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Saenz‐Antoñanzas A, Muñoz‐Culla M, Rigo P, Ruiz‐Barreiro L, Moreno‐Valladares M, Alberro A, Cruces‐Salguero S, Arroyo‐Izaga M, Arranz AM, Otaegui D, Guillemot F, Matheu A. Centenarian hippocampus displays high levels of astrocytic metallothioneins. Aging Cell 2024; 23:e14201. [PMID: 38769809 PMCID: PMC11320342 DOI: 10.1111/acel.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/10/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024] Open
Abstract
The hippocampus is a brain area linked to cognition. The mechanisms that maintain cognitive activity in humans are poorly understood. Centenarians display extreme longevity which is generally accompanied by better quality of life, lower cognitive impairment, and reduced incidence of pathologies including neurodegenerative diseases. We performed transcriptomic studies in hippocampus samples from individuals of different ages (centenarians [≥97 years], old, and young) and identified a differential gene expression pattern in centenarians compared to the other two groups. In particular, several isoforms of metallothioneins (MTs) were highly expressed in centenarians. Moreover, we identified that MTs were mainly expressed in astrocytes. Functional studies in human primary astrocytes revealed that MT1 and MT3 are necessary for their homeostasis maintenance. Overall, these results indicate that the expression of MTs specifically in astrocytes is a mechanism for protection during aging.
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Affiliation(s)
| | - Maider Muñoz‐Culla
- Multiple Sclerosis GroupBiodonostia Health Research InstituteSan SebastianSpain
- CIBERNED, ISCIIIMadridSpain
- Department of Basic Psychological Processes and their DevelopmentUniversity of the Basque Country (UPV/EHU)San SebastianSpain
| | - Piero Rigo
- Neural Stem Cell Biology LaboratoryThe Francis Crick InstituteLondonUK
| | - Leire Ruiz‐Barreiro
- Laboratory of Humanized Models of Disease, Achucarro Basque Center for NeuroscienceLeioaSpain
| | | | - Ainhoa Alberro
- Multiple Sclerosis GroupBiodonostia Health Research InstituteSan SebastianSpain
- CIBERNED, ISCIIIMadridSpain
| | | | - Marta Arroyo‐Izaga
- BIOMICs Research Group, Microfluidics & BIOMICs, Department of Pharmacy and Food Sciences, Lascaray Research CenterUniversity of the Basque Country (UPV/EHU), BioarabaVitoriaSpain
| | - Amaia M. Arranz
- Laboratory of Humanized Models of Disease, Achucarro Basque Center for NeuroscienceLeioaSpain
- IKERBASQUE, Basque Foundation for ScienceBilbaoSpain
| | - David Otaegui
- Multiple Sclerosis GroupBiodonostia Health Research InstituteSan SebastianSpain
- CIBERNED, ISCIIIMadridSpain
| | | | - Ander Matheu
- Cellular Oncology GroupBiodonostia Health Research InstituteSan SebastianSpain
- IKERBASQUE, Basque Foundation for ScienceBilbaoSpain
- CIBERFES, ISCIIIMadridSpain
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Heywood A, Stocks J, Schneider JA, Arfanakis K, Bennett DA, Beg MF, Wang L. In vivo effect of LATE-NC on integrity of white matter connections to the hippocampus. Alzheimers Dement 2024; 20:4401-4410. [PMID: 38877688 PMCID: PMC11247713 DOI: 10.1002/alz.13808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION TAR DNA-binding protein 43 (TDP-43) is a highly prevalent proteinopathy that is involved in neurodegenerative processes, including axonal damage. To date, no ante mortem biomarkers exist for TDP-43, and few studies have directly assessed its impact on neuroimaging measures utilizing pathologic quantification. METHODS Ante mortem diffusion-weighted images were obtained from community-dwelling older adults. Regression models calculated the relationship between post mortem TDP-43 burden and ante mortem fractional anisotropy (FA) within each voxel in connection with the hippocampus, controlling for coexisting Alzheimer's disease and demographics. RESULTS Results revealed a significant negative relationship (false discovery rate [FDR] corrected p < .05) between post mortem TDP-43 and ante mortem FA in one cluster within the left medial temporal lobe connecting to the parahippocampal cortex, entorhinal cortex, and cingulate, aligning with the ventral subdivision of the cingulum. FA within this cluster was associated with cognition. DISCUSSION Greater TDP-43 burden is associated with lower FA within the limbic system, which may contribute to impairment in learning and memory. HIGHLIGHTS Post mortem TDP-43 pathological burden is associated with reduced ante mortem fractional anisotropy. Reduced FA located in the parahippocampal portion of the cingulum. FA in this area was associated with reduced episodic and semantic memory. FA in this area was associated with increased inward hippocampal surface deformation.
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Affiliation(s)
- Ashley Heywood
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane Stocks
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Biomedical Engineering, Illinois Institute of Technology, Suite, Chicago, Illinois, USA
- Department of Diagnostic Radiology, Rush University Medical Center, Chicago, Illinois, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Mirza Faisal Beg
- Simon Fraser University, School of Engineering Science, 8888 University Drive, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, Ohio, USA
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Nelson PT, Fardo DW, Wu X, Aung KZ, Cykowski MD, Katsumata Y. Limbic-predominant age-related TDP-43 encephalopathy (LATE-NC): Co-pathologies and genetic risk factors provide clues about pathogenesis. J Neuropathol Exp Neurol 2024; 83:396-415. [PMID: 38613823 PMCID: PMC11110076 DOI: 10.1093/jnen/nlae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is detectable at autopsy in more than one-third of people beyond age 85 years and is robustly associated with dementia independent of other pathologies. Although LATE-NC has a large impact on public health, there remain uncertainties about the underlying biologic mechanisms. Here, we review the literature from human studies that may shed light on pathogenetic mechanisms. It is increasingly clear that certain combinations of pathologic changes tend to coexist in aging brains. Although "pure" LATE-NC is not rare, LATE-NC often coexists in the same brains with Alzheimer disease neuropathologic change, brain arteriolosclerosis, hippocampal sclerosis of aging, and/or age-related tau astrogliopathy (ARTAG). The patterns of pathologic comorbidities provide circumstantial evidence of mechanistic interactions ("synergies") between the pathologies, and also suggest common upstream influences. As to primary mediators of vulnerability to neuropathologic changes, genetics may play key roles. Genes associated with LATE-NC include TMEM106B, GRN, APOE, SORL1, ABCC9, and others. Although the anatomic distribution of TDP-43 pathology defines the condition, important cofactors for LATE-NC may include Tau pathology, endolysosomal pathways, and blood-brain barrier dysfunction. A review of the human phenomenology offers insights into disease-driving mechanisms, and may provide clues for diagnostic and therapeutic targets.
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Affiliation(s)
- Peter T Nelson
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky, USA
- Department of Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
| | - David W Fardo
- Department of Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
| | - Xian Wu
- Department of Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
| | - Khine Zin Aung
- Department of Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Yuriko Katsumata
- Department of Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
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Kapasi A, Capuano AW, Lamar M, Leurgans SE, Evia AM, Bennett DA, Arfanakis K, Schneider JA. Atherosclerosis and Hippocampal Volumes in Older Adults: The Role of Age and Blood Pressure. J Am Heart Assoc 2024; 13:e031551. [PMID: 38240240 PMCID: PMC11056126 DOI: 10.1161/jaha.123.031551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/05/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Lower hippocampal volume is associated with late-life cognitive decline and is an important, but nonspecific marker for clinical Alzheimer's dementia. Cerebrovascular disease may also be associated with hippocampal volume. Here we study the role of intracranial large vessel disease (atherosclerosis) in association with hippocampal volume and the potential role of age, average late-life blood pressure across all visits, and other factors (sex, apolipoprotein ε4 [APOE ε4], and diabetes). METHODS AND RESULTS Data came from 765 community-based older people (91 years old on average at death; 72% women), from 2 ongoing clinical-pathologic cohort studies. Participants completed baseline assessment, annual standardized blood pressure measurements, vascular risk assessment for diabetes, and blood draws to determine APOE genotype, and at death, brains were removed and underwent ex vivo magnetic resonance imaging and neuropathologic evaluation for atherosclerosis pathology and other cerebrovascular and neurodegenerative pathologies. Linear regression models examined the association of atherosclerosis and hippocampal to hemisphere volume ratio and whether age at death, blood pressure, and other factors modified associations. In linear regression models adjusted for demographics and neurodegenerative and other cerebrovascular pathologies, atherosclerosis severity was associated with a lower hippocampal to hemisphere volume ratio. In separate models, we found the effect of atherosclerosis on the ratio of hippocampal to hemisphere volume was attenuated among advanced age at death or having higher systolic blood pressure (interaction terms P≤0.03). We did not find confounding or interactions with sex, diabetes, or APOE ε4. CONCLUSIONS Atherosclerosis severity is associated with lower hippocampal volume, independent of neurodegenerative and other cerebrovascular pathologies. Higher systolic blood pressures and advanced age attenuate associations.
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Affiliation(s)
- Alifiya Kapasi
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Pathology (Neuropathology)Rush University Medical CenterChicagoIL
| | - Ana W. Capuano
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Neurological SciencesRush University Medical CenterChicagoIL
| | - Melissa Lamar
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIL
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Neurological SciencesRush University Medical CenterChicagoIL
| | - Arnold M. Evia
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
| | - David A. Bennett
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Neurological SciencesRush University Medical CenterChicagoIL
| | - Konstantinos Arfanakis
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Biomedical EngineeringIllinois Institute of TechnologyChicagoIL
- Department of Diagnostic RadiologyRush University Medical CenterChicagoIL
| | - Julie A. Schneider
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Pathology (Neuropathology)Rush University Medical CenterChicagoIL
- Department of Neurological SciencesRush University Medical CenterChicagoIL
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Katsumata Y, Wu X, Aung KZ, Gauthreaux K, Mock C, Forrest SL, Kovacs GG, Nelson PT. Pathologic correlates of aging-related tau astrogliopathy: ARTAG is associated with LATE-NC and cerebrovascular pathologies, but not with ADNC. Neurobiol Dis 2024; 191:106412. [PMID: 38244935 PMCID: PMC10892903 DOI: 10.1016/j.nbd.2024.106412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/22/2024] Open
Abstract
Age-related tau astrogliopathy (ARTAG) is detectable in the brains of over one-third of autopsied persons beyond age 80, but the pathoetiology of ARTAG is poorly understood. Insights can be gained by analyzing risk factors and comorbid pathologies. Here we addressed the question of which prevalent co-pathologies are observed with increased frequency in brains with ARTAG. The study sample was the National Alzheimer's Coordinating Center (NACC) data set, derived from multiple Alzheimer's disease research centers (ADRCs) in the United States. Data from persons with unusual conditions (e.g. frontotemporal dementia) were excluded leaving 504 individual autopsied research participants, clustering from 20 different ADRCs, autopsied since 2020; ARTAG was reported in 222 (44.0%) of included participants. As has been shown previously, ARTAG was increasingly frequent with older age and in males. The presence and severity of other common subtypes of pathology that were previously linked to dementia were analyzed, stratifying for the presence of ARTAG. In logistical regression-based statistical models that included age and sex as covariates, ARTAG was relatively more likely to be found in brains with limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC), and in brains with comorbid cerebrovascular pathology (arteriolosclerosis and/or brain infarcts). However, ARTAG was not associated with severe Alzheimer's disease neuropathologic change (ADNC), or primary age-related tauopathy (PART). In a subset analysis of 167 participants with neurocognitive testing data, there was a marginal trend for ARTAG pathology to be associated with cognitive impairment as assessed with MMSE scores (P = 0.07, adjusting for age, sex, interval between final clinic visit and death, and ADNC severity). A limitation of the study was that there were missing data about ARTAG pathologies, with incomplete operationalization of ARTAG according to anatomic region and pathologic subtypes (e.g., thorn-shaped or granular-fuzzy astrocytes). In summary, ARTAG was not associated with ADNC, whereas prior observations about ARTAG occurring with increased frequency in aging, males, and brains with LATE-NC were replicated. It remains to be determined whether the increased frequency of ARTAG in brains with comorbid cerebrovascular pathology is related to local infarctions or neuroinflammatory signaling, or with some other set of correlated factors including blood-brain barrier dysfunction.
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Affiliation(s)
- Yuriko Katsumata
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, United States of America; Department of Biostatistics, University of Kentucky, Lexington, KY 40506, United States of America
| | - Xian Wu
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, United States of America; Department of Biostatistics, University of Kentucky, Lexington, KY 40506, United States of America
| | - Khine Zin Aung
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, United States of America; Department of Biostatistics, University of Kentucky, Lexington, KY 40506, United States of America
| | - Kathryn Gauthreaux
- National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, WA 98105, United States of America
| | - Charles Mock
- National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, WA 98105, United States of America
| | - Shelley L Forrest
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Canada; Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, Canada
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Canada; Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, Canada
| | - Peter T Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, United States of America; Department of Pathology, Division of Neuropathology, University of Kentucky, Lexington, KY, United States of America.
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Bermejo-Pareja F, del Ser T. Controversial Past, Splendid Present, Unpredictable Future: A Brief Review of Alzheimer Disease History. J Clin Med 2024; 13:536. [PMID: 38256670 PMCID: PMC10816332 DOI: 10.3390/jcm13020536] [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: 10/12/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Background: The concept of Alzheimer disease (AD)-since its histological discovery by Alzheimer to the present day-has undergone substantial modifications. Methods: We conducted a classical narrative review of this field with a bibliography selection (giving preference to Medline best match). Results: The following subjects are reviewed and discussed: Alzheimer's discovery, Kraepelin's creation of a new disease that was a rare condition until the 1970's, the growing interest and investment in AD as a major killer in a society with a large elderly population in the second half of the 20th century, the consolidation of the AD clinicopathological model, and the modern AD nosology based on the dominant amyloid hypothesis among many others. In the 21st century, the development of AD biomarkers has supported a novel biological definition of AD, although the proposed therapies have failed to cure this disease. The incidence of dementia/AD has shown a decrease in affluent countries (possibly due to control of risk factors), and mixed dementia has been established as the most frequent etiology in the oldest old. Conclusions: The current concept of AD lacks unanimity. Many hypotheses attempt to explain its complex physiopathology entwined with aging, and the dominant amyloid cascade has yielded poor therapeutic results. The reduction in the incidence of dementia/AD appears promising but it should be confirmed in the future. A reevaluation of the AD concept is also necessary.
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Affiliation(s)
- Félix Bermejo-Pareja
- CIBERNED, Institute of Health Carlos III, 28029 Madrid, Spain
- Institute of Research i+12, University Hospital “12 de Octubre”, 28041 Madrid, Spain
| | - Teodoro del Ser
- Alzheimer’s Centre Reina Sofia—CIEN Foundation, Institute of Health Carlos III, 28031 Madrid, Spain;
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Bittner N, Funk CSM, Schmidt A, Bermpohl F, Brandl EJ, Algharably EEA, Kreutz R, Riemer TG. Psychiatric Adverse Events of Acetylcholinesterase Inhibitors in Alzheimer's Disease and Parkinson's Dementia: Systematic Review and Meta-Analysis. Drugs Aging 2023; 40:953-964. [PMID: 37682445 PMCID: PMC10600312 DOI: 10.1007/s40266-023-01065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The acetylcholinesterase inhibitors (AChEIs) donepezil, galantamine, and rivastigmine are commonly used in the management of various forms of dementia. OBJECTIVES While these drugs are known to induce classic cholinergic adverse events such as diarrhea, their potential to cause psychiatric adverse events has yet to be thoroughly examined. METHODS We sought to determine the risk of psychiatric adverse events associated with the use of AChEIs through a systematic review and meta-analysis of double-blind randomized controlled trials involving patients with Alzheimer's dementia and Parkinson's dementia. RESULTS A total of 48 trials encompassing 22,845 patients were included in our analysis. Anorexia was the most commonly reported psychiatric adverse event, followed by agitation, insomnia, and depression. Individuals exposed to AChEIs had a greater risk of experiencing appetite disorders, insomnia, or depression compared with those who received placebo (anorexia: odds ratio [OR] 2.93, 95% confidence interval [CI] 2.29-3.75; p < 0.00001; decreased appetite: OR 1.93, 95% CI 1.33-2.82; p = 0.0006; insomnia: OR 1.55, 95% CI 1.25-1.93; p < 0.0001; and depression: OR 1.59, 95% CI 1.23-2.06, p = 0.0004). Appetite disorders were also more frequent with high-dose versus low-dose therapy. A subgroup analysis revealed that the risk of insomnia was higher for donepezil than for galantamine. CONCLUSIONS Our findings suggest that AChEI therapy may negatively impact psychological health, and careful monitoring of new psychiatric symptoms is warranted. Lowering the dose may resolve some psychiatric adverse events, as may switching to galantamine in the case of insomnia. CLINICAL TRIAL REGISTRATION The study was pre-registered on PROSPERO (CRD42021258376).
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Affiliation(s)
- Nadine Bittner
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Cleo S. M. Funk
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
| | - Alexander Schmidt
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Eva J. Brandl
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Engi E. A. Algharably
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
| | - Thomas G. Riemer
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
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Balu D, Valencia-Olvera AC, Islam Z, Mielczarek C, Hansen A, Perez Ramos TM, York J, LaDu MJ, Tai LM. APOE genotype and sex modulate Alzheimer's disease pathology in aged EFAD transgenic mice. Front Aging Neurosci 2023; 15:1279343. [PMID: 38020764 PMCID: PMC10644540 DOI: 10.3389/fnagi.2023.1279343] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Increasing evidence supports that age, APOE and sex interact to modulate Alzheimer's disease (AD) risk, however the underlying pathways are unclear. One way that AD risk factors may modulate cognition is by impacting amyloid beta (Aβ) accumulation as plaques, and/or neuroinflammation Therefore, the goal of the present study was to evaluate the extent to which age, APOE and sex modulate Aβ pathology, neuroinflammation and behavior in vivo. To achieve this goal, we utilized the EFAD mice, which express human APOE3 or APOE4 and have five familial AD mutations (FAD) that result in Aβ42 overproduction. We assessed Aβ levels, reactive glia and Morris water maze performance in 6-, 10-, 14-, and 18-month-old EFAD mice. Female APOE4 mice had the highest Aβ deposition, fibrillar amyloid deposits and neuroinflammation as well as earlier behavior deficits. Interestingly, we found that female APOE3 mice and male APOE4 mice had similar levels of pathology. Collectively our data support that the combination of APOE4 and female sex is the most detrimental combination for AD, and that at older ages, female sex may be equivalent to APOE4 genotype.
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Affiliation(s)
- Deebika Balu
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States
| | - Ana C. Valencia-Olvera
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States
| | - Zarak Islam
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States
- University of Illinois College of Medicine, Chicago, IL, United States
| | - Clare Mielczarek
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States
| | - Allison Hansen
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States
- University of Illinois College of Medicine, Peoria, IL, United States
| | - Tamara M. Perez Ramos
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States
- School of Medicine, St. George’s University, St. George’s, Grenada
| | - Jason York
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States
| | - Mary Jo LaDu
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States
| | - Leon M. Tai
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States
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9
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Lynch MT, Taub MA, Farfel JM, Yang J, Abadir P, De Jager PL, Grodstein F, Bennett DA, Mathias RA. Evaluating genomic signatures of aging in brain tissue as it relates to Alzheimer's disease. Sci Rep 2023; 13:14747. [PMID: 37679407 PMCID: PMC10484923 DOI: 10.1038/s41598-023-41400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023] Open
Abstract
Telomere length (TL) attrition, epigenetic age acceleration, and mitochondrial DNA copy number (mtDNAcn) decline are established hallmarks of aging. Each has been individually associated with Alzheimer's dementia, cognitive function, and pathologic Alzheimer's disease (AD). Epigenetic age and mtDNAcn have been studied in brain tissue directly but prior work on TL in brain is limited to small sample sizes and most studies have examined leukocyte TL. Importantly, TL, epigenetic age clocks, and mtDNAcn have not been studied jointly in brain tissue from an AD cohort. We examined dorsolateral prefrontal cortex (DLPFC) tissue from N = 367 participants of the Religious Orders Study (ROS) or the Rush Memory and Aging Project (MAP). TL and mtDNAcn were estimated from whole genome sequencing (WGS) data and cortical clock age was computed on 347 CpG sites. We examined dementia, MCI, and level of and change in cognition, pathologic AD, and three quantitative AD traits, as well as measures of other neurodegenerative diseases and cerebrovascular diseases (CVD). We previously showed that mtDNAcn from DLPFC brain tissue was associated with clinical and pathologic features of AD. Here, we show that those associations are independent of TL. We found TL to be associated with β-amyloid levels (beta = - 0.15, p = 0.023), hippocampal sclerosis (OR = 0.56, p = 0.0015) and cerebral atherosclerosis (OR = 1.44, p = 0.0007). We found strong associations between mtDNAcn and clinical measures of AD. The strongest associations with pathologic measures of AD were with cortical clock and there were associations of mtDNAcn with global AD pathology and tau tangles. Of the other pathologic traits, mtDNAcn was associated with hippocampal sclerosis, macroscopic infarctions and CAA and cortical clock was associated with Lewy bodies. Multi-modal age acceleration, accelerated aging on both mtDNAcn and cortical clock, had greater effect size than a single measure alone. These findings highlight for the first time that age acceleration determined on multiple genomic measures, mtDNAcn and cortical clock may have a larger effect on AD/AD related disorders (ADRD) pathogenesis than single measures.
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Affiliation(s)
- Megan T Lynch
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Margaret A Taub
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jose M Farfel
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Jingyun Yang
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Peter Abadir
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Philip L De Jager
- Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Francine Grodstein
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Rasika A Mathias
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Abdolmaleky HM, Zhou JR. Underlying Mechanisms of Brain Aging and Neurodegenerative Diseases as Potential Targets for Preventive or Therapeutic Strategies Using Phytochemicals. Nutrients 2023; 15:3456. [PMID: 37571393 PMCID: PMC10473240 DOI: 10.3390/nu15153456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
During aging, several tissues and biological systems undergo a progressive decline in function, leading to age-associated diseases such as neurodegenerative, inflammatory, metabolic, and cardiovascular diseases and cancer. In this review, we focus on the molecular underpinning of senescence and neurodegeneration related to age-associated brain diseases, in particular, Alzheimer's and Parkinson's diseases, along with introducing nutrients or phytochemicals that modulate age-associated molecular dysfunctions, potentially offering preventive or therapeutic benefits. Based on current knowledge, the dysregulation of microglia genes and neuroinflammation, telomere attrition, neuronal stem cell degradation, vascular system dysfunction, reactive oxygen species, loss of chromosome X inactivation in females, and gut microbiome dysbiosis have been seen to play pivotal roles in neurodegeneration in an interactive manner. There are several phytochemicals (e.g., curcumin, EGCG, fucoidan, galangin, astin C, apigenin, resveratrol, phytic acid, acacetin, daucosterol, silibinin, sulforaphane, withaferin A, and betulinic acid) that modulate the dysfunction of one or several key genes (e.g., TREM2, C3, C3aR1, TNFA, NF-kb, TGFB1&2, SIRT1&6, HMGB1, and STING) affected in the aged brain. Although phytochemicals have shown promise in slowing down the progression of age-related brain diseases, more studies to identify their efficacy, alone or in combinations, in preclinical systems can help to design novel nutritional strategies for the management of neurodegenerative diseases in humans.
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Affiliation(s)
| | - Jin-Rong Zhou
- Nutrition/Metabolism Laboratory, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
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11
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Neuville RS, Biswas R, Ho CC, Bukhari S, Sajjadi SA, Paganini-Hill A, Montine TJ, Corrada MM, Kawas CH. Study of neuropathological changes and dementia in 100 centenarians in The 90+ Study. Alzheimers Dement 2023; 19:3417-3425. [PMID: 36795955 PMCID: PMC10427735 DOI: 10.1002/alz.12981] [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: 09/23/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION The association between neuropathological changes and dementia among centenarians and nonagenarians remains unclear. METHODS We examined brain tissue from 100 centenarians and 297 nonagenarians from The 90+ Study, a community-based longitudinal study of aging. We determined the prevalence of 10 neuropathological changes and compared their associations with dementia and cognitive performance between centenarians and nonagenarians. RESULTS A total of 59% of centenarians and 47% of nonagenarians had at least four neuropathological changes. In centenarians, neuropathological changes were associated with higher odds of dementia and, compared to nonagenarians, the odds were not attenuated. For each additional neuropathological change, the Mini-Mental State Examination score was lower by 2 points for both groups. DISCUSSION Neuropathological changes continue to be strongly related to dementia in centenarians, highlighting the importance of slowing or preventing the development of multiple neuropathological changes in the aging brain to maintain cognitive health. HIGHLIGHTS Individual and multiple neuropathological changes are frequent in centenarians. These neuropathological changes are strongly associated with dementia. There is no attenuation of this association with age.
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Affiliation(s)
- Raumin S. Neuville
- School of Medicine, University of California, Irvine,
Irvine, CA 92617, USA
| | - Roshni Biswas
- Department of Neurology, University of California, Irvine,
Hewitt Hall, Irvine, CA 92697, USA
| | - Chu-Ching Ho
- Institute for Memory Impairments and Neurological
Disorders, University of California, Irvine, Irvine, CA 92697, USA
| | - Syed Bukhari
- Department of Pathology, Stanford University, 300 Pasteur
Drive, Stanford, CA 94305, USA
| | - S. Ahmad Sajjadi
- Department of Neurology, University of California, Irvine,
Hewitt Hall, Irvine, CA 92697, USA
- Institute for Memory Impairments and Neurological
Disorders, University of California, Irvine, Irvine, CA 92697, USA
- Department of Neurobiology & Behavior, University of
California, Irvine, Gillespie NRF, Irvine, CA 92697, USA
| | - Annlia Paganini-Hill
- Department of Neurology, University of California, Irvine,
Hewitt Hall, Irvine, CA 92697, USA
| | - Thomas J. Montine
- Department of Pathology, Stanford University, 300 Pasteur
Drive, Stanford, CA 94305, USA
| | - María M. Corrada
- Department of Neurology, University of California, Irvine,
Hewitt Hall, Irvine, CA 92697, USA
- Institute for Memory Impairments and Neurological
Disorders, University of California, Irvine, Irvine, CA 92697, USA
- Department of Epidemiology, University of California,
Irvine, Anteater Instruction & Research Offices (AIRB), 653 E. Peltason Drive,
Irvine, CA 92697, USA
| | - Claudia H. Kawas
- Department of Neurology, University of California, Irvine,
Hewitt Hall, Irvine, CA 92697, USA
- Institute for Memory Impairments and Neurological
Disorders, University of California, Irvine, Irvine, CA 92697, USA
- Department of Neurobiology & Behavior, University of
California, Irvine, Gillespie NRF, Irvine, CA 92697, USA
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Nelson PT, Schneider JA, Jicha GA, Duong MT, Wolk DA. When Alzheimer's is LATE: Why Does it Matter? Ann Neurol 2023; 94:211-222. [PMID: 37245084 PMCID: PMC10516307 DOI: 10.1002/ana.26711] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/07/2023] [Accepted: 05/18/2023] [Indexed: 05/29/2023]
Abstract
Recent therapeutic advances provide heightened motivation for accurate diagnosis of the underlying biologic causes of dementia. This review focuses on the importance of clinical recognition of limbic-predominant age-related TDP-43 encephalopathy (LATE). LATE affects approximately one-quarter of older adults and produces an amnestic syndrome that is commonly mistaken for Alzheimer's disease (AD). Although AD and LATE often co-occur in the same patients, these diseases differ in the protein aggregates driving neuropathology (Aβ amyloid/tau vs TDP-43). This review discusses signs and symptoms, relevant diagnostic testing, and potential treatment implications for LATE that may be helpful for physicians, patients, and families. ANN NEUROL 2023;94:211-222.
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Affiliation(s)
| | | | | | | | - David A. Wolk
- University of Pennsylvania Alzheimer’s Disease Research Center
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13
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Luebke M, Parulekar M, Thomas FP. Fluid biomarkers for the diagnosis of neurodegenerative diseases. Biomark Neuropsychiatry 2023. [DOI: 10.1016/j.bionps.2023.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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14
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I F. The unique neuropathological vulnerability of the human brain to aging. Ageing Res Rev 2023; 87:101916. [PMID: 36990284 DOI: 10.1016/j.arr.2023.101916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
Alzheimer's disease (AD)-related neurofibrillary tangles (NFT), argyrophilic grain disease (AGD), aging-related tau astrogliopathy (ARTAG), limbic predominant TDP-43 proteinopathy (LATE), and amygdala-predominant Lewy body disease (LBD) are proteinopathies that, together with hippocampal sclerosis, progressively appear in the elderly affecting from 50% to 99% of individuals aged 80 years, depending on the disease. These disorders usually converge on the same subject and associate with additive cognitive impairment. Abnormal Tau, TDP-43, and α-synuclein pathologies progress following a pattern consistent with an active cell-to-cell transmission and abnormal protein processing in the host cell. However, cell vulnerability and transmission pathways are specific for each disorder, albeit abnormal proteins may co-localize in particular neurons. All these alterations are unique or highly prevalent in humans. They all affect, at first, the archicortex and paleocortex to extend at later stages to the neocortex and other regions of the telencephalon. These observations show that the phylogenetically oldest areas of the human cerebral cortex and amygdala are not designed to cope with the lifespan of actual humans. New strategies aimed at reducing the functional overload of the human telencephalon, including optimization of dream repair mechanisms and implementation of artificial circuit devices to surrogate specific brain functions, appear promising.
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Affiliation(s)
- Ferrer I
- Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain; Emeritus Researcher of the Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain; Biomedical Research Network of Neurodegenerative Diseases (CIBERNED), Barcelona, Spain; Institute of Neurosciences, University of Barcelona, Barcelona, Spain; Hospitalet de Llobregat, Barcelona, Spain.
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15
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Wei X, Tan Y, Ke C, Cao Y, Xie Z, Yuan L, Pan J, Zhang W. Is the combination of acupuncture and Western medicine superior to monotherapy in the treatment of patients with Alzheimer's disease: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e32093. [PMID: 36550850 PMCID: PMC9771294 DOI: 10.1097/md.0000000000032093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Alzheimer disease (AD) is a common cause of dementia, and there are still a lack of treatment options to reverse or prevent disease progression. Existing evidence shows that acupuncture has advantages in the treatment of AD, but whether the efficacy of acupuncture belongs to the placebo effect remains controversial, and there is no strict systematic review and network meta-analysis to evaluate the efficacy and safety of acupuncture combined with Western medicine in the treatment of AD. METHODS From the inception to February 2023, the Embase, Latin American and Caribbean Health Sciences Literature, Medline, the Cochrane Collaboration's Controlled Clinical Trials, Scopus, China Biomedical Literature Database, Wanfang Database, China National Knowledge Infrastructure, and Australian Medical Index will be searched using the key phrases "acupuncture," "warm needling," "electroacupuncture," "Alzheimer disease," and "cohort" for all relevant studies. Quality assessment of all studies included in this review will be independently assessed by 2 reviewers using the Cochrane Collaborations tool. When significant heterogeneity is indicated, we will find the source of heterogeneity by subgroup or sensitivity analysis. DISCUSSION This study will evaluate the efficacy of acupuncture combined with Western medicine in improving cognitive function and activities of daily living in AD patients. The results of this study will verify whether the efficacy of acupuncture in the treatment of AD belongs to the placebo effect, which will also provide a reference for the clinical use of acupuncture combined with Western medicine in the treatment of AD.
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Affiliation(s)
- Xinran Wei
- Department of Acupuncture, Moxibustion, Tuina and Rehabilitation, The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Hunan province, China
| | - Yan Tan
- Hunan University of Traditional Chinese Medicine, Hunan province, China
| | - Chao Ke
- Hunan University of Traditional Chinese Medicine, Hunan province, China
| | - Yang Cao
- Department of Acupuncture, Moxibustion, Tuina and Rehabilitation, The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Hunan province, China
| | - Zhengrong Xie
- Hunan University of Traditional Chinese Medicine, Hunan province, China
| | - Liumei Yuan
- Hunan University of Traditional Chinese Medicine, Hunan province, China
| | - Jiang Pan
- Department of Acupuncture, Moxibustion, Tuina and Rehabilitation, The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Hunan province, China
| | - Wei Zhang
- Department of Acupuncture, Moxibustion, Tuina and Rehabilitation, The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Hunan province, China
- * Correspondence: Wei Zhang, Department of Acupuncture, Moxibustion, Tuina and Rehabilitation, The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Hunan province, 410007, China (e-mail: )
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16
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Montine TJ, Corrada MM, Kawas C, Bukhari SA, White LR, Tian L, Cholerton B. Association of Cognition and Dementia With Neuropathologic Changes of Alzheimer Disease and Other Conditions in the Oldest Old. Neurology 2022; 99:e1067-e1078. [PMID: 35705500 PMCID: PMC9519247 DOI: 10.1212/wnl.0000000000200832] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Age is the largest risk factor for dementia. However, dementia is not universal, even among the oldest-old age groups. Following contemporary neuropathologic guidelines, our objectives were to describe the key neuropathologic lesions and their associations with antemortem cognition in oldest-old individuals. METHODS Participants were those enrolled in The 90+ Study, a longitudinal, population-based study of aging/dementia in the oldest old, who agreed to postmortem brain examination. All autopsied brains as of December 2020 were evaluated for the prevalence of Alzheimer disease neuropathologic change (ADNC) and non-ADNC neuropathologic comorbidities. Associations between neuropathologic lesions or the total neuropathologic burden score (sum of the individual scores) and cognition were assessed using multinomial logistic regression and multiple linear regression. Separate regression analyses evaluated relationships between limbic-predominant age-related TDP-43 encephalopathy (LATE-NC) and hippocampal sclerosis (HS) or ADNC/primary age-related tauopathy (PART). Resistance, or failure to develop ADNC/PART, and resilience, inferred from higher-than-expected cognitive functioning, were evaluated in the presence or absence of non-ADNC neuropathologic features. RESULTS The most common neuropathologic features in the sample (n = 367) were ADNC/PART related. Increased dementia odds were associated with elevated total neuropathologic burden (odds ratio [OR] 1.5, 95% CI 1.3-1.7, p < 0.0001), β-amyloid (OR 1.6, 95% CI 1.2-2.0, p < 0.0001), neurofibrillary tangles (OR 2.6, 95% CI 1.7-4.1, p < 0.0001), and LATE-NC (OR 2.3, 95% CI 1.7-3.1, p < 0.0001), correcting for multiple comparisons. LATE-NC was associated with dementia with (OR 6.1, 95% CI 2.0-18.7, p = 0.002) and without (OR 5.0, 95% CI 2.6-9.7, p < 0.0001) co-occurring HS and increased the odds of dementia among participants with ADNC (OR 5.0, 95% CI 2.7-9.2, p < 0.0001). Resistance to moderate/severe ADNC/PART was rare (3%), but resilience to ADNC/PART was not (55%). Resilience was rarer in the presence of non-ADNC comorbid lesions, particularly LATE-NC. Among those with moderate/severe ADNC/PART, dementia odds increased with each non-ADNC comorbid lesion (e.g., 1 lesion: OR 2.4, 95% CI 1.3-4.5, p < 0.005; 2 lesions: OR 5.9, 95% CI 2.8-12.3, p < 0.0001). DISCUSSION These results highlight the importance of non-ADNC neuropathologic comorbidity, predominantly LATE-NC, to cognition in the oldest old. Given the cumulative effects of non-ADNC comorbid neuropathologic abnormalities, reducing their prevalence, especially LATE-NC, will be vital to the ultimate goal of reducing dementia burden in the oldest-old individuals.
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Affiliation(s)
- Thomas J Montine
- From the Department of Pathology (T.J.M., S.B., B.C.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (M.M.C., C.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.K.), University of California Irvine; Pacific Health Research and Education Institute (L.W.), Honolulu, HI; and Department of Biomedical Data Science (L.T.), Stanford University School of Medicine, Palo Alto, CA
| | - Maria M Corrada
- From the Department of Pathology (T.J.M., S.B., B.C.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (M.M.C., C.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.K.), University of California Irvine; Pacific Health Research and Education Institute (L.W.), Honolulu, HI; and Department of Biomedical Data Science (L.T.), Stanford University School of Medicine, Palo Alto, CA
| | - Claudia Kawas
- From the Department of Pathology (T.J.M., S.B., B.C.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (M.M.C., C.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.K.), University of California Irvine; Pacific Health Research and Education Institute (L.W.), Honolulu, HI; and Department of Biomedical Data Science (L.T.), Stanford University School of Medicine, Palo Alto, CA
| | - Syed A Bukhari
- From the Department of Pathology (T.J.M., S.B., B.C.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (M.M.C., C.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.K.), University of California Irvine; Pacific Health Research and Education Institute (L.W.), Honolulu, HI; and Department of Biomedical Data Science (L.T.), Stanford University School of Medicine, Palo Alto, CA
| | - Lon R White
- From the Department of Pathology (T.J.M., S.B., B.C.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (M.M.C., C.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.K.), University of California Irvine; Pacific Health Research and Education Institute (L.W.), Honolulu, HI; and Department of Biomedical Data Science (L.T.), Stanford University School of Medicine, Palo Alto, CA
| | - Lu Tian
- From the Department of Pathology (T.J.M., S.B., B.C.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (M.M.C., C.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.K.), University of California Irvine; Pacific Health Research and Education Institute (L.W.), Honolulu, HI; and Department of Biomedical Data Science (L.T.), Stanford University School of Medicine, Palo Alto, CA
| | - Brenna Cholerton
- From the Department of Pathology (T.J.M., S.B., B.C.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (M.M.C., C.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.K.), University of California Irvine; Pacific Health Research and Education Institute (L.W.), Honolulu, HI; and Department of Biomedical Data Science (L.T.), Stanford University School of Medicine, Palo Alto, CA.
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17
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Gómez-Isla T, Frosch MP. Lesions without symptoms: understanding resilience to Alzheimer disease neuropathological changes. Nat Rev Neurol 2022; 18:323-332. [PMID: 35332316 PMCID: PMC10607925 DOI: 10.1038/s41582-022-00642-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 12/12/2022]
Abstract
Since the original description of amyloid-β plaques and tau tangles more than 100 years ago, these lesions have been considered the neuropathological hallmarks of Alzheimer disease (AD). The prevalence of plaques, tangles and dementia increases with age, and the lesions are considered to be causally related to the cognitive symptoms of AD. Current schemes for assessing AD lesion burden examine the distribution, abundance and characteristics of plaques and tangles at post mortem, yielding an estimate of the likelihood of cognitive impairment. Although this approach is highly predictive for most individuals, in some instances, a striking mismatch between lesions and symptoms can be observed. A small subset of individuals harbour a high burden of plaques and tangles at autopsy, which would be expected to have had devastating clinical consequences, but remain at their cognitive baseline, indicating 'resilience'. The study of these brains might provide the key to understanding the 'black box' between the accumulation of plaques and tangles and cognitive impairment, and show the way towards disease-modifying treatments for AD. In this Review, we begin by considering the heterogeneity of clinical manifestations associated with the presence of plaques and tangles, and then focus on insights derived from the rare yet informative individuals who display high amounts of amyloid and tau deposition in their brains (observed directly at autopsy) without manifesting dementia during life. The resilient response of these individuals to the gradual accumulation of plaques and tangles has potential implications for assessing an individual's risk of AD and for the development of interventions aimed at preserving cognition.
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Affiliation(s)
- Teresa Gómez-Isla
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
- Massachusetts Alzheimer's Disease Research Center, Boston, MA, USA.
| | - Matthew P Frosch
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Massachusetts Alzheimer's Disease Research Center, Boston, MA, USA
- C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, MA, USA
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18
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Taddei RN, Sanchez-Mico MV, Bonnar O, Connors T, Gaona A, Denbow D, Frosch MP, Gómez-Isla T. Changes in glial cell phenotypes precede overt neurofibrillary tangle formation, correlate with markers of cortical cell damage, and predict cognitive status of individuals at Braak III-IV stages. Acta Neuropathol Commun 2022; 10:72. [PMID: 35534858 PMCID: PMC9082857 DOI: 10.1186/s40478-022-01370-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
Clinico-pathological correlation studies show that some otherwise healthy elderly individuals who never developed cognitive impairment harbor a burden of Alzheimer's disease lesions (plaques and tangles) that would be expected to result in dementia. In the absence of comorbidities explaining such discrepancies, there is a need to identify other brain changes that meaningfully contribute to the cognitive status of an individual in the face of such burdens of plaques and tangles. Glial inflammatory responses, a universal phenomenon in symptomatic AD, show robust association with degree of cognitive impairment, but their significance in early tau pathology stages and contribution to the trajectory of cognitive decline at an individual level remain widely unexplored. We studied 55 brains from individuals at intermediate stages of tau tangle pathology (Braak III-IV) with diverging antemortem cognition (demented vs. non-demented, here termed `resilient'), and age-matched cognitively normal controls (Braak 0-II). We conducted quantitative assessments of amyloid and tau lesions, cellular vulnerability markers, and glial phenotypes in temporal pole (Braak III-IV region) and visual cortex (Braak V-VI region) using artificial-intelligence based semiautomated quantifications. We found distinct glial responses with increased proinflammatory and decreased homeostatic markers, both in regions with tau tangles (temporal pole) and without overt tau deposits (visual cortex) in demented but not in resilient. These changes were significantly associated with markers of cortical cell damage. Similar phenotypic glial changes were detected in the white matter of demented but not resilient and were associated with higher burden of overlying cortical cellular damage in regions with and without tangles. Our data suggest that changes in glial phenotypes in cortical and subcortical regions represent an early phenomenon that precedes overt tau deposition and likely contributes to cell damage and loss of brain function predicting the cognitive status of individuals at intermediate stages of tau aggregate burden (Braak III-IV).
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Affiliation(s)
- Raquel N Taddei
- Department of Neurology, Massachusetts General Hospital, 15th Parkman St, Boston, MA, 02114, USA
- Massachusetts Alzheimer's Disease Research Center, Boston, MA, USA
- Department of Neurology, Dementia Research Institute, University College London, London, UK
| | - Maria V Sanchez-Mico
- Department of Neurology, Massachusetts General Hospital, 15th Parkman St, Boston, MA, 02114, USA
| | - Orla Bonnar
- Department of Neurology, Massachusetts General Hospital, 15th Parkman St, Boston, MA, 02114, USA
| | - Theresa Connors
- Massachusetts Alzheimer's Disease Research Center, Boston, MA, USA
- C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, MA, USA
| | - Angelica Gaona
- Massachusetts Alzheimer's Disease Research Center, Boston, MA, USA
- C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, MA, USA
| | - Dominique Denbow
- Department of Neurology, Massachusetts General Hospital, 15th Parkman St, Boston, MA, 02114, USA
| | - Matthew P Frosch
- Massachusetts Alzheimer's Disease Research Center, Boston, MA, USA
- C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, MA, USA
| | - Teresa Gómez-Isla
- Department of Neurology, Massachusetts General Hospital, 15th Parkman St, Boston, MA, 02114, USA.
- Massachusetts Alzheimer's Disease Research Center, Boston, MA, USA.
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19
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Tasaki S, Xu J, Avey DR, Johnson L, Petyuk VA, Dawe RJ, Bennett DA, Wang Y, Gaiteri C. Inferring protein expression changes from mRNA in Alzheimer's dementia using deep neural networks. Nat Commun 2022; 13:655. [PMID: 35115553 PMCID: PMC8814036 DOI: 10.1038/s41467-022-28280-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 01/19/2022] [Indexed: 12/30/2022] Open
Abstract
Identifying the molecular systems and proteins that modify the progression of Alzheimer's disease and related dementias (ADRD) is central to drug target selection. However, discordance between mRNA and protein abundance, and the scarcity of proteomic data, has limited our ability to advance candidate targets that are mainly based on gene expression. Therefore, by using a deep neural network that predicts protein abundance from mRNA expression, here we attempt to track the early protein drivers of ADRD. Specifically, by applying the clei2block deep learning model to 1192 brain RNA-seq samples, we identify protein modules and disease-associated expression changes that were not directly observed at the mRNA level. Moreover, pseudo-temporal trajectory inference based on the predicted proteome became more closely correlated with cognitive decline and hippocampal atrophy compared to RNA-based trajectories. This suggests that the predicted changes in protein expression could provide a better molecular representation of ADRD progression. Furthermore, overlaying clinical traits on protein pseudotime trajectory identifies protein modules altered before cognitive impairment. These results demonstrate how our method can be used to identify potential early protein drivers and possible drug targets for treating and/or preventing ADRD.
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Affiliation(s)
- Shinya Tasaki
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
| | - Jishu Xu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Denis R Avey
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Lynnaun Johnson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Vladislav A Petyuk
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Robert J Dawe
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Yanling Wang
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Chris Gaiteri
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
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20
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Bennett DA. Reducing Your Risk of Alzheimer's Dementia: Building a Better Brain as We Age. Arch Clin Neuropsychol 2021; 36:1257-1265. [PMID: 34651647 PMCID: PMC8517621 DOI: 10.1093/arclin/acab052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/14/2022] Open
Abstract
Alzheimer' dementia is a large and growing public health problem. Of utmost importance for limiting the impact of the disease on society is the prevention of dementia, that is, delay onset either by years whereby death ensues prior to dementia onset. The Religious Orders Study and the Rush Memory and Aging Project are two harmonized cohort studies of aging and dementia that include organ donation at death. Ongoing since 1994 and 1997, respectively, we published on the association of numerous experiential, psychological, and medical risk factors for dementia, many of which are potentially modifiable. Here, selected findings are reviewed based on a presentation at the 2020 National Academy of Neuropsychology given virtually in Chicago in October of 2020.
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Affiliation(s)
- David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA,Corresponding author at: Rush Alzheimer’s Disease Center; 1750 W. Harrison Street, Suite 1000; Chicago, IL 60612, USA. E-mail address:
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Agrawal S, Yu L, Nag S, Arfanakis K, Barnes LL, Bennett DA, Schneider JA. The association of Lewy bodies with limbic-predominant age-related TDP-43 encephalopathy neuropathologic changes and their role in cognition and Alzheimer's dementia in older persons. Acta Neuropathol Commun 2021; 9:156. [PMID: 34563269 PMCID: PMC8466680 DOI: 10.1186/s40478-021-01260-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022] Open
Abstract
Lewy bodies (LBs) and limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) are common in older persons and associated with cognitive impairment. However, little is known about the relationship between LBs and LATE-NC and their combined roles in cognitive impairment and Alzheimer's dementia in community-dwelling participants. The study included 1670 community-based participants (mean age-at-death, 89.5 years (SD = 6.65); 69% females) who underwent annual assessments of cognition to create summary measures of global cognition and cognitive domains and evaluation for Alzheimer's dementia. Systematic neuropathologic evaluations were performed to assess LBs, LATE-NC, and Alzheimer's disease (AD) pathology. We excluded cases with pathologically confirmed frontotemporal lobar degeneration in this study. Logistic and linear regression analyses were used, adjusted for demographics and AD pathology. LBs were present in 428 (25.6%) decedents (29 nigra-predominant, 165 limbic-type, and 234 neocortical-type) while 865 (51.7%) decedents exhibited LATE-NC (307 stage 1, 167 stage 2, and 391 stage 3). LBs combined with LATE-NC were common (15% of all participants) and in those with Alzheimer's dementia (25%). Neocortical-type, but not nigral-predominant or limbic-type LBs increased the odds of stage 2/3 LATE-NC (odds ratio = 1.70; 95% confidence interval = 1.26-2.30). The association between neocortical-type LBs and stage 2/3 LATE-NC was stronger in those under 90 years of age and in women. In analyses of cognition and Alzheimer's dementia, LATE-NC and neocortical-type LBs, separately, were related to lower global cognition, five specific cognitive domains, and an increased odds of Alzheimer's dementia, above and beyond the AD pathology. Limbic-type LBs were related to lower global cognition, and the domains of episodic, working, and semantic memory, and increased odds of Alzheimer's dementia. Furthermore, there was no interaction between limbic/neocortical-type LBs and LATE-NC on cognitive function, cognitive domains, or Alzheimer's dementia. These findings suggest that neocortical-type LBs are associated with LATE-NC, specifically in the younger old and in women. Limbic/neocortical-type LBs and LATE-NC have separate and additive effects on cognitive function and odds of Alzheimer's dementia.
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Affiliation(s)
- Sonal Agrawal
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA.
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA.
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sukriti Nag
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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22
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Abstract
PURPOSE OF REVIEW People over 90 are the fastest growing segment of the population with the highest rates of dementia. This review highlights recent findings that provide insight to our understanding of dementia and cognition at all ages. RECENT FINDINGS Risk factors for Alzheimer's disease (AD) and dementia differ by age, with some factors, like the development of hypertension, actually becoming protective in the oldest-old. At least half of all dementia in this age group is due to non AD pathologies, including microinfarcts, hippocampal sclerosis and TDP-43. The number of pathologic changes found in the brain is related to both risk and severity of dementia, but many people in this age group appear to be 'resilient' to these pathologies. Resilience to Alzheimer pathology, in part, may be related to absence of other pathologies, and imaging and spinal fluid biomarkers for AD have limited utility in this age group. SUMMARY Studies of dementia in the oldest-old are important for our understanding and eventual treatment or prevention of dementia at all ages.
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Affiliation(s)
- Claudia H. Kawas
- Department of Neurology and Department of Neurobiology & Behavior, University of California, Irvine, Irvine, California, USA
| | - Nienke Legdeur
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC and Department of Internal Medicine, Spaarne Gasthuis, Haarlem, the Netherlands
| | - María M. Corrada
- Department of Neurology and Department of Epidemiology, University of California, Irvine, Irvine, California, USA
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23
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Beach TG, Malek-Ahmadi M. Alzheimer's Disease Neuropathological Comorbidities are Common in the Younger-Old. J Alzheimers Dis 2021; 79:389-400. [PMID: 33285640 PMCID: PMC8034496 DOI: 10.3233/jad-201213] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinicopathological studies have demonstrated that Alzheimer's disease dementia (ADD) is often accompanied by clinically undetectable comorbid neurodegenerative and cerebrovascular disease that alter the rate of cognitive decline. Aside from causing increased variability in clinical response, it is possible that the major ADD comorbidities may not respond to ADD-specific molecular therapeutics. OBJECTIVE As most reports have focused on comorbidity in the oldest-old, its extent in younger age groups that are more likely to be involved in clinical trials is largely unknown; our objective is to provide this information. METHODS We conducted a survey of neuropathological comorbidities in sporadic ADD using data from the US National Alzheimer's Coordinating Center. Subject data was restricted to those with dementia and meeting National Institute on Aging-Alzheimer's Association intermediate or high AD Neuropathological Change levels, excluding those with known autosomal dominant AD-related mutations. RESULTS Highly prevalent ADD comorbidities are not restricted to the oldest-old but are common even in early-onset ADD. The percentage of cases with ADD as the sole major neuropathological diagnosis is highest in the under-60 group, where "pure" ADD cases are still in the minority at 44%. After this AD as a sole major pathology in ADD declines to roughly 20%in the 70s and beyond. Lewy body disease is the most common comorbidity at younger ages but actually is less common at later ages, while for most others, their prevalence increases with age. CONCLUSION Alzheimer's disease neuropathological comorbidities are highly prevalent even in the younger-old.
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Kapasi A, Yu L, Boyle PA, Barnes LL, Bennett DA, Schneider JA. Limbic-predominant age-related TDP-43 encephalopathy, ADNC pathology, and cognitive decline in aging. Neurology 2020; 95:e1951-e1962. [PMID: 32753441 PMCID: PMC7682843 DOI: 10.1212/wnl.0000000000010454] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/16/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To examine the impact of 3 pathologic groups, pure limbic-predominant age-related transactive response DNA-binding protein 43 encephalopathy (LATE) neuropathologic changes (NC), pure Alzheimer disease neuropathologic change (ADNC), and mixed ADNC with LATE-NC, on late-life cognitive decline. METHODS Data came from 1,356 community-based older persons who completed detailed annual cognitive testing and systematic neuropathologic examination at autopsy to identify LATE-NC, ADNC, and other age-related pathologies. Persons were categorized into (0) a group without a pathologic diagnosis of LATE or ADNC (n = 378), (1) LATE-NC without ADNC (n = 91), (2) ADNC without LATE-NC (n = 535), and (3) mixed ADNC with LATE-NC (n = 352). We used mixed-effect models to examine the group associations with rate of decline in global cognition and 5 cognitive domains and then examined whether age modified associations. RESULTS Compared to those without LATE-NC or ADNC, those with pure LATE-NC had a faster decline in global cognition (p = 0.025) and episodic memory (p = 0.002); however, compared to persons with pure ADNC, those with pure LATE-NC showed a slower decline. Those with mixed ADNC with LATE-NC showed the fastest decline compared to those with either pathology alone. Persons ≥90 years of age with mixed ADNC with LATE-NC had slower cognitive decline compared to those ≤89 years of age. CONCLUSION Persons with pure LATE-NC follow a slower trajectory compared to those with pure ADNC. Those with mixed LATE/ADNC have a steeper decline than individuals with either pathology alone. In addition, age may modify the effect of pathology on cognitive decline. These findings have important implications for the development of biomarkers and prognosis for late-life cognitive decline. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that LATE-NC and Alzheimer disease pathologic changes are associated with different trajectories of late-life cognitive decline.
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Affiliation(s)
- Alifiya Kapasi
- From the Rush Alzheimer's Disease Center (A.K., L.Y., P.A.B., L.L.B., D.A.B., J.A.S.), Department of Pathology (A.K., J.A.S.), Department of Neurological Sciences (L.Y., L.L.B., D.A.B., J.A.S.), and Department of Behavioral Sciences (P.A.B., L.L.B.), Rush University Medical Center, Chicago, IL.
| | - Lei Yu
- From the Rush Alzheimer's Disease Center (A.K., L.Y., P.A.B., L.L.B., D.A.B., J.A.S.), Department of Pathology (A.K., J.A.S.), Department of Neurological Sciences (L.Y., L.L.B., D.A.B., J.A.S.), and Department of Behavioral Sciences (P.A.B., L.L.B.), Rush University Medical Center, Chicago, IL
| | - Patricia A Boyle
- From the Rush Alzheimer's Disease Center (A.K., L.Y., P.A.B., L.L.B., D.A.B., J.A.S.), Department of Pathology (A.K., J.A.S.), Department of Neurological Sciences (L.Y., L.L.B., D.A.B., J.A.S.), and Department of Behavioral Sciences (P.A.B., L.L.B.), Rush University Medical Center, Chicago, IL
| | - Lisa L Barnes
- From the Rush Alzheimer's Disease Center (A.K., L.Y., P.A.B., L.L.B., D.A.B., J.A.S.), Department of Pathology (A.K., J.A.S.), Department of Neurological Sciences (L.Y., L.L.B., D.A.B., J.A.S.), and Department of Behavioral Sciences (P.A.B., L.L.B.), Rush University Medical Center, Chicago, IL
| | - David A Bennett
- From the Rush Alzheimer's Disease Center (A.K., L.Y., P.A.B., L.L.B., D.A.B., J.A.S.), Department of Pathology (A.K., J.A.S.), Department of Neurological Sciences (L.Y., L.L.B., D.A.B., J.A.S.), and Department of Behavioral Sciences (P.A.B., L.L.B.), Rush University Medical Center, Chicago, IL
| | - Julie A Schneider
- From the Rush Alzheimer's Disease Center (A.K., L.Y., P.A.B., L.L.B., D.A.B., J.A.S.), Department of Pathology (A.K., J.A.S.), Department of Neurological Sciences (L.Y., L.L.B., D.A.B., J.A.S.), and Department of Behavioral Sciences (P.A.B., L.L.B.), Rush University Medical Center, Chicago, IL
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25
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Jellinger KA. Neuropathological assessment of the Alzheimer spectrum. J Neural Transm (Vienna) 2020; 127:1229-1256. [PMID: 32740684 DOI: 10.1007/s00702-020-02232-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022]
Abstract
Alzheimer disease (AD), the most common form of dementia globally, classically defined a clinicopathological entity, is a heterogenous disorder with various pathobiological subtypes, currently referred to as Alzheimer continuum. Its morphological hallmarks are extracellular parenchymal β-amyloid (amyloid plaques) and intraneuronal (tau aggregates forming neurofibrillary tangles) lesions accompanied by synaptic loss and vascular amyloid deposits, that are essential for the pathological diagnosis of AD. In addition to "classical" AD, several subtypes with characteristic regional patterns of tau pathology have been described that show distinct clinical features, differences in age, sex distribution, biomarker levels, and patterns of key network destructions responsible for cognitive decline. AD is a mixed proteinopathy (amyloid and tau), frequently associated with other age-related co-pathologies, such as cerebrovascular lesions, Lewy and TDP-43 pathologies, hippocampal sclerosis, or argyrophilic grain disease. These and other co-pathologies essentially influence the clinical picture of AD and may accelerate disease progression. The purpose of this review is to provide a critical overview of AD pathology, its defining pathological substrates, and the heterogeneity among the Alzheimer spectrum entities that may provide a broader diagnostic coverage of this devastating disorder as a basis for implementing precision medicine approaches and for ultimate development of successful disease-modifying drugs for AD.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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26
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Ponjoan A, Garre-Olmo J, Blanch J, Fages E, Alves-Cabratosa L, Martí-Lluch R, Comas-Cufí M, Parramon D, Garcia-Gil M, Ramos R. Is it time to use real-world data from primary care in Alzheimer's disease? Alzheimers Res Ther 2020; 12:60. [PMID: 32423489 PMCID: PMC7236302 DOI: 10.1186/s13195-020-00625-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The analysis of real-world data in clinical research is rising, but its use to study dementia subtypes has been hardly addressed. We hypothesized that real-world data might be a powerful tool to update AD epidemiology at a lower cost than face-to-face studies, to estimate the prevalence and incidence rates of AD in Catalonia (Southern Europe), and to assess the adequacy of real-world data routinely collected in primary care settings for epidemiological research on AD. METHODS We obtained data from the System for the Development of Research in Primary Care (SIDIAP) database, which contains anonymized information of > 80% of the Catalan population. We estimated crude and standardized incidence rates and prevalences (95% confidence intervals (CI)) of AD in people aged at least 65 years living in Catalonia in 2016. RESULTS Age- and sex-standardized prevalence and incidence rate of AD were 3.1% (95%CI 2.7-3.6) and 4.2 per 1000 person-years (95%CI 3.8-4.6), respectively. Prevalence and incidence were higher in women and in the oldest people. CONCLUSIONS Our incidence and prevalence estimations were slightly lower than the recent face-to-face studies conducted in Spain and higher than other analyses of electronic health data from other European populations. Real-world data routinely collected in primary care settings could be a powerful tool to study the epidemiology of AD.
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Affiliation(s)
- Anna Ponjoan
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGi), Girona, Catalonia, Spain
- Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), Catalonia, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IDIBGi), Girona, Catalonia, Spain
| | - Jordi Blanch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Ester Fages
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
- Primary Care Services, Catalan Institute of Health (ICS), Girona, Catalonia, Spain
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Ruth Martí-Lluch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGi), Girona, Catalonia, Spain
- Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), Catalonia, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Dídac Parramon
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
- Primary Care Services, Catalan Institute of Health (ICS), Girona, Catalonia, Spain
| | - María Garcia-Gil
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.
- Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Catalonia, Spain.
- IDIAPJGol, c/ Maluquer Salvador, 11 baixos, 17002, Girona, Catalonia, Spain.
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27
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Verny M, Duyckaerts C. Cognitive deficit, and neuropathological correlates, in the oldest-old. Rev Neurol (Paris) 2020; 176:670-676. [PMID: 32178879 DOI: 10.1016/j.neurol.2020.01.355] [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] [Received: 12/19/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/14/2022]
Abstract
Several disorders are usually involved in the cognitive deficit of the oldest old. Alzheimer disease is the commonest. It is usually characterized by progressive memory impairment - neocortical symptoms occurring much later in the course of the disease. Alzheimer disease should not be considered any more as the single cause of a cognitive deficit in a very old patient. Vascular alterations, possibly causing microinfarcts, are commonly associated, especially in cerebral amyloid angiopathy. A slowly progressive memory deficit with negative CSF biomarkers of Alzheimer's disease may be due to hippocampal sclerosis that may be the consequence of multiple causes: in most of the cases, it is associated with neuronal TDP-43 inclusions. Recently, a distribution of these inclusions to a territory more extensive than the hippocampus has been reported and attributed to a new entity, called Limbic-predominant Age-related TDP-43 Encephalopathy (LATE) with or without hippocampal sclerosis. The presence of cortical Lewy bodies may cause an intellectual deficit or contribute to it. The prevalence of dementia with cortical Lewy bodies in the oldest old is discussed. Tau inclusions in cortical glia have also been shown to participate to the intellectual deficit. Association of neurodegenerative and vascular changes is the most frequent situation in the very old patients. Systemic diseases such as diabetes or heart failure, prescription drugs (when misused), or toxic such as alcohol may also contribute to the cognitive impairment and be amenable to treatment.
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Affiliation(s)
- M Verny
- Centre de gériatrie, pavillon Marguerite-Bottard, hôpital de la Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83, boulevard de l'Hôpital, 75651 Paris cedex, France; Team Neuronal Cell Biology & Pathology, Sorbonne University and UMR8256 (CNRS), Paris, France.
| | - C Duyckaerts
- Département de Neuropathologie Escourolle, AP-HP Sorbonne Université, Paris, France; ICM, équipe Alzheimer-Prions, Paris, France
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