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Lohman T, Kapoor A, Engstrom AC, Shenasa F, Alitin JPM, Gaubert A, Rodgers KE, Bradford D, Mather M, Han SD, Head E, Sordo L, Thayer JF, Nation DA. Central autonomic network dysfunction and plasma Alzheimer's disease biomarkers in older adults. Alzheimers Res Ther 2024; 16:124. [PMID: 38851772 PMCID: PMC11162037 DOI: 10.1186/s13195-024-01486-9] [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: 03/22/2024] [Accepted: 05/24/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Higher order regulation of autonomic function is maintained by the coordinated activity of specific cortical and subcortical brain regions, collectively referred to as the central autonomic network (CAN). Autonomic changes are frequently observed in Alzheimer's disease (AD) and dementia, but no studies to date have investigated whether plasma AD biomarkers are associated with CAN functional connectivity changes in at risk older adults. METHODS Independently living older adults (N = 122) without major neurological or psychiatric disorder were recruited from the community. Participants underwent resting-state brain fMRI and a CAN network derived from a voxel-based meta-analysis was applied for overall, sympathetic, and parasympathetic CAN connectivity using the CONN Functional Toolbox. Sensorimotor network connectivity was studied as a negative control. Plasma levels of amyloid (Aβ42, Aβ40), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP) were assessed using digital immunoassay. The relationship between plasma AD biomarkers and within-network functional connectivity was studied using multiple linear regression adjusted for demographic covariates and Apolipoprotein E (APOE) genotype. Interactive effects with APOE4 carrier status were also assessed. RESULTS All autonomic networks were positively associated with Aβ42/40 ratio and remained so after adjustment for age, sex, and APOE4 carrier status. Overall and parasympathetic networks were negatively associated with GFAP. The relationship between the parasympathetic CAN and GFAP was moderated by APOE4 carrier status, wherein APOE4 carriers with low parasympathetic CAN connectivity displayed the highest plasma GFAP concentrations (B = 910.00, P = .004). Sensorimotor connectivity was not associated with any plasma AD biomarkers, as expected. CONCLUSION The present study findings suggest that CAN function is associated with plasma AD biomarker levels. Specifically, lower CAN functional connectivity is associated with decreased plasma Aβ42/40, indicative of cerebral amyloidosis, and increased plasma GFAP in APOE4 carriers at risk for AD. These findings could suggest higher order autonomic and parasympathetic dysfunction in very early-stage AD, which may have clinical implications.
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Affiliation(s)
- Trevor Lohman
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, CA, USA
| | - Arunima Kapoor
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Allison C Engstrom
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Fatemah Shenasa
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - John Paul M Alitin
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, CA, USA
| | - Aimee Gaubert
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, CA, USA
| | - Kathleen E Rodgers
- Center for Innovations in Brain Science, Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - David Bradford
- Center for Innovations in Brain Science, Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Mara Mather
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, CA, USA
| | - S Duke Han
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA, USA
| | - Lorena Sordo
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA, USA
| | - Julian F Thayer
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Daniel A Nation
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, CA, USA.
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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2
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Wrzesień A, Andrzejewski K, Jampolska M, Kaczyńska K. Respiratory Dysfunction in Alzheimer's Disease-Consequence or Underlying Cause? Applying Animal Models to the Study of Respiratory Malfunctions. Int J Mol Sci 2024; 25:2327. [PMID: 38397004 PMCID: PMC10888758 DOI: 10.3390/ijms25042327] [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: 01/17/2024] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Alzheimer's disease (AD) is a neurodegenerative brain disease that is the most common cause of dementia among the elderly. In addition to dementia, which is the loss of cognitive function, including thinking, remembering, and reasoning, and behavioral abilities, AD patients also experience respiratory disturbances. The most common respiratory problems observed in AD patients are pneumonia, shortness of breath, respiratory muscle weakness, and obstructive sleep apnea (OSA). The latter is considered an outcome of Alzheimer's disease and is suggested to be a causative factor. While this narrative review addresses the bidirectional relationship between obstructive sleep apnea and Alzheimer's disease and reports on existing studies describing the most common respiratory disorders found in patients with Alzheimer's disease, its main purpose is to review all currently available studies using animal models of Alzheimer's disease to study respiratory impairments. These studies on animal models of AD are few in number but are crucial for establishing mechanisms, causation, implementing potential therapies for respiratory disorders, and ultimately applying these findings to clinical practice. This review summarizes what is already known in the context of research on respiratory disorders in animal models, while pointing out directions for future research.
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Affiliation(s)
| | | | | | - Katarzyna Kaczyńska
- Department of Respiration Physiology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland; (A.W.); (K.A.); (M.J.)
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3
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Liu KY, Whitsel EA, Heiss G, Palta P, Reeves S, Lin FV, Mather M, Roiser JP, Howard R. Heart rate variability and risk of agitation in Alzheimer's disease: the Atherosclerosis Risk in Communities Study. Brain Commun 2023; 5:fcad269. [PMID: 37946792 PMCID: PMC10631859 DOI: 10.1093/braincomms/fcad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/24/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023] Open
Abstract
Agitation in Alzheimer's disease is common and may be related to impaired emotion regulation capacity. Heart rate variability, a proposed index of autonomic and emotion regulation neural network integrity, could be associated with agitation propensity in Alzheimer's disease. We used the Atherosclerosis Risk in Communities Study cohort data, collected over seven visits spanning over two decades, to investigate whether heart rate variability (change) was associated with agitation risk in individuals clinically diagnosed with dementia due to Alzheimer's disease. Agitation (absence/presence) at Visit 5, the primary outcome, was based on the Neuropsychiatric Inventory agitation/aggression subscale, or a composite score comprising the total number of agitation/aggression, irritability, disinhibition and aberrant motor behaviour subscales present. Visit 1-5 heart rate variability measures were the log-transformed root mean square of successive differences in R-R intervals and standard deviation of normal-to-normal R-R intervals obtained from resting, supine, standard 12-lead ECGs. To aid interpretability, heart rate variability data were scaled such that model outputs were expressed for each 0.05 log-unit change in heart rate variability (which approximated to the observed difference in heart rate variability with every 5 years of age). Among 456 participants who had dementia, 120 were clinically classified to have dementia solely attributable to Alzheimer's disease. This group showed a positive relationship between heart rate variability and agitation risk in regression models, which was strongest for measures of (potentially vagally mediated) heart rate variability change over the preceding two decades. Here, a 0.05 log-unit of heart rate variability change was associated with an up to 10-fold increase in the odds of agitation and around a half-unit increase in the composite agitation score. Associations persisted after controlling for participants' cognitive status, heart rate (change), sociodemographic factors, co-morbidities and medications with autonomic effects. Further confirmatory studies, incorporating measures of emotion regulation, are needed to support heart rate variability indices as potential agitation propensity markers in Alzheimer's disease and to explore underlying mechanisms as targets for treatment development.
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Affiliation(s)
- Kathy Y Liu
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Priya Palta
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Suzanne Reeves
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Feng V Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Mara Mather
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London WC1N 3AZ, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London W1T 7NF, UK
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4
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Nair SS, Govindankutty MM, Balakrishnan M, Prasad K, Sathyaprabha TN, Udupa K. Investigation of Autonomic Dysfunction in Alzheimer's Disease-A Computational Model-Based Approach. Brain Sci 2023; 13:1322. [PMID: 37759923 PMCID: PMC10526304 DOI: 10.3390/brainsci13091322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background and Objective: Alzheimer's disease (AD) is commonly accompanied by autonomic dysfunction. Investigating autonomic dysfunction's occurrence patterns and severity may aid in making a distinction between different dementia subtypes, as cardiac autonomic dysfunction and AD severity are correlated. Heart rate variability (HRV) allows for a non-invasive assessment of the autonomic nervous system (ANS). AD is characterized by cholinergic depletion. A computational model of ANS based on the kinetics of acetylcholine and norepinephrine is used to simulate HRV for various autonomic states. The model has the flexibility to suitably modulate the concentration of acetylcholine corresponding to different autonomic states. (2) Methods: Twenty clinically plausible AD patients are compared to 20 age- and gender-matched healthy controls using HRV measures. Statistical analysis is performed to identify the HRV parameters that vary significantly in AD. By modulating the acetylcholine concentration in a controlled manner, different autonomic states of Alzheimer's disease are simulated using the ANS model. (3) Results: In patients with AD, there is a significant decrease in vagal activity, sympathovagal imbalance with a dominant sympathetic activity, and change in the time domain, frequency domain, and nonlinear HRV characteristics. Simulated HRV features corresponding to 10 progressive states of AD are presented. (4) Conclusions: There is a significant difference in the HRV features during AD. As cholinergic depletion and autonomic dysfunction have a common neurological basis, autonomic function assessment can help in diagnosis and assessment of AD. Quantitative models may help in better comprehending the pathophysiology of the disease and assessment of its progress.
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Affiliation(s)
| | | | - Minimol Balakrishnan
- Model Engineering College, Cochin University of Science and Technology, Kochi 682022, India
| | - Krishna Prasad
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Talakad N. Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Kaviraja Udupa
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
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5
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Karunungan K, Garza RH, Grodzki AC, Holt M, Lein PJ, Chandrasekaran V. Gamma secretase activity modulates BMP-7-induced dendritic growth in primary rat sympathetic neurons. Auton Neurosci 2023; 247:103085. [PMID: 37031474 PMCID: PMC10330319 DOI: 10.1016/j.autneu.2023.103085] [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: 12/16/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
Autonomic dysfunction has been observed in Alzheimer's disease (AD); however, the effects of genes involved in AD on the peripheral nervous system are not well understood. Previous studies have shown that presenilin-1 (PSEN1), the catalytic subunit of the gamma secretase (γ-secretase) complex, mutations in which are associated with familial AD function, regulates dendritic growth in hippocampal neurons. In this study, we examined whether the γ-secretase pathway also influences dendritic growth in primary sympathetic neurons. Using immunoblotting and immunocytochemistry, molecules of the γ-secretase complex, PSEN1, PSEN2, PEN2, nicastrin and APH1a, were detected in sympathetic neurons dissociated from embryonic (E20/21) rat sympathetic ganglia. Addition of bone morphogenetic protein-7 (BMP-7), which induces dendrites in these neurons, did not alter expression or localization of γ-secretase complex proteins. BMP-7-induced dendritic growth was inhibited by siRNA knockdown of PSEN1 and by three γ-secretase inhibitors, γ-secretase inhibitor IX (DAPT), LY-411575 and BMS-299897. These effects were specific to dendrites and concentration-dependent and did not alter early downstream pathways of BMP signaling. In summary, our results indicate that γ-secretase activity enhances BMP-7 induced dendritic growth in sympathetic neurons. These findings provide insight into the normal cellular role of the γ-secretase complex in sympathetic neurons.
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Affiliation(s)
- Krystal Karunungan
- Department of Biology, Saint Mary's College of California, 1928 Saint Mary's Road, Moraga, CA 94556, United States of America
| | - Rachel H Garza
- Department of Biology, Saint Mary's College of California, 1928 Saint Mary's Road, Moraga, CA 94556, United States of America
| | - Ana Cristina Grodzki
- Department of Molecular Biosciences, University of California, Davis, 1089 Veterinary Medicine Drive, Davis, CA 95616, United States of America
| | - Megan Holt
- Department of Biology, Saint Mary's College of California, 1928 Saint Mary's Road, Moraga, CA 94556, United States of America
| | - Pamela J Lein
- Department of Molecular Biosciences, University of California, Davis, 1089 Veterinary Medicine Drive, Davis, CA 95616, United States of America
| | - Vidya Chandrasekaran
- Department of Biology, Saint Mary's College of California, 1928 Saint Mary's Road, Moraga, CA 94556, United States of America.
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Demura T, Okuno T, Miwa T, Iritani O, Nakano H, Yamamoto J, Shiga H, Kodera K, Morimoto C, Demura N, Morimoto S. Sarcopenia and decline in appendicular skeletal muscle mass are associated with hypoperfusion in key hubs of central autonomic network on 3DSRT in older adults with progression of normal cognition to Alzheimer's disease. Geriatr Gerontol Int 2023; 23:16-24. [PMID: 36527175 PMCID: PMC10107092 DOI: 10.1111/ggi.14515] [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: 09/30/2022] [Revised: 10/30/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
AIM Although sarcopenia is common in patients with Alzheimer's disease (AD), the neural substrates involved remain unclear. We investigated the relationship between sarcopenia, as well as its definition components, and regional cerebral blood flow (rCBF) in older adults with progression of normal cognition to AD. METHODS 99m Tc-ethyl-cysteinate-dimer single-photon emission computed tomography was carried out in 95 older adults with progression of normal cognition to AD (40 men and 55 women, mean ± SD age 80.9 ± 6.8 years). The associations of rCBF determined by 3-D stereotactic region of interest template software, with sarcopenia and its definition components, slower gait speed, weaker grip strength, and decline in appendicular skeletal muscle mass index (ASMI) were analyzed. RESULTS Logistic regression analysis adjusted by age, sex, mini-mental state examination score and education showed that sarcopenia as well as ASMI less than the cut-off (men 7.0 kg/m2 , women 5.7 kg/m2 ) were associated with significantly reduced rCBF in the key hub of the central autonomic network, including the insula, anterior cingulate cortex, subcallosal area, rectal gyrus, hypothalamus, amygdala and caudate head. Sarcopenia and ASMI decline were associated with hypoperfusion in the aforementioned cortical hubs of the central autonomic network in men, but with hypoperfusion of the hypothalamus in women. Linear regression analysis showed significant correlations of ASMI/cut-off with rCBF in the bilateral medial frontal cortex, as well as rCBF in the aforementioned key hubs. CONCLUSIONS Hypoperfusion in key hubs of central autonomic network is implicated in the emergence of sarcopenia, probably through ASMI decline in vulnerable older adults. Geriatr Gerontol Int 2023; 23: 16-24.
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Affiliation(s)
- Taichi Demura
- Department of Oral and Maxillofacial SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Tazuo Okuno
- Center for Comprehensive Care on Memory DisordersKanazawa Medical UniversityUchinadaJapan
| | - Takaki Miwa
- Department of OtorhinolaryngologyKanazawa Medical UniversityUchinadaJapan
| | - Osamu Iritani
- Center for Comprehensive Care on Memory DisordersKanazawa Medical UniversityUchinadaJapan
| | - Hiroyuki Nakano
- Department of Oral and Maxillofacial SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Junpei Yamamoto
- Department of OtorhinolaryngologyKanazawa Medical UniversityUchinadaJapan
| | - Hideaki Shiga
- Department of OtorhinolaryngologyKanazawa Medical UniversityUchinadaJapan
| | - Kumie Kodera
- Center for Comprehensive Care on Memory DisordersKanazawa Medical UniversityUchinadaJapan
| | - Chihiro Morimoto
- Department of Oral and Maxillofacial SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Noboru Demura
- Department of Oral and Maxillofacial SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Shigeto Morimoto
- Center for Comprehensive Care on Memory DisordersKanazawa Medical UniversityUchinadaJapan
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7
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Guo C, Wen D, Zhang Y, Mustaklem R, Mustaklem B, Zhou M, Ma T, Ma YY. Amyloid-β oligomers in the nucleus accumbens decrease motivation via insertion of calcium-permeable AMPA receptors. Mol Psychiatry 2022; 27:2146-2157. [PMID: 35105968 PMCID: PMC9133055 DOI: 10.1038/s41380-022-01459-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/31/2021] [Accepted: 01/18/2022] [Indexed: 12/17/2022]
Abstract
It is essential to identify the neuronal mechanisms of Alzheimer's Disease (AD)-associated neuropsychiatric symptoms, e.g., apathy, before improving the life quality of AD patients. Here, we focused on the nucleus accumbens (NAc), a critical brain region processing motivation, also known to display AD-associated pathological changes in human cases. We found that the synaptic calcium permeable (CP)-AMPA receptors (AMPARs), which are normally absent in the NAc, can be revealed by acute exposure to Aβ oligomers (AβOs), and play a critical role in the emergence of synaptic loss and motivation deficits. Blockade of NAc CP-AMPARs can effectively prevent AβO-induced downsizing and pruning of spines and silencing of excitatory synaptic transmission. We conclude that AβO-triggered synaptic insertion of CP-AMPARs is a key mechanism mediating synaptic degeneration in AD, and preserving synaptic integrity may prevent or delay the onset of AD-associated psychiatric symptoms.
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Affiliation(s)
- Changyong Guo
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Di Wen
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Yihong Zhang
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Richie Mustaklem
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Basil Mustaklem
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Miou Zhou
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Tao Ma
- Department of Internal Medicine-Gerontology and Geriatric Medicine; Department of Physiology and Pharmacology; Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Yao-Ying Ma
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA. .,Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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8
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Liu F, Zhang Z, Zhang L, Meng RN, Gao J, Jin M, Li M, Wang XP. Effect of metal ions on Alzheimer's disease. Brain Behav 2022; 12:e2527. [PMID: 35212185 PMCID: PMC8933773 DOI: 10.1002/brb3.2527] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/22/2021] [Accepted: 01/29/2022] [Indexed: 11/11/2022] Open
Abstract
Alzheimer's disease (AD) is a degenerative disease of the nervous system. The typical pathological changes of AD are Aβ deposition, neurofibrillary tangles, neuron loss, and chronic inflammation. The balance of metal ions is essential for numerous physiological functions, especially in the central nervous system. More studies showed that metal ions participate in the development of AD. However, the involvement of metal ions in AD is controversial. Thus, we reviewed articles about the relationship between metal ions and AD and discussed some contradictory reports in order to better understand the role of metal ions in AD.
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Affiliation(s)
- Fan Liu
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhuo Zhang
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lin Zhang
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ruo-Ni Meng
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jia Gao
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ming Jin
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ming Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiao-Peng Wang
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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9
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Liu KY, Elliott T, Knowles M, Howard R. Heart rate variability in relation to cognition and behavior in neurodegenerative diseases: A systematic review and meta-analysis. Ageing Res Rev 2022; 73:101539. [PMID: 34883203 PMCID: PMC8783051 DOI: 10.1016/j.arr.2021.101539] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/05/2021] [Accepted: 12/03/2021] [Indexed: 12/24/2022]
Abstract
Neurodegenerative diseases, which frequently present with neuropsychiatric symptoms related to prefrontal cortical dysfunction, can alter the integrity of the neural networks involved in central autonomic nervous system regulation, which is proposed to be indexed by heart rate variability (HRV). We systematically reviewed the characteristics, methodology and outcomes of 27 studies of HRV in relation to measures of cognition and behavior in neurodegenerative conditions, and assessed the strength of this relationship, cross-sectionally, across 18 studies. A significant, moderate effect was observed (r = 0.25), such that higher HRV was related to better cognitive and behavioral scores, which was not influenced by mean age or cognitive status. There was no evidence of small-study effects but we could not rule out publication bias, and other factors may have contributed to heterogeneity between studies. Our findings support the proposal that HRV may be a marker of self-regulatory processes in neurodegenerative conditions, and further research on this association is needed in relation to neuropsychiatric symptoms and alongside neuroimaging methods. Heart rate variability is proposed to be influenced by a neural network involved in autonomic regulation. Neurodegenerative processes alter the integrity of the central autonomic network. We reviewed studies of HRV and cognition/behavior in neurodegenerative diseases. We found a moderate correlation between HRV and measures of cognition/behavior.
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10
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Iaccarino L, Sala A, Caminiti SP, Presotto L, Perani D. In vivo MRI Structural and PET Metabolic Connectivity Study of Dopamine Pathways in Alzheimer's Disease. J Alzheimers Dis 2021; 75:1003-1016. [PMID: 32390614 DOI: 10.3233/jad-190954] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is characterized by an involvement of brain dopamine (DA) circuitry, the presence of which has been associated with emergence of both neuropsychiatric symptoms and cognitive deficits. OBJECTIVE In order to investigate whether and how the DA pathways are involved in the pathophysiology of AD, we assessed by in vivo neuroimaging the structural and metabolic alterations of subcortical and cortical DA pathways and targets. METHODS We included 54 healthy control participants, 53 amyloid-positive subjects with mild cognitive impairment due to AD (MCI-AD), and 60 amyloid-positive patients with probable dementia due to AD (ADD), all with structural 3T MRI and 18F-FDG-PET scans. We assessed MRI-based gray matter reductions in the MCI-AD and ADD groups within an anatomical a priori-defined Nigrostriatal and Mesocorticolimbic DA pathways, followed by 18F-FDG-PET metabolic connectivity analyses to evaluate network-level metabolic connectivity changes. RESULTS We found significant tissue loss in the Mesocorticolimbic over the Nigrostriatal pathway. Atrophy was evident in the ventral striatum, orbitofrontal cortex, and medial temporal lobe structures, and already plateaued in the MCI-AD stage. Degree of atrophy in Mesocorticolimbic regions positively correlated with the severity of depression, anxiety, and apathy in MCI-AD and ADD subgroups. Additionally, we observed significant alterations of metabolic connectivity between the ventral striatum and fronto-cingulate regions in ADD, but not in MCI-AD. There were no metabolic connectivity changes within the Nigrostriatal pathway. CONCLUSION Our cross-sectional data support a clinically-meaningful, yet stage-dependent, involvement of the Mesocorticolimbic system in AD. Longitudinal and clinical correlation studies are needed to further establish the relevance of DA system involvement in AD.
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Affiliation(s)
- Leonardo Iaccarino
- Vita-Salute San Raffaele University, Milan, Italy.,In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Memory and Aging Center, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Arianna Sala
- Vita-Salute San Raffaele University, Milan, Italy.,In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Paola Caminiti
- Vita-Salute San Raffaele University, Milan, Italy.,In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Presotto
- In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy.,In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
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11
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Bakker C, Tasker T, Liptrot J, Hart EP, Klaassen ES, Prins S, van der Doef TF, Brown GA, Brown A, Congreve M, Weir M, Marshall FH, Cross DM, Groeneveld GJ, Nathan PJ. First-in-man study to investigate safety, pharmacokinetics and exploratory pharmacodynamics of HTL0018318, a novel M 1 -receptor partial agonist for the treatment of dementias. Br J Clin Pharmacol 2021; 87:2945-2955. [PMID: 33351971 PMCID: PMC8359307 DOI: 10.1111/bcp.14710] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/23/2022] Open
Abstract
AIMS HTL0018318 is a selective M1 receptor partial agonist currently under development for the symptomatic treatment of cognitive and behavioural symptoms in Alzheimer's disease and other dementias. We investigated safety, tolerability, pharmacokinetics and exploratory pharmacodynamics (PD) of HTL0018318 following single ascending doses. METHODS This randomized, double-blind, placebo-controlled study in 40 healthy younger adult and 57 healthy elderly subjects, investigated oral doses of 1-35 mg HTL0018318. Pharmacodynamic assessments were performed using a battery of neurocognitive tasks and electrophysiological measurements. Cerebrospinal fluid concentrations of HTL0018318 and food effects on pharmacokinetics of HTL0018318 were investigated in an open label and partial cross-over design in 14 healthy subjects. RESULTS Pharmacokinetics of HTL0018318 were well-characterized showing dose proportional increases in exposure from 1-35 mg. Single doses of HTL0018318 were associated with mild dose-related adverse events of low incidence in both younger adult and elderly subjects. The most frequently reported cholinergic AEs included hyperhidrosis and increases in blood pressure up to 10.3 mmHg in younger adults (95% CI [4.2-16.3], 35-mg dose) and up to 11.9 mmHg in elderly subjects (95% CI [4.9-18.9], 15-mg dose). There were no statistically significant effects on cognitive function but the study was not powered to detect small to moderate effect sizes of clinical relevance. CONCLUSION HTL0018318 showed well-characterized pharmacokinetics and following single doses were generally well tolerated in the dose range studied. These provide encouraging data in support of the development for HTL0018318 for Alzheimer's disease and other dementias.
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Affiliation(s)
| | | | | | - Ellen P Hart
- Centre for Human Drug Research (CDHR), Leiden, Netherlands
| | | | - Samantha Prins
- Centre for Human Drug Research (CDHR), Leiden, Netherlands
| | | | | | | | | | | | | | | | - Geert Jan Groeneveld
- Centre for Human Drug Research (CDHR), Leiden, Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Pradeep J Nathan
- Sosei Heptares, Cambridge, UK.,Department of Psychiatry, University of Cambridge, UK.,School of Psychological Sciences, Monash University, Australia
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12
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Li YT, Chang CY, Hsu YC, Fuh JL, Kuo WJ, Yeh JNT, Lin FH. Impact of physiological noise in characterizing the functional MRI default-mode network in Alzheimer's disease. J Cereb Blood Flow Metab 2021; 41:166-181. [PMID: 32070180 PMCID: PMC7747160 DOI: 10.1177/0271678x19897442] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The functional connectivity of the default-mode network (DMN) monitored by functional magnetic resonance imaging (fMRI) in Alzheimer's disease (AD) patients has been found weaker than that in healthy participants. Since breathing and heart beating can cause fluctuations in the fMRI signal, these physiological activities may affect the fMRI data differently between AD patients and healthy participants. We collected resting-state fMRI data from AD patients and age-matched healthy participants. With concurrent cardiac and respiratory recordings, we estimated both physiological responses phase-locked and non-phase-locked to heart beating and breathing. We found that the cardiac and respiratory physiological responses in AD patients were 3.00 ± 0.51 s and 3.96 ± 0.52 s later (both p < 0.0001) than those in healthy participants, respectively. After correcting the physiological noise in the resting-state fMRI data by population-specific physiological response functions, the DMN estimated by seed-correlation was more localized to the seed region. The DMN difference between AD patients and healthy controls became insignificant after suppressing physiological noise. Our results indicate the importance of controlling physiological noise in the resting-state fMRI analysis to obtain clinically related characterizations in AD.
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Affiliation(s)
- Yi-Tien Li
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Medical Imaging, Taipei Medical University - Shuang-Ho Hospital, New Taipei, Taiwan
| | - Chun-Yuan Chang
- Department of Neurology, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Yi-Cheng Hsu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Jong-Ling Fuh
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
| | - Wen-Jui Kuo
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Jhy-Neng Tasso Yeh
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Fa-Hsuan Lin
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada.,Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
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13
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Rangon CM, Krantic S, Moyse E, Fougère B. The Vagal Autonomic Pathway of COVID-19 at the Crossroad of Alzheimer's Disease and Aging: A Review of Knowledge. J Alzheimers Dis Rep 2020; 4:537-551. [PMID: 33532701 PMCID: PMC7835993 DOI: 10.3233/adr-200273] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
Coronavirus Disease 2019 (COVID-19) pandemic-triggered mortality is significantly higher in older than in younger populations worldwide. Alzheimer's disease (AD) is related to aging and was recently reported to be among the major risk factors for COVID-19 mortality in older people. The symptomatology of COVID-19 indicates that lethal outcomes of infection rely on neurogenic mechanisms. The present review compiles the available knowledge pointing to the convergence of COVID-19 complications with the mechanisms of autonomic dysfunctions in AD and aging. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is prone to neuroinvasion from the lung along the vagus nerve up to the brainstem autonomic nervous centers involved in the coupling of cardiovascular and respiratory rhythms. The brainstem autonomic network allows SARS-CoV-2 to trigger a neurogenic switch to hypertension and hypoventilation, which may act in synergy with aging- and AD-induced dysautonomias, along with an inflammatory "storm". The lethal outcomes of COVID-19, like in AD and unhealthy aging, likely rely on a critical hypoactivity of the efferent vagus nerve cholinergic pathway, which is involved in lowering cardiovascular pressure and systemic inflammation tone. We further discuss the emerging evidence supporting the use of 1) the non-invasive stimulation of vagus nerve as an additional therapeutic approach for severe COVID-19, and 2) the demonstrated vagal tone index, i.e., heart rate variability, via smartphone-based applications as a non-serological low-cost diagnostic of COVID-19. These two well-known medical approaches are already available and now deserve large-scale testing on human cohorts in the context of both AD and COVID-19.
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Affiliation(s)
- Claire-Marie Rangon
- Pain and Neuromodulation Unit, Division of Neurosurgery, Hôpital Fondation Ophtalmologique A. De Rothschild, Paris, France
| | - Slavica Krantic
- Sorbonne Université, St. Antoine Research Center (CRSA), Inserm UMRS-938, Hopital St-Antoine, Paris, France
| | - Emmanuel Moyse
- INRAE Centre Val-de-Loire, Physiology of Reproduction and Behavior Unit (PRC, UMR-85), Team ER2, Nouzilly, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France
- Education, Ethics, Health (EA 7505), Tours University, Tours, France
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14
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Kuzmin VS, Potekhina VM, Odnoshivkina YG, Chelombitko MA, Fedorov AV, Averina OA, Borodkov AS, Shevtsova AA, Lovat ML, Petrov AM. Proarrhythmic atrial ectopy associated with heart sympathetic innervation dysfunctions is specific for murine B6CBAF1 hybrid strain. Life Sci 2020; 266:118887. [PMID: 33316264 DOI: 10.1016/j.lfs.2020.118887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 11/20/2022]
Abstract
A lot of animal models are developed with aim to advance in atrial fibrillation (AF) understanding. The hybrid B6CBAF1 mice are used extensively as a background to create manifestation of various diseases, however, their atrial electrophysiology, autonomic sympathetic innervation of the heart and potential for AF investigation is poorly characterized. In the present study we used ECG and microelectrode recordings from multicellular atrial preparations to reveal attributes of atrial electrical activity in B6CBAF1. Also, experiments with a fluorescent false monoamine neurotransmitter and glyoxylic acid-based staining were carried out to characterize functionally and morphologically catecholaminergic innervation of the B6CBAF1 atria. Atrial myocardium of B6CBAF1 is highly prone to ectopic automaticity and exhibits abnormal spontaneous action potential accompanied by multiple postdepolarizations that result in proarrhythmic triggered activity unlike two parental C57Bl/6 and CBA strains. In vivo experiments revealed that B6CBAF1 hybrids are more susceptible to the norepinephrine induced AF. Also, sympathetic nerve terminals are partially dysfunctional in B6CBAF1 revealing lower ability to accumulate and release neurotransmitters unlike two parental strains. The analysis of the heart rate variability revealed suppressed sympathetic component of the autonomic heart control in B6CBAF1. The organization of sympathetic innervation is very similar morphologically in all three murine strains however the abundance of non-bifurcated catecholamine-positive fibers in B6CBAF1 was increased. These results suggest that B6CBAF1 mice exhibit enhanced intrinsic atrial proarrhythmicity, while the abnormalities of sympathetic neurotransmitter cycling probably underlie disturbed autonomic heart control.
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Affiliation(s)
- Vlad S Kuzmin
- Lomonosov Moscow State University, Biological Faculty, Department of Human and Animal Physiology, Leninskie gory 1, building 12, 119991 Moscow, Russia; Pirogov Russian National Research Medical University (RNRMU), Ostrovitjanova 1, 117997 Moscow, Russia
| | - Viktoriia M Potekhina
- Lomonosov Moscow State University, Biological Faculty, Department of Human and Animal Physiology, Leninskie gory 1, building 12, 119991 Moscow, Russia.
| | | | - Maria A Chelombitko
- The A.N. Belozersky Institute of Physico-Chemical Biology, MSU, Moscow, Russia
| | - Artem V Fedorov
- Lomonosov Moscow State University, Biological Faculty, Department of Human and Animal Physiology, Leninskie gory 1, building 12, 119991 Moscow, Russia
| | - Olga A Averina
- The A.N. Belozersky Institute of Physico-Chemical Biology, MSU, Moscow, Russia; Institute of Functional Genomics, Lomonosov Moscow State University, Moscow, Russia
| | - Alexey S Borodkov
- Vernadsky Institute of Geochemistry and Analytical Chemistry of Russian Academу of Sciences, Moscow, Russia
| | - Anna A Shevtsova
- Lomonosov Moscow State University, Faculty of Biology, Department of Genetics, Moscow, Russia
| | - Maxim L Lovat
- Lomonosov Moscow State University, Biological Faculty, Department of Human and Animal Physiology, Leninskie gory 1, building 12, 119991 Moscow, Russia
| | - Alexey M Petrov
- Institute of Neuroscience, Kazan State Medial University, Kazan, Russia; Laboratory of Biophysics of Synaptic Processes, Kazan Institute of Biochemistry and Biophysics, Federal Research Center "Kazan Scientific Center of RAS", Kazan, Russia
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15
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Bown CW, Do R, Khan OA, Liu D, Cambronero FE, Moore EE, Osborn KE, Gupta DK, Pechman KR, Mendes LA, Hohman TJ, Gifford KA, Jefferson AL. Lower Cardiac Output Relates to Longitudinal Cognitive Decline in Aging Adults. Front Psychol 2020; 11:569355. [PMID: 33240156 PMCID: PMC7680861 DOI: 10.3389/fpsyg.2020.569355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/08/2020] [Indexed: 11/13/2022] Open
Abstract
Background Subclinical reductions in cardiac output correspond to lower cerebral blood flow (CBF), placing the brain at risk for functional changes. Objectives This study aims to establish the consequences of reduced cardiac output on longitudinal cognitive outcomes in aging adults. Methods Vanderbilt Memory and Aging Project participants free of clinical dementia and heart failure (n = 306, 73 ± 7, 58% male) underwent baseline echocardiography to assess cardiac output (L/min) and longitudinal neuropsychological assessment at baseline, 18 months, 3 and 5 years. Linear mixed-effects regressions related cardiac output to trajectory for each longitudinal neuropsychological outcome, adjusting for age, sex, race/ethnicity, education, body surface area, Framingham Stroke Risk Profile score, apolipoprotein E (APOE) ε4 status and follow-up time. Models were repeated, testing interactions with cognitive diagnosis and APOE-ε4 status. Results Lower baseline cardiac output related to faster declines in language (β = 0.11, p = 0.01), information processing speed (β = 0.31, p = 0.006), visuospatial skills (β = 0.09, p = 0.03), and episodic memory (β = 0.02, p = 0.001). No cardiac output x cognitive diagnosis interactions were observed (p > 0.26). APOE-ε4 status modified the association between cardiac output and longitudinal episodic memory (β = 0.03, p = 0.047) and information processing speed outcomes (β = 0.55, p = 0.02) with associations stronger in APOE-ε4 carriers. Conclusion The present study provides evidence that even subtle reductions in cardiac output may be associated with more adverse longitudinal cognitive health, including worse language, information processing speed, visuospatial skills, and episodic memory performances. Preservation of healthy cardiac functioning is important for maintaining optimal brain aging among older adults.
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Affiliation(s)
- Corey W Bown
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, United States
| | - Rachel Do
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, United states
| | - Omair A Khan
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Dandan Liu
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Francis E Cambronero
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, United States
| | - Elizabeth E Moore
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, United States.,Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, United states
| | - Katie E Osborn
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Deepak K Gupta
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Heart Imaging Core Lab, Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kimberly R Pechman
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lisa A Mendes
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Timothy J Hohman
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, United States.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Katherine A Gifford
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Angela L Jefferson
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, United States.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
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16
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Lennon MJ, Makkar SR, Crawford JD, Sachdev PS. Midlife Hypertension and Alzheimer's Disease: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2020; 71:307-316. [PMID: 31381518 DOI: 10.3233/jad-190474] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hypertension is an established risk factor for stroke and vascular dementia but recent meta-analyses examining the association between Alzheimer's disease (AD) and hypertension have found no significant association. These meta-analyses included short term studies starting in late life which may have obscured the real effect of midlife hypertension. OBJECTIVE To examine the association of AD with midlife hypertension, by including only studies with a sufficiently long follow up duration. METHODS Relevant studies were found by searches of MEDLINE, EMBASE, and PubMed. Study outcomes were grouped by measures of blood pressure and definition of hypertension (e.g., systolic hypertension > 140 mmHg or > 160 mmHg). We assessed pooled effect estimates using random effects models and heterogeneity of pooled estimates through the I2 statistic. RESULTS Literature search found 3,426 publications of which 7 were eligible studies. There was a significant association between systolic hypertension (>160 mm Hg) and AD (HR 1.25, 95CI 1.06 - 1.47, p = 0.0065). Similarly, for systolic hypertension > 140 mm Hg, there was a smaller but still significant association (HR 1.18, 95CI 1.02 - 1.35, p = 0.021). For diastolic hypertension, all four studies found no significant associations between diastolic hypertension and AD, and these data could not be pooled due to heterogeneity in reporting. CONCLUSIONS Our study found that midlife stage 1 and stage 2 systolic hypertension is associated with increased risk of AD by 18 and 25%, respectively, although no association was found for diastolic hypertension. It is likely that assertive control of systolic hypertension starting in midlife is important to preventing AD.
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Affiliation(s)
- Matthew J Lennon
- School of Medicine, University of New South Wales, NSW, Australia.,Centre for Healthy Brain Aging, University of New South Wales, NSW, Australia
| | - Steve R Makkar
- School of Medicine, University of New South Wales, NSW, Australia.,Centre for Healthy Brain Aging, University of New South Wales, NSW, Australia
| | - John D Crawford
- School of Medicine, University of New South Wales, NSW, Australia.,Centre for Healthy Brain Aging, University of New South Wales, NSW, Australia
| | - Perminder S Sachdev
- School of Medicine, University of New South Wales, NSW, Australia.,Centre for Healthy Brain Aging, University of New South Wales, NSW, Australia.,Department of Neuropsychiatry, Prince of Wales Hospital, NSW, Australia
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17
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Tulbă D, Cozma L, Popescu BO, Davidescu EI. Dysautonomia in Alzheimer's Disease. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E337. [PMID: 32650427 PMCID: PMC7404689 DOI: 10.3390/medicina56070337] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022]
Abstract
Alzheimer's disease is the most common neurodegenerative disorder, and its prevalence increases with age. Although there is a large amount of scientific literature focusing on Alzheimer's disease cardinal cognitive features, autonomic nervous system dysfunction remains understudied despite being common in the elderly. In this article, we reviewed the evidence for autonomic nervous system involvement in Alzheimer's disease. We identified four major potential causes for dysautonomia in Alzheimer's disease, out of which two are well-studied (comorbidities and medication) and two are rather hypothetical (Alzheimer's pathology and brain co-pathology). Although there appears to be some evidence linking Alzheimer's disease pathology to autonomic nervous system dysfunction, there is an important gap between two types of studies; histopathologic studies do not address dysautonomia manifestations, whereas clinical studies do not employ histopathologic diagnostic confirmation. Moreover, brain co-pathology is emerging as an important confounding factor. Therefore, we consider the correlation between dysautonomia and Alzheimer's disease to be an open question that needs further study. Nevertheless, given its impact on morbidity and mortality, we emphasize the importance of assessing autonomic dysfunction in patients with Alzheimer clinical syndrome.
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Affiliation(s)
- Delia Tulbă
- Department of Neurology, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19–21, 020125 Bucharest, Romania; (D.T.); (L.C.); (E.I.D.)
- Colentina—Research and Development Center, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19–21, 020125 Bucharest, Romania
- Department of Clinical Neurosciences, School of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, 050474 Bucharest, Romania
| | - Liviu Cozma
- Department of Neurology, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19–21, 020125 Bucharest, Romania; (D.T.); (L.C.); (E.I.D.)
- Department of Clinical Neurosciences, School of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, 050474 Bucharest, Romania
| | - Bogdan Ovidiu Popescu
- Department of Neurology, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19–21, 020125 Bucharest, Romania; (D.T.); (L.C.); (E.I.D.)
- Department of Clinical Neurosciences, School of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, 050474 Bucharest, Romania
- Laboratory of Cell Biology, Neurosciences and Experimental Myology, Victor Babeș National Institute of Pathology, Splaiul Independenței 99–101, 050096 Bucharest, Romania
| | - Eugenia Irene Davidescu
- Department of Neurology, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19–21, 020125 Bucharest, Romania; (D.T.); (L.C.); (E.I.D.)
- Department of Clinical Neurosciences, School of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, 050474 Bucharest, Romania
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18
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Neurostimulation techniques to enhance sleep and improve cognition in aging. Neurobiol Dis 2020; 141:104865. [DOI: 10.1016/j.nbd.2020.104865] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/16/2020] [Accepted: 04/02/2020] [Indexed: 01/09/2023] Open
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19
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Lorenzi RM, Palesi F, Castellazzi G, Vitali P, Anzalone N, Bernini S, Cotta Ramusino M, Sinforiani E, Micieli G, Costa A, D’Angelo E, Gandini Wheeler-Kingshott CAM. Unsuspected Involvement of Spinal Cord in Alzheimer Disease. Front Cell Neurosci 2020; 14:6. [PMID: 32082122 PMCID: PMC7002560 DOI: 10.3389/fncel.2020.00006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Brain atrophy is an established biomarker for dementia, yet spinal cord involvement has not been investigated to date. As the spinal cord is relaying sensorimotor control signals from the cortex to the peripheral nervous system and vice-versa, it is indeed a very interesting question to assess whether it is affected by atrophy due to a disease that is known for its involvement of cognitive domains first and foremost, with motor symptoms being clinically assessed too. We, therefore, hypothesize that in Alzheimer's disease (AD), severe atrophy can affect the spinal cord too and that spinal cord atrophy is indeed an important in vivo imaging biomarker contributing to understanding neurodegeneration associated with dementia. Methods: 3DT1 images of 31 AD and 35 healthy control (HC) subjects were processed to calculate volume of brain structures and cross-sectional area (CSA) and volume (CSV) of the cervical cord [per vertebra as well as the C2-C3 pair (CSA23 and CSV23)]. Correlated features (ρ > 0.7) were removed, and the best subset identified for patients' classification with the Random Forest algorithm. General linear model regression was used to find significant differences between groups (p ≤ 0.05). Linear regression was implemented to assess the explained variance of the Mini-Mental State Examination (MMSE) score as a dependent variable with the best features as predictors. Results: Spinal cord features were significantly reduced in AD, independently of brain volumes. Patients classification reached 76% accuracy when including CSA23 together with volumes of hippocampi, left amygdala, white and gray matter, with 74% sensitivity and 78% specificity. CSA23 alone explained 13% of MMSE variance. Discussion: Our findings reveal that C2-C3 spinal cord atrophy contributes to discriminate AD from HC, together with more established features. The results show that CSA23, calculated from the same 3DT1 scan as all other brain volumes (including right and left hippocampi), has a considerable weight in classification tasks warranting further investigations. Together with recent studies revealing that AD atrophy is spread beyond the temporal lobes, our result adds the spinal cord to a number of unsuspected regions involved in the disease. Interestingly, spinal cord atrophy explains also cognitive scores, which could significantly impact how we model sensorimotor control in degenerative diseases with a primary cognitive domain involvement. Prospective studies should be purposely designed to understand the mechanisms of atrophy and the role of the spinal cord in AD.
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Affiliation(s)
| | - Fulvia Palesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroradiology Unit, Brain MRI 3T Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Gloria Castellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Paolo Vitali
- Neuroradiology Unit, Brain MRI 3T Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Sara Bernini
- Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Cotta Ramusino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Sinforiani
- Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Micieli
- Department of Emergency Neurology, IRCCS Mondino Foundation, Pavia, Italy
| | - Alfredo Costa
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Pavia, Italy
| | - Egidio D’Angelo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Brain Connectivity Center (BCC), IRCCS Mondino Foundation, Pavia, Italy
| | - Claudia A. M. Gandini Wheeler-Kingshott
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
- Brain MRI 3T Research Center, IRCCS Mondino Foundation, Pavia, Italy
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20
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Brown AG, Thapa M, Hooker JW, Ostrowski TD. Impaired chemoreflex correlates with decreased c-Fos in respiratory brainstem centers of the streptozotocin-induced Alzheimer's disease rat model. Exp Neurol 2018; 311:285-292. [PMID: 30359566 DOI: 10.1016/j.expneurol.2018.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/17/2018] [Accepted: 10/20/2018] [Indexed: 12/29/2022]
Abstract
Besides impairment in cognition and memory, patients with Alzheimer's disease (AD) often exhibit marked dysfunction in respiratory control. Sleep-disordered breathing (SDB) is commonly found in cases of AD, resulting in periods of hypoxia during sleep. Early structural changes in brainstem areas controlling respiratory function may account for SDB in the course of AD. However, to date the underlying mechanisms for these complications are not known. The streptozotocin (STZ)-induced rat model of AD exhibits abnormal responses to hypoxia and increased astrogliosis in a key region for respiratory control. In this study we further defined the pathophysiological respiratory response of STZ-AD rats to 10% O2. In addition, we analyzed hypoxia-induced neuronal activation in respiratory and cardiovascular nuclei of the dorsal and ventral brainstem. Two hours of hypoxia induced a transient increase in tidal volume that was followed by a prolonged increase in respiratory rate. Only respiratory rate was significantly blunted in the STZ-AD model, which continued over the entire duration of the hypoxic episode. Analysis of c-Fos expression as a marker for neuronal activation showed abundant labeling throughout the nTS, nuclei of the ventral respiratory column, and A1/C1 cells of cardiovascular centers in the ventral brainstem. STZ-AD rats showed a significant decrease of c-Fos labeling in the caudal/medial nTS, rostral ventral respiratory group, and Bötzinger complex. c-Fos in other respiratory centers and A1/C1 cells was unaltered when compared to control. The results of this study document a region-specific impact of STZ-induced AD in respiratory brainstem nuclei. This decrease in c-Fos expression correlates with the observed blunting of respiration to hypoxia in the STZ-AD rat model.
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Affiliation(s)
- Andrea G Brown
- Department of Physiology, Kirksville College of Osteopathic Medicine, A.T. Still University of Health Sciences, Kirksville, MO, USA
| | - Mahima Thapa
- Department of Biology, Truman State University, Kirksville, MO, USA
| | - John W Hooker
- Department of Biology, Truman State University, Kirksville, MO, USA
| | - Tim D Ostrowski
- Department of Physiology, Kirksville College of Osteopathic Medicine, A.T. Still University of Health Sciences, Kirksville, MO, USA.
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21
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Singh G, Samavedham L, Lim ECH. Determination of Imaging Biomarkers to Decipher Disease Trajectories and Differential Diagnosis of Neurodegenerative Diseases (DIsease TreND). J Neurosci Methods 2018; 305:105-116. [PMID: 29800593 DOI: 10.1016/j.jneumeth.2018.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 01/30/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Understanding disease progression of neurodegenerative diseases (NDs) is important for better prognosis and decisions on the appropriate course of treatment to slow down the disease progression. NEW METHOD We present here an innovative machine learning framework capable of (1) indicating the trajectory of disease progression by identifying relevant imaging biomarkers and (2) automated disease diagnosis. Self-Organizing Maps (SOM) have been used for data dimensionality reduction and to reveal potentially useful disease-specific biomarkers, regions of interest (ROIs). These ROIs have been used for automated disease diagnosis using Least Square Support Vector Machines (LS-SVM) and to delineate disease progression. RESULTS A multi-site, multi-scanner dataset containing 1316 MRIs was obtained from ADNI3 and PPMI. Identified biomarkers have been used to decipher (1) trajectory of disease progression and (2) identify clinically relevant ROIs. Furthermore, we have obtained a classification accuracy of 94.29 ± 0.08% and 95.37 ± 0.02% for distinguishing AD and PD from HC subjects respectively. COMPARISON WITH OTHER EXISTING METHODS The goal of this study was fundamentally different from other machine learning based studies for automated disease diagnosis. We aimed to develop a method that has two-fold benefits (1) It can be used to understand pathology of neurodegenerative diseases and (2) It also achieves automated disease diagnosis. CONCLUSIONS In the absence of established disease biomarkers, clinical diagnosis is heavily prone to misdiagnosis. Being clinically relevant and readily adaptable in the current clinical settings, the developed framework could be a stepping stone to make machine learning based Clinical Decision Support System (CDSS) for neurodegenerative disease diagnosis a reality.
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Affiliation(s)
- Gurpreet Singh
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Singapore; Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, United States.
| | - Lakshminarayanan Samavedham
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Singapore; Residential College 4, 8 College Avenue West, #02-16W, Education Resource Centre, Singapore 138608, Singapore.
| | - Erle Chuen-Hian Lim
- Department of Neurology, National University Health System, National University of Singapore, Singapore.
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22
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Ebel DL, Torkilsen CG, Ostrowski TD. Blunted Respiratory Responses in the Streptozotocin-Induced Alzheimer's Disease Rat Model. J Alzheimers Dis 2017; 56:1197-1211. [PMID: 28106557 DOI: 10.3233/jad-160974] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Alzheimer's disease (AD) is known for the progressive decline of cognition and memory. In addition to these disease-defining symptoms, impairment of respiratory function is frequently observed and often expressed by sleep-disordered breathing or reduced ability to adjust respiration when oxygen demand is elevated. The mechanisms for this are widely unknown. Postmortem analysis from the brainstem of AD patients reveals pathological alterations, including in nuclei responsible for respiratory control. In this study, we analyzed respiratory responses and morphological changes in brainstem nuclei following intracerebroventricular (ICV) injections of streptozotocin (STZ), a rat model commonly used to mimic sporadic AD. ICV-STZ induced significant astrogliosis in the commissural part of the nucleus tractus solitarii, an area highly involved in respiration control. The astrogliosis was identified by a significant increase in S100B-immunofluorescence that is similar to the astrogliosis found in the CA1 region of the hippocampus. Using plethysmography, the control group displayed a typical age-dependent decrease of ventilation that was absent in the STZ rat group. This is indicative of elevated minute ventilation at rest after STZ treatment. Peripheral chemoreflex responses were significantly blunted in STZ rats as seen by a reduced respiratory rate and minute ventilation to hypoxia. Central chemoreflex responses to hypercapnia, on the other hand, only decreased in respiratory rate following STZ treatment. Overall, our results show that ICV-STZ induces respiratory dysfunction at rest and in response to hypoxia. This provides a new tool to study the underlying mechanisms of breathing disorders in clinical AD.
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Pini L, Pievani M, Bocchetta M, Altomare D, Bosco P, Cavedo E, Galluzzi S, Marizzoni M, Frisoni GB. Brain atrophy in Alzheimer's Disease and aging. Ageing Res Rev 2016; 30:25-48. [PMID: 26827786 DOI: 10.1016/j.arr.2016.01.002] [Citation(s) in RCA: 445] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/15/2016] [Accepted: 01/20/2016] [Indexed: 01/22/2023]
Abstract
Thanks to its safety and accessibility, magnetic resonance imaging (MRI) is extensively used in clinical routine and research field, largely contributing to our understanding of the pathophysiology of neurodegenerative disorders such as Alzheimer's disease (AD). This review aims to provide a comprehensive overview of the main findings in AD and normal aging over the past twenty years, focusing on the patterns of gray and white matter changes assessed in vivo using MRI. Major progresses in the field concern the segmentation of the hippocampus with novel manual and automatic segmentation approaches, which might soon enable to assess also hippocampal subfields. Advancements in quantification of hippocampal volumetry might pave the way to its broader use as outcome marker in AD clinical trials. Patterns of cortical atrophy have been shown to accurately track disease progression and seem promising in distinguishing among AD subtypes. Disease progression has also been associated with changes in white matter tracts. Recent studies have investigated two areas often overlooked in AD, such as the striatum and basal forebrain, reporting significant atrophy, although the impact of these changes on cognition is still unclear. Future integration of different MRI modalities may further advance the field by providing more powerful biomarkers of disease onset and progression.
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Affiliation(s)
- Lorenzo Pini
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Michela Pievani
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy
| | - Martina Bocchetta
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy; Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Daniele Altomare
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Paolo Bosco
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy
| | - Enrica Cavedo
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy; Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) Hôpital de la Pitié-Salpétrière & Institut du Cerveau et de la Moelle épinière (ICM), UMR S 1127, Hôpital de la Pitié-Salpétrière Paris & CATI Multicenter Neuroimaging Platform, France
| | - Samantha Galluzzi
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy
| | - Moira Marizzoni
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy
| | - Giovanni B Frisoni
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy; Memory Clinic and LANVIE-Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland.
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