Pathomechanisms of atrophy in insular cortex in Alzheimer's disease

Cerebrospinal Fluid Cortisol and Dehydroepiandrosterone Sulfate, Alzheimer’s Disease Pathology, and Cognitive Decline

Introduction

Elevated cortisol levels have been reported in Alzheimer’s disease (AD) and may accelerate the development of brain pathology and cognitive decline. Dehydroepiandrosterone sulfate (DHEAS) has anti-glucocorticoid effects and it may be involved in the AD pathophysiology.

Objectives

To investigate associations of cerebrospinal fluid (CSF) cortisol and DHEAS levels with (1) cognitive performance at baseline; (2) CSF biomarkers of amyloid pathology (as assessed by CSF Aβ levels), neuronal injury (as assessed by CSF tau), and tau hyperphosphorylation (as assessed by CSF p-tau); (3) regional brain volumes; and (4) clinical disease progression.

Materials and Methods

Individuals between 49 and 88 years (n = 145) with mild cognitive impairment or dementia or with normal cognition were included. Clinical scores, AD biomarkers, brain MRI volumetry along with CSF cortisol and DHEAS were obtained at baseline. Cognitive and functional performance was re-assessed at 18 and 36 months from baseline. We also assessed the following covariates: apolipoprotein E (APOE) genotype, BMI, and education. We used linear regression and mixed models to address associations of interest.

Results

Higher CSF cortisol was associated with poorer global cognitive performance and higher disease severity at baseline. Cortisol and cortisol/DHEAS ratio were positively associated with tau and p-tau CSF levels, and negatively associated with the amygdala and insula volumes at baseline. Higher CSF cortisol predicted more pronounced cognitive decline and clinical disease progression over 36 months. Higher CSF DHEAS predicted more pronounced disease progression over 36 months.

Conclusion

Increased cortisol in the CNS is associated with tau pathology and neurodegeneration, and with decreased insula and amygdala volume. Both CSF cortisol and DHEAS levels predict faster clinical disease progression. These results have implications for the identification of patients at risk of rapid decline as well as for the development of interventions targeting both neurodegeneration and clinical manifestations of AD.

Regional Strength of Large-Scale Functional Brain Networks is Associated with Regional Volumes in Older Adults and in Alzheimer's Disease

Background: The association between regional volumes and resting-state functional networks was tested within the default-mode network (DMN), influenced by Alzheimer pathology, salience network (SalN), not under similar pathological influence, and sensorimotor network (SMN), usually spared by pathology. Methods: A total of 148 participants, with Alzheimer's disease (AD) dementia, mild cognitive impairment (MCI), and healthy controls underwent multimodal brain magnetic resonance imaging (MRI). Functional network identification was achieved with group-level independent-component analysis of functional MRI (fMRI) scans. T1 weighted images were also analyzed. Ten regions of interest (ROI) were defined in core hubs of the three networks. Gray-matter volume/functional network strength association was tested within-ROI and cross-ROI in each group by using partial-correlation models and ROI-to-ROI, ROI-to-voxel, and voxel-to-voxel correlations. Results: In controls, a negative association was found between right inferior-parietal volumes and SMN expression in the left precentral gyrus, as revealed by ROI-to-ROI models. In AD, DMN expression was positively associated with the volume of the left insula and the right inferior parietal lobule, and SalN expression was positively associated with volume of the left inferior parietal lobule. ROI-to-voxel models revealed significant associations between the volume of the posterior cingulate cortex and SMN expression in sensorimotor and premotor regions. No significant findings emerged in the MCI nor from voxel-to-voxel analyses. Discussion: Regional volumes of main network hubs are significantly associated with hemodynamic network expression, although patterns are intricate and dependent on diagnostic status. Since distinct networks are differentially influenced by Alzheimer pathology, it appears that pathology plays a significant role in influencing the association between regional volumes and regional functional network strength.

Muscle Strength Is Independently Related to Brain Atrophy in Patients with Alzheimer's Disease

BACKGROUND/AIMS

Alzheimer's disease (AD) is the most common cause of dementia worldwide. Interestingly, muscle mass (MM) and muscle strength (MS) are related to AD. In addition to the muscle profile, brain atrophy is also a prominent feature of AD. There is substantial evidence showing an association between muscle profile and dementia, but the role of the muscle profile and cerebral cortical atrophy within this association is less well understood. The objective of this study was to determine if there is any association between muscle profile and brain regional volume in AD. A secondary objective was to determine whether this relationship continues as the clinical stage of AD progresses.

METHODS

We recruited 28 patients with probable AD without weakness. We assessed the patients' basic demographic characteristics, Mini-Mental State Examination score, and brain magnetic resonance images. MM was measured using body dual-energy X-ray absorptiometry. MS was assessed in Nm/kg with an isokinetic knee extensor using an isokinetic device at an angular velocity of 60°/s. An automatic analysis program was used for brain regional volumetric measurements. Dementia was divided into two stages: mild and moderate.

RESULTS

MS was related to left hippocampal volume ratio. After adjusting for age and cognitive status, the relationship remained. MS did not demonstrate any relationship to any brain regional volume ratio in the mild stage; however, in the moderate stage, it was positively related to both the right and the left hippocampal volume ratio.

CONCLUSIONS

Our findings imply a shared underlying pathology relating MS and brain volume and suggest cognitive functional declines through the muscle-brain axis. Further longitudinal studies are needed to find possible and related causes of reduced MS and cortical atrophy in patients with dementia.

Neuropathological sequelae of Human Immunodeficiency Virus and apathy: A review of neuropsychological and neuroimaging studies

Apathy remains a common neuropsychiatric disturbance in the Human Immunodeficiency Virus (HIV-1) despite advances in anti-retroviral treatment (ART). The goal of the current review is to recapitulate findings relating apathy to the deleterious biobehavioral effects of HIV-1 in the post-ART era. Available literatures demonstrate that the emergence of apathy with other neurocognitive and neuropsychiatric symptoms may be attributed to neurotoxic effects of viral proliferation, e.g., aggregative effect of Tat and gp120 on apoptosis, transport and other enzymatic reactions amongst dopaminergic neurons and neuroglia. An assortment of neuroimaging modalities converge on the severity of apathy symptoms associated with the propensity of the virus to replicate within frontal-striatal brain circuits that facilitate emotional processing. Burgeoning research into functional brain connectivity also supports the effects of microvascular and neuro-inflammatory injury linked to aging with HIV-1 on the presentation of neuropsychiatric symptoms. Summarizing these findings, we review domains of HIV-associated neurocognitive and neuropsychiatric impairment linked to apathy in HIV. Taken together, these lines of research suggest that loss of affective, cognitive and behavioral inertia is commensurate with the neuropathology of HIV-1.