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Morales CD, Cotton-Samuel D, Lao PJ, Chang JF, Pyne JD, Alshikho MJ, Lippert RV, Bista K, Hale C, Edwards NC, Igwe KC, Deters K, Zimmerman ME, Brickman AM. Small vessel cerebrovascular disease is associated with cognition in prospective Alzheimer's clinical trial participants. Alzheimers Res Ther 2024; 16:25. [PMID: 38308344 PMCID: PMC10836014 DOI: 10.1186/s13195-024-01395-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Secondary prevention clinical trials for Alzheimer's disease (AD) target amyloid accumulation in asymptomatic, amyloid-positive individuals, but it is unclear to what extent other pathophysiological processes, such as small vessel cerebrovascular disease, account for participant performance on the primary cognitive outcomes in those trials. White matter hyperintensities are areas of increased signal on T2-weighted magnetic resonance imaging (MRI) that reflect small vessel cerebrovascular disease. They are associated with cognitive functioning in older adults and with clinical presentation and course of AD, particularly when distributed in posterior brain regions. The purpose of this study was to examine to what degree regional WMH volume is associated with performance on the primary cognitive outcome measure in the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) study, a secondary prevention trial. METHODS Data from 1791 participants (59.5% women, mean age (SD) 71.6 (4.74)) in the A4 study and the Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) companion study at the screening visit were used to quantify WMH volumes on T2-weighted fluid-attenuated inversion recovery (FLAIR) MR images. Cognition was assessed with the preclinical Alzheimer cognitive composite (PACC). We tested the association of total and regional WMH volumes with PACC performance, adjusting for age, education, and amyloid positivity status, with general linear models. We also considered interactions between WMH and amyloid positivity status. RESULTS Increased frontal and parietal lobe WMH volume was associated with poorer performance on the PACC. While amyloid positivity was also associated with lower cognitive test scores, WMH volumes did not interact with amyloid positivity status. CONCLUSION These results highlight the potential of small vessel cerebrovascular disease to drive AD-related cognitive profiles. Measures of small vessel cerebrovascular disease should be considered when evaluating outcome in trials, both as potential effect modifiers and as a possible target for intervention or prevention.
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Affiliation(s)
- Clarissa D Morales
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Dejania Cotton-Samuel
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Patrick J Lao
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Julia F Chang
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Jeffrey D Pyne
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Mohamad J Alshikho
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Rafael V Lippert
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Kelsang Bista
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Christiane Hale
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Natalie C Edwards
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Kay C Igwe
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Kacie Deters
- Department of Integrative Biology & Physiology, University of California, Los Angeles, CA, USA
| | | | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.
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Ali DG, Bahrani AA, El Khouli RH, Gold BT, Jiang Y, Zachariou V, Wilcock DM, Jicha GA. White matter hyperintensities influence distal cortical β-amyloid accumulation in default mode network pathways. Brain Behav 2023; 13:e3209. [PMID: 37534614 PMCID: PMC10570488 DOI: 10.1002/brb3.3209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease (SVD) has been suggested to contribute to the pathogenesis of Alzheimer's disease (AD). Yet, the role of SVD in potentially contributing to AD pathology is unclear. The main objective of this study was to test the hypothesis that WMHs influence amyloid β (Aβ) levels within connected default mode network (DMN) tracts and cortical regions in cognitively unimpaired older adults. METHODS Regional standard uptake value ratios (SUVr) from Aβ-PET and white matter hyperintensity (WMH) volumes from three-dimensional magnetic resonance imaging FLAIR images were analyzed across a sample of 72 clinically unimpaired (mini-mental state examination ≥26), older adults (mean age 74.96 and standard deviation 8.13) from the Alzheimer's Disease Neuroimaging Initiative (ADNI3). The association of WMH volumes in major fiber tracts projecting from cortical DMN regions and Aβ-PET SUVr in the connected cortical DMN regions was analyzed using linear regression models adjusted for age, sex, ApoE, and total brain volumes. RESULTS The regression analyses demonstrate that increased WMH volumes in the superior longitudinal fasciculus were associated with increased regional SUVr in the inferior parietal lobule (p = .011). CONCLUSION The findings suggest that the relation between Aβ in parietal cortex is associated with SVD in downstream white matter (WM) pathways in preclinical AD. The biological relationships and interplay between Aβ and WM microstructure alterations that precede overt WMH development across the continuum of AD progression warrant further study.
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Affiliation(s)
- Doaa G. Ali
- Sanders‐Brown Center on Aging, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
- Department of Behavioral Science, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
| | - Ahmed A. Bahrani
- Sanders‐Brown Center on Aging, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
- Department of Neurology, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
| | - Riham H. El Khouli
- Department of Radiology, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
| | - Brian T. Gold
- Sanders‐Brown Center on Aging, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
- Department of Neuroscience, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
| | - Yang Jiang
- Sanders‐Brown Center on Aging, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
- Department of Behavioral Science, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
| | - Valentinos Zachariou
- Department of Neuroscience, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
| | - Donna M. Wilcock
- Sanders‐Brown Center on Aging, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
- Department of Physiology, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
| | - Gregory A. Jicha
- Sanders‐Brown Center on Aging, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
- Department of Behavioral Science, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
- Department of Neurology, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
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