S.N.G.), Department of Neurology, Massachusetts General Hospital, Charlestown; and Neurochemistry Lab (C.T.), Department of Laboratory Medicine, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Hui-May Chu
- From the CervoMed (formerly EIP Pharma) (J.J.A., S.R.D., J.C.), Inc., Boston, MA; CogState Ltd London (P.M.), United Kingdom; Anoixis Corporation (H.-M.C.), Natick; Massachusetts Alzheimer's Disease Research Center (S.N.G.), Department of Neurology, Massachusetts General Hospital, Charlestown; and Neurochemistry Lab (C.T.), Department of Laboratory Medicine, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Jennifer Conway
- From the CervoMed (formerly EIP Pharma) (J.J.A., S.R.D., J.C.), Inc., Boston, MA; CogState Ltd London (P.M.), United Kingdom; Anoixis Corporation (H.-M.C.), Natick; Massachusetts Alzheimer's Disease Research Center (S.N.G.), Department of Neurology, Massachusetts General Hospital, Charlestown; and Neurochemistry Lab (C.T.), Department of Laboratory Medicine, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Stephen N Gomperts
- From the CervoMed (formerly EIP Pharma) (J.J.A., S.R.D., J.C.), Inc., Boston, MA; CogState Ltd London (P.M.), United Kingdom; Anoixis Corporation (H.-M.C.), Natick; Massachusetts Alzheimer's Disease Research Center (S.N.G.), Department of Neurology, Massachusetts General Hospital, Charlestown; and Neurochemistry Lab (C.T.), Department of Laboratory Medicine, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Charlotte Teunissen
- From the CervoMed (formerly EIP Pharma) (J.J.A., S.R.D., J.C.), Inc., Boston, MA; CogState Ltd London (P.M.), United Kingdom; Anoixis Corporation (H.-M.C.), Natick; Massachusetts Alzheimer's Disease Research Center (S.N.G.), Department of Neurology, Massachusetts General Hospital, Charlestown; and Neurochemistry Lab (C.T.), Department of Laboratory Medicine, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
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Aveneau C, Wallon D, Degos B, Obadia A, Hourregue C, Benisty S, Garcin B, Dumurgier J, Paquet C. Is the clinical phenotype impact the prognosis in dementia with Lewy bodies? Alzheimers Res Ther 2023; 15:169. [PMID: 37821973 PMCID: PMC10565988 DOI: 10.1186/s13195-023-01305-7] [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] [Received: 07/17/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION The first predominant clinical symptoms of dementia with Lewy bodies (DLB) are highly variable; however, the prognosis based on initial predominant symptoms remains poorly understood. METHODS Multicenter retrospective study in 4 French expert neurological centers. Patients were categorized in 3 groups according to their first more predominant symptoms: cognitive, psychiatric, or motor. RESULTS Analysis of 310 DLB patients. The mean age was 73.5 years old (SD 7.5) including 32.3% of women. The mean follow-up was 7.25 years (SD 3.6). We observed that the full clinical picture was more frequent in the motor group than in the cognitive group (p = 0.01); male gender and age at onset were associated with a significant excess risk of instantaneous mortality (p = 0.01). CONCLUSION Initial symptoms may affect the clinical course of patients, but no significant difference in mortality was observed.
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Affiliation(s)
- Clément Aveneau
- Cognitive Neurology Center, Université Paris Cité, Lariboisière Fernand Widal Hospital, Assistance PubliqueHôpitaux de Paris, Paris, France
- INSERM U1144, Therapeutic Optimization in Neuropsychopharmacology, Paris, France
| | - David Wallon
- Department of Neurology and CNR-MAJ, 76000INSERM U1245, Normandy Center for Genomic and Personalized Medicine, Normandie University, UNIROUEN, CHU Rouen, Rouen, France
| | - Bertrand Degos
- Neurology Department, Avicenne Hospital, APHP, Hôpitaux, Universitaires de Paris-Seine Saint Denis (HUPSSD), Sorbonne Paris Nord, Réseau NS-PARK/FCRIN, Bobigny, France
| | - Alexandre Obadia
- Neurology Department, Fondation Adolphe de Rothschild, Paris, France
| | - Claire Hourregue
- Cognitive Neurology Center, Université Paris Cité, Lariboisière Fernand Widal Hospital, Assistance PubliqueHôpitaux de Paris, Paris, France
| | - Sarah Benisty
- Neurology Department, Fondation Adolphe de Rothschild, Paris, France
| | - Béatrice Garcin
- Neurology Department, Avicenne Hospital, APHP, Hôpitaux, Universitaires de Paris-Seine Saint Denis (HUPSSD), Sorbonne Paris Nord, Réseau NS-PARK/FCRIN, Bobigny, France
| | - Julien Dumurgier
- Cognitive Neurology Center, Université Paris Cité, Lariboisière Fernand Widal Hospital, Assistance PubliqueHôpitaux de Paris, Paris, France
| | - Claire Paquet
- Cognitive Neurology Center, Université Paris Cité, Lariboisière Fernand Widal Hospital, Assistance PubliqueHôpitaux de Paris, Paris, France.
- INSERM U1144, Therapeutic Optimization in Neuropsychopharmacology, Paris, France.
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13
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Coughlin DG, Irwin DJ. Fluid and Biopsy Based Biomarkers in Parkinson's Disease. Neurotherapeutics 2023; 20:932-954. [PMID: 37138160 PMCID: PMC10457253 DOI: 10.1007/s13311-023-01379-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/05/2023] Open
Abstract
Several advances in fluid and tissue-based biomarkers for use in Parkinson's disease (PD) and other synucleinopathies have been made in the last several years. While work continues on species of alpha-synuclein (aSyn) and other proteins which can be measured from spinal fluid and plasma samples, immunohistochemistry and immunofluorescence from peripheral tissue biopsies and alpha-synuclein seeding amplification assays (aSyn-SAA: including real-time quaking induced conversion (RT-QuIC) and protein misfolding cyclic amplification (PMCA)) now offer a crucial advancement in their ability to identify aSyn species in PD patients in a categorical fashion (i.e., of aSyn + vs aSyn -); to augment clinical diagnosis however, aSyn-specific assays that have quantitative relevance to pathological burden remain an unmet need. Alzheimer's disease (AD) co-pathology is commonly found postmortem in PD, especially in those who develop dementia, and dementia with Lewy bodies (DLB). Biofluid biomarkers for tau and amyloid beta species can detect AD co-pathology in PD and DLB, which does have relevance for prognosis, but further work is needed to understand the interplay of aSyn tau, amyloid beta, and other pathological changes to generate comprehensive biomarker profiles for patients in a manner translatable to clinical trial design and individualized therapies.
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Affiliation(s)
- David G Coughlin
- Department of Neurosciences, University of California San Diego, 9444 Medical Center Drive, ECOB 03-021, MCC 0886, La Jolla, CA, 92037, USA.
| | - David J Irwin
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Noguchi-Shinohara M, Ono K. The Mechanisms of the Roles of α-Synuclein, Amyloid-β, and Tau Protein in the Lewy Body Diseases: Pathogenesis, Early Detection, and Therapeutics. Int J Mol Sci 2023; 24:10215. [PMID: 37373401 DOI: 10.3390/ijms241210215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Lewy body diseases (LBD) are pathologically defined as the accumulation of Lewy bodies composed of an aggregation of α-synuclein (αSyn). In LBD, not only the sole aggregation of αSyn but also the co-aggregation of amyloidogenic proteins, such as amyloid-β (Aβ) and tau, has been reported. In this review, the pathophysiology of co-aggregation of αSyn, Aβ, and tau protein and the advancement in imaging and fluid biomarkers that can detect αSyn and co-occurring Aβ and/or tau pathologies are discussed. Additionally, the αSyn-targeted disease-modifying therapies in clinical trials are summarized.
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Affiliation(s)
- Moeko Noguchi-Shinohara
- Department of Neurology, Kanazawa University Graduate School of Medical Sciences, Kanazawa 920-8640, Japan
| | - Kenjiro Ono
- Department of Neurology, Kanazawa University Graduate School of Medical Sciences, Kanazawa 920-8640, Japan
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15
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Jellinger KA. Morphological characteristics differentiate dementia with Lewy bodies from Parkinson disease with and without dementia. J Neural Transm (Vienna) 2023:10.1007/s00702-023-02660-3. [PMID: 37306790 DOI: 10.1007/s00702-023-02660-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/01/2023] [Indexed: 06/13/2023]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson disease (PD) with and without dementia are entities of a spectrum of Lewy body diseases. About 26.3% of all PD patients develop dementia increasing up to 83%. Parkinson disease-dementia (PDD) and DLB share many clinical and morphological features that separate them from non-demented PD (PDND). Clinically distinguished by the temporal sequence of motor and cognitive symptoms, the pathology of PDD and DLB includes variable combinations of Lewy body (LB) and Alzheimer (AD) lesions, both being more severe in DLB, but much less frequent and less severe in PDND. The objective of this study was to investigate the morphological differences between these three groups. 290 patients with pathologically confirmed PD were reviewed. 190 of them had clinical dementia; 110 met the neuropathological criteria of PDD and 80 of DLB. The major demographic and clinical data were obtained from medical records. Neuropathology included semiquantitative assessment of LB and AD pathologies including cerebral amyloid angiopathy (CAA). PDD patients were significantly older than PDND and DLB ones (83.9 vs 77.9 years, p < 0.05); the age of DLB patients was between them (80.0 years), while the disease duration was shortest in DLB. Brain weight was lowest in DLB, which showed higher Braak LB scores (mean 5.2 vs 4.2) and highest Braak tau stages (mean 5.2 vs 4.4 and 2.3, respectively). Thal Aβ phases were also highest in DLB (mean 4.1 vs 3.0 and 1.8, respectively). Major findings were frequency and degree of CAA, being highest in DLB (95% vs 50% and 24%, with scores 2.9 vs 0.7 and 0.3, respectively), whereas other small vessel lesions showed no significant differences. Striatal Aβ deposits also differentiated DLB from the other groups. This and other studies of larger cohorts of PD patients indicate that the association of CAA and cortical tau-but less-LB pathologies are associated with more severe cognitive decline and worse prognosis that distinguish DLB from PDD and PDND. The particular impact of both CAA and tau pathology supports the concept of a pathogenic continuum ranging from PDND to DLB + AD within the spectrum of age-related synucleinopathies.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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16
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Chin KS, Gajamange S, Desmond PM, Villemagne VL, Rowe CC, Churilov L, Yassi N, Watson R. Association between amyloid-beta deposition and cortical thickness in dementia with Lewy bodies. Aust N Z J Psychiatry 2023; 57:594-602. [PMID: 35196886 DOI: 10.1177/00048674221081773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Amyloid-beta often co-exists in dementia with Lewy bodies, but its clinical relevance in dementia with Lewy bodies remains unclear. This study aimed to investigate the clinical and imaging correlates of amyloid-beta deposition in dementia with Lewy bodies, particularly its relationship with cortical thickness in Alzheimer's disease-prone regions and hippocampal volume. METHODS Twenty-four participants with probable dementia with Lewy bodies underwent high-resolution magnetic resonance imaging and amyloid-beta positron emission tomography imaging using the radiotracer 18F-NAV4694. Amyloid-beta deposition was quantified and reported using the Centiloid method. RESULTS Amyloid-beta positivity, defined as Centiloid > 50, was present in 45.8% of dementia with Lewy bodies participants. There were no statistically significant differences in clinical characteristics between Aβ+ and Aβ- dementia with Lewy bodies. Compared with the Aβ- group, Aβ+ dementia with Lewy bodies exhibited greater global cortical thinning as well as in the Alzheimer's disease-prone region of interest, adjusted for age, sex and years of education. A mean cortical thickness of 5.12 mm across a combined meta-region of interest has a sensitivity of 88.9% and specificity of 90.0% in discriminating Aβ+ from Aβ- dementia with Lewy bodies. Hippocampal volume was not different between groups. CONCLUSION Early structural changes in cortical thickness, but not hippocampal volume, were observed in dementia with Lewy bodies with significant amyloid-beta burden. This may represent an early Alzheimer's disease-related neurodegenerative process.
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Affiliation(s)
- Kai Sin Chin
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
- Department of Aged Care, The Royal Melbourne Hospital, Parkville, VIC, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Sanuji Gajamange
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Patricia M Desmond
- Department of Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Victor L Villemagne
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Molecular Imaging & Therapy, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - Christopher C Rowe
- Department of Molecular Imaging & Therapy, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - Leonid Churilov
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Nawaf Yassi
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Rosie Watson
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
- Department of Aged Care, The Royal Melbourne Hospital, Parkville, VIC, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
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Cousins KAQ, Irwin DJ, Chen-Plotkin A, Shaw LM, Arezoumandan S, Lee EB, Wolk DA, Weintraub D, Spindler M, Deik A, Grossman M, Tropea TF. Plasma GFAP associates with secondary Alzheimer's pathology in Lewy body disease. Ann Clin Transl Neurol 2023; 10:802-813. [PMID: 37000892 DOI: 10.1002/acn3.51768] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE Within Lewy body spectrum disorders (LBSD) with α-synuclein pathology (αSyn), concomitant Alzheimer's disease (AD) pathology is common and is predictive of clinical outcomes, including cognitive impairment and decline. Plasma phosphorylated tau 181 (p-tau181 ) is sensitive to AD neuropathologic change (ADNC) in clinical AD, and plasma glial fibrillary acidic protein (GFAP) is associated with the presence of β-amyloid plaques. While these plasma biomarkers are well tested in clinical and pathological AD, their diagnostic and prognostic performance for concomitant AD in LBSD is unknown. METHODS In autopsy-confirmed αSyn-positive LBSD, we tested how plasma p-tau181 and GFAP differed across αSyn with concomitant ADNC (αSyn+AD; n = 19) and αSyn without AD (αSyn; n = 30). Severity of burden was scored on a semiquantitative scale for several pathologies (e.g., β-amyloid and tau), and scores were averaged across sampled brainstem, limbic, and neocortical regions. RESULTS Linear models showed that plasma GFAP was significantly higher in αSyn+AD compared to αSyn (β = 0.31, 95% CI = 0.065-0.56, and P = 0.015), after covarying for age at plasma, plasma-to-death interval, and sex; plasma p-tau181 was not (P = 0.37). Next, linear models tested associations of AD pathological features with both plasma analytes, covarying for plasma-to-death, age at plasma, and sex. GFAP was significantly associated with brain β-amyloid (β = 15, 95% CI = 6.1-25, and P = 0.0018) and tau burden (β = 12, 95% CI = 2.5-22, and P = 0.015); plasma p-tau181 was not associated with either (both P > 0.34). INTERPRETATION Findings indicate that plasma GFAP may be sensitive to concomitant AD pathology in LBSD, especially accumulation of β-amyloid plaques.
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Affiliation(s)
- Katheryn A Q Cousins
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David J Irwin
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alice Chen-Plotkin
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanaz Arezoumandan
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Wolk
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meredith Spindler
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andres Deik
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Thomas F Tropea
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Chiu SY, Wyman-Chick KA, Ferman TJ, Bayram E, Holden SK, Choudhury P, Armstrong MJ. Sex differences in dementia with Lewy bodies: Focused review of available evidence and future directions. Parkinsonism Relat Disord 2023; 107:105285. [PMID: 36682958 PMCID: PMC10024862 DOI: 10.1016/j.parkreldis.2023.105285] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/07/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
In this review, we summarize the current knowledge on sex differences in dementia with Lewy bodies (DLB) relating to epidemiology, clinical features, neuropathology, biomarkers, disease progression, and caregiving. While many studies show a higher DLB prevalence in men, this finding is inconsistent and varies by study approach. Visual hallucinations may be more common and occur earlier in women with DLB, whereas REM sleep behavior disorder may be more common and occur earlier in men. Several studies report a higher frequency of parkinsonism in men with DLB, while the frequency of fluctuations appears similar between sexes. Women tend to be older, have greater cognitive impairment at their initial visit, and are delayed in meeting DLB criteria compared to men. Women are also more likely to have Lewy body disease with co-existing AD-related pathology than so-called "pure" Lewy body disease, while men may present with either. Research is mixed regarding the impact of sex on DLB progression. Biomarker and treatment research assessing for sex differences is lacking. Women provide the majority of caregiving in DLB but how this affects the caregiving experience is uncertain. Gaining a better understanding of sex differences will be instrumental in aiding future development of sex-specific strategies in DLB for early diagnosis, care, and drug development.
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Affiliation(s)
- Shannon Y Chiu
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA; Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville, FL, USA.
| | - Kathryn A Wyman-Chick
- Center for Memory and Aging, Department of Neurology, HealthPartners, Saint Paul, MN, USA
| | - Tanis J Ferman
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Ece Bayram
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Parichita Choudhury
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA; Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville, FL, USA
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19
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Zhao Z, Mei X, Shi L, Zheng C. The effect of antidepressant therapy on a patient with progressive supranuclear palsy accompanied by depression, anxiety and fluctuating dementia. Asian J Psychiatr 2023; 80:103418. [PMID: 36565660 DOI: 10.1016/j.ajp.2022.103418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 12/10/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Progressive supranuclear palsy (PSP) is a complex clinicopathologic disease which can only be definitively confirmed at autopsy. It belongs to a family of conditions exhibiting Parkinson's syndrome, including Lewy body dementia (LBD) or dementia with Lewy body (DLB), and Parkinson's disease dementia (PDD). In regards to clinical manifestations, these two dementias have many overlapping characteristics. The declines of cognition in older patients of dementia are generally accompanied by depression, anxiety, hallucinations, delusions, eating and sleep disorders. This can lead to the difficulty in distinguishing the types of dementia and accurately diagnosing the disease. Herein, we present a complex case of PSP with depression, anxiety, and fluctuating dementia in which DLB was initially suspected. Before antidepressant therapy, the patient showed extrapyramidal symptoms as well as major depression, which lead to greatly impaired movement. Moreover, this patient was an older person with depression disorders, implicating further complexities of late life depression. After two weeks of therapy with antidepressants, the patient had reduced depressive symptoms, and even the somatic symptoms were improved. This case demonstrated that antidepressant therapy can be effective in improving emotion and cognition among patients with late life depression.
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Affiliation(s)
- Zheng Zhao
- Department of Geriatrics, Ningbo Kangning Hospital, Zhejiang Province, China
| | - Xi Mei
- Key Lab of Sleep Medicine, Ningbo Kangning Hospital, Zhejiang Province, China.
| | - Lingli Shi
- Department of Neurology, Ningbo Kangning Hospital, Zhejiang Province, China
| | - Chengying Zheng
- Department of Geriatrics, Ningbo Kangning Hospital, Zhejiang Province, China.
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20
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Toledo JB, Abdelnour C, Weil RS, Ferreira D, Rodriguez-Porcel F, Pilotto A, Wyman-Chick KA, Grothe MJ, Kane JPM, Taylor A, Rongve A, Scholz S, Leverenz JB, Boeve BF, Aarsland D, McKeith IG, Lewis S, Leroi I, Taylor JP. Dementia with Lewy bodies: Impact of co-pathologies and implications for clinical trial design. Alzheimers Dement 2023; 19:318-332. [PMID: 36239924 PMCID: PMC9881193 DOI: 10.1002/alz.12814] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 02/01/2023]
Abstract
Dementia with Lewy bodies (DLB) is clinically defined by the presence of visual hallucinations, fluctuations, rapid eye movement (REM) sleep behavioral disorder, and parkinsonism. Neuropathologically, it is characterized by the presence of Lewy pathology. However, neuropathological studies have demonstrated the high prevalence of coexistent Alzheimer's disease, TAR DNA-binding protein 43 (TDP-43), and cerebrovascular pathologic cases. Due to their high prevalence and clinical impact on DLB individuals, clinical trials should account for these co-pathologies in their design and selection and the interpretation of biomarkers values and outcomes. Here we discuss the frequency of the different co-pathologies in DLB and their cross-sectional and longitudinal clinical impact. We then evaluate the utility and possible applications of disease-specific and disease-nonspecific biomarkers and how co-pathologies can impact these biomarkers. We propose a framework for integrating multi-modal biomarker fingerprints and step-wise selection and assessment of DLB individuals for clinical trials, monitoring target engagement, and interpreting outcomes in the setting of co-pathologies.
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Affiliation(s)
- Jon B Toledo
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA
| | - Carla Abdelnour
- Fundació ACE. Barcelona Alzheimer Treatment and Research Center, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Rimona S Weil
- Dementia Research Centre, Wellcome Centre for Human Neuroimaging, Movement Disorders Consortium, National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer's Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, University of Brescia, Parkinson's Disease Rehabilitation Centre, FERB ONLUS-S, Isidoro Hospital, Trescore Balneario (BG), Italy
| | - Kathryn A Wyman-Chick
- HealthPartners Center for Memory and Aging and Struthers Parkinson's Center, Saint Paul, Minnesota, USA
| | - Michel J Grothe
- Instituto de Biomedicina de Sevilla (IBiS), Unidad de Trastornos del Movimiento, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Joseph P M Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Angela Taylor
- Lewy Body Dementia Association, Lilburn, Georgia, USA
| | - Arvid Rongve
- Department of Research and Innovation, Institute of Clinical Medicine (K1), Haugesund Hospital, Norway and The University of Bergen, Bergen, Norway
| | - Sonja Scholz
- Department of Neurology, National Institute of Neurological Disorders and Stroke, Neurodegenerative Diseases Research Unit, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bradley F Boeve
- Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Ian G McKeith
- Newcastle University Translational and Clinical Research Institute (NUTCRI, Newcastle upon Tyne, UK
| | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, School of Medical Sciences, Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - John P Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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21
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Seeing the Woods for the Trees? Applying Diagnostic Criteria for Dementia with Lewy Bodies to Patients Presenting with Posterior Cortical Atrophy. Alzheimer Dis Assoc Disord 2023; 37:88-91. [PMID: 35969849 DOI: 10.1097/wad.0000000000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Abstract
Posterior cortical atrophy (PCA) is a clinico-radiological syndrome characterised by progressive decline in visual processing and other posterior cognitive functions, relatively preserved memory and language in the early stages, and atrophy of posterior brain regions. Often considered a "visual variant" of Alzheimer's disease, a number of other pathological substrates are recognised. Dementia with Lewy Bodies is the second most common neurodegenerative dementia and there is increasing recognition of presentations with little or no parkinsonism, highlighting significant under-recognition of this condition. To complicate matters, some patients with PCA exhibit additional features consistent with other neurodegenerative conditions. We present a series of three such patients presenting with features satisfying the recent consensus criteria for "PCA-Plus (DLB)". We review the current classification of PCA and highlight the importance of deep clinico-radiological phenotyping in neurodegenerative disease to guide targeted interventions and establish future trial-ready cohorts.
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22
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Zhu CW, Gu Y, Kociolek AJ, Fernandez KK, Cosentino S, Stern Y. Costs During the Last Five Years of Life for Patients with Clinical and Pathological Confirmed Diagnosis of Lewy Body Dementia and Alzheimer's Disease. J Alzheimers Dis 2023; 92:457-466. [PMID: 36776064 PMCID: PMC10120914 DOI: 10.3233/jad-221021] [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] [Accepted: 01/05/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Little is known regarding healthcare expenditures for patients with dementia with Lewy bodies (DLB) during the end of life. OBJECTIVE This study estimated Medicare expenditures during the last 5 years of life in a decedent sample of patients who were clinically diagnosed with Alzheimer's disease (AD) or DLB and had autopsy confirmed diagnosis. METHODS The study included 58 participants clinically diagnosed with mild dementia at study entry (AD: n = 44, DLB: n = 14) and also had autopsy-confirmed diagnoses of pure AD (n = 32), mixed AD+Lewy body (LB) (n = 5), or pure LB (n = 11). Total Medicare expenditures were compared by clinical and pathology confirmed diagnosis, adjusting for sex, age at death, and patient's cognition, function, comorbidities, and psychiatric and extrapyramidal symptoms. RESULTS When pathology diagnoses were not considered, predicted annualized total Medicare expenditures during the last 5 years of life were similar between clinically diagnosed AD ($7,465±1,098) and DLB ($7,783±1,803). When clinical diagnoses were not considered, predicted expenditures were substantially higher in patients with pathology confirmed mixed AD+LB ($12,005±2,455) than either pure AD ($6,173±941) or pure LB ($4,629±1,968) cases. Considering clinical and pathology diagnosis together, expenditures for patients with clinical DLB and pathology mixed AD+LB ($23,592±3,679) dwarfed other groups. CONCLUSION Medicare expenditures during the last 5 years of life were substantially higher in patients with mixed AD+LB pathology compared to those with pure-AD and pure-LB pathologies, particularly in those clinically diagnosed with DLB. Results highlight the importance of having both clinical and pathology diagnoses in examining healthcare costs.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, Bronx, NY, USA
| | - Yian Gu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anton J. Kociolek
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Kayri K. Fernandez
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Yaakov Stern
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
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23
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van Gils AM, van de Beek M, van Unnik AAJM, Tolonen A, Handgraaf D, van Leeuwenstijn M, Lötjönen J, van der Flier WM, Lemstra A, Rhodius‐Meester HFM. Optimizing cCOG, a Web-based tool, to detect dementia with Lewy Bodies. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12379. [PMID: 36569383 PMCID: PMC9773307 DOI: 10.1002/dad2.12379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 12/24/2022]
Abstract
Introduction Distinguishing dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) is challenging due to overlapping presentations. We adapted a Web-based test tool, cCOG, by adding a visuospatial task and a brief clinical survey and assessed its ability to differentiate between DLB and AD. Methods We included 110 patients (n = 30 DLB, n = 32 AD dementia, and n = 48 controls with subjective cognitive decline (SCD)). Full cCOG comprises six cognitive subtasks and a survey addressing self-reported DLB core and autonomic features. First, we compared cCOG cognitive tasks to traditional neuropsychological tasks for all diagnostic groups and clinical questions to validated assessments of clinical features in DLB only. Then, we studied the performance of cCOG cognitive tasks and clinical questions, separately and combined, in differentiating diagnostic groups. Results cCOG cognitive tasks and clinical survey had moderate to strong correlations to standard neuropsychological testing (.61≤ r s ≤ .77) and to validated assessments of clinical features (.41≤ r s ≤ .65), except for fluctuations and REM-sleep behavior disorder (RBD) (r s = .32 and r s = .10). Full cCOG, including both cognitive tasks and brief survey had a diagnostic accuracy (acc) of 0.82 [95% CI 0.73-0.89], with good discrimination of DLB versus AD (acc 0.87 [0.76-0.95]) and DLB versus controls (acc 0.94 [0.86-0.98]). Conclusion We illustrated that cCOG aids in distinguishing DLB and AD patients by using remote assessment of cognition and clinical features. Our findings pave the way to a funneled, harmonized diagnostic process among memory clinics and, eventually, a more timely and accurate diagnosis of DLB and AD.
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Affiliation(s)
- Aniek M. van Gils
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Marleen van de Beek
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Annemartijn A. J. M. van Unnik
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | | | - Dédé Handgraaf
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Mardou van Leeuwenstijn
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | | | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands,Department of Epidemiology and Data SciencesVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Afina Lemstra
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Hanneke F. M. Rhodius‐Meester
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands,Department of Internal MedicineGeriatric Medicine SectionVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
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24
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Chen S, Price AC, Cardinal RN, Moylett S, Kershenbaum AD, Fitzgerald J, Mueller C, Stewart R, O’Brien JT. Association between antidementia medication use and mortality in people diagnosed with dementia with Lewy bodies in the UK: A retrospective cohort study. PLoS Med 2022; 19:e1004124. [PMID: 36472984 PMCID: PMC9725132 DOI: 10.1371/journal.pmed.1004124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dementia with Lewy bodies (DLBs) is a common cause of dementia but has higher mortality than Alzheimer's disease (AD). The reasons for this are unclear, but antidementia drugs (including acetylcholinesterase inhibitors [AChEIs] and memantine) symptomatically benefit people with DLB and might improve outcomes. We investigated whether AChEIs and/or memantine were associated with reduced hospital admissions and mortality. METHODS AND FINDINGS We performed a retrospective cohort study of those diagnosed with DLB between 1 January 2005 and 31 December 2019, using data from electronic clinical records of secondary care mental health services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), United Kingdom (catchment area population approximately 0.86 million), as well as linked records from national Hospital Episode Statistics (HES) data. Eligible patients were those who started AChEIs or memantine within 3 months of their diagnosis (cases) and those who never used AChEIs or memantine (controls). Outcomes included admission, length of stay, and mortality. Cox proportional hazard and linear regression models were used. Of 592 patients with DLB, 219 never took AChEIs or memantine, 100 took AChEIs only, and 273 took both AChEIs and memantine. The cohorts were followed up for an average of 896 days, 981 days, and 1,004 days, respectively. There were no significant differences in the cohorts' baseline characteristics, except for socioeconomic status that was lower in patients who never took AChEIs or memantine (χ2 = 23.34, P = 0.003). After controlling for confounding by sociodemographic factors (age, sex, marital status, ethnicity, socioeconomic status), antipsychotic use, antidepressant use, cognitive status, physical comorbidity, anticholinergic burden, and global health performance, compared with patients who never took AChEIs or memantine, patients taking AChEIs only or taking both had a significantly lower risk of death (adjusted hazard ratio (HR) = 0.67, 95% CI = 0.48 to 0.93, p = 0.02; adjusted HR = 0.64, 95% CI = 0.50 to 0.83, P = 0.001, respectively). Those taking AChEIs or both AChEIs and memantine had significantly shorter periods of unplanned hospital admission for physical disorders (adjusted coefficient -13.48, 95% CI = [-26.87, -0.09], P = 0.049; adjusted coefficient -14.21, 95% CI = [-24.58, -3.85], P = 0.007, respectively), but no difference in length of stay for planned admissions for physical disorders, or for admissions for mental health disorders. No significant additional associations of memantine on admission, length of stay, and mortality were found (all P > 0.05). The main limitation was that this was a naturalistic study and possible confounds cannot be fully controlled, and there may be selection bias resulting from nonrandom prescription behaviour in clinical practice. However, we mimicked the intention-to-treat design of clinical trials, and the majority of baseline characters were balanced between cohorts. In addition, our series of sensitivity analyses confirmed the consistency of our results. CONCLUSION In this study, we observed that use of AChEIs with or without memantine in DLB was associated with shorter duration of hospital admissions and decreased risk of mortality. Although our study was naturalistic, it supports further the use of AChEIs in DLB.
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Affiliation(s)
- Shanquan Chen
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Annabel C. Price
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Rudolf N. Cardinal
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Sinéad Moylett
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Laboratory of Neuroimmunology, KU Leuven, Leuven, Belgium
| | - Anne D. Kershenbaum
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - James Fitzgerald
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Christoph Mueller
- King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Robert Stewart
- King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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Weintraub D, Irwin D. Diagnosis and Treatment of Cognitive and Neuropsychiatric Symptoms in Parkinson Disease and Dementia With Lewy Bodies. Continuum (Minneap Minn) 2022; 28:1314-1332. [DOI: 10.1212/con.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Neuropsychological Impairments and Their Cognitive Architecture in Mild Cognitive Impairment (MCI) with Lewy Bodies and MCI-Alzheimer's Disease. J Int Neuropsychol Soc 2022; 28:963-973. [PMID: 34666864 DOI: 10.1017/s1355617721001181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study aimed to clarify the neuropsychological profile of the emergent diagnostic category of Mild Cognitive Impairment with Lewy bodies (MCI-LB) and determine whether domain-specific impairments such as in memory were related to deficits in domain-general cognitive processes (executive function or processing speed). METHOD Patients (n = 83) and healthy age- and sex-matched controls (n = 34) underwent clinical and imaging assessments. Probable MCI-LB (n = 44) and MCI-Alzheimer's disease (AD) (n = 39) were diagnosed following National Institute on Aging-Alzheimer's Association (NIA-AA) and dementia with Lewy bodies (DLB) consortium criteria. Neuropsychological measures included cognitive and psychomotor speed, executive function, working memory, and verbal and visuospatial recall. RESULTS MCI-LB scored significantly lower than MCI-AD on processing speed [Trail Making Test B: p = .03, g = .45; Digit Symbol Substitution Test (DSST): p = .04, g = .47; DSST Error Check: p < .001, g = .68] and executive function [Trail Making Test Ratio (A/B): p = .04, g = .52] tasks. MCI-AD performed worse than MCI-LB on memory tasks, specifically visuospatial (Modified Taylor Complex Figure: p = .01, g = .46) and verbal (Rey Auditory Verbal Learning Test: p = .04, g = .42) delayed recall measures. Stepwise discriminant analysis correctly classified the subtype in 65.1% of MCI patients (72.7% specificity, 56.4% sensitivity). Processing speed accounted for more group-associated variance in visuospatial and verbal memory in both MCI subtypes than executive function, while no significant relationships between measures were observed in controls (all ps > .05). CONCLUSIONS MCI-LB was characterized by executive dysfunction and slowed processing speed but did not show the visuospatial dysfunction expected, while MCI-AD displayed an amnestic profile. However, there was considerable neuropsychological profile overlap and processing speed mediated performance in both MCI subtypes.
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27
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Jellinger KA. Are there morphological differences between Parkinson's disease-dementia and dementia with Lewy bodies? Parkinsonism Relat Disord 2022; 100:24-32. [PMID: 35691178 DOI: 10.1016/j.parkreldis.2022.05.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/21/2022] [Accepted: 05/30/2022] [Indexed: 12/17/2022]
Abstract
Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) are two major neurocognitive disorders in the spectrum of Lewy body diseases that overlap in many clinical and neuropathological features, although they show several differences. Clinically distinguished mainly based on the duration of parkinsonism prior to development of dementia, their morphology is characterized by a variable combination of Lewy body (LB) and Alzheimer's disease (AD) pathologies, the latter usually being more frequent and severe in DLB. OBJECTIVE The aims of the study were to investigate essential neuropathological differences between PDD and DLB in a larger cohort of autopsy cases. METHODS 110 PDD autopsy cases were compared with 78 DLB cases. The major demographic, clinical (duration of illness, final MMSE) and neuropathological data were assessed retrospectively. Neuropathological studies used standardized methods and immunohistochemistry for phospho-tau, β-amyloid (Aß) and α-synuclein, with semiquantitative assessment of the major histological lesions. RESULTS PDD patients were significantly older at death than DLB ones (mean 83.9 vs. 79.8 years), with a significantly longer disease duration (mean 9.2 vs. 6.7 years). Braak LB scores and particularly neuritic Braak stages were significantly higher in the DLB group (mean 5.1and 5.1 vs. 4.2 and 4.4, respectively), as were Thal Aβ phases (mean 4.1 vs. 3.0). Diffuse striatal Aβ plaques were considerable in 55% and moderate in 45% of DLB cases, but were extremely rare in PDD. The most significant differences concerned the frequency and degree of cerebral amyloid angiopathy (CAA), being significantly higher in DLB (98.7 vs. 50%, and mean degree of 2.9 vs. 0.72, respectively). Worse prognosis in DLB than in PDD was linked to both increased Braak neuritic stages and more severe CAA. INTERPRETATION These and other recent studies imply the association of CAA, more severe concomitant AD pathology, and striatal Aβ load with cognitive decline and more rapid disease process that distinguishes DLB from PDD, while the influence of other cerebrovascular diseases or co-pathologies in both disorders was not specifically examined. The importance of both CAA and tau pathology in DLB and much less in PDD supports the concept of a pathogenetic continuum from Parkinson's disease (PD) - > PDD - > DLB - > DLB + AD and subtypes of AD with LB pathology within the spectrum of age-related proteinopathies.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Vienna, Austria, Alberichgasse 5/13, A-1150, Vienna, Austria.
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28
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Babiloni C. The Dark Side of Alzheimer's Disease: Neglected Physiological Biomarkers of Brain Hyperexcitability and Abnormal Consciousness Level. J Alzheimers Dis 2022; 88:801-807. [PMID: 35754282 DOI: 10.3233/jad-220582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Claudio Babiloni
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy.,Hospital San Raffaele Cassino, Cassino (FR), Italy
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Perovnik M, Tomše P, Jamšek J, Tang C, Eidelberg D, Trošt M. Metabolic brain pattern in dementia with Lewy bodies: Relationship to Alzheimer's disease topography. Neuroimage Clin 2022; 35:103080. [PMID: 35709556 PMCID: PMC9207351 DOI: 10.1016/j.nicl.2022.103080] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 10/28/2022]
Abstract
PURPOSE Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia, that shares clinical and metabolic similarities with both Alzheimer's and Parkinson's disease. In this study we aimed to identify a DLB-related pattern (DLBRP), study its relationship with other metabolic brain patterns and explore its diagnostic and prognostic value. METHODS A cohort of 79 participants with DLB, 63 with dementia due to Alzheimer's disease (AD) and 41 normal controls (NCs) and their 2-[18F]FDG PET scans were analysed for identification and validation of DLBRP. Voxel-wise correlation and multiple linear regression were used to study the relation between DLBRP and Alzheimer's disease-related pattern (ADRP), Parkinson's disease-related pattern (PDRP) and PD-related cognitive pattern (PDCP). Diagnostic and prognostic value of DLBRP and of modified DLBRP after accounting for ADRP overlap (DLBRP ⊥ ADRP), were explored. RESULTS The newly identified DLBRP shared topographic similarities with ADRP (R2 = 24%) and PDRP (R2 = 37%), but not with PDCP. We could accurately discriminate between DLB and NC (AUC = 0.99) based on DLBRP expression, and between DLB and AD (AUC = 0.87) based on DLBRP ⊥ ADRP expression. DLBRP expression correlated with cognitive impairment, but the correlation was lost after accounting for ADRP overlap. DLBRP and DLBRP ⊥ ADRP correlated with patients' survival time. CONCLUSION DLBRP has proven to be a specific metabolic brain biomarker of DLB, sharing similarities with ADRP and PDRP, but not PDCP. We observed a similar metabolic mechanism underlying cognitive impairment in DLB and AD. DLB-specific metabolic changes were more detrimental for overall survival.
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Affiliation(s)
- Matej Perovnik
- Department of Neurology, University Medical Center Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia.
| | - Petra Tomše
- Department of Nuclear Medicine, University Medical Center Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Jan Jamšek
- Department of Nuclear Medicine, University Medical Center Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Chris Tang
- Center for Neurosciences, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - Maja Trošt
- Department of Neurology, University Medical Center Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; Department of Nuclear Medicine, University Medical Center Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
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Chen Q, Przybelski SA, Senjem ML, Schwarz CG, Lesnick TG, Botha H, Knopman DS, Graff‐Radford J, Savica R, Jones DT, Fields JA, Jain MK, Graff‐Radford NR, Ferman TJ, Kremers WK, Jack CR, Petersen RC, Boeve BF, Lowe VJ, Kantarci K. Longitudinal Tau Positron Emission Tomography in Dementia with Lewy Bodies. Mov Disord 2022; 37:1256-1264. [PMID: 35261094 PMCID: PMC9232920 DOI: 10.1002/mds.28973] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Patients with dementia with Lewy bodies (DLB) may have overlapping Alzheimer's disease pathology. We investigated the longitudinal rate of tau accumulation and its association with neurodegeneration and clinical disease progression in DLB. METHODS Consecutive patients with probable DLB (n = 22) from the Mayo Clinic Alzheimer's Disease Research Center and age-matched and sex-matched cognitively unimpaired controls (CU; n = 22) with serial magnetic resonance imaging and flortaucipir positron emission tomography scans within an average of 1.6 years were included. Regional annualized rates of flortaucipir uptake standardized uptake value ratios (SUVr) were calculated. Regional annualized rates of cortical volume change were measured with the Tensor Based Morphometry-Syn algorithm. RESULTS The annual increase of flortaucipir SUVr was greater in the middle and superior occipital, fusiform, and inferior parietal cortices in DLB (mean: 0.017, 0.019, 0.019, and 0.015, respectively) compared with the CU (mean: -0.006, -0.009, -0.003, and - 0.005, respectively; P < 0.05). In patients with DLB (but not the CU), a longitudinal increase in flortaucipir SUVr was associated with longitudinal cortical atrophy rates in the lateral occipital and inferior temporoparietal cortices, hippocampus, and the temporal pole as well as a concurrent decline on Mini-Mental State Examination and Clinical Dementia Rating-Sum of Boxes in the lateral occipital and the fusiform cortices. CONCLUSIONS Tau accumulation was faster in DLB compared with the CU, with increased accumulation rates in the lateral occipital and temporoparietal cortices. These increased rates of tau accumulation were associated with neurodegeneration and faster disease progression in DLB. Tau may be a potential treatment target in a subset of patients with DLB. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Qin Chen
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduChina
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
| | | | | | | | - Timothy G. Lesnick
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Hugo Botha
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | | | | | | | | | - Julie A. Fields
- Department of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Manoj K. Jain
- Department of RadiologyMayo ClinicJacksonvilleFloridaUSA
| | | | - Tanis J. Ferman
- Department of Psychology and PsychiatryMayo ClinicJacksonvilleFloridaUSA
| | - Walter K. Kremers
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | | | | | - Val J. Lowe
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
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Gu Y, Kociolek A, Fernandez KK, Cosentino SA, Zhu CW, Jin Z, Leverenz JB, Stern YB. Clinical Trajectories at the End of Life in Autopsy-Confirmed Dementia Patients With Alzheimer Disease and Lewy Bodies Pathologies. Neurology 2022; 98:e2140-e2149. [PMID: 35379761 PMCID: PMC9169937 DOI: 10.1212/wnl.0000000000200259] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 02/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Evaluating and understanding the heterogeneity in dementia course has important implications for clinical practice, health care decision-making, and research. However, inconsistent findings have been reported with regard to the disease courses of the 2 most common dementias: Alzheimer disease (AD) and dementia with Lewy bodies (DLB). Using autopsy-confirmed diagnoses, we aimed to examine the disease trajectories in the years before death among patients with dementia with pure AD, pure DLB, or mixed (AD and DLB) pathologies. METHODS The current retrospective longitudinal study included 62 participants with autopsy-confirmed diagnoses of pure AD (n = 34), mixed AD and DLB (AD + DLB; n = 17), or pure DLB (n = 11) from the Predictors 2 Cohort Study, a prospective, clinic-based, cohort of patients with dementia. Generalized estimating equation models, with time zero at death, were used to examine the trajectory of cognition (Folstein Mini-Mental State Examination [MMSE]), function (activities of daily living [ADL]), and Dependence Scale among patients with different autopsy-confirmed diagnosis (pure AD, AD + DLB, and pure DLB). The models were adjusted for age, sex, education, and baseline features including extrapyramidal signs, MMSE, ADL, and Dependence Scale. RESULTS The participants on average received 9.4 ± 4.6 assessments at 6-month intervals during a mean 5.4 ± 2.9 years of follow-up. The 3 groups were similar in both cognition and function status at baseline. Cognition and function were highly correlated among patients with AD + DLB but not in pure AD or pure DLB at baseline. Patients of the 3 groups all declined in both cognition and function but had different trajectories of decline. More specifically, the patients with pure DLB experienced approximately double the rate of both cognitive decline and functional decline than the patients with pure AD, and the mixed pathology group showed double the rate of functional decline as compared to pure AD. DISCUSSION In this longitudinal study, we found that among patients with dementia, those with Lewy body pathology experienced faster cognitive and functional decline than those with pure AD pathology.
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Affiliation(s)
- Yian Gu
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH.
| | - Anton Kociolek
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Kayri K Fernandez
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Stephanie A Cosentino
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Carolyn Wei Zhu
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Zhezhen Jin
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - James B Leverenz
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Yaakov B Stern
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
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Jaramillo-Jimenez A, Ying Y, Ren P, Xiao Z, Zhang Q, Wang J, Rong H, Borda MG, Bonanni L, Aarsland D, Wu D. Prodromal Dementia With Lewy Bodies and Recurrent Panic Attacks as the First Symptom: A Case Report. Front Neurol 2022; 13:839539. [PMID: 35493812 PMCID: PMC9043811 DOI: 10.3389/fneur.2022.839539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Psychiatric-onset dementia with Lewy bodies (DLB) might include symptoms of depression, hallucinations, anxiety, and apathy. Here, we report a patient with DLB with recurrent panic attacks as her first symptom 5 years before a biological-based diagnosis of probable DLB. We provide an extended description of the clinical presentation and course from psychiatric-onset DLB to dementia in an 83-year-old woman. This case illustrates the common misdiagnosis of DLB and the delay of having a detailed clinical and biomarker assessment for structured diagnosis. With a detailed description of the clinical presentation of this case, the empirical treatment strategies, and the patient perspectives, we aim to make clinicians aware of panic attacks within the psychiatric-onset DLB.
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Affiliation(s)
- Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Grupo de Neurociencias de Antioquia, School of Medicine Medellín, Universidad de Antioquia, Medellín, Colombia
- Grupo Neuropsicología y Conducta, School of Medicine Medellín, Universidad de Antioquia, Medellín, Colombia
| | - Yinbing Ying
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Ping Ren
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Zhan Xiao
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Qian Zhang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Jian Wang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Han Rong
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Laura Bonanni
- Department of Medicine and Aging Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Donghui Wu
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
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Manual and automated analysis of atrophy patterns in dementia with Lewy bodies on MRI. BMC Neurol 2022; 22:114. [PMID: 35331168 PMCID: PMC8943955 DOI: 10.1186/s12883-022-02642-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dementia with Lewy bodies (DLB) is the second most common dementia type in patients older than 65 years. Its atrophy patterns remain unknown. Its similarities to Parkinson's disease and differences from Alzheimer's disease are subjects of current research. Methods The aim of our study was (i) to form a group of patients with DLB (and a control group) and create a 3D MRI data set (ii) to volumetrically analyze the entire brain in these groups, (iii) to evaluate visual and manual metric measurements of the innominate substance for real-time diagnosis, and (iv) to compare our groups and results with the latest literature. We identified 102 patients with diagnosed DLB in our psychiatric and neurophysiological archives. After exclusion, 63 patients with valid 3D data sets remained. We compared them with a control group of 25 patients of equal age and sex distribution. We evaluated the atrophy patterns in both (1) manually and (2) via Fast Surfers segmentation and volumetric calculations. Subgroup analyses were done of the CSF data and quality of 3D T1 data sets. Results Concordant with the literature, we detected moderate, symmetric atrophy of the hippocampus, entorhinal cortex and amygdala, as well as asymmetric atrophy of the right parahippocampal gyrus in DLB. The caudate nucleus was unaffected in patients with DLB, while all the other measured territories were slightly too moderately atrophied. The area under the curve analysis of the left hippocampus volume ratio (< 3646mm3) revealed optimal 76% sensitivity and 100% specificity (followed by the right hippocampus and left amygdala). The substantia innominata’s visual score attained a 51% optimal sensitivity and 84% specificity, and the measured distance 51% optimal sensitivity and 68% specificity in differentiating DLB from our control group. Conclusions In contrast to other studies, we observed a caudate nucleus sparing atrophy of the whole brain in patients with DLB. As the caudate nucleus is known to be the last survivor in dopamine-uptake, this could be the result of an overstimulation or compensation mechanism deserving further investigation. Its relative hypertrophy compared to all other brain regions could enable an imaging based identification of patients with DLB via automated segmentation and combined volumetric analysis of the hippocampus and amygdala. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02642-0.
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Scott GD, Arnold MR, Beach TG, Gibbons CH, Kanthasamy AG, Lebovitz RM, Lemstra AW, Shaw LM, Teunissen CE, Zetterberg H, Taylor AS, Graham TC, Boeve BF, Gomperts SN, Graff-Radford NR, Moussa C, Poston KL, Rosenthal LS, Sabbagh MN, Walsh RR, Weber MT, Armstrong MJ, Bang JA, Bozoki AC, Domoto-Reilly K, Duda JE, Fleisher JE, Galasko DR, Galvin JE, Goldman JG, Holden SK, Honig LS, Huddleston DE, Leverenz JB, Litvan I, Manning CA, Marder KS, Pantelyat AY, Pelak VS, Scharre DW, Sha SJ, Shill HA, Mari Z, Quinn JF, Irwin DJ. Fluid and Tissue Biomarkers of Lewy Body Dementia: Report of an LBDA Symposium. Front Neurol 2022; 12:805135. [PMID: 35173668 PMCID: PMC8841880 DOI: 10.3389/fneur.2021.805135] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022] Open
Abstract
The Lewy Body Dementia Association (LBDA) held a virtual event, the LBDA Biofluid/Tissue Biomarker Symposium, on January 25, 2021, to present advances in biomarkers for Lewy body dementia (LBD), which includes dementia with Lewy bodies (DLBs) and Parkinson's disease dementia (PDD). The meeting featured eight internationally known scientists from Europe and the United States and attracted over 200 scientists and physicians from academic centers, the National Institutes of Health, and the pharmaceutical industry. Methods for confirming and quantifying the presence of Lewy body and Alzheimer's pathology and novel biomarkers were discussed.
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Affiliation(s)
- Gregory D. Scott
- Department of Pathology, Oregon Health and Science University, Portland, OR, United States
- Department of Pathology and Laboratory Services, VA Portland Medical Center, Portland, OR, United States
| | - Moriah R. Arnold
- Graduate Program in Biomedical Sciences, School of Medicine M.D./Ph.D. Program, Oregon Health and Science University, Portland, OR, United States
| | - Thomas G. Beach
- Civin Laboratory for Neuropathology and Brain and Body Donation Program, Banner Sun Health Research Institute, Sun City, AZ, United States
| | - Christopher H. Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Anumantha G. Kanthasamy
- Department of Physiology and Pharmacology, Center for Brain Sciences and Neurodegenerative Diseases, University of Georgia, Athens, GA, United States
| | | | - Afina W. Lemstra
- Department of Neurology, Amsterdam University Medical Center (UMC), Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leslie M. Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, London, United Kingdom
- UK Dementia Research Institute at University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | | | - Todd C. Graham
- Lewy Body Dementia Association, Lilburn, GA, United States
| | - Bradley F. Boeve
- Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, MN, United States
| | - Stephen N. Gomperts
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | | | - Charbel Moussa
- Department of Neurology, Georgetown University Medical Center, Washington DC, CA, United States
| | - Kathleen L. Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Liana S. Rosenthal
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Marwan N. Sabbagh
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Ryan R. Walsh
- Barrow Neurological Institute and Muhammed Ali Parkinson Center, Phoenix, AZ, United States
| | - Miriam T. Weber
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Jee A. Bang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Andrea C. Bozoki
- Department of Neurology, University of North Carolina, Chapel Hill, NC, United States
| | | | - John E. Duda
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jori E. Fleisher
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States
| | - Douglas R. Galasko
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - James E. Galvin
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jennifer G. Goldman
- Shirley Ryan Abilitylab and Department of Physical Medicine and Rehabilitation and Neurology, Parkinson's Disease and Movement Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Lawrence S. Honig
- Columbia University Irving Medical Center, New York, NY, United States
| | - Daniel E. Huddleston
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - James B. Leverenz
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, United States
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Carol A. Manning
- Department of Neurology, University of Virginia, Charlottesville, VA, United States
| | - Karen S. Marder
- Columbia University Irving Medical Center, New York, NY, United States
| | - Alexander Y. Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Victoria S. Pelak
- Departments of Neurology and Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Douglas W. Scharre
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Sharon J. Sha
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Holly A. Shill
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Zoltan Mari
- Lou Ruvo Center for Brain Health, Cleveland Clinic Lerner College of Medicine, Las Vegas, NV, United States
| | - Joseph F. Quinn
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Department of Neurology, VA Portland Medical Center, Portland, OR, United States
| | - David J. Irwin
- Department of Neurology, University of Pennsylvania Health System, Philadelphia, PA, United States
- Digital Neuropathology Laboratory, Philadelphia, PA, United States
- Lewy Body Disease Research Center of Excellence, Philadelphia, PA, United States
- Frontotemporal Degeneration Center, Philadelphia, PA, United States
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van de Beek M, Ooms FAH, Ebenau JL, Barkhof F, Scheltens P, Teunissen CE, van Harten AC, van der Flier WM, Lemstra AW. Association of the ATN Research Framework With Clinical Profile, Ccognitive Decline, and Mortality in Patients With Dementia With Lewy Bodies. Neurology 2022; 98:e1262-e1272. [PMID: 35074893 DOI: 10.1212/wnl.0000000000200048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The ATN framework has been developed to categorize biological processes within the Alzheimer's disease (AD) continuum. Since AD pathology often coincides with dementia with Lewy Bodies (DLB), we aimed to investigate the distribution of ATN profiles in DLB and associate ATN-profiles in DLB to prognosis. METHODS We included 202 DLB patients from the Amsterdam Dementia Cohort (68±7yrs, 19%F, MMSE: 24±3, DAT-SPECT abnormal: 105/119). Patients were classified into eight profiles according to the ATN framework, using CSF Aβ42 (A), CSF p-tau (T) and medial temporal atrophy scores (N). We compared presence of clinical symptoms in ATN profiles and used linear mixed models to analyze decline on cognitive tests (follow-up 3±2yrs for n=139). Mortality risk was assessed using Cox proportional hazards analysis. Analyses were performed on both the eight profiles, as well as three clustered categories (normal AD biomarkers, non-AD pathologic change, AD continuum). RESULTS Fifty (25%) DLB patients had normal AD biomarkers (A-T-N-), 37 (18%) had non-AD pathologic change (A-T+N-: 10%/A-T-N+: 6%/A-T+N+: 3%) and 115 (57%) were classified within the AD continuum (A+T-N-: 20%/A+T+N-: 16%/A+T-N+: 10%/A+T+N+: 9%). A+T+N+ patients were older and least often had RBD symptoms. Parkinsonism was more often present in A+T-, compared to A-T+ (independent of N). Compared to patients with normal AD biomarkers, patients in A+ categories showed steeper decline on memory tests and higher mortality risk. Cognitive decline and mortality did not differ between non-AD pathologic change and normal AD biomarkers. DISCUSSION In our DLB cohort, we found clinically relevant associations between ATN categories and disease manifestation. Patients within the AD continuum had steeper cognitive decline and shorter survival. Implementing the ATN framework within DLB patients aids in subtyping patients based on underlying biological processes and could provide targets for future treatment strategies, e.g. AD modifying treatment. Expanding the framework by incorporating markers for alpha-synucleinopathy would improve the use of the framework to characterize dementia patients with mixed pathology, which could enhance proper stratification of patients for therapeutic trials.
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Affiliation(s)
- Marleen van de Beek
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Floor A H Ooms
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jarith L Ebenau
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands.,Institutes of Neurology and Healthcare Engineering, UCL, London, England, United Kingdom
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Department of Neurochemistry, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Argonde C van Harten
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Epidemiology and Data Sciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Afina W Lemstra
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Abdelnour C, Ferreira D, van de Beek M, Cedres N, Oppedal K, Cavallin L, Blanc F, Bousiges O, Wahlund LO, Pilotto A, Padovani A, Boada M, Pagonabarraga J, Kulisevsky J, Aarsland D, Lemstra AW, Westman E. Parsing heterogeneity within dementia with Lewy bodies using clustering of biological, clinical, and demographic data. Alzheimers Res Ther 2022; 14:14. [PMID: 35063023 PMCID: PMC8783432 DOI: 10.1186/s13195-021-00946-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) includes various core clinical features that result in different phenotypes. In addition, Alzheimer's disease (AD) and cerebrovascular pathologies are common in DLB. All this increases the heterogeneity within DLB and hampers clinical diagnosis. We addressed this heterogeneity by investigating subgroups of patients with similar biological, clinical, and demographic features. METHODS We studied 107 extensively phenotyped DLB patients from the European DLB consortium. Factorial analysis of mixed data (FAMD) was used to identify dimensions in the data, based on sex, age, years of education, disease duration, Mini-Mental State Examination (MMSE), cerebrospinal fluid (CSF) levels of AD biomarkers, core features of DLB, and regional brain atrophy. Subsequently, hierarchical clustering analysis was used to subgroup individuals based on the FAMD dimensions. RESULTS We identified 3 dimensions using FAMD that explained 38% of the variance. Subsequent hierarchical clustering identified 4 clusters. Cluster 1 was characterized by amyloid-β and cerebrovascular pathologies, medial temporal atrophy, and cognitive fluctuations. Cluster 2 had posterior atrophy and showed the lowest frequency of visual hallucinations and cognitive fluctuations and the worst cognitive performance. Cluster 3 had the highest frequency of tau pathology, showed posterior atrophy, and had a low frequency of parkinsonism. Cluster 4 had virtually normal AD biomarkers, the least regional brain atrophy and cerebrovascular pathology, and the highest MMSE scores. CONCLUSIONS This study demonstrates that there are subgroups of DLB patients with different biological, clinical, and demographic characteristics. These findings may have implications in the diagnosis and prognosis of DLB, as well as in the treatment response in clinical trials.
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Affiliation(s)
- Carla Abdelnour
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya-Barcelona, Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.
- Department of Medicine of the Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marleen van de Beek
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nira Cedres
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Sensory Cognitive Interaction Laboratory (SCI-lab), Stockholm University, Stockholm, Sweden
| | - Ketil Oppedal
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
- Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Lena Cavallin
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology Karolinska University Hospital, Stockholm, Sweden
| | - Frédéric Blanc
- Service, Memory Resources and Research Centre, University Hospital of Strasbourg, Strasbourg, France
- Team IMIS/Neurocrypto, French National Center for Scientific Research, ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Strasbourg, France
| | - Olivier Bousiges
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Strasbourg, France
- Laboratory of Biochemistry and Molecular Biology, CNRS, Laboratoire de Neurosciences Cognitives et Adaptatives, UMR7364, University Hospital of Strasbourg, Strasbourg, France
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Mercè Boada
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya-Barcelona, Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau. Biomedical Research Institute (IIB-Sant Pau), Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau. Biomedical Research Institute (IIB-Sant Pau), Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Afina W Lemstra
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Eric Westman
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Kurasz AM, De Wit L, Smith GE, Armstrong MJ. Neuropathological and Clinical Correlates of Lewy Body Disease Survival by Race and Ethnicity in the National Alzheimer's Coordinating Center. J Alzheimers Dis 2022; 89:1339-1349. [PMID: 36031892 PMCID: PMC9588566 DOI: 10.3233/jad-220297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Survival and associated clinical and pathological characteristics in Lewy body disease (LBD)-related dementias are understudied. Available studies focus primarily on white non-Hispanic samples. OBJECTIVE We investigated demographic, clinical, and pathological correlates of survival by race and ethnicity in an autopsy-confirmed cohort of LBD cases. METHODS Using National Alzheimer's Coordinating Center data, we selected participants who self-identified as Black, Hispanic, or white who had neuropathological assessments showing transitional or diffuse LBD pathology. We used Kruskal-Wallis and Pearson χ2 analyses to investigate group differences in demographic and presenting clinical and pathological characteristics. We used linear regressions to identify predictors of survival with sex, age at symptom onset, education, ethnoracial status, LBD pathology type, and Braak tangle stage included in the model. RESULTS Data from 1,441 white, 60 Black, and 54 Hispanic participants were available for analysis. Hispanics were more likely to have transitional LBD pathology and had a longer survival than white and Black participants. After controlling for demographic and pathological variables, length of survival did not differ between Hispanics and Black or white participants. Additional key findings demonstrated discrepancies between clinical diagnoses received at last visit and pathological findings, particularly among Black participants. CONCLUSION LBD survival differences by race and ethnicity can be accounted for by LBD pathology type and co-occurring Alzheimer's disease pathology. The discrepancies between clinical diagnoses and pathological findings raise the concern that dementia with Lewy bodies is underdiagnosed in NACC, especially for Black older adults.
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Affiliation(s)
- Andrea M. Kurasz
- Department of Clinical and Health Psychology, University of Florida College of Public Health & Health Professions, Gainesville, FL, 32611, USA
| | - Liselotte De Wit
- Department of Clinical and Health Psychology, University of Florida College of Public Health & Health Professions, Gainesville, FL, 32611, USA
| | - Glenn E. Smith
- Department of Clinical and Health Psychology, University of Florida College of Public Health & Health Professions, Gainesville, FL, 32611, USA
| | - Melissa J. Armstrong
- Departments of Neurology and Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, 32611, USA
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Weinshel S, Irwin DJ, Zhang P, Weintraub D, Shaw LM, Siderowf A, Xie SX. Appropriateness of Applying Cerebrospinal Fluid Biomarker Cutoffs from Alzheimer's Disease to Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1155-1167. [PMID: 35431261 PMCID: PMC9934950 DOI: 10.3233/jpd-212989] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND While cutoffs for abnormal levels of the cerebrospinal fluid (CSF) biomarkers amyloid-β 1-42 (Aβ142), total tau (t-tau), phosphorylated tau (p-tau), and the ratios of t-tau/Aβ142 and p-tau/Aβ142, have been established in Alzheimer's disease (AD), biologically relevant cutoffs have not been studied extensively in Parkinson's disease (PD). OBJECTIVE Assess the suitability and diagnostic accuracy of established AD-derived CSF biomarker cutoffs in the PD population. METHODS Baseline and longitudinal data on CSF biomarkers, cognitive diagnoses, and PET amyloid imaging in 423 newly diagnosed patients with PD from the Parkinson's Progression Markers Initiative (PPMI) cohort were used to evaluate established AD biomarker cutoffs compared with optimal cutoffs derived from the PPMI cohort. RESULTS Using PET amyloid imaging as the gold standard for AD pathology, the optimal cutoff of Aβ142 was higher than the AD cutoff, the optimal cutoffs of t-tau/Aβ142 and p-tau/Aβ142 were lower than the AD cutoffs, and their confidence intervals (CIs) did not overlap with the AD cutoffs. Optimal cutoffs for t-tau and p-tau to predict cognitive impairment were significantly lower than the AD cutoffs, and their CIs did not overlap with the AD cutoffs. CONCLUSION Optimal cutoffs for the PPMI cohort for Aβ142, t-tau/Aβ142, and p-tau/Aβ142 to predict amyloid-PET positivity and for t-tau and p-tau to predict cognitive impairment differ significantly from cutoffs derived from AD populations. The presence of additional pathologies such as alpha-synuclein in PD may lead to disease-specific CSF biomarker characteristics.
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Affiliation(s)
- Sarah Weinshel
- Swarthmore College, Swarthmore, PA, USA;,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David J. Irwin
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Panpan Zhang
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA;,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA;,Michael J. Crescenz VA Medical Center, Parkinson’s Disease Research, Education, and Clinical Center, Philadelphia, PA, USA
| | - Leslie M. Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X. Xie
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Schumacher J, Gunter JL, Przybelski SA, Jones DT, Graff-Radford J, Savica R, Schwarz CG, Senjem ML, Jack CR, Lowe VJ, Knopman DS, Fields JA, Kremers WK, Petersen RC, Graff-Radford NR, Ferman TJ, Boeve BF, Thomas AJ, Taylor JP, Kantarci K. Dementia with Lewy bodies: association of Alzheimer pathology with functional connectivity networks. Brain 2021; 144:3212-3225. [PMID: 34114602 PMCID: PMC8634124 DOI: 10.1093/brain/awab218] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/19/2021] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
Dementia with Lewy bodies (DLB) is neuropathologically defined by the presence of α-synuclein aggregates, but many DLB cases show concurrent Alzheimer's disease pathology in the form of amyloid-β plaques and tau neurofibrillary tangles. The first objective of this study was to investigate the effect of Alzheimer's disease co-pathology on functional network changes within the default mode network (DMN) in DLB. Second, we studied how the distribution of tau pathology measured with PET relates to functional connectivity in DLB. Twenty-seven DLB, 26 Alzheimer's disease and 99 cognitively unimpaired participants (balanced on age and sex to the DLB group) underwent tau-PET with AV-1451 (flortaucipir), amyloid-β-PET with Pittsburgh compound-B (PiB) and resting-state functional MRI scans. The resing-state functional MRI data were used to assess functional connectivity within the posterior DMN. This was then correlated with overall cortical flortaucipir PET and PiB PET standardized uptake value ratio (SUVr). The strength of interregional functional connectivity was assessed using the Schaefer atlas. Tau-PET covariance was measured as the correlation in flortaucipir SUVr between any two regions across participants. The association between region-to-region functional connectivity and tau-PET covariance was assessed using linear regression. Additionally, we identified the region with highest and the region with lowest tau SUVrs (tau hot- and cold spots) and tested whether tau SUVr in all other brain regions was associated with the strength of functional connectivity to these tau hot and cold spots. A reduction in posterior DMN connectivity correlated with overall higher cortical tau- (r = -0.39, P = 0.04) and amyloid-PET uptake (r = -0.41, P = 0.03) in the DLB group, i.e. patients with DLB who have more concurrent Alzheimer's disease pathology showed a more severe loss of DMN connectivity. Higher functional connectivity between regions was associated with higher tau covariance in cognitively unimpaired, Alzheimer's disease and DLB. Furthermore, higher functional connectivity of a target region to the tau hotspot (i.e. inferior/medial temporal cortex) was related to higher flortaucipir SUVrs in the target region, whereas higher functional connectivity to the tau cold spot (i.e. sensory-motor cortex) was related to lower flortaucipir SUVr in the target region. Our findings suggest that a higher burden of Alzheimer's disease co-pathology in patients with DLB is associated with more Alzheimer's disease-like changes in functional connectivity. Furthermore, we found an association between the brain's functional network architecture and the distribution of tau pathology that has recently been described in Alzheimer's disease. We show that this relationship also exists in patients with DLB, indicating that similar mechanisms of connectivity-dependent occurrence of tau pathology might be at work in both diseases.
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Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, UK
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey L Gunter
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Scott A Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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40
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Gonzalez MC, Ashton NJ, Gomes BF, Tovar-Rios DA, Blanc F, Karikari TK, Mollenhauer B, Pilotto A, Lemstra A, Paquet C, Abdelnour C, Kramberger MG, Bonanni L, Vandenberghe R, Hye A, Blennow K, Zetterberg H, Aarsland D. Association of Plasma p-tau181 and p-tau231 Concentrations With Cognitive Decline in Patients With Probable Dementia With Lewy Bodies. JAMA Neurol 2021; 79:32-37. [PMID: 34807233 DOI: 10.1001/jamaneurol.2021.4222] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Plasma phosphorylated tau (p-tau) has proven to be an accurate biomarker for Alzheimer disease (AD) pathologic characteristics, offering a less expensive and less invasive alternative to cerebrospinal fluid (CSF) and positron emission tomography biomarkers for amyloid-β and tau. Alzheimer disease comorbid pathologic characteristics are common and are associated with more rapid cognitive decline in patients with dementia with Lewy bodies (DLB); therefore, it is anticipated that plasma p-tau concentrations may have utility in assessing cognitive impairment in individuals with this disorder. Objective To measure the concentrations of plasma p-tau (p-tau181 and p-tau231) and evaluate their associations with cognitive decline in individuals with probable DLB. Design, Setting, and Participants This multicenter longitudinal cohort study included participants from the European-DLB (E-DLB) Consortium cohort enrolled at 10 centers with harmonized diagnostic procedures from January 1, 2002, to December 31, 2020, with up to 5 years of follow-up. A total of 1122 participants with plasma samples were available. Participants with acute delirium or terminal illness and patients with other previous major psychiatric or neurologic disorders were excluded, leaving a cohort of 987 clinically diagnosed participants with probable DLB (n = 371), Parkinson disease (n = 204), AD (n = 207), as well as healthy controls (HCs) (n = 205). Main Outcomes and Measures The main outcome was plasma p-tau181 and p-tau231 levels measured with in-house single molecule array assays. The Mini-Mental State Examination (MMSE) was used to measure cognition. Results Among this cohort of 987 patients (512 men [51.9%]; mean [SD] age, 70.0 [8.8] years), patients with DLB did not differ significantly regarding age, sex, or years of education from those in the AD group, but the DLB group was older than the HC group and included more men than the AD and HC groups. Baseline concentrations of plasma p-tau181 and p-tau231 in patients with DLB were significantly higher than those in the HC group but lower than in the AD group and similar to the Parkinson disease group. Higher plasma concentrations of both p-tau markers were found in a subgroup of patients with DLB with abnormal CSF amyloid-β42 levels compared with those with normal levels (difference in the groups in p-tau181, -3.61 pg/mL; 95% CI, -5.43 to -1.79 pg/mL; P = .049; difference in the groups in p-tau231, -2.51 pg/mL; 95% CI, -3.63 to -1.39 pg/mL; P = .02). There was no difference between p-tau181 level and p-tau231 level across confirmed AD pathologic characteristcs based on reduced Aβ42 level in CSF in individuals with DLB. In DLB, a significant association was found between higher plasma p-tau181 and p-tau231 levels and lower MMSE scores at baseline (for p-tau181, -0.092 MMSE points; 95% CI, -0.12 to -0.06 MMSE points; P = .001; for p-tau231, -0.16 MMSE points; 95% CI, -0.21 to -0.12 MMSE points; P < .001), as well as more rapid MMSE decline over time. Plasma p-tau181 level was associated with a decrease of -0.094 MMSE points per year (95% CI, -0.144 to -0.052 MMSE points; P = .02), whereas plasma p-tau231 level was associated with an annual decrease of -0.130 MMSE points (95% CI, -0.201 to -0.071 MMSE points; P = .02), after adjusting for sex and age. Conclusions and Relevance This study suggests that plasma p-tau181 and p-tau231 levels may be used as cost-effective and accessible biomarkers to assess cognitive decline in individuals with DLB.
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Affiliation(s)
- Maria C Gonzalez
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Bárbara Fernandes Gomes
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | | | - Frédéric Blanc
- Memory Resource and Research Centre, Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
| | - Thomas K Karikari
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany, and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Afina Lemstra
- Amsterdam Alzheimer Center, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Claire Paquet
- Université de Paris, Neurology Center, Assistance Publique Hôpitaux de Paris, Lariboisière Fernand-Widal Hospital, INSERMU1144, Paris, France
| | - Carla Abdelnour
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Milica G Kramberger
- University Medical Centre Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Laura Bonanni
- Department of Medicine and Aging Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Abdul Hye
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
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41
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Added value of semiquantitative analysis of brain FDG-PET for the differentiation between MCI-Lewy bodies and MCI due to Alzheimer's disease. Eur J Nucl Med Mol Imaging 2021; 49:1263-1274. [PMID: 34651219 DOI: 10.1007/s00259-021-05568-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/17/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE FDG-PET is an established supportive biomarker in dementia with Lewy bodies (DLB), but its diagnostic accuracy is unknown at the mild cognitive impairment (MCI-LB) stage when the typical metabolic pattern may be difficultly recognized at the individual level. Semiquantitative analysis of scans could enhance accuracy especially in less skilled readers, but its added role with respect to visual assessment in MCI-LB is still unknown. METHODS We assessed the diagnostic accuracy of visual assessment of FDG-PET by six expert readers, blind to diagnosis, in discriminating two matched groups of patients (40 with prodromal AD (MCI-AD) and 39 with MCI-LB), both confirmed by in vivo biomarkers. Readers were provided in a stepwise fashion with (i) maps obtained by the univariate single-subject voxel-based analysis (VBA) with respect to a control group of 40 age- and sex-matched healthy subjects, and (ii) individual odds ratio (OR) plots obtained by the volumetric regions of interest (VROI) semiquantitative analysis of the two main hypometabolic clusters deriving from the comparison of MCI-AD and MCI-LB groups in the two directions, respectively. RESULTS Mean diagnostic accuracy of visual assessment was 76.8 ± 5.0% and did not significantly benefit from adding the univariate VBA map reading (77.4 ± 8.3%) whereas VROI-derived OR plot reading significantly increased both accuracy (89.7 ± 2.3%) and inter-rater reliability (ICC 0.97 [0.96-0.98]), regardless of the readers' expertise. CONCLUSION Conventional visual reading of FDG-PET is moderately accurate in distinguishing between MCI-LB and MCI-AD, and is not significantly improved by univariate single-subject VBA but by a VROI analysis built on macro-regions, allowing for high accuracy independent of reader skills.
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Ferreira D, Nedelska Z, Graff-Radford J, Przybelski SA, Lesnick TG, Schwarz CG, Botha H, Senjem ML, Fields JA, Knopman DS, Savica R, Ferman TJ, Graff-Radford NR, Lowe VJ, Jack CR, Petersen RC, Lemstra AW, van de Beek M, Barkhof F, Blanc F, Loureiro de Sousa P, Philippi N, Cretin B, Demuynck C, Hort J, Oppedal K, Boeve BF, Aarsland D, Westman E, Kantarci K. Cerebrovascular disease, neurodegeneration, and clinical phenotype in dementia with Lewy bodies. Neurobiol Aging 2021; 105:252-261. [PMID: 34130107 PMCID: PMC8338792 DOI: 10.1016/j.neurobiolaging.2021.04.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
We investigated whether cerebrovascular disease contributes to neurodegeneration and clinical phenotype in dementia with Lewy bodies (DLB). Regional cortical thickness and subcortical gray matter volumes were estimated from structural magnetic resonance imaging (MRI) in 165 DLB patients. Cortical and subcortical infarcts were recorded and white matter hyperintensities (WMHs) were assessed. Subcortical only infarcts were more frequent (13.3%) than cortical only infarcts (3.1%) or both subcortical and cortical infarcts (2.4%). Infarcts, irrespective of type, were associated with WMHs. A higher WMH volume was associated with thinner orbitofrontal, retrosplenial, and posterior cingulate cortices, smaller thalamus and pallidum, and larger caudate volume. A higher WMH volume was associated with the presence of visual hallucinations and lower global cognitive performance, and tended to be associated with the absence of probable rapid eye movement sleep behavior disorder. Presence of infarcts was associated with the absence of parkinsonism. We conclude that cerebrovascular disease is associated with gray matter neurodegeneration in patients with probable DLB, which may have implications for the multifactorial treatment of probable DLB.
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Affiliation(s)
- Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Zuzana Nedelska
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | | | | | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Afina W Lemstra
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands
| | - Marleen van de Beek
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands; Queen Square Institute of Neurology, University College London, London, UK
| | - Frederic Blanc
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Paulo Loureiro de Sousa
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Nathalie Philippi
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Benjamin Cretin
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Catherine Demuynck
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Jakub Hort
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ketil Oppedal
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway; Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | | | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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van der Lee SJ, van Steenoven I, van de Beek M, Tesi N, Jansen IE, van Schoor NM, Reinders MJT, Huisman M, Scheltens P, Teunissen CE, Holstege H, van der Flier WM, Lemstra AW. Genetics Contributes to Concomitant Pathology and Clinical Presentation in Dementia with Lewy Bodies. J Alzheimers Dis 2021; 83:269-279. [PMID: 34308904 PMCID: PMC8461715 DOI: 10.3233/jad-210365] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Dementia with Lewy bodies (DLB) is a complex, progressive neurodegenerative disease with considerable phenotypic, pathological, and genetic heterogeneity. Objective: We tested if genetic variants in part explain the heterogeneity in DLB. Methods: We tested the effects of variants previously associated with DLB (near APOE, GBA, and SNCA) and polygenic risk scores for Alzheimer’s disease (AD-PRS) and Parkinson’s disease (PD-PRS). We studied 190 probable DLB patients from the Alzheimer’s dementia cohort and compared them to 2,552 control subjects. The p-tau/Aβ1–42 ratio in cerebrospinal fluid was used as in vivo proxy to separate DLB cases into DLB with concomitant AD pathology (DLB-AD) or DLB without AD (DLB-pure). We studied the clinical measures age, Mini-Mental State Examination (MMSE), and the presence of core symptoms at diagnosis and disease duration. Results: We found that all studied genetic factors significantly associated with DLB risk (all-DLB). Second, we stratified the DLB patients by the presence of concomitant AD pathology and found that APOE ɛ4 and the AD-PRS associated specifically with DLB-AD, but less with DLB-pure. In addition, the GBA p.E365K variant showed strong associated with DLB-pure and less with DLB-AD. Last, we studied the clinical measures and found that APOE ɛ4 associated with reduced MMSE, higher odds to have fluctuations and a shorter disease duration. In addition, the GBA p.E365K variant reduced the age at onset by 5.7 years, but the other variants and the PRS did not associate with clinical features. Conclusion: These finding increase our understanding of the pathological and clinical heterogeneity in DLB.
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Affiliation(s)
- Sven J van der Lee
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Section Genomics of Neurdegenerative Diseases and Aging, Department of Human Genetics Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger van Steenoven
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marleen van de Beek
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Niccolò Tesi
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Section Genomics of Neurdegenerative Diseases and Aging, Department of Human Genetics Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Pattern Recognition & Bioinformatics, Delft University of Technology, Delft, The Netherlands
| | - Iris E Jansen
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije University, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marcel J T Reinders
- Pattern Recognition & Bioinformatics, Delft University of Technology, Delft, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Henne Holstege
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Section Genomics of Neurdegenerative Diseases and Aging, Department of Human Genetics Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Afina W Lemstra
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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44
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Are Parkinson's Disease Patients the Ideal Preclinical Population for Alzheimer's Disease Therapeutics? J Pers Med 2021; 11:jpm11090834. [PMID: 34575610 PMCID: PMC8472048 DOI: 10.3390/jpm11090834] [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: 07/02/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Concomitant neuropathological hallmarks of Alzheimer's Disease (AD) are common in the brains of people with Parkinson's disease (PD). Furthermore, AD biomarkers are associated with cognitive decline and dementia in PD patients during life. Here, we highlight the considerable overlap between AD and PD, emphasizing neuropathological, biomarker, and mechanistic studies. We suggest that precision medicine approaches may successfully identify PD patients most likely to develop concomitant AD. The ability to identify PD patients at high risk for future concomitant AD in turn provides an ideal cohort for trials of AD-directed therapies in PD patients, aimed at delaying or preventing cognitive symptoms.
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45
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Naasan G, Shdo SM, Rodriguez EM, Spina S, Grinberg L, Lopez L, Karydas A, Seeley WW, Miller BL, Rankin KP. Psychosis in neurodegenerative disease: differential patterns of hallucination and delusion symptoms. Brain 2021; 144:999-1012. [PMID: 33501939 DOI: 10.1093/brain/awaa413] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
Although psychosis is a defining feature of Lewy body disease, psychotic symptoms occur in a subset of patients with every major neurodegenerative disease. Few studies, however, have compared disease-related rates of psychosis prevalence in a large autopsy-based cohort, and it remains unclear how diseases differ with respect to the nature or content of the psychosis. We conducted a retrospective chart review of 372 patients with autopsy-confirmed neurodegenerative pathology: 111 with Alzheimer's disease, 59 with Lewy body disease and concomitant Alzheimer's disease, 133 with frontotemporal lobar degeneration (FTLD) with tau inclusions (including progressive supranuclear palsy, corticobasal degeneration or Pick's disease), and 69 with FTLD and TDP inclusions (FTLD-TDP, including types A-C). Psychosis content was classified by subtype, and the frequency of each subtype was compared among pathological diagnoses using logistic regression. A total of 111 of 372 patients had psychosis. Compared to other groups, patients with Lewy body disease/Alzheimer's disease pathology were significantly more likely to have hallucinations and were more likely to have more than one subtype of hallucination. Patients with Braak Parkinson stage 5-6 Lewy body disease were significantly more likely than those with no Lewy body disease to have visual hallucinations of misperception, peripheral hallucinations, hallucinations that moved, hallucinations of people/animals/objects, as well as delusions regarding a place and delusions of misidentification. The feeling of a presence occurred significantly more frequently in patients with Lewy body disease/Alzheimer's disease than all other pathologies. Patients with FTLD-TDP were significantly more likely to have delusions, and for the delusions to occur in the first 3 years of the disease, when compared to patients with Alzheimer's disease and FTLD-tau, though rates were not significantly greater than patients with Lewy body disease/Alzheimer's disease. Paranoia occurred more frequently in the FTLD-TDP and Lewy body disease/Alzheimer's disease categories compared to patients with Alzheimer's disease or FTLD-tau. Patients with FTLD-TDP pathology had delusions of misidentification as frequently as patients with Lewy body disease/Alzheimer's disease, and were significantly more likely to have self-elevating delusions such as grandiosity and erotomania compared to patients with other pathologies including FTLD-tau. These data show that the nature and content of psychosis can provide meaningful information about the underlying neurodegenerative pathology, emphasizing the importance of characterizing patients' psychoses for prediction of the neuropathological diagnosis, regardless of a patient's clinical syndrome.
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Affiliation(s)
- Georges Naasan
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA.,The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Suzanne M Shdo
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA.,Department of Psychology, University of California Berkeley, Berkeley, CA, USA
| | - Estrella Morenas Rodriguez
- Biomedizinisches Centrum (BMC), Biochemistry Chair, Ludwig-Maximilians-Universität and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Munich, Germany
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Lea Grinberg
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Lucia Lopez
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Anna Karydas
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
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Dumurgier J, Sabia S. Life expectancy in dementia subtypes: exploring a leading cause of mortality. THE LANCET. HEALTHY LONGEVITY 2021; 2:e449-e450. [DOI: 10.1016/s2666-7568(21)00166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022] Open
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47
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Jellinger KA. Significance of cerebral amyloid angiopathy and other co-morbidities in Lewy body diseases. J Neural Transm (Vienna) 2021; 128:687-699. [PMID: 33928445 DOI: 10.1007/s00702-021-02345-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/22/2021] [Indexed: 01/12/2023]
Abstract
Lewy body dementia (LBD) and Parkinson's disease-dementia (PDD) are two major neurocognitive disorders with Lewy bodies (LB) of unknown etiology. There is considerable clinical and pathological overlap between these two conditions that are clinically distinguished based on the duration of Parkinsonism prior to development of dementia. Their morphology is characterized by a variable combination of LB and Alzheimer's disease (AD) pathologies. Cerebral amyloid angiopathy (CAA), very common in aged persons and particularly in AD, is increasingly recognized for its association with both pathologies and dementia. To investigate neuropathological differences between LB diseases with and without dementia, 110 PDD and 60 LBD cases were compared with 60 Parkinson's disease (PD) cases without dementia (PDND). The major demographic and neuropathological data were assessed retrospectively. PDD patients were significantly older than PDND ones (83.9 vs 77.8 years; p < 0.05); the age of LB patients was in between both groups (mean 80.2 years), while the duration of disease was LBD < PDD < PDND (mean 6.7 vs 12.5 and 14.3 years). LBD patients had higher neuritic Braak stages (mean 5.1 vs 4.5 and 4.0, respectively), LB scores (mean 5.3 vs 4.2 and 4.0, respectively), and Thal amyloid phases (mean 4.1 vs 3.0 and 2.3, respectively) than the two other groups. CAA was more common in LBD than in the PDD and PDND groups (93 vs 50 and 21.7%, respectively). Its severity was significantly greater in LBD than in PDD and PDND (p < 0.01), involving mainly the occipital lobes. Moreover, striatal Aβ deposition highly differentiated LBD brains from PDD. Braak neurofibrillary tangle (NFT) stages, CAA, and less Thal Aβ phases were positively correlated with LB pathology (p < 0.05), which was significantly higher in LBD than in PDD < PDND. Survival analysis showed worse prognosis in LBD than in PDD (and PDND), which was linked to both increased Braak tau stages and more severe CAA. These and other recent studies imply the association of CAA-and both tau and LB pathologies-with cognitive decline and more rapid disease progression that distinguishes LBD from PDD (and PDND).
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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48
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Vergouw LJM, Bosman B, van de Beek M, Salomé M, Hoogers SE, van Steenoven I, Roks G, Bonifati V, van Swieten JC, Lemstra AW, de Jong FJ. Family History is Associated with Phenotype in Dementia with Lewy Bodies. J Alzheimers Dis 2021; 73:269-275. [PMID: 31771063 PMCID: PMC7029358 DOI: 10.3233/jad-190825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is currently unknown whether patients with dementia with Lewy bodies (DLB) with relatives with dementia or Parkinson’s disease (familial DLB patients) have a different phenotype than sporadic DLB patients. In this study, we aimed to examine disease onset, rate of cognitive decline, survival, and Alzheimer’s disease (AD) biomarkers in patients with familial DLB (n = 154) and sporadic DLB (n = 137), using linear mixed model analysis and Cox regression analysis, among others. Familial patients had a shorter survival (8.0 years) and more often elevated cerebrospinal fluid AD biomarkers (47%) than sporadic patients (9.0 years; p≤0.001; 30%, p = 0.037). Our findings suggest that genetic factors are important in DLB and that the identification of new genetic factors will probably improve the prediction of prognosis.
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Affiliation(s)
- Leonie J M Vergouw
- Alzheimer Center Erasmus MC, Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Brechje Bosman
- Alzheimer Center Erasmus MC, Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marleen van de Beek
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mariet Salomé
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands.,Department of Neurology, St Jansdal Ziekenhuis, Harderwijk, The Netherlands
| | - Susanne E Hoogers
- Alzheimer Center Erasmus MC, Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Inger van Steenoven
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gerwin Roks
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Vincenzo Bonifati
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - John C van Swieten
- Alzheimer Center Erasmus MC, Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Afina W Lemstra
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frank Jan de Jong
- Alzheimer Center Erasmus MC, Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
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Olivieri P, Lebouvier T, Hardouin JB, Courtemanche H, Le Dily S, Barbin L, Pallardy A, Derkinderen P, Boutoleau-Bretonnière C. LeSCoD: a new clinical scale for the detection of Lewy body disease in neurocognitive disorders. J Neurol 2021; 268:3886-3896. [PMID: 33830336 DOI: 10.1007/s00415-021-10539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dementia with Lewy bodies remains underdiagnosed in clinical practice mainly because of the low sensitivity of existing diagnostic criteria and a strong overlap with Alzheimer's pathology that can mask the Lewy phenotype. OBJECTIVE The objective of this study was therefore to develop and validate a new clinical scale designed to detect signs of Lewy body disease, called LeSCoD for Lewy body Screening scale in Cognitive Disorders. METHODS 128 patients who fulfilled the clinical criteria of dementia with Lewy bodies (DLB; n = 32), Alzheimer's disease (AD; n = 77) or both (n = 19) was prospectively enrolled. 18F-DOPA PET imaging and/or CSF biomarkers were available in some patients. LeSCoD scale was systematically administered and the potential correlation with 18F-DOPA PET imaging was evaluated in a subgroup of patients. RESULTS LeSCoD scale showed robust internal and external validity. We determined a cut-off of 10 above which the sensitivity and specificity for Lewy body disease diagnosis were 86% and 95%, respectively. The LeSCoD scale correlated with striatal dopamine uptake in 18F-DOPA PET. CONCLUSION LeSCoD scale is a simple and reliable tool for the evaluation of Lewy body disease in routine clinical practice, with a higher sensitivity and specificity than the existing criteria. It might be an alternative to the use of dopamine-specific imaging.
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Affiliation(s)
- Pauline Olivieri
- Department of Neurology of Memory and Language, GHU Paris Psychiatry and Neurosciences, Hôpital Sainte Anne, 75014, Paris, France.,Université de Paris, 75006, Paris, France
| | - Thibaud Lebouvier
- University of Lille, Inserm U1172, CHU Lille, DISTALZ, Lille, France
| | - Jean-Benoît Hardouin
- UMR INSERM 1246-SPHERE "Methods in Patient-Centered Outcomes and Health Research", Université de Nantes, Université de Tours, Tours, France.,Unit of Methodology and Biostatistics, Université de Nantes, Nantes, France
| | - Hélène Courtemanche
- Centre Mémoire Ressource et Recherche (CMRR), Department of Neurology, CHU Nantes, 44093, Nantes, France.,INSERM CIC 04, Nantes, France
| | | | | | | | | | - Claire Boutoleau-Bretonnière
- Centre Mémoire Ressource et Recherche (CMRR), Department of Neurology, CHU Nantes, 44093, Nantes, France. .,INSERM CIC 04, Nantes, France. .,Claire Boutoleau-Bretonnière, Centre Mémoire Ressource et Recherche (CMRR), Centre Hospitalier Universitaire de Nantes Hôpital Laennec, Boulevard Jacques Monod, 44000, Nantes, France.
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Howard E, Irwin DJ, Rascovsky K, Nevler N, Shellikeri S, Tropea TF, Spindler M, Deik A, Chen-Plotkin A, Siderowf A, Dahodwala N, Weintraub D, Shaw LM, Trojanowski JQ, Vaishnavi SN, Wolk DA, Mechanic-Hamilton D, Morley JF, Duda JE, Grossman M, Cousins KAQ. Cognitive Profile and Markers of Alzheimer Disease-Type Pathology in Patients With Lewy Body Dementias. Neurology 2021; 96:e1855-e1864. [PMID: 33593865 PMCID: PMC8105963 DOI: 10.1212/wnl.0000000000011699] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To determine whether patients with Lewy body dementia (LBD) with likely Alzheimer disease (AD)-type copathology are more impaired on confrontation naming than those without likely AD-type copathology. METHODS We selected 57 patients with LBD (dementia with Lewy bodies [DLB], n = 38; Parkinson disease dementia [PDD], n = 19) with available AD CSF biomarkers and neuropsychological data. CSF β-amyloid1-42 (Aβ42), phosphorylated-tau (p-tau), and total-tau (t-tau) concentrations were measured. We used an autopsy-validated CSF cut point (t-tau:Aβ42 ratio > 0.3, n = 43), or autopsy data when available (n = 14), to categorize patients as having LBD with (LBD + AD, n = 26) and without (LBD - AD, n = 31) likely AD-type copathology. Analysis of covariance tested between-group comparisons across biologically defined groups (LBD + AD, LBD - AD) and clinical phenotypes (DLB, PDD) on confrontation naming (30-item Boston Naming Test [BNT]), executive abilities (letter fluency [LF], reverse digit span [RDS]), and global cognition (Mini-Mental State Examination [MMSE]), with adjustment for age at dementia onset, time from dementia onset to test date, and time from CSF to test date. Spearman correlation related cognitive performance to CSF analytes. RESULTS Patients with LBD + AD performed worse on BNT than patients with LBD - AD (F = 4.80, p = 0.03); both groups performed similarly on LF, RDS, and MMSE (all p > 0.1). Clinically defined PDD and DLB groups did not differ in performance on any of these measures (all p > 0.05). A correlation across all patients showed that BNT score was negatively associated with CSF t-tau (ρ = -0.28, p < 0.05) and p-tau (ρ = -0.26, p = 0.05) but not Aβ42 (p > 0.1). CONCLUSION Markers of AD-type copathology are implicated in impaired language performance in LBD. Biologically based classification of LBD may be advantageous over clinically defined syndromes to elucidate clinical heterogeneity.
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Affiliation(s)
- Erica Howard
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - David J Irwin
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Katya Rascovsky
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Naomi Nevler
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Sanjana Shellikeri
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Thomas F Tropea
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Meredith Spindler
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Andres Deik
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Alice Chen-Plotkin
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Andrew Siderowf
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Nabila Dahodwala
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Daniel Weintraub
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Leslie M Shaw
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - John Q Trojanowski
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Sanjeev N Vaishnavi
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - David A Wolk
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Dawn Mechanic-Hamilton
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - James F Morley
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - John E Duda
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Murray Grossman
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA
| | - Katheryn A Q Cousins
- From the Department of Neurology (E.H., D.J.I., K.R., N.N., S.S., T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W., S.N.V., D.A.W., D.M.-H., J.F.M., J.E.D., M.G., K.A.Q.C.), Frontotemporal Degeneration Center (E.H., D.J.I., K.R., N.N., S.S., M.G., K.A.Q.C.), Parkinson's Disease and Movement Disorders Center (T.F.T., M.S., A.D., A.C.-P., A.S., N.D., D.W.), Digital Neuropathology Laboratory (D.J.I.), Alzheimer's Disease Center (J.Q.T., S.N.V., D.A.W., D.M.-H.), Center for Neurodegenerative Disease Research (L.M.S., J.Q.T.), and Department of Pathology and Laboratory Medicine (L.M.S., J.Q.T., D.A.W.), Perelman School of Medicine at the University of Pennsylvania; and Michael J. Crescenz VA Medical Center (D.W., J.F.M., J.E.D.), Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA.
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