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Oba R, Ujike N, Ono Y, Okano T, Murakami T. Label-free autofluorescence and hyperspectral imaging of cerebral amyloid-β lesions in aged squirrel monkeys. J Vet Diagn Invest 2024; 36:41-45. [PMID: 37830746 PMCID: PMC10734585 DOI: 10.1177/10406387231204876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
The observation of amyloid-β (Aβ) lesions using autofluorescence in transgenic mice and human Alzheimer disease patients has been reported frequently. However, no reports verify the autofluorescence of spontaneous Aβ amyloidosis in animals, to our knowledge. We validated the autofluorescence of Aβ lesions in spontaneous squirrel monkey cases under label-free conditions; lesions had intense blue-white autofluorescence in fluorescence microscopy using excitation light at 400-440 nm. Thioflavin S staining and immunohistochemistry of the same specimens revealed that this blue-white autofluorescence was derived from Aβ lesions. Hyperspectral analysis of these lesions revealed a characteristic spectrum with bimodal peaks at 440 and 460 nm, as reported for Aβ lesions in mice. Principal component analysis using hyperspectral data specifically separated the Aβ lesions from other autofluorescent substances, such as lipofuscin. A non-labeled and mechanistic detection of Aβ lesions by hyperspectral imaging could provide valuable insights for developing early diagnostic techniques.
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Affiliation(s)
- Ryohei Oba
- Laboratory of Veterinary Toxicology, Cooperative Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
| | - Naoki Ujike
- Laboratory of Veterinary Toxicology, Cooperative Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
| | - Yuki Ono
- Advanced Technology Center, Corporate R&D Headquarters, Konica Minolta, Hachioji, Tokyo, Japan
| | - Takayuki Okano
- Advanced Technology Center, Corporate R&D Headquarters, Konica Minolta, Hachioji, Tokyo, Japan
| | - Tomoaki Murakami
- Laboratory of Veterinary Toxicology, Cooperative Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
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Amiri P, Pirnejad H, Bahaadinbeigy K, Baghini MS, Khazaee PR, Niazkhani Z. A qualitative study of factors influencing ePHR adoption by caregivers and care providers of Alzheimer's patients: An extension of the unified theory of acceptance and use of technology model. Health Sci Rep 2023; 6:e1394. [PMID: 37425233 PMCID: PMC10323167 DOI: 10.1002/hsr2.1394] [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: 10/17/2022] [Revised: 05/06/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023] Open
Abstract
Background and Aims As the nowadays provision of many healthcare services relies on technology, a better understanding of the factors contributing to the acceptance and use of technology in health care is essential. For Alzheimer's patients, an electronic personal health record (ePHR) is one such technology. Stakeholders should understand the factors affecting the adoption of this technology for its smooth implementation, adoption, and sustainable use. So far, these factors have not fully been understood for Alzheimer's disease (AD)-specific ePHR. Therefore, the present study aimed to understand these factors in ePHR adoption based on the perceptions and views of care providers and caregivers involved in AD care. Methods This qualitative study was conducted from February 2020 to August 2021 in Kerman, Iran. Seven neurologists and 13 caregivers involved in AD care were interviewed using semi-structured and in-depth interviews. All interviews were conducted through phone contacts amid Covid-19 imposed restrictions, recorded, and transcribed verbatim. The transcripts were coded using thematic analysis based on the unified theory of acceptance and use of technology (UTAUT) model. ATLAS.ti8 was used for data analysis. Results The factors affecting ePHR adoption in our study comprised subthemes under the five main themes of performance expectancy, effort expectancy, social influence, facilitating conditions of the UTAUT model, and the participants' sociodemographic factors. From the 37 facilitating factors and 13 barriers identified for ePHR adoption, in general, the participants had positive attitudes toward the ease of use of this system. The stated obstacles were dependent on the participants' sociodemographic factors (such as age and level of education) and social influence (including concern about confidentiality and privacy). In general, the participants considered ePHRs efficient and useful in increasing neurologists' information about their patients and managing their symptoms in order to provide better and timely treatment. Conclusion The present study gives a comprehensive insight into the acceptance of ePHR for AD in a developing setting. The results of this study can be utilized for similar healthcare settings with regard to technical, legal, or cultural characteristics. To develop a useful and user-friendly system, ePHR developers should involve users in the design process to take into account the functions and features that match their skills, requirements, and preferences.
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Affiliation(s)
- Parastoo Amiri
- Student Research CommitteeKerman University of Medical SciencesKermanIran
| | - Habibollah Pirnejad
- Patient Safety Research Center, Clinical Research InstituteUrmia University of Medical SciencesUrmiaIran
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute of Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Mahdie Shojaei Baghini
- Medical Informatics Research Center, Institute of Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | | | - Zahra Niazkhani
- Nephrology and Kidney Transplant Research Center, Clinical Research InstituteUrmia University of Medical SciencesUrmiaIran
- Health Care Governance, Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
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Oliveira FFD. Looking Behind the Curtain: Patient Stratification According to Genetic or Demographic Factors May Yield Unexpected Results in Studies of Neurodegenerative Diseases. J Alzheimers Dis 2023:JAD230561. [PMID: 37393510 DOI: 10.3233/jad-230561] [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: 07/03/2023]
Abstract
Amyloid-PET studies of neurodegenerative diseases may yield inconclusive findings due to lacking stratification according to genetic or demographic variants. APOEɛ4 alleles are the major variants to increase disease susceptibility and cause earlier onset and more behavioral features in patients with late-onset Alzheimer's disease, but have no linear effects on cognitive or functional decline; thus, sample stratification according to APOEɛ4 carrier status may be the best option. Interactions among APOEɛ4 alleles, sex, and age on amyloid-β deposition may reveal even more innovative findings with sufficiently large samples, suggesting variable genomic effects of cognitive reserve, sex differences, and cerebrovascular risk on neurodegeneration.
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Li P, Quan W, Wang Z, Liu Y, Cai H, Chen Y, Wang Y, Zhang M, Tian Z, Zhang H, Zhou Y. Early-stage differentiation between Alzheimer's disease and frontotemporal lobe degeneration: Clinical, neuropsychology, and neuroimaging features. Front Aging Neurosci 2022; 14:981451. [PMID: 36389060 PMCID: PMC9659748 DOI: 10.3389/fnagi.2022.981451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD) are the two most common forms of neurodegenerative dementia. Although both of them have well-established diagnostic criteria, achieving early diagnosis remains challenging. Here, we aimed to make the differential diagnosis of AD and FTLD from clinical, neuropsychological, and neuroimaging features. MATERIALS AND METHODS In this retrospective study, we selected 95 patients with PET-CT defined AD and 106 patients with PET-CT/biomarker-defined FTLD. We performed structured chart examination to collect clinical data and ascertain clinical features. A series of neuropsychological scales were used to assess the neuropsychological characteristics of patients. Automatic tissue segmentation of brain by Dr. Brain tool was used to collect multi-parameter volumetric measurements from different brain areas. All patients' structural neuroimage data were analyzed to obtain brain structure and white matter hyperintensities (WMH) quantitative data. RESULTS The prevalence of vascular disease associated factors was higher in AD patients than that in FTLD group. 56.84% of patients with AD carried at least one APOE ε4 allele, which is much high than that in FTLD patients. The first symptoms of AD patients were mostly cognitive impairment rather than behavioral abnormalities. In contrast, behavioral abnormalities were the prominent early manifestations of FTLD, and few patients may be accompanied by memory impairment and motor symptoms. In direct comparison, patients with AD had slightly more posterior lesions and less frontal atrophy, whereas patients with FTLD had more frontotemporal atrophy and less posterior lesions. The WMH burden of AD was significantly higher, especially in cortical areas, while the WMH burden of FTLD was higher in periventricular areas. CONCLUSION These results indicate that dynamic evaluation of cognitive function, behavioral and psychological symptoms, and multimodal neuroimaging are helpful for the early diagnosis and differentiation between AD and FTLD.
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Affiliation(s)
- Pan Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital Affiliated to Tianjin Medical University, Tianjin Huanhu Hospital Affiliated to Nankai University, Tianjin University Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgery Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Wei Quan
- Department of Neurosurgery, General Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Zengguang Wang
- Department of Neurosurgery, General Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Ying Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital Affiliated to Tianjin Medical University, Tianjin Huanhu Hospital Affiliated to Nankai University, Tianjin University Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgery Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Hao Cai
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital Affiliated to Tianjin Medical University, Tianjin Huanhu Hospital Affiliated to Nankai University, Tianjin University Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgery Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Yuan Chen
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital Affiliated to Tianjin Medical University, Tianjin Huanhu Hospital Affiliated to Nankai University, Tianjin University Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgery Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Yan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital Affiliated to Tianjin Medical University, Tianjin Huanhu Hospital Affiliated to Nankai University, Tianjin University Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgery Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Miao Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital Affiliated to Tianjin Medical University, Tianjin Huanhu Hospital Affiliated to Nankai University, Tianjin University Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgery Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhiyan Tian
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital Affiliated to Tianjin Medical University, Tianjin Huanhu Hospital Affiliated to Nankai University, Tianjin University Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgery Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Huihong Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital Affiliated to Tianjin Medical University, Tianjin Huanhu Hospital Affiliated to Nankai University, Tianjin University Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgery Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Yuying Zhou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital Affiliated to Tianjin Medical University, Tianjin Huanhu Hospital Affiliated to Nankai University, Tianjin University Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgery Institute, Tianjin Huanhu Hospital, Tianjin, China
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Alhasan DM, Lohman MC, Hirsch JA, Miller MC, Cai B, Jackson CL. Neighborhood characteristics and dementia symptomology among community-dwelling older adults with Alzheimer's disease. Front Aging Neurosci 2022; 14:937915. [PMID: 36204556 PMCID: PMC9530440 DOI: 10.3389/fnagi.2022.937915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/31/2022] [Indexed: 01/05/2023] Open
Abstract
Background Neuropsychiatric symptoms (NPSs) lead to myriad poor health outcomes among individuals with Alzheimer's disease (AD). Prior studies have observed associations between the various aspects of the home environment and NPSs, but macro-level environmental stressors (e.g., neighborhood income) may also disrupt the neuronal microenvironment and exacerbate NPSs. Yet, to our knowledge, no studies have investigated the relationship between the neighborhood environment and NPSs. Methods Using 2010 data among older adults with AD collected from a sample of the South Carolina Alzheimer's Disease Registry, we estimated cross-sectional associations between neighborhood characteristics and NPSs in the overall population and by race/ethnicity. Neighborhood measures (within a 1/2-mile radius of residence) came from the American Community Survey and Rural Urban Commuting Area Code. We categorized median household income into tertiles: < $30,500, $30,500-40,000, and > $40,000, and rurality as: rural, small urban, and large urban. Residential instability was defined as the percent of residents who moved within the past year. NPSs were defined using the Neuropsychiatric Inventory Questionnaire that included the composite measure of all 12 domains. Adjusting for age, sex/gender, race/ethnicity, and caregiver educational attainment, we used negative binomial regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for NPSs by neighborhood characteristics. Results Among 212 eligible participants, mean age was 82 ± 8.7 years, 72% were women, and 55% non-Hispanic (NH)-Black. Individuals with AD living in < $30,500 vs. > $40,000 income neighborhoods had a 53% (PR = 1.53; 95% CI = 1.06-2.23) higher prevalence of NPSs while individuals living in rural vs. large urban neighborhoods had a 36% lower prevalence of NPSs (PR = 0.64; 95% CI = 0.45-0.90), after adjustment. We did not observe an association between residential instability and NPSs (PR = 0.92; 95% CI = 0.86-1.00); however, our estimates suggested differences by race/ethnicity where NH-White older adults living in residential instable areas had lower NPSs (PR = 0.89; 95% CI = 0.82-0.96) compared to NH-Black older adults (PR = 0.96; 95% CI = 0.86-1.07). Discussion Across racial/ethnic groups, individuals with AD had more symptomology when living in lower income areas. Pending replication, intervention efforts should consider resource allocation to high-need neighborhoods (e.g., lower income), and studies should investigate underlying mechanisms for this relationship.
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Affiliation(s)
- Dana M Alhasan
- Epidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jana A Hirsch
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Maggi C Miller
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Chandra L Jackson
- Epidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States.,Intramural Program, Department of Health and Human Services, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
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Allostery Inhibition of BACE1 by Psychotic and Meroterpenoid Drugs in Alzheimer's Disease Therapy. Molecules 2022; 27:molecules27144372. [PMID: 35889246 PMCID: PMC9320338 DOI: 10.3390/molecules27144372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
In over a century since its discovery, Alzheimer’s disease (AD) has continued to be a global health concern due to its incurable nature and overwhelming increase among older people. In this paper, we give an overview of the efforts of researchers towards identifying potent BACE1 exosite-binding antibodies and allosteric inhibitors. Herein, we apply computer-aided drug design (CADD) methods to unravel the interactions of some proposed psychotic and meroterpenoid BACE1 allosteric site inhibitors. This study is aimed at validating the allosteric potentials of these selected compounds targeted at BACE1 inhibition. Molecular docking, molecular dynamic (MD) simulations, and post-MD analyses are carried out on these selected compounds, which have been experimentally proven to exhibit allosteric inhibition on BACE1. The SwissDock software enabled us to identify more than five druggable pockets on the BACE1 structural surface using docking. Besides the active site region, a melatonin derivative (compound 1) previously proposed as a BACE1 allostery inhibitor showed appreciable stability at eight different subsites on BACE1. Refinement with molecular dynamic (MD) simulations shows that the identified non-catalytic sites are potential allostery sites for compound 1. The allostery and binding mechanism of the selected potent inhibitors show that the smaller the molecule, the easier the attachment to several enzyme regions. This finding hereby establishes that most of these selected compounds failed to exhibit strong allosteric binding with BACE1 except for compound 1. We hereby suggest that further studies and additional identification/validation of other BACE1 allosteric compounds be done. Furthermore, this additional allosteric site investigation will help in reducing the associated challenges with designing BACE1 inhibitors while exploring the opportunities in the design of allosteric BACE1 inhibitors.
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Long-term use of pharmacological treatment in Alzheimer's disease: a retrospective cohort study in real-world clinical practice. Eur J Clin Pharmacol 2022; 78:1155-1163. [PMID: 35484251 DOI: 10.1007/s00228-022-03325-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 04/18/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE To assess the impact of long-term use of different drugs commonly prescribed in Alzheimer's disease (AD) on its clinical course and to identify clinical and therapeutic factors associated with a delay in AD progression. METHODS We retrospectively enrolled 50 patients visited at the Neurology Unit, Careggi University Hospital (Florence), followed for at least 24 months. AD diagnosis was made according to clinical diagnostic criteria for probable/possible AD dementia, always supported at least by one biomarker. Clinical features, MMSE scores evaluated at diagnosis and every 6 months, and AD drugs used for at least 6 months, were recorded. Cox regression analysis was performed to estimate the hazard ratio (HR) for AD progression, assuming as the "final event," the progression to a more severe disease stage, defined as the achievement of an MMSE score less than 10. RESULTS At baseline, the median MMSE score was 22. During follow-up (median of 41 months), 56% of patients progressed to a more severe disease stage. The use of memantine, either alone (HR 0.24; 95% CI 0.09-0.60) or combined with acetylcholinesterase inhibitors (HR 0.35; 95% CI 0.14-0.88) and a higher MMSE score at baseline (HR 0.82; 95% CI 0.70-0.96) were associated with a significantly lower risk of AD progression. CONCLUSION Nowadays, effective disease-modifying therapy for AD is missing. Nevertheless, when the diagnosis is established, our results support the advantage of long-term use of available pharmacological treatments, especially in combination, in delaying AD progression to its more severe disease stage.
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Qu F, Yang X, Yang J, Zhou Q, Yang X, Chen M, Xiong Y, Hu Y. Interaction between arteriosclerosis and the APOE4 gene in cognitive decline in older adults: a cross-sectional study in rural minority areas in western China. Psychogeriatrics 2022; 22:243-251. [PMID: 35048467 DOI: 10.1111/psyg.12808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/14/2021] [Accepted: 12/28/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Numerous studies have confirmed that the apolipoprotein E4 allele (APOE4) gene and arteriosclerosis (AS) have a combined effect on the occurrence of cognitive function impairment, and dyslipidaemia levels are significantly correlated with APOE4 levels and AS. Few studies have focused on the combined effect of the APOE4 gene and AS on cognitive function. Therefore, this study aimed to investigate the effect of APOE4 gene and AS acting together on cognitive function through dyslipidaemia levels, which could provide certain scientific research value for future studies. METHODS A multi-stage cluster sampling method was used to investigate older adults aged 60 years and above in rural areas of Guizhou, China. The demographic sociological characteristics were collected, and laboratory tests, blood lipid measurements, and physical examinations were performed. Mini-Mental State Examination (MMSE) was used to determine cognitive function. Analysis of variance with two-factor factorial design was used to analyse the interaction between the APOE4 gene and AS on cognitive function and its domains. RESULTS A total of 549 elderly subjects were eligible for this study. The result of the factorial design analysis revealed there was a significant interaction between the APOE4 gene and AS in terms of attention and numeracy (F = 6.878, P = 0.009). CONCLUSIONS The combination of the APOE4 gene and AS leads to a decrease in the level of attention and numeracy domains, and certain attention should be focused on such populations in the future.
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Affiliation(s)
- Fang Qu
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Xing Yang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
| | - Jingyuan Yang
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Quanxiang Zhou
- Department of Medicine, Qiannan Medical College for Nationalities, Duyun, China
| | - Xi Yang
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Mingyan Chen
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Yan Xiong
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Yuxin Hu
- School of Public Health, Guizhou Medical University, Guiyang, China
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Song H, Park JH. Effects of Changes in Physical Activity with Cognitive Decline in Korean Home-Dwelling Older Adults. J Multidiscip Healthc 2022; 15:333-341. [PMID: 35228804 PMCID: PMC8881931 DOI: 10.2147/jmdh.s326612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Hyunjong Song
- Department of Health Policy and Management, College of Health Sciences, Sangji University, Gangwon-do, Republic of Korea
| | - Jin-Hwa Park
- College of Nursing, Institute of Nursing Science, Daegu Catholic University, Daegu, Republic of Korea
- Correspondence: Jin-Hwa Park, Tel +82 53 650 4754, Fax +82 53 650 4392, Email
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Rodella C, Bernini S, Panzarasa S, Sinforiani E, Picascia M, Quaglini S, Cavallini E, Vecchi T, Tassorelli C, Bottiroli S. A double-blind randomized controlled trial combining cognitive training (CoRe) and neurostimulation (tDCS) in the early stages of cognitive impairment. Aging Clin Exp Res 2022; 34:73-83. [PMID: 34156651 DOI: 10.1007/s40520-021-01912-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prevalence of neurodegenerative diseases is expected to increase over the next years, therefore, new methods able to prevent and delay cognitive decline are needed. AIMS To evaluate the effectiveness of a combined treatment protocol associating a computerized cognitive training (CoRe) with anodal transcranial direct current stimulation (tDCS). METHODS In this randomized controlled trial, 33 patients in the early stage of cognitive impairment were assigned to the experimental group (CoRE + real tDCS) or control group (CoRE + sham tDCS). In each group, the intervention lasted 3 consecutive weeks (4 sessions/week). A neuropsychological assessment was administered at baseline (T0), post-intervention (T1) and 6-months later (T2). RESULTS The CoRE + real tDCS group only improved in working memory and attention/processing speed at both T1 and T2. It reported a stable MMSE score at T2, while the CoRE + sham tDCS group worsened. Age, mood, and T0 MMSE score resulted to play a role in predicting treatment effects. CONCLUSION Combined multi-domain interventions may contribute to preventing or delaying disease progression. TRIAL REGISTRATION Trial registration number (ClinicalTrials.gov): NCT04118686.
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Li Q, Zhang Q, Zhang S, Du M, Wang X, Hu S, Li L. Relationship between frailty and cognitive decline in Chinese older patients with Alzheimer's disease: The mediating role of social contact. Geriatr Nurs 2021; 43:175-181. [PMID: 34911018 DOI: 10.1016/j.gerinurse.2021.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/13/2022]
Abstract
This study aimed to evaluate the effects of frailty and social contact on cognitive decline among Chinese older patients with Alzheimer's disease (AD), and examine the mediating role of social contact between frailty and cognitive decline. A total of 205 eligible participants were recruited from a tertiary A hospital in Anhui province, China. A structural equation modeling was conducted to test the hypothetical mediating model. Frailty and cognitive decline were significantly and negatively correlated with social contact. Meanwhile, frailty exerted a significant positive effect on cognitive decline. The indirect effect of frailty on the cognitive decline through social contact was 0.401. Social contact could exert a partial mediating effect on the relationship between frailty and cognitive decline in this population. These findings could help guide effective interventions to improve the cognitive abilities of AD patients, thereby reducing the burden of this population on their caregivers.
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Affiliation(s)
- Qingfeng Li
- Department of Nursing, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Qianqian Zhang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Shuping Zhang
- Department of Emergency Surgery, The Fourth Affiliated Hospital of Anhui Medical University, Hefei 230011, China
| | - Mingchao Du
- Department of Information Centre, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Xia Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Shaohua Hu
- Department of Nursing, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Lunlan Li
- Department of Personnel, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
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Alexander N, Alexander DC, Barkhof F, Denaxas S. Identifying and evaluating clinical subtypes of Alzheimer's disease in care electronic health records using unsupervised machine learning. BMC Med Inform Decis Mak 2021; 21:343. [PMID: 34879829 PMCID: PMC8653614 DOI: 10.1186/s12911-021-01693-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is a highly heterogeneous disease with diverse trajectories and outcomes observed in clinical populations. Understanding this heterogeneity can enable better treatment, prognosis and disease management. Studies to date have mainly used imaging or cognition data and have been limited in terms of data breadth and sample size. Here we examine the clinical heterogeneity of Alzheimer's disease patients using electronic health records (EHR) to identify and characterise disease subgroups using multiple clustering methods, identifying clusters which are clinically actionable. METHODS We identified AD patients in primary care EHR from the Clinical Practice Research Datalink (CPRD) using a previously validated rule-based phenotyping algorithm. We extracted and included a range of comorbidities, symptoms and demographic features as patient features. We evaluated four different clustering methods (k-means, kernel k-means, affinity propagation and latent class analysis) to cluster Alzheimer's disease patients. We compared clusters on clinically relevant outcomes and evaluated each method using measures of cluster structure, stability, efficiency of outcome prediction and replicability in external data sets. RESULTS We identified 7,913 AD patients, with a mean age of 82 and 66.2% female. We included 21 features in our analysis. We observed 5, 2, 5 and 6 clusters in k-means, kernel k-means, affinity propagation and latent class analysis respectively. K-means was found to produce the most consistent results based on four evaluative measures. We discovered a consistent cluster found in three of the four methods composed of predominantly female, younger disease onset (43% between ages 42-73) diagnosed with depression and anxiety, with a quicker rate of progression compared to the average across other clusters. CONCLUSION Each clustering approach produced substantially different clusters and K-Means performed the best out of the four methods based on the four evaluative criteria. However, the consistent appearance of one particular cluster across three of the four methods potentially suggests the presence of a distinct disease subtype that merits further exploration. Our study underlines the variability of the results obtained from different clustering approaches and the importance of systematically evaluating different approaches for identifying disease subtypes in complex EHR.
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Affiliation(s)
- Nonie Alexander
- Institute of Health Informatics, University College London, London, UK. .,Health Data Research UK, London, UK.
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Frederik Barkhof
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK.,UCL Institute of Neurology, University College London, London, UK.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK.,Health Data Research UK, London, UK.,Alan Turing Institute, London, UK
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13
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Hsieh TJ, Lee WJ, Liao YC, Hsu CC, Fang YH, Chen TY, Lin YS, Chang IS, Wang SJ, Hsiung CA, Fuh JL. Association between Alzheimer's disease genes and trajectories of cognitive function decline in Han Chinese in Taiwan. Aging (Albany NY) 2021; 13:17237-17252. [PMID: 34214049 PMCID: PMC8312434 DOI: 10.18632/aging.203204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 06/08/2021] [Indexed: 01/01/2023]
Abstract
Genetic background has been considered one of the important contributors to the rate of cognitive decline among patients with Alzheimer’s disease (AD). We conducted a 4-year longitudinal follow-up study, recruited 255 AD and 44 mild cognitive impairment (MCI) patients, and used a data-driven trajectory analysis to examine the influence of selected AD risk genes on the age for and the rate of cognitive decline in Han Chinese population. Genotyping of selected single-nucleotide polymorphisms in the APOE, ABCA7, SORL1, BIN1, GAB2, and CD33 genes was conducted, and a Bayesian hierarchical model was fitted to analyze the trajectories of cognitive decline among different genotypes. After adjusting for sex and education years, the APOE ε4 allele was associated with an earlier mean change of −2.39 years in the age at midpoint of cognitive decline, the G allele in ABCA7 rs3764650 was associated with an earlier mean change of −1.75 years, and the T allele in SORL1 rs3737529 was associated with a later mean change of 2.6 years. Additionally, the rate of cognitive decline was associated with the APOE ε4 allele and SORL1 rs3737529. In summary, APOE and SORL1 might be the most important genetic factors related to cognitive decline in Han Chinese population.
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Affiliation(s)
- Tsung-Jen Hsieh
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Wei-Ju Lee
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.,Dementia Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chu Liao
- Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yao-Hwei Fang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Tzu-Yu Chen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yung-Shuan Lin
- Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-Shou Chang
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao A Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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14
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Davis KAS, Bishara D, Molokhia M, Mueller C, Perera G, Stewart RJ. Aspirin in people with dementia, long-term benefits, and harms: a systematic review. Eur J Clin Pharmacol 2021; 77:943-954. [PMID: 33483830 PMCID: PMC8184554 DOI: 10.1007/s00228-021-03089-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/11/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE People with dementia may have indications for aspirin prescription and clinicians are asked to balance the potential risks against benefits. This review examines the evidence for the risk and benefit of long-term aspirin use in people with dementia aged over 65 years, including randomised controlled trials and observational studies. METHODS We searched three databases for research published between 2007 and 2020. Each eligible article was assessed for risk of bias, and confidence in findings was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Four papers met inclusion criteria: one randomised controlled trial, two cohort studies, and one with pooled data. All looked only at dementia of Alzheimer's type, and none addressed myocardial or cerebral infarction as outcomes. Dementia progression was reported by two studies, with conflicting results. The trial found no significant effect of aspirin on mortality (odds ratio aspirin vs. no aspirin 1.07, 95% confidence interval 0.58-1.97) but found more events of severe bleeding with aspirin (OR aspirin vs. no aspirin 6.9, 1.5-31.2). An excess in intracranial haemorrhage in the aspirin group was judged plausible based on two non-randomised studies. CONCLUSIONS The review findings are limited because studies include only people with Alzheimer's-type dementia and lack confirmatory studies, although an increased risk of bleeding events is recognised. Further research that addresses the benefits and risks of aspirin in more representative groups of people with dementia is needed to guide prescribing decisions.
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Affiliation(s)
- Katrina A S Davis
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - Delia Bishara
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mariam Molokhia
- King's College London Population Health Sciences, London, UK
| | - Christoph Mueller
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Gayan Perera
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert J Stewart
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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15
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Abstract
PURPOSE OF REVIEW The risks of developing cancer and dementia both increase with age, giving rise to the complex question of whether continued cancer screening for older dementia patients is appropriate. This paper offers a practice-based clinical approach to determine an answer to this challenging question. RECENT FINDINGS There is no consensus on the prevalence of cancer and dementia as co-diagnoses. Persons with dementia are screened less often compared to those without dementia. There is significant literature focusing on screening in the geriatric population, but there is little evidence to support decision-making for screening for older patients with dementia. Given this lack of evidence, individualized decisions should be made in collaboration with patients and family caregivers. Four considerations to help guide this process include prognosis, behavioral constraints, cognitive capacity, and goals for care. Future research will be challenging due to variability of factors that inform screening decisions and the vulnerable nature of this patient population.
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16
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Kociolek AJ, Fernandez KK, Jin Z, Cosentino S, Zhu CW, Gu Y, Stern Y. Extrapyramidal signs and Alzheimer's disease prognosis in a multiethnic, community-based sample of demented elders. Alzheimers Dement 2021; 17:1465-1473. [PMID: 33710771 DOI: 10.1002/alz.12309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/06/2021] [Accepted: 01/17/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Extrapyramidal signs (EPS) are a common feature of Alzheimer's disease associated with worse outcomes in observational studies of dementia. Less research has been conducted on ethnic minority and non-clinic-based populations. METHODS One hundred and forty-two multiethnic community-dwelling participants with dementia were selected. Adjusted Cox models were fitted for mortality, cognitive (Mini Mental State Examination ≤10), functional (Blessed Dementia Rating Scale ≥10), and dependency (needs full-time care) endpoints with baseline EPS as predictor. RESULTS Thirty-seven participants (26.06%) had EPS at baseline. EPS predicted more rapid time to death (hazard ratio [HR] = 2.76, 95% confidence interval [CI] = 1.49, 5.42), and functional endpoint (HR = 3.88, 95% CI = 1.75, 8.62) but not cognitive and dependency endpoints. No evidence of interaction by ethnicity, age, sex, education, or apolipoprotein E ε4 polymorphism was found. DISCUSSION Our results partially confirm previous studies on predominantly White, clinic-based samples. Further research is needed to better understand the etiological role of EPS in AD.
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Affiliation(s)
- Anton J Kociolek
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Kayri K Fernandez
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Stephanie Cosentino
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Carolyn W Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,James J. Peters VA Medical Center, Bronx, New York, USA
| | - Yian Gu
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Epidemiology, Columbia University, New York, New York, USA
| | - Yaakov Stern
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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17
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Li H, Li W, Zhang X, Ma XC, Zhang RW. Aspirin Use on Incident Dementia and Mild Cognitive Decline: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2021; 12:578071. [PMID: 33613260 PMCID: PMC7890199 DOI: 10.3389/fnagi.2020.578071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background: More people with cognitive dysfunction and dementia also fall into the category of high vascular risk, for which aspirin is one of the most frequently used drugs. However, previous studies reporting that aspirin buffers against mild cognitive decline (MCI) and dementia remain controversial. We thus conducted an updated systematic review and meta-analysis to evaluate the association of aspirin use with the risk of MCI and dementia in older adults. Methods: Data sources from PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trails (RCTs) and cohort studies (published between January 1, 2000 and April 11, 2020). Relative risks (RRs) and 95% confidence intervals (95% CIs) were used to pool data on the occurrence of dementia and MCI with random-effects models. Results: Of 3,193 identified articles, 15 studies (12 cohort studies and three RCTs) were eligible and were included in our analysis, which involved a total of 100,909 participants without cognitive dysfunctions or dementia at baseline. In pooled cohort studies, aspirin use did not reduce the incidence of MCI and dementia (the pooled RR = 0.97; 95% CI = 0.85–1.11; Ifor heterogeneity2 = 65%) compared with non-users. However, low-dose aspirin (75–100 mg/day) was associated with a decreased likelihood of developing dementia or MCI (the pooled RR = 0.75; 95% CI = 0.63–0.9; Ifor heterogeneity2 = 50.5%). This association existed in studies including all-cause dementia (the pooled RR = 0.82; 95% CI = 0.71–0.96) and Alzheimer's disease (AD) (the pooled RR = 0.54; 95% CI = 0.33–0.89), but not in MCI (the pooled RR = 0.58; 95% CI = 0.31–1.08). In RCTs, low-dose aspirin use was not significantly associated with less prevalence of dementia or MCI (RR = 0.94; 95% CI = 0.84–1.05; Ifor heterogeneity2 = 0.0%). Conclusions: In cohort studies, we found that low-dose aspirin use had a higher likelihood of reducing the incidence of dementia, which was not supported by RCTs. The evidence was insufficient to fully evaluate the effect of aspirin on cognitive function and dementia. Well-designed studies and innovative approaches are therefore needed to clarify whether the use of aspirin improves cognitive function and reduces the risk of dementia.
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Affiliation(s)
- Hui Li
- Department of Gerontology and Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wan Li
- Department of Neurology, The Ninth People's Hospital of Shenyang, Shenyang, China
| | - Xun Zhang
- Department of Gerontology and Geriatrics, The Forth People's Hospital of Shenyang, Shenyang, China
| | - Xiao-Chuan Ma
- Department of Gerontology and Geriatrics, The Third People's Hospital of Shenyang, Shenyang, China
| | - Rong-Wei Zhang
- Department of Gerontology and Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang, China
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18
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Abstract
The history of Alzheimer's disease (AD) started in 1907, but we needed to wait until the end of the century to identify the components of pathological hallmarks and genetic subtypes and to formulate the first pathogenic hypothesis. Thanks to biomarkers and new technologies, the concept of AD then rapidly changed from a static view of an amnestic dementia of the presenium to a biological entity that could be clinically manifested as normal cognition or dementia of different types. What is clearly emerging from studies is that AD is heterogeneous in each aspect, such as amyloid composition, tau distribution, relation between amyloid and tau, clinical symptoms, and genetic background, and thus it is probably impossible to explain AD with a single pathological process. The scientific approach to AD suffers from chronological mismatches between clinical, pathological, and technological data, causing difficulty in conceiving diagnostic gold standards and in creating models for drug discovery and screening. A recent mathematical computer-based approach offers the opportunity to study AD in real life and to provide a new point of view and the final missing pieces of the AD puzzle.
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Affiliation(s)
- Camilla Ferrari
- Department of Neuroscience, Psychology, Drug Research, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research, and Child Health (NEUROFARBA), University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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19
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Loeffler DA. Modifiable, Non-Modifiable, and Clinical Factors Associated with Progression of Alzheimer's Disease. J Alzheimers Dis 2021; 80:1-27. [PMID: 33459643 DOI: 10.3233/jad-201182] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is an extensive literature relating to factors associated with the development of Alzheimer's disease (AD), but less is known about factors which may contribute to its progression. This review examined the literature with regard to 15 factors which were suggested by PubMed search to be positively associated with the cognitive and/or neuropathological progression of AD. The factors were grouped as potentially modifiable (vascular risk factors, comorbidities, malnutrition, educational level, inflammation, and oxidative stress), non-modifiable (age at clinical onset, family history of dementia, gender, Apolipoprotein E ɛ4, genetic variants, and altered gene regulation), and clinical (baseline cognitive level, neuropsychiatric symptoms, and extrapyramidal signs). Although conflicting results were found for the majority of factors, a positive association was found in nearly all studies which investigated the relationship of six factors to AD progression: malnutrition, genetic variants, altered gene regulation, baseline cognitive level, neuropsychiatric symptoms, and extrapyramidal signs. Whether these or other factors which have been suggested to be associated with AD progression actually influence the rate of decline of AD patients is unclear. Therapeutic approaches which include addressing of modifiable factors associated with AD progression should be considered.
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Affiliation(s)
- David A Loeffler
- Beaumont Research Institute, Department of Neurology, Beaumont Health, Royal Oak, MI, USA
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20
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Ganglion Cell Layer Thinning in Alzheimer's Disease. ACTA ACUST UNITED AC 2020; 56:medicina56100553. [PMID: 33096909 PMCID: PMC7590216 DOI: 10.3390/medicina56100553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022]
Abstract
The main advantages of optical retinal imaging may allow researchers to achieve deeper analysis of retinal ganglion cells (GC) in vivo using optical coherence tomography (OCT). Using this device to elucidate the impact of Alzheimer’s disease (AD) on retinal health with the aim to identify a new AD biomarker, a large amount of studies has analyzed GC in different stages of the disease. Our review highlights recent knowledge into measuring retinal morphology in AD making distinctive between whether those studies included patients with clinical dementia stage or also mild cognitive impairment (MCI), which selection criteria were applied to diagnosed patients included, and which device of OCT was employed. Despite several differences, previous works found a significant thinning of GC layer in patients with AD and MCI. In the long term, an important future direction is to achieve a specific ocular biomarker with enough sensitivity to reveal preclinical AD disorder and to monitor progression.
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21
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Sherva R, Gross A, Mukherjee S, Koesterer R, Amouyel P, Bellenguez C, Dufouil C, Bennett DA, Chibnik L, Cruchaga C, del-Aguila J, Farrer LA, Mayeux R, Munsie L, Winslow A, Newhouse S, Saykin AJ, Kauwe JS, Crane PK, Green RC. Genome-wide association study of rate of cognitive decline in Alzheimer's disease patients identifies novel genes and pathways. Alzheimers Dement 2020; 16:1134-1145. [PMID: 32573913 PMCID: PMC7924136 DOI: 10.1002/alz.12106] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/18/2019] [Accepted: 03/11/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Variability exists in the disease trajectories of Alzheimer's disease (AD) patients. We performed a genome-wide association study to examine rate of cognitive decline (ROD) in patients with AD. METHODS We tested for interactions between genetic variants and time since diagnosis to predict the ROD of a composite cognitive score in 3946 AD cases and performed pathway analysis on the top genes. RESULTS Suggestive associations (P < 1.0 × 10-6 ) were observed on chromosome 15 in DNA polymerase-γ (rs3176205, P = 1.11 × 10-7 ), chromosome 7 (rs60465337,P = 4.06 × 10-7 ) in contactin-associated protein-2, in RP11-384F7.1 on chromosome 3 (rs28853947, P = 5.93 × 10-7 ), family with sequence similarity 214 member-A on chromosome 15 (rs2899492, P = 5.94 × 10-7 ), and intergenic regions on chromosomes 16 (rs4949142, P = 4.02 × 10-7 ) and 4 (rs1304013, P = 7.73 × 10-7 ). Significant pathways involving neuronal development and function, apoptosis, memory, and inflammation were identified. DISCUSSION Pathways related to AD, intelligence, and neurological function determine AD progression, while previously identified AD risk variants, including the apolipoprotein (APOE) ε4 and ε2 variants, do not have a major impact.
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Affiliation(s)
- Richard Sherva
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, 72 East Concord St., E-200, Boston, MA 02118, USA
| | - Alden Gross
- Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St, Johns Hopkins Center on Aging and Health, Suite 2-700, Baltimore, MD 21205, USA
| | - Shubhabrata Mukherjee
- Department of Medicine, University of Washington, Box 359780, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Ryan Koesterer
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Philippe Amouyel
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Inserm UMR-1167, Institut Pasteur de Lille, 1 rue du Professeur Calmette, BP 245 - 59019 LILLE cedex, FRANCE
- Institut Pasteur de Lille, Lille, France
- University of Lille, DISTALZ Laboratory of Excellence (LabEx), Lille, France
| | - Celine Bellenguez
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Inserm UMR-1167, Institut Pasteur de Lille, 1 rue du Professeur Calmette, BP 245 - 59019 LILLE cedex, FRANCE
- Institut Pasteur de Lille, Lille, France
- University of Lille, DISTALZ Laboratory of Excellence (LabEx), Lille, France
| | - Carole Dufouil
- Inserm Unit 1219 Bordeaux Population Health, CIC 1401-EC (Clinical Epidemiology), University of Bordeaux, ISPED (Bordeaux School of Public Health), Bordeaux University Hospital, Bordeaux, France
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Lori Chibnik
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Carlos Cruchaga
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 425 S. Euclid Ave, Office 9607, St. Louis, MO 63110, USA
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics. Washington University School of Medicine, Saint Louis, USA
| | - Jorge del-Aguila
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 425 S. Euclid Ave, Office 9607, St. Louis, MO 63110, USA
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics. Washington University School of Medicine, Saint Louis, USA
| | - Lindsay A. Farrer
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, 72 East Concord St., E-200, Boston, MA 02118, USA
- Bioinformatics Graduate Program, Boston University, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Richard Mayeux
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Leanne Munsie
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Ashley Winslow
- Orphan Disease Center, Perelman School of Medicine, University of Pennsylvania, 125 South 31st Street, Pennsylvania, PA 19104, USA
| | - Stephen Newhouse
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- NIHR BioResource Centre Maudsley, NIHR Maudsley Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust (SLaM) & Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- Health Data Research UK London, University College London, London, UK
- dd Institute of Health Informatics, University College London, London, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - Andrew J. Saykin
- Indiana Alzheimer Disease Center and Department of Radiology and Imaging Sciences, Indiana University School of Medicine, IU Health Neuroscience Center, Suite 4100, 355 West 16th Street, Indianapolis, IN 46202, USA
| | - John S.K. Kauwe
- Department of Biology, Brigham Young University, 105 FPH, Provo, UT 84602, USA
| | | | - Paul K. Crane
- Department of Medicine, University of Washington, Box 359780, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Robert C. Green
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, EC Alumnae Building, Suite 301, 41 Avenue Louis Pasteur, Boston, MA 02115, USA
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Partners HealthCare Personalized Medicine, Boston, MA, USA
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Hsieh SW, Huang LC, Chang YP, Hung CH, Yang YH. M2b macrophage subset decrement as an indicator of cognitive function in Alzheimer's disease. Psychiatry Clin Neurosci 2020; 74:383-391. [PMID: 32170772 DOI: 10.1111/pcn.13000] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/29/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023]
Abstract
AIM Alzheimer's disease (AD) is a chronic neurodegenerative disease. Various inflammatory processes account for the pathology of AD, and macrophages in particular have a distinct polarization phenotype related to M1/M2 classification. We aimed to investigate macrophage polarization patterns as an indicator of cognitive function in AD. METHODS We recruited 54 non-demented individuals as control and 105 AD patients as experimental groups respectively. Percentages of macrophage (PM2K+ CD14+ and PM2K+ CD14- ) and macrophage polarization subsets (M1, M2a, M2b, and M2c) were assessed using flow cytometry. All AD patients were classified by dementia severity using clinical Dementia Rating scale (CDR) as CDR 0.5, 1 and ≧2. AD patients had cognitive function evaluation using Mini-Mental State Examination (MMSE) and Cognitive Assessment Screening Instrument (CASI). We compared the macrophage polarization patterns between control and patient groups. Cognitive function was evaluated in association with macrophage polarization patterns in AD patients. RESULTS The percentages of PM2K+ CD14+ and PM2K+ CD14- macrophages were higher in AD patients than in controls. M2b macrophage subset decrement and M1 macrophage subset increment of PM2K+ CD14+ and PM2K+ CD14- macrophages were observed in AD patients compared with controls. Although percentages of macrophage subsets were not consistent with CDR staging, PM2K+ CD14+ M2b macrophage subset decrement was correlated with worse cognitive functioning by MMSE and CASI in AD patients. CONCLUSION M2b macrophage subset decrement and M1 macrophage subset increment were noted in AD patients, while PM2K+ CD14+ M2b macrophage subset decrement indicated worse cognitive function in such patients.
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Affiliation(s)
- Sun-Wung Hsieh
- Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ling-Chun Huang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Hsing Hung
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pediatrics, Faculty of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pediatrics, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of and Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Chinese Mentality Protection Association, Kaohsiung, Taiwan
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Abstract
BACKGROUND/AIMS Few longitudinal studies have explored the progression of cognitive and functional impairment of patients with primary progressive aphasia (PPA). The aims of the study were to describe the clinical, neuroimaging, and genetic features of a cohort of 68 PPA patients, and to outline the natural history of the disease. MATERIALS AND METHODS A sample of 23 patients with the logopenic variant, 26 with the nonfluent/agrammatic variant, and 19 with the semantic variant was retrospectively collected and followed-up for a maximum of 6 years. Clinical-neuropsychological assessment, fluorodeoxyglucose positron emission tomographic imaging, and genetic analyses were acquired at baseline. Disease progression was evaluated in terms of language impairment, global cognitive decline, and functional dependency. RESULTS During follow-up, one third of subjects presented total language loss, and 20% severe functional dependency. Global cognitive decline after the first year (hazard ratio, 5.93; confidence interval, 1.63-21.56) and high schooling (hazard ratio, 0.07; confidence interval, 0.008-0.74) represented risk factors for functional impairment. The apolipoprotein E status was associated with the progression of cognitive decline. Positive family history for dementia was frequent and 3 genetic autosomal dominant mutations were identified. CONCLUSIONS There were no differences in the progression of PPA subtypes. Genetics plays an important role in disease onset and progression.
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Tay L, Leung B, Yeo A, Chan M, Lim WS. Elevations in Serum Dickkopf-1 and Disease Progression in Community-Dwelling Older Adults With Mild Cognitive Impairment and Mild-to-Moderate Alzheimer's Disease. Front Aging Neurosci 2019; 11:278. [PMID: 31680933 PMCID: PMC6803458 DOI: 10.3389/fnagi.2019.00278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/26/2019] [Indexed: 02/02/2023] Open
Abstract
Background: Disruption of Wnt signaling has been implicated in dysfunctional synaptic plasticity, the degree of which correlates with Alzheimer's disease severity. We sought to examine whether serum levels of Dickkopf-1 (Dkk-1), a Wnt antagonist, are associated with global disease progression in older adults with mild cognitive impairment (MCI) and mild-to-moderate AD. Methods: We prospectively followed 88 older adults with MCI and mild-to-moderate AD attending a Memory Clinic. Cognitive performance, functional performance and neuropsychological symptoms were assessed at baseline and after 1 year. We reviewed neuroimaging for white matter changes and medial temporal atrophy, and performed ApoE genotyping at baseline. Serum Dkk-1 was assayed at baseline and 1 year, along with blood biomarkers of inflammation and endocrine dysfunction. We defined global disease progression ("progressors") as an increase in Clinical Dementia Rating Sum-of-Boxes (CDR-SB) score by >2 points at 1 year. Results: Fifteen (17.0%) participants had global disease progression. At baseline, there was no difference in cognitive performance and neuropsychiatric symptoms between groups, although progressors were more impaired in instrumental activities of daily living (p = 0.008). Progressors had significantly greater deterioration in cognitive performance (p = 0.002), with significantly worse functional performance and more severe neuropsychiatric symptoms (p = 0.042) at follow-up. Serum inflammatory and endocrine biomarkers at baseline and 1 year were similar between progressors and non-progressors. Serum Dkk-1 had increased significantly from baseline amongst progressors, while non-progressors exhibited decremental Dkk-1 over time (Dkk-1change: 354.304 ± 670.467 vs. -173.582 ± 535.676 ng/ml, p = 0.001). Adjusting for age, gender and baseline cognitive performance, incremental Dkk-1 independently predicted global cognitive decline (p = 0.012). Conclusion: Our results suggest progressively dysfunctional Wnt signaling through Dkk-1 antagonism contributes to disease progression amongst older adults with MCI and mild-moderate AD.
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Affiliation(s)
- Laura Tay
- Department of General Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Bernard Leung
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore.,Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore
| | - Audrey Yeo
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Mark Chan
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
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25
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de Oliveira FF, de Almeida SS, Chen ES, Smith MC, Naffah-Mazzacoratti MDG, Bertolucci PHF. Lifetime Risk Factors for Functional and Cognitive Outcomes in Patients with Alzheimer's Disease. J Alzheimers Dis 2019; 65:1283-1299. [PMID: 30149448 DOI: 10.3233/jad-180303] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lifetime risk factors for cognitive and functional decline in Alzheimer's disease (AD) are not fully understood, and were prospectively evaluated in patients with low mean schooling from São Paulo, Brazil. Consecutive outpatients with late-onset AD were assessed for APOE haplotypes and the following potential baseline predictors: gender, schooling, age at dementia onset, lifetime urban living and sanitary conditions, occupational complexity, cognitive and physical activities, cerebrovascular risk factors (obesity, lifetime alcohol use and smoking, length of arterial hypertension, diabetes mellitus, and a dyslipidemic profile), use of a pacemaker, creatinine clearance, body mass index, waist circumference, head traumas with unconsciousness, treated systemic bacterial infections, amount of surgical procedures under general anesthesia, and family history of AD. Participants were followed from October 2010 to May 2017 for baseline risk factor associations with time since dementia onset for Clinical Dementia Rating and Mini-Mental State Examination score changes. For 227 patients (154 women, 119 APOE ε 4 carriers), later AD onset (mean 73.60±6.4 years-old, earlier for APOE ε 4/ε 4 carriers, p < 0.001) was the only variable hastening all endpoints, baseline creatinine clearance and lifetime alcohol use were hazardous for earlier cognitive and functional endpoints, women had earlier cognitive endpoints only, and schooling had a cumulative protective effect over later cognitive endpoints, particularly for carriers of APOE ε 4. Exclusively for carriers of APOE ε 4, head traumas with unconsciousness were hazardous for earlier cognitive endpoints, while lifetime sanitary conditions were protective regarding later cognitive endpoints. Functional and cognitive outcomes in AD represent probable interactions between effects of brain reserve and cerebral perfusion over neurodegeneration.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sandro Soares de Almeida
- Department of Biophysics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Elizabeth Suchi Chen
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marilia Cardoso Smith
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Pillai JA, Appleby BS, Safar J, Leverenz JB. Rapidly Progressive Alzheimer's Disease in Two Distinct Autopsy Cohorts. J Alzheimers Dis 2019; 64:973-980. [PMID: 29966195 DOI: 10.3233/jad-180155] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND A rapidly progressive phenotype of Alzheimer's disease (AD) has been described in some prion disease cohorts. Limited information regarding rapidly progressive AD (rpAD) is available from longitudinal national cohorts. OBJECTIVE To compare the clinical characteristics of rpAD in two different national cohorts. METHODS A retrospective analysis was performed on AD subjects with available neuropathology in the National Alzheimer's Coordinating Center (NACC) database and among neuropathologically characterized AD cases from the National Prion Disease Pathology Surveillance Center (NPDPSC) that were evaluated for suspected prion disease. In the NACC cohort, rpAD was delineated by the lower 10th percentile of follow up duration from pre-dementia to death duration among subjects meeting pathological diagnosis of AD. RESULTS rpAD from the NPDPSC had a shorter mean symptom duration than the NACC identified rpAD cases (11.6 months versus 62.4 months) and were also younger at the time of their death (60.0 versus 81.8 years). NACC identified rpAD subjects, beginning from a predementia stage, had slower rate of MMSE change per year than NPDPSC cases (2.5 versus 6.0 points). CONCLUSIONS rpAD constitute an important subset of AD subjects in whom a rapid course of symptomatic clinical decline is noted, as confirmed in both national cohorts. rpAD was best characterized by survival time (≤3 years), as there were clear differences between the rpAD cohorts in terms of symptom duration, age at death, and MMSE change per year, likely due to the strong selection biases. rpAD could shed light on the biology of rate of progression in AD.
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27
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Gao Y, Liu Q, Xu L, Zheng N, He X, Xu F. Imaging and Spectral Characteristics of Amyloid Plaque Autofluorescence in Brain Slices from the APP/PS1 Mouse Model of Alzheimer's Disease. Neurosci Bull 2019; 35:1126-1137. [PMID: 31127445 DOI: 10.1007/s12264-019-00393-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/12/2018] [Indexed: 10/26/2022] Open
Abstract
Amyloid deposits are one of the hallmark pathological lesions of Alzheimer's disease (AD). They can be visualized by thioflavin-S, silver impregnation, Congo red staining, and immunohistochemical reactions. However, that amyloid deposits generate blue autofluorescence (auto-F) has been ignored. Here, we report that visible light-induced auto-F of senile plaques (SPs) was detected and validated with conventional methods. Brain slices from APP/PS1 (amyloid precursor protein/presenilin 1) transgenic mice were mounted on slides, rinsed, coverslipped and observed for details of the imaging and spectral characteristics of the auto-F of SPs. Then the slices were treated with the above classic methods for comparative validation. We found that the SP auto-F was greatest under blue-violet excitation with a specific emission spectrum, and was much easier, more sensitive, and reliable than the classic methods. Because it does not damage slices, observation of auto-F can be combined with all post-staining techniques in slices and for brain-wide imaging in AD.
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Affiliation(s)
- Yunling Gao
- Research Section, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Qing Liu
- Center for Brain Science, State Key Laboratory of Magnetic Resonance and Atomic Molecular Physics, National Center for Magnetic Resonance in Wuhan, Key Laboratory of Magnetic Resonance in Biological Systems, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, China.
| | - Lingling Xu
- National Center for Magnetic Resonance in Wuhan, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Ning Zheng
- Center for Brain Science, State Key Laboratory of Magnetic Resonance and Atomic Molecular Physics, National Center for Magnetic Resonance in Wuhan, Key Laboratory of Magnetic Resonance in Biological Systems, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Xiaoming He
- Neurology Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China.
| | - Fuqiang Xu
- Center for Brain Science, State Key Laboratory of Magnetic Resonance and Atomic Molecular Physics, National Center for Magnetic Resonance in Wuhan, Key Laboratory of Magnetic Resonance in Biological Systems, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, China. .,Wuhan National Laboratory for Optoelectronics, Wuhan, 430074, China.
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28
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Abstract
PURPOSE OF REVIEW To date, most research in dementia has focused either on the identification of dementia risk prediction or on understanding changes and predictors experienced by individuals before diagnosis. Despite little is known about how individuals change after dementia diagnosis, there is agreement that changes occur over different time scales and are multidomain. In this study, we present an overview of the literature regarding the longitudinal course of dementia. RECENT FINDINGS Our review suggests the evidence is scarce and findings reported are often inconsistent. We identified large heterogeneity in dementia trajectories, risk factors considered and modelling approaches employed. The heterogeneity of dementia trajectories also varies across outcomes and domains investigated. SUMMARY It became clear that dementia progresses very differently, both between and within individuals. This implies an average trajectory is not informative to individual persons and this needs to be taken into account when communicating prognosis in clinical care. As persons with dementia change in many more ways during their patient journey, heterogeneous disease progressions are the result of disease and patient characteristics. Prognostic models would benefit from including variables across a number of domains. International coordination of replication and standardization of the research approach is recommended.
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29
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The dual role of cognitive reserve in subjective cognitive decline and mild cognitive impairment: a 7-year follow-up study. J Neurol 2019; 266:487-497. [PMID: 30604054 DOI: 10.1007/s00415-018-9164-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/26/2018] [Accepted: 12/17/2018] [Indexed: 12/18/2022]
Abstract
The aim of this study was to evaluate the effect of cognitive reserve (CR), in progression from subjective cognitive decline (SCD) to mild cognitive impairment (MCI) and Alzheimer's disease (AD). For this purpose, we followed up 263 patients (154 SCD; 109 MCI) for a mean time of 7 years. CR was assessed by the Test di Intelligenza Breve (TIB), functionally equivalent to the National Adult Reading Test. High CR resulted as a protective factor for progression from SCD to MCI. Age at conversion to MCI was delayed 9 years on average in SCD with high CR with respect to SCD with low CR. On the contrary, high CR resulted as a risk factor for progression from MCI to AD dementia only in APOE ε4 carriers. Conversion time from MCI to AD dementia was 3 years shorter in ε4 carriers with high CR than subjects with low CR and ε4 non-carriers with high CR. Consistent with the CR hypothesis, our results showed that higher levels of CR protect against the earliest clinical manifestations of AD. In line with the previous researches, we found an interaction between CR and APOE in progression from MCI to AD dementia.
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30
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Cabinio M, Saresella M, Piancone F, LaRosa F, Marventano I, Guerini FR, Nemni R, Baglio F, Clerici M. Association between Hippocampal Shape, Neuroinflammation, and Cognitive Decline in Alzheimer’s Disease. J Alzheimers Dis 2018; 66:1131-1144. [DOI: 10.3233/jad-180250] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Monia Cabinio
- Laboratory of Molecular Medicine and Imaging in Rehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Marina Saresella
- Laboratory of Molecular Medicine and Imaging in Rehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Federica Piancone
- Laboratory of Molecular Medicine and Imaging in Rehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Francesca LaRosa
- Laboratory of Molecular Medicine and Imaging in Rehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Ivana Marventano
- Laboratory of Molecular Medicine and Imaging in Rehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Franca Rosa Guerini
- Laboratory of Molecular Medicine and Imaging in Rehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Raffaello Nemni
- Neurorehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesca Baglio
- Laboratory of Molecular Medicine and Imaging in Rehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Mario Clerici
- Laboratory of Molecular Medicine and Imaging in Rehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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