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Jung YH, Jang H, Park S, Kim HJ, Seo SW, Kim GB, Shon YM, Kim S, Na DL. Effectiveness of Personalized Hippocampal Network-Targeted Stimulation in Alzheimer Disease: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e249220. [PMID: 38709534 PMCID: PMC11074813 DOI: 10.1001/jamanetworkopen.2024.9220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/01/2024] [Indexed: 05/07/2024] Open
Abstract
Importance Repetitive transcranial magnetic stimulation (rTMS) has emerged as a safe and promising intervention for Alzheimer disease (AD). Objective To investigate the effect of a 4-week personalized hippocampal network-targeted rTMS on cognitive and functional performance, as well as functional connectivity in AD. Design, Setting, and Participants This randomized clinical trial, which was sham-controlled and masked to participants and evaluators, was conducted between May 2020 and April 2022 at a single Korean memory clinic. Eligible participants were between ages 55 and 90 years and had confirmed early AD with evidence of an amyloid biomarker. Participants who met the inclusion criteria were randomly assigned to receive hippocampal network-targeted rTMS or sham stimulation. Participants received 4-week rTMS treatment, with assessment conducted at weeks 4 and 8. Data were analyzed between April 2022 and January 2024. Interventions Each patient received 20 sessions of personalized rTMS targeting the left parietal area, functionally connected to the hippocampus, based on fMRI connectivity analysis over 4 weeks. The sham group underwent the same procedure, excluding actual magnetic stimulation. A personalized 3-dimensional printed frame to fix the TMS coil to the optimal target site was produced. Main Outcomes and Measures The primary outcome was the change in the AD Assessment Scale-Cognitive Subscale test (ADAS-Cog) after 8 weeks from baseline. Secondary outcomes included changes in the Clinical Dementia Rating-Sum of Boxes (CDR-SOB) and Seoul-Instrumental Activity Daily Living (S-IADL) scales, as well as resting-state fMRI connectivity between the hippocampus and cortical areas. Results Among 30 participants (18 in the rTMS group; 12 in the sham group) who completed the 8-week trial, the mean (SD) age was 69.8 (9.1) years; 18 (60%) were female. As the primary outcome, the change in ADAS-Cog at the eighth week was significantly different between the rTMS and sham groups (coefficient [SE], -5.2 [1.6]; P = .002). The change in CDR-SOB (-4.5 [1.4]; P = .007) and S-IADL (1.7 [0.7]; P = .004) were significantly different between the groups favoring rTMS groups. The fMRI connectivity analysis revealed that rTMS increased the functional connectivity between the hippocampus and precuneus, with its changes associated with improvements in ADAS-Cog (r = -0.57; P = .005). Conclusions and Relevance This randomized clinical trial demonstrated the positive effects of rTMS on cognitive and functional performance, and the plastic changes in the hippocampal-cortical network. Our results support the consideration of rTMS as a potential treatment for AD. Trial Registration ClinicalTrials.gov Identifier: NCT04260724.
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Affiliation(s)
- Young Hee Jung
- Department of Neurology, Myongji Hospital, Hanyang University, Goyang, Korea
| | - Hyemin Jang
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
- Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Sungbeen Park
- Department of Artificial Intelligence, Hanyang University, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
- Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
- Department of Health Science and Technology, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
- Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
- Department of Health Science and Technology, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
| | | | - Young-Min Shon
- Department of Health Science and Technology, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
- Smart Healthcare Research Institute, Samsung Medical Center, Seoul, Korea
| | - Sungshin Kim
- Department of Artificial Intelligence, Hanyang University, Seoul, Korea
- Smart Healthcare Research Institute, Samsung Medical Center, Seoul, Korea
- Department of Data Science, Hanyang University, Seoul, Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
- Happymind Clinic, Seoul, Korea
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Huszár Z, Engh MA, Pavlekovics M, Sato T, Steenkamp Y, Hanseeuw B, Terebessy T, Molnár Z, Hegyi P, Csukly G. Risk of conversion to mild cognitive impairment or dementia among subjects with amyloid and tau pathology: a systematic review and meta-analysis. Alzheimers Res Ther 2024; 16:81. [PMID: 38610055 PMCID: PMC11015617 DOI: 10.1186/s13195-024-01455-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Measurement of beta-amyloid (Aβ) and phosphorylated tau (p-tau) levels offers the potential for early detection of neurocognitive impairment. Still, the probability of developing a clinical syndrome in the presence of these protein changes (A+ and T+) remains unclear. By performing a systematic review and meta-analysis, we investigated the risk of mild cognitive impairment (MCI) or dementia in the non-demented population with A+ and A- alone and in combination with T+ and T- as confirmed by PET or cerebrospinal fluid examination. METHODS A systematic search of prospective and retrospective studies investigating the association of Aβ and p-tau with cognitive decline was performed in three databases (MEDLINE via PubMed, EMBASE, and CENTRAL) on January 9, 2024. The risk of bias was assessed using the Cochrane QUIPS tool. Odds ratios (OR) and Hazard Ratios (HR) were pooled using a random-effects model. The effect of neurodegeneration was not studied due to its non-specific nature. RESULTS A total of 18,162 records were found, and at the end of the selection process, data from 36 cohorts were pooled (n= 7,793). Compared to the unexposed group, the odds ratio (OR) for conversion to dementia in A+ MCI patients was 5.18 [95% CI 3.93; 6.81]. In A+ CU subjects, the OR for conversion to MCI or dementia was 5.79 [95% CI 2.88; 11.64]. Cerebrospinal fluid Aβ42 or Aβ42/40 analysis and amyloid PET imaging showed consistent results. The OR for conversion in A+T+ MCI subjects (11.60 [95% CI 7.96; 16.91]) was significantly higher than in A+T- subjects (2.73 [95% CI 1.65; 4.52]). The OR for A-T+ MCI subjects was non-significant (1.47 [95% CI 0.55; 3.92]). CU subjects with A+T+ status had a significantly higher OR for conversion (13.46 [95% CI 3.69; 49.11]) than A+T- subjects (2.04 [95% CI 0.70; 5.97]). Meta-regression showed that the ORs for Aβ exposure decreased with age in MCI. (beta = -0.04 [95% CI -0.03 to -0.083]). CONCLUSIONS Identifying Aβ-positive individuals, irrespective of the measurement technique employed (CSF or PET), enables the detection of the most at-risk population before disease onset, or at least at a mild stage. The inclusion of tau status in addition to Aβ, especially in A+T+ cases, further refines the risk assessment. Notably, the higher odds ratio associated with Aβ decreases with age. TRIAL REGISTRATION The study was registered in PROSPERO (ID: CRD42021288100).
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Affiliation(s)
- Zsolt Huszár
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa utca 6, Budapest, 1083, Hungary
| | - Marie Anne Engh
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Márk Pavlekovics
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Neurology, Jahn Ferenc Teaching Hospital, Köves utca 1, Budapest, 1204, Hungary
| | - Tomoya Sato
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Yalea Steenkamp
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Bernard Hanseeuw
- Department of Neurology and Institute of Neuroscience, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, 1200, Belgium
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02155, USA
| | - Tamás Terebessy
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Zsolt Molnár
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Üllői út 78/A, Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 49 Przybyszewskiego St, Poznan, Poland
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, 7624, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Tömő 25-29, Budapest, 1083, Hungary
- Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research Development and Innovation University of Szeged, Budapesti 9, Szeged, 6728, Hungary
| | - Gábor Csukly
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa utca 6, Budapest, 1083, Hungary.
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Jukkola J, Kaakinen M, Singh A, Moradi S, Ferdinando H, Myllylä T, Kiviniemi V, Eklund L. Blood pressure lowering enhances cerebrospinal fluid efflux to the systemic circulation primarily via the lymphatic vasculature. Fluids Barriers CNS 2024; 21:12. [PMID: 38279178 PMCID: PMC10821255 DOI: 10.1186/s12987-024-00509-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Inside the incompressible cranium, the volume of cerebrospinal fluid is directly linked to blood volume: a change in either will induce a compensatory change in the other. Vasodilatory lowering of blood pressure has been shown to result in an increase of intracranial pressure, which, in normal circumstances should return to equilibrium by increased fluid efflux. In this study, we investigated the effect of blood pressure lowering on fluorescent cerebrospinal fluid tracer absorption into the systemic blood circulation. METHODS Blood pressure lowering was performed by an i.v. administration of nitric oxide donor (sodium nitroprusside, 5 µg kg-1 min-1) or the Ca2+-channel blocker (nicardipine hydrochloride, 0.5 µg kg-1 min-1) for 10, and 15 to 40 min, respectively. The effect of blood pressure lowering on cerebrospinal fluid clearance was investigated by measuring the efflux of fluorescent tracers (40 kDa FITC-dextran, 45 kDa Texas Red-conjugated ovalbumin) into blood and deep cervical lymph nodes. The effect of nicardipine on cerebral hemodynamics was investigated by near-infrared spectroscopy. The distribution of cerebrospinal fluid tracers (40 kDa horse radish peroxidase,160 kDa nanogold-conjugated IgG) in exit pathways was also analyzed at an ultrastructural level using electron microscopy. RESULTS Nicardipine and sodium nitroprusside reduced blood pressure by 32.0 ± 19.6% and 24.0 ± 13.3%, while temporarily elevating intracranial pressure by 14.0 ± 7.0% and 18.2 ± 15.0%, respectively. Blood pressure lowering significantly increased tracer accumulation into dorsal dura, deep cervical lymph nodes and systemic circulation, but reduced perivascular inflow along penetrating arteries in the brain. The enhanced tracer efflux by blood pressure lowering into the systemic circulation was markedly reduced (- 66.7%) by ligation of lymphatic vessels draining into deep cervical lymph nodes. CONCLUSIONS This is the first study showing that cerebrospinal fluid clearance can be improved with acute hypotensive treatment and that the effect of the treatment is reduced by ligation of a lymphatic drainage pathway. Enhanced cerebrospinal fluid clearance by blood pressure lowering may have therapeutic potential in diseases with dysregulated cerebrospinal fluid flow.
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Affiliation(s)
- Jari Jukkola
- Oulu Center for Cell-Matrix Research, Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Mika Kaakinen
- Oulu Center for Cell-Matrix Research, Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Abhishek Singh
- Oulu Center for Cell-Matrix Research, Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Sadegh Moradi
- Opto-Electronics and Measurement Technique Research Unit, Infotech Oulu, University of Oulu, Oulu, Finland
| | - Hany Ferdinando
- Research Unit of Health Science and Technology, University of Oulu, Oulu, Finland
| | - Teemu Myllylä
- Opto-Electronics and Measurement Technique Research Unit, Infotech Oulu, University of Oulu, Oulu, Finland
- Research Unit of Health Science and Technology, University of Oulu, Oulu, Finland
| | - Vesa Kiviniemi
- Oulu Functional NeuroImaging (OFNI), Diagnostic Imaging, Medical Research Center (MRC), Oulu University Hospital, Oulu, Finland
- Research Unit of Health Sciences and Technology (HST), Faculty of Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Lauri Eklund
- Oulu Center for Cell-Matrix Research, Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland.
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Sánchez-Soblechero A, López-García S, Lage C, Fernández-Matarrubia M, Irure J, López-Hoyos M, Jiménez-Bonilla J, Quirce R, de Arcocha-Torres M, Cuenca-Vera O, Martín-Arroyo J, Martínez-Dubarbie F, Pozueta A, García-Martínez M, Infante J, Sánchez-Juan P, Rodríguez-Rodríguez E. Where Should I Draw the Line: PET-Driven, Data-Driven, or Manufacturer Cut-Off? J Alzheimers Dis 2024; 98:957-967. [PMID: 38489172 DOI: 10.3233/jad-230678] [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: 03/17/2024]
Abstract
Background The optimal cut-off for Alzheimer's disease (AD) CSF biomarkers remains controversial. Objective To analyze the performance of cut-off points standardized by three methods: one that optimized the agreement between 11C-Pittsburgh compound B PET (a-PET) and CSF biomarkers (Aβ1-42, pTau, tTau, and Aβ1-42/Aβ1-40 ratio) in our population, called PET-driven; an unbiased cut-off using data from a healthy research cohort, called data-driven, and that provided by the manufacturer. We also compare changes in ATN classification. Methods CSF biomarkers measured by the LUMIPULSE G600II platform and qualitative visualization of amyloid positron emission tomography (a-PET) were performed in all the patients. We established a cut-off for each single biomarker and Aβ1-42/Aβ1-40 ratio that optimized their agreement with a-PET using ROC curves. Sensitivity, Specificity, and Overall Percent of Agreement are assessed using a-PET or clinical diagnosis as gold standard for every cut-off. Also, we established a data-driven cut-off from our cognitively unimpaired cohort. We then analyzed changes in ATN classification. Results One hundred and ten patients were recruited. Sixty-six (60%) were a-PET positive. PET-driven cut-offs were: pTau > 57, tTau > 362.62, Aβ1-42/Aβ1-40 < 0.069. For a single biomarker, pTau showed the highest accuracy (AUC 0.926). New PET-driven cut-offs classified patients similarly to manufacturer cut-offs (only two patients changed). However, 20 patients (18%) changed when data-driven cut-offs were used. Conclusions We established our sample's best CSF biomarkers cut-offs using a-PET as the gold standard. These cut-offs categorize better symptomatic subjects than data-driven in ATN classification, but they are very similar to the manufacturer's.
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Affiliation(s)
| | - Sara López-García
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Carmen Lage
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Marta Fernández-Matarrubia
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Irure
- Immunology Department, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
| | - Marcos López-Hoyos
- Immunology Department, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
| | - Julio Jiménez-Bonilla
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Nuclear Medicine Department, 'Marqués de Valdecilla' University Hospital, Santander, Spain
| | - Remedios Quirce
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Nuclear Medicine Department, 'Marqués de Valdecilla' University Hospital, Santander, Spain
| | - María de Arcocha-Torres
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Nuclear Medicine Department, 'Marqués de Valdecilla' University Hospital, Santander, Spain
| | - Oriana Cuenca-Vera
- Nuclear Medicine Department, 'Marqués de Valdecilla' University Hospital, Santander, Spain
| | - Juan Martín-Arroyo
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
| | - Francisco Martínez-Dubarbie
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Ana Pozueta
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - María García-Martínez
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Jon Infante
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
| | - Pascual Sánchez-Juan
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Alzheimer's Centre Reina Sofia-CIEN Foundation-ISCIII, Madrid, Spain
| | - Eloy Rodríguez-Rodríguez
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
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Jain L, Khrestian M, Formica S, Tuason ED, Pillai JA, Rao S, Oguh O, Lippa CF, Lopez OL, Berman SB, Tsuang DW, Zabetian CP, Irwin DJ, Galasko DR, Litvan I, Marder KS, Honig LS, Fleisher JE, Galvin JE, Bozoki AC, Taylor AS, Sabbagh MN, Leverenz JB, Bekris LM. ATN cerebrospinal fluid biomarkers in dementia with Lewy bodies: Initial results from the United States Dementia with Lewy Bodies Consortium. Alzheimers Dement 2024; 20:549-562. [PMID: 37740924 PMCID: PMC10840643 DOI: 10.1002/alz.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION The National Institute on Aging - Alzheimer's Association (NIA-AA) ATN research framework proposes to use biomarkers for amyloid (A), tau (T), and neurodegeneration (N) to stage individuals with AD pathological features and track changes longitudinally. The overall aim was to utilize this framework to characterize pre-mortem ATN status longitudinally in a clinically diagnosed cohort of dementia with Lewy bodies (DLB) and to correlate it with the post mortem diagnosis. METHODS The cohort was subtyped by cerebrospinal fluid (CSF) ATN category. A subcohort had longitudinal data, and a subgroup was neuropathologically evaluated. RESULTS We observed a significant difference in Aβ42/40 after 12 months in the A+T- group. Post mortem neuropathologic analyses indicated that most of the p-Tau 181 positive (T+) cases also had a high Braak stage. DISCUSSION This suggests that DLB patients who are A+ but T- may need to be monitored to determine whether they remain A+ or ever progress to T positivity. HIGHLIGHTS Some A+T- DLB subjects transition from A+ to negative after 12-months. Clinically diagnosed DLB with LBP-AD (A+T+) maintain their positivity. Clinically diagnosed DLB with LBP-AD (A+T+) maintain their positivity. Monitoring of the A+T- sub-type of DLB may be necessary.
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Affiliation(s)
- Lavanya Jain
- Genomic Medicine InstituteCleveland ClinicClevelandOhioUSA
| | | | - Shane Formica
- Genomic Medicine InstituteCleveland ClinicClevelandOhioUSA
| | | | - Jagan A. Pillai
- Cleveland Clinic Lou Ruvo Center for Brain HealthCleveland ClinicClevelandOhioUSA
| | - Stephen Rao
- Cleveland Clinic Lou Ruvo Center for Brain HealthCleveland ClinicClevelandOhioUSA
| | - Odinachi Oguh
- Cleveland Clinic Lou Ruvo Center for Brain Health‐Las VegasCleveland ClinicLas VegasNevadaUSA
| | - Carol F. Lippa
- Cleveland Clinic Lou Ruvo Center for Brain Health‐Las VegasCleveland ClinicLas VegasNevadaUSA
| | - Oscar L. Lopez
- Cognitive Disorders & Comprehensive Alzheimer's Disease CenterThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Sarah B. Berman
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Debby W. Tsuang
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashingtonUSA
- Geriatric Research, Education, and Clinical CenterVA Puget Sound Health Care SystemSeattleWashingtonUSA
| | - Cyrus P. Zabetian
- Geriatric Research, Education, and Clinical CenterVA Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of NeurologyUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - David J. Irwin
- Department of NeurologyUniversity of Pennsylvania Health SystemPhiladelphiaPennsylvaniaUSA
- Digital Neuropathology LaboratoryPhiladelphiaPennsylvaniaUSA
- Lewy Body Disease Research Center of ExcellencePhiladelphiaPennsylvaniaUSA
- Frontotemporal Degeneration CenterPhiladelphiaPennsylvaniaUSA
| | - Douglas R. Galasko
- Department of NeurosciencesUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Irene Litvan
- Department of NeurosciencesUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Karen S. Marder
- Columbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Lawrence S. Honig
- Department of NeurosciencesUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Jori E. Fleisher
- Department of Neurological SciencesRush Medical CollegeChicagoIllinoisUSA
| | - James E. Galvin
- Department of NeurologyComprehensive Center for Brain HealthUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Andrea C. Bozoki
- Department of NeurologyUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | | | - Marwan N. Sabbagh
- Department of NeurologyBarrow Neurological InstitutePhoenixArizonaUSA
| | - James B. Leverenz
- Cleveland Clinic Lou Ruvo Center for Brain HealthCleveland ClinicClevelandOhioUSA
| | - Lynn M. Bekris
- Genomic Medicine InstituteCleveland ClinicClevelandOhioUSA
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Chun MY, Jang H, Kim HJ, Kim JP, Gallacher J, Allué JA, Sarasa L, Castillo S, Pascual-Lucas M, Na DL, Seo SW. Contribution of clinical information to the predictive performance of plasma β-amyloid levels for amyloid positron emission tomography positivity. Front Aging Neurosci 2023; 15:1126799. [PMID: 36998318 PMCID: PMC10044013 DOI: 10.3389/fnagi.2023.1126799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/24/2023] [Indexed: 03/15/2023] Open
Abstract
BackgroundEarly detection of β-amyloid (Aβ) accumulation, a major biomarker for Alzheimer’s disease (AD), has become important. As fluid biomarkers, the accuracy of cerebrospinal fluid (CSF) Aβ for predicting Aβ deposition on positron emission tomography (PET) has been extensively studied, and the development of plasma Aβ is beginning to receive increased attention recently. In the present study, we aimed to determine whether APOE genotypes, age, and cognitive status increase the predictive performance of plasma Aβ and CSF Aβ levels for Aβ PET positivity.MethodsWe recruited 488 participants who underwent both plasma Aβ and Aβ PET studies (Cohort 1) and 217 participants who underwent both cerebrospinal fluid (CSF) Aβ and Aβ PET studies (Cohort 2). Plasma and CSF samples were analyzed using ABtest-MS, an antibody-free liquid chromatography-differential mobility spectrometry-triple quadrupole mass spectrometry method and INNOTEST enzyme-linked immunosorbent assay kits, respectively. To evaluate the predictive performance of plasma Aβ and CSF Aβ, respectively, logistic regression and receiver operating characteristic analyses were performed.ResultsWhen predicting Aβ PET status, both plasma Aβ42/40 ratio and CSF Aβ42 showed high accuracy (plasma Aβ area under the curve (AUC) 0.814; CSF Aβ AUC 0.848). In the plasma Aβ models, the AUC values were higher than plasma Aβ alone model, when the models were combined with either cognitive stage (p < 0.001) or APOE genotype (p = 0.011). On the other hand, there was no difference between the CSF Aβ models, when these variables were added.ConclusionPlasma Aβ might be a useful predictor of Aβ deposition on PET status as much as CSF Aβ, particularly when considered with clinical information such as APOE genotype and cognitive stage.
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Affiliation(s)
- Min Young Chun
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea
| | - Hyemin Jang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
- *Correspondence: Hyemin Jang, ; Sang Won Seo,
| | - Hee Jin Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jun Pyo Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Center for Neuroimaging, Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - John Gallacher
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | | | | | | | | | - Duk L. Na
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Won Seo
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- *Correspondence: Hyemin Jang, ; Sang Won Seo,
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7
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Kasuga K, Tsukie T, Kikuchi M, Tokutake T, Washiyama K, Simizu S, Yoshizawa H, Kuroha Y, Yajima R, Mori H, Arakawa Y, Onda K, Miyashita A, Onodera O, Iwatsubo T, Ikeuchi T. The Clinical Application of Optimized AT(N) Classification in Alzheimer’s Clinical Syndrome (ACS) and non-ACS Conditions. Neurobiol Aging 2023; 127:23-32. [PMID: 37030016 DOI: 10.1016/j.neurobiolaging.2023.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
We aimed to assess the utility of AT(N) classification in clinical practice. We measured the cerebrospinal fluid levels of amyloid-β (Aβ) 42, Aβ40, phosphorylated tau, total tau, and neurofilament light chain (NfL) in samples from 230 patients with Alzheimer's clinical syndrome (ACS) and 328 patients with non-ACS. The concordance of two A-markers (i.e., Aβ42 alone and the Aβ42/Aβ40 ratio) was not significantly different between the ACS (87.4%) and non-ACS (74.1%) groups. However, the frequency of discordant cases with AAβ42-alone+/AAβ-ratio- was significantly higher in the non-ACS (23.8%) than in the ACS group (7.4%). The concordance of two N-markers (i.e., total tau and NfL) was 40.4% in the ACS group and 24.4% in the non-ACS group. In the ACS samples, the frequency of biological Alzheimer's disease (i.e., A+T+) in Ntau+ cases was 95% while that in NNfL+ cases was 65%. Reflecting Aβ deposition and neurodegeneration more accurately, we recommend the use of AT(N) classification defined by cerebrospinal fluid AAβ-ratioTNNfL in clinical practice.
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8
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Kandiah N, Choi SH, Hu CJ, Ishii K, Kasuga K, Mok VC. Current and Future Trends in Biomarkers for the Early Detection of Alzheimer's Disease in Asia: Expert Opinion. J Alzheimers Dis Rep 2022; 6:699-710. [PMID: 36606209 PMCID: PMC9741748 DOI: 10.3233/adr-220059] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/23/2022] [Indexed: 11/16/2022] Open
Abstract
Alzheimer's disease (AD) poses a substantial healthcare burden in the rapidly aging Asian population. Early diagnosis of AD, by means of biomarkers, can lead to interventions that might alter the course of the disease. The amyloid, tau, and neurodegeneration (AT[N]) framework, which classifies biomarkers by their core pathophysiological features, is a biomarker measure of amyloid plaques and neurofibrillary tangles. Our current AD biomarker armamentarium, comprising neuroimaging biomarkers and cerebrospinal fluid biomarkers, while clinically useful, may be invasive and expensive and hence not readily available to patients. Several studies have also investigated the use of blood-based measures of established core markers for detection of AD, such as amyloid-β and phosphorylated tau. Furthermore, novel non-invasive peripheral biomarkers and digital biomarkers could potentially expand access to early AD diagnosis to patients in Asia. Despite the multiplicity of established and potential biomarkers in AD, a regional framework for their optimal use to guide early AD diagnosis remains lacking. A group of experts from five regions in Asia gathered at a meeting in March 2021 to review the current evidence on biomarkers in AD diagnosis and discuss best practice around their use, with the goal of developing practical guidance that can be implemented easily by clinicians in Asia to support the early diagnosis of AD. This article summarizes recent key evidence on AD biomarkers and consolidates the experts' insights into the current and future use of these biomarkers for the screening and early diagnosis of AD in Asia.
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Affiliation(s)
- Nagaendran Kandiah
- Dementia Research Centre (Singapore), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,Correspondence to: Nagaendran Kandiah, Dementia Research Centre, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232. Tel.: +65 6592 2653; Fax: +65 6339 2889; E-mail: ; ORCID: 0000-0001-9244-4298
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Chaur-Jong Hu
- Department of Neurology, Dementia Center, Shuang Ho Hospital, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kenji Ishii
- Team for Neuroimaging Research, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kensaku Kasuga
- Department of Molecular Genetics, Center for Bioresources, Brain Research Institute, Niigata University, Niigata, Japan
| | - Vincent C.T. Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China,Li Ka Shing Institute of Health Sciences, Gerald Choa Neuroscience Institute, Lui Che Woo Institute of Innovative Medicine, Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
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9
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Vipin A, Koh CL, Wong BYX, Zailan FZ, Tan JY, Soo SA, Satish V, Kumar D, Wang BZ, Ng ASL, Chiew HJ, Ng KP, Kandiah N. Amyloid-Tau-Neurodegeneration Profiles and Longitudinal Cognition in Sporadic Young-Onset Dementia. J Alzheimers Dis 2022; 90:543-551. [DOI: 10.3233/jad-220448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined amyloid-tau-neurodegeneration biomarker effects on cognition in a Southeast-Asian cohort of 84 sporadic young-onset dementia (YOD; age-at-onset <65 years) patients. They were stratified into A+N+, A– N+, and A– N– profiles via cerebrospinal fluid amyloid-β1–42 (A), phosphorylated-tau (T), MRI medial temporal atrophy (neurodegeneration– N), and confluent white matter hyperintensities cerebrovascular disease (CVD). A, T, and CVD effects on longitudinal Mini-Mental State Examination (MMSE) were evaluated. A+N+ patients demonstrated steeper MMSE decline than A– N+ (β = 1.53; p = 0.036; CI 0.15:2.92) and A– N– (β = 4.68; p = 0.001; CI 1.98:7.38) over a mean follow-up of 1.24 years. Within A– N+, T– CVD+ patients showed greater MMSE decline compared to T+CVD– patients (β = – 2.37; p = 0.030; CI – 4.41:– 0.39). A+ results in significant cognitive decline, while CVD influences longitudinal cognition in the A– sub-group.
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Affiliation(s)
- Ashwati Vipin
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
| | - Chen Ling Koh
- National Neuroscience Institute, Singapore, Singapore
| | | | - Fatin Zahra Zailan
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
| | - Jayne Yi Tan
- National Neuroscience Institute, Singapore, Singapore
| | - See Ann Soo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
| | - Vaynii Satish
- National Neuroscience Institute, Singapore, Singapore
| | - Dilip Kumar
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
| | | | - Adeline Su Lyn Ng
- National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Hui Jin Chiew
- National Neuroscience Institute, Singapore, Singapore
| | - Kok Pin Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Nagaendran Kandiah
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Kasuga K, Kikuchi M, Tsukie T, Suzuki K, Ihara R, Iwata A, Hara N, Miyashita A, Kuwano R, Iwatsubo T, Ikeuchi T. Different AT(N) profiles and clinical progression classified by two different N markers using total tau and neurofilament light chain in cerebrospinal fluid. BMJ Neurol Open 2022; 4:e000321. [PMID: 36046332 PMCID: PMC9379489 DOI: 10.1136/bmjno-2022-000321] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/29/2022] [Indexed: 12/12/2022] Open
Abstract
Background The AT(N) classification was proposed for categorising individuals according to biomarkers. However, AT(N) profiles may vary depending on the markers chosen and the target population. Methods We stratified 177 individuals who participated in the Japanese Alzheimer's Disease Neuroimaging Initiative by AT(N) classification according to cerebrospinal fluid (CSF) biomarkers. We compared the frequency of AT(N) profiles between the classification using total tau and neurofilament light chain (NfL) as N markers (AT(N)tau and AT(N)NfL). Baseline characteristics, and longitudinal biological and clinical changes were examined between AT(N) profiles. Results We found that 9% of cognitively unimpaired subjects, 49% of subjects with mild cognitive impairment, and 61% of patients with Alzheimer's disease (AD) dementia had the biological AD profile (ie, A+T+) in the cohort. The frequency of AT(N) profiles substantially differed between the AT(N)tau and AT(N)NfL classifications. When we used t-tau as the N marker (AT(N)tau), those who had T- were more frequently assigned to (N)-, whereas those who had T+were more frequently assigned to (N)+ than when we used NfL as the N marker (AT(N)NfL). During a follow-up, the AD continuum group progressed clinically and biologically compared with the normal biomarker group in both the AT(N)tau and AT(N)NfL classifications. More frequent conversion to dementia was observed in the non-AD pathological change group in the AT(N)tau classification, but not in the AT(N)NfL classification. Conclusions AT(N)tau and AT(N)NfL in CSF may capture different aspects of neurodegeneration and provide a different prognostic value. The AT(N) classification aids in understanding the AD continuum biology in various populations.
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Affiliation(s)
- Kensaku Kasuga
- Molecular Genetics, Niigata University Brain Research Institute, Niigata, Japan
| | - Masataka Kikuchi
- Genome Informatics, Graduate School of Medicine, Osaka University, Osaka, Japan.,Computational Biology and Medical Science, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Tamao Tsukie
- Molecular Genetics, Niigata University Brain Research Institute, Niigata, Japan
| | - Kazushi Suzuki
- Neurology, National Defense Medical College, Tokorozawa, Japan
| | - Ryoko Ihara
- Neurology, Tokyo Metropolitan Geriatric Medical Center Hospital, Tokyo, Japan
| | - Atsushi Iwata
- Neurology, Tokyo Metropolitan Geriatric Medical Center Hospital, Tokyo, Japan
| | - Norikazu Hara
- Molecular Genetics, Niigata University Brain Research Institute, Niigata, Japan
| | - Akinori Miyashita
- Molecular Genetics, Niigata University Brain Research Institute, Niigata, Japan
| | | | - Takeshi Iwatsubo
- Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeshi Ikeuchi
- Molecular Genetics, Niigata University Brain Research Institute, Niigata, Japan
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11
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Blessing EM, Parekh A, Betensky RA, Babb J, Saba N, Debure L, Varga AW, Ayappa I, Rapoport DM, Butler TA, de Leon MJ, Wisniewski T, Lopresti BJ, Osorio RS. Association between lower body temperature and increased tau pathology in cognitively normal older adults. Neurobiol Dis 2022; 171:105748. [PMID: 35550158 DOI: 10.1016/j.nbd.2022.105748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/25/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Preclinical studies suggest body temperature (Tb) and consequently brain temperature has the potential to bidirectionally interact with tau pathology in Alzheimer's Disease (AD). Tau phosphorylation is substantially increased by a small (<1 °C) decrease in temperature within the human physiological range, and thermoregulatory nuclei are affected by tau pathology early in the AD continuum. In this study we evaluated whether Tb (as a proxy for brain temperature) is cross-sectionally associated with clinically utilized markers of tau pathology in cognitively normal older adults. METHODS Tb was continuously measured with ingestible telemetry sensors for 48 h. This period included two nights of nocturnal polysomnography to delineate whether Tb during waking vs sleep is differentially associated with tau pathology. Tau phosphorylation was assessed with plasma and cerebrospinal fluid (CSF) tau phosphorylated at threonine 181 (P-tau), sampled the day following Tb measurement. In addition, neurofibrillary tangle (NFT) burden in early Braak stage regions was imaged with PET-MR using the [18F]MK-6240 radiotracer on average one month later. RESULTS Lower Tb was associated with increased NFT burden, as well as increased plasma and CSF P-tau levels (p < 0.05). NFT burden was associated with lower Tb during waking (p < 0.05) but not during sleep intervals. Plasma and CSF P-tau levels were highly correlated with each other (p < 0.05), and both variables were correlated with tau tangle radiotracer uptake (p < 0.05). CONCLUSIONS These results, the first available for human, suggest that lower Tb in older adults may be associated with increased tau pathology. Our findings add to the substantial preclinical literature associating lower body and brain temperature with tau hyperphosphorylation. CLINICAL TRIAL NUMBER NCT03053908.
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Affiliation(s)
- Esther M Blessing
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, United States of America.
| | - Ankit Parekh
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States of America.
| | - Rebecca A Betensky
- Department of NYU School of Global Public Health, New York, NY 10016, United States of America.
| | - James Babb
- Alzheimer's Disease Research Center, Department of Neurology, NYU Grossman School of Medicine, New York, NY 10016, United States of America.
| | - Natalie Saba
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, United States of America.
| | - Ludovic Debure
- Alzheimer's Disease Research Center, Department of Neurology, NYU Grossman School of Medicine, New York, NY 10016, United States of America.
| | - Andrew W Varga
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States of America.
| | - Indu Ayappa
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States of America.
| | - David M Rapoport
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States of America.
| | - Tracy A Butler
- Department of Neurology, Weill Cornell Medicine, New York, NY 10065, United States of America.
| | - Mony J de Leon
- Department of Neurology, Weill Cornell Medicine, New York, NY 10065, United States of America.
| | - Thomas Wisniewski
- Alzheimer's Disease Research Center, Department of Neurology, NYU Grossman School of Medicine, New York, NY 10016, United States of America.
| | - Brian J Lopresti
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, United States of America.
| | - Ricardo S Osorio
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, United States of America; Alzheimer's Disease Research Center, Department of Neurology, NYU Grossman School of Medicine, New York, NY 10016, United States of America.
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12
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Arakaki X, Hung SM, Rochart R, Fonteh AN, Harrington MG. Alpha desynchronization during Stroop test unmasks cognitively healthy individuals with abnormal CSF Amyloid/Tau. Neurobiol Aging 2022; 112:87-101. [PMID: 35066324 PMCID: PMC8976735 DOI: 10.1016/j.neurobiolaging.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 01/15/2023]
Abstract
Synaptic dysfunctions precede cognitive decline in Alzheimer's disease by decades, affect executive functions, and can be detected by quantitative electroencephalography (qEEG). We used quantitative electroencephalography combined with Stroop testing to identify changes of inhibitory controls in cognitively healthy individuals with an abnormal versus normal ratio of cerebrospinal fluid (CSF) amyloid/total-tau. We studied two groups of participants (60-94 years) with either normal (CH-NAT or controls, n = 20) or abnormal (CH-PAT, n = 21) CSF amyloid/tau ratio. We compared: alpha event-related desynchronization (ERD), alpha spectral entropy (SE), and their relationships with estimated cognitive reserve. CH-PATs had more negative occipital alpha ERD, and higher frontal and occipital alpha SE during low load congruent trials, indicating hyperactivity. CH-PATs demonstrated fewer frontal SE changes with higher load, incongruent Stroop testing. Correlations of alpha ERD with estimated cognitive reserve were significant in CH-PATs but not in CH-NATs. These results suggested compensatory hyperactivity in CH-PATs compared to CH-NATs. We did not find differences in alpha ERD comparisons with individual CSF amyloid(A), p-tau(T), total-tau(N) biomarkers.
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13
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Jang H, Kim JS, Lee HJ, Kim CH, Na DL, Kim HJ, Allué JA, Sarasa L, Castillo S, Pesini P, Gallacher J, Seo SW. Performance of the plasma Aβ42/Aβ40 ratio, measured with a novel HPLC-MS/MS method, as a biomarker of amyloid PET status in a DPUK-KOREAN cohort. ALZHEIMERS RESEARCH & THERAPY 2021; 13:179. [PMID: 34686209 PMCID: PMC8540152 DOI: 10.1186/s13195-021-00911-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/02/2021] [Indexed: 12/20/2022]
Abstract
Background We assessed the feasibility of plasma Aβ42/Aβ40 determined using a novel liquid chromatography-mass spectrometry method (LC-MS) as a useful biomarker of PET status in a Korean cohort from the DPUK Study. Methods A total of 580 participants belonging to six groups, Alzheimer’s disease dementia (ADD, n = 134), amnestic mild cognitive impairment (aMCI, n = 212), old controls (OC, n = 149), young controls (YC, n = 15), subcortical vascular cognitive impairment (SVCI, n = 58), and cerebral amyloid angiopathy (CAA, n = 12), were included in this study. Plasma Aβ40 and Aβ42 were quantitated using a new antibody-free, LC-MS, which drastically reduced the sample preparation time and cost. We performed receiver operating characteristic (ROC) analysis to develop the cutoff of Aβ42/Aβ40 and investigated its performance predicting centiloid-based PET positivity (PET+). Results Plasma Aβ42/Aβ40 were lower for PET+ individuals in ADD, aMCI, OC, and SVCI (p < 0.001), but not in CAA (p = 0.133). In the group of YC, OC, aMCI, and ADD groups, plasma Aβ42/Aβ40 predicted PET+ with an area under the ROC curve (AUC) of 0.814 at a cutoff of 0.2576. When adding age, APOE4, and diagnosis, the AUC significantly improved to 0.912. Conclusion Plasma Aβ42/Aβ40, as measured by this novel LC-MS method, showed good discriminating performance based on PET positivity. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00911-7.
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Affiliation(s)
- Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Alzheimer's Disease Convergence Research Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ji Sun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hye Joo Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Alzheimer's Disease Convergence Research Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Chi-Hun Kim
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea.,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Alzheimer's Disease Convergence Research Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Department of Health Sciences and Technology, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Alzheimer's Disease Convergence Research Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | | | - Leticia Sarasa
- Araclon Biotech-Grifols, Vía Hispanidad, 21, 50009, Zaragoza, Spain
| | - Sergio Castillo
- Araclon Biotech-Grifols, Vía Hispanidad, 21, 50009, Zaragoza, Spain
| | - Pedro Pesini
- Araclon Biotech-Grifols, Vía Hispanidad, 21, 50009, Zaragoza, Spain
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Alzheimer's Disease Convergence Research Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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