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Koch PJ, Rudolf LF, Schramm P, Frontzkowski L, Marburg M, Matthis C, Schacht H, Fiehler J, Thomalla G, Hummel FC, Neumann A, Münte TF, Royl G, Machner B, Schulz R. Preserved Corticospinal Tract Revealed by Acute Perfusion Imaging Relates to Better Outcome After Thrombectomy in Stroke. Stroke 2023; 54:3081-3089. [PMID: 38011237 DOI: 10.1161/strokeaha.123.044221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/04/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The indication for mechanical thrombectomy (MT) in stroke patients with large vessel occlusion has been constantly expanded over the past years. Despite remarkable treatment effects at the group level in clinical trials, many patients remain severely disabled even after successful recanalization. A better understanding of this outcome variability will help to improve clinical decision-making on MT in the acute stage. Here, we test whether current outcome models can be refined by integrating information on the preservation of the corticospinal tract as a functionally crucial white matter tract derived from acute perfusion imaging. METHODS We retrospectively analyzed 162 patients with stroke and large vessel occlusion of the anterior circulation who were admitted to the University Medical Center Lübeck between 2014 and 2020 and underwent MT. The ischemic core was defined as fully automatized based on the acute computed tomography perfusion with cerebral blood volume data using outlier detection and clustering algorithms. Normative whole-brain structural connectivity data were used to infer whether the corticospinal tract was affected by the ischemic core or preserved. Ordinal logistic regression models were used to correlate this information with the modified Rankin Scale after 90 days. RESULTS The preservation of the corticospinal tract was associated with a reduced risk of a worse functional outcome in large vessel occlusion-stroke patients undergoing MT, with an odds ratio of 0.28 (95% CI, 0.15-0.53). This association was still significant after adjusting for multiple confounding covariables, such as age, lesion load, initial symptom severity, sex, stroke side, and recanalization status. CONCLUSIONS A preinterventional computed tomography perfusion-based surrogate of corticospinal tract preservation or disconnectivity is strongly associated with functional outcomes after MT. If validated in independent samples this concept could serve as a novel tool to improve current outcome models to better understand intersubject variability after MT in large vessel occlusion stroke.
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Affiliation(s)
- Philipp J Koch
- Department of Neurology (P.J.K., M.M., G.R., B.M.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Germany (P.J.K., T.F.M., G.R., B.M.)
| | - Linda F Rudolf
- Department of Neuroradiology (L.F.R., P.S., H.S., A.N.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Peter Schramm
- Department of Neuroradiology (L.F.R., P.S., H.S., A.N.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Lukas Frontzkowski
- Department of Neurology (L.F., G.T., R.S.) University Medical Center Hamburg Eppendorf, Germany
| | - Maria Marburg
- Department of Neurology (P.J.K., M.M., G.R., B.M.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Christine Matthis
- Department of Social Medicine and Epidemiology (C.M.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Hannes Schacht
- Department of Neuroradiology (L.F.R., P.S., H.S., A.N.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Jens Fiehler
- Department of Neuroradiology (J.F.) University Medical Center Hamburg Eppendorf, Germany
| | - Götz Thomalla
- Department of Neurology (L.F., G.T., R.S.) University Medical Center Hamburg Eppendorf, Germany
| | - Friedhelm C Hummel
- Neuro-X Institute and Brain Mind Institute, Swiss Federal Institute of Technology, Geneva, Switzerland (F.C.H.)
- Neuro-X Institute and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland (F.C.H.)
- Clinical Neuroscience, University of Geneva Medical School, Switzerland (F.C.H.)
| | - Alexander Neumann
- Department of Neuroradiology (L.F.R., P.S., H.S., A.N.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Thomas F Münte
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Germany (P.J.K., T.F.M., G.R., B.M.)
| | - Georg Royl
- Department of Neurology (P.J.K., M.M., G.R., B.M.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Germany (P.J.K., T.F.M., G.R., B.M.)
| | - Björn Machner
- Department of Neurology (P.J.K., M.M., G.R., B.M.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Germany (P.J.K., T.F.M., G.R., B.M.)
- Department of Neurology, Schoen Clinic Neustadt, Holstein, Germany (B.M.)
| | - Robert Schulz
- Department of Neurology (L.F., G.T., R.S.) University Medical Center Hamburg Eppendorf, Germany
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Franzmeier N, Ewers M, Brendel M, Biel D, Ossenkoppele R, Hager P, Steward A, Dewenter A, Rubinski A, Buerger K, Janowitz D, Binette AP, Smith R, Strandberg O, Mattsson‐Carlgren N, Dichgans M, Frontzkowski L, Hansson O. Earlier Alzheimer's disease onset is associated with a shift of tau pathology towards brain hubs which facilitates tau spreading. Alzheimers Dement 2022. [DOI: 10.1002/alz.067043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich Germany
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital, LMU Munich Munich Germany
| | - Davina Biel
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich Germany
| | - Rik Ossenkoppele
- Clinical Memory Research Unit, Lund University Malmö Sweden
- Amsterdam University Medical Center Amsterdam Netherlands
| | - Paul Hager
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich Munich Germany
| | - Anna Steward
- Institute for Stroke and Dementia Research, LMU, Munich Munich Germany
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich Germany
| | - Anna Rubinski
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich Germany
| | - Katharina Buerger
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich Munich Germany
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich Germany
| | | | - Ruben Smith
- Clinical Memory Research Unit, Lund University Malmö Sweden
| | | | | | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich Germany
| | - Lukas Frontzkowski
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig Maximilian University Munich Munich Germany
| | - Oskar Hansson
- Clinical Memory Research Unit, Lund University Malmö Sweden
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3
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Frontzkowski L, Ewers M, Brendel M, Biel D, Ossenkoppele R, Hager P, Steward A, Dewenter A, Römer S, Rubinski A, Buerger K, Janowitz D, Binette AP, Smith R, Strandberg O, Carlgren NM, Dichgans M, Hansson O, Franzmeier N. Earlier Alzheimer’s disease onset is associated with tau pathology in brain hub regions and facilitated tau spreading. Nat Commun 2022; 13:4899. [PMID: 35987901 PMCID: PMC9392750 DOI: 10.1038/s41467-022-32592-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 08/08/2022] [Indexed: 12/20/2022] Open
Abstract
AbstractIn Alzheimer’s disease (AD), younger symptom onset is associated with accelerated disease progression and tau spreading, yet the mechanisms underlying faster disease manifestation are unknown. To address this, we combined resting-state fMRI and longitudinal tau-PET in two independent samples of controls and biomarker-confirmed AD patients (ADNI/BioFINDER, n = 240/57). Consistent across both samples, we found that younger symptomatic AD patients showed stronger tau-PET in globally connected fronto-parietal hubs, i.e., regions that are critical for maintaining cognition in AD. Stronger tau-PET in hubs predicted faster subsequent tau accumulation, suggesting that tau in globally connected regions facilitates connectivity-mediated tau spreading. Further, stronger tau-PET in hubs mediated the association between younger age and faster tau accumulation in symptomatic AD patients, which predicted faster cognitive decline. These independently validated findings suggest that younger AD symptom onset is associated with stronger tau pathology in brain hubs, and accelerated tau spreading throughout connected brain regions and cognitive decline.
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4
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Ewers M, Luan Y, Frontzkowski L, Neitzel J, Rubinski A, Dichgans M, Hassenstab J, Gordon BA, Chhatwal JP, Levin J, Schofield P, Benzinger TLS, Morris JC, Goate A, Karch CM, Fagan AM, McDade E, Allegri R, Berman S, Chui H, Cruchaga C, Farlow M, Graff-Radford N, Jucker M, Lee JH, Martins RN, Mori H, Perrin R, Xiong C, Rossor M, Fox NC, O'Connor A, Salloway S, Danek A, Buerger K, Bateman RJ, Habeck C, Stern Y, Franzmeier N. Segregation of functional networks is associated with cognitive resilience in Alzheimer's disease. Brain 2021; 144:2176-2185. [PMID: 33725114 DOI: 10.1093/brain/awab112] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/26/2020] [Accepted: 12/29/2020] [Indexed: 11/14/2022] Open
Abstract
Cognitive resilience is an important modulating factor of cognitive decline in Alzheimer's disease, but the functional brain mechanisms that support cognitive resilience remain elusive. Given previous findings in normal ageing, we tested the hypothesis that higher segregation of the brain's connectome into distinct functional networks represents a functional mechanism underlying cognitive resilience in Alzheimer's disease. Using resting-state functional MRI, we assessed both resting-state functional MRI global system segregation, i.e. the balance of between-network to within-network connectivity, and the alternate index of modularity Q as predictors of cognitive resilience. We performed all analyses in two independent samples for validation: (i) 108 individuals with autosomal dominantly inherited Alzheimer's disease and 71 non-carrier controls; and (ii) 156 amyloid-PET-positive subjects across the spectrum of sporadic Alzheimer's disease and 184 amyloid-negative controls. In the autosomal dominant Alzheimer's disease sample, disease severity was assessed by estimated years from symptom onset. In the sporadic Alzheimer's sample, disease stage was assessed by temporal lobe tau-PET (i.e. composite across Braak stage I and III regions). In both samples, we tested whether the effect of disease severity on cognition was attenuated at higher levels of functional network segregation. For autosomal dominant Alzheimer's disease, we found higher functional MRI-assessed system segregation to be associated with an attenuated effect of estimated years from symptom onset on global cognition (P = 0.007). Similarly, for patients with sporadic Alzheimer's disease, higher functional MRI-assessed system segregation was associated with less decrement in global cognition (P = 0.001) and episodic memory (P = 0.004) per unit increase of temporal lobe tau-PET. Confirmatory analyses using the alternate index of modularity Q revealed consistent results. In conclusion, higher segregation of functional connections into distinct large-scale networks supports cognitive resilience in Alzheimer's disease.
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Affiliation(s)
- Michael Ewers
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilian-University LMU, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Ying Luan
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilian-University LMU, Munich, Germany
| | - Lukas Frontzkowski
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilian-University LMU, Munich, Germany
| | - Julia Neitzel
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilian-University LMU, Munich, Germany
| | - Anna Rubinski
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilian-University LMU, Munich, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilian-University LMU, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster for Systems Neurology, SyNergy, Ludwig-Maximilian-University LMU, Munich, Germany
| | - Jason Hassenstab
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA.,Department of Psychological and Brain Sciences, Washington University, St. Louis, MO, USA
| | - Brian A Gordon
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA.,Department of Psychological and Brain Sciences, Washington University, St. Louis, MO, USA
| | - Jasmeer P Chhatwal
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School, MA, USA
| | - Johannes Levin
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Peter Schofield
- Neuroscience Research Australia, Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Tammie L S Benzinger
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiology, Washington University in St Louis, St Louis, MO, USA
| | - John C Morris
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA.,Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Alison Goate
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Ronald M. Loeb Center for Alzheimer's Disease, Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Celeste M Karch
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA.,Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
| | - Anne M Fagan
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA.,Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
| | - Eric McDade
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Ricardo Allegri
- Department of Neurology, FLENI Fondation, Buenos Aires, Argentina
| | - Sarah Berman
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Helena Chui
- Alzheimer's Disease Research Center, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carlos Cruchaga
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA.,Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA.,Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA.,NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO, USA
| | - Marty Farlow
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Mathias Jucker
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ralph N Martins
- Centre of Excellence for Alzheimer's Disease Research and Care, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Australian Alzheimer's Research Foundation, Ralph and Patricia Sarich Neuroscience Research Institute, Nedlands, WA, Australia.,Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia.,KaRa Institute of Neurological Diseases, Sydney, NSW, Australia
| | - Hiroshi Mori
- Department of Clinical Neuroscience, Osaka City University Medical School, Osaka, Japan
| | - Richard Perrin
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Chengjie Xiong
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Department of Biostatistics, Washington University, St Louis, MO, USA
| | - Martin Rossor
- Dementia Research Centre, University College London, Queen Square, London, UK
| | - Nick C Fox
- Dementia Research Centre, University College London, Queen Square, London, UK
| | - Antoinette O'Connor
- Dementia Research Centre, University College London, Queen Square, London, UK.,UK Dementia Research Institute at UCL, UCL, London, UK
| | - Stephen Salloway
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Katharina Buerger
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilian-University LMU, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Randall J Bateman
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA.,Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Christian Habeck
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY, USA
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilian-University LMU, Munich, Germany
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5
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Franzmeier N, Suárez‐Calvet M, Frontzkowski L, Morenas‐Rodríguez E, Kleinberger G, Shaw LM, Trojanowski JQ, Haass C, Ewers M. Higher CSF STREM2/P‐tau ratio levels attenuate effects of polygenic Alzheimer’s disease risk on cognitive decline and neurodegeneration. Alzheimers Dement 2020. [DOI: 10.1002/alz.044800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nicolai Franzmeier
- Institute for Stroke and Dementia Research Klinikum der Universität München Munich Germany
| | - Marc Suárez‐Calvet
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES) Madrid Spain
| | - Lukas Frontzkowski
- Institute for Stroke and Dementia Research Klinikum der Universität München Ludwig Maximilian University Munich Munich Germany
| | - Estrella Morenas‐Rodríguez
- Sant Pau Memory Unit ‐ Hospital de la Santa Creu i Sant Pau ‐ Biomedical Research Institute Sant Pau Barcelona Spain
| | | | - Leslie M. Shaw
- Perelman School of Medicine, University of Pennsylvania, Department of Pathology and Laboratory Medicine Philadelphia PA USA
| | - John Q. Trojanowski
- Center for Neurodegenerative Disease Research University of Pennsylvania Philadelphia PA USA
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6
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Ewers M, Frontzkowski L, Neitzel J, Rubinski A, Habeck C, Gordon BA, Benzinger TLS, Levin J, Cruchaga C, Goate AM, Fagan AM, Karch CM, Morris JC, Holtzman DM, Bateman RJ, Stern Y, Franzmeier N. Global system segregation enhances reserve in normal aging and Alzheimer’s disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.037930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Lukas Frontzkowski
- Institute for Stroke and Dementia Research, Klinikum der Universität München Ludwig Maximilian University Munich Munich Germany
| | - Julia Neitzel
- Institute for Stroke and Dementia Research Klinikum der Universität München Munich Germany
| | - Anna Rubinski
- Institute for Stroke and Dementia Research Klinikum der Universität München Munich Germany
| | | | - Brian A Gordon
- Knight Alzheimer Disease Research Center St. Louis MO USA
| | | | | | - Carlos Cruchaga
- Hope Center for Neurological Disorders Washington University School of Medicine St. Louis MO USA
| | - Alison M Goate
- Ronald M. Loeb Center for Alzheimer’s Disease New York NY USA
| | - Anne M Fagan
- Washington University School of Medicine St. Louis MO USA
| | - Celeste M Karch
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | - John C Morris
- Knight Alzheimer Disease Research Center St. Louis MO USA
| | - David M Holtzman
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | - Randall J Bateman
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | | | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research Klinikum der Universität München Munich Germany
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7
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Franzmeier N, Frontzkowski L, Rubinski A, Neitzel J, Smith R, Strandberg O, Ossenkoppele R, Hansson O, Ewers M. Modeling patient‐specific tau spreading patterns in Alzheimer’s disease: Towards precision medicine. Alzheimers Dement 2020. [DOI: 10.1002/alz.040587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nicolai Franzmeier
- Institute for Stroke and Dementia Research Klinikum der Universität München Munich Germany
| | - Lukas Frontzkowski
- Institute for Stroke and Dementia Research, Klinikum der Universität München Ludwig Maximilian University Munich Munich Germany
| | - Anna Rubinski
- Institute for Stroke and Dementia Research Klinikum der Universität München Munich Germany
| | - Julia Neitzel
- Institute for Stroke and Dementia Research Klinikum der Universität München Munich Germany
| | - Ruben Smith
- Clinical Memory Research Unit Lund University Malmö Sweden
| | - Olof Strandberg
- Clinical Memory Research Unit, Department of Clinical Sciences Mälmo Lund University Lund Sweden
| | - Rik Ossenkoppele
- VU University Medical Center Amsterdam UMC Amsterdam Netherlands
| | - Oskar Hansson
- Clinical Memory Research Unit Lund University Malmö Sweden
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8
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Frontzkowski L, Franzmeier N, Neitzel J, Luan Y, Habeck C, Stern Y, Ewers M. Left frontal hub connectivity enhances task‐related brain network segregation and cognition in aging: Implications for reserve. Alzheimers Dement 2020. [DOI: 10.1002/alz.045788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Lukas Frontzkowski
- Institute for Stroke and Dementia Research Klinikum der Universität München Ludwig Maximilian University Munich Munich Germany
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research Klinikum der Universität München Munich Germany
| | - Julia Neitzel
- Institute for Stroke and Dementia Research Klinikum der Universität München Munich Germany
| | - Ying Luan
- Institute for Stroke and Dementia Research Munich Germany
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9
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Franzmeier N, Dewenter A, Frontzkowski L, Dichgans M, Rubinski A, Neitzel J, Smith R, Strandberg O, Ossenkoppele R, Buerger K, Duering M, Hansson O, Ewers M. Patient-centered connectivity-based prediction of tau pathology spread in Alzheimer's disease. Sci Adv 2020; 6:eabd1327. [PMID: 33246962 PMCID: PMC7695466 DOI: 10.1126/sciadv.abd1327] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/02/2020] [Indexed: 05/25/2023]
Abstract
In Alzheimer's disease (AD), the Braak staging scheme suggests a stereotypical tau spreading pattern that does, however, not capture interindividual variability in tau deposition. This complicates the prediction of tau spreading, which may become critical for defining individualized tau-PET readouts in clinical trials. Since tau is assumed to spread throughout connected regions, we used functional connectivity to improve tau spreading predictions over Braak staging methods. We included two samples with longitudinal tau-PET from controls and AD patients. Cross-sectionally, we found connectivity of tau epicenters (i.e., regions with earliest tau) to predict estimated tau spreading sequences. Longitudinally, we found tau accumulation rates to correlate with connectivity strength to patient-specific tau epicenters. A connectivity-based, patient-centered tau spreading model improved the assessment of tau accumulation rates compared to Braak stage-specific readouts and reduced sample sizes by ~40% in simulated tau-targeting interventions. Thus, connectivity-based tau spreading models may show utility in clinical trials.
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Affiliation(s)
- Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Lukas Frontzkowski
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Anna Rubinski
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Julia Neitzel
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Ruben Smith
- Department of Neurology, Skåne University Hospital, Lund, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Olof Strandberg
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Rik Ossenkoppele
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Katharina Buerger
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
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Franzmeier N, Suárez-Calvet M, Frontzkowski L, Moore A, Hohman TJ, Morenas-Rodriguez E, Nuscher B, Shaw L, Trojanowski JQ, Dichgans M, Kleinberger G, Haass C, Ewers M. Higher CSF sTREM2 attenuates ApoE4-related risk for cognitive decline and neurodegeneration. Mol Neurodegener 2020; 15:57. [PMID: 33032659 PMCID: PMC7545547 DOI: 10.1186/s13024-020-00407-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022] Open
Abstract
Background The Apolipoprotein E ε4 allele (i.e. ApoE4) is the strongest genetic risk factor for sporadic Alzheimer’s disease (AD). TREM2 (i.e. Triggering receptor expressed on myeloid cells 2) is a microglial transmembrane protein brain that plays a central role in microglia activation in response to AD brain pathologies. Whether higher TREM2-related microglia activity modulates the risk to develop clinical AD is an open question. Thus, the aim of the current study was to assess whether higher sTREM2 attenuates the effects of ApoE4-effects on future cognitive decline and neurodegeneration. Methods We included 708 subjects ranging from cognitively normal (CN, n = 221) to mild cognitive impairment (MCI, n = 414) and AD dementia (n = 73) from the Alzheimer’s disease Neuroimaging Initiative. We used linear regression to test the interaction between ApoE4-carriage by CSF-assessed sTREM2 levels as a predictor of longitudinally assessed cognitive decline and MRI-assessed changes in hippocampal volume changes (mean follow-up of 4 years, range of 1.7-7 years). Results Across the entire sample, we found that higher CSF sTREM2 at baseline was associated with attenuated effects of ApoE4-carriage (i.e. sTREM2 x ApoE4 interaction) on longitudinal global cognitive (p = 0.001, Cohen’s f2 = 0.137) and memory decline (p = 0.006, Cohen’s f2 = 0.104) as well as longitudinally assessed hippocampal atrophy (p = 0.046, Cohen’s f2 = 0.089), independent of CSF markers of primary AD pathology (i.e. Aβ1–42, p-tau181). While overall effects of sTREM2 were small, exploratory subanalyses stratified by diagnostic groups showed that beneficial effects of sTREM2 were pronounced in the MCI group. Conclusion Our results suggest that a higher CSF sTREM2 levels are associated with attenuated ApoE4-related risk for future cognitive decline and AD-typical neurodegeneration. These findings provide further evidence that TREM2 may be protective against the development of AD.
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Affiliation(s)
- Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig Maximilian University (LMU), Munich, Germany.
| | - M Suárez-Calvet
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Servei de Neurologia, Hospital del Mar, Barcelona, Spain
| | - Lukas Frontzkowski
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig Maximilian University (LMU), Munich, Germany
| | - Annah Moore
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, USA
| | - Timothy J Hohman
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, USA
| | - Estrella Morenas-Rodriguez
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Brigitte Nuscher
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Leslie Shaw
- Center for Neurodegenerative Disease Research, Institute on Aging, Perelman School of Medicine University, Philadelphia, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig Maximilian University (LMU), Munich, Germany.,Munich Cluster for Systems Neurology, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | | | - Christian Haass
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany.,Munich Cluster for Systems Neurology, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig Maximilian University (LMU), Munich, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
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