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Xu H, Habich A, Ferreira D, Elisabet L, Westman E, Eriksdotter M. Long-term effects of cholinesterase inhibitors and memantine on cognitive decline, cardiovascular events, and mortality in dementia with Lewy bodies: An up to 10-year follow-up study. Alzheimers Dement 2024. [PMID: 39177108 DOI: 10.1002/alz.14118] [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: 02/16/2024] [Revised: 05/18/2024] [Accepted: 05/31/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION We aimed to assess the impact of cholinesterase inhibitors (ChEIs) and memantine on cognition, major adverse cardiovascular events (MACE) and mortality in dementia with Lewy bodies (DLB). METHODS A total of 1,095 incident DLB patients from the Swedish Registry on cognitive/dementia disorders were included. Using an inverse probability of treatment weighting, the effect of initiating ChEI or memantine within 90 days of DLB diagnosis and nonuse was evaluated on cognitive trajectories and risks of MACE and death. RESULTS The use of ChEIs significantly slowed cognitive decline at follow-ups (Mini-Mental State Examination [MMSE] -0.39 points/y; 95% confidence interval [CI], -0.96 to 0.18) compared to memantine (-2.49 points/y; -4.02 to -0.97) and nonuse (-2.50 points/y; -4.28 to -0.73). Treatment groups did not differ in MACE events. ChEI use was associated with lower risk of death in the first year after DLB diagnosis (adjusted hazard ratio [HR] 0.66, 95% CI 0.46, 0.94). DISCUSSION Our findings illuminate the potential benefits of ChEI treatment in DLB patients. HIGHLIGHTS Cholinesterase inhibitors slow cognitive decline over a 5-year follow-up period when compared to both memantine treatment and nonuse in patients with dementia with Lewy bodies. Cholinesterase Inhibitors reduce risk of mortality within the initial year, but this effect is not sustained after 1 year in patients with dementia with Lewy bodies.
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Affiliation(s)
- Hong Xu
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Annegret Habich
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Las Palmas, España
| | - Londos Elisabet
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Institution of Clinical Sciences, Lund University, Malmö, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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2
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Babiloni C, Noce G, Tucci F, Jakhar D, Ferri R, Panerai S, Catania V, Soricelli A, Salvatore M, Nobili F, Arnaldi D, Famà F, Buttinelli C, Giubilei F, Onofrj M, Stocchi F, Vacca L, Radicati F, Fuhr P, Gschwandtner U, Ransmayr G, Parnetti L, Marizzoni M, D'Antonio F, Bruno G, De Lena C, Güntekin B, Yıldırım E, Hanoğlu L, Yener G, Hünerli D, Taylor JP, Schumacher J, McKeith I, Frisoni GB, Antonini A, Ferreri F, Bonanni L, De Pandis MF, Del Percio C. Poor reactivity of posterior electroencephalographic alpha rhythms during the eyes open condition in patients with dementia due to Parkinson's disease. Neurobiol Aging 2024; 135:1-14. [PMID: 38142464 DOI: 10.1016/j.neurobiolaging.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023]
Abstract
Here, we hypothesized that the reactivity of posterior resting-state electroencephalographic (rsEEG) alpha rhythms during the transition from eyes-closed to -open condition might be lower in patients with Parkinson's disease dementia (PDD) than in patients with Alzheimer's disease dementia (ADD). A Eurasian database provided clinical-demographic-rsEEG datasets in 73 PDD patients, 35 ADD patients, and 25 matched cognitively unimpaired (Healthy) persons. The eLORETA freeware was used to estimate cortical rsEEG sources. Results showed substantial (greater than -10%) reduction (reactivity) in the posterior alpha source activities from the eyes-closed to the eyes-open condition in 88% of the Healthy seniors, 57% of the ADD patients, and only 35% of the PDD patients. In these alpha-reactive participants, there was lower reactivity in the parietal alpha source activities in the PDD group than in the healthy control seniors and the ADD patients. These results suggest that PDD patients show poor reactivity of mechanisms desynchronizing posterior rsEEG alpha rhythms in response to visual inputs. That neurophysiological biomarker may provide an endpoint for (non) pharmacological interventions for improving vigilance regulation in those patients.
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Affiliation(s)
- Claudio Babiloni
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy; Hospital San Raffaele Cassino, Cassino, FR, Italy.
| | | | - Federico Tucci
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
| | - Dharmendra Jakhar
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
| | | | | | | | - Andrea Soricelli
- IRCCS Synlab SDN, Naples, Italy; Department of Motor Sciences and Healthiness, University of Naples Parthenope, Naples, Italy
| | | | - Flavio Nobili
- Dipartimento di Neuroscienze, Oftalmologia, Genetica, Riabilitazione e Scienze Materno-infantili (DiNOGMI), Università di Genova, Italy; Clinica neurologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Dario Arnaldi
- Dipartimento di Neuroscienze, Oftalmologia, Genetica, Riabilitazione e Scienze Materno-infantili (DiNOGMI), Università di Genova, Italy; Neurofisiopatologia, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Famà
- Dipartimento di Neuroscienze, Oftalmologia, Genetica, Riabilitazione e Scienze Materno-infantili (DiNOGMI), Università di Genova, Italy; Neurofisiopatologia, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carla Buttinelli
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Franco Giubilei
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Marco Onofrj
- Department of Neuroscience Imaging and Clinical Sciences, CESI, and Department of Medicine and Aging Sciences, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Fabrizio Stocchi
- IRCCS San Raffaele, Rome, Italy; Telematic University San Raffaele, Rome, Italy
| | | | | | - Peter Fuhr
- Universitätsspital Basel, Abteilung Neurophysiologie, Petersgraben 4, 4031 Basel, Switzerland; Departments of Neurology and of Clinical Research, University Hospital Basel, Switzerland
| | - Ute Gschwandtner
- Universitätsspital Basel, Abteilung Neurophysiologie, Petersgraben 4, 4031 Basel, Switzerland; Departments of Neurology and of Clinical Research, University Hospital Basel, Switzerland
| | - Gerhard Ransmayr
- Department of Neurology 2, Med Campus III, Faculty of Medicine, Johannes Kepler University, Kepler University Hospital, Krankenhausstr. 9, A-4020 Linz., Austria
| | - Lucilla Parnetti
- Centre for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, University of Perugia, Italy
| | - Moira Marizzoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Fabrizia D'Antonio
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Bruno
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Bahar Güntekin
- Department of Biophysics, School of Medicine, Istanbul Medipol University, Istanbul, Turkey; Research Institute for Health Sciences and Technologies (SABITA), Neuroscience Research Center, Istanbul Medipol University, Istanbul, Turkey
| | - Ebru Yıldırım
- Program of Electroneurophysiology, Vocational School, Istanbul Medipol University, Istanbul, Turkey
| | - Lutfu Hanoğlu
- Department of Neurology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Görsev Yener
- Izmir University of Economics, Faculty of Medicine, Izmir, Turkey
| | - Duygu Hünerli
- Health Sciences Institute, Department of Neurosciences, Dokuz Eylül University, Izmir, Turkey
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Ian McKeith
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Giovanni B Frisoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Memory Clinic and LANVIE - Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Angelo Antonini
- Unit and Study Center for Neurodegenerative diseases (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Florinda Ferreri
- Unit and Study Center for Neurodegenerative diseases (CESNE), Department of Neuroscience, University of Padua, Padua, Italy; Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Laura Bonanni
- Department of Medicine and Aging Sciences, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
| | | | - Claudio Del Percio
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
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Corasaniti MT, Bagetta G, Nicotera P, Maione S, Tonin P, Guida F, Scuteri D. Exploitation of Autophagy Inducers in the Management of Dementia: A Systematic Review. Int J Mol Sci 2024; 25:1264. [PMID: 38279266 PMCID: PMC10816917 DOI: 10.3390/ijms25021264] [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: 12/17/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024] Open
Abstract
The social burden of dementia is remarkable since it affects some 57.4 million people all over the world. Impairment of autophagy in age-related diseases, such as dementia, deserves deep investigation for the detection of novel disease-modifying approaches. Several drugs belonging to different classes were suggested to be effective in managing Alzheimer's disease (AD) by means of autophagy induction. Useful autophagy inducers in AD should be endowed with a direct, measurable effect on autophagy, have a safe tolerability profile, and have the capability to cross the blood-brain barrier, at least with poor penetration. According to the PRISMA 2020 recommendations, we propose here a systematic review to appraise the measurable effectiveness of autophagy inducers in the improvement of cognitive decline and neuropsychiatric symptoms in clinical trials and retrospective studies. The systematic search retrieved 3067 records, 10 of which met the eligibility criteria. The outcomes most influenced by the treatment were cognition and executive functioning, pointing at a role for metformin, resveratrol, masitinib and TPI-287, with an overall tolerable safety profile. Differences in sample power, intervention, patients enrolled, assessment, and measure of outcomes prevents generalization of results. Moreover, the domain of behavioral symptoms was found to be less investigated, thus prompting new prospective studies with homogeneous design. PROSPERO registration: CRD42023393456.
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Affiliation(s)
| | - Giacinto Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy;
| | - Pierluigi Nicotera
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany;
| | - Sabatino Maione
- Division of Pharmacology, Department of Experimental Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (S.M.); (F.G.)
- Laboratory of Biomolecules, Venoms and Theranostic Application, Institute Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia
| | - Paolo Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy;
| | - Francesca Guida
- Division of Pharmacology, Department of Experimental Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (S.M.); (F.G.)
| | - Damiana Scuteri
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
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4
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Silva-Rodríguez J, Labrador-Espinosa MA, Moscoso A, Schöll M, Mir P, Grothe MJ. Characteristics of amnestic patients with hypometabolism patterns suggestive of Lewy body pathology. Brain 2023; 146:4520-4531. [PMID: 37284793 PMCID: PMC10629761 DOI: 10.1093/brain/awad194] [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: 01/25/2023] [Revised: 04/27/2023] [Accepted: 05/16/2023] [Indexed: 06/08/2023] Open
Abstract
A clinical diagnosis of Alzheimer's disease dementia (ADD) encompasses considerable pathological and clinical heterogeneity. While Alzheimer's disease patients typically show a characteristic temporo-parietal pattern of glucose hypometabolism on 18F-fluorodeoxyglucose (FDG)-PET imaging, previous studies have identified a subset of patients showing a distinct posterior-occipital hypometabolism pattern associated with Lewy body pathology. Here, we aimed to improve the understanding of the clinical relevance of these posterior-occipital FDG-PET patterns in patients with Alzheimer's disease-like amnestic presentations. Our study included 1214 patients with clinical diagnoses of ADD (n = 305) or amnestic mild cognitive impairment (aMCI, n = 909) from the Alzheimer's Disease Neuroimaging Initiative, who had FDG-PET scans available. Individual FDG-PET scans were classified as being suggestive of Alzheimer's (AD-like) or Lewy body (LB-like) pathology by using a logistic regression classifier trained on a separate set of patients with autopsy-confirmed Alzheimer's disease or Lewy body pathology. AD- and LB-like subgroups were compared on amyloid-β and tau-PET, domain-specific cognitive profiles (memory versus executive function performance), as well as the presence of hallucinations and their evolution over follow-up (≈6 years for aMCI, ≈3 years for ADD). Around 12% of the aMCI and ADD patients were classified as LB-like. For both aMCI and ADD patients, the LB-like group showed significantly lower regional tau-PET burden than the AD-like subgroup, but amyloid-β load was only significantly lower in the aMCI LB-like subgroup. LB- and AD-like subgroups did not significantly differ in global cognition (aMCI: d = 0.15, P = 0.16; ADD: d = 0.02, P = 0.90), but LB-like patients exhibited a more dysexecutive cognitive profile relative to the memory deficit (aMCI: d = 0.35, P = 0.01; ADD: d = 0.85 P < 0.001), and had a significantly higher risk of developing hallucinations over follow-up [aMCI: hazard ratio = 1.8, 95% confidence interval = (1.29, 3.04), P = 0.02; ADD: hazard ratio = 2.2, 95% confidence interval = (1.53, 4.06) P = 0.01]. In summary, a sizeable group of clinically diagnosed ADD and aMCI patients exhibit posterior-occipital FDG-PET patterns typically associated with Lewy body pathology, and these also show less abnormal Alzheimer's disease biomarkers as well as specific clinical features typically associated with dementia with Lewy bodies.
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Affiliation(s)
- Jesús Silva-Rodríguez
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Sevilla, Spain
| | - Miguel A Labrador-Espinosa
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain
| | - Alexis Moscoso
- Wallenberg Center for Molecular and Translational Medicine and Department of Psychiatry and Neurochemistry, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Michael Schöll
- Wallenberg Center for Molecular and Translational Medicine and Department of Psychiatry and Neurochemistry, University of Gothenburg, 41345 Gothenburg, Sweden
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, WC1ELondon, UK
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain
| | - Michel J Grothe
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain
- Wallenberg Center for Molecular and Translational Medicine and Department of Psychiatry and Neurochemistry, University of Gothenburg, 41345 Gothenburg, Sweden
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Quadalti C, Palmqvist S, Hall S, Rossi M, Mammana A, Janelidze S, Dellavalle S, Mattsson-Carlgren N, Baiardi S, Stomrud E, Hansson O, Parchi P. Clinical effects of Lewy body pathology in cognitively impaired individuals. Nat Med 2023; 29:1964-1970. [PMID: 37464058 PMCID: PMC10427416 DOI: 10.1038/s41591-023-02449-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/08/2023] [Indexed: 07/20/2023]
Abstract
There is poor knowledge about the clinical effects of Lewy body (LB) pathology in patients with cognitive impairment, especially when coexisting with Alzheimer's disease (AD) pathology (amyloid-β and tau). Using a seed amplification assay, we analyzed cerebrospinal fluid for misfolded LB-associated α-synuclein in 883 memory clinic patients with mild cognitive impairment or dementia from the BioFINDER study. Twenty-three percent had LB pathology, of which only 21% fulfilled clinical criteria of Parkinson's disease or dementia with Lewy bodies at baseline. Among these LB-positive patients, 48% had AD pathology. Fifty-four percent had AD pathology in the whole sample (17% of mild cognitive impairment and 24% of patients with dementia were also LB-positive). When examining independent cross-sectional effects, LB pathology but not amyloid-β or tau, was associated with hallucinations and worse attention/executive, visuospatial and motor function. LB pathology was also associated with faster longitudinal decline in all examined cognitive functions, independent of amyloid-β, tau, cognitive stage and a baseline diagnosis of dementia with Lewy bodies/Parkinson's disease. LB status provides a better precision-medicine approach to predict clinical trajectories independent of AD biomarkers and a clinical diagnosis, which could have implications for the clinical management of cognitive impairment and the design of AD and LB drug trials.
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Affiliation(s)
- Corinne Quadalti
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Sara Hall
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Marcello Rossi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Angela Mammana
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Shorena Janelidze
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Sofia Dellavalle
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Neurology Clinic, Skåne University Hospital, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Simone Baiardi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
- Memory Clinic, Skåne University Hospital, Malmö, Sweden.
| | - Piero Parchi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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Phongpreecha T, Cholerton B, Bhukari S, Chang AL, De Francesco D, Thuraiappah M, Godrich D, Perna A, Becker MG, Ravindra NG, Espinosa C, Kim Y, Berson E, Mataraso S, Sha SJ, Fox EJ, Montine KS, Baker LD, Craft S, White L, Poston KL, Beecham G, Aghaeepour N, Montine TJ. Prediction of neuropathologic lesions from clinical data. Alzheimers Dement 2023; 19:3005-3018. [PMID: 36681388 PMCID: PMC10359434 DOI: 10.1002/alz.12921] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/15/2022] [Accepted: 12/12/2022] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Post-mortem analysis provides definitive diagnoses of neurodegenerative diseases; however, only a few can be diagnosed during life. METHODS This study employed statistical tools and machine learning to predict 17 neuropathologic lesions from a cohort of 6518 individuals using 381 clinical features (Table S1). The multisite data allowed validation of the model's robustness by splitting train/test sets by clinical sites. A similar study was performed for predicting Alzheimer's disease (AD) neuropathologic change without specific comorbidities. RESULTS Prediction results show high performance for certain lesions that match or exceed that of research annotation. Neurodegenerative comorbidities in addition to AD neuropathologic change resulted in compounded, but disproportionate, effects across cognitive domains as the comorbidity number increased. DISCUSSION Certain clinical features could be strongly associated with multiple neurodegenerative diseases, others were lesion-specific, and some were divergent between lesions. Our approach could benefit clinical research, and genetic and biomarker research by enriching cohorts for desired lesions.
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Affiliation(s)
- Thanaphong Phongpreecha
- Department of Pathology, Stanford University 300 Pasteur Drive Medicine Lane Building L235 Stanford, CA 94305 USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University 300 Pasteur Drive, Room H3580 MC 5640 Stanford, CA 94305 USA
- Department of Biomedical Data Science, Stanford University 1265 Welch Road MC5464 MSOB West Wing, Third Floor Stanford, CA 94305 USA
| | - Brenna Cholerton
- Department of Pathology, Stanford University 300 Pasteur Drive Medicine Lane Building L235 Stanford, CA 94305 USA
| | - Syed Bhukari
- Department of Pathology, Stanford University 300 Pasteur Drive Medicine Lane Building L235 Stanford, CA 94305 USA
| | - Alan L. Chang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University 300 Pasteur Drive, Room H3580 MC 5640 Stanford, CA 94305 USA
- Department of Biomedical Data Science, Stanford University 1265 Welch Road MC5464 MSOB West Wing, Third Floor Stanford, CA 94305 USA
- Department of Pediatrics, Stanford University 453 Quarry Road MC 5660 Palo Alto, CA 94304 USA
| | - Davide De Francesco
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University 300 Pasteur Drive, Room H3580 MC 5640 Stanford, CA 94305 USA
- Department of Biomedical Data Science, Stanford University 1265 Welch Road MC5464 MSOB West Wing, Third Floor Stanford, CA 94305 USA
- Department of Pediatrics, Stanford University 453 Quarry Road MC 5660 Palo Alto, CA 94304 USA
| | - Melan Thuraiappah
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University 300 Pasteur Drive, Room H3580 MC 5640 Stanford, CA 94305 USA
- Department of Biomedical Data Science, Stanford University 1265 Welch Road MC5464 MSOB West Wing, Third Floor Stanford, CA 94305 USA
- Department of Pediatrics, Stanford University 453 Quarry Road MC 5660 Palo Alto, CA 94304 USA
| | - Dana Godrich
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami 1501 NW 10 Ave, Miami, Florida 33136 USA
| | - Amalia Perna
- Department of Pathology, Stanford University 300 Pasteur Drive Medicine Lane Building L235 Stanford, CA 94305 USA
| | - Martin G. Becker
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University 300 Pasteur Drive, Room H3580 MC 5640 Stanford, CA 94305 USA
- Department of Biomedical Data Science, Stanford University 1265 Welch Road MC5464 MSOB West Wing, Third Floor Stanford, CA 94305 USA
- Department of Pediatrics, Stanford University 453 Quarry Road MC 5660 Palo Alto, CA 94304 USA
| | - Neal G. Ravindra
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University 300 Pasteur Drive, Room H3580 MC 5640 Stanford, CA 94305 USA
- Department of Biomedical Data Science, Stanford University 1265 Welch Road MC5464 MSOB West Wing, Third Floor Stanford, CA 94305 USA
- Department of Pediatrics, Stanford University 453 Quarry Road MC 5660 Palo Alto, CA 94304 USA
| | - Camilo Espinosa
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University 300 Pasteur Drive, Room H3580 MC 5640 Stanford, CA 94305 USA
- Department of Biomedical Data Science, Stanford University 1265 Welch Road MC5464 MSOB West Wing, Third Floor Stanford, CA 94305 USA
- Department of Pediatrics, Stanford University 453 Quarry Road MC 5660 Palo Alto, CA 94304 USA
| | - Yeasul Kim
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University 300 Pasteur Drive, Room H3580 MC 5640 Stanford, CA 94305 USA
- Department of Biomedical Data Science, Stanford University 1265 Welch Road MC5464 MSOB West Wing, Third Floor Stanford, CA 94305 USA
- Department of Pediatrics, Stanford University 453 Quarry Road MC 5660 Palo Alto, CA 94304 USA
| | - Eloise Berson
- Department of Pathology, Stanford University 300 Pasteur Drive Medicine Lane Building L235 Stanford, CA 94305 USA
- Department of Biomedical Data Science, Stanford University 1265 Welch Road MC5464 MSOB West Wing, Third Floor Stanford, CA 94305 USA
- Department of Pediatrics, Stanford University 453 Quarry Road MC 5660 Palo Alto, CA 94304 USA
| | - Samson Mataraso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University 300 Pasteur Drive, Room H3580 MC 5640 Stanford, CA 94305 USA
- Department of Biomedical Data Science, Stanford University 1265 Welch Road MC5464 MSOB West Wing, Third Floor Stanford, CA 94305 USA
- Department of Pediatrics, Stanford University 453 Quarry Road MC 5660 Palo Alto, CA 94304 USA
| | - Sharon J. Sha
- Department of Neurology & Neurological Sciences, Stanford University 213 Quarry Road, MC 5979 Palo Alto, CA 94304 USA
| | - Edward J. Fox
- Department of Pathology, Stanford University 300 Pasteur Drive Medicine Lane Building L235 Stanford, CA 94305 USA
| | - Kathleen S. Montine
- Department of Pathology, Stanford University 300 Pasteur Drive Medicine Lane Building L235 Stanford, CA 94305 USA
| | - Laura D. Baker
- Department of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine 475 Vine Street, Winston-Salem, NC 27101 USA
| | - Suzanne Craft
- Department of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine 475 Vine Street, Winston-Salem, NC 27101 USA
| | - Lon White
- Pacific Health Research and Education Institute, Hawaii 3375 Koapaka Street, I-540, Honolulu, HI 96819 USA
| | - Kathleen L. Poston
- Department of Neurology & Neurological Sciences, Stanford University 213 Quarry Road, MC 5979 Palo Alto, CA 94304 USA
| | - Gary Beecham
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami 1501 NW 10 Ave, Miami, Florida 33136 USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University 300 Pasteur Drive, Room H3580 MC 5640 Stanford, CA 94305 USA
- Department of Biomedical Data Science, Stanford University 1265 Welch Road MC5464 MSOB West Wing, Third Floor Stanford, CA 94305 USA
- Department of Pediatrics, Stanford University 453 Quarry Road MC 5660 Palo Alto, CA 94304 USA
| | - Thomas J. Montine
- Department of Pathology, Stanford University 300 Pasteur Drive Medicine Lane Building L235 Stanford, CA 94305 USA
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7
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Krishnamurthy S, Harrison W, Craft S, Lockhart SN, Bateman JR. When prion disease Isn't suspected: prion disease as the cause of terminal decline in chronic mixed dementia. Neurocase 2023; 29:92-97. [PMID: 38687122 PMCID: PMC11145467 DOI: 10.1080/13554794.2024.2346990] [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: 11/13/2023] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
Alzheimer's Disease (AD) is the most common cause of dementia, although multiple pathologies are found in nearly half of the cases with clinically diagnosed AD. Prion diseases, such as Creutzfeldt-Jakob disease (CJD), are rare causes of dementia and typically manifest as a rapidly progressive dementia, where symptom onset to dementia most often occurs over the course of months. In this brief report, we describe a patient's typically progressive dementia with a precipitous decline at the end of their life who, on neuropathological evaluation, was found to have multiple neurodegenerative proteinopathies as well as spongiform encephalopathy due to CJD. This case of unsuspected CJD highlights a rare, but epidemiologically important, cause of sudden decline in well-established neurodegenerative dementias.
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Affiliation(s)
- Sudarshan Krishnamurthy
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - William Harrison
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Suzanne Craft
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Samuel N. Lockhart
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - James R. Bateman
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC
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8
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Bayram E, Holden SK, Fullard M, Armstrong MJ. Race and Ethnicity in Lewy Body Dementia: A Narrative Review. J Alzheimers Dis 2023; 94:861-878. [PMID: 37355902 PMCID: PMC10448838 DOI: 10.3233/jad-230207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
Lewy body dementia is the third most common and costliest type of dementia. It is an umbrella term for dementia with Lewy bodies and Parkinson's disease dementia, both of which place a substantial burden on the person and society. Recent findings outline ethnoracial differences in dementia risk. Delayed and misdiagnosis across ethnoracial groups contribute to higher levels of burden. In this context, we aimed to summarize current knowledge, gaps, and unmet needs relating to race and ethnicity in Lewy body dementia. In this narrative review, we provide an overview of studies on Lewy body dementia focusing on differences across ethnoracial groups and outline several recommendations for future studies. The majority of the findings comparing different ethnoracial groups were from North American sites. There were no differences in clinical prevalence and progression across ethnoracial groups. Compared to people identifying as non-Hispanic White, co-pathologies were more common and clinical diagnostic accuracy was lower for people identifying as Black. Co-morbidities (e.g., diabetes, hypertension) were more common and medication use rates (e.g., antidepressants, antiparkinsonian agents) were lower for people identifying as Black or Hispanic compared to people identifying as White. More than 90% of clinical trial participants identified as non-Hispanic White. Despite increasing efforts to overcome disparities in Alzheimer's disease and related dementias, inclusion of individuals from minoritized communities in Lewy body dementia studies continues to be limited and the findings are inconclusive. Representation of diverse populations is crucial to improve the diagnostic and therapeutic efforts in Lewy body dementia.
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Affiliation(s)
- Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michelle Fullard
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
- Fixel Institute for Neurological Diseases, Gainesville, FL, USA
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9
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McGinnis SM, McCann RF, Patel V, Doughty CT, Miller MB, Gale SA, Silbersweig DA, Daffner KR. Case Study 5: A 74-Year-Old Man With Dysphagia, Weakness, and Memory Loss. J Neuropsychiatry Clin Neurosci 2023; 35:210-217. [PMID: 37448308 DOI: 10.1176/appi.neuropsych.20230030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Scott M McGinnis
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Ruth F McCann
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Viharkumar Patel
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Christopher T Doughty
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Michael B Miller
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Seth A Gale
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - David A Silbersweig
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Kirk R Daffner
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
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10
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Zhu CW, Gu Y, Kociolek AJ, Fernandez KK, Cosentino S, Stern Y. Costs During the Last Five Years of Life for Patients with Clinical and Pathological Confirmed Diagnosis of Lewy Body Dementia and Alzheimer's Disease. J Alzheimers Dis 2023; 92:457-466. [PMID: 36776064 PMCID: PMC10120914 DOI: 10.3233/jad-221021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Little is known regarding healthcare expenditures for patients with dementia with Lewy bodies (DLB) during the end of life. OBJECTIVE This study estimated Medicare expenditures during the last 5 years of life in a decedent sample of patients who were clinically diagnosed with Alzheimer's disease (AD) or DLB and had autopsy confirmed diagnosis. METHODS The study included 58 participants clinically diagnosed with mild dementia at study entry (AD: n = 44, DLB: n = 14) and also had autopsy-confirmed diagnoses of pure AD (n = 32), mixed AD+Lewy body (LB) (n = 5), or pure LB (n = 11). Total Medicare expenditures were compared by clinical and pathology confirmed diagnosis, adjusting for sex, age at death, and patient's cognition, function, comorbidities, and psychiatric and extrapyramidal symptoms. RESULTS When pathology diagnoses were not considered, predicted annualized total Medicare expenditures during the last 5 years of life were similar between clinically diagnosed AD ($7,465±1,098) and DLB ($7,783±1,803). When clinical diagnoses were not considered, predicted expenditures were substantially higher in patients with pathology confirmed mixed AD+LB ($12,005±2,455) than either pure AD ($6,173±941) or pure LB ($4,629±1,968) cases. Considering clinical and pathology diagnosis together, expenditures for patients with clinical DLB and pathology mixed AD+LB ($23,592±3,679) dwarfed other groups. CONCLUSION Medicare expenditures during the last 5 years of life were substantially higher in patients with mixed AD+LB pathology compared to those with pure-AD and pure-LB pathologies, particularly in those clinically diagnosed with DLB. Results highlight the importance of having both clinical and pathology diagnoses in examining healthcare costs.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, Bronx, NY, USA
| | - Yian Gu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anton J. Kociolek
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Kayri K. Fernandez
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Yaakov Stern
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
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11
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Maneval J, Woods JK, Feany MB, Miller MB, Silbersweig DA, Gale SA, Daffner KR, McGinnis SM. Case Study 3: A 58-Year-Old Woman Referred for Evaluation of Suspected Alzheimer Dementia. J Neuropsychiatry Clin Neurosci 2022; 34:307-315. [PMID: 36239480 PMCID: PMC9823288 DOI: 10.1176/appi.neuropsych.20220113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jeffrey Maneval
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - Jared K. Woods
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - Mel B. Feany
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - Michael B. Miller
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - David A. Silbersweig
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - Seth A. Gale
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - Kirk R. Daffner
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - Scott M. McGinnis
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
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