1
|
García-Escobar G, Puig-Pijoan A, Puente-Periz V, Fernández-Lebrero A, María Manero R, Navalpotro-Gómez I, Suárez-Calvet M, Grau-Rivera O, Contador-Muñana J, Cascales-Lahoz D, Duran-Jordà X, Boltes N, Pont-Sunyer MC, Ortiz-Gil J, Carrillo-Molina S, López-Villegas MD, Abellán-Vidal MT, Martínez-Casamitjana MI, Hernández-Sánchez JJ, Padrós-Fluvià A, Peña-Casanova J, Sánchez-Benavides G. NEURONORMA Cognitive Battery Associations with Cerebrospinal Fluid Amyloid-β and Tau Levels in the Continuum of Alzheimer's Disease. J Alzheimers Dis 2023; 92:1303-1321. [PMID: 37038810 DOI: 10.3233/jad-220930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Neuropsychological assessments are essential to define the cognitive profile and contribute to the diagnosis of Alzheimer's disease (AD). The progress in knowledge about the pathophysiological process of the disease has allowed conceptualizing AD through biomarkers as a biological continuum that encompasses different clinical stages. OBJECTIVE To explore the association between cerebrospinal fluid (CSF) biomarkers of AD and cognition using the NEURONORMA battery, in a sample of cognitively unimpaired (CU), mild cognitive impaired (MCI), and mild dementia of the Alzheimer type (DAT) subjects, and to characterize the cognitive profiles in MCI subjects classified by A/T/N system. METHODS 42 CU, 35 MCI, and 35 mild DAT were assessed using the NEURONORMA battery. Core AD biomarkers [amyloid-β42 (Aβ42) peptide, total tau (t-tau), and phosphorylated tau 181 (p-tau181)] proteins were measured in CSF. Correlation coefficients, multivariate regression, and effect sizes were calculated. We explored the age- and education-adjusted cognitive profiles by A/T/N variants within the MCI group. RESULTS Cognitive outcomes were directly associated with CSF Aβ42 and inversely with CSF tau measures. We found differences in both biomarkers and cognitive outcomes comparing all pairs except for CSF measures between cognitively impaired groups. The highest effect size was in memory tasks and biomarkers ratios. Lower performances were in memory and executive domains in MCI subjects with AD pathology (A+T+N±) compared to those with normal levels of AD biomarkers (A- T- N). CONCLUSION This study provides further evidence of the validity of Spanish NEURONORMA cognitive battery to characterize cognitive impairment in the AD pathological continuum.
Collapse
Affiliation(s)
- Greta García-Escobar
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Albert Puig-Pijoan
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Víctor Puente-Periz
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Aida Fernández-Lebrero
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Rosa María Manero
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Irene Navalpotro-Gómez
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Marc Suárez-Calvet
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Oriol Grau-Rivera
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - José Contador-Muñana
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Diego Cascales-Lahoz
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - Núncia Boltes
- Neurology Department, Hospital General de Granollers, Granollers, Spain
| | | | - Jordi Ortiz-Gil
- Neurology Department, Hospital General de Granollers, Granollers, Spain
- Psychology Unit, Hospital General de Granollers, Granollers, Spain
- Maria Angustias Gimenez Research Foundation (FIDMAG), Sant Boi del Llobregat, Spain
| | - Sara Carrillo-Molina
- Neurology Department, Hospital General de Granollers, Granollers, Spain
- Psychology Unit, Hospital General de Granollers, Granollers, Spain
| | - María Dolores López-Villegas
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centre Emili Mira, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Santa Coloma de Gramenet, Spain
| | - María Teresa Abellán-Vidal
- Centre Emili Mira, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Santa Coloma de Gramenet, Spain
| | | | | | | | - Jordi Peña-Casanova
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Gonzalo Sánchez-Benavides
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| |
Collapse
|
2
|
Alexopoulos P, Skondra M, Kontogianni E, Vratsista A, Frounta M, Konstantopoulou G, Aligianni SI, Charalampopoulou M, Lentzari I, Gourzis P, Kliegel M, Economou P, Politis A. Validation of the Cognitive Telephone Screening Instruments COGTEL and COGTEL+ in Identifying Clinically Diagnosed Neurocognitive Disorder Due to Alzheimer's Disease in a Naturalistic Clinical Setting. J Alzheimers Dis 2021; 83:259-268. [PMID: 34275904 PMCID: PMC8461705 DOI: 10.3233/jad-210477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Telephone-based neurocognitive instruments embody valuable tools in identifying cognitive impairment in research settings and lately also in clinical contexts due to the pandemic crisis. The accuracy of the Cognitive Telephone Screening Instrument (COGTEL) in detecting mild- (MiND) and major (MaND) neurocognitive disorder has not been studied yet. Objective: Comparison of the utility of COGTEL and COGTEL+, which is enriched with orientation items, with the modified Mini-Mental State Examination (3MS) in detecting MiND and MaND due to Alzheimer’s disease (AD) and assessment of the impact of COGTEL face-to-face-versus telephone administration on individual performance. Methods: The study included 197 cognitively intact individuals (CI), being at least 45 years old, 95 and 65 patients with MiND and MaND due to AD, respectively. In 20 individuals COGTEL was administered both in face-to-face and telephone sessions. Statistical analyses included proportional odds logistic regression models, stratified repeated random subsampling used to recursive partitioning to training and validation set (70/30 ratio), and an appropriate F-test. Results: All studied instruments were significant predictors of diagnostic outcome, but COGTEL+ and 3MS explained more variance relative to the original COGTEL. Except for the validation regression models including COGTEL in which the average misclassification error slightly exceeded 15%, in all other cases the average misclassification errors (%) were lower than 15%. COGTEL administration modality was not related to systematic over- or underestimation of performance on COGTEL. Conclusion: COGTEL+ is a valuable instrument in detecting MiND and MaND and can be administered in face-to-face or telephone sessions.
Collapse
Affiliation(s)
- Panagiotis Alexopoulos
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece.,Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany.,Psychogeriatric Unit for Neurocognitive Assessment and Caregiver Counselling, Patras Office of The Hellenic Red Cross, Patras, Greece.,Patras Dementia Day Care Center, Corporation for Succor and Care of Elderly and Disabled -FRODIZO, Patras, Greece
| | - Maria Skondra
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece.,Psychogeriatric Unit for Neurocognitive Assessment and Caregiver Counselling, Patras Office of The Hellenic Red Cross, Patras, Greece
| | - Evagellia Kontogianni
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Frounta
- Patras Dementia Day Care Center, Corporation for Succor and Care of Elderly and Disabled -FRODIZO, Patras, Greece
| | - Georgia Konstantopoulou
- Special Office for Health Consulting Services and Faculty of Education and Social Work, School of Humanities and Social Sciences, University of Patras, Patras, Greece
| | - Suzana Ioanna Aligianni
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Marina Charalampopoulou
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Iliana Lentzari
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Philippos Gourzis
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Matthias Kliegel
- Laboratory of Cognitive Aging, University of Geneva, Geneva, Switzerland
| | - Polychronis Economou
- Department of Civil Engineering (Statistics), School of Engineering, University of Patras, Patras, Greece
| | - Antonios Politis
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins Medical School, Baltimore, MD, USA
| |
Collapse
|
3
|
Cognitive reserve hypothesis in frontotemporal dementia: A FDG-PET study. NEUROIMAGE-CLINICAL 2020; 29:102535. [PMID: 33369564 PMCID: PMC7773557 DOI: 10.1016/j.nicl.2020.102535] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/17/2020] [Accepted: 12/12/2020] [Indexed: 11/21/2022]
Abstract
The cognitive reserve hypothesis is also applicable for FTD. The educational level predicts left-temporal hypometabolism in FTD. Residualized cognitive performance is positively correlated with education. Residualized cognitive performance is negatively correlated with hypometabolism.
Background and objective Reserve is defined as the ability to maintain cognitive functions relatively well at a given level of pathology. Early life experiences such as education are associated with lower dementia risk in general. However, whether more years of education guards against the impact of brain alterations also in frontotemporal dementia (FTD) has not been shown in a large patient collective. Therefore, we assessed whether education is associated with relatively high cognitive performance despite the presence of [18F]-fluorodeoxyglucose positron-emission-tomography (FDG-PET) hypometabolism in FTD. Methods Sixty-six FTD subjects (age 67 ± 8 years) and twenty-four cognitively healthy controls (HC) were evaluated. Brain regions with FTD-related glucose hypometabolism in the contrast against HC and brain regions that correlate with the cognitive function were defined by a voxel-based analysis and individual FDG-PET values were extracted from all frontotemporal brain areas. Linear regression analysis served to test if education is associated with residualized cognitive performance and regional FDG-PET hypometabolism after controlling for global cognition. Results Compared to healthy controls, patients with FTD showed glucose hypometabolism in bilateral frontal and temporal brain areas whereas cognition was only associated with deteriorated glucose metabolism in the left temporal lobe. The education level was significantly correlated with the residualized cognitive performance (residuals from regression analysis between hypometabolism and cognitive function as a quantitative index of reserve) and also negatively correlated with left temporal FDG-PET hypometabolism after controlling for cognition. Conclusions In patients with FTD, the education level predicts the existing left temporal FDG-PET hypometabolism at the same cognition level, supporting the cognitive reserve hypothesis in FTD.
Collapse
|
4
|
May neuropsychiatric symptoms be a potential intervention target to delay functional impairment in Alzheimer's disease? Int Psychogeriatr 2020; 32:689-691. [PMID: 32616115 DOI: 10.1017/s1041610219002254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
5
|
Economou P, Batsidis A, Tzavelas G, Alexopoulos P. Berkson's paradox and weighted distributions: An application to Alzheimer's disease. Biom J 2019; 62:238-249. [PMID: 31696967 DOI: 10.1002/bimj.201900046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 09/11/2019] [Accepted: 09/18/2019] [Indexed: 11/07/2022]
Abstract
One reason for observing in practice a false positive or negative correlation between two random variables, which are either not correlated or correlated with a different direction, is the overrepresentation in the sample of individuals satisfying specific properties. In 1946, Berkson first illustrated the presence of a false correlation due to this last reason, which is known as Berkson's paradox and is one of the most famous paradox in probability and statistics. In this paper, the concept of weighted distributions is utilized to describe Berskon's paradox. Moreover, a proper procedure is suggested to make inference for the population given a biased sample which possesses all the characteristics of Berkson's paradox. A real data application for patients with dementia due to Alzheimer's disease demonstrates that the proposed method reveals characteristics of the population that are masked by the sampling procedure.
Collapse
Affiliation(s)
| | | | - George Tzavelas
- Department of Statistics and Insurance Science, University of Piraeus, Piraeus, Greece
| | - Panagiotis Alexopoulos
- Department of Psychiatry, Faculty of Medicine, University of Patras, University Hospital of Rion, Rion Patras, Greece.,Department of Psychiatry and Psychotherapy, Faculty of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | | |
Collapse
|
6
|
Alzheimer’s disease (AD) therapeutics – 1: Repeated clinical failures continue to question the amyloid hypothesis of AD and the current understanding of AD causality. Biochem Pharmacol 2018; 158:359-375. [DOI: 10.1016/j.bcp.2018.09.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/24/2018] [Indexed: 12/17/2022]
|
7
|
Mullane K, Williams M. Alzheimer's disease (AD) therapeutics - 2: Beyond amyloid - Re-defining AD and its causality to discover effective therapeutics. Biochem Pharmacol 2018; 158:376-401. [PMID: 30273552 DOI: 10.1016/j.bcp.2018.09.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/24/2018] [Indexed: 12/25/2022]
Abstract
Compounds targeted for the treatment of Alzheimer's Disease (AD) have consistently failed in clinical trials despite evidence for target engagement and pharmacodynamic activity. This questions the relevance of compounds acting at current AD drug targets - the majority of which reflect the seminal amyloid and, to a far lesser extent, tau hypotheses - and limitations in understanding AD causality as distinct from general dementia. The preeminence of amyloid and tau led to many alternative approaches to AD therapeutics being ignored or underfunded to the extent that their causal versus contributory role in AD remains unknown. These include: neuronal network dysfunction; cerebrovascular disease; chronic, local or systemic inflammation involving the innate immune system; infectious agents including herpes virus and prion proteins; neurotoxic protein accumulation associated with sleep deprivation, circadian rhythm and glymphatic/meningeal lymphatic system and blood-brain-barrier dysfunction; metabolic related diseases including diabetes, obesity hypertension and hypocholesterolemia; mitochondrial dysfunction and environmental factors. As AD has become increasingly recognized as a multifactorial syndrome, a single treatment paradigm is unlikely to work in all patients. However, the biomarkers required to diagnose patients and parse them into mechanism/disease-based sub-groups remain rudimentary and unvalidated as do non-amyloid, non-tau translational animal models. The social and economic impact of AD is also discussed in the context of new FDA regulatory draft guidance and a proposed biomarker-based Framework (re)-defining AD and its stages as part of the larger landscape of treating dementia via the 2013 G8 initiative to identify a disease-modifying therapy for dementia/AD by 2025.
Collapse
Affiliation(s)
- Kevin Mullane
- Gladstone Institutes, San Francisco, CA, United States
| | - Michael Williams
- Department of Biological Chemistry and Pharmacology, College of Medicine, Ohio State University, Columbus, OH, United States.
| |
Collapse
|
8
|
Li X, Ba M, Ng KP, Mathotaarachchi S, Pascoal TA, Rosa-Neto P, Gauthier S. Characterizing biomarker features of cognitively normal individuals with ventriculomegaly. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 10:12-21. [PMID: 29159265 PMCID: PMC5678356 DOI: 10.1016/j.dadm.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction The clinical significance of ventriculomegaly in cognitively normal elderly individuals remains unclear. Methods We selected cognitively normal individuals (n = 425) from the Alzheimer's Disease Neuroimaging Initiative database and calculated Evans index (EI) based on the ratio of the frontal horn and skull diameter. We defined ventriculomegaly as EI ≥ 0.30, and the participants were stratified into EI ≥ 0.30 group and EI < 0.30 group. Neuropsychological, imaging, and fluid biomarker profiles between the two groups were then compared using regression models. Results A total of 96 (22.5%) individuals who had ventriculomegaly performed worse on the cognitive tests; showed smaller hippocampal volume but larger caudate, cingulate, and paracentral gyrus volumes; and displayed lower positron emission tomography [18F]fluorodeoxyglucose standardized uptake value ratio but higher amyloid burden represented by higher [18F]florbetapir standardized uptake value ratio and lower cerebrospinal fluid amyloid β 1–42 levels compared to those without ventriculomegaly. Discussion Asymptomatic ventriculomegaly might be an early imaging signature of preclinical Alzheimer's disease and/or normal pressure hydrocephalus.
Collapse
Affiliation(s)
- Xiaofeng Li
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.,Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Maowen Ba
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada.,Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao Medical University, Shandong, PR China
| | - Kok Pin Ng
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada.,Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Sulantha Mathotaarachchi
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Tharick A Pascoal
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Pedro Rosa-Neto
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Serge Gauthier
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, McGill University, Montreal, Canada.,Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| |
Collapse
|