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Imokawa T, Yokoyama K, Takahashi K, Oyama J, Tsuchiya J, Sanjo N, Tateishi U. Brain perfusion SPECT in dementia: what radiologists should know. Jpn J Radiol 2024:10.1007/s11604-024-01612-5. [PMID: 38888851 DOI: 10.1007/s11604-024-01612-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024]
Abstract
The findings of brain perfusion single-photon emission computed tomography (SPECT), which detects abnormalities often before changes manifest in morphological imaging, mainly reflect neurodegeneration and contribute to dementia evaluation. A major shift is about to occur in dementia practice to the approach of diagnosing based on biomarkers and treating with disease-modifying drugs. Accordingly, brain perfusion SPECT will be required to serve as a biomarker of neurodegeneration. Hypoperfusion in Alzheimer's disease (AD) is typically seen in the posterior cingulate cortex and precuneus early in the disease, followed by the temporoparietal cortices. On the other hand, atypical presentations of AD such as the posterior variant, logopenic variant, frontal variant, and corticobasal syndrome exhibit hypoperfusion in areas related to symptoms. Additionally, hypoperfusion especially in the precuneus and parietal association cortex can serve as a predictor of progression from mild cognitive impairment to AD. In dementia with Lewy bodies (DLB), the differentiating feature is the presence of hypoperfusion in the occipital lobes in addition to that observed in AD. Hypoperfusion of the occipital lobe is not a remarkable finding, as it is assumed to reflect functional loss due to impairment of the cholinergic and dopaminergic systems rather than degeneration per se. Moreover, the cingulate island sign reflects the degree of AD pathology comorbid in DLB. Frontotemporal dementia is characterized by regional hypoperfusion according to the three clinical types, and the background pathology is diverse. Idiopathic normal pressure hydrocephalus shows apparent hypoperfusion around the Sylvian fissure and corpus callosum and apparent hyperperfusion in high-convexity areas. The cortex or striatum with diffusion restriction on magnetic resonance imaging in prion diseases reflects spongiform degeneration and brain perfusion SPECT reveals hypoperfusion in the same areas. Brain perfusion SPECT findings in dementia should be carefully interpreted considering background pathology.
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Affiliation(s)
- Tomoki Imokawa
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan
- Department of Radiology, Japanese Red Cross Omori Hospital, Ota-Ku, Tokyo, Japan
| | - Kota Yokoyama
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan.
| | - Kanae Takahashi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan
| | - Jun Oyama
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan
| | - Nobuo Sanjo
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan
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Penny LK, Lofthouse R, Arastoo M, Porter A, Palliyil S, Harrington CR, Wischik CM. Considerations for biomarker strategies in clinical trials investigating tau-targeting therapeutics for Alzheimer's disease. Transl Neurodegener 2024; 13:25. [PMID: 38773569 PMCID: PMC11107038 DOI: 10.1186/s40035-024-00417-w] [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: 11/08/2023] [Accepted: 04/24/2024] [Indexed: 05/24/2024] Open
Abstract
The use of biomarker-led clinical trial designs has been transformative for investigating amyloid-targeting therapies for Alzheimer's disease (AD). The designs have ensured the correct selection of patients on these trials, supported target engagement and have been used to support claims of disease modification and clinical efficacy. Ultimately, this has recently led to approval of disease-modifying, amyloid-targeting therapies for AD; something that should be noted for clinical trials investigating tau-targeting therapies for AD. There is a clear overlap of the purpose of biomarker use at each stage of clinical development between amyloid-targeting and tau-targeting clinical trials. However, there are differences within the potential context of use and interpretation for some biomarkers in particular measurements of amyloid and utility of soluble, phosphorylated tau biomarkers. Given the complexities of tau in health and disease, it is paramount that therapies target disease-relevant tau and, in parallel, appropriate assays of target engagement are developed. Tau positron emission tomography, fluid biomarkers reflecting tau pathology and downstream measures of neurodegeneration will be important both for participant recruitment and for monitoring disease-modification in tau-targeting clinical trials. Bespoke design of biomarker strategies and interpretations for different modalities and tau-based targets should also be considered.
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Affiliation(s)
- Lewis K Penny
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
- Scottish Biologics Facility, University of Aberdeen, Aberdeen, UK
- TauRx Therapeutics Ltd, Aberdeen, UK
| | - Richard Lofthouse
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
- Scottish Biologics Facility, University of Aberdeen, Aberdeen, UK
| | - Mohammad Arastoo
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
- Scottish Biologics Facility, University of Aberdeen, Aberdeen, UK
| | - Andy Porter
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
- Scottish Biologics Facility, University of Aberdeen, Aberdeen, UK
| | - Soumya Palliyil
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
- Scottish Biologics Facility, University of Aberdeen, Aberdeen, UK
| | - Charles R Harrington
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
- GT Diagnostics (UK) Ltd, Aberdeen, UK
- TauRx Therapeutics Ltd, Aberdeen, UK
| | - Claude M Wischik
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK.
- GT Diagnostics (UK) Ltd, Aberdeen, UK.
- TauRx Therapeutics Ltd, Aberdeen, UK.
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Li Q, Lv X, Qian Q, Liao K, Du X. Neuroticism polygenic risk predicts conversion from mild cognitive impairment to Alzheimer's disease by impairing inferior parietal surface area. Hum Brain Mapp 2024; 45:e26709. [PMID: 38746977 PMCID: PMC11094517 DOI: 10.1002/hbm.26709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 03/19/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
The high prevalence of conversion from amnestic mild cognitive impairment (aMCI) to Alzheimer's disease (AD) makes early prevention of AD extremely critical. Neuroticism, a heritable personality trait associated with mental health, has been considered a risk factor for conversion from aMCI to AD. However, whether the neuroticism genetic risk could predict the conversion of aMCI and its underlying neural mechanisms is unclear. Neuroticism polygenic risk score (N-PRS) was calculated in 278 aMCI patients with qualified genomic and neuroimaging data from ADNI. After 1-year follow-up, N-PRS in patients of aMCI-converted group was significantly greater than those in aMCI-stable group. Logistic and Cox survival regression revealed that N-PRS could significantly predict the early-stage conversion risk from aMCI to AD. These results were well replicated in an internal dataset and an independent external dataset of 933 aMCI patients from the UK Biobank. One sample Mendelian randomization analyses confirmed a potentially causal association from higher N-PRS to lower inferior parietal surface area to higher conversion risk of aMCI patients. These analyses indicated that neuroticism genetic risk may increase the conversion risk from aMCI to AD by impairing the inferior parietal structure.
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Affiliation(s)
- Qiaojun Li
- College of Information EngineeringTianjin University of CommerceTianjinChina
| | - Xingping Lv
- College of SciencesTianjin University of CommerceTianjinChina
| | - Qian Qian
- Department of Radiology and Tianjin Key Laboratory of Functional ImagingTianjin Medical University General HospitalTianjinChina
| | - Kun Liao
- College of SciencesTianjin University of CommerceTianjinChina
| | - Xin Du
- Department of Radiology and Tianjin Key Laboratory of Functional ImagingTianjin Medical University General HospitalTianjinChina
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AlMansoori ME, Jemimah S, Abuhantash F, AlShehhi A. Predicting early Alzheimer's with blood biomarkers and clinical features. Sci Rep 2024; 14:6039. [PMID: 38472245 DOI: 10.1038/s41598-024-56489-1] [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: 07/05/2023] [Accepted: 03/07/2024] [Indexed: 03/14/2024] Open
Abstract
Alzheimer's disease (AD) is an incurable neurodegenerative disorder that leads to dementia. This study employs explainable machine learning models to detect dementia cases using blood gene expression, single nucleotide polymorphisms (SNPs), and clinical data from Alzheimer's Disease Neuroimaging Initiative (ADNI). Analyzing 623 ADNI participants, we found that the Support Vector Machine classifier with Mutual Information (MI) feature selection, trained on all three data modalities, achieved exceptional performance (accuracy = 0.95, AUC = 0.94). When using gene expression and SNP data separately, we achieved very good performance (AUC = 0.65, AUC = 0.63, respectively). Using SHapley Additive exPlanations (SHAP), we identified significant features, potentially serving as AD biomarkers. Notably, genetic-based biomarkers linked to axon myelination and synaptic vesicle membrane formation could aid early AD detection. In summary, this genetic-based biomarker approach, integrating machine learning and SHAP, shows promise for precise AD diagnosis, biomarker discovery, and offers novel insights for understanding and treating the disease. This approach addresses the challenges of accurate AD diagnosis, which is crucial given the complexities associated with the disease and the need for non-invasive diagnostic methods.
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Affiliation(s)
- Muaath Ebrahim AlMansoori
- Department of Biomedical Engineering, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates
| | - Sherlyn Jemimah
- Department of Biomedical Engineering, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates
| | - Ferial Abuhantash
- Department of Biomedical Engineering, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates
| | - Aamna AlShehhi
- Department of Biomedical Engineering, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates.
- Healthcare Engineering Innovation Center (HEIC), Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates.
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Perera Molligoda Arachchige AS, Garner AK. Seven Tesla MRI in Alzheimer's disease research: State of the art and future directions: A narrative review. AIMS Neurosci 2023; 10:401-422. [PMID: 38188012 PMCID: PMC10767068 DOI: 10.3934/neuroscience.2023030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Seven tesla magnetic resonance imaging (7T MRI) is known to offer a superior spatial resolution and a signal-to-noise ratio relative to any other non-invasive imaging technique and provides the possibility for neuroimaging researchers to observe disease-related structural changes, which were previously only apparent on post-mortem tissue analyses. Alzheimer's disease is a natural and widely used subject for this technology since the 7T MRI allows for the anticipation of disease progression, the evaluation of secondary prevention measures thought to modify the disease trajectory, and the identification of surrogate markers for treatment outcome. In this editorial, we discuss the various neuroimaging biomarkers for Alzheimer's disease that have been studied using 7T MRI, which include morphological alterations, molecular characterization of cerebral T2*-weighted hypointensities, the evaluation of cerebral microbleeds and microinfarcts, biochemical changes studied with MR spectroscopy, as well as some other approaches. Finally, we discuss the limitations of the 7T MRI regarding imaging Alzheimer's disease and we provide our outlook for the future.
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Subtirelu RC, Teichner EM, Su Y, Al-Daoud O, Patel M, Patil S, Writer M, Werner T, Revheim ME, Høilund-Carlsen PF, Alavi A. Aging and Cerebral Glucose Metabolism: 18F-FDG-PET/CT Reveals Distinct Global and Regional Metabolic Changes in Healthy Patients. Life (Basel) 2023; 13:2044. [PMID: 37895426 PMCID: PMC10608490 DOI: 10.3390/life13102044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/01/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Alterations in cerebral glucose metabolism can be indicative of both normal and pathological aging processes. In this retrospective study, we evaluated global and regional neurological glucose metabolism in 73 healthy individuals (mean age: 35.8 ± 13.1 years; 82.5% female) using 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). This population exhibited a low prevalence of comorbidities associated with cerebrovascular risk factors. We utilized 18F-FDG-PET/CT imaging and quantitative regional analysis to assess cerebral glucose metabolism. A statistically significant negative correlation was found between age and the global standardized uptake value mean (SUVmean) of FDG uptake (p = 0.000795), indicating a decrease in whole-brain glucose metabolism with aging. Furthermore, region-specific analysis identified significant correlations in four cerebral regions, with positive correlations in the basis pontis, cerebellar hemisphere, and cerebellum and a negative correlation in the lateral orbital gyrus. These results were further confirmed via linear regression analysis. Our findings reveal a nuanced understanding of how aging affects glucose metabolism in the brain, providing insight into normal neurology. The study underscores the utility of 18F-FDG-PET/CT as a sensitive tool in monitoring these metabolic changes, highlighting its potential for the early detection of neurological diseases and disorders related to aging.
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Affiliation(s)
| | - Eric Michael Teichner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19144, USA
| | - Yvonne Su
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Omar Al-Daoud
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Milan Patel
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shiv Patil
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19144, USA
| | - Milo Writer
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Thomas Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- The Intervention Center, Division of Technology and Innovation, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, 0315 Oslo, Norway
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Yang Z, Cummings JL, Kinney JW, Cordes D. Accelerated hypometabolism with disease progression associated with faster cognitive decline among amyloid positive patients. Front Neurosci 2023; 17:1151820. [PMID: 37123373 PMCID: PMC10140339 DOI: 10.3389/fnins.2023.1151820] [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: 01/26/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Objective To evaluate the progression of brain glucose metabolism among participants with biological signature of Alzheimer's disease (AD) and its relevance to cognitive decline. Method We studied 602 amyloid positive individuals who underwent 18F-fluorodeoxyglucose PET (FDG-PET) scan, 18F-AV-45 amyloid PET (AV45-PET) scan, structural MRI scan and neuropsychological examination, including 116 cognitively normal (CN) participants, 314 participants diagnosed as mild cognitive impairment (MCI), and 172 participants diagnosed as AD dementia. The first FDG-PET scan satisfying the inclusion criteria was considered as the baseline scan. Cross-sectional analysis were conducted with the baseline FDG-PET data to compare the regional differences between diagnostic groups after adjusting confounding factors. Among these participants, 229 participants (55 CN, 139 MCI, and 35 AD dementia) had two-year follow-up FDG-PET data available. Regional glucose metabolism was computed and the progression rates of regional glucose metabolism were derived from longitudinal FDG-PET scans. Then the group differences of regional progression rates were examined to assess whether glucose metabolism deficit accelerates or becomes stable with disease progression. The association of cognitive decline rate with baseline regional glucose metabolism, and progression rate in longitudinal data, were evaluated. Results Participants with AD dementia showed substantial glucose metabolism deficit than CN and MCI at left hippocampus, in addition to the traditionally reported frontal and parietal-temporal lobe. More substantial metabolic change was observed with the contrast AD - MCI than the contrast MCI - CN, even after adjusting time duration since cognitive symptom onset. With the longitudinal data, glucose metabolism was observed to decline the most rapidly in the AD dementia group and at a slower rate in MCI. Lower regional glucose metabolism was correlated to faster cognitive decline rate with mild-moderate correlations, and the progression rate was correlated to cognitive decline rate with moderate-large correlations. Discussion and conclusion Hippocampus was identified to experience hypometabolism in AD pathology. Hypometabolism accelerates with disease progression toward AD dementia. FDG-PET, particularly longitudinal scans, could potentially help predict how fast cognition declines and assess the impact of treatment in interventional trials.
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Affiliation(s)
- Zhengshi Yang
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
- Department of Brain Health, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Jeffrey L. Cummings
- Department of Brain Health, University of Nevada, Las Vegas, Las Vegas, NV, United States
- Chambers-Grundy Center for Transformative Neuroscience, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Jefferson W. Kinney
- Department of Brain Health, University of Nevada, Las Vegas, Las Vegas, NV, United States
- Chambers-Grundy Center for Transformative Neuroscience, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Dietmar Cordes
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
- Department of Brain Health, University of Nevada, Las Vegas, Las Vegas, NV, United States
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States
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Hu J, Wang Y, Guo D, Qu Z, Sui C, He G, Wang S, Chen X, Wang C, Liu X. Diagnostic performance of magnetic resonance imaging-based machine learning in Alzheimer's disease detection: a meta-analysis. Neuroradiology 2023; 65:513-527. [PMID: 36477499 DOI: 10.1007/s00234-022-03098-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Advanced machine learning (ML) algorithms can assist rapid medical image recognition and realize automatic, efficient, noninvasive, and convenient diagnosis. We aim to further evaluate the diagnostic performance of ML to distinguish patients with probable Alzheimer's disease (AD) from normal older adults based on structural magnetic resonance imaging (MRI). METHODS The Medline, Embase, and Cochrane Library databases were searched for relevant literature published up until July 2021. We used the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool and Checklist for Artificial Intelligence in Medical Imaging (CLAIM) to evaluate all included studies' quality and potential bias. Random-effects models were used to calculate pooled sensitivity and specificity, and the Deeks' test was used to assess publication bias. RESULTS We included 24 models based on different brain features extracted by ML algorithms in 19 papers. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic curve for ML in detecting AD were 0.85 (95%CI 0.81-0.89), 0.88 (95%CI 0.84-0.91), 7.15 (95%CI 5.40-9.47), 0.17 (95%CI 0.12-0.22), 43.34 (95%CI 26.89-69.84), and 0.93 (95%CI 0.91-0.95). CONCLUSION ML using structural MRI data performed well in diagnosing probable AD patients and normal elderly. However, more high-quality, large-scale prospective studies are needed to further enhance the reliability and generalizability of ML for clinical applications before it can be introduced into clinical practice.
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Affiliation(s)
- Jiayi Hu
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Yashan Wang
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Dingjie Guo
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Zihan Qu
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Chuanying Sui
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Guangliang He
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Song Wang
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Xiaofei Chen
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Chunpeng Wang
- School of Mathematics and Statistics, Northeast Normal University, Changchun, Jilin, China.
| | - Xin Liu
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China.
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Stocks J, Heywood A, Popuri K, Beg MF, Rosen H, Wang L. Longitudinal Spatial Relationships Between Atrophy and Hypometabolism Across the Alzheimer's Disease Continuum. J Alzheimers Dis 2023; 92:513-527. [PMID: 36776061 DOI: 10.3233/jad-220975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The A/T/N framework allows for the assessment of pathology-specific markers of MRI-derived structural atrophy and hypometabolism on 18FDG-PET. However, how these measures relate to each other locally and distantly across pathology-defined A/T/N groups is currently unclear. OBJECTIVE To determine the regions of association between atrophy and hypometabolism in A/T/N groups both within and across time points. METHODS We examined multivariate multimodal neuroimaging relationships between MRI and 18FDG-PET among suspected non-Alzheimer's disease pathology (SNAP) (A-T/N+; n = 14), Amyloid Only (A+T-N-; n = 24) and Probable AD (A+T+N+; n = 77) groups. Sparse canonical correlation analyses were employed to model spatially disjointed regions of association between MRI and 18FDG-PET data. These relationships were assessed at three combinations of time points -cross-sectionally, between baseline visits and between month 12 (M-12) follow-up visits, as well as longitudinally between baseline and M-12 follow-up. RESULTS In the SNAP group, spatially overlapping relationships between atrophy and hypometabolism were apparent in the bilateral temporal lobes when both modalities were assessed at the M-12 timepoint. Amyloid-Only subjects showed spatially discordant distributed atrophy-hypometabolism relationships at all time points assessed. In Probable AD subjects, local correlations were evident in the bilateral temporal lobes when both modalities were assessed at baseline and at M-12. Across groups, hypometabolism at baseline correlated with non-local, or distant, atrophy at M-12. CONCLUSION These results support the view that local concordance of atrophy and hypometabolism is the result of a tau-mediated process driving neurodegeneration.
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Affiliation(s)
- Jane Stocks
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ashley Heywood
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karteek Popuri
- School of Engineering Science, Simon Fraser University, Canada.,Memorial University of Newfoundland, Department of Computer Science, St. John's, NL, Canada
| | | | - Howie Rosen
- School of Medicine, University of California, San Francisco, CA, USA
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
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Ribarič S. Detecting Early Cognitive Decline in Alzheimer's Disease with Brain Synaptic Structural and Functional Evaluation. Biomedicines 2023; 11:biomedicines11020355. [PMID: 36830892 PMCID: PMC9952956 DOI: 10.3390/biomedicines11020355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Early cognitive decline in patients with Alzheimer's (AD) is associated with quantifiable structural and functional connectivity changes in the brain. AD dysregulation of Aβ and tau metabolism progressively disrupt normal synaptic function, leading to loss of synapses, decreased hippocampal synaptic density and early hippocampal atrophy. Advances in brain imaging techniques in living patients have enabled the transition from clinical signs and symptoms-based AD diagnosis to biomarkers-based diagnosis, with functional brain imaging techniques, quantitative EEG, and body fluids sampling. The hippocampus has a central role in semantic and episodic memory processing. This cognitive function is critically dependent on normal intrahippocampal connections and normal hippocampal functional connectivity with many cortical regions, including the perirhinal and the entorhinal cortex, parahippocampal cortex, association regions in the temporal and parietal lobes, and prefrontal cortex. Therefore, decreased hippocampal synaptic density is reflected in the altered functional connectivity of intrinsic brain networks (aka large-scale networks), including the parietal memory, default mode, and salience networks. This narrative review discusses recent critical issues related to detecting AD-associated early cognitive decline with brain synaptic structural and functional markers in high-risk or neuropsychologically diagnosed patients with subjective cognitive impairment or mild cognitive impairment.
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Affiliation(s)
- Samo Ribarič
- Faculty of Medicine, Institute of Pathophysiology, University of Ljubljana, Zaloška 4, SI-1000 Ljubljana, Slovenia
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Ruan D, Sun L. Amyloid-β PET in Alzheimer's disease: A systematic review and Bayesian meta-analysis. Brain Behav 2023; 13:e2850. [PMID: 36573329 PMCID: PMC9847612 DOI: 10.1002/brb3.2850] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 10/29/2022] [Accepted: 11/30/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In recent years, longitudinal studies of Alzheimer's disease (AD) have been successively concluded. Our aim is to determine the efficacy of amyloid-β (Aβ) PET in diagnosing AD and early prediction of mild cognitive impairment (MCI) converting to AD. By pooling studies from different centers to explore in-depth whether diagnostic performance varies by population type, radiotracer type, and diagnostic approach, thus providing a more comprehensive theoretical basis for the subsequent widespread application of Aβ PET in the clinical setting. METHODS Relevant studies were searched through PubMed. The pooled sensitivities, specificities, DOR, and the summary ROC curve were obtained based on a Bayesian random-effects model. RESULTS Forty-eight studies, including 5967 patients, were included. Overall, the pooled sensitivity, specificity, DOR, and AUC of Aβ PET for diagnosing AD were 0.90, 0.80, 35.68, and 0.91, respectively. Subgroup analysis showed that Aβ PET had high sensitivity (0.91) and specificity (0.81) for differentiating AD from normal controls but very poor specificity (0.49) for determining AD from MCI. The pooled sensitivity and specificity were 0.84 and 0.62, respectively, for predicting the conversion of MCI to AD. The differences in diagnostic efficacy between visual assessment and quantitative analysis and between 11 C-PIB PET and 18 F-florbetapir PET were insignificant. CONCLUSIONS The overall performance of Aβ PET in diagnosing AD is favorable, but the differentiation between MCI and AD patients should consider that some MCI may be at risk of conversion to AD and may be misdiagnosed. A multimodal diagnostic approach and machine learning analysis may be effective in improving diagnostic accuracy.
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Affiliation(s)
- Dan Ruan
- Department of Nuclear Medicine, Zhongshan Hospital (Xiamen), Fudan University, Fujian, China
| | - Long Sun
- Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China
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Xu Z, Zhao L, Yin L, Liu Y, Ren Y, Yang G, Wu J, Gu F, Sun X, Yang H, Peng T, Hu J, Wang X, Pang M, Dai Q, Zhang G. MRI-based machine learning model: A potential modality for predicting cognitive dysfunction in patients with type 2 diabetes mellitus. Front Bioeng Biotechnol 2022; 10:1082794. [PMID: 36483770 PMCID: PMC9725113 DOI: 10.3389/fbioe.2022.1082794] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/10/2022] [Indexed: 07/27/2023] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) is a crucial risk factor for cognitive impairment. Accurate assessment of patients' cognitive function and early intervention is helpful to improve patient's quality of life. At present, neuropsychiatric screening tests is often used to perform this task in clinical practice. However, it may have poor repeatability. Moreover, several studies revealed that machine learning (ML) models can effectively assess cognitive impairment in Alzheimer's disease (AD) patients. We investigated whether we could develop an MRI-based ML model to evaluate the cognitive state of patients with T2DM. Objective: To propose MRI-based ML models and assess their performance to predict cognitive dysfunction in patients with type 2 diabetes mellitus (T2DM). Methods: Fluid Attenuated Inversion Recovery (FLAIR) of magnetic resonance images (MRI) were derived from 122 patients with T2DM. Cognitive function was assessed using the Chinese version of the Montréal Cognitive Assessment Scale-B (MoCA-B). Patients with T2DM were separated into the Dementia (DM) group (n = 40), MCI group (n = 52), and normal cognitive state (N) group (n = 30), according to the MoCA scores. Radiomics features were extracted from MR images with the Radcloud platform. The variance threshold, SelectKBest, and least absolute shrinkage and selection operator (LASSO) were used for the feature selection. Based on the selected features, the ML models were constructed with three classifiers, k-NearestNeighbor (KNN), Support Vector Machine (SVM), and Logistic Regression (LR), and the validation method was used to improve the effectiveness of the model. The area under the receiver operating characteristic curve (ROC) determined the appearance of the classification. The optimal classifier was determined by the principle of maximizing the Youden index. Results: 1,409 features were extracted and reduced to 13 features as the optimal discriminators to build the radiomics model. In the validation set, ROC curves revealed that the LR classifier had the best predictive performance, with an area under the curve (AUC) of 0.831 in DM, 0.883 in MIC, and 0.904 in the N group, compared with the SVM and KNN classifiers. Conclusion: MRI-based ML models have the potential to predict cognitive dysfunction in patients with T2DM. Compared with the SVM and KNN, the LR algorithm showed the best performance.
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Affiliation(s)
- Zhigao Xu
- Department of Radiology, Radiology-Based AI Innovation Workroom, The Third People’s Hospital of Datong, Datong, China
| | - Lili Zhao
- Department of Radiology, Radiology-Based AI Innovation Workroom, The Third People’s Hospital of Datong, Datong, China
| | - Lei Yin
- Graduate School, Changzhi Medical College, Changzhi, China
| | - Yan Liu
- Department of Endocrinology, The Third People’s Hospital of Datong, Datong, China
| | - Ying Ren
- Department of Materials Science and Engineering, Henan University of Technology, Zhengzhou, China
| | - Guoqiang Yang
- College of Medical Imaging, Shanxi Medical University, Taiyuan, China
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jinlong Wu
- Department of Radiology, Radiology-Based AI Innovation Workroom, The Third People’s Hospital of Datong, Datong, China
| | - Feng Gu
- Department of Radiology, Radiology-Based AI Innovation Workroom, The Third People’s Hospital of Datong, Datong, China
| | - Xuesong Sun
- Medical Department, The Third People’s Hospital of Datong, Datong, China
| | - Hui Yang
- Department of Radiology, Radiology-Based AI Innovation Workroom, The Third People’s Hospital of Datong, Datong, China
| | - Taisong Peng
- Department of Radiology, The Second People’s Hospital of Datong, Datong, China
| | - Jinfeng Hu
- Department of Radiology, The Second People’s Hospital of Datong, Datong, China
| | - Xiaogeng Wang
- Department of Radiology, Affiliated Hospital of Datong University, Datong, China
| | - Minghao Pang
- Department of Radiology, The People’s Hospital of Yunzhou District, Datong, China
| | - Qiong Dai
- Huiying Medical Technology (Beijing) Co. Ltd, Beijing, China
| | - Guojiang Zhang
- Department of Cardiovasology, Department of Science and Education, The Third People’s Hospital of Datong, Datong, China
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Kandiah N, Choi SH, Hu CJ, Ishii K, Kasuga K, Mok VC. Current and Future Trends in Biomarkers for the Early Detection of Alzheimer's Disease in Asia: Expert Opinion. J Alzheimers Dis Rep 2022; 6:699-710. [PMID: 36606209 PMCID: PMC9741748 DOI: 10.3233/adr-220059] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/23/2022] [Indexed: 11/16/2022] Open
Abstract
Alzheimer's disease (AD) poses a substantial healthcare burden in the rapidly aging Asian population. Early diagnosis of AD, by means of biomarkers, can lead to interventions that might alter the course of the disease. The amyloid, tau, and neurodegeneration (AT[N]) framework, which classifies biomarkers by their core pathophysiological features, is a biomarker measure of amyloid plaques and neurofibrillary tangles. Our current AD biomarker armamentarium, comprising neuroimaging biomarkers and cerebrospinal fluid biomarkers, while clinically useful, may be invasive and expensive and hence not readily available to patients. Several studies have also investigated the use of blood-based measures of established core markers for detection of AD, such as amyloid-β and phosphorylated tau. Furthermore, novel non-invasive peripheral biomarkers and digital biomarkers could potentially expand access to early AD diagnosis to patients in Asia. Despite the multiplicity of established and potential biomarkers in AD, a regional framework for their optimal use to guide early AD diagnosis remains lacking. A group of experts from five regions in Asia gathered at a meeting in March 2021 to review the current evidence on biomarkers in AD diagnosis and discuss best practice around their use, with the goal of developing practical guidance that can be implemented easily by clinicians in Asia to support the early diagnosis of AD. This article summarizes recent key evidence on AD biomarkers and consolidates the experts' insights into the current and future use of these biomarkers for the screening and early diagnosis of AD in Asia.
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Affiliation(s)
- Nagaendran Kandiah
- Dementia Research Centre (Singapore), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,Correspondence to: Nagaendran Kandiah, Dementia Research Centre, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232. Tel.: +65 6592 2653; Fax: +65 6339 2889; E-mail: ; ORCID: 0000-0001-9244-4298
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Chaur-Jong Hu
- Department of Neurology, Dementia Center, Shuang Ho Hospital, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kenji Ishii
- Team for Neuroimaging Research, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kensaku Kasuga
- Department of Molecular Genetics, Center for Bioresources, Brain Research Institute, Niigata University, Niigata, Japan
| | - Vincent C.T. Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China,Li Ka Shing Institute of Health Sciences, Gerald Choa Neuroscience Institute, Lui Che Woo Institute of Innovative Medicine, Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
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14
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Yang J, Wang Z, Fu Y, Xu J, Zhang Y, Qin W, Zhang Q. Prediction value of the genetic risk of type 2 diabetes on the amnestic mild cognitive impairment conversion to Alzheimer’s disease. Front Aging Neurosci 2022; 14:964463. [PMID: 36185474 PMCID: PMC9521369 DOI: 10.3389/fnagi.2022.964463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Amnestic mild cognitive impairment (aMCI) and Type 2 diabetes mellitus (T2DM) are both important risk factors for Alzheimer’s disease (AD). We aimed to investigate whether a T2DM-specific polygenic risk score (PRSsT2DM) can predict the conversion of aMCI to AD and further explore the underlying neurological mechanism. All aMCI patients were from the Alzheimer’s disease Neuroimaging Initiative (ADNI) database and were divided into conversion (aMCI-C, n = 164) and stable (aMCI-S, n = 222) groups. PRSsT2DM was calculated by PRSice-2 software to explore the predictive efficacy of the aMCI conversion to AD. We found that PRSsT2DM could independently predict the aMCI conversion to AD after removing the common variants of these two diseases. PRSsT2DM was significantly negatively correlated with gray matter volume (GMV) of the right superior frontal gyrus in the aMCI-C group. In all aMCI patients, PRSsT2DM was significantly negatively correlated with the cortical volume of the right superior occipital gyrus. The cortical volume of the right superior occipital gyrus could significantly mediate the association between PRSsT2DM and aMCI conversion. Gene-based analysis showed that T2DM-specific genes are highly expressed in cortical neurons and involved in ion and protein binding, neural development and generation, cell junction and projection, and PI3K-Akt and MAPK signaling pathway, which might increase the aMCI conversion by affecting the Tau phosphorylation and amyloid-beta (Aβ) accumulation. Therefore, the PRSsT2DM could be used as a measure to predict the conversion of aMCI to AD.
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15
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Faldu KG, Shah JS. Alzheimer's disease: a scoping review of biomarker research and development for effective disease diagnosis. Expert Rev Mol Diagn 2022; 22:681-703. [PMID: 35855631 DOI: 10.1080/14737159.2022.2104639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Alzheimer's disease (AD) is regarded as the foremost reason for neurodegeneration that prominently affects the geriatric population. Characterized by extracellular accumulation of amyloid-beta (Aβ), intracellular aggregation of hyperphosphorylated tau (p-tau), and neuronal degeneration that causes impairment of memory and cognition. Amyloid/tau/neurodegeneration (ATN) classification is utilized for research purposes and involves amyloid, tau, and neuronal injury staging through MRI, PET scanning, and CSF protein concentration estimations. CSF sampling is invasive, and MRI and PET scanning requires sophisticated radiological facilities which limit its widespread diagnostic use. ATN classification lacks effectiveness in preclinical AD. AREAS COVERED This publication intends to collate and review the existing biomarker profile and the current research and development of a new arsenal of biomarkers for AD pathology from different biological samples, microRNA (miRNA), proteomics, metabolomics, artificial intelligence, and machine learning for AD screening, diagnosis, prognosis, and monitoring of AD treatments. EXPERT OPINION It is an accepted observation that AD-related pathological changes occur over a long period of time before the first symptoms are observed providing ample opportunity for detection of biological alterations in various biological samples that can aid in early diagnosis and modify treatment outcomes.
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Affiliation(s)
- Khushboo Govind Faldu
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
| | - Jigna Samir Shah
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
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16
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Doering E, Hoenig MC, Bischof GN, Bohn KP, Ellingsen LM, van Eimeren T, Drzezga A. Introducing a gatekeeping system for amyloid status assessment in mild cognitive impairment. Eur J Nucl Med Mol Imaging 2022; 49:4478-4489. [PMID: 35831715 PMCID: PMC9605923 DOI: 10.1007/s00259-022-05879-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Abstract
Background In patients with mild cognitive impairment (MCI), enhanced cerebral amyloid-β plaque burden is a high-risk factor to develop dementia with Alzheimer’s disease (AD). Not all patients have immediate access to the assessment of amyloid status (A-status) via gold standard methods. It may therefore be of interest to find suitable biomarkers to preselect patients benefitting most from additional workup of the A-status. In this study, we propose a machine learning–based gatekeeping system for the prediction of A-status on the grounds of pre-existing information on APOE-genotype 18F-FDG PET, age, and sex. Methods Three hundred and forty-two MCI patients were used to train different machine learning classifiers to predict A-status majority classes among APOE-ε4 non-carriers (APOE4-nc; majority class: amyloid negative (Aβ-)) and carriers (APOE4-c; majority class: amyloid positive (Aβ +)) from 18F-FDG-PET, age, and sex. Classifiers were tested on two different datasets. Finally, frequencies of progression to dementia were compared between gold standard and predicted A-status. Results Aβ- in APOE4-nc and Aβ + in APOE4-c were predicted with a precision of 87% and a recall of 79% and 51%, respectively. Predicted A-status and gold standard A-status were at least equally indicative of risk of progression to dementia. Conclusion We developed an algorithm allowing approximation of A-status in MCI with good reliability using APOE-genotype, 18F-FDG PET, age, and sex information. The algorithm could enable better estimation of individual risk for developing AD based on existing biomarker information, and support efficient selection of patients who would benefit most from further etiological clarification. Further potential utility in clinical routine and clinical trials is discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05879-6.
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Affiliation(s)
- E Doering
- German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany. .,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Nuclear Medicine, Multimodal Neuroimaging Group, Cologne, Germany.
| | - M C Hoenig
- German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany.,Institute for Neuroscience and Medicine II-Molecular Organization of the Brain, Research Center Juelich, Jülich, Germany
| | - G N Bischof
- German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany.,Institute for Neuroscience and Medicine II-Molecular Organization of the Brain, Research Center Juelich, Jülich, Germany
| | - K P Bohn
- Klinikum Dritter Orden, Department of Radiology and Nuclear Medicine, Munich, Germany
| | - L M Ellingsen
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.,Department of Electrical and Computer Engineering, University of Iceland, Reykjavik, Iceland
| | - T van Eimeren
- German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - A Drzezga
- German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Nuclear Medicine, Multimodal Neuroimaging Group, Cologne, Germany.,Institute for Neuroscience and Medicine II-Molecular Organization of the Brain, Research Center Juelich, Jülich, Germany
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17
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Functional Imaging for Neurodegenerative Diseases. Presse Med 2022; 51:104121. [PMID: 35490910 DOI: 10.1016/j.lpm.2022.104121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/13/2022] [Accepted: 04/11/2022] [Indexed: 12/16/2022] Open
Abstract
Diagnosis and monitoring of neurodegenerative diseases has changed profoundly over the past twenty years. Biomarkers are now included in most diagnostic procedures as well as in clinical trials. Neuroimaging biomarkers provide access to brain structure and function over the course of neurodegenerative diseases. They have brought new insights into a wide range of neurodegenerative diseases and have made it possible to describe some of the imaging challenges in clinical populations. MRI mainly explores brain structure while molecular imaging, functional MRI and electro- and magnetoencephalography examine brain function. In this paper, we describe and analyse the current and potential contribution of MRI and molecular imaging in the field of neurodegenerative diseases.
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Neuroimaging Modalities in Alzheimer’s Disease: Diagnosis and Clinical Features. Int J Mol Sci 2022; 23:ijms23116079. [PMID: 35682758 PMCID: PMC9181385 DOI: 10.3390/ijms23116079] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022] Open
Abstract
Alzheimer’s disease (AD) is a neurodegenerative disease causing progressive cognitive decline until eventual death. AD affects millions of individuals worldwide in the absence of effective treatment options, and its clinical causes are still uncertain. The onset of dementia symptoms indicates severe neurodegeneration has already taken place. Therefore, AD diagnosis at an early stage is essential as it results in more effective therapy to slow its progression. The current clinical diagnosis of AD relies on mental examinations and brain imaging to determine whether patients meet diagnostic criteria, and biomedical research focuses on finding associated biomarkers by using neuroimaging techniques. Multiple clinical brain imaging modalities emerged as potential techniques to study AD, showing a range of capacity in their preciseness to identify the disease. This review presents the advantages and limitations of brain imaging modalities for AD diagnosis and discusses their clinical value.
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19
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Prediction of Medical Conditions Using Machine Learning Approaches: Alzheimer’s Case Study. MATHEMATICS 2022. [DOI: 10.3390/math10101767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Alzheimer’s Disease (AD) is a highly prevalent condition and most of the people suffering from it receive the diagnosis late in the process. The diagnosis is currently established following an evaluation of the protein biomarkers in cerebrospinal fluid (CSF), brain imaging, cognitive tests, and the medical history of the individuals. While diagnostic tools based on CSF collections are invasive, the tools used for acquiring brain scans are expensive. Taking these into account, an early predictive system, based on Artificial Intelligence (AI) approaches, targeting the diagnosis of this condition, as well as the identification of lead biomarkers becomes an important research direction. In this survey, we review the state-of-the-art research on machine learning (ML) techniques used for the detection of AD and Mild Cognitive Impairment (MCI). We attempt to identify the most accurate and efficient diagnostic approaches, which employ ML techniques and therefore, the ones most suitable to be used in practice. Research is still ongoing to determine the best biomarkers for the task of AD classification. At the beginning of this survey, after an introductory part, we enumerate several available resources, which can be used to build ML models targeting the diagnosis and classification of AD, as well as their main characteristics. After that, we discuss the candidate markers which were used to build AI models with the best results in terms of diagnostic accuracy, as well as their limitations.
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Biomarkers for Alzheimer's Disease in the Current State: A Narrative Review. Int J Mol Sci 2022; 23:ijms23094962. [PMID: 35563350 PMCID: PMC9102515 DOI: 10.3390/ijms23094962] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 02/07/2023] Open
Abstract
Alzheimer’s disease (AD) has become a problem, owing to its high prevalence in an aging society with no treatment available after onset. However, early diagnosis is essential for preventive intervention to delay disease onset due to its slow progression. The current AD diagnostic methods are typically invasive and expensive, limiting their potential for widespread use. Thus, the development of biomarkers in available biofluids, such as blood, urine, and saliva, which enables low or non-invasive, reasonable, and objective evaluation of AD status, is an urgent task. Here, we reviewed studies that examined biomarker candidates for the early detection of AD. Some of the candidates showed potential biomarkers, but further validation studies are needed. We also reviewed studies for non-invasive biomarkers of AD. Given the complexity of the AD continuum, multiple biomarkers with machine-learning-classification methods have been recently used to enhance diagnostic accuracy and characterize individual AD phenotypes. Artificial intelligence and new body fluid-based biomarkers, in combination with other risk factors, will provide a novel solution that may revolutionize the early diagnosis of AD.
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21
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Pavel DG, Henderson TA, DeBruin S. The Legacy of the TTASAAN Report-Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I. Front Neurol 2022; 12:749579. [PMID: 35450131 PMCID: PMC9017602 DOI: 10.3389/fneur.2021.749579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970's. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was originally approved in 1988, but was unstable. As a result, the quality of SPECT images varied greatly based on technique until 1993, when a method of stabilizing HMPAO was developed. In addition, most SPECT perfusion studies pre-1996 were performed on single-head gamma cameras. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. Although the TTASAAN report was published in January 1996, it was approved for publication in October 1994. Consequently, the reported brain SPECT studies relied upon to derive the conclusions of the TTASAAN report largely pre-date the introduction of stabilized HMPAO. While only 12% of the studies on traumatic brain injury (TBI) in the TTASAAN report utilized stable tracers and multi-head cameras, 69 subsequent studies with more than 23,000 subjects describe the utility of perfusion SPECT scans in the evaluation of TBI. Similarly, dementia SPECT imaging has improved. Modern SPECT utilizing multi-headed gamma cameras and quantitative analysis has a sensitivity of 86% and a specificity of 89% for the diagnosis of mild to moderate Alzheimer's disease-comparable to fluorodeoxyglucose positron emission tomography. Advances also have occurred in seizure neuroimaging. Lastly, developments in SPECT imaging of neurotoxicity and neuropsychiatric disorders have been striking. At the 25-year anniversary of the publication of the TTASAAN report, it is time to re-examine the utility of perfusion SPECT brain imaging. Herein, we review studies cited by the TTASAAN report vs. current brain SPECT imaging research literature for the major indications addressed in the report, as well as for emerging indications. In Part II, we elaborate technical aspects of SPECT neuroimaging and discuss scan interpretation for the clinician.
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Affiliation(s)
- Dan G Pavel
- Pathfinder Brain SPECT Imaging, Deerfield, IL, United States.,The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States
| | - Theodore A Henderson
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States
| | - Simon DeBruin
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Good Lion Imaging, Columbia, SC, United States
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22
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Qiu A, Xu L, Liu C. Predicting diagnosis 4 years prior to Alzheimer's disease incident. Neuroimage Clin 2022; 34:102993. [PMID: 35344803 PMCID: PMC8958535 DOI: 10.1016/j.nicl.2022.102993] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022]
Abstract
This study employed a deep learning longitudinal model, graph convolutional and recurrent neural network (graph-CNN-RNN), on a series of brain structural MRI scans for AD prognosis. It characterized whole-brain morphology via incorporating longitudinal cortical and subcortical morphology and defined a probabilistic risk for the prediction of AD as a function of age prior to clinical diagnosis. The graph-CNN-RNN model was trained on half of the Alzheimer's Disease Neuroimaging Initiative dataset (ADNI, n = 1559) and validated on the other half of the ADNI dataset and the Open Access Series of Imaging Studies-3 (OASIS-3, n = 930). Our findings demonstrated that the graph-CNN-RNN can reliably and robustly diagnose AD at the accuracy rate of 85% and above across all the time points for both datasets. The graph-CNN-RNN predicted the AD conversion from 0 to 4 years before the AD onset at ∼80% of accuracy. The AD probabilistic risk was associated with clinical traits, cognition, and amyloid burden assessed using [18F]-Florbetapir (AV45) positron emission tomography (PET) across all the time points. The graph-CNN-RNN provided the quantitative trajectory of brain morphology from prognosis to overt stages of AD. Such a deep learning tool and the AD probabilistic risk have great potential in clinical applications for AD prognosis.
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Affiliation(s)
- Anqi Qiu
- Department of Biomedical Engineering, National University of Singapore, Singapore; The N.1 Institute for Health, National University of Singapore, Singapore; Institute of Data Science, National University of Singapore, Singapore; NUS (Suzhou) Research Institute, Suzhou, China; School of Computer Engineering and Science, Shanghai University, China; Department of Biomedical Engineering, the Johns Hopkins University, USA.
| | - Liyuan Xu
- School of Computer Engineering and Science, Shanghai University, China
| | - Chaoqiang Liu
- Department of Biomedical Engineering, National University of Singapore, Singapore
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Liu Y, Han PR, Hu H, Wang ZT, Guo Y, Ou YN, Cao XP, Tan L, Yu JT. A Multi-Dimensional Comparison of Alzheimer's Disease Neurodegenerative Biomarkers. J Alzheimers Dis 2022; 87:197-209. [PMID: 35275546 DOI: 10.3233/jad-215724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the 2018 AT(N) framework, neurodegenerative (N) biomarkers plays an essential role in the research and staging of Alzheimer's disease (AD); however, the different choice of N may result in discordances. OBJECTIVE We aimed to compare different potential N biomarkers. METHODS We examined these N biomarkers among 1,238 participants from Alzheimer's Disease Neuroimaging Initiative (ADNI) in their 1) diagnostic utility, 2) cross-sectional and longitudinal correlations between different N biomarkers and clinical variables, and 3) the conversion risk of different N profiles. RESULTS Six neurodegenerative biomarkers changed significantly from preclinical AD, through prodromal AD to AD dementia stage, thus they were chosen as the candidate N biomarkers: hippocampal volume (HV), 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET), cerebrospinal fluid (CSF), total tau (T-tau), plasma neurofilament light chain (NFL), CSF NFL, and CSF neurogranin (Ng). Results indicated that FDG-PET not only had the greatest diagnostic utility in differentiating AD from controls (area under the curve: FDG-PET, 0.922), but also had the strongest association with cognitive scores. Furthermore, FDG-PET positive group showed the fastest memory decline (hazard ratio: FDG-PET, 3.45), which was also true even in the presence of amyloid-β pathology. Moreover, we observed great discordances between three valuable N biomarkers (FDG-PET, HV, and T-tau). CONCLUSION These results underline the importance of using FDG-PET as N in terms of cognitive decline and AD conversion, followed by HV, and could be a great complement to the AT(N) framework.
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Affiliation(s)
- Ying Liu
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China
| | - Pei-Ran Han
- Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Hao Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Zuo-Teng Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yu Guo
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xi-Peng Cao
- Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China.,Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
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AutoEncoder-based feature ranking for Alzheimer Disease classification using PET image. MACHINE LEARNING WITH APPLICATIONS 2021. [DOI: 10.1016/j.mlwa.2021.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Talwar P, Kushwaha S, Chaturvedi M, Mahajan V. Systematic Review of Different Neuroimaging Correlates in Mild Cognitive Impairment and Alzheimer's Disease. Clin Neuroradiol 2021; 31:953-967. [PMID: 34297137 DOI: 10.1007/s00062-021-01057-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
Alzheimer's disease (AD) is a heterogeneous progressive neurocognitive disorder. Although different neuroimaging modalities have been used for the identification of early diagnostic and prognostic factors of AD, there is no consolidated view of the findings from the literature. Here, we aim to provide a comprehensive account of different neural correlates of cognitive dysfunction via magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), functional MRI (fMRI) (resting-state and task-related), positron emission tomography (PET) and magnetic resonance spectroscopy (MRS) modalities across the cognitive groups i.e., normal cognition, mild cognitive impairment (MCI), and AD. A total of 46 meta-analyses met the inclusion criteria, including relevance to MCI, and/or AD along with neuroimaging modality used with quantitative and/or functional data. Volumetric MRI identified early anatomical changes involving transentorhinal cortex, Brodmann area 28, followed by the hippocampus, which differentiated early AD from healthy subjects. A consistent pattern of disruption in the bilateral precuneus along with the medial temporal lobe and limbic system was observed in fMRI, while DTI substantiated the observed atrophic alterations in the corpus callosum among MCI and AD cases. Default mode network hypoconnectivity in bilateral precuneus (PCu)/posterior cingulate cortices (PCC) and hypometabolism/hypoperfusion in inferior parietal lobules and left PCC/PCu was evident. Molecular imaging revealed variable metabolite concentrations in PCC. In conclusion, the use of different neuroimaging modalities together may lead to identification of an early diagnostic and/or prognostic biomarker for AD.
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Affiliation(s)
- Puneet Talwar
- Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), 110095, Dilshad Garden, Delhi, India.
| | - Suman Kushwaha
- Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), 110095, Dilshad Garden, Delhi, India.
| | - Monali Chaturvedi
- Department of Neuroradiology, Institute of Human Behaviour and Allied Sciences (IHBAS), 110095, Dilshad Garden, Delhi, India
| | - Vidur Mahajan
- Centre for Advanced Research in Imaging, Neuroscience and Genomics (CARING), Mahajan Imaging, New Delhi, India
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Ferrando R, Damian A. Brain SPECT as a Biomarker of Neurodegeneration in Dementia in the Era of Molecular Imaging: Still a Valid Option? Front Neurol 2021; 12:629442. [PMID: 34040574 PMCID: PMC8141564 DOI: 10.3389/fneur.2021.629442] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/06/2021] [Indexed: 12/21/2022] Open
Abstract
Biomarkers are playing a progressively leading role in both clinical practice and scientific research in dementia. Although amyloid and tau biomarkers have gained ground in the clinical community in recent years, neurodegeneration biomarkers continue to play a key role due to their ability to identify different patterns of brain involvement that sign the transition between asymptomatic and symptomatic stages of the disease with high sensitivity and specificity. Both 18F-FDG positron emission tomography (PET) and perfusion single photon emission computed tomography (SPECT) have proved useful to reveal the functional alterations underlying various neurodegenerative diseases. Although the focus of nuclear neuroimaging has shifted to PET, the lower cost and wider availability of SPECT make it a still valid alternative for the study of patients with dementia. This review discusses the principles of both techniques, compares their diagnostic performance for the diagnosis of neurodegenerative diseases and highlights the role of SPECT to characterize patients from low- and middle-income countries, where special care of additional costs is particularly needed to meet the new recommendations for the diagnosis and characterization of patients with dementia.
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Affiliation(s)
- Rodolfo Ferrando
- Centro de Medicina Nuclear e Imagenología Molecular, Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay.,Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
| | - Andres Damian
- Centro de Medicina Nuclear e Imagenología Molecular, Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay.,Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
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27
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Bao W, Xie F, Zuo C, Guan Y, Huang YH. PET Neuroimaging of Alzheimer's Disease: Radiotracers and Their Utility in Clinical Research. Front Aging Neurosci 2021; 13:624330. [PMID: 34025386 PMCID: PMC8134674 DOI: 10.3389/fnagi.2021.624330] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/23/2021] [Indexed: 12/14/2022] Open
Abstract
Alzheimer's Disease (AD), the leading cause of senile dementia, is a progressive neurodegenerative disorder affecting millions of people worldwide and exerting tremendous socioeconomic burden on all societies. Although definitive diagnosis of AD is often made in the presence of clinical manifestations in late stages, it is now universally believed that AD is a continuum of disease commencing from the preclinical stage with typical neuropathological alterations appearing decades prior to its first symptom, to the prodromal stage with slight symptoms of amnesia (amnestic mild cognitive impairment, aMCI), and then to the terminal stage with extensive loss of basic cognitive functions, i.e., AD-dementia. Positron emission tomography (PET) radiotracers have been developed in a search to meet the increasing clinical need of early detection and treatment monitoring for AD, with reference to the pathophysiological targets in Alzheimer's brain. These include the pathological aggregations of misfolded proteins such as β-amyloid (Aβ) plagues and neurofibrillary tangles (NFTs), impaired neurotransmitter system, neuroinflammation, as well as deficient synaptic vesicles and glucose utilization. In this article we survey the various PET radiotracers available for AD imaging and discuss their clinical applications especially in terms of early detection and cognitive relevance.
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Affiliation(s)
- Weiqi Bao
- PET Center, Huanshan Hospital, Fudan University, Shanghai, China
| | - Fang Xie
- PET Center, Huanshan Hospital, Fudan University, Shanghai, China
| | - Chuantao Zuo
- PET Center, Huanshan Hospital, Fudan University, Shanghai, China
| | - Yihui Guan
- PET Center, Huanshan Hospital, Fudan University, Shanghai, China
| | - Yiyun Henry Huang
- Department of Radiology and Biomedical Imaging, PET Center, Yale University School of Medicine, New Haven, CT, United States
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Abstract
This article presents an overview of imaging agents for PET that have been applied for research and diagnostic purposes in patients affected by dementia. Classified by the target which the agents visualize, seven groups of tracers can be distinguished, namely radiopharmaceuticals for: (1) Misfolded proteins (ß-amyloid, tau, α-synuclein), (2) Neuroinflammation (overexpression of translocator protein), (3) Elements of the cholinergic system, (4) Elements of monoamine neurotransmitter systems, (5) Synaptic density, (6) Cerebral energy metabolism (glucose transport/ hexokinase), and (7) Various other proteins. This last category contains proteins involved in mechanisms underlying neuroinflammation or cognitive impairment, which may also be potential therapeutic targets. Many receptors belong to this category: AMPA, cannabinoid, colony stimulating factor 1, metabotropic glutamate receptor 1 and 5 (mGluR1, mGluR5), opioid (kappa, mu), purinergic (P2X7, P2Y12), sigma-1, sigma-2, receptor for advanced glycation endproducts, and triggering receptor expressed on myeloid cells-1, besides several enzymes: cyclooxygenase-1 and 2 (COX-1, COX-2), phosphodiesterase-5 and 10 (PDE5, PDE10), and tropomyosin receptor kinase. Significant advances in neuroimaging have been made in the last 15 years. The use of 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) for quantification of regional cerebral glucose metabolism is well-established. Three tracers for ß-amyloid plaques have been approved by the Food and Drug Administration and European Medicines Agency. Several tracers for tau neurofibrillary tangles are already applied in clinical research. Since many novel agents are in the preclinical or experimental stage of development, further advances in nuclear medicine imaging can be expected in the near future. PET studies with established tracers and tracers for novel targets may result in early diagnosis and better classification of neurodegenerative disorders and in accurate monitoring of therapy trials which involve these targets. PET data have prognostic value and may be used to assess the response of the human brain to interventions, or to select the appropriate treatment strategy for an individual patient.
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Affiliation(s)
- Aren van Waarde
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands.
| | - Sofia Marcolini
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
| | - Peter Paul de Deyn
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands; University of Antwerp, Born-Bunge Institute, Neurochemistry and Behavior, Campus Drie Eiken, Wilrijk, Belgium
| | - Rudi A J O Dierckx
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands; Ghent University, Ghent, Belgium
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Nangare S, Patil P. Nanoarchitectured Bioconjugates and Bioreceptors Mediated Surface Plasmon Resonance Biosensor for In Vitro Diagnosis of Alzheimer’s Disease: Development and Future Prospects. Crit Rev Anal Chem 2021; 52:1139-1169. [DOI: 10.1080/10408347.2020.1864716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sopan Nangare
- Department of Pharmaceutical Chemistry, H. R. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Pravin Patil
- Department of Pharmaceutical Chemistry, H. R. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
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Blazhenets G, Frings L, Ma Y, Sörensen A, Eidelberg D, Wiltfang J, Meyer PT. Validation of the Alzheimer Disease Dementia Conversion-Related Pattern as an ATN Biomarker of Neurodegeneration. Neurology 2021; 96:e1358-e1368. [PMID: 33408150 DOI: 10.1212/wnl.0000000000011521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/09/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether the Alzheimer disease (AD) dementia conversion-related pattern (ADCRP) on [18F]FDG PET can serve as a valid predictor for the development of AD dementia, the individual expression of the ADCRP (subject score) and its prognostic value were examined in patients with mild cognitive impairment (MCI) and biologically defined AD. METHODS A total of 269 patients with available [18F]FDG PET, [18F]AV-45 PET, phosphorylated and total tau in CSF, and neurofilament light chain in plasma were included. Following the AT(N) classification scheme, where AD is defined biologically by in vivo biomarkers of β-amyloid (Aβ) deposition ("A") and pathologic tau ("T"), patients were categorized to the A-T-, A+T-, A+T+ (AD), and A-T+ groups. RESULTS The mean subject score of the ADCRP was significantly higher in the A+T+ group compared to each of the other group (all p < 0.05) but was similar among the latter (all p > 0.1). Within the A+T+ group, the subject score of ADCRP was a significant predictor of conversion to dementia (hazard ratio, 2.02 per z score increase; p < 0.001), with higher predictive value than of alternative biomarkers of neurodegeneration (total tau and neurofilament light chain). Stratification of A+T+ patients by the subject score of ADCRP yielded well-separated groups of high, medium, and low conversion risks. CONCLUSIONS The ADCRP is a valuable biomarker of neurodegeneration in patients with MCI and biologically defined AD. It shows great potential for stratifying the risk and estimating the time to conversion to dementia in patients with MCI and underlying AD (A+T+). CLASSIFICATION OF EVIDENCE This study provides Class I evidence that [18F]FDG PET predicts the development of AD dementia in individuals with MCI and underlying AD as defined by the AT(N) framework.
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Affiliation(s)
- Ganna Blazhenets
- From the Department of Nuclear Medicine (G.B., L.F., A.S., P.T.M.), Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; Center for Neurosciences (Y.M., D.E.), Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY; and Department of Psychiatry and Psychotherapy (J.W.), University Medical Center, Georg-August-University, Göttingen, Germany.
| | - Lars Frings
- From the Department of Nuclear Medicine (G.B., L.F., A.S., P.T.M.), Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; Center for Neurosciences (Y.M., D.E.), Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY; and Department of Psychiatry and Psychotherapy (J.W.), University Medical Center, Georg-August-University, Göttingen, Germany
| | - Yilong Ma
- From the Department of Nuclear Medicine (G.B., L.F., A.S., P.T.M.), Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; Center for Neurosciences (Y.M., D.E.), Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY; and Department of Psychiatry and Psychotherapy (J.W.), University Medical Center, Georg-August-University, Göttingen, Germany
| | - Arnd Sörensen
- From the Department of Nuclear Medicine (G.B., L.F., A.S., P.T.M.), Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; Center for Neurosciences (Y.M., D.E.), Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY; and Department of Psychiatry and Psychotherapy (J.W.), University Medical Center, Georg-August-University, Göttingen, Germany
| | - David Eidelberg
- From the Department of Nuclear Medicine (G.B., L.F., A.S., P.T.M.), Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; Center for Neurosciences (Y.M., D.E.), Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY; and Department of Psychiatry and Psychotherapy (J.W.), University Medical Center, Georg-August-University, Göttingen, Germany
| | - Jens Wiltfang
- From the Department of Nuclear Medicine (G.B., L.F., A.S., P.T.M.), Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; Center for Neurosciences (Y.M., D.E.), Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY; and Department of Psychiatry and Psychotherapy (J.W.), University Medical Center, Georg-August-University, Göttingen, Germany
| | - Philipp T Meyer
- From the Department of Nuclear Medicine (G.B., L.F., A.S., P.T.M.), Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; Center for Neurosciences (Y.M., D.E.), Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY; and Department of Psychiatry and Psychotherapy (J.W.), University Medical Center, Georg-August-University, Göttingen, Germany
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31
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Drzezga A, Bischof GN, Giehl K, van Eimeren T. PET and SPECT Imaging of Neurodegenerative Diseases. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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32
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Tondo G, Carli G, Santangelo R, Mattoli MV, Presotto L, Filippi M, Magnani G, Iannaccone S, Cerami C, Perani D. Biomarker-based stability in limbic-predominant amnestic mild cognitive impairment. Eur J Neurol 2020; 28:1123-1133. [PMID: 33185922 DOI: 10.1111/ene.14639] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The amnestic presentation of mild cognitive impairment (aMCI) represents the most common prodromal stage of Alzheimer's disease (AD) dementia. There is, however, some evidence of aMCI with typical amnestic syndrome but showing long-term clinical stability. The ability to predict stability or progression to dementia in the aMCI condition is important, particularly for the selection of candidates in clinical trials. We aimed to establish the role of in vivo biomarkers, as assessed by cerebrospinal fluid (CSF) measures and [18 F]fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging, in predicting prognosis in a large aMCI cohort. METHODS We conducted a retrospective study, including 142 aMCI subjects who had a long follow-up (4-19 years), baseline CSF data and [18 F]FDG-PET scans individually assessed by validated voxel-based procedures, classifying subjects into either limbic-predominant or AD-like hypometabolism patterns. RESULTS The two aMCI cohorts were clinically comparable at baseline. At follow-up, the aMCI group with a limbic-predominant [18 F]FDG-PET pattern showed clinical stability over a very long follow-up (8.20 ± 3.30 years), no decline in Mini-Mental State Examination score, and only 7% conversion to dementia. Conversely, the aMCI group with an AD-like [18 F]FDG-PET pattern had a high rate of dementia progression (86%) over a shorter follow-up (6.47 ± 2.07 years). Individual [18 F]FDG-PET hypometabolism patterns predicted stability or conversion with high accuracy (area under the curve = 0.89), sensitivity (0.90) and specificity (0.89). In the limbic-predominant aMCI cohort, CSF biomarkers showed large variability and no prognostic value. CONCLUSIONS In a large series of clinically comparable subjects with aMCI at baseline, the specific [18 F]FDG-PET limbic-predominant hypometabolism pattern was associated with clinical stability, making progression to AD very unlikely. The identification of a biomarker-based benign course in aMCI subjects has important implications for prognosis and in planning clinical trials.
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Affiliation(s)
- Giacomo Tondo
- 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
| | - Giulia Carli
- 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
| | - Roberto Santangelo
- Department of Neurology and INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Vittoria Mattoli
- Department of Neuroscience, Imaging and Clinical Science, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Luca Presotto
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Massimo Filippi
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology and INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Magnani
- Department of Neurology and INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - Sandro Iannaccone
- Clinical Neuroscience Department, San Raffaele Turro Hospital, Milan, Italy
| | - Chiara Cerami
- Scuola Universitaria Superiore IUSS, Pavia, Italy.,Cognitive Computational Neuroscience Research Unit, IRCCS Mondino Foundation, Pavia, 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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Chételat G, Arbizu J, Barthel H, Garibotto V, Law I, Morbelli S, van de Giessen E, Agosta F, Barkhof F, Brooks DJ, Carrillo MC, Dubois B, Fjell AM, Frisoni GB, Hansson O, Herholz K, Hutton BF, Jack CR, Lammertsma AA, Landau SM, Minoshima S, Nobili F, Nordberg A, Ossenkoppele R, Oyen WJG, Perani D, Rabinovici GD, Scheltens P, Villemagne VL, Zetterberg H, Drzezga A. Amyloid-PET and 18F-FDG-PET in the diagnostic investigation of Alzheimer's disease and other dementias. Lancet Neurol 2020; 19:951-962. [PMID: 33098804 DOI: 10.1016/s1474-4422(20)30314-8] [Citation(s) in RCA: 220] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022]
Abstract
Various biomarkers are available to support the diagnosis of neurodegenerative diseases in clinical and research settings. Among the molecular imaging biomarkers, amyloid-PET, which assesses brain amyloid deposition, and 18F-fluorodeoxyglucose (18F-FDG) PET, which assesses glucose metabolism, provide valuable and complementary information. However, uncertainty remains regarding the optimal timepoint, combination, and an order in which these PET biomarkers should be used in diagnostic evaluations because conclusive evidence is missing. Following an expert panel discussion, we reached an agreement on the specific use of the individual biomarkers, based on available evidence and clinical expertise. We propose a diagnostic algorithm with optimal timepoints for these PET biomarkers, also taking into account evidence from other biomarkers, for early and differential diagnosis of neurodegenerative diseases that can lead to dementia. We propose three main diagnostic pathways with distinct biomarker sequences, in which amyloid-PET and 18F-FDG-PET are placed at different positions in the order of diagnostic evaluations, depending on clinical presentation. We hope that this algorithm can support diagnostic decision making in specialist clinical settings with access to these biomarkers and might stimulate further research towards optimal diagnostic strategies.
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Affiliation(s)
- Gaël Chételat
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237, Groupement d'Intérêt Public Cyceron, Caen, France.
| | - Javier Arbizu
- Department of Nuclear Medicine, University of Navarra, Clinica Universidad de Navarra, Pamplona, Spain
| | - Henryk Barthel
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTlab, Geneva University, Geneva, Switzerland
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Silvia Morbelli
- Nuclear Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - David J Brooks
- Institute of Neuroscience, Newcastle University, Newcastle, UK; Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bruno Dubois
- Centre des Maladies Cognitives et Comportementales, University Hospital of Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Paris, France
| | - Anders M Fjell
- Center for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Norway, Oslo; Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Giovanni B Frisoni
- Memory Clinic, Department of Rehabilitation and Geriatrics, Geneva University and University Hospitals, Geneva, Switzerland
| | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, Malmö, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Karl Herholz
- Wolfson Molecular Imaging Centre, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Brian F Hutton
- Institute of Nuclear Medicine, University College London, London, UK
| | | | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Susan M Landau
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA
| | - Satoshi Minoshima
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Flavio Nobili
- UO Clinica Neurologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Child and Mother Health, University of Genoa, Genova, Italy
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Wim J G Oyen
- Humanitas University and Humanitas Clinical and Research Center, Department of Nuclear Medicine, Milan, Italy; Rijnstate, Department of Radiology and Nuclear Medicine, Arnhem, Netherlands; Radboud UMC, Department of Radiology and Nuclear Medicine, Nijmegen, Netherlands
| | - Daniela Perani
- Vita-Salute San Raffaele University, Nuclear Medicine Unit, San Raffaele Hospital, Division of Neuroscience San Raffaele Scientific Institute, Milan, Italy
| | - Gil D Rabinovici
- Departments of Neurology, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Victor L Villemagne
- Department of Molecular Imaging & Therapy, Austin Health, Department of Medicine, University of Melbourne, Austin Health, Heidelberg, VIC, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UK Dementia Research Institute at University College London, London, UK
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; German Center for Neurodegenerative Diseases, Bonn-Cologne, Germany; Institute of Neuroscience and Medicine, Molecular Organization of the Brain, Forschungszentrum Jülich, Germany
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34
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Current role of 18F-FDG-PET in the differential diagnosis of the main forms of dementia. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00366-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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35
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36
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Ferrari BL, Neto GDCC, Nucci MP, Mamani JB, Lacerda SS, Felício AC, Amaro E, Gamarra LF. The accuracy of hippocampal volumetry and glucose metabolism for the diagnosis of patients with suspected Alzheimer's disease, using automatic quantitative clinical tools. Medicine (Baltimore) 2019; 98:e17824. [PMID: 31702636 PMCID: PMC6855664 DOI: 10.1097/md.0000000000017824] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The hippocampus is one of the earliest sites involved in the pathology of Alzheimer's disease (AD). Therefore, we specifically investigated the sensitivity and specificity of hippocampal volume and glucose metabolism in patients being evaluated for AD, using automated quantitative tools (NeuroQuant - magnetic resonance imaging [MRI] and Scenium - positron emission tomography [PET]) and clinical evaluation.This retrospective study included adult patients over the age of 45 years with suspected AD, who had undergone fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET-CT) and MRI. FDG-PET-CT images were analyzed both qualitatively and quantitatively. In quantitative volumetric MRI analysis, the percentage of the total intracranial volume of each brain region, as well as the total hippocampal volume, were considered in comparison to an age-adjusted percentile. The remaining brain regions were compared between groups according to the final diagnosis.Thirty-eight patients were included in this study. After a mean follow-up period of 23 ± 11 months, the final diagnosis for 16 patients was AD or high-risk mild cognitive impairment (MCI). Out of the 16 patients, 8 patients were women, and the average age of all patients was 69.38 ± 10.98 years. Among the remaining 22 patients enrolled in the study, 14 were women, and the average age was 67.50 ± 11.60 years; a diagnosis of AD was initially excluded, but the patients may have low-risk MCI. Qualitative FDG-PET-CT analysis showed greater accuracy (0.87), sensitivity (0.76), and negative predictive value (0.77), when compared to quantitative PET analysis, hippocampal MRI volumetry, and specificity. The positive predictive value of FDG-PET-CT was similar to the MRI value.The performance of FDG-PET-CT qualitative analysis was significantly more effective compared to MRI volumetry. At least in part, this observation could corroborate the sequential hypothesis of AD pathophysiology, which posits that functional changes (synaptic dysfunction) precede structural changes (atrophy).
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Affiliation(s)
| | | | - Mariana Penteado Nucci
- LIM44, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Benedet AL, Ashton NJ, Pascoal TA, Leuzy A, Mathotaarachchi S, Kang MS, Therriault J, Savard M, Chamoun M, Schöll M, Zimmer ER, Gauthier S, Labbe A, Zetterberg H, Blennow K, Neto PR. Plasma neurofilament light associates with Alzheimer's disease metabolic decline in amyloid-positive individuals. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2019; 11:679-689. [PMID: 31673598 PMCID: PMC6816316 DOI: 10.1016/j.dadm.2019.08.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Introduction Neurofilament light chain (NfL) is a promising blood biomarker to detect neurodegeneration in Alzheimer's disease (AD) and other brain disorders. However, there are limited reports of how longitudinal NfL relates to imaging biomarkers. We herein investigated the relationship between blood NfL and brain metabolism in AD. Methods Voxelwise regression models tested the cross-sectional association between [18F]fluorodeoxyglucose ([18F]FDG) and both plasma and cerebrospinal fluid NfL in cognitively impaired and unimpaired subjects. Linear mixed models were also used to test the longitudinal association between NfL and [18F]FDG in amyloid positive (Aβ+) and negative (Aβ-) subjects. Results Higher concentrations of plasma and cerebrospinal fluid NfL were associated with reduced [18F]FDG uptake in correspondent brain regions. In Aβ+ participants, NfL associates with hypometabolism in AD-vulnerable regions. Longitudinal changes in the association [18F]FDG-NfL were confined to cognitively impaired Aβ+ individuals. Discussion These findings indicate that plasma NfL is a proxy for neurodegeneration in AD-related regions in Aβ+ subjects.
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Affiliation(s)
- Andréa L Benedet
- Translational Neuroimaging Laboratory, McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada.,CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Institute Clinical Neuroscience Institute, London, UK.,NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
| | - Tharick A Pascoal
- Translational Neuroimaging Laboratory, McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
| | - Antoine Leuzy
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Sulantha Mathotaarachchi
- Translational Neuroimaging Laboratory, McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
| | - Min S Kang
- Translational Neuroimaging Laboratory, McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
| | - Joseph Therriault
- Translational Neuroimaging Laboratory, McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
| | - Melissa Savard
- Translational Neuroimaging Laboratory, McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
| | - Mira Chamoun
- Translational Neuroimaging Laboratory, McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
| | - Michael Schöll
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.,Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Eduardo R Zimmer
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, Montreal, McGill University, Montreal, Quebec, Canada.,Department of Pharmacology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Serge Gauthier
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, Montreal, McGill University, Montreal, Quebec, Canada
| | - Aurélie Labbe
- Department of Decision Sciences, HEC Montreal, Montreal, Quebec, Canada
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Pedro R Neto
- Translational Neuroimaging Laboratory, McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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Mukku SSR, Sivakumar PT, Nagaraj C, Mangalore S, Harbishettar V, Varghese M. Clinical utility of 18F-FDG-PET/MRI brain in dementia: Preliminary experience from a geriatric clinic in South India. Asian J Psychiatr 2019; 44:99-105. [PMID: 31336358 DOI: 10.1016/j.ajp.2019.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND 18F-FDG-PET is a potential sensitive biomarker indicating neuronal damage. 18F-FDG-PET has proven to be useful in subtyping dementia. Utility of simultaneous 18F-FDG-PET and MRI-brain was investigated in the evaluation of dementia in this facility. METHOD All case notes of patients who underwent 18 F-FDG-PET/MRI brain attending the Geriatric Clinic for 18 month period between January 2017 and June 2018 were retrospectively reviewed. Their socio-demographic details, MRI-brain finding, 18F- FDG-PET findings and comorbid illnesses were studied. RESULTS A total of 21 patients underwent 18F-FDG-PET/MRI brain during study period. The mean age was 61.23, SD-8.6 years (range: 36-75 years). Among them 5 (23.8%) had Mild Cognitive Impairment (MCI) and 16 (76.2%) had dementia. Majority of patients had early onset cognitive decline (76.2%). Based on the pattern of hypometabolism, the MCI group had one patient each indicative of AD, Semantic-Frontotemporal dementia (Semantic-FTD), mixed Alzheimer's dementia (AD + FTD) and two patients had patterns suggestive of Behaviour Variant of FTD (Bv-FTD). In Dementia group the pattern of hypometabolism was indicative of Bv-FTD in seven, AD in four, Posterior Cortical Atrophy (PCA) in one, Semantic-FTD in one, Mixed AD-Diffuse Lewy Body Dementia (DLBD) in one and no specific pattern in two patients. MRI and 18 F-FDG-PET brain had concordance in 9 (56.26%) patients. DISCUSSION 18F-FDG-PET/MRI helped in overall clinical diagnosis and management in 19 (90.5%) patients especially with early onset dementia. In MCI group it indicated underlying aetiology and in dementia group it helped in subtyping. CONCLUSION The study supports the role of 18F-FDG-PET/MRI as an emerging diagnostic tool to assist in dementia evaluation in India.
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Affiliation(s)
- Shiva Shanker Reddy Mukku
- Geriatric Clinic & Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Palanimuthu Thangaraju Sivakumar
- Geriatric Clinic & Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Chandana Nagaraj
- Department of Neuroimaging and interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Sandhya Mangalore
- Department of Neuroimaging and interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Vijaykumar Harbishettar
- Geriatric Clinic & Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Mathew Varghese
- Geriatric Clinic & Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
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Beyer L, Schnabel J, Kazmierczak P, Ewers M, Schönecker S, Prix C, Meyer-Wilmes J, Unterrainer M, Catak C, Pogarell O, Perneczky R, Albert NL, Bartenstein P, Danek A, Buerger K, Levin J, Rominger A, Brendel M. Neuronal injury biomarkers for assessment of the individual cognitive reserve in clinically suspected Alzheimer's disease. NEUROIMAGE-CLINICAL 2019; 24:101949. [PMID: 31398553 PMCID: PMC6699250 DOI: 10.1016/j.nicl.2019.101949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 06/18/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Many predictive or influencing factors have emerged in investigations of the cognitive reserve model of patients with Alzheimer's disease (AD). For example, neuronal injury, which correlates with cognitive decline in AD, can be assessed by [18F]-fluorodeoxyglucose positron-emission-tomography (FDG-PET), structural magnetic resonance imaging (MRI) and total tau in cerebrospinal fluid (CSFt-tau), all according to the A/T/N-classification. The aim of this study was to calculate residual cognitive performance based on neuronal injury biomarkers as a surrogate of cognitive reserve, and to test the predictive value of this index for the individual clinical course. METHODS 110 initially mild cognitive impaired and demented subjects (age 71 ± 8 years) with a final diagnosis of AD dementia were assessed at baseline by clinical mini-mental-state-examination (MMSE), FDG-PET, MRI and CSFt-tau. All neuronal injury markers were tested for an association with clinical MMSE and the resulting residuals were correlated with years of education. We used multiple regression analysis to calculate the expected MMSE score based on neuronal injury biomarkers and covariates. The residuals of the partial correlation for each biomarker and the predicted residualized memory function were correlated with individual cognitive changes measured during clinical follow-up (27 ± 13 months). RESULTS FDG-PET correlated highly with clinical MMSE (R = -0.49, p < .01), whereas hippocampal atrophy to MRI (R = -0.15, p = .14) and CSFt-tau (R = -0.12, p = .22) showed only weak correlations. Residuals of all neuronal injury biomarker regressions correlated significantly with education level, indicating them to be surrogates of cognitive reserve. A positive residual was associated with faster cognitive deterioration at follow-up for the residuals of stand-alone FDG-PET (R = -0.36, p = .01) and the combined residualized memory function model (R = -0.35, p = .02). CONCLUSIONS These findings suggest that subjects with higher cognitive reserve had accumulated more pathology, which subsequently caused a faster cognitive decline over time. Together with previous findings suggesting that higher reserve is associated with slower cognitive decline, we propose a biphasic reserve effect, with an initially protective phase followed by more rapid decompensation once the protection is overwhelmed.
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Affiliation(s)
- Leonie Beyer
- Dept. of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Jonas Schnabel
- Dept. of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Philipp Kazmierczak
- Institute for Radiology, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Michael Ewers
- DZNE - German Center for Neurodegenerative Diseases, Feodor-Lynen-Straße 17, 81377 Munich, Germany
| | - Sonja Schönecker
- Dept. of Neurology, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Catharina Prix
- Dept. of Neurology, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Johanna Meyer-Wilmes
- Dept. of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Marcus Unterrainer
- Dept. of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Cihan Catak
- Institute for Stroke and Dementia Research, University Hospital of Munich, LMU Munich, Feodor-Lynen-Straße 17, 81377 Munich, Germany
| | - Oliver Pogarell
- Dept. of Psychiatry, University Hospital of Munich, LMU Munich, Nußbaumstraße 7, 80336 Munich, Germany
| | - Robert Perneczky
- DZNE - German Center for Neurodegenerative Diseases, Feodor-Lynen-Straße 17, 81377 Munich, Germany; Dept. of Psychiatry, University Hospital of Munich, LMU Munich, Nußbaumstraße 7, 80336 Munich, Germany; Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College, Charing Cross Hospital, St Dunstan's Road, London W6 8RP, United Kingdom; West London Mental Health NHS Trust, 1 Armstrong Way, Southhall UB2 4SD, United Kingdom
| | - Nathalie L Albert
- Dept. of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Peter Bartenstein
- Dept. of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Straße 17, 81377 Munich, Germany
| | - Adrian Danek
- Dept. of Neurology, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Katharina Buerger
- DZNE - German Center for Neurodegenerative Diseases, Feodor-Lynen-Straße 17, 81377 Munich, Germany; Institute for Stroke and Dementia Research, University Hospital of Munich, LMU Munich, Feodor-Lynen-Straße 17, 81377 Munich, Germany
| | - Johannes Levin
- Dept. of Neurology, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Axel Rominger
- Dept. of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; Dept. of Nuclear Medicine, University of Bern, Inselspital, Freiburgstraße 18, 3010 Bern, Switzerland; Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Straße 17, 81377 Munich, Germany
| | - Matthias Brendel
- Dept. of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Straße 17, 81377 Munich, Germany.
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Xu J, Li Q, Qin W, Jun Li M, Zhuo C, Liu H, Liu F, Wang J, Schumann G, Yu C. Neurobiological substrates underlying the effect of genomic risk for depression on the conversion of amnestic mild cognitive impairment. Brain 2019; 141:3457-3471. [PMID: 30445590 DOI: 10.1093/brain/awy277] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/12/2018] [Indexed: 12/28/2022] Open
Abstract
Depression increases the conversion risk from amnestic mild cognitive impairment to Alzheimer's disease with unknown mechanisms. We hypothesize that the cumulative genomic risk for major depressive disorder may be a candidate cause for the increased conversion risk. Here, we aimed to investigate the predictive effect of the polygenic risk scores of major depressive disorder-specific genetic variants (PRSsMDD) on the conversion from non-depressed amnestic mild cognitive impairment to Alzheimer's disease, and its underlying neurobiological mechanisms. The PRSsMDD could predict the conversion from amnestic mild cognitive impairment to Alzheimer's disease, and amnestic mild cognitive impairment patients with high risk scores showed 16.25% higher conversion rate than those with low risk. The PRSsMDD was correlated with the left hippocampal volume, which was found to mediate the predictive effect of the PRSsMDD on the conversion of amnestic mild cognitive impairment. The major depressive disorder-specific genetic variants were mapped into genes using different strategies, and then enrichment analyses and protein-protein interaction network analysis revealed that these genes were involved in developmental process and amyloid-beta binding. They showed temporal-specific expression in the hippocampus in middle and late foetal developmental periods. Cell type-specific expression analysis of these genes demonstrated significant over-representation in the pyramidal neurons and interneurons in the hippocampus. These cross-scale neurobiological analyses and functional annotations indicate that major depressive disorder-specific genetic variants may increase the conversion from amnestic mild cognitive impairment to Alzheimer's disease by modulating the early hippocampal development and amyloid-beta binding. The PRSsMDD could be used as a complementary measure to select patients with amnestic mild cognitive impairment with high conversion risk to Alzheimer's disease.
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Affiliation(s)
- Jiayuan Xu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Qiaojun Li
- College of Information Engineering, Tianjin University of Commerce, Tianjin, P.R. China
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Mulin Jun Li
- Collaborative Innovation Center of Tianjin for Medical Epigenetics, Tianjin Key Laboratory of Medical Epigenetics, Department of Pharmacology, Tianjin Medical University, Tianjin, P.R. China
| | - Chuanjun Zhuo
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, P.R. China.,Department of Psychiatry Functional Neuroimaging Laboratory, Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin, P.R. China
| | - Huaigui Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Feng Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Junping Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Gunter Schumann
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Medical Research Council Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, P.R. China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, P.R. China
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Márquez F, Yassa MA. Neuroimaging Biomarkers for Alzheimer's Disease. Mol Neurodegener 2019; 14:21. [PMID: 31174557 PMCID: PMC6555939 DOI: 10.1186/s13024-019-0325-5] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 05/28/2019] [Indexed: 12/11/2022] Open
Abstract
Currently, over five million Americans suffer with Alzheimer's disease (AD). In the absence of a cure, this number could increase to 13.8 million by 2050. A critical goal of biomedical research is to establish indicators of AD during the preclinical stage (i.e. biomarkers) allowing for early diagnosis and intervention. Numerous advances have been made in developing biomarkers for AD using neuroimaging approaches. These approaches offer tremendous versatility in terms of targeting distinct age-related and pathophysiological mechanisms such as structural decline (e.g. volumetry, cortical thinning), functional decline (e.g. fMRI activity, network correlations), connectivity decline (e.g. diffusion anisotropy), and pathological aggregates (e.g. amyloid and tau PET). In this review, we survey the state of the literature on neuroimaging approaches to developing novel biomarkers for the amnestic form of AD, with an emphasis on combining approaches into multimodal biomarkers. We also discuss emerging methods including imaging epigenetics, neuroinflammation, and synaptic integrity using PET tracers. Finally, we review the complementary information that neuroimaging biomarkers provide, which highlights the potential utility of composite biomarkers as suitable outcome measures for proof-of-concept clinical trials with experimental therapeutics.
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Affiliation(s)
- Freddie Márquez
- Department of Neurobiology and Behavior, Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, CA, 92697, USA.
| | - Michael A Yassa
- Department of Neurobiology and Behavior, Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, CA, 92697, USA.
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Wilson H, Pagano G, Politis M. Dementia spectrum disorders: lessons learnt from decades with PET research. J Neural Transm (Vienna) 2019; 126:233-251. [PMID: 30762136 PMCID: PMC6449308 DOI: 10.1007/s00702-019-01975-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/21/2019] [Indexed: 02/07/2023]
Abstract
The dementia spectrum encompasses a range of disorders with complex diagnosis, pathophysiology and limited treatment options. Positron emission tomography (PET) imaging provides insights into specific neurodegenerative processes underlying dementia disorders in vivo. Here we focus on some of the most common dementias: Alzheimer's disease, Parkinsonism dementias including Parkinson's disease with dementia, dementia with Lewy bodies, progressive supranuclear palsy and corticobasal syndrome, and frontotemporal lobe degeneration. PET tracers have been developed to target specific proteinopathies (amyloid, tau and α-synuclein), glucose metabolism, cholinergic system and neuroinflammation. Studies have shown distinct imaging abnormalities can be detected early, in some cases prior to symptom onset, allowing disease progression to be monitored and providing the potential to predict symptom onset. Furthermore, advances in PET imaging have identified potential therapeutic targets and novel methods to accurately discriminate between different types of dementias in vivo. There are promising imaging markers with a clinical application on the horizon, however, further studies are required before they can be implantation into clinical practice.
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Affiliation(s)
- Heather Wilson
- Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, 125 Coldharbour Lane, Camberwell, London, SE5 9NU, UK
| | - Gennaro Pagano
- Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, 125 Coldharbour Lane, Camberwell, London, SE5 9NU, UK
| | - Marios Politis
- Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, 125 Coldharbour Lane, Camberwell, London, SE5 9NU, UK.
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Sun Y, Bi Q, Wang X, Hu X, Li H, Li X, Ma T, Lu J, Chan P, Shu N, Han Y. Prediction of Conversion From Amnestic Mild Cognitive Impairment to Alzheimer's Disease Based on the Brain Structural Connectome. Front Neurol 2019; 9:1178. [PMID: 30687226 PMCID: PMC6335339 DOI: 10.3389/fneur.2018.01178] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/20/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Early prediction of disease progression in patients with amnestic mild cognitive impairment (aMCI) is important for early diagnosis and intervention of Alzheimer's disease (AD). Previous brain network studies have suggested topological disruptions of the brain connectome in aMCI patients. However, whether brain connectome markers at baseline can predict longitudinal conversion from aMCI to AD remains largely unknown. Methods: In this study, 52 patients with aMCI and 26 demographically matched healthy controls from a longitudinal cohort were evaluated. During 2 years of follow-up, 26 patients with aMCI were retrospectively classified as aMCI converters and 26 patients remained stable as aMCI non-converters based on whether they were subsequently diagnosed with AD. For each participant, diffusion tensor imaging at baseline and deterministic tractography were used to map the whole-brain white matter structural connectome. Graph theoretical analysis was applied to investigate the convergent and divergent connectivity patterns of structural connectome between aMCI converters and non-converters. Results: Disrupted topological organization of the brain structural connectome were identified in both aMCI converters and non-converters. More severe disruptions of structural connectivity in aMCI converters compared with non-converters were found, especially in the default-mode network regions and connections. Finally, a support vector machine-based classification demonstrated the good discriminative ability of structural connectivity in differentiating aMCI patients from controls with an accuracy of 98%, and in discriminating converters from non-converters with an accuracy of 81%. Conclusion: Our study provides potential structural connectome/connectivity-based biomarkers for predicting disease progression in aMCI, which is important for the early diagnosis of AD.
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Affiliation(s)
- Yu Sun
- Department of Neurology, XuanWu Hospital of Capital Medical University, Beijing, China
| | - Qiuhui Bi
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
| | - Xiaoni Wang
- Department of Neurology, XuanWu Hospital of Capital Medical University, Beijing, China
| | - Xiaochen Hu
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Huijie Li
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China
| | - Xiaobo Li
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Ting Ma
- Department of Electronic and Information Engineering, Harbin Institute of Technology Shenzhen Graduate School, Shenzhen, China
| | - Jie Lu
- Department of Radiology, XuanWu Hospital of Capital Medical University, Beijing, China
| | - Piu Chan
- Department of Neurology, XuanWu Hospital of Capital Medical University, Beijing, China.,Beijing Institute of Geriatrics, XuanWu Hospital of Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
| | - Ying Han
- Department of Neurology, XuanWu Hospital of Capital Medical University, Beijing, China.,Beijing Institute of Geriatrics, XuanWu Hospital of Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China.,Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China
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44
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Leuzy A, Heurling K, Ashton NJ, Schöll M, Zimmer ER. In vivo Detection of Alzheimer's Disease. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2018; 91:291-300. [PMID: 30258316 PMCID: PMC6153625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recent revisions to the diagnostic criteria for Alzheimer's disease (AD) incorporated conceptual advances in the field. Specifically, AD is now recognized to encompass a continuum, spanning from preclinical (accruing brain pathology in the absence of symptoms) through symptomatic predementia (prodromal AD, mild cognitive impairment) and dementia phases. The role of biological markers (biomarkers) of both the underlying molecular pathologies and related neurodegenerative changes has also been acknowledged. In this abridged review, we provide an overview of fluid (cerebrospinal fluid and blood) and molecular imaging-based biomarkers used within the field and discuss the potential role of computer driven artificial intelligence approaches for both the early and accurate identification of AD and as a tool for population enrichment in clinical trials testing candidate disease modifying therapies.
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Affiliation(s)
- Antoine Leuzy
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Kerstin Heurling
- Wallenberg Centre for Molecular and Translational Medicine, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Nicholas J. Ashton
- Wallenberg Centre for Molecular and Translational Medicine, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Michael Schöll
- Wallenberg Centre for Molecular and Translational Medicine, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden,Clinical Memory Research Unit, Lund University, Sweden
| | - Eduardo R. Zimmer
- Department of Pharmacology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil,Graduate Program in Biological Sciences: Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil,Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil,To whom all correspondence should be addressed: Eduardo R. Zimmer, PhD, Department of Pharmacology, Federal University of Rio Grande do Sul, 500 Sarmento Leite Street, 90050-170, Porto Alegre, RS, Brazil; Tel: +55 51 33085558,
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Sarikaya I, Sarikaya A, Elgazzar AH. Current Status of 18F-FDG PET Brain Imaging in Patients with Dementia. J Nucl Med Technol 2018; 46:362-367. [DOI: 10.2967/jnmt.118.210237] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/07/2018] [Indexed: 11/16/2022] Open
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Tabatabaei-Jafari H, Walsh E, Shaw ME, Cherbuin N. A simple and clinically relevant combination of neuroimaging and functional indexes for the identification of those at highest risk of Alzheimer's disease. Neurobiol Aging 2018; 69:102-110. [PMID: 29864716 DOI: 10.1016/j.neurobiolaging.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 01/04/2023]
Abstract
The current challenge in clinical practice is to identify those with mild cognitive impairment (MCI), who are at greater risk of Alzheimer's disease (AD) conversion in the near future. The aim of this study was to assess a clinically practical new hippocampal index-hippocampal volume normalized by cerebellar volume (hippocampus to cerebellum volume ratio) used alone or in combination with scores on the Mini-Mental State Examination, as a predictor of conversion from MCI to AD. The predictive value of the HCCR was also contrasted to that of the hippocampal volume to intracranial volume ratio. The findings revealed that the performance of the combination of measures was significantly better than that of each measure used individually. The combination of Mini-Mental State Examination and hippocampal volume, normalized by the cerebellum or by intracranial volume, accurately discriminated individuals with MCI who progress to AD within 5 years from other MCI types (stable, reverters) and those with intact cognition (area under receiver operating curve of 0.88 and 0.89, respectively). Normalization by cerebellar volume was as accurate as normalization by intracranial volume with the advantage of being more practical, particularly for serial assessments.
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Affiliation(s)
- Hossein Tabatabaei-Jafari
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australia.
| | - Erin Walsh
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australia
| | - Marnie E Shaw
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australia
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- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australia
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Visual Rating and Computer-Assisted Analysis of FDG PET in the Prediction of Conversion to Alzheimer’s Disease in Mild Cognitive Impairment. Mol Diagn Ther 2018; 22:475-483. [DOI: 10.1007/s40291-018-0334-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Clinical utility of FDG-PET for the clinical diagnosis in MCI. Eur J Nucl Med Mol Imaging 2018; 45:1497-1508. [DOI: 10.1007/s00259-018-4039-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
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Ma HR, Sheng LQ, Pan PL, Wang GD, Luo R, Shi HC, Dai ZY, Zhong JG. Cerebral glucose metabolic prediction from amnestic mild cognitive impairment to Alzheimer's dementia: a meta-analysis. Transl Neurodegener 2018; 7:9. [PMID: 29713467 PMCID: PMC5911957 DOI: 10.1186/s40035-018-0114-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/03/2018] [Indexed: 12/14/2022] Open
Abstract
Brain 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) has been utilized to monitor disease conversion from amnestic mild cognitive impairment (aMCI) to Alzheimer’s dementia (AD). However, the conversion patterns of FDG-PET metabolism across studies are not conclusive. We conducted a voxel-wise meta-analysis using Seed-based d Mapping that included 10 baseline voxel-wise FDG-PET comparisons between 93 aMCI converters and 129 aMCI non-converters from nine longitudinal studies. The most robust and reliable metabolic alterations that predicted conversion from aMCI to AD were localized in the left posterior cingulate cortex (PCC)/precuneus. Furthermore, meta-regression analyses indicated that baseline mean age and severity of cognitive impairment, and follow-up duration were significant moderators for metabolic alterations in aMCI converters. Our study revealed hypometabolism in the left PCC/precuneus as an early feature in the development of AD. This finding has important implications in understanding the neural substrates for AD conversion and could serve as a potential imaging biomarker for early detection of AD as well as for tracking disease progression at the predementia stage.
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Affiliation(s)
- Hai Rong Ma
- 1Department of Neurology, Traditional Chinese Medicine Hospital of Kunshan, Kunshan, People's Republic of China
| | - Li Qin Sheng
- 1Department of Neurology, Traditional Chinese Medicine Hospital of Kunshan, Kunshan, People's Republic of China
| | - Ping Lei Pan
- 2Department of Neurology, School of Medicine, Affiliated Yancheng Hospital, Southeast University, West Xindu Road 2#, Yancheng, Jiangsu Province 224001 People's Republic of China
| | - Gen Di Wang
- 2Department of Neurology, School of Medicine, Affiliated Yancheng Hospital, Southeast University, West Xindu Road 2#, Yancheng, Jiangsu Province 224001 People's Republic of China
| | - Rong Luo
- 2Department of Neurology, School of Medicine, Affiliated Yancheng Hospital, Southeast University, West Xindu Road 2#, Yancheng, Jiangsu Province 224001 People's Republic of China
| | - Hai Cun Shi
- 2Department of Neurology, School of Medicine, Affiliated Yancheng Hospital, Southeast University, West Xindu Road 2#, Yancheng, Jiangsu Province 224001 People's Republic of China
| | - Zhen Yu Dai
- 3Department of Radiology, School of Medicine, Affiliated Yancheng Hospital, Southeast University, West Xindu Road 2#, Yancheng, Jiangsu Province 224001 People's Republic of China
| | - Jian Guo Zhong
- 2Department of Neurology, School of Medicine, Affiliated Yancheng Hospital, Southeast University, West Xindu Road 2#, Yancheng, Jiangsu Province 224001 People's Republic of China
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Beishon L, Haunton VJ, Panerai RB, Robinson TG. Cerebral Hemodynamics in Mild Cognitive Impairment: A Systematic Review. J Alzheimers Dis 2018; 59:369-385. [PMID: 28671118 DOI: 10.3233/jad-170181] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The incidence of dementia is projected to rise over the coming decades, but with no sensitive diagnostic tests available. Vascular pathology precedes the deposition of amyloid and is an attractive early target. OBJECTIVE The aim of this review was to investigate the use of cerebral hemodynamics and oxygenation as a novel biomarker for mild cognitive impairment (MCI), focusing on transcranial Doppler ultrasonography (TCD) and near-infrared spectroscopy (NIRS). METHODS 2,698 articles were identified from Medline, Embase, PsychINFO, and Web of Science databases. 306 articles were screened and quality assessed independently by two reviewers; 26 met the inclusion criteria. Meta-analyses were performed for each marker with two or more studies and limited heterogeneity. RESULTS Eleven studies were TCD, 8 NIRS, 5 magnetic resonance imaging, and 2 positron/single photon emission tomography. Meta-analyses showed reduced tissue oxygenation index, cerebral blood flow and velocity, with higher pulsatility index, phase and cerebrovascular resistance in MCI compared to controls. The majority of studies found reduced CO2 reactivity in MCI, with mixed findings in neuroactivation studies. CONCLUSION Despite small sample sizes and heterogeneity, meta-analyses demonstrate clear abnormalities in cerebral hemodynamic and oxygenation parameters, even at an early stage of cognitive decline. Further work is required to investigate the use of cerebral hemodynamic and oxygenation parameters as a sensitive biomarker for dementia.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Biomedical Research Unit in Cardiovascular Disease, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Biomedical Research Unit in Cardiovascular Disease, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Biomedical Research Unit in Cardiovascular Disease, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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