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Hattori Y, Kakino Y, Kiyoshige E, Ogata S, Nishimura K, Iida H, Ihara M. Blood Midregional Proadrenomedullin as a Hemodynamic Severity Marker in Asymptomatic Carotid Artery Stenosis/Occlusion. Stroke 2024; 55:e182-e184. [PMID: 38860369 DOI: 10.1161/strokeaha.124.047160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Affiliation(s)
- Yorito Hattori
- Department of Neurology (Y.H., Y.K., M.I.), National Cerebral and Cardiovascular Center, Japan
| | - Yoshinori Kakino
- Department of Neurology (Y.H., Y.K., M.I.), National Cerebral and Cardiovascular Center, Japan
| | - Eri Kiyoshige
- Department of Preventive Medicine and Epidemiology (E.K., S.O., K.N.), National Cerebral and Cardiovascular Center, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology (E.K., S.O., K.N.), National Cerebral and Cardiovascular Center, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology (E.K., S.O., K.N.), National Cerebral and Cardiovascular Center, Japan
| | - Hidehiro Iida
- Turku PET Centre, University of Turku and Turku University Hospital, Finland (H.I.)
| | - Masafumi Ihara
- Department of Neurology (Y.H., Y.K., M.I.), National Cerebral and Cardiovascular Center, Japan
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Kim AY, Al Jerdi S, MacDonald R, Triggle CR. Alzheimer's disease and its treatment-yesterday, today, and tomorrow. Front Pharmacol 2024; 15:1399121. [PMID: 38868666 PMCID: PMC11167451 DOI: 10.3389/fphar.2024.1399121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/25/2024] [Indexed: 06/14/2024] Open
Abstract
Alois Alzheimer described the first patient with Alzheimer's disease (AD) in 1907 and today AD is the most frequently diagnosed of dementias. AD is a multi-factorial neurodegenerative disorder with familial, life style and comorbidity influences impacting a global population of more than 47 million with a projected escalation by 2050 to exceed 130 million. In the USA the AD demographic encompasses approximately six million individuals, expected to increase to surpass 13 million by 2050, and the antecedent phase of AD, recognized as mild cognitive impairment (MCI), involves nearly 12 million individuals. The economic outlay for the management of AD and AD-related cognitive decline is estimated at approximately 355 billion USD. In addition, the intensifying prevalence of AD cases in countries with modest to intermediate income countries further enhances the urgency for more therapeutically and cost-effective treatments and for improving the quality of life for patients and their families. This narrative review evaluates the pathophysiological basis of AD with an initial focus on the therapeutic efficacy and limitations of the existing drugs that provide symptomatic relief: acetylcholinesterase inhibitors (AChEI) donepezil, galantamine, rivastigmine, and the N-methyl-D-aspartate receptor (NMDA) receptor allosteric modulator, memantine. The hypothesis that amyloid-β (Aβ) and tau are appropriate targets for drugs and have the potential to halt the progress of AD is critically analyzed with a particular focus on clinical trial data with anti-Aβ monoclonal antibodies (MABs), namely, aducanumab, lecanemab and donanemab. This review challenges the dogma that targeting Aβ will benefit the majority of subjects with AD that the anti-Aβ MABs are unlikely to be the "magic bullet". A comparison of the benefits and disadvantages of the different classes of drugs forms the basis for determining new directions for research and alternative drug targets that are undergoing pre-clinical and clinical assessments. In addition, we discuss and stress the importance of the treatment of the co-morbidities, including hypertension, diabetes, obesity and depression that are known to increase the risk of developing AD.
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Affiliation(s)
- A. Y. Kim
- Medical Education, Weill Cornell Medicine—Qatar, Doha, Qatar
| | | | - R. MacDonald
- Health Sciences Library, Weill Cornell Medicine—Qatar, Doha, Qatar
| | - C. R. Triggle
- Department of Pharmacology and Medical Education, Weill Cornell Medicine—Qatar, Doha, Qatar
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Moussavi Z, Uehara M, Rutherford G, Lithgow B, Millikin C, Wang X, Saha C, Mansouri B, Omelan C, Fellows L, Fitzgerald PB, Koski L. Repetitive transcranial magnetic stimulation as a treatment for Alzheimer's disease: A randomized placebo-controlled double-blind clinical trial. Neurotherapeutics 2024; 21:e00331. [PMID: 38360452 PMCID: PMC10937236 DOI: 10.1016/j.neurot.2024.e00331] [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: 10/16/2023] [Revised: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
We report results of a large multisite double-blind randomized trial investigating the short and long-term efficacy of repetitive transcranial magnetic stimulation (rTMS) applied to patients with Alzheimer's disease (AD) at mild to moderate stages, in doses of either 2 or 4 weeks of treatment (5 days/week), whilst compared with 4 weeks of sham rTMS. Randomization to treatment group was stratified based on age and severity. The objectives of this study were to: 1) investigate the efficacy of active rTMS versus sham, 2) investigate the effect of dose of treatment (2 or 4 weeks), and 3) investigate the length of benefits from treatment. The rTMS pulses (20 Hz, 30 pulses/train, 25 trains, 10-s intertrain interval) were applied serially to the left and right dorsolateral prefrontal cortex using neuro-navigation. We compared the primary outcome measure's (ADAS-Cog) score changes from pre- to post-treatment, with assessments at baseline and 4 more times up to 6 months post-treatment. Data of 135 patients were analyzed. The mean total ADAS-Cog score at baseline did not differ between the active and sham treatment groups, nor across the three study sites. The overall results show significant cognitive improvement after treatment up to two months post-treatment with either sham or active coils. The results show both short and long-term benefits of active rTMS treatment but also show similar benefits for sham coil treatment of mild/moderate AD. We discuss this finding in the context of the existing literature on rTMS therapy for AD, as well as evidence of the sham coil's potential to induce a low-level current in the brain. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02908815.
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Affiliation(s)
- Zahra Moussavi
- Biomedical Engineering, University of Manitoba, Winnipeg, MB Canada; Riverview Health Center, Winnipeg, MB, Canada.
| | - Maria Uehara
- Biomedical Engineering, University of Manitoba, Winnipeg, MB Canada
| | - Grant Rutherford
- Biomedical Engineering, University of Manitoba, Winnipeg, MB Canada
| | - Brian Lithgow
- Biomedical Engineering, University of Manitoba, Winnipeg, MB Canada; Riverview Health Center, Winnipeg, MB, Canada; Monash Alfred Psychiatry Research Center, Prahran, Victoria, Australia
| | - Colleen Millikin
- Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Xikui Wang
- Warren Centre for Actuarial Studies and Research, University of Manitoba, Winnipeg, MB Canada
| | - Chandan Saha
- Biomedical Engineering, University of Manitoba, Winnipeg, MB Canada
| | | | - Craig Omelan
- Psychiatry, University of Manitoba, Winnipeg, MB Canada
| | - Lesley Fellows
- Neurology & Neurosurgery, McGill University, Montreal, QC Canada
| | - Paul B Fitzgerald
- School of Medicine and Psychology, ANU College of Health and Medicine, Canberra, NSW Australia
| | - Lisa Koski
- Clinical Psychology, McGill University, Montreal, QC Canada
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Ning K, Cannon PB, Yu J, Shenoi S, Wang L, Sarkar J. 3D convolutional neural networks uncover modality-specific brain-imaging predictors for Alzheimer's disease sub-scores. Brain Inform 2024; 11:5. [PMID: 38310619 PMCID: PMC10838875 DOI: 10.1186/s40708-024-00218-x] [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: 10/13/2023] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Different aspects of cognitive functions are affected in patients with Alzheimer's disease. To date, little is known about the associations between features from brain-imaging and individual Alzheimer's disease (AD)-related cognitive functional changes. In addition, how these associations differ among different imaging modalities is unclear. Here, we trained and investigated 3D convolutional neural network (CNN) models that predicted sub-scores of the 13-item Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog13) based on MRI and FDG-PET brain-imaging data. Analysis of the trained network showed that each key ADAS-Cog13 sub-score was associated with a specific set of brain features within an imaging modality. Furthermore, different association patterns were observed in MRI and FDG-PET modalities. According to MRI, cognitive sub-scores were typically associated with structural changes of subcortical regions, including amygdala, hippocampus, and putamen. Comparatively, according to FDG-PET, cognitive functions were typically associated with metabolic changes of cortical regions, including the cingulated gyrus, occipital cortex, middle front gyrus, precuneus cortex, and the cerebellum. These findings brought insights into complex AD etiology and emphasized the importance of investigating different brain-imaging modalities.
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Affiliation(s)
- Kaida Ning
- Peng Cheng Laboratory, Shenzhen, Guangdong, China
| | | | | | | | - Lu Wang
- Holmusk Inc, Singapore, Singapore
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Nowell J, Raza S, Livingston NR, Sivanathan S, Gentleman S, Edison P. Do Tau Deposition and Glucose Metabolism Dissociate in Alzheimer's Disease Trajectory? J Alzheimers Dis 2024; 101:987-999. [PMID: 39302365 DOI: 10.3233/jad-240434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Background Tau aggregation demonstrates close associations with hypometabolism in Alzheimer's disease (AD), although differing pathophysiological processes may underlie their development. Objective To establish whether tau deposition and glucose metabolism have different trajectories in AD progression and evaluate the utility of global measures of these pathological hallmarks in predicting cognitive deficits. Methods 279 participants with amyloid-β (Aβ) status, and T1-weighted MRI scans, were selected from the Alzheimer's Disease Neuroimaging Initiative (http://adni.loni.usc.edu). We created the standard uptake value ratio images using Statistical Parametric Mapping 12 for [18F]AV1451-PET (tau) and [18F]FDG-PET (glucose metabolism) scans. Voxel-wise group and single-subject level SPM analysis evaluated the relationship between global [18F]FDG-PET and [18F]AV1451-PET depending on the Aβ status. Linear models assessed whether tau deposition or glucose metabolism better predicted clinical progression. Results There was a dissociation between global cerebral glucose hypometabolism and global tau load in amyloid-positive AD and amyloid-negative mild cognitive impairment (MCI) (p > 0.05). Global hypometabolism was only associated with global cortical tau in amyloid-positive MCI. Voxel-level single subject tau load better predicted neuropsychological performance, Alzheimer's disease assessment scale-cognitive (ADAS-Cog) 13 score, and one-year change compared with regional and global hypometabolism. Conclusions A dissociation between tau pathology and glucose metabolism at a global level in AD could imply that other pathological processes influence glucose metabolism. Furthermore, as tau is a better predictor of clinical progression, these processes may have independent trajectories and require independent consideration in the context of therapeutic interventions.
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Affiliation(s)
- Joseph Nowell
- Department of Brain Sciences, Division of Neurology, Faculty of Medicine, Imperial College London, London, UK
| | - Sanara Raza
- Department of Brain Sciences, Division of Neurology, Faculty of Medicine, Imperial College London, London, UK
| | - Nicholas R Livingston
- Department of Brain Sciences, Division of Neurology, Faculty of Medicine, Imperial College London, London, UK
| | - Shayndhan Sivanathan
- Department of Brain Sciences, Division of Neurology, Faculty of Medicine, Imperial College London, London, UK
| | - Steve Gentleman
- Department of Brain Sciences, Division of Neurology, Faculty of Medicine, Imperial College London, London, UK
| | - Paul Edison
- Department of Brain Sciences, Division of Neurology, Faculty of Medicine, Imperial College London, London, UK
- School of Medicine, Cardiff University, Cardiff, Wales, UK
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Hattori Y, Kakino Y, Hattori Y, Iwashita M, Uchiyama H, Noda K, Yoshimoto T, Iida H, Ihara M. Long-Term Resveratrol Intake for Cognitive and Cerebral Blood Flow Impairment in Carotid Artery Stenosis/Occlusion. J Stroke 2024; 26:64-74. [PMID: 38326707 PMCID: PMC10850448 DOI: 10.5853/jos.2023.02733] [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: 08/21/2023] [Revised: 10/28/2023] [Accepted: 12/04/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND AND PURPOSE Carotid artery stenosis or occlusion (CASO) is a causative disease of vascular cognitive impairment (VCI) attributed to cerebral hypoperfusion, even without the development of symptomatic ischemic stroke. Preclinically, resveratrol has been demonstrated to play an important role in improving cognitive function in rodent CASO models. This study investigated the association between long-term resveratrol intake and improvements in cognitive and cerebral hemodynamic impairments in patients with CASO. METHODS A retrospective cohort study was conducted on patients with asymptomatic carotid artery stenosis of ≥50% or occlusion who underwent 15O-gas positron emission tomography (15O-gas PET) and neuropsychological tests such as Montreal Cognitive Assessment (MoCA) and Alzheimer's Disease Assessment Scale-Cognitive Subscale 13 (ADAS-Cog) twice between July 2020 and March 2022 allowing >125-day interval. Patients were administered 30 mg/day resveratrol after the first 15O-gas PET and neuropsychological tests were compared with those who were not. RESULTS A total of 79 patients were enrolled in this study; 36 received resveratrol and 43 did not. Over a mean follow-up of 221.2 and 244.8 days, long-term resveratrol treatment significantly improved visuospatial/executive function (P=0.020) in MoCA, and memory domain (P=0.007) and total score (P=0.019) in ADAS-Cog. Cerebral blood flow demonstrated improvement in the right frontal lobe (P=0.027), left lenticular nucleus (P=0.009), right thalamus (P=0.035), and left thalamus (P=0.010) on 15O-gas PET. No adverse events were reported. CONCLUSION Long-term daily intake of oral resveratrol may prevent or treat VCI by improving the cerebral blood flow in asymptomatic patients with CASO.
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Affiliation(s)
- Yorito Hattori
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshinori Kakino
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuji Hattori
- Department of Pharmacology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mari Iwashita
- R&D Division, Towa Pharmaceutical Co., Ltd., Kadoma, Japan
| | | | - Kotaro Noda
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hidehiro Iida
- Turku PET Centre, University of Turku, Turku, Finland
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
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Wu L, Jin L, Li L, Yu K, Wu J, Lei Y, Jiang S, He J. An examination of Alzheimer's disease and white matter from 1981 to 2023: a Bibliometric and visual analysis. Front Neurol 2023; 14:1268566. [PMID: 38033779 PMCID: PMC10683644 DOI: 10.3389/fneur.2023.1268566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023] Open
Abstract
Background Alzheimer's disease (AD) is characterized by the presence of gray matter lesions and alterations in white matter. This study aims to investigate the research related to white matter in the context of AD from a Bibliometric standpoint. Methods Regular and review articles focusing on the research pertaining to Alzheimer's disease (AD) and white matter were extracted from the Web of Science Core Collection (WOSCC) database, covering the period from its inception to 10th July 2023. The "Bibliometrix" R package was employed to summarize key findings, to quantify the occurrence of top keywords, and to visualize the collaborative network among countries. Furthermore, VOSviewer software was utilized to conduct co-authorship and co-occurrence analyses. CiteSpace was employed to identify the most influential references and keywords based on their citation bursts. The retrieval of AD- and white matter-related publications was conducted by the Web of Science Core Collection. Bibliometric analysis and visualization, including the examination of annual publication distribution, prominent countries, active institutions and authors, core journals, co-cited references, and keywords, were carried out by using VOSviewer, CiteSpace, the Bibliometrix Package, and the ggplot2 Package. The quality and impact of publications were assessed using the total global citation score and total local citation score. Results A total of 5,714 publications addressing the intersection of Alzheimer's disease (AD) and white matter were included in the analysis. The majority of publications originated from the United States, China, and the United Kingdom. Prominent journals were heavily featured in the publication output. In addition to "Alzheimer's disease" and "white matter," "mild cognitive impairment," "MRI" and "atrophy" had been frequently utilized as "keywords." Conclusion This Bibliometric investigation delineated a foundational knowledge framework that encompasses countries, institutions, authors, journals, and articles within the AD and white matter research domain spanning from 1981 to 2023. The outcomes provide a comprehensive perspective on the broader landscape of this research field.
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Affiliation(s)
- Linman Wu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
- Nanchong Mental Health Center of Sichuan Province, Nanchong, China
| | - Liuyin Jin
- Lishui Second People’s Hospital, Wenzhou Medical University, Lishui, China
| | - Lixia Li
- Nanchong Mental Health Center of Sichuan Province, Nanchong, China
| | - Kai Yu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Junnan Wu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yuying Lei
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Shulan Jiang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Jue He
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
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Wang KW, Yuan YX, Zhu B, Zhang Y, Wei YF, Meng FS, Zhang S, Wang JX, Zhou JY. X chromosome-wide association study of quantitative biomarkers from the Alzheimer's Disease Neuroimaging Initiative study. Front Aging Neurosci 2023; 15:1277731. [PMID: 38035272 PMCID: PMC10682795 DOI: 10.3389/fnagi.2023.1277731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Alzheimer's disease (AD) is a complex neurodegenerative disease with high heritability. Compared to autosomes, a higher proportion of disorder-associated genes on X chromosome are expressed in the brain. However, only a few studies focused on the identification of the susceptibility loci for AD on X chromosome. Methods Using the data from the Alzheimer's Disease Neuroimaging Initiative Study, we conducted an X chromosome-wide association study between 16 AD quantitative biomarkers and 19,692 single nucleotide polymorphisms (SNPs) based on both the cross-sectional and longitudinal studies. Results We identified 15 SNPs statistically significantly associated with different quantitative biomarkers of the AD. For the cross-sectional study, six SNPs (rs5927116, rs4596772, rs5929538, rs2213488, rs5920524, and rs5945306) are located in or near to six genes DMD, TBX22, LOC101928437, TENM1, SPANXN1, and ZFP92, which have been reported to be associated with schizophrenia or neuropsychiatric diseases in literature. For the longitudinal study, four SNPs (rs4829868, rs5931111, rs6540385, and rs763320) are included in or near to two genes RAC1P4 and AFF2, which have been demonstrated to be associated with brain development or intellectual disability in literature, while the functional annotations of other five novel SNPs (rs12157031, rs428303, rs5953487, rs10284107, and rs5955016) have not been found. Discussion 15 SNPs were found statistically significantly associated with the quantitative biomarkers of the AD. Follow-up study in molecular genetics is needed to verify whether they are indeed related to AD. The findings in this article expand our understanding of the role of the X chromosome in exploring disease susceptibility, introduce new insights into the molecular genetics behind the AD, and may provide a mechanistic clue to further AD-related studies.
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Affiliation(s)
- Kai-Wen Wang
- State Key Laboratory of Organ Failure Research, Ministry of Education, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, China
| | - Yu-Xin Yuan
- State Key Laboratory of Organ Failure Research, Ministry of Education, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, China
| | - Bin Zhu
- State Key Laboratory of Organ Failure Research, Ministry of Education, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, China
| | - Yi Zhang
- State Key Laboratory of Organ Failure Research, Ministry of Education, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, China
| | - Yi-Fang Wei
- State Key Laboratory of Organ Failure Research, Ministry of Education, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, China
| | - Fan-Shuo Meng
- State Key Laboratory of Organ Failure Research, Ministry of Education, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, China
| | - Shun Zhang
- State Key Laboratory of Organ Failure Research, Ministry of Education, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jing-Xuan Wang
- State Key Laboratory of Organ Failure Research, Ministry of Education, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ji-Yuan Zhou
- State Key Laboratory of Organ Failure Research, Ministry of Education, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, China
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Yi F, Yang H, Chen D, Qin Y, Han H, Cui J, Bai W, Ma Y, Zhang R, Yu H. XGBoost-SHAP-based interpretable diagnostic framework for alzheimer's disease. BMC Med Inform Decis Mak 2023; 23:137. [PMID: 37491248 PMCID: PMC10369804 DOI: 10.1186/s12911-023-02238-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 07/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Due to the class imbalance issue faced when Alzheimer's disease (AD) develops from normal cognition (NC) to mild cognitive impairment (MCI), present clinical practice is met with challenges regarding the auxiliary diagnosis of AD using machine learning (ML). This leads to low diagnosis performance. We aimed to construct an interpretable framework, extreme gradient boosting-Shapley additive explanations (XGBoost-SHAP), to handle the imbalance among different AD progression statuses at the algorithmic level. We also sought to achieve multiclassification of NC, MCI, and AD. METHODS We obtained patient data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database, including clinical information, neuropsychological test results, neuroimaging-derived biomarkers, and APOE-ε4 gene statuses. First, three feature selection algorithms were applied, and they were then included in the XGBoost algorithm. Due to the imbalance among the three classes, we changed the sample weight distribution to achieve multiclassification of NC, MCI, and AD. Then, the SHAP method was linked to XGBoost to form an interpretable framework. This framework utilized attribution ideas that quantified the impacts of model predictions into numerical values and analysed them based on their directions and sizes. Subsequently, the top 10 features (optimal subset) were used to simplify the clinical decision-making process, and their performance was compared with that of a random forest (RF), Bagging, AdaBoost, and a naive Bayes (NB) classifier. Finally, the National Alzheimer's Coordinating Center (NACC) dataset was employed to assess the impact path consistency of the features within the optimal subset. RESULTS Compared to the RF, Bagging, AdaBoost, NB and XGBoost (unweighted), the interpretable framework had higher classification performance with accuracy improvements of 0.74%, 0.74%, 1.46%, 13.18%, and 0.83%, respectively. The framework achieved high sensitivity (81.21%/74.85%), specificity (92.18%/89.86%), accuracy (87.57%/80.52%), area under the receiver operating characteristic curve (AUC) (0.91/0.88), positive clinical utility index (0.71/0.56), and negative clinical utility index (0.75/0.68) on the ADNI and NACC datasets, respectively. In the ADNI dataset, the top 10 features were found to have varying associations with the risk of AD onset based on their SHAP values. Specifically, the higher SHAP values of CDRSB, ADAS13, ADAS11, ventricle volume, ADASQ4, and FAQ were associated with higher risks of AD onset. Conversely, the higher SHAP values of LDELTOTAL, mPACCdigit, RAVLT_immediate, and MMSE were associated with lower risks of AD onset. Similar results were found for the NACC dataset. CONCLUSIONS The proposed interpretable framework contributes to achieving excellent performance in imbalanced AD multiclassification tasks and provides scientific guidance (optimal subset) for clinical decision-making, thereby facilitating disease management and offering new research ideas for optimizing AD prevention and treatment programs.
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Affiliation(s)
- Fuliang Yi
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001 P.R. China
| | - Hui Yang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001 P.R. China
| | - Durong Chen
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001 P.R. China
| | - Yao Qin
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001 P.R. China
| | - Hongjuan Han
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001 P.R. China
| | - Jing Cui
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001 P.R. China
| | - Wenlin Bai
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001 P.R. China
| | - Yifei Ma
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001 P.R. China
| | - Rong Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001 P.R. China
| | - Hongmei Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001 P.R. China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, China
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Jia M, Wu Y, Xiang C, Fang Y. Predicting Alzheimer's Disease with Interpretable Machine Learning. Dement Geriatr Cogn Disord 2023; 52:249-257. [PMID: 37482057 DOI: 10.1159/000531819] [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: 04/18/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION This study aimed to develop novel machine learning models for predicting Alzheimer's disease (AD) and identify key factors for targeted prevention. METHODS We included 1,219, 863, and 482 participants aged 60+ years with only sociodemographic, both sociodemographic and self-reported health, both the former two and blood biomarkers information from Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Machine learning models were constructed for predicting the risk of AD for the above three populations. Model performance was evaluated by discrimination, calibration, and clinical usefulness. SHapley Additive exPlanation (SHAP) was applied to identify key predictors of optimal models. RESULTS The mean age was 73.49, 74.52, and 74.29 years for the three populations, respectively. Models with sociodemographic information and models with both sociodemographic and self-reported health information showed modest performance. For models with sociodemographic, self-reported health, and blood biomarker information, their overall performance improved substantially, specifically, logistic regression performed best, with an AUC value of 0.818. Blood biomarkers of ptau protein and plasma neurofilament light, age, blood tau protein, and education level were top five significant predictors. In addition, taurine, inosine, xanthine, marital status, and L.Glutamine also showed importance to AD prediction. CONCLUSION Interpretable machine learning showed promise in screening high-risk AD individual and could further identify key predictors for targeted prevention.
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Affiliation(s)
- Maoni Jia
- Center for Aging and Health Research, School of Public Health, Xiamen University, Xiamen, China
| | - Yafei Wu
- Center for Aging and Health Research, School of Public Health, Xiamen University, Xiamen, China,
| | - Chaoyi Xiang
- Center for Aging and Health Research, School of Public Health, Xiamen University, Xiamen, China
| | - Ya Fang
- Center for Aging and Health Research, School of Public Health, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
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11
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Marizzoni M, Mirabelli P, Mombelli E, Coppola L, Festari C, Lopizzo N, Luongo D, Mazzelli M, Naviglio D, Blouin JL, Abramowicz M, Salvatore M, Pievani M, Cattaneo A, Frisoni GB. A peripheral signature of Alzheimer's disease featuring microbiota-gut-brain axis markers. Alzheimers Res Ther 2023; 15:101. [PMID: 37254223 PMCID: PMC10230724 DOI: 10.1186/s13195-023-01218-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/21/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Increasing evidence links the gut microbiota (GM) to Alzheimer's disease (AD) but the mechanisms through which gut bacteria influence the brain are still unclear. This study tests the hypothesis that GM and mediators of the microbiota-gut-brain axis (MGBA) are associated with the amyloid cascade in sporadic AD. METHODS We included 34 patients with cognitive impairment due to AD (CI-AD), 37 patients with cognitive impairment not due to AD (CI-NAD), and 13 cognitively unimpaired persons (CU). We studied the following systems: (1) fecal GM, with 16S rRNA sequencing; (2) a panel of putative MGBA mediators in the blood including immune and endothelial markers as bacterial products (i.e., lipopolysaccharide, LPS), cell adhesion molecules (CAMs) indicative of endothelial dysfunction (VCAM-1, PECAM-1), vascular changes (P-, E-Selectin), and upregulated after infections (NCAM, ICAM-1), as well as pro- (IL1β, IL6, TNFα, IL18) and anti- (IL10) inflammatory cytokines; (3) the amyloid cascade with amyloid PET, plasma phosphorylated tau (pTau-181, for tau pathology), neurofilament light chain (NfL, for neurodegeneration), and global cognition measured using MMSE and ADAScog. We performed 3-group comparisons of markers in the 3 systems and calculated correlation matrices for the pooled group of CI-AD and CU as well as CI-NAD and CU. Patterns of associations based on Spearman's rho were used to validate the study hypothesis. RESULTS CI-AD were characterized by (1) higher abundance of Clostridia_UCG-014 and decreased abundance of Moryella and Blautia (p < .04); (2) elevated levels of LPS (p < .03), upregulation of CAMs, Il1β, IL6, and TNFα, and downregulation of IL10 (p < .05); (3) increased brain amyloid, plasma pTau-181, and NfL (p < 0.004) compared with the other groups. CI-NAD showed (1) higher abundance of [Eubacterium] coprostanoligenes group and Collinsella and decreased abundance of Lachnospiraceae_ND3007_group, [Ruminococcus]_gnavus_group and Oscillibacter (p < .03); (2) upregulation of PECAM-1 and TNFα (p < .03); (4) increased plasma levels of NfL (p < .02) compared with CU. Different GM genera were associated with immune and endothelial markers in both CI-NAD and CI-AD but these mediators were widely related to amyloid cascade markers only in CI-AD. CONCLUSIONS Specific bacterial genera are associated with immune and endothelial MGBA mediators, and these are associated with amyloid cascade markers in sporadic AD. The physiological mechanisms linking the GM to the amyloid cascade should be further investigated to elucidate their potential therapeutic implications.
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Affiliation(s)
- Moira Marizzoni
- Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy.
- Laboratory of Neuroimaging and Alzheimer's Epidemiology, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy.
| | | | - Elisa Mombelli
- Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | | | - Cristina Festari
- Laboratory of Neuroimaging and Alzheimer's Epidemiology, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | - Nicola Lopizzo
- Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Delia Luongo
- Istituto Di Biostrutture E Bioimmagini (I.B.B.) - CNR, Naples, Italy
| | - Monica Mazzelli
- Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Daniele Naviglio
- Dip.to Di Scienze Chimiche, Università Degli Studi Di Napoli - Federico II, Naples, Italy
| | - Jean-Louis Blouin
- Genetic Medicine Division, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Marc Abramowicz
- Genetic Medicine Division, University Hospitals and University of Geneva, Geneva, Switzerland
| | | | - Michela Pievani
- Laboratory of Neuroimaging and Alzheimer's Epidemiology, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | - Annamaria Cattaneo
- Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Giovanni B Frisoni
- Memory Clinic and LANVIE - Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
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Nath K, Ferguson I, Puleio A, Wall K, Stark J, Clark S, Story C, Cohen B, Anderson-Hanley C. Brain Health Indicators Following Acute Neuro-Exergaming: Biomarker and Cognition in Mild Cognitive Impairment (MCI) after Pedal-n-Play (iPACES). Brain Sci 2023; 13:844. [PMID: 37371324 DOI: 10.3390/brainsci13060844] [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: 03/16/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Facing an unrelenting rise in dementia cases worldwide, researchers are exploring non-pharmacological ways to ameliorate cognitive decline in later life. Twenty older adults completed assessments before and after a single bout of interactive physical and cognitive exercise, by playing a neuro-exergame that required pedaling and steering to control progress in a tablet-based video game tailored to impact executive function (the interactive Physical and Cognitive Exercise System; iPACES v2). This study explored the cognitive and biomarker outcomes for participants with mild cognitive impairment (MCI) and normative older adults after 20 min of pedal-to-play exercise. Neuropsychological and salivary assessments were performed pre- and post-exercise to assess the impact. Repeated-measures ANOVAs revealed significant interaction effects, with MCI participants experiencing greater changes in executive function and alpha-amylase levels than normative older adults; within-group changes were also significant. This study provides further data regarding cognitive effects and potential mechanisms of action for exercise as an intervention for MCI.
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Affiliation(s)
- Kartik Nath
- Union College, 807 Union Street, Schenectady, NY 12308, USA
| | | | - Alexa Puleio
- Union College, 807 Union Street, Schenectady, NY 12308, USA
| | - Kathryn Wall
- Union College, 807 Union Street, Schenectady, NY 12308, USA
| | - Jessica Stark
- Union College, 807 Union Street, Schenectady, NY 12308, USA
| | - Sean Clark
- Gordon College, 255 Grapevine Rd, Wenham, MA 01984, USA
| | - Craig Story
- Gordon College, 255 Grapevine Rd, Wenham, MA 01984, USA
| | - Brian Cohen
- Union College, 807 Union Street, Schenectady, NY 12308, USA
| | - Cay Anderson-Hanley
- Union College, 807 Union Street, Schenectady, NY 12308, USA
- iPACES LLC, 56 Clifton Country Road, Suite 104 (Box#11), Clifton Park, NY 12065, USA
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Hattori Y, Saito S, Nakaoku Y, Ogata S, Hattori M, Nakatsuji M, Nishimura K, Ihara M. Taxifolin for Cognitive Preservation in Patients with Mild Cognitive Impairment or Mild Dementia. J Alzheimers Dis 2023; 93:743-754. [PMID: 37092223 DOI: 10.3233/jad-221293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND The development of numerous disease-modifying drugs for age-related dementia has been attempted based on the amyloid-β (Aβ) hypothesis without much success. Taxifolin (TAX), a natural bioactive flavonoid, shows pleiotropic neuroprotective effects with inhibition of Aβ aggregation, production, and glycation, antiinflammatory effects, and amelioration of the waste clearance system. We hypothesized that TAX intake is associated with the suppression of cognitive deterioration. OBJECTIVE To investigate associations between TAX intake and cognitive changes. METHODS We retrospectively identified patients who orally took TAX 300 mg/day and regularly underwent Alzheimer's Disease Assessment Scale-Cognitive Subscale 13 (ADAS-Cog) and Montreal Cognitive Assessment (MoCA) and compared the temporal changes in ADAS-Cog and MoCA between the non-treatment (pre-TAX) period (180±100 days) and following treatment (on-TAX) period (180±100 days) from June 2020 to November 2021. Since some additional patients underwent the Mini-Mental State Examination (MMSE) instead of the MoCA at the beginning of the pre-TAX period, the same comparison was performed using the MoCA total score converted from MMSE as a sensitivity analysis. RESULTS Sixteen patients were identified. TAX intake was associated with significantly higher interval changes in the MoCA subscale scores of visuospatial/executive function (p = 0.016), verbal fluency (p = 0.02), and the total score (p = 0.034), but not with ADAS-Cog (total score, p = 0.27). In the sensitivity analysis, 29 patients were included. TAX intake was associated with a significantly higher interval change in the total MoCA score (p = 0.004) but not with ADAS-Cog (p = 0.41). CONCLUSION Our findings provide a basis for TAX as a novel strategy for maintaining brain health during aging. A prospective cohort study is required to confirm these findings.
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Affiliation(s)
- Yorito Hattori
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Saito
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuriko Nakaoku
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masashi Hattori
- Next Generation Business Development Department, Business Development Division, Towa Pharmaceutical Co., Ltd, Kadoma, Osaka, Japan
| | - Mio Nakatsuji
- Scientific Research and Business Development Department, Towa Pharmaceutical Co., Ltd, Settsu, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Chiu EC, Wang YC, Huang SL, Hsueh IP, Chiang HY, Hsieh CL. Test-retest reliabilities and minimal detectable changes of 5 versions of the Alzheimer's Disease Assessment Scale-Cognitive Subscale in people with dementia. Disabil Rehabil 2023; 45:1398-1404. [PMID: 35403536 DOI: 10.1080/09638288.2022.2060334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To compare the test-retest reliability and minimal detectable change (MDC) of the commonly used versions of the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) (the ADAS-Cog-11 (11 items), ADAS-Cog-3 (three items), ADAS-Cog-5-Subset (five items), ADAS-Cog-6-Subset (six items), and ADAS-Rasch (11 items)) in people with dementia. MATERIALS AND METHODS A repeated-assessments design (2 weeks apart) was used to examine the ADAS-Cog-11, ADAS-Cog-3, ADAS-Cog-5-Subset, ADAS-Cog-6-Subset, and ADAS-Rasch. Participants with dementia were recruited from one hospital, one elder care center, and two day-care centers using convenience sampling. RESULTS Fifty-two participants finished the assessments twice in two weeks. All versions showed high intraclass correlation coefficients (ICCs) (0.82-0.96), minimal standardized response means (-0.07 to 0.08) and low to acceptable MDC% (9.2-28.6%). The ADAS-Rasch had the highest ICC (0.96) and the lowest MDC%. The ADAS-Cog-3 had an ICC lower than 0.90 (0.82) and the highest MDC% (28.6%). CONCLUSIONS The ADAS-Rasch seems to be the most reliable version of the ADAS-Cog for group- and individual-level comparisons. The ADAS-Cog-3 may be a better choice for researchers for group-level comparisons because it requires fewer items to achieve acceptable reliability. The ADAS-Cog-11, ADAS-Cog-5-Subset, ADAS-Cog-6-Subset, and ADAS-Rasch could be considered for clinical usage for individual-level comparisons.Implications for rehabilitationThe ADAS-Rasch is the most reliable version of the ADAS-Cog for group- and individual-level comparisons due to its excellent test-retest reliability, lowest random measurement error and absence of a practice effect.The ADAS-Cog-5-Subset and ADAS-Cog-6-Subset might be good substitutes for the ADAS-Rasch in clinical settings because of their comparable reliability features and superior administration efficiency.
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Affiliation(s)
- En-Chi Chiu
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yi-Ching Wang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sheau-Ling Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Yu Chiang
- Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
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15
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Teng E, Li Y, Manser PT, Pickthorn K, Butcher BD, Blendstrup M, Randolph C, Sikkes SA. Cross-sectional and longitudinal assessments of function in prodromal-to-mild Alzheimer's disease: A comparison of the ADCS-ADL and A-IADL-Q scales. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12452. [PMID: 37325545 PMCID: PMC10262908 DOI: 10.1002/dad2.12452] [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: 12/23/2022] [Accepted: 05/01/2023] [Indexed: 06/17/2023]
Abstract
Introduction Prior observational work in a heterogeneous cohort of participants with mild cognitive impairment suggests the Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q) may have greater sensitivity for functional decline than the more established Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale. However, the relative utility of the A-IADL-Q versus the ADCS-ADL for clinical trials in early Alzheimer's disease (AD) remains uncertain. Methods We compared baseline and longitudinal performance of the A-IADL-Q and ADCS-ADL in participants with biomarker-confirmed prodromal (pAD; n = 158) or mild (mAD; n = 283) AD enrolled in the 18-month Tauriel study of semorinemab (NCT03289143). Results The A-IADL-Q exhibited numerically stronger discrimination between pAD and mAD participants at baseline per Cohen's d analyses and similar sensitivity to longitudinal decline across cohorts over 18 months relative to the ADCS-ADL. Discussion The comparable performance of the ADCS-ADL and A-IADL-Q supports the utility of the A-IADL-Q in early AD clinical trials. Highlights The Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q) may be more sensitive than the Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale (ADCS-ADL) for distinguishing prodromal and mild Alzheimer's disease (AD).A-IADL-Q and ADCS-ADL are similarly sensitive to decline in early AD over 18 months.Comparable performance of these indices supports A-IADL-Q use in future AD trials.Additional AD clinical trial data could extend findings across more diverse cohorts.
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Affiliation(s)
- Edmond Teng
- GenentechInc.South San FranciscoCaliforniaUSA
| | - Yihao Li
- GenentechInc.South San FranciscoCaliforniaUSA
| | | | | | | | | | | | - Sietske A.M. Sikkes
- Alzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterVU University AmsterdamAmsterdamthe Netherlands
- Department of ClinicalNeuro‐ and Developmental PsychologyVU UniversityAmsterdamthe Netherlands
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16
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Wong MYC, Ou KL, Chung PK, Chui KYK, Zhang CQ. The relationship between physical activity, physical health, and mental health among older Chinese adults: A scoping review. Front Public Health 2023; 10:914548. [PMID: 36684983 PMCID: PMC9853435 DOI: 10.3389/fpubh.2022.914548] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
The aging Chinese population is growing fast, and the proportion of the population aged 60 years old is projected to reach 28% by 2040, estimated 402 million. With increased life expectancy, the aging population tends to suffer from health risks and diseases, which create a burden on public health policy. Hence, it is essential to promote healthy and active aging, which includes improving older adults' physical and mental capacities and advocating for the achievement of a healthy life expectancy. Despite the rapidly growing aging population in China, there have been no reviews investigating the effect of physical activity on physical and mental health among older Chinese adults. Therefore, the current study aimed to review studies from the past 15 years that illustrate the effect of physical activity on physical and mental health among Chinese older adults. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR), this review addresses the associations between physical activity, physical health and mental health among older Chinese adults. A total of 371 studies were included in the scoping review, which covered the relationships between physical activity, physical health and mental health variables. The scoping review also revealed the impact of various kinds of physical activity affecting older adults' physical health, such as functional fitness, body composition, fall risk and balance, and mental health issues, such as depression, anxiety, cognitive function and quality of life. Moreover, studies have identified innovative forms of physical activity as emerging trends in physical activity interventions for older adults. To conclude, this scoping review captured the common effects between physical activity and overall wellbeing, including physical, mental, and cognitive health. Additionally, diverse forms of physical activity intervention, such as group-based and supervised individual interventions, should be supported, and cross-cultural exercise comparisons should be made in future explorations.
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Affiliation(s)
- Ming Yu Claudia Wong
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Kai-ling Ou
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Pak Kwong Chung
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Kei Yee Katie Chui
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Chun-qing Zhang
- Department of Psychology, Sun Yat-sen University, Guangzhou, China
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Thabtah F, Ong S, Peebles D. Examining Cognitive Factors for Alzheimer's Disease Progression Using Computational Intelligence. Healthcare (Basel) 2022; 10:2045. [PMID: 36292492 PMCID: PMC9601744 DOI: 10.3390/healthcare10102045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Prognosis of Alzheimer's disease (AD) progression has been recognized as a challenging problem due to the massive numbers of cognitive, and pathological features recorded for patients and controls. While there have been many studies investigated the diagnosis of dementia using pathological characteristics, predicting the advancement of the disease using cognitive elements has not been heavily studied particularly using technologies like artificial intelligence and machine learning. This research aims at evaluating items of the Alzheimer's Disease Assessment Scale-Cognitive 13 (ADAS-Cog-13) test to determine key cognitive items that influence the progression of AD. A methodology that consists of machine learning and feature selection (FS) techniques was designed, implemented, and then tested against real data observations (cases and controls) of the Alzheimer's Disease Neuroimaging Initiative (ADNI) repository with a narrow scope on cognitive items of the ADAS-Cog-13 test. Results obtained by ten-fold cross validation and using dissimilar classification and FS techniques revealed that the decision tree algorithm produced classification models with the best performing results from the cognitive items. For ADAS-Cog-13 test, memory and learning features including word recall, delayed word recall and word recognition were the key items pinpointing to AD advancement. When these three cognitive items are processed excluding demographics by C4.5 algorithm the models derived showed 82.90% accuracy, 87.60% sensitivity and 78.20% specificity.
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Affiliation(s)
| | - Swan Ong
- Digital Technologies, Manukau Institute of Technology, Auckland 0481, New Zealand
| | - David Peebles
- Department of Psychology, University of Huddersfield, Huddersfield HD1 3DH, UK
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Transcranial Electromagnetic Treatment Stops Alzheimer’s Disease Cognitive Decline over a 2½-Year Period: A Pilot Study. MEDICINES 2022; 9:medicines9080042. [PMID: 36005647 PMCID: PMC9416517 DOI: 10.3390/medicines9080042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/29/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022]
Abstract
Background: There is currently no therapeutic that can stop or reverse the progressive memory impairment of Alzheimer’s disease (AD). However, we recently published that 2 months of daily, in-home transcranial electromagnetic treatment (TEMT) reversed the cognitive impairment in eight mild/moderate AD subjects. These cognitive enhancements were accompanied by predicted changes in AD markers within both the blood and cerebrospinal fluid (CSF). Methods: In view of these encouraging findings, the initial clinical study was extended twice to encompass a period of 2½ years. The present study reports on the resulting long-term safety, cognitive assessments, and AD marker evaluations from the five subjects who received long-term treatment. Results: TEMT administration was completely safe over the 2½-year period, with no deleterious side effects. In six cognitive/functional tasks (including the ADAS-cog13, Rey AVLT, MMSE, and ADL), no decline in any measure occurred over this 2½-year period. Long-term TEMT induced reductions in the CSF levels of C-reactive protein, p-tau217, Aβ1-40, and Aβ1-42 while modulating CSF oligomeric Aβ levels. In the plasma, long-term TEMT modulated/rebalanced levels of both p-tau217 and total tau. Conclusions: Although only a limited number of AD patients were involved in this study, the results suggest that TEMT can stop the cognitive decline of AD over a period of at least 2½ years and can do so with no safety issues.
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Wei YC, Chen CK, Lin C, Chen PY, Hsu PC, Lin CP, Shyu YC, Huang WY. Normative Data of Mini-Mental State Examination, Montreal Cognitive Assessment, and Alzheimer's Disease Assessment Scale-Cognitive Subscale of Community-Dwelling Older Adults in Taiwan. Dement Geriatr Cogn Disord 2022; 51:365-376. [PMID: 35820405 PMCID: PMC9677874 DOI: 10.1159/000525615] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/14/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Appropriate tools and references are essential for evaluating individuals' cognitive levels. This study validated the Taiwan version of the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-cog) and provided normative data for the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and ADAS-cog in community-dwelling older adults. METHODS MMSE, MoCA, and ADAS-cog were administered to 150 nondemented healthy adults aged 55-85 years during 2018-2020 as part of the Northeastern Taiwan Community Medicine Research Cohort. ADAS-cog was translated from the original English version to traditional Chinese with cultural and language considerations in Taiwan. Cronbach's alpha (α) tested the reliability of ADAS-cog, and Pearson correlations examined its external validity using MMSE and MoCA as comparisons. Normative data were generated and stratified by age and education, and the one-way analysis of variance compared scores between age and education groups. Another 20 hospital-acquired participants with cognitive impairment joined the 150 healthy participants. Comparisons in the Clinical Dementia Rating (CDR) tiers tested the discriminability of the tests for different cognitive levels. The area under the receiver operating characteristic curve (AUROC) analyzed the power of ADAS-cog in predicting CDR 0.5 from CDR 0. RESULTS The Taiwan version of ADAS-cog had fair reliability between items (α = 0.727) and good correlations to MMSE (r = -0.673, p < 0.001) and MoCA (r = -0.746, p < 0.001). The normative data of MMSE, MoCA, and ADAS-cog showed ladder changes with age (p = 0.006, 0.001, and 0.437) and education (p < 0.001, <0.001, and <0.001) in the 150 nondemented older adults. Next, in the 170 mixed participants from the communities and the hospital, MMSE, MoCA, and ADAS-cog scores were well differentiable between CDR 0, 0.5, and 1. In addition, ADAS-cog discriminated CDR 0.5 from 0 by an AUROC of 0.827 (p < 0.001). DISCUSSION/CONCLUSION The three structured cognitive tests consistently reflect cognitive levels of healthy older adults. The Taiwan version of ADAS-cog is compatible with MMSE and MoCA to distinguish people with mildly impaired from normal cognition. In addition, this study derived MMSE, MoCA, and ADAS-cog norms tailored to demographic factors. The findings highlight the need for stratification of age and education rather than applying a fixed cutoff for defining normal and abnormal cognition.
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Affiliation(s)
- Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan, .,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan, .,Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan,
| | - Chih-Ken Chen
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan,Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chemin Lin
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan,Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pin-Yuan Chen
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan,Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Pei-Chun Hsu
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan,Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan,*Wen-Yi Huang,
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20
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Prediction of Medical Conditions Using Machine Learning Approaches: Alzheimer’s Case Study. MATHEMATICS 2022. [DOI: 10.3390/math10101767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Alzheimer’s Disease (AD) is a highly prevalent condition and most of the people suffering from it receive the diagnosis late in the process. The diagnosis is currently established following an evaluation of the protein biomarkers in cerebrospinal fluid (CSF), brain imaging, cognitive tests, and the medical history of the individuals. While diagnostic tools based on CSF collections are invasive, the tools used for acquiring brain scans are expensive. Taking these into account, an early predictive system, based on Artificial Intelligence (AI) approaches, targeting the diagnosis of this condition, as well as the identification of lead biomarkers becomes an important research direction. In this survey, we review the state-of-the-art research on machine learning (ML) techniques used for the detection of AD and Mild Cognitive Impairment (MCI). We attempt to identify the most accurate and efficient diagnostic approaches, which employ ML techniques and therefore, the ones most suitable to be used in practice. Research is still ongoing to determine the best biomarkers for the task of AD classification. At the beginning of this survey, after an introductory part, we enumerate several available resources, which can be used to build ML models targeting the diagnosis and classification of AD, as well as their main characteristics. After that, we discuss the candidate markers which were used to build AI models with the best results in terms of diagnostic accuracy, as well as their limitations.
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21
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Asaoka D, Xiao J, Takeda T, Yanagisawa N, Yamazaki T, Matsubara Y, Sugiyama H, Endo N, Higa M, Kasanuki K, Ichimiya Y, Koido S, Ohno K, Bernier F, Katsumata N, Nagahara A, Arai H, Ohkusa T, Sato N. Effect of Probiotic Bifidobacterium breve in Improving Cognitive Function and Preventing Brain Atrophy in Older Patients with Suspected Mild Cognitive Impairment: Results of a 24-Week Randomized, Double-Blind, Placebo-Controlled Trial. J Alzheimers Dis 2022; 88:75-95. [PMID: 35570493 PMCID: PMC9277669 DOI: 10.3233/jad-220148] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Probiotics have been reported to ameliorate cognitive impairment. Objective: We investigated the effect of the probiotic strain Bifidobacterium breve MCC1274 (A1) in enhancing cognition and preventing brain atrophy of older patients with mild cognitive impairment (MCI). Methods: In this RCT, 130 patients aged from 65 to 88 years old with suspected MCI received once daily either probiotic (B. breve MCC1274, 2×1010 CFU) or placebo for 24 weeks. Cognitive functions were assessed by ADAS-Jcog and MMSE tests. Participants underwent MRI to determine brain atrophy changes using Voxel-based Specific Regional Analysis System for Alzheimer’s disease (VSRAD). Fecal samples were collected for the analysis of gut microbiota composition. Results: Analysis was performed on 115 participants as the full analysis set (probiotic 55, placebo 60). ADAS-Jcog subscale “orientation” was significantly improved compared to placebo at 24 weeks. MMSE subscales “orientation in time” and “writing” were significantly improved compared to placebo in the lower baseline MMSE (< 25) subgroup at 24 weeks. VSRAD scores worsened in the placebo group; probiotic supplementation tended to suppress the progression, in particular among those subjects with progressed brain atrophy (VOI Z-score ≥1.0). There were no marked changes in the overall composition of the gut microbiota by the probiotic supplementation. Conclusion: Improvement of cognitive function was observed on some subscales scores only likely due to the lower sensitiveness of these tests for MCI subjects. Probiotics consumption for 24 weeks suppressed brain atrophy progression, suggesting that B. breve MCC1274 helps prevent cognitive impairment of MCI subjects.
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Affiliation(s)
- Daisuke Asaoka
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Jinzhong Xiao
- Department of Microbiota Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Next Generation Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Japan
| | - Tsutomu Takeda
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | | | - Takahiro Yamazaki
- Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoichiro Matsubara
- Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideki Sugiyama
- Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Noemi Endo
- Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Motoyuki Higa
- Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Koji Kasanuki
- Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Yosuke Ichimiya
- Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Shigeo Koido
- Department of Gastroenterology and Hepatology, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Kazuya Ohno
- Next Generation Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Japan
| | - Francois Bernier
- Next Generation Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Japan
| | - Noriko Katsumata
- Department of Microbiota Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Next Generation Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Toshifumi Ohkusa
- Department of Microbiota Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Gastroenterology and Hepatology, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Nobuhiro Sato
- Department of Microbiota Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
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22
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Rodriguez-Porcel F, Wyman-Chick KA, Abdelnour Ruiz C, Toledo JB, Ferreira D, Urwyler P, Weil RS, Kane J, Pilotto A, Rongve A, Boeve B, Taylor JP, McKeith I, Aarsland D, Lewis SJG. Clinical outcome measures in dementia with Lewy bodies trials: critique and recommendations. Transl Neurodegener 2022; 11:24. [PMID: 35491418 PMCID: PMC9059356 DOI: 10.1186/s40035-022-00299-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/31/2022] [Indexed: 12/28/2022] Open
Abstract
The selection of appropriate outcome measures is fundamental to the design of any successful clinical trial. Although dementia with Lewy bodies (DLB) is one of the most common neurodegenerative conditions, assessment of therapeutic benefit in clinical trials often relies on tools developed for other conditions, such as Alzheimer's or Parkinson's disease. These may not be sufficiently valid or sensitive to treatment changes in DLB, decreasing their utility. In this review, we discuss the limitations and strengths of selected available tools used to measure DLB-associated outcomes in clinical trials and highlight the potential roles for more specific objective measures. We emphasize that the existing outcome measures require validation in the DLB population and that DLB-specific outcomes need to be developed. Finally, we highlight how the selection of outcome measures may vary between symptomatic and disease-modifying therapy trials.
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Affiliation(s)
- Federico Rodriguez-Porcel
- Department of Neurology, Medical University of South Carolina, 208b Rutledge Av., Charleston, SC, 29403, USA.
| | - Kathryn A Wyman-Chick
- Department of Neurology, Center for Memory and Aging, HealthPartners, Saint Paul, MN, USA
| | | | - Jon B Toledo
- Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer's Research, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Prabitha Urwyler
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Rimona S Weil
- Dementia Research Centre, University College London, London, UK
| | - Joseph Kane
- Centre for Public Health, Queen's University, Belfast, UK
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Arvid Rongve
- Department of Research and Innovation, Helse Fonna, Haugesund Hospital, Haugesund, Norway
- Institute of Clinical Medicine (K1), The University of Bergen, Bergen, Norway
| | - Bradley Boeve
- Department of Neurology, Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian McKeith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
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23
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An efficient combination of quadruple biomarkers in binary classification using ensemble machine learning technique for early onset of Alzheimer disease. Neural Comput Appl 2022. [DOI: 10.1007/s00521-022-07076-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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24
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Cohen S, Cummings J, Knox S, Potashman M, Harrison J. Clinical Trial Endpoints and Their Clinical Meaningfulness in Early Stages of Alzheimer's Disease. J Prev Alzheimers Dis 2022; 9:507-522. [PMID: 35841252 PMCID: PMC9843702 DOI: 10.14283/jpad.2022.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
As the focus of Alzheimer's disease (AD) therapeutic development shifts to the early stages of the disease, the clinical endpoints used in drug trials, and how these might translate into clinical practice, are of increasing importance. The clinical meaningfulness of trial outcome measures is often unclear, with a lack of conclusive evidence as to how these measures correlate to changes in disease progression and treatment response. Clarifying this would benefit all, including patients, care partners, primary care providers, regulators, and payers, and would enhance our understanding of the relationship between clinical trial endpoints and assessments used in everyday practice. At present, there is a wide range of assessment tools used in clinical trials for AD and substantial variability in measures selected as endpoints across these trials. The aim of this review is to summarize the most commonly used assessment tools for early stages of AD, describe their use in clinical trials and clinical practice, and discuss what might constitute clinically meaningful change in these measures in relation to disease progression and treatment response.
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Affiliation(s)
- S. Cohen
- Toronto Memory Program, Toronto, ON, Canada
| | - J. Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas (UNLV), NV, USA
| | - S. Knox
- Biogen International GmbH, Baar, Switzerland
| | | | - J. Harrison
- Metis Cognition Ltd, Wiltshire, UK,Alzheimer Center, AU Medical Center, Amsterdam, the Netherlands,Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
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25
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Dansson HV, Stempfle L, Egilsdóttir H, Schliep A, Portelius E, Blennow K, Zetterberg H, Johansson FD. Predicting progression and cognitive decline in amyloid-positive patients with Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2021; 13:151. [PMID: 34488882 PMCID: PMC8422748 DOI: 10.1186/s13195-021-00886-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/08/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND In Alzheimer's disease, amyloid- β (A β) peptides aggregate in the lowering CSF amyloid levels - a key pathological hallmark of the disease. However, lowered CSF amyloid levels may also be present in cognitively unimpaired elderly individuals. Therefore, it is of great value to explain the variance in disease progression among patients with A β pathology. METHODS A cohort of n=2293 participants, of whom n=749 were A β positive, was selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database to study heterogeneity in disease progression for individuals with A β pathology. The analysis used baseline clinical variables including demographics, genetic markers, and neuropsychological data to predict how the cognitive ability and AD diagnosis of subjects progressed using statistical models and machine learning. Due to the relatively low prevalence of A β pathology, models fit only to A β-positive subjects were compared to models fit to an extended cohort including subjects without established A β pathology, adjusting for covariate differences between the cohorts. RESULTS A β pathology status was determined based on the A β42/A β40 ratio. The best predictive model of change in cognitive test scores for A β-positive subjects at the 2-year follow-up achieved an R2 score of 0.388 while the best model predicting adverse changes in diagnosis achieved a weighted F1 score of 0.791. A β-positive subjects declined faster on average than those without A β pathology, but the specific level of CSF A β was not predictive of progression rate. When predicting cognitive score change 4 years after baseline, the best model achieved an R2 score of 0.325 and it was found that fitting models to the extended cohort improved performance. Moreover, using all clinical variables outperformed the best model based only on a suite of cognitive test scores which achieved an R2 score of 0.228. CONCLUSION Our analysis shows that CSF levels of A β are not strong predictors of the rate of cognitive decline in A β-positive subjects when adjusting for other variables. Baseline assessments of cognitive function accounts for the majority of variance explained in the prediction of 2-year decline but is insufficient for achieving optimal results in longer-term predictions. Predicting changes both in cognitive test scores and in diagnosis provides multiple perspectives of the progression of potential AD subjects.
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Affiliation(s)
- Hákon Valur Dansson
- Department of Computer Science and Engineering, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Lena Stempfle
- Department of Computer Science and Engineering, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden.
| | - Hildur Egilsdóttir
- Department of Computer Science and Engineering, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Alexander Schliep
- Department of Computer Science and Engineering, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Erik Portelius
- 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
| | - Kaj Blennow
- 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
| | - 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, London, UK.,UK Dementia Research Institute, UCL, London, UK
| | - Fredrik D Johansson
- Department of Computer Science and Engineering, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
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26
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Gulley E, Verghese J, Blumen HM, Ayers E, Wang C, Portenoy RK, Zwerling JL, Weiss E, Knotkova H. Neurostimulation for cognitive enhancement in Alzheimer's disease (the NICE-AD study): a randomized clinical trial. Neurodegener Dis Manag 2021; 11:277-288. [PMID: 34240627 DOI: 10.2217/nmt-2020-0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
New therapies for symptoms in Alzheimer's disease (AD) are urgently needed. Prior studies suggest that transcranial direct current stimulation (tDCS), a noninvasive neuromodulatory method, may be a safe and potentially effective treatment, but conclusions have been limited by small-sample sizes and brief stimulation protocols. This double-blind randomized trial involving 100 older adults with mild-to-moderate AD examines effects of 6 months of at-home active tDCS or sham delivered over the dorsolateral prefrontal cortex. The primary outcome is global cognitive performance. Secondary outcomes include executive-control/spatial selective attention, functional neuroplasticity, depressive symptoms, quality of life and the durability of effects 3 months after the stimulation period. The results will provide evidence on the efficacy of multimonth at-home tDCS in the AD treatment. =Clinical trial identifier NCT04404153 (Clinicaltrials.gov).
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Affiliation(s)
- Emma Gulley
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA.,Department of Medicine, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Helena M Blumen
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA.,Department of Medicine, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Cuiling Wang
- Department of Epidemiology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Russell K Portenoy
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA.,Department of Family & Social Medicine, Albert Einstein College of Medicine, The Bronx, NY 10461, USA.,MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA.,MJHS Hospice & Palliative Care, New York, NY 10006, USA
| | - Jessica L Zwerling
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Erica Weiss
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Helena Knotkova
- Department of Family & Social Medicine, Albert Einstein College of Medicine, The Bronx, NY 10461, USA.,MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA
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27
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Rentz DM, Wessels AM, Annapragada AV, Berger A, Edgar CJ, Gold M, Miller DS, Randolph C, Ryan JM, Wunderlich G, Zoschg MC, Trépel D, Knopman DS, Staffaroni AM, Bain LJ, Carrillo MC, Weber CJ. Building clinically relevant outcomes across the Alzheimer's disease spectrum. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12181. [PMID: 34195350 PMCID: PMC8234696 DOI: 10.1002/trc2.12181] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/24/2021] [Accepted: 04/16/2021] [Indexed: 11/08/2022]
Abstract
Demonstrating that treatments are clinically meaningful across the Alzheimer's disease (AD) continuum is critical for meeting our goals of accelerating a cure by 2025. While this topic has been a focus of several Alzheimer's Association Research Roundtable (AARR) meetings, there remains no consensus as to what constitutes a "clinically meaningful outcome" in the eyes of patients, clinicians, care partners, policymakers, payers, and regulatory bodies. Furthermore, the field has not come to agreement as to what constitutes a clinically meaningful treatment effect at each stage of disease severity. The AARR meeting on November 19-20, 2019, reviewed current approaches to defining clinical meaningfulness from various perspectives including those of patients and care partners, clinicians, regulators, health economists, and public policymakers. Participants discussed approaches that may confer clinical relevance at each stage of the disease continuum and fostered discussion about what should guide us in the future.
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Affiliation(s)
- Dorene M. Rentz
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Center for Alzheimer Research and TreatmentDepartment of NeurologyBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Ananth V. Annapragada
- E.B. Singleton Department of RadiologyTexas Children's Hospital & Baylor College of MedicineHoustonTexasUSA
| | | | | | | | | | - Christopher Randolph
- WCG MedAvante‐ProPhaseHamiltonNew JerseyUSA
- Department of NeurologyLoyola University Medical CenterMaywoodIllinoisUSA
| | | | | | | | - Dominic Trépel
- Global Brain Health InstituteTrinity College DublinDublinIreland
- School of MedicineTrinity College DublinUniversity of DublinDublinIreland
| | | | - Adam M. Staffaroni
- Memory and Aging CenterDepartment of NeurologyWeill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoUSA
| | - Lisa J. Bain
- Independent Science WriterElversonPennsylvaniaUSA
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28
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Choi Y, Jung IC, Kim AR, Park HJ, Kwon O, Lee JH, Kim JH. Feasibility and Effect of Electroacupuncture on Cognitive Function Domains in Patients with Mild Cognitive Impairment: A Pilot Exploratory Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11060756. [PMID: 34200354 PMCID: PMC8228462 DOI: 10.3390/brainsci11060756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 02/08/2023] Open
Abstract
Although Electroacupuncture (EA) has been reported to be potentially effective for cognitive disorders, there is limited information about which domains of cognitive function can be improved by EA treatment. Sixty patients with MCI were randomly assigned (1:1:1) to groups to receive 24 sessions over 12 weeks of EA, sham EA, or usual care. In the EA group, electric stimulation was applied at bilateral PC6 and HT7. Various cognitive tests included in the Seoul Neuropsychological Screening Battery II (SNSB-II) were performed at baseline and post-treatment to explore effects of EA on five cognitive domains: attention, language, visuospatial function, memory, and frontal/executive function. Among 60 randomized participants (63.7 ± 7.1 years, 89.7% females), 45 (75%) completed the study. Of the five cognitive function domains of SNSB-II, the T score of visuospatial function showed a tendency to be higher in the EA group than in the usual care group at post-treatment assessment (mean difference: 10.16 (95% CI, 1.14, 19.18), Cohen’s d = 0.72, p = 0.0283). According to the results of this pilot study, the estimated effect size of EA on the visuospatial function of MCI patients compared to usual care was medium. Large-scale clinical trials are needed to confirm effects of EA on cognitive functions.
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Affiliation(s)
- Yujin Choi
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea; (Y.C.); (A.-R.K.); (H.-J.P.); (O.K.); (J.-H.L.)
| | - In-Chul Jung
- Department of Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon 34520, Korea;
| | - Ae-Ran Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea; (Y.C.); (A.-R.K.); (H.-J.P.); (O.K.); (J.-H.L.)
| | - Hyo-Ju Park
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea; (Y.C.); (A.-R.K.); (H.-J.P.); (O.K.); (J.-H.L.)
| | - Ojin Kwon
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea; (Y.C.); (A.-R.K.); (H.-J.P.); (O.K.); (J.-H.L.)
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea; (Y.C.); (A.-R.K.); (H.-J.P.); (O.K.); (J.-H.L.)
- Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korean Institute of Oriental Medicine, Daejeon 34054, Korea
| | - Joo-Hee Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju-si 26339, Korea
- Research Institute of Korean Medicine, Sangji University, Wonju-si 26339, Korea
- Correspondence: ; Tel.: +82-33-741-9268
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29
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Kim CM, Montal V, Diez I, Orwig W, Sepulcre J. Network interdigitations of Tau and amyloid-beta deposits define cognitive levels in aging. Hum Brain Mapp 2021; 42:2990-3004. [PMID: 33955621 PMCID: PMC8193537 DOI: 10.1002/hbm.25350] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/16/2020] [Accepted: 01/11/2021] [Indexed: 12/18/2022] Open
Abstract
Amyloid‐beta (Aβ) plaques and tau neurofibrillary tangles are pathological hallmarks of Alzheimer's disease (AD); their contribution to neurodegeneration and clinical manifestations are critical in understanding preclinical AD. At present, the mechanisms related to Aβ and tau pathogenesis leading to cognitive decline in older adults remain largely unknown. Here, we examined graph theory‐based positron emission tomography (PET) analytical approaches, within and between tau and Aβ PET modalities, and tested the effects on cognitive changes in cognitively normal older adults (CN). Particularly, we focused on the network interdigitations of Aβ and tau deposits, along with cognitive test scores in CN at both baseline and 2‐year follow‐up (FU). We found highly significant Aβ‐tau network integrations in AD vulnerable areas, as well as significant associations between those Aβ‐tau interdigitations and general cognitive impairment in CN at baseline and FU. Our findings suggest a distinctive contribution of interlinking network relationships between Aβ and tau deposits in heteromodal areas of the human brain. They support a network‐based interaction between Aβ and tau accumulations as a key factor for cognitive deterioration in CN prior to dementia.
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Affiliation(s)
- Chan-Mi Kim
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Victor Montal
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain.,Centro de Investigacón Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Ibai Diez
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - William Orwig
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | | | - Jorge Sepulcre
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
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Bellio M, Oxtoby NP, Walker Z, Henley S, Ribbens A, Blandford A, Alexander DC, Yong KXX. Analyzing large Alzheimer's disease cognitive datasets: Considerations and challenges. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12135. [PMID: 33313379 PMCID: PMC7720865 DOI: 10.1002/dad2.12135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022]
Abstract
Recent data-sharing initiatives of clinical and preclinical Alzheimer's disease (AD) have led to a growing number of non-clinical researchers analyzing these datasets using modern data-driven computational methods. Cognitive tests are key components of such datasets, representing the principal clinical tool to establish phenotypes and monitor symptomatic progression. Despite the potential of computational analyses in complementing the clinical understanding of AD, the characteristics and multifactorial nature of cognitive tests are often unfamiliar to computational researchers and other non-specialist audiences. This perspective paper outlines core features, idiosyncrasies, and applications of cognitive test data. We report tests commonly featured in data-sharing initiatives, highlight key considerations in their selection and analysis, and provide suggestions to avoid risks of misinterpretation. Ultimately, the greater transparency of cognitive measures will maximize insights offered in AD, particularly regarding understanding the extent and basis of AD phenotypic heterogeneity.
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Affiliation(s)
- Maura Bellio
- UCL Centre for Medical Image Computing (CMIC)Department of Computer ScienceUniversity College LondonLondonUK
- UCL Interaction Centre (UCLIC)Department of Computer ScienceUniversity College LondonLondonUK
| | - Neil P. Oxtoby
- UCL Centre for Medical Image Computing (CMIC)Department of Computer ScienceUniversity College LondonLondonUK
| | - Zuzana Walker
- Division of PsychiatryUniversity College LondonLondonUK
| | - Susie Henley
- Dementia Research CentreDepartment of Neurodegeneration, National Hospital for Neurology and NeurosurgeryUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | | | - Ann Blandford
- UCL Interaction Centre (UCLIC)Department of Computer ScienceUniversity College LondonLondonUK
| | - Daniel C. Alexander
- UCL Centre for Medical Image Computing (CMIC)Department of Computer ScienceUniversity College LondonLondonUK
| | - Keir X. X. Yong
- Dementia Research CentreDepartment of Neurodegeneration, National Hospital for Neurology and NeurosurgeryUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
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Cerebellar Volume Is Associated with Cognitive Decline in Mild Cognitive Impairment: Results from ADNI. THE CEREBELLUM 2020; 19:217-225. [PMID: 31900856 DOI: 10.1007/s12311-019-01099-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease (AD) is a disease with dysfunctional brain network. Previous studies found the cerebellar volume changes over the course of AD disease progression; however, whether cerebellar volume change contributes to the cognitive decline in AD, or its earlier disease stage (i.e., mild cognitive impairment [MCI]) remains unclear. In ADNI, cognitive function was assessed using Alzheimer's Disease Assessment Scale-Cognitive Behavior section (ADAS-Cog). We used linear regression and linear mixed effects models to examine whether cerebellar volume is associated with either baseline cognition or with cognitive changes over time in MCI or in AD. We used logistic regression to assess the relationship between cerebellar volume and disease progression to MCI and AD. We found that cerebellar volume is associated with cognition in patients with MCI, after adjusting for age, gender, education, hippocampal volume, and APOE4 status. Consistently, cerebellar volume is associated with increased odds of the disease stages of MCI and AD when compared to controls. However, cerebellar volume is not associated with cognitive changes over time in either MCI or AD. In summary, cerebellar volume may contribute to cognition level in MCI, but not in AD, indicating that the cerebellar network might modulate the cognitive function in the early stage of the disease. The cerebellum may be a potential target for neuromodulation in treating MCI.
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Tang‐Wai DF, Smith EE, Bruneau M, Burhan AM, Chatterjee A, Chertkow H, Choudhury S, Dorri E, Ducharme S, Fischer CE, Ghodasara S, Herrmann N, Hsiung GR, Kumar S, Laforce R, Lee L, Massoud F, Shulman KI, Stiffel M, Gauthier S, Ismail Z. CCCDTD5 recommendations on early and timely assessment of neurocognitive disorders using cognitive, behavioral, and functional scales. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12057. [PMID: 33209972 PMCID: PMC7657153 DOI: 10.1002/trc2.12057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Earlier diagnosis of neurocognitive disorders and neurodegenerative disease is needed to implement preventative interventions, minimize harm, and reduce risk of exploitation in the context of undetected disease. Along the spectrum from subjective cognitive decline (SCD) to dementia, evidence continues to emerge with respect to detection, staging, and monitoring. Updates to previous guidelines are required for clinical practice. METHODS A subcommittee of the 5th Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD) reviewed emerging evidence to address the following: (1) Is there a role for screening at-risk patients without clinical concerns? In what context is assessment for dementia appropriate? (2) What tools can be used to evaluate patients in whom cognitive decline is suspected? (3) What important information can be gained from an informant, using which measures? (4) What instruments can be used to get more in-depth information to diagnose mild cognitive impairment (MCI) or dementia? (5) What is the approach to those with cognitive concerns but without objective changes (ie, SCD)? (6) How do we track response to treatment and change over time? The Grading of Recommendations Assessment, Development, and Evaluation system was used to rate quality of the evidence and strength of the recommendations. RESULTS We recommend instruments to assess and monitor cognition, behavior, and function across the cognitive spectrum, including reports from patient and informant. We recommend against screening asymptomatic older adults but recommend investigation for self- or informant reports of changes in cognition, emergence of behavioral or psychiatric symptoms, or decline in function or self-care. Standardized assessments should be used for cognitive and behavioral change that have sufficient validity for use in clinical practice. DISCUSSION The CCCDTD5 provides evidence-based recommendations for detection, assessment, and monitoring of neurocognitive disorders. Although these guidelines were developed for use in Canada, they may also be useful in other jurisdictions.
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Affiliation(s)
- David F. Tang‐Wai
- Department of Medicine, Divisions of Neurology and Geriatric MedicineUniversity of Toronto, University Health Network Memory Clinic, Krembil Brain InstituteTorontoOntarioCanada
| | - Eric E. Smith
- Department of Clinical Neurosciences and Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Marie‐Andrée Bruneau
- Department of Psychiatry and AddictologyUniversity of Montreal, Geriatric Institute of Montreal Research CenterMontrealQuebecCanada
| | - Amer M. Burhan
- Department of PsychiatrySchulich School of Medicine and DentistryWestern Universityand Parkwood Institute‐Mental HealthLondonOntarioCanada
| | - Atri Chatterjee
- Division of NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Howard Chertkow
- Department of Medicine NeurologyRotman Research InstituteUniversity of TorontoTorontoOntarioCanada
| | - Samira Choudhury
- Centre for Addiction and Mental HealthUniversity of TorontoTorontoOntarioCanada
| | - Ehsan Dorri
- Department of PsychiatryUniversity of AlbertaEdmontonAlbertaCanada
| | - Simon Ducharme
- Department of Psychiatry, Montreal QC, McConnell Brain ImagingMcGill University Health CentreMcGill University, Montreal Neurological InstituteMontrealQuebecCanada
| | - Corinne E. Fischer
- Keenan Research Centre for Biomedical ScienceSt. Michael's HospitalLi Ka Shing Knowledge Institute, University of TorontoTorontoOntarioCanada
| | - Sheena Ghodasara
- Department of Psychiatry, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Nathan Herrmann
- Sunnybrook Health Sciences CentreDepartment of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | | | - Sanjeev Kumar
- Centre for Addiction and Mental Health, University of TorontoTorontoOntarioCanada
| | - Robert Laforce
- Clinique Interdisciplinaire de MémoireDépartement des Sciences NeurologiquesCHU de Québec, Université LavalQuebecCanada
| | - Linda Lee
- Department of Family MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Fadi Massoud
- Centre Hospitalier Charles LeMoyne and Institut Universitaire de Gériatrie de Montréal, Department of MedicineUniversity of Sherbrooke and Department of MedicineUniversity of MontrealMontrealQuebecCanada
| | - Kenneth I. Shulman
- Sunnybrook Health Sciences CentreDepartment of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | | | - Serge Gauthier
- McGill Center for Studies in AgingAlzheimer Disease Research UnitMontrealQuebecCanada
| | - Zahinoor Ismail
- Departments of PsychiatryClinical Neurosciences, Community Health SciencesHotchkiss Brain Institute and O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
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Crocco E, Curiel-Cid RE, Kitaigorodsky M, González-Jiménez CJ, Zheng D, Duara R, Loewenstein DA. A Brief Version of the LASSI-L Detects Prodromal Alzheimer's Disease States. J Alzheimers Dis 2020; 78:789-799. [PMID: 33074233 DOI: 10.3233/jad-200790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) is an increasingly utilized cognitive stress test designed to identify early cognitive changes associated with incipient neurodegenerative disease. OBJECTIVE To examine previously derived cut-points for cognitively unimpaired older adults that were suggestive of performance impairment on multiple subscales of the LASSI-L. These cut-points were applied to a new sample of older adults who were cognitive healthy controls (HC: n = 26) and those on the Alzheimer's disease (AD) continuum from early stage mild cognitive impairment (EMCI: n = 28), late stage MCI (LMCI: n = 18) to mild AD (AD: n = 27). METHODS All participants were administered the LASSI-L. All cognitively impaired participants were PET amyloid positive which likely reflects underlying AD neuropathology, while cognitively normal counterparts were deemed to have amyloid negative scans. RESULTS There was a monotonic relationship between the number of deficits on LASSI-L subscales and independent classification of study groups with greater severity of cognitive impairment. Importantly, taken together, impairment on maximum learning ability and measures of proactive semantic interference (both reflected by cued recall and intrusion errors) correctly classified 74.1% of EMCI, 94.4% of LMCI, and 96.3% of AD. Only 7.7% of HC were incorrectly classified as having impairments. CONCLUSION A modest number of LASSI-L subscales taking approximately 8 minutes to administer, had excellent discriminative ability using established cut-offs among individuals with presumptive stages of AD. This has potential implications for both clinical practice and clinical research settings targeting AD during early prodromal stages.
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Affiliation(s)
- Elizabeth Crocco
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,1Florida Alzheimer's Disease Research Center, Miami, FL, USA
| | - Rosie E Curiel-Cid
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,1Florida Alzheimer's Disease Research Center, Miami, FL, USA
| | - Marcela Kitaigorodsky
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christian J González-Jiménez
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diane Zheng
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjan Duara
- 1Florida Alzheimer's Disease Research Center, Miami, FL, USA.,Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami, FL, USA
| | - David A Loewenstein
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,1Florida Alzheimer's Disease Research Center, Miami, FL, USA
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Riva G, Mancuso V, Cavedoni S, Stramba-Badiale C. Virtual reality in neurorehabilitation: a review of its effects on multiple cognitive domains. Expert Rev Med Devices 2020; 17:1035-1061. [PMID: 32962433 DOI: 10.1080/17434440.2020.1825939] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Neurological diseases frequently cause adult-onset disability and have increased the demand for rehabilitative interventions. Neurorehabilitation has been progressively relying on computer-assisted programs and, more recently, on virtual reality (VR). Current reviews explore VR-based neurorehabilitation for assessing and treating the most common neurological pathologies. However, none of them explored specifically the impact of VR on multiple cognitive domains. AREAS COVERED The present work is a review of 6 years of literature (2015-2020) on VR in neurorehabilitation with the purpose of analyzing its effects on memory, attention, executive functions, language, and visuospatial ability. EXPERT OPINION Our review suggests that VR-based neurorehabilitation showed encouraging results for executive functions and visuospatial abilities particularly for both acute and neurodegenerative conditions. Conversely, memory, and attention outcomes are conflicting, and language did not show significant improvements following VR-based rehabilitation. Within five years, it is plausible that VR-based intervention would be provided in standalone and mobile-based platforms that won't need a PC to work, with reduced latency and improved user interaction.
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Affiliation(s)
- Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart , Milan, Italy
| | - Valentina Mancuso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy
| | - Silvia Cavedoni
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy
| | - Chiara Stramba-Badiale
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy
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Zhang L, Ni H, Yu Z, Wang J, Qin J, Hou F, Yang A. Investigation on the Alteration of Brain Functional Network and Its Role in the Identification of Mild Cognitive Impairment. Front Neurosci 2020; 14:558434. [PMID: 33100958 PMCID: PMC7556272 DOI: 10.3389/fnins.2020.558434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/04/2020] [Indexed: 01/13/2023] Open
Abstract
Mild cognitive impairment (MCI) is generally regarded as a prodromal stage of Alzheimer’s disease (AD). In coping with the challenges caused by AD, we analyzed resting-state functional magnetic resonance imaging data of 82 MCI subjects and 93 normal controls (NCs). The alteration of brain functional network in MCI was investigated on three scales, including global metrics, nodal characteristics, and modular properties. The results supported the existence of small worldness, hubs, and community structure in the brain functional networks of both groups. Compared with NCs, the network altered in MCI over all the three scales. In scale I, we found significantly decreased characteristic path length and increased global efficiency in MCI. Moreover, altered global network metrics were associated with cognitive level evaluated by neuropsychological assessments. In scale II, the nodal betweenness centrality of some global hubs, such as the right Crus II of cerebellar hemisphere (CERCRU2.R) and fusiform gyrus (FFG.R), changed significantly and associated with the severity and cognitive impairment in MCI. In scale III, although anatomically adjacent regions tended to be clustered into the same module regardless of group, discrepancies existed in the composition of modules in both groups, with a prominent separation of the cerebellum and a less localized organization of community structure in MCI compared with NC. Taking advantages of random forest approach, we achieved an accuracy of 91.4% to discriminate MCI patients from NCs by integrating cognitive assessments and network analysis. The importance of the used features fed into the classifier further validated the nodal characteristics of CERCRU2.R and FFG.R could be potential biomarkers in the identification of MCI. In conclusion, the present study demonstrated that the brain functional connectome data altered at the stage of MCI and could assist the automatic diagnosis of MCI patients.
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Affiliation(s)
- Lulu Zhang
- Key Laboratory of Biomedical Functional Materials, School of Science, China Pharmaceutical University, Nanjing, China
| | - Huangjing Ni
- Smart Health Big Data Analysis and Location Services Engineering Lab of Jiangsu Province, School of Geographic and Biologic Information, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Zhinan Yu
- Key Laboratory of Biomedical Functional Materials, School of Science, China Pharmaceutical University, Nanjing, China
| | - Jun Wang
- Smart Health Big Data Analysis and Location Services Engineering Lab of Jiangsu Province, School of Geographic and Biologic Information, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Jiaolong Qin
- Key Laboratory of Intelligent Perception and Systems for High-Dimensional Information of Ministry of Education, School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, China
| | - Fengzhen Hou
- Key Laboratory of Biomedical Functional Materials, School of Science, China Pharmaceutical University, Nanjing, China
| | - Albert Yang
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States
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Zhang X, Yu R, Wang H, Zheng R. Effects of rivastigmine hydrogen tartrate and donepezil hydrochloride on the cognitive function and mental behavior of patients with Alzheimer's disease. Exp Ther Med 2020; 20:1789-1795. [PMID: 32742410 PMCID: PMC7388270 DOI: 10.3892/etm.2020.8872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 04/06/2020] [Indexed: 12/16/2022] Open
Abstract
The present study aimed to examine the effects of rivastigmine hydrogen tartrate and donepezil hydrochloride on the cognitive function and mental behavior of patients with Alzheimer's disease (AD). For this purpose, a total of 126 patients with AD admitted to Luoyang Central Hospital from January, 2018 to December, 2018 were enrolled. Patients were divided into different groups according to the treatment they selected. Patients treated with single-agent donepezil were separated into a monotherapy group (n=56), and patients receiving donepezil plus rivastigmine were placed in the combination group (n=70). Before and after treatment, the cognitive functions, mental behavior and quality of life of the patients in the two groups were respectively evaluated by the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), the Mini-Mental State Examination (MMSE), the Blessed-Roth Dementia Scale (BRDS) and the QOL-AD. In addition, the serum bradykinin level was detected by enzyme-linked immunosorbent assay. Following treatment, the MMSE score, BRDS, ADAS-Cog and QOL-AD scores were improved compared with those before treatment (P<0.05). However, following treatment, the 4 scores in the combination group were significantly higher than those in the monotherapy group (P<0.05). No significant differences were observed in the incidence of adverse reactions between the 2 groups (P>0.05). Following treatment, the bradykinin level in both groups was significantly decreased (P<0.05), although the decrease in the combination group was more significant than that in the monotherapy group (P<0.05). On the whole, the findings of the present study indicate that rivastigmine hydrogen tartrate used in combination with donepezil hydrochloride relieves the symptoms and improves the quality of life of patients with AD more effectively, which may be related to the reduction of the bradykinin level in these patients.
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Affiliation(s)
- Xiaohong Zhang
- Department of Rehabilitation, Luoyang Central Hospital, Luoyang, Henan 471000, P.R. China
| | - Ronghua Yu
- Department of Rehabilitation, Luoyang Central Hospital, Luoyang, Henan 471000, P.R. China
| | - Huilin Wang
- Department of Neurology, Luoyang Central Hospital, Luoyang, Henan 471000, P.R. China
| | - Ruifeng Zheng
- Department of Rehabilitation, Luoyang Central Hospital, Luoyang, Henan 471000, P.R. China
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Boada M, López OL, Olazarán J, Núñez L, Pfeffer M, Paricio M, Lorites J, Piñol-Ripoll G, Gámez JE, Anaya F, Kiprov D, Lima J, Grifols C, Torres M, Costa M, Bozzo J, Szczepiorkowski ZM, Hendrix S, Páez A. A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study. Alzheimers Dement 2020; 16:1412-1425. [PMID: 32715623 PMCID: PMC7984263 DOI: 10.1002/alz.12137] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 12/19/2022]
Abstract
Introduction This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild‐to‐moderate Alzheimer's disease (AD). Methods Three hundred forty‐seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6‐week period of weekly conventional PE followed by a 12‐month period of monthly low‐volume PE), and placebo (sham). Results PE‐treated patients performed significantly better than placebo for the co‐primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study–Activities of Daily Living (ADCS‐ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale–Cognitive Subscale (ADAS‐Cog; P = .06; 66% less decline) scores at month 14. Moderate‐AD patients (baseline Mini‐Mental State Examination [MMSE] 18‐21) scored better on ADCS‐ADL (P = .002) and ADAS‐Cog (P = .05), 61% less decline both. There were no changes in mild‐AD patients (MMSE 22‐26). PE‐treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR‐sb) (P = .002; 71% less decline) and Alzheimer's Disease Cooperative Study‐Clinical Global Impression of Change (ADCS‐CGIC) (P < .0001; 100% less decline) scales. Discussion This trial suggests that PE with albumin replacement could slow cognitive and functional decline in AD, although further studies are warranted.
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Affiliation(s)
- Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Oscar L López
- Departments of Neurology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Javier Olazarán
- Neurology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Memory Disorders Unit - HM Hospitals, Madrid, Spain
| | - Laura Núñez
- Alzheimer's Research Group, Grifols, Barcelona, Spain
| | - Michael Pfeffer
- Medical Services, Allied Biomedical Research Institute, Inc., Miami, Florida, USA
| | - María Paricio
- Center for Prevention of Alzheimer´s Disease, Miami Dade Medical Research Institute, Miami, Florida, USA
| | - Jesús Lorites
- Medical Services, L&L Research Choices, Inc., Miami, Florida, USA
| | - Gerard Piñol-Ripoll
- Seizure Disorders Unit, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria, Lleida, Spain
| | - José E Gámez
- Psychiatry Department, Galiz Research, Hialeah, Florida, USA
| | - Fernando Anaya
- Nephrology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Dobri Kiprov
- Apheresis Care Group and Fresenius Medical Care, San Francisco, California, USA
| | - José Lima
- American Red Cross Southern Blood Services Region, Atlanta, Georgia, USA
| | | | - Mireia Torres
- Alzheimer's Research Group, Grifols, Barcelona, Spain
| | | | - Jordi Bozzo
- Alzheimer's Research Group, Grifols, Barcelona, Spain
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - Antonio Páez
- Alzheimer's Research Group, Grifols, Barcelona, Spain
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38
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Cognitive Health of Nonagenarians in Southern Italy: A Descriptive Analysis from a Cross-Sectional, Home-Based Pilot Study of Exceptional Longevity (Cilento Initiative on Aging Outcomes Or CIAO). ACTA ACUST UNITED AC 2020; 56:medicina56050218. [PMID: 32380778 PMCID: PMC7279440 DOI: 10.3390/medicina56050218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 12/27/2022]
Abstract
Background: Nonagenarians and centenarians (NCs) are an extremely fragile population, particularly in regard to their physical and cognitive function. The aim of this study was to define the neurocognitive profiles among 29 NCs and their 49 younger cohabitants aged 50-75 years from The Cilento Initiative on Aging Outcomes (CIAO) Pilot study in the South of Italy that had provided initial hypotheses regarding positive psychological traits related to exceptional longevity. Methods: During the home visits, lifestyle information with specific questionnaires, functional autonomy and the neuropsychological Mini Mental Scale Examination (MMSE), and the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) scale were obtained by qualified study personnel. The total blood oxidative capacity was also determined by testing the reactive derivative of oxygen metabolites (d-ROM) and by the Biological Antioxidant Potential (BAP). In all individuals, the APOE genotype determination was also performed. Results: All the subjects in both groups showed high adherence to the Mediterranean Diet. None of the NCs had severe cognitive impairment, and a very low incidence of dementia was found. The data obtained on the Activities ed Instrumental Activities of Daily Living (ADL-IADL) scale showed that the majority of NCs (16/29) were autonomous in daily life activities. The comparative assessment of NCs and cohabitants showed no significant differences in the laboratory assessment of oxidative stress and APOE genotype. Conclusion: In the Cilento Region of Southern Italy, NCs seemed to have good cognitive status when compared to younger cohabitants aging 50-65 years without significant differences in oxidative stress markers or APOE genotype. These results might be related to optimal adherence to the Mediterranean diet, although other lifestyle factors and positive personality traits may also contribute to their healthy aging. Further studies on a larger population should be performed to confirm the results of this pilot study.
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Devanand DP, Andrews H, Kreisl WC, Razlighi Q, Gershon A, Stern Y, Mintz A, Wisniewski T, Acosta E, Pollina J, Katsikoumbas M, Bell KL, Pelton GH, Deliyannides D, Prasad KM, Huey ED. Antiviral therapy: Valacyclovir Treatment of Alzheimer's Disease (VALAD) Trial: protocol for a randomised, double-blind,placebo-controlled, treatment trial. BMJ Open 2020; 10:e032112. [PMID: 32034019 PMCID: PMC7045215 DOI: 10.1136/bmjopen-2019-032112] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/16/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION After infection, herpes simplex virus-1 (HSV1) becomes latent in the trigeminal ganglion and can enter the brain via retrograde axonal transport. Recurrent reactivation of HSV1 may lead to neurodegeneration and Alzheimer's disease (AD) pathology. HSV1 (oral herpes) and HSV2 (genital herpes) can trigger amyloid beta-protein (Aβ) aggregation and HSV1 DNA is common in amyloid plaques. Anti-HSV drugs reduce Aβ and phosphorylated tau accumulation in cell-culture models. Cognitive impairment is greater in patients with HSV seropositive, and antiviral drugs show robust efficacy against peripheral HSV infection. Recent studies of electronic health records databases demonstrate that HSV infections increase dementia risk, and that antiviral medication treatment reduces this risk. The generic antiviral drug valacyclovir was superior to placebo in improving memory in a schizophrenia pilot trial but has not been tested in AD. METHODS AND ANALYSIS In patients with mild AD who test positive for HSV1 or HSV2 serum antibodies, valacyclovir, repurposed as an anti-AD drug, will be compared with placebo (lactose pills) in 130 patients (65 valacyclovir and 65 placebo) in a randomised, double-blind, 78-week phase II proof-of-concept trial. Patients on valacyclovir, dose-titrated from 2 g to a targeted oral dose of 4 g daily, compared with placebo, are hypothesised to show smaller cognitive and functional decline, and, using 18F-Florbetapir positron emission tomography (PET) and 18F-MK-6240 PET imaging, to show less amyloid and tau accumulation, respectively. In the lumbar puncture subsample, cerebrospinal fluid acyclovir will be assayed to assess central nervous system valacyclovir penetration. ETHICS AND DISSEMINATION The trial is being overseen by the New York State Psychiatric Institute Institutional Review Board (protocol 7537), the National Institute on Ageing, and the Data Safety Monitoring Board. Written informed consent is obtained for all subjects. Results will be disseminated via publication, clinicaltrials.gov, media and conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier (NCT03282916) Pre-results.
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Affiliation(s)
- D P Devanand
- Department of Psychiatry, Columbia University, New York, New York, USA
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Howard Andrews
- Department of Psychiatry, Columbia University, New York, New York, USA
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Biostatistics, Columbia University Medical Center, New York, New York, USA
| | - William C Kreisl
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Qolamreza Razlighi
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Anne Gershon
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Yaakov Stern
- Department of Psychiatry, Columbia University, New York, New York, USA
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Akiva Mintz
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Thomas Wisniewski
- Center for Cognitive Neurology, Departments of Neurology, New York University Medical Center, New York, New York, USA
| | - Edward Acosta
- Department of Pharmacology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Julianna Pollina
- Department of Psychiatry, Columbia University, New York, New York, USA
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Mariasofia Katsikoumbas
- Department of Psychiatry, Columbia University, New York, New York, USA
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Karen L Bell
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Gregory H Pelton
- Department of Psychiatry, Columbia University, New York, New York, USA
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Deborah Deliyannides
- Department of Psychiatry, Columbia University, New York, New York, USA
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - K M Prasad
- Departments of Psychiatry and Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pennsylvania, USA
| | - Edward D Huey
- Department of Psychiatry, Columbia University, New York, New York, USA
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Ortner M, Drost R, Hedderich D, Goldhardt O, Müller-Sarnowski F, Diehl-Schmid J, Förstl H, Yakushev I, Grimmer T. Amyloid PET, FDG-PET or MRI? - the power of different imaging biomarkers to detect progression of early Alzheimer's disease. BMC Neurol 2019; 19:264. [PMID: 31672138 PMCID: PMC6822351 DOI: 10.1186/s12883-019-1498-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/15/2019] [Indexed: 01/10/2023] Open
Abstract
Background As investigations of disease modifying drugs aim to slow down progression of Alzheimer’ disease (AD) biomarkers to reliably track disease progression gain more importance. This is especially important as clinical symptoms, including psychometric measures, are only modestly associated with the underlying disease pathology, in particular at the pre-dementia stages. The decision which biomarkers to choose in clinical trials is crucial and depends on effect size. However, longitudinal studies of multiple biomarkers in parallel that allow direct comparison on effect size are scarce. Methods We calculated effect size and minimal sample size for three common imaging biomarkers of AD, namely amyloid deposition measured with PiB-PET, neuronal dysfunction measured with FDG-PET and cortical thickness measured with MRI in a prospective 24-month follow-up study in a monocentric cohort of early AD. Results Post hoc power calculation revealed large effect sizes of Cohen’s d for PiB-PET and cortical thickness and a small effect size for FDG-PET (1.315, 0.914, and 0.341, respectively). Accordingly, sample sizes for PiB-PET and cortical thickness required significantly smaller sample sizes than FDG-PET to reliably detect statistically significant changes after 24 months in early AD (n = 7, n = 12, and n = 70, respectively). Conclusion Amyloid imaging with PET and measuring cortical thickness with MRI are suitable biomarkers to detect disease progression in early AD within a small sample.
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Affiliation(s)
- Marion Ortner
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - René Drost
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Dennis Hedderich
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Oliver Goldhardt
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felix Müller-Sarnowski
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Hans Förstl
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Igor Yakushev
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Liu C, Yu J. Genome-Wide Association Studies for Cerebrospinal Fluid Soluble TREM2 in Alzheimer's Disease. Front Aging Neurosci 2019; 11:297. [PMID: 31708768 PMCID: PMC6823606 DOI: 10.3389/fnagi.2019.00297] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022] Open
Abstract
Alzheimer’s disease (AD) is the most common form of dementia. Rare variants in triggering receptor expressed on myeloid cells 2 (TREM2) have been identified as risk factors for AD. Soluble TREM2 (sTREM2) in the cerebrospinal fluid (CSF) is a potential and novel biomarker of neuroinflammation implicated in the onset and progression of AD. To explore the roles of CSF sTREM2 on the pathogenesis of AD, we performed genome-wide association studies (GWAS) by using the data from Alzheimer’s Disease Neuroimaging Initiative (ADNI). We found CSF sTREM2 levels were elevated with the disease stages, but there was no significant difference between that of AD patients and normal participants. CSF sTREM2 was positively correlated with CSF total tau and phosphorylated-tau levels (ρ > 0.35, p < 1e-06; ρ > 0.32, p < 1e-05, respectively) for all disease states. We identified the most significant CSF sTREM2 related locus was rs7232 (FDR = 3.01e-08), a missense variant in MS4A6A gene of chromosome 11. Moreover, we also detected rs7232 was highly associated with MS4A6A gene expression (FDR = 1.37e-18). In addition, our pathway analysis for our significant GWAS results showed that biological processes for regulation of viruses and immune response were highly overrepresented or enriched. Our study suggests that CSF sTREM2 plays an informative role in AD progression. Moreover, CSF sTREM2 and AD is highly related to viral infections and immune response.
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Affiliation(s)
- Changan Liu
- Department of Mathematics, University of Houston, Houston, TX, United States
| | - Jun Yu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Rasmussen J. The LipiDiDiet trial: what does it add to the current evidence for Fortasyn Connect in early Alzheimer's disease? Clin Interv Aging 2019; 14:1481-1492. [PMID: 31616139 PMCID: PMC6699494 DOI: 10.2147/cia.s211739] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/14/2019] [Indexed: 11/23/2022] Open
Abstract
Nutritional factors can influence the risk of developing Alzheimer’s disease (AD) and its rate of progression, and there is, therefore, increasing interest in nutrition as a modifiable risk factor for the disease. Synaptic loss is an important feature of early AD, and the formation of new synapses is dependent on key nutritional elements that are known to be deficient in patients with AD. The daily medical food, Souvenaid, contains Fortasyn Connect, a multinutrient combination developed to specifically address these deficiencies, comprising docosahexaenoic acid, eicosapentaenoic acid, uridine monophosphate, choline, phospholipids, selenium, folic acid, and vitamins B12, B6, C, and E. Although yielding heterogeneous findings, clinical studies of Fortasyn Connect provide preliminary evidence of clinically relevant benefits on cognitive outcomes in prodromal and early AD. The LipiDiDiet trial investigated the effects of Fortasyn Connect on cognition and related measures in prodromal AD, and is the first randomized, controlled, double-blind, multicenter trial study of a non-pharmacological intervention in this setting. The primary efficacy endpoint was change over 24 months in a composite score of cognitive performance using a neuropsychological test battery. Fortasyn Connect had no significant effect on this endpoint, but demonstrated a significant benefit on secondary endpoints, including domains of cognition affected by AD (attention, memory, executive function) and hippocampal atrophy, suggesting a potential benefit on disease progression. Other studies have demonstrated benefits for Fortasyn Connect on nutritional markers and levels of plasma homocysteine. Taken together, current evidence indicates that Fortasyn Connect may show benefit on domains of cognition affected by AD and nutritional measures that influence risk factors for its progression; that it has greater potential for benefit earlier rather than later in the disease; and that it is safe and well tolerated, alone or in combination with AD medications. Further research into its potential role in AD management is therefore warranted.
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Affiliation(s)
- Jill Rasmussen
- Primary Care Specialist Mental Health in Dementia and Learning Disability, Surrey, UK.,Royal College of General Practitioners Representative for Dementia, London, UK
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43
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Kueper JK, Speechley M, Montero-Odasso M. The Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog): Modifications and Responsiveness in Pre-Dementia Populations. A Narrative Review. J Alzheimers Dis 2019; 63:423-444. [PMID: 29660938 PMCID: PMC5929311 DOI: 10.3233/jad-170991] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog) was developed in the 1980s to assess the level of cognitive dysfunction in Alzheimer’s disease. Advancements in the research field have shifted focus toward pre-dementia populations, and use of the ADAS-Cog has extended into these pre-dementia studies despite concerns about its ability to detect important changes at these milder stages of disease progression. If the ADAS-Cog cannot detect important changes, our understanding of pre-dementia disease progression may be compromised and trials may incorrectly conclude that a novel treatment approach is not beneficial. The purpose of this review was to assess the performance of the ADAS-Cog in pre-dementia populations, and to review all modifications that have been made to the ADAS-Cog to improve its measurement performance in dementia or pre-dementia populations. The contents of this review are based on bibliographic searches of electronic databases to locate all studies using the ADAS-Cog in pre-dementia samples or subsamples, and to locate all modified versions. Citations from relevant articles were also consulted. Overall, our results suggest the original ADAS-Cog is not an optimal outcome measure for pre-dementia studies; however, given the prominence of the ADAS-Cog, care must be taken when considering the use of alternative outcome measures. Thirty-one modified versions of the ADAS-Cog were found. Modification approaches that appear most beneficial include altering scoring methodology or adding tests of memory, executive function, and/or daily functioning. Although modifications improve the performance of the ADAS-Cog, this is at the cost of introducing heterogeneity that may limit between-study comparison.
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Affiliation(s)
- Jacqueline K Kueper
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada.,Schulich Interfaculty Program in Public Health, The University of Western Ontario, London, ON, Canada
| | - Manuel Montero-Odasso
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada.,Department of Medicine, Division of Geriatric Medicine, The University of Western Ontario, London, ON, Canada.,Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
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Burke SL, Naseh M, Rodriguez MJ, Burgess A, Loewenstein D. Dementia-Related Neuropsychological Testing Considerations in Non-Hispanic White and Latino/Hispanic Populations. PSYCHOLOGY & NEUROSCIENCE 2019; 12:144-168. [PMID: 31649798 PMCID: PMC6812579 DOI: 10.1037/pne0000163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hispanic individuals are at greater risk for health disparities, less than optimal health care, and are diagnosed at later stages of cognitive impairment than white non-Hispanics. Acculturation and different attitudes toward test-taking may result in decrements in performance, especially on unfamiliar measures that emphasize speed and accuracy. Non-Hispanic individuals often outperform Hispanic individuals on cognitive and neuropsychological measures in community and clinical populations. Current neuropsychological testing may not provide accurate data related to monolingual and bilingual individuals of Hispanic descent. Testing instruments were identified by searching academic databases using combinations of relevant search terms. Neuropsychological instruments were included if they were designed to detect cognitive impairment, had an administration time of less than 45 minutes, and were available in English. Validity studies were required to employ gold standard comparison diagnostic criteria. Twenty-nine instruments were evaluated in dementia staging, global cognition, memory, memory and visual abilities, working memory and attention, verbal learning and memory, recall, language, premorbid intelligence, literacy/cognitive reserve, visuospatial, attention, problem-solving, problem solving and perception, functional assessment, and mood/daily functioning domains. Spanish-language neuropsychological instruments need to be made widely available and existing instruments to be normed in Spanish to best serve and assess diverse populations. Psychometric data were reported for neuropsychological instruments, which may be administered to Hispanic older adults presenting for evaluation related to dementia-spectrum disorders. This is one of the few reviews to provide an overview of the sensitivity and specificity of available Spanish translated neuropsychological instruments.
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Affiliation(s)
- Shanna L Burke
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | - Mitra Naseh
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | | | - Aaron Burgess
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | - David Loewenstein
- Center on Aging as the Center for Cognitive Neuroscience and Aging and Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami
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45
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Lin C, Huang C, Huang K, Lin K, Yen T, Kuo H. A metabolomic approach to identifying biomarkers in blood of Alzheimer's disease. Ann Clin Transl Neurol 2019; 6:537-545. [PMID: 30911577 PMCID: PMC6414491 DOI: 10.1002/acn3.726] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 01/28/2023] Open
Abstract
Objective This study aims to identify metabolites with altered levels of expression in patients with early and progressive stages of Alzheimer's disease (AD). Methods All participants of the study underwent genetic screening and were diagnosed using both neuropsychological assessment and amyloid imaging before metabolome analysis. According to these assessments, the patients were classified as normal (n = 15), with mild cognitive impairment (n = 10), and with AD (n = 15). Results Using a targeted metabolomic approach, we found that plasma levels of C3, C5, and C5-DC acylcarnitines, arginine, phenylalanine, creatinine, symmetric dimethylarginine (SDMA) and phosphatidylcholine ae C38:2 were significantly altered in patients with early and progressive stages of AD. We created a predictive model based on the decision tree that included three main parameters: age, arginine and C5 plasma concentrations. The model distinguished AD patients from other participants with 60% sensitivity and 86.7% specificity. For healthy controls, the sensitivity was 85.7% and specificity was 61.5%. Multivariate ROC analysis to develop a decision tree showed that our model reached moderate diagnostic power in differentiating between older adults who are cognitively normal (AUC = 0.77) and those with AD (AUC = 0.72). Interpretation The plasma levels of arginine and valeryl carnitine, together with subject age, are promising as biomarkers for the diagnosis of AD in older adults.
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Affiliation(s)
- Chia‐Ni Lin
- Department of Laboratory MedicineChang Gung Memorial HospitalTaoyuanTaiwan
- Department of Medical Biotechnology and Laboratory ScienceCollege of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Chin‐Chang Huang
- Department of NeurologyChang Gung Memorial Hospital at Linkou Medical CenterChang Gung University College of MedicineTaoyuanTaiwan
| | - Kuo‐Lun Huang
- Department of NeurologyChang Gung Memorial Hospital at Linkou Medical CenterChang Gung University College of MedicineTaoyuanTaiwan
| | - Kun‐Ju Lin
- Molecular Imaging Center and Department of Nuclear MedicineChang Gung Memorial HospitalTaoyuanTaiwan
- Department of Medical Imaging and Radiological SciencesHealthy Aging Research CenterChang Gung UniversityTaoyuanTaiwan
| | - Tzu‐Chen Yen
- Molecular Imaging Center and Department of Nuclear MedicineChang Gung Memorial HospitalTaoyuanTaiwan
- Department of Medical Imaging and Radiological SciencesHealthy Aging Research CenterChang Gung UniversityTaoyuanTaiwan
| | - Hung‐Chou Kuo
- Department of NeurologyChang Gung Memorial Hospital at Linkou Medical CenterChang Gung University College of MedicineTaoyuanTaiwan
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Sabbagh MN, Hendrix S, Harrison JE. FDA position statement "Early Alzheimer's disease: Developing drugs for treatment, Guidance for Industry". ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2019; 5:13-19. [PMID: 31650002 PMCID: PMC6804505 DOI: 10.1016/j.trci.2018.11.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Despite billions of dollars invested in clinical trials to develop novel therapeutics for Alzheimer's disease, no approved treatments have been developed in the past 15 years. In that span, new classes of drugs have been developed and tested, including monoclonal antibodies, γ-secretase modulators, γ-secretase inhibitors, BACE inhibitors, RAGE inhibitors, nicotinic agonists, 5HT6 antagonists, and others. The one constant for all of these clinical trials programs is the use of the ADAS-cog as the primary scale to determine efficacy. The question that needs to be considered is whether it is the target engagement of the drug or the clinical trial measure testing the efficacy. The FDA put out a new position statement in 2018 informing the field on possible considerations for demonstrating efficacy to open the path for approval. Here, we propose and comment on a variety of approaches that are alternatives to the ADAS for FDA-specified stage 3 and 4 Alzheimer's disease. These novel outcomes are being validated in current clinical trials and could be used as efficacy measures moving forward.
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Affiliation(s)
- Marwan N Sabbagh
- Cleveland Clinic, Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | | | - John E Harrison
- Principal Consultant at Metis Cognition Ltd, Kilmington, UK.,Associate Professor at the Alzheimer Center, VUmc, Amsterdam, The Netherlands.,Visiting Professor Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
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Arendash G, Cao C, Abulaban H, Baranowski R, Wisniewski G, Becerra L, Andel R, Lin X, Zhang X, Wittwer D, Moulton J, Arrington J, Smith A. A Clinical Trial of Transcranial Electromagnetic Treatment in Alzheimer's Disease: Cognitive Enhancement and Associated Changes in Cerebrospinal Fluid, Blood, and Brain Imaging. J Alzheimers Dis 2019; 71:57-82. [PMID: 31403948 PMCID: PMC6839500 DOI: 10.3233/jad-190367] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Small aggregates (oligomers) of the toxic proteins amyloid-β (Aβ) and phospho-tau (p-tau) are essential contributors to Alzheimer's disease (AD). In mouse models for AD or human AD brain extracts, Transcranial Electromagnetic Treatment (TEMT) disaggregates both Aβ and p-tau oligomers, and induces brain mitochondrial enhancement. These apparent "disease-modifying" actions of TEMT both prevent and reverse memory impairment in AD transgenic mice. OBJECTIVE To evaluate the safety and initial clinical efficacy of TEMT against AD, a comprehensive open-label clinical trial was performed. METHODS Eight mild/moderate AD patients were treated with TEMT in-home by their caregivers for 2 months utilizing a unique head device. TEMT was given for two 1-hour periods each day, with subjects primarily evaluated at baseline, end-of-treatment, and 2 weeks following treatment completion. RESULTS No deleterious behavioral effects, discomfort, or physiologic changes resulted from 2 months of TEMT, as well as no evidence of tumor or microhemorrhage induction. TEMT induced clinically important and statistically significant improvements in ADAS-cog, as well as in the Rey AVLT. TEMT also produced increases in cerebrospinal fluid (CSF) levels of soluble Aβ1-40 and Aβ1-42, cognition-related changes in CSF oligomeric Aβ, a decreased CSF p-tau/Aβ1-42 ratio, and reduced levels of oligomeric Aβ in plasma. Pre- versus post-treatment FDG-PET brain scans revealed stable cerebral glucose utilization, with several subjects exhibiting enhanced glucose utilization. Evaluation of diffusion tensor imaging (fractional anisotropy) scans in individual subjects provided support for TEMT-induced increases in functional connectivity within the cognitively-important cingulate cortex/cingulum. CONCLUSION TEMT administration to AD subjects appears to be safe, while providing cognitive enhancement, changes to CSF/blood AD markers, and evidence of stable/enhanced brain connectivity.
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Affiliation(s)
| | - Chuanhai Cao
- College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Haitham Abulaban
- University of South Florida Health/Byrd Alzheimer’s Institute, Tampa, FL, USA
| | | | | | | | - Ross Andel
- School of Aging Studies, University of South Florida, Tampa, FL, USA
- Department of Neurology, 2nd Faculty of Medicine, Charles University/Motol University Hospital, Prague, Czech Republic
| | - Xiaoyang Lin
- College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Xiaolin Zhang
- College of Pharmacy, University of South Florida, Tampa, FL, USA
| | | | | | | | - Amanda Smith
- University of South Florida Health/Byrd Alzheimer’s Institute, Tampa, FL, USA
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Questions concerning the role of amyloid-β in the definition, aetiology and diagnosis of Alzheimer's disease. Acta Neuropathol 2018; 136:663-689. [PMID: 30349969 PMCID: PMC6208728 DOI: 10.1007/s00401-018-1918-8] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 12/29/2022]
Abstract
The dominant hypothesis of Alzheimer’s disease (AD) aetiology, the neuropathological guidelines for diagnosing AD and the majority of high-profile therapeutic efforts, in both research and in clinical practice, have been built around one possible causal factor, amyloid-β (Aβ). However, the causal link between Aβ and AD remains unproven. Here, in the context of a detailed assessment of historical and contemporary studies, we raise critical questions regarding the role of Aβ in the definition, diagnosis and aetiology of AD. We illustrate that a holistic view of the available data does not support an unequivocal conclusion that Aβ has a central or unique role in AD. Instead, the data suggest alternative views of AD aetiology are potentially valid, at this time. We propose that an unbiased way forward for the field, beyond the current Aβ-centric approach, without excluding a role for Aβ, is required to come to an accurate understanding of AD dementia and, ultimately, an effective treatment.
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49
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Liu C, Chyr J, Zhao W, Xu Y, Ji Z, Tan H, Soto C, Zhou X. Genome-Wide Association and Mechanistic Studies Indicate That Immune Response Contributes to Alzheimer's Disease Development. Front Genet 2018; 9:410. [PMID: 30319691 PMCID: PMC6166008 DOI: 10.3389/fgene.2018.00410] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022] Open
Abstract
Alzheimer’s disease (AD) is the most common cause of dementia. Although genome-wide association study (GWAS) have reported hundreds of single-nucleotide polymorphisms (SNPs) and genes linked to AD, the mechanisms about how these SNPs modulate the development of AD remain largely unknown. In this study, we performed GWAS for three traits in cerebrospinal fluid (CSF) and one clinical trait in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. Our analysis identified five most significant AD related SNPs (FDR < 0.05) within or proximal to APOE, APOC1, and TOMM40. One of the SNPs was co-inherited with APOE allele 4, which is the most important genetic risk factor for AD. Three of the five SNPs were located in promoter or enhancer regions, and transcription factor (TF) binding affinity calculations showed dramatic changes (| Log2FC| > 2) of three TFs (PLAG1, RREB1, and ZBTB33) for two motifs containing SNPs rs2075650 and rs157580. In addition, our GWAS showed that both rs2075650 and rs157580 were significantly associated with the poliovirus receptor-related 2 (PVRL2) gene (FDR < 0.25), which is involved in spreading of herpes simplex virus (HSV). The altered regulation of PVRL2 may increase the susceptibility AD patients to HSV and other virus infections of the brain. Our work suggests that AD is a type of immune disorder driven by viral or microbial infections of the brain during aging.
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Affiliation(s)
- Changan Liu
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jacqueline Chyr
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Weiling Zhao
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yungang Xu
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Zhiwei Ji
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Hua Tan
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Claudio Soto
- Department of Neurology, The George and Cynthia W Mitchell Center for Alzheimer's Disease and Other Brain Related Illnesses, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Xiaobo Zhou
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Wall K, Stark J, Schillaci A, Saulnier ET, McLaren E, Striegnitz K, Cohen BD, Arciero PJ, Kramer AF, Anderson-Hanley C. The Enhanced Interactive Physical and Cognitive Exercise System (iPACES TM v2.0): Pilot Clinical Trial of an In-Home iPad-Based Neuro-Exergame for Mild Cognitive Impairment (MCI). J Clin Med 2018; 7:E249. [PMID: 30200183 PMCID: PMC6162846 DOI: 10.3390/jcm7090249] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/17/2018] [Accepted: 08/24/2018] [Indexed: 12/20/2022] Open
Abstract
Given increasing longevity worldwide, older adults and caregivers are seeking ways to curb cognitive decline especially for those with mild cognitive impairment (MCI, now mild neurocognitive disorder, mNCD, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V). This quasi-experimental, within-subjects pilot clinical trial was designed to replicate and extend the study of cognitive benefits for MCI by improving upon our prior interactive Physical and Cognitive Exercise Study (iPACESTM v1.0) by increasing the usability of the neuro-exergame and exploring possible underlying neurobiological mechanisms. Older adults were enrolled in a three-month, in-home trial of a portable neuro-exergame (iPACES™ v2.0) where participants pedaled and steered along a virtual bike path (Memory Lane™). Neuropsychological function was assessed at baseline after component familiarization intervals (e.g., two weeks of exercise-only, game-only, etc.) and after three months of interactive neuro-exergame intervention. Fourteen participants were enrolled in the study and seven completed the final evaluation. Intent-to-treat analyses were conducted with imputed missing data (total n = 14). Significant improvement in executive function (Stroop) was found (d = 0.68, p = 0.02) only. Changes in salivary biomarkers (cortisol and insulin-like growth factor 1; IGF-1) were significantly associated with improved cognition. Further research is needed, but pilot data suggest that a portable in-home neuro-exergame may be an additional, practical tool to fight back against cognitive decline and dementia.
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Affiliation(s)
- Kathryn Wall
- Healthy Aging & Neuropsychology Lab, Union College, Schenectady, NY 12308, USA.
- Biology Department, Union College, Schenectady, NY 12308, USA.
| | - Jessica Stark
- Healthy Aging & Neuropsychology Lab, Union College, Schenectady, NY 12308, USA.
| | - Alexa Schillaci
- Healthy Aging & Neuropsychology Lab, Union College, Schenectady, NY 12308, USA.
| | | | | | - Kristina Striegnitz
- Computer Science Department & Neuroscience Program, Union College, Schenectady, NY 12308, USA.
| | - Brian D Cohen
- Biology Department, Union College, Schenectady, NY 12308, USA.
| | - Paul J Arciero
- Health & Human Physiological Sciences Department, Skidmore College, Saratoga Springs, NY 12866, USA.
| | - Arthur F Kramer
- Center for Cognitive & Brain Health, Psychology Department, Northeastern University, Boston, NY 02115, USA.
| | - Cay Anderson-Hanley
- Healthy Aging & Neuropsychology Lab, Union College, Schenectady, NY 12308, USA.
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