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Giacomucci G, Mazzeo S, Ingannato A, Crucitti C, Bagnoli S, Padiglioni S, Romano L, Galdo G, Emiliani F, Frigerio D, Ferrari C, Moschini V, Morinelli C, Notarelli A, Sorbi S, Nacmias B, Bessi V. Future perspective and clinical applicability of the combined use of plasma phosphorylated tau 181 and neurofilament light chain in Subjective Cognitive Decline and Mild Cognitive Impairment. Sci Rep 2024; 14:11307. [PMID: 38760423 PMCID: PMC11101654 DOI: 10.1038/s41598-024-61655-6] [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: 03/01/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Abstract
We aimed to assess diagnostic accuracy of plasma p-tau181 and NfL separately and in combination in discriminating Subjective Cognitive Decline (SCD) and Mild Cognitive Impairment (MCI) patients carrying Alzheimer's Disease (AD) pathology from non-carriers; to propose a flowchart for the interpretation of the results of plasma p-tau181 and NfL. We included 43 SCD, 41 MCI and 21 AD-demented (AD-d) patients, who underwent plasma p-tau181 and NfL analysis. Twenty-eight SCD, 41 MCI and 21 AD-d patients underwent CSF biomarkers analysis (Aβ1-42, Aβ1-42/1-40, p-tau, t-tau) and were classified as carriers of AD pathology (AP+) it they were A+/T+ , or non-carriers (AP-) when they were A-, A+/T-/N-, or A+/T-/N+ according to the A/T(N) system. Plasma p-tau181 and NfL separately showed a good accuracy (AUC = 0.88), while the combined model (NfL + p-tau181) showed an excellent accuracy (AUC = 0.92) in discriminating AP+ from AP- patients. Plasma p-tau181 and NfL results were moderately concordant (Coehn's k = 0.50, p < 0.001). Based on a logistic regression model, we estimated the risk of AD pathology considering the two biomarkers: 10.91% if both p-tau181 and NfL were negative; 41.10 and 76.49% if only one biomarker was positive (respectively p-tau18 and NfL); 94.88% if both p-tau181 and NfL were positive. Considering the moderate concordance and the risk of presenting an underlying AD pathology according to the positivity of plasma p-tau181 and NfL, we proposed a flow chart to guide the combined use of plasma p-tau181 and NfL and the interpretation of biomarker results to detect AD pathology.
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Affiliation(s)
- Giulia Giacomucci
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
| | - Salvatore Mazzeo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Assunta Ingannato
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
| | - Chiara Crucitti
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
| | - Sonia Padiglioni
- Regional Referral Centre for Relational Criticalities - Tuscany Region, University of Florence, Florence, Italy
- Research and Innovation Centre for Dementia-CRIDEM, AOU Careggi, Florence, Italy
| | | | - Giulia Galdo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
| | - Filippo Emiliani
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
| | - Daniele Frigerio
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
| | - Camilla Ferrari
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
| | - Valentina Moschini
- SOD Neurologia I, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy
| | - Carmen Morinelli
- SOD Neurologia I, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy
| | - Antonella Notarelli
- Research and Innovation Centre for Dementia-CRIDEM, AOU Careggi, Florence, Italy
- SOD Neurologia I, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy.
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
| | - Valentina Bessi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
- Research and Innovation Centre for Dementia-CRIDEM, AOU Careggi, Florence, Italy
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Pozzi FE, Remoli G, Tremolizzo L, Appollonio I, Ferrarese C, Cuffaro L. Brain Health and Cognition in Older Adults: Roadmap and Milestones towards the Implementation of Preventive Strategies. Brain Sci 2024; 14:55. [PMID: 38248270 PMCID: PMC10813413 DOI: 10.3390/brainsci14010055] [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: 11/28/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
In this narrative review, we delve into the evolving concept of brain health, as recognized by the WHO, focusing on its intersection with cognitive decline. We emphasize the imperative need for preventive strategies, particularly in older adults. We describe the target population that might benefit the most from risk-based approaches-namely, people with subjective cognitive decline. Additionally, we consider universal prevention in cognitively unimpaired middle-aged and older adults. Delving into multidomain personalized preventive strategies, we report on empirical evidence surrounding modifiable risk factors and interventions crucial in mitigating cognitive decline. Next, we highlight the emergence of brain health services (BHS). We explain their proposed role in risk assessment, risk communication, and tailored interventions to reduce the risk of dementia. Commenting on ongoing BHS pilot experiences, we present the inception and framework of our own BHS in Monza, Italy, outlining its operational structure and care pathways. We emphasize the need for global collaboration and intensified research efforts to address the intricate determinants of brain health and their potential impact on healthcare systems worldwide.
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Affiliation(s)
- Federico Emanuele Pozzi
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (G.R.); (L.T.); (I.A.); (C.F.); (L.C.)
- Neurology Department & Brain Health Service, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, 20126 Milan, Italy
| | - Giulia Remoli
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (G.R.); (L.T.); (I.A.); (C.F.); (L.C.)
- Neurology Department & Brain Health Service, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Lucio Tremolizzo
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (G.R.); (L.T.); (I.A.); (C.F.); (L.C.)
- Neurology Department & Brain Health Service, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, 20126 Milan, Italy
| | - Ildebrando Appollonio
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (G.R.); (L.T.); (I.A.); (C.F.); (L.C.)
- Neurology Department & Brain Health Service, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, 20126 Milan, Italy
| | - Carlo Ferrarese
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (G.R.); (L.T.); (I.A.); (C.F.); (L.C.)
- Neurology Department & Brain Health Service, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, 20126 Milan, Italy
| | - Luca Cuffaro
- School of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy; (G.R.); (L.T.); (I.A.); (C.F.); (L.C.)
- Neurology Department & Brain Health Service, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, 20126 Milan, Italy
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Mazzeo S, Ingannato A, Giacomucci G, Manganelli A, Moschini V, Balestrini J, Cavaliere A, Morinelli C, Galdo G, Emiliani F, Piazzesi D, Crucitti C, Frigerio D, Polito C, Berti V, Bagnoli S, Padiglioni S, Sorbi S, Nacmias B, Bessi V. Plasma neurofilament light chain predicts Alzheimer's disease in patients with subjective cognitive decline and mild cognitive impairment: A cross-sectional and longitudinal study. Eur J Neurol 2024; 31:e16089. [PMID: 37797300 PMCID: PMC11235835 DOI: 10.1111/ene.16089] [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: 06/15/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the accuracy of plasma neurofilament light chain (NfL) in predicting Alzheimer's disease (AD) and the progression of cognitive decline in patients with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). METHODS This longitudinal cohort study involved 140 patients (45 with SCD, 73 with MCI, and 22 with AD dementia [AD-D]) who underwent plasma NfL and AD biomarker assessments (cerebrospinal fluid, amyloid positron emission tomography [PET], and 18 F-fluorodeoxyglucose-PET) at baseline. The patients were rated according to the amyloid/tau/neurodegeneration (A/T/N) system and followed up for a mean time of 2.72 ± 0.95 years to detect progression from SCD to MCI and from MCI to AD. Forty-eight patients (19 SCD, 29 MCI) also underwent plasma NfL measurements 2 years after baseline. RESULTS At baseline, plasma NfL detected patients with biomarker profiles consistent with AD (A+/T+/N+ or A+/T+/N-) with high accuracy (area under the curve [AUC] 0.82). We identified cut-off values of 19.45 pg/mL for SCD and 20.45 pg/mL for MCI. During follow-up, nine SCD patients progressed to MCI (progressive SCD [p-SCD]), and 14 MCI patients developed AD dementia (progressive MCI [p-MCI]). The previously identified cut-off values provided good accuracy in identifying p-SCD (80% [95% confidence interval 65.69: 94.31]). The rate of NfL change was higher in p-MCI (3.52 ± 4.06 pg/mL) compared to non-progressive SCD (0.81 ± 1.25 pg/mL) and non-progressive MCI (-0.13 ± 3.24 pg/mL) patients. A rate of change lower than 1.64 pg/mL per year accurately excluded progression from MCI to AD (AUC 0.954). CONCLUSION Plasma NfL concentration and change over time may be a reliable, non-invasive tool to detect AD and the progression of cognitive decline at the earliest stages of the disease.
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Affiliation(s)
- Salvatore Mazzeo
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
- Research and Innovation Centre for Dementia‐CRIDEMAzienda Ospedaliero‐Universitaria CareggiFlorenceItaly
| | - Assunta Ingannato
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
| | - Giulia Giacomucci
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
| | - Alberto Manganelli
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
| | - Valentina Moschini
- Research and Innovation Centre for Dementia‐CRIDEMAzienda Ospedaliero‐Universitaria CareggiFlorenceItaly
| | - Juri Balestrini
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
| | - Arianna Cavaliere
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
| | - Carmen Morinelli
- Research and Innovation Centre for Dementia‐CRIDEMAzienda Ospedaliero‐Universitaria CareggiFlorenceItaly
| | - Giulia Galdo
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
| | - Filippo Emiliani
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
| | - Diletta Piazzesi
- Research and Innovation Centre for Dementia‐CRIDEMAzienda Ospedaliero‐Universitaria CareggiFlorenceItaly
| | - Chiara Crucitti
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
| | - Daniele Frigerio
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
| | | | - Valentina Berti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio"University of FlorenceFlorenceItaly
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
| | - Sonia Padiglioni
- Research and Innovation Centre for Dementia‐CRIDEMAzienda Ospedaliero‐Universitaria CareggiFlorenceItaly
- Regional Referral Centre for Relational Criticalities – 50139Tuscany RegionItaly
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
- Research and Innovation Centre for Dementia‐CRIDEMAzienda Ospedaliero‐Universitaria CareggiFlorenceItaly
- IRCCS Fondazione Don Carlo GnocchiFlorenceItaly
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
- IRCCS Fondazione Don Carlo GnocchiFlorenceItaly
| | - Valentina Bessi
- Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
- Research and Innovation Centre for Dementia‐CRIDEMAzienda Ospedaliero‐Universitaria CareggiFlorenceItaly
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