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Switzer AR, Charidimou A, McCarter S, Vemuri P, Nguyen AT, Przybelski SA, Lesnick TG, Rabinstein AA, Brown RD, Knopman DS, Petersen RC, Jack CR, Reichard RR, Graff-Radford J. Boston Criteria v2.0 for Cerebral Amyloid Angiopathy Without Hemorrhage: An MRI-Neuropathologic Validation Study. Neurology 2024; 102:e209386. [PMID: 38710005 DOI: 10.1212/wnl.0000000000209386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Updated criteria for the clinical-MRI diagnosis of cerebral amyloid angiopathy (CAA) have recently been proposed. However, their performance in individuals without symptomatic intracerebral hemorrhage (ICH) presentations is less defined. We aimed to assess the diagnostic performance of the Boston criteria version 2.0 for CAA diagnosis in a cohort of individuals ranging from cognitively normal to dementia in the community and memory clinic settings. METHODS Fifty-four participants from the Mayo Clinic Study of Aging or Alzheimer's Disease Research Center were included if they had an antemortem MRI with gradient-recall echo sequences and a brain autopsy with CAA evaluation. Performance of the Boston criteria v2.0 was compared with v1.5 using histopathologically verified CAA as the reference standard. RESULTS The median age at MRI was 75 years (interquartile range 65-80) with 28/54 participants having histopathologically verified CAA (i.e., moderate-to-severe CAA in at least 1 lobar region). The sensitivity and specificity of the Boston criteria v2.0 were 28.6% (95% CI 13.2%-48.7%) and 65.3% (95% CI 44.3%-82.8%) for probable CAA diagnosis (area under the receiver operating characteristic curve [AUC] 0.47) and 75.0% (55.1-89.3) and 38.5% (20.2-59.4) for any CAA diagnosis (possible + probable; AUC 0.57), respectively. The v2.0 Boston criteria were not superior in performance compared with the prior v1.5 criteria for either CAA diagnostic category. DISCUSSION The Boston criteria v2.0 have low accuracy in patients who are asymptomatic or only have cognitive symptoms. Additional biomarkers need to be explored to optimize CAA diagnosis in this population.
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Affiliation(s)
- Aaron R Switzer
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Andreas Charidimou
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Stuart McCarter
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Prashanthi Vemuri
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Aivi T Nguyen
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Scott A Przybelski
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Timothy G Lesnick
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Alejandro A Rabinstein
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Robert D Brown
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - David S Knopman
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Ronald C Petersen
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Clifford R Jack
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - R Ross Reichard
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Jonathan Graff-Radford
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
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Kouri N, Frankenhauser I, Peng Z, Labuzan SA, Boon BDC, Moloney CM, Pottier C, Wickland DP, Caetano-Anolles K, Corriveau-Lecavalier N, Tranovich JF, Wood AC, Hinkle KM, Lincoln SJ, Spychalla AJ, Senjem ML, Przybelski SA, Engelberg-Cook E, Schwarz CG, Kwan RS, Lesser ER, Crook JE, Carter RE, Ross OA, Lachner C, Ertekin-Taner N, Ferman TJ, Fields JA, Machulda MM, Ramanan VK, Nguyen AT, Reichard RR, Jones DT, Graff-Radford J, Boeve BF, Knopman DS, Petersen RC, Jack CR, Kantarci K, Day GS, Duara R, Graff-Radford NR, Dickson DW, Lowe VJ, Vemuri P, Murray ME. Clinicopathologic Heterogeneity and Glial Activation Patterns in Alzheimer Disease. JAMA Neurol 2024:2817289. [PMID: 38619853 PMCID: PMC11019448 DOI: 10.1001/jamaneurol.2024.0784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/05/2024] [Indexed: 04/16/2024]
Abstract
Importance Factors associated with clinical heterogeneity in Alzheimer disease (AD) lay along a continuum hypothesized to associate with tangle distribution and are relevant for understanding glial activation considerations in therapeutic advancement. Objectives To examine clinicopathologic and neuroimaging characteristics of disease heterogeneity in AD along a quantitative continuum using the corticolimbic index (CLix) to account for individuality of spatially distributed tangles found at autopsy. Design, Setting, and Participants This cross-sectional study was a retrospective medical record review performed on the Florida Autopsied Multiethnic (FLAME) cohort accessioned from 1991 to 2020. Data were analyzed from December 2022 to December 2023. Structural magnetic resonance imaging (MRI) and tau positron emission tomography (PET) were evaluated in an independent neuroimaging group. The FLAME cohort includes 2809 autopsied individuals; included in this study were neuropathologically diagnosed AD cases (FLAME-AD). A digital pathology subgroup of FLAME-AD cases was derived for glial activation analyses. Main Outcomes and Measures Clinicopathologic factors of heterogeneity that inform patient history and neuropathologic evaluation of AD; CLix score (lower, relative cortical predominance/hippocampal sparing vs higher, relative cortical sparing/limbic predominant cases); neuroimaging measures (ie, structural MRI and tau-PET). Results Of the 2809 autopsied individuals in the FLAME cohort, 1361 neuropathologically diagnosed AD cases were evaluated. A digital pathology subgroup included 60 FLAME-AD cases. The independent neuroimaging group included 93 cases. Among the 1361 FLAME-AD cases, 633 were male (47%; median [range] age at death, 81 [54-96] years) and 728 were female (53%; median [range] age at death, 81 [53-102] years). A younger symptomatic onset (Spearman ρ = 0.39, P < .001) and faster decline on the Mini-Mental State Examination (Spearman ρ = 0.27; P < .001) correlated with a lower CLix score in FLAME-AD series. Cases with a nonamnestic syndrome had lower CLix scores (median [IQR], 13 [9-18]) vs not (median [IQR], 21 [15-27]; P < .001). Hippocampal MRI volume (Spearman ρ = -0.45; P < .001) and flortaucipir tau-PET uptake in posterior cingulate and precuneus cortex (Spearman ρ = -0.74; P < .001) inversely correlated with CLix score. Although AD cases with a CLix score less than 10 had higher cortical tangle count, we found lower percentage of CD68-activated microglia/macrophage burden (median [IQR], 0.46% [0.32%-0.75%]) compared with cases with a CLix score of 10 to 30 (median [IQR], 0.75% [0.51%-0.98%]) and on par with a CLix score of 30 or greater (median [IQR], 0.40% [0.32%-0.57%]; P = .02). Conclusions and Relevance Findings show that AD heterogeneity exists along a continuum of corticolimbic tangle distribution. Reduced CD68 burden may signify an underappreciated association between tau accumulation and microglia/macrophages activation that should be considered in personalized therapy for immune dysregulation.
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Affiliation(s)
- Naomi Kouri
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Isabelle Frankenhauser
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
- Paracelsus Medical Private University, Salzburg, Austria
| | - Zhongwei Peng
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | | | | | | | - Cyril Pottier
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Daniel P. Wickland
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | | | - Nick Corriveau-Lecavalier
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Ashley C. Wood
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Kelly M. Hinkle
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | | | | | | | - Scott A. Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | | | | | - Rain S. Kwan
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Elizabeth R. Lesser
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Julia E. Crook
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Owen A. Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Christian Lachner
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida
| | - Nilüfer Ertekin-Taner
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | - Tanis J. Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida
| | - Julie A. Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | | | - Aivi T. Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - David T. Jones
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Gregory S. Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | - Ranjan Duara
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Florida
| | | | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Robinson CG, Goodrich AW, Weigand SD, Pham NTT, Carlos AF, Buciuc M, Murray ME, Nguyen AT, Reichard RR, Knopman DS, Petersen RC, Dickson DW, Utianski RL, Whitwell JL, Josephs KA, Machulda MM. Determinants of confrontation naming deficits on the Boston Naming Test associated with transactive response DNA-binding protein 43 pathology. J Int Neuropsychol Soc 2024:1-9. [PMID: 38525671 DOI: 10.1017/s1355617724000146] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To determine whether poorer performance on the Boston Naming Test (BNT) in individuals with transactive response DNA-binding protein 43 pathology (TDP-43+) is due to greater loss of word knowledge compared to retrieval-based deficits. METHODS Retrospective clinical-pathologic study of 282 participants with Alzheimer's disease neuropathologic changes (ADNC) and known TDP-43 status. We evaluated item-level performance on the 60-item BNT for first and last available assessment. We fit cross-sectional negative binomial count models that assessed total number of incorrect items, number correct of responses with phonemic cue (reflecting retrieval difficulties), and number of "I don't know" (IDK) responses (suggestive of loss of word knowledge) at both assessments. Models included TDP-43 status and adjusted for sex, age, education, years from test to death, and ADNC severity. Models that evaluated the last assessment adjusted for number of prior BNT exposures. RESULTS 43% were TDP-43+. The TDP-43+ group had worse performance on BNT total score at first (p = .01) and last assessments (p = .01). At first assessment, TDP-43+ individuals had an estimated 29% (CI: 7%-56%) higher mean number of incorrect items after adjusting for covariates, and a 51% (CI: 15%-98%) higher number of IDK responses compared to TDP-43-. At last assessment, compared to TDP-43-, the TDP-43+ group on average missed 31% (CI: 6%-62%; p = .01) more items and had 33% more IDK responses (CI: 1% fewer to 78% more; p = .06). CONCLUSIONS An important component of poorer performance on the BNT in participants who are TDP-43+ is having loss of word knowledge versus retrieval difficulties.
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Affiliation(s)
| | - Austin W Goodrich
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Stephen D Weigand
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Arenn F Carlos
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Marina Buciuc
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Shir D, Corriveau-Lecavalier N, Bermudez Noguera C, Barnard L, Pham NTT, Botha H, Duffy JR, Clark HM, Utianski RL, Knopman DS, Petersen RC, Boeve BF, Murray ME, Nguyen AT, Reichard RR, Dickson DW, Day GS, Kremers WK, Graff-Radford NR, Jones DT, Machulda MM, Fields JA, Whitwell JL, Josephs KA, Graff-Radford J. Clinicoradiological and neuropathological evaluation of primary progressive aphasia. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332862. [PMID: 38514176 DOI: 10.1136/jnnp-2023-332862] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Primary progressive aphasia (PPA) defines a group of neurodegenerative disorders characterised by language decline. Three PPA variants correlate with distinct underlying pathologies: semantic variant PPA (svPPA) with transactive response DNA-binding protein of 43 kD (TDP-43) proteinopathy, agrammatic variant PPA (agPPA) with tau deposition and logopenic variant PPA (lvPPA) with Alzheimer's disease (AD). Our objectives were to differentiate PPA variants using clinical and neuroimaging features, assess progression and evaluate structural MRI and a novel 18-F fluorodeoxyglucose positron emission tomography (FDG-PET) image decomposition machine learning algorithm for neuropathology prediction. METHODS We analysed 82 autopsied patients diagnosed with PPA from 1998 to 2022. Clinical histories, language characteristics, neuropsychological results and brain imaging were reviewed. A machine learning framework using a k-nearest neighbours classifier assessed FDG-PET scans from 45 patients compared with a large reference database. RESULTS PPA variant distribution: 35 lvPPA (80% AD), 28 agPPA (89% tauopathy) and 18 svPPA (72% frontotemporal lobar degeneration-TAR DNA-binding protein (FTLD-TDP)). Apraxia of speech was associated with 4R-tauopathy in agPPA, while pure agrammatic PPA without apraxia was linked to 3R-tauopathy. Longitudinal data revealed language dysfunction remained the predominant deficit for patients with lvPPA, agPPA evolved to corticobasal or progressive supranuclear palsy syndrome (64%) and svPPA progressed to behavioural variant frontotemporal dementia (44%). agPPA-4R-tauopathy exhibited limited pre-supplementary motor area atrophy, lvPPA-AD displayed temporal atrophy extending to the superior temporal sulcus and svPPA-FTLD-TDP had severe temporal pole atrophy. The FDG-PET-based machine learning algorithm accurately predicted clinical diagnoses and underlying pathologies. CONCLUSIONS Distinguishing 3R-taupathy and 4R-tauopathy in agPPA may rely on apraxia of speech presence. Additional linguistic and clinical features can aid neuropathology prediction. Our data-driven brain metabolism decomposition approach effectively predicts underlying neuropathology.
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Affiliation(s)
- Dror Shir
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Leland Barnard
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary M Machulda
- Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julie A Fields
- Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Walton RL, Koga S, Beasley AI, White LJ, Griesacker T, Murray ME, Kasanuki K, Hou X, Fiesel FC, Springer W, Uitti RJ, Fields JA, Botha H, Ramanan VK, Kantarci K, Lowe VJ, Jack CR, Ertekin-Taner N, Savica R, Graff-Radford J, Petersen RC, Parisi JE, Reichard RR, Graff-Radford NR, Ferman TJ, Boeve BF, Wszolek ZK, Dickson DW, Ross OA, Heckman MG. Role of GBA variants in Lewy body disease neuropathology. Acta Neuropathol 2024; 147:54. [PMID: 38472443 PMCID: PMC11049671 DOI: 10.1007/s00401-024-02699-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 03/14/2024]
Abstract
Rare and common GBA variants are risk factors for both Parkinson's disease (PD) and dementia with Lewy bodies (DLB). However, the degree to which GBA variants are associated with neuropathological features in Lewy body disease (LBD) is unknown. Herein, we assessed 943 LBD cases and examined associations of 15 different neuropathological outcomes with common and rare GBA variants. Neuropathological outcomes included LBD subtype, presence of a high likelihood of clinical DLB (per consensus guidelines), LB counts in five cortical regions, tyrosine hydroxylase immunoreactivity in the dorsolateral and ventromedial putamen, ventrolateral substantia nigra neuronal loss, Braak neurofibrillary tangle (NFT) stage, Thal amyloid phase, phospho-ubiquitin (pS65-Ub) level, TDP-43 pathology, and vascular disease. Sequencing of GBA exons revealed a total of 42 different variants (4 common [MAF > 0.5%], 38 rare [MAF < 0.5%]) in our series, and 165 cases (17.5%) had a copy of the minor allele for ≥ 1 variant. In analysis of common variants, p.L483P was associated with a lower Braak NFT stage (OR = 0.10, P < 0.001). In gene-burden analysis, presence of the minor allele for any GBA variant was associated with increased odds of a high likelihood of DLB (OR = 2.00, P < 0.001), a lower Braak NFT stage (OR = 0.48, P < 0.001), a lower Thal amyloid phase (OR = 0.55, P < 0.001), and a lower pS65-Ub level (β: -0.37, P < 0.001). Subgroup analysis revealed that GBA variants were most common in LBD cases with a combination of transitional/diffuse LBD and Braak NFT stage 0-II or Thal amyloid phase 0-1, and correspondingly that the aforementioned associations of GBA gene-burden with a decreased Braak NFT stage and Thal amyloid phase were observed only in transitional or diffuse LBD cases. Our results indicate that in LBD, GBA variants occur most frequently in cases with greater LB pathology and low AD pathology, further informing disease-risk associations of GBA in PD, PD dementia, and DLB.
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Affiliation(s)
- Ronald L Walton
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Launia J White
- Division of Clinical Trials and Biostatistics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA
| | | | | | - Koji Kasanuki
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Xu Hou
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Julie A Fields
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Kejal Kantarci
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Department of Nuclear Medicine, Mayo Clinic, Rochester, MN, USA
| | - Clifford R Jack
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
| | - Nilufer Ertekin-Taner
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Joseph E Parisi
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R Ross Reichard
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, USA
| | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA.
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6
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Bielinski SJ, Manemann SM, Lopes GS, Jiang R, Weston SA, Reichard RR, Norman AD, Vachon CM, Takahashi PY, Singh M, Larson NB, Roger VL, St Sauver JL. The Importance of Estimating Excess Deaths Regionally During the COVID-19 Pandemic. Mayo Clin Proc 2024; 99:437-444. [PMID: 38432749 PMCID: PMC10914321 DOI: 10.1016/j.mayocp.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 03/05/2024]
Abstract
National or statewide estimates of excess deaths have limited value to understanding the impact of the COVID-19 pandemic regionally. We assessed excess deaths in a 9-county geographically defined population that had low rates of COVID-19 and widescale availability of testing early in the pandemic, well-annotated clinical data, and coverage by 2 medical examiner's offices. We compared mortality rates (MRs) per 100,000 person-years in 2020 and 2021 with those in the 2019 reference period and MR ratios (MRRs). In 2020 and 2021, 177 and 219 deaths, respectively, were attributed to COVID-19 (MR = 52 and 66 per 100,000 person-years, respectively). COVID-19 MRs were highest in males, older persons, those living in rural areas, and those with 7 or more chronic conditions. Compared with 2019, we observed a 10% excess death rate in 2020 (MRR = 1.10 [95% CI, 1.04 to 1.15]), with excess deaths in females, older adults, and those with 7 or more chronic conditions. In contrast, we did not observe excess deaths overall in 2021 compared with 2019 (MRR = 1.04 [95% CI, 0.99 to 1.10]). However, those aged 18 to 39 years (MRR = 1.36 [95% CI, 1.03 to 1.80) and those with 0 or 1 chronic condition (MRR = 1.28 [95% CI, 1.05 to 1.56]) or 7 or more chronic conditions (MRR = 1.09 [95% CI, 1.03 to 1.15]) had increased mortality compared with 2019. This work highlights the value of leveraging regional populations that experienced a similar pandemic wave timeline, mitigation strategies, testing availability, and data quality.
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Affiliation(s)
- Suzette J Bielinski
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
| | - Sheila M Manemann
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Guilherme S Lopes
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Ruoxiang Jiang
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Susan A Weston
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Aaron D Norman
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Celine M Vachon
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Paul Y Takahashi
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Nicholas B Larson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Véronique L Roger
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jennifer L St Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
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7
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Raulin AC, Doss SV, Heckman MG, Craver EC, Li Z, Ikezu TC, Sekiya H, Liu CC, Martens YA, Rosenberg CL, Kuchenbecker LA, DeTure M, Reichard RR, Nguyen AT, Constantopoulos E, Larsen RA, Kounaves EK, Murray ME, Dickson DW, Petersen RC, Bu G, Kanekiyo T. Impact of APOE on amyloid and tau accumulation in argyrophilic grain disease and Alzheimer's disease. Acta Neuropathol Commun 2024; 12:25. [PMID: 38336940 PMCID: PMC10854035 DOI: 10.1186/s40478-024-01731-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024] Open
Abstract
Alzheimer's disease (AD), characterized by the deposition of amyloid-β (Aβ) in senile plaques and neurofibrillary tangles of phosphorylated tau (pTau), is increasingly recognized as a complex disease with multiple pathologies. AD sometimes pathologically overlaps with age-related tauopathies such as four repeat (4R)-tau predominant argyrophilic grain disease (AGD). While AGD is often detected with AD pathology, the contribution of APOE4 to AGD risk is not clear despite its robust effects on AD pathogenesis. Specifically, how APOE genotype influences Aβ and tau pathology in co-occurring AGD and AD has not been fully understood. Using postmortem brain samples (N = 353) from a neuropathologically defined cohort comprising of cases with AD and/or AGD pathology built to best represent different APOE genotypes, we measured the amounts of major AD-related molecules, including Aβ40, Aβ42, apolipoprotein E (apoE), total tau (tTau), and pTau181, in the temporal cortex. The presence of tau lesions characteristic of AD (AD-tau) was correlated with cognitive decline based on Mini-Mental State Examination (MMSE) scores, while the presence of AGD tau lesions (AGD-tau) was not. Interestingly, while APOE4 increased the risk of AD-tau pathology, it did not increase the risk of AGD-tau pathology. Although APOE4 was significantly associated with higher levels of insoluble Aβ40, Aβ42, apoE, and pTau181, the APOE4 effect was no longer detected in the presence of AGD-tau. We also found that co-occurrence of AGD with AD was associated with lower insoluble Aβ42 and pTau181 levels. Overall, our findings suggest that different patterns of Aβ, tau, and apoE accumulation mediate the development of AD-tau and AGD-tau pathology, which is affected by APOE genotype.
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Affiliation(s)
| | - Sydney V Doss
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Zonghua Li
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Tadafumi C Ikezu
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Hiroaki Sekiya
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Chia-Chen Liu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- Biogen, Cambridge, MA, 02142, USA
| | - Yuka A Martens
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- SciNeuro Pharmaceuticals, Rockville, MD, 20850, USA
| | | | | | - Michael DeTure
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Eleni Constantopoulos
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Rachel A Larsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Emmaline K Kounaves
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | | | - Guojun Bu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- Division of Life Science, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong, China
| | - Takahisa Kanekiyo
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA.
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8
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Troxel AB, Bind MAC, Flotte TJ, Cordon-Cardo C, Decker LA, Finn AV, Padera RF, Reichard RR, Stone JR, Adolphi NL, Casimero FVC, Crary JF, Elifritz J, Faustin A, Ghosh SKB, Krausert A, Martinez-Lage M, Melamed J, Mitchell RA, Sampson BA, Seifert AC, Simsir A, Adams C, Haasnoot S, Hafner S, Siciliano MA, Vallejos BB, Del Boccio P, Lamendola-Essel MF, Young CE, Kewlani D, Akinbo PA, Parent B, Chung A, Cato TC, Mudumbi PC, Esquenazi-Karonika S, Wood MJ, Chan J, Monteiro J, Shinnick DJ, Thaweethai T, Nguyen AN, Fitzgerald ML, Perlowski AA, Stiles LE, Paskett ML, Katz SD, Foulkes AS. Researching COVID to enhance recovery (RECOVER) tissue pathology study protocol: Rationale, objectives, and design. PLoS One 2024; 19:e0285645. [PMID: 38198481 PMCID: PMC10781091 DOI: 10.1371/journal.pone.0285645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/23/2023] [Indexed: 01/12/2024] Open
Abstract
IMPORTANCE SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or organ dysfunction after the acute phase of infection, termed Post-Acute Sequelae of SARS-CoV-2 (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are poorly understood. The objectives of the Researching COVID to Enhance Recovery (RECOVER) tissue pathology study (RECOVER-Pathology) are to: (1) characterize prevalence and types of organ injury/disease and pathology occurring with PASC; (2) characterize the association of pathologic findings with clinical and other characteristics; (3) define the pathophysiology and mechanisms of PASC, and possible mediation via viral persistence; and (4) establish a post-mortem tissue biobank and post-mortem brain imaging biorepository. METHODS RECOVER-Pathology is a cross-sectional study of decedents dying at least 15 days following initial SARS-CoV-2 infection. Eligible decedents must meet WHO criteria for suspected, probable, or confirmed infection and must be aged 18 years or more at the time of death. Enrollment occurs at 7 sites in four U.S. states and Washington, DC. Comprehensive autopsies are conducted according to a standardized protocol within 24 hours of death; tissue samples are sent to the PASC Biorepository for later analyses. Data on clinical history are collected from the medical records and/or next of kin. The primary study outcomes include an array of pathologic features organized by organ system. Causal inference methods will be employed to investigate associations between risk factors and pathologic outcomes. DISCUSSION RECOVER-Pathology is the largest autopsy study addressing PASC among US adults. Results of this study are intended to elucidate mechanisms of organ injury and disease and enhance our understanding of the pathophysiology of PASC.
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Affiliation(s)
- Andrea B. Troxel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Marie-Abele C. Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States of America
| | - Thomas J. Flotte
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - Carlos Cordon-Cardo
- Department of Pathology, Molecular and Cell-Based Medicine, Mount Sinai Health System, New York, NY, United States of America
| | - Lauren A. Decker
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM, United States of America
| | - Aloke V. Finn
- Department of Pathology, CVPath Institute, Gaithersburg, MD, United States of America
| | - Robert F. Padera
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - James R. Stone
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Natalie L. Adolphi
- Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, NM, United States of America
| | | | - John F. Crary
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, United States of America
| | - Jamie Elifritz
- Departments of Radiology and Pathology, University of New Mexico, Albuquerque, NM, United States of America
| | - Arline Faustin
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Saikat Kumar B. Ghosh
- Department of Molecular Biology and Genomics, CVPath Institute, Gaithersburg, MD, United States of America
| | - Amanda Krausert
- Department of Pathology, Molecular and Cell-Based Medicine, Mount Sinai Health System, New York, NY, United States of America
| | - Maria Martinez-Lage
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jonathan Melamed
- Department of Anatomical Pathology, NYU Langone Hospital—Long Island, Mineola, NY, United States of America
| | - Roger A. Mitchell
- Department of Pathology, Howard University College of Medicine, Washington DC, United States of America
| | - Barbara A. Sampson
- Department of Pathology, Molecular and Cell-Based Medicine, Mount Sinai Health System, New York, NY, United States of America
| | - Alan C. Seifert
- Biomedical Engineering and Imaging Institute, Department of Radiology, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Aylin Simsir
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Cheryle Adams
- Department of Pathology, Howard University College of Medicine, Washington DC, United States of America
| | - Stephanie Haasnoot
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, United States of America
| | - Stephanie Hafner
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - Michelle A. Siciliano
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Brittany B. Vallejos
- Office of the Medical Investigators, Department of Research, University of New Mexico, Albuquerque, NM, United States of America
| | - Phoebe Del Boccio
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Michelle F. Lamendola-Essel
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Chloe E. Young
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Deepshikha Kewlani
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Precious A. Akinbo
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Brendan Parent
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Alicia Chung
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Teresa C. Cato
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Praveen C. Mudumbi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Shari Esquenazi-Karonika
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Marion J. Wood
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jonathan Monteiro
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States of America
| | - Daniel J. Shinnick
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States of America
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States of America
| | - Amber N. Nguyen
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States of America
| | - Megan L. Fitzgerald
- Patient-Led Research Collaborative on COVID-19, Washington DC, United States of America
| | | | - Lauren E. Stiles
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Moira L. Paskett
- Department of Anatomical Pathology, NYU Langone Hospital—Long Island, Mineola, NY, United States of America
| | - Stuart D. Katz
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States of America
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9
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Carlos AF, Sekiya H, Koga S, Gatto RG, Casey MC, Pham NTT, Sintini I, Machulda MM, Jack CR, Lowe VJ, Whitwell JL, Petrucelli L, Reichard RR, Petersen RC, Dickson DW, Josephs KA. Clinicopathologic features of a novel star-shaped transactive response DNA-binding protein 43 (TDP-43) pathology in the oldest old. J Neuropathol Exp Neurol 2023; 83:36-52. [PMID: 38086178 PMCID: PMC10746697 DOI: 10.1093/jnen/nlad105] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
Transactive response DNA-binding protein 43 (TDP-43) pathology is categorized as type A-E in frontotemporal lobar degeneration and as type α-β in Alzheimer disease (AD) based on inclusion type. We screened amygdala slides of 131 cases with varying ages at death, clinical/neuroimaging findings, and AD neuropathologic changes for TDP-43 pathology using anti-phospho-TDP-43 antibodies. Seven cases (5%) only showed atypical TDP-43 inclusions that could not be typed. Immunohistochemistry and immunofluorescence assessed the atypical star-shaped TDP-43 pathology including its distribution, species, cellular localization, and colocalization with tau. All 7 had died at an extremely old age (median: 100 years [IQR: 94-101]) from nonneurological causes and none had dementia (4 cognitively unimpaired, 3 with amnestic mild cognitive impairment). Neuroimaging showed mild medial temporal involvement. Pathologically, the star-shaped TDP-43-positive inclusions were found in medial (subpial) amygdala and, occasionally, in basolateral regions. Hippocampus only showed TDP-43-positive neurites in the fimbria and subiculum while the frontal lobe was free of TDP-43 inclusions. The star-shaped inclusions were better detected with antibodies against N-terminal than C-terminal TDP-43. Double-labeling studies confirmed deposition of TDP-43 within astrocytes and colocalization with tau. We have identified a novel TDP-43 pathology with star-shaped morphology associated with superaging, with a homogeneous clinicopathologic picture, possibly representing a novel, true aging-related TDP-43 pathology.
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Affiliation(s)
- Arenn F Carlos
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hiroaki Sekiya
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Rodolfo G Gatto
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Irene Sintini
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary M Machulda
- Department of Psychiatry (Psychology), Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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10
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Corriveau-Lecavalier N, Botha H, Graff-Radford J, Switzer AR, Przybelski SA, Wiste HJ, Murray ME, Reichard RR, Dickson DW, Nguyen AT, Ramanan VK, McCarter SJ, Boeve BF, Machulda MM, Fields JA, Stricker NH, Nelson PT, Grothe MJ, Knopman DS, Lowe VJ, Petersen RC, Jack CR, Jones DT. A limbic-predominant amnestic neurodegenerative syndrome associated with TDP-43 pathology. medRxiv 2023:2023.11.19.23298314. [PMID: 38045300 PMCID: PMC10690340 DOI: 10.1101/2023.11.19.23298314] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Limbic-predominant age-related TDP-43 encephalopathy (LATE) is a neuropathologically-defined disease that affects 40% of persons in advanced age, but its associated neurological syndrome is not defined. LATE neuropathological changes (LATE-NC) are frequently comorbid with Alzheimer's disease neuropathologic changes (ADNC). When seen in isolation, LATE-NC have been associated with a predominantly amnestic profile and slow clinical progression. We propose a set of clinical criteria for a limbic-predominant amnestic neurodegenerative syndrome (LANS) that is highly associated with LATE-NC but also other pathologic entities. The LANS criteria incorporate core, standard and advanced features that are measurable in vivo, including older age at evaluation, mild clinical syndrome, disproportionate hippocampal atrophy, impaired semantic memory, limbic hypometabolism, absence of neocortical degenerative patterns and low likelihood of neocortical tau, with degrees of certainty (highest, high, moderate, low). We operationalized this set of criteria using clinical, imaging and biomarker data to validate its associations with clinical and pathologic outcomes. We screened autopsied patients from Mayo Clinic (n = 922) and ADNI (n = 93) cohorts and applied the LANS criteria to those with an antemortem predominant amnestic syndrome (Mayo, n = 165; ADNI, n = 53). ADNC, ADNC/LATE-NC and LATE-NC accounted for 35%, 37% and 4% of cases in the Mayo cohort, respectively, and 30%, 22%, and 9% of cases in the ADNI cohort, respectively. The LANS criteria effectively categorized these cases, with ADNC having the lowest LANS likelihoods, LATE-NC patients having the highest likelihoods, and ADNC/LATE-NC patients having intermediate likelihoods. A logistic regression model using the LANS features as predictors of LATE-NC achieved a balanced accuracy of 74.6% in the Mayo cohort, and out-of-sample predictions in the ADNI cohort achieved a balanced accuracy of 73.3%. Patients with high LANS likelihoods had a milder and slower clinical course and more severe temporo-limbic degeneration compared to those with low likelihoods. Stratifying ADNC/LATE-NC patients from the Mayo cohort according to their LANS likelihood revealed that those with higher likelihoods had more temporo-limbic degeneration and a slower rate of cognitive decline, and those with lower likelihoods had more lateral temporo-parietal degeneration and a faster rate of cognitive decline. The implementation of LANS criteria has implications to disambiguate the different driving etiologies of progressive amnestic presentations in older age and guide prognosis, treatment, and clinical trials. The development of in vivo biomarkers specific to TDP-43 pathology are needed to refine molecular associations between LANS and LATE-NC and precise antemortem diagnoses of LATE.
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Affiliation(s)
- Nick Corriveau-Lecavalier
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Heather J. Wiste
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, MN, USA
| | | | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA
| | | | - Aivi T. Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA
| | | | | | | | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Julie A. Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Nikki H. Stricker
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Peter T. Nelson
- Department of Pathology, University of Kentucky, Lexington, KY, USA
| | - Michel J. Grothe
- CIEN Foundation/Queen Sofia Foundation Alzheimer Center, Madrid, Spain
- Wallenberg Center for Molecular and Translational Medicine and Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Clifford R. Jack
- Department of Neuroscience, Mayo Clinic Jacksonville, FL, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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11
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Switzer A, Charidimou A, McCarter SJ, Vemuri P, Nguyen A, Przybelski SA, Lesnick TG, Rabinstein AA, Brown RD, Knopman DS, Petersen RC, Jack CR, Reichard RR, Graff-Radford J. Boston criteria v2.0 for cerebral amyloid angiopathy without hemorrhage: An MRI-neuropathological validation study. medRxiv 2023:2023.11.09.23298325. [PMID: 37986913 PMCID: PMC10659504 DOI: 10.1101/2023.11.09.23298325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Updated criteria for the clinical-MRI diagnosis of cerebral amyloid angiopathy (CAA) have recently been proposed. However, their performance in individuals without intracerebral hemorrhage (ICH) or transient focal neurological episodes (TFNE) is unknown. We assessed the diagnostic performance of the Boston criteria version 2.0 for CAA diagnosis in a cohort of individuals presenting without symptomatic ICH. METHODS Fifty-four participants from the Mayo Clinic Study of Aging or Alzheimer's Disease Research Center were included if they had an antemortem MRI with gradient-recall echo sequences and a brain autopsy with CAA evaluation. Performance of the Boston criteria v2.0 was compared to v1.5 using histopathologically verified CAA as the reference standard. RESULTS Median age at MRI was 75 years (IQR 65-80) with 28/54 participants having histopathologically verified CAA (i.e., moderate-to-severe CAA in at least 1 lobar region). The sensitivity and specificity of the Boston criteria v2.0 were 28.6% (95%CI: 13.2-48.7%) and 65.3% (95%CI: 44.3-82.8%) for probable CAA diagnosis (AUC 0.47) and 75.0% (55.1-89.3) and 38.5% (20.2-59.4) for any CAA diagnosis (possible + probable; AUC: 0.57), respectively. The v2.0 Boston criteria was not superior in performance compared to the prior v1.5 criteria for either CAA diagnostic category. CONCLUSIONS The Boston criteria v2.0 have low accuracy in patients who are asymptomatic or only have cognitive symptoms.. Additional biomarkers need to be explored to optimize CAA diagnosis in this population.
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Holzbauer SM, Schrodt CA, Prabhu RM, Asch-Kendrick RJ, Ireland M, Klumb C, Firestone MJ, Liu G, Harry K, Ritter JM, Levine MZ, Orciari LA, Wilkins K, Yager P, Gigante CM, Ellison JA, Zhao H, Niezgoda M, Li Y, Levis R, Scott D, Satheshkumar PS, Petersen BW, Rao AK, Bell WR, Bjerk SM, Forrest S, Gao W, Dasheiff R, Russell K, Pappas M, Kiefer J, Bickler W, Wiseman A, Jurantee J, Reichard RR, Smith KE, Lynfield R, Scheftel J, Wallace RM, Bonwitt J. Fatal Human Rabies Infection With Suspected Host-Mediated Failure of Post-Exposure Prophylaxis Following a Recognized Zoonotic Exposure-Minnesota, 2021. Clin Infect Dis 2023; 77:1201-1208. [PMID: 36988328 DOI: 10.1093/cid/ciad098] [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: 12/07/2022] [Revised: 02/03/2023] [Accepted: 02/15/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND No human rabies post-exposure prophylaxis (PEP) failure has been documented in the United States using modern cell culture-based vaccines. In January 2021, an 84-year-old male died from rabies 6 months after being bitten by a rabid bat despite receiving timely rabies PEP. We investigated the cause of breakthrough infection. METHODS We reviewed medical records, laboratory results, and autopsy findings and performed whole-genome sequencing (WGS) to compare patient and bat virus sequences. Storage, administration, and integrity of PEP biologics administered to the patient were assessed; samples from leftover rabies immunoglobulin were evaluated for potency. We conducted risk assessments for persons potentially exposed to the bat and for close patient contacts. RESULTS Rabies virus antibodies present in serum and cerebrospinal fluid were nonneutralizing. Antemortem blood testing revealed that the patient had unrecognized monoclonal gammopathy of unknown significance. Autopsy findings showed rabies meningoencephalitis and metastatic prostatic adenocarcinoma. Rabies virus sequences from the patient and the offending bat were identical by WGS. No deviations were identified in potency, quality control, administration, or storage of administered PEP. Of 332 persons assessed for potential rabies exposure to the case patient, 3 (0.9%) warranted PEP. CONCLUSIONS This is the first reported failure of rabies PEP in the Western Hemisphere using a cell culture-based vaccine. Host-mediated primary vaccine failure attributed to previously unrecognized impaired immunity is the most likely explanation for this breakthrough infection. Clinicians should consider measuring rabies neutralizing antibody titers after completion of PEP if there is any suspicion for immunocompromise.
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Affiliation(s)
- Stacy M Holzbauer
- Minnesota Department of Health, St. Paul, Minnesota, USA
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caroline A Schrodt
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Malia Ireland
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Carrie Klumb
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Melanie J Firestone
- Minnesota Department of Health, St. Paul, Minnesota, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gongping Liu
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Katie Harry
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Jana M Ritter
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min Z Levine
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lillian A Orciari
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kimberly Wilkins
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pamela Yager
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Crystal M Gigante
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James A Ellison
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hui Zhao
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Niezgoda
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yu Li
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robin Levis
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Dorothy Scott
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Panayampalli S Satheshkumar
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brett W Petersen
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Agam K Rao
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - W Robert Bell
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | | | | | | | | | | | | | | | | | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kirk E Smith
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Joni Scheftel
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Ryan M Wallace
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jesse Bonwitt
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Holzbauer SM, Schrodt CA, Prabhu RM, Asch-Kendrick RJ, Ireland M, Klumb C, Firestone MJ, Liu G, Harry K, Levine MZ, Orciari LA, Wilkins K, Ellison JA, Zhao H, Niezgoda M, Satheshkumar PS, Petersen BW, Rao AK, Bell WR, Forrest S, Gao W, Dasheiff R, Russell K, Wiseman A, Reichard RR, Smith KE, Lynfield R, Scheftel J, Wallace RM, Bonwitt J. Reply to Willoughby. Clin Infect Dis 2023; 77:931-932. [PMID: 37200504 DOI: 10.1093/cid/ciad295] [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] [Received: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 05/20/2023] Open
Affiliation(s)
- Stacy M Holzbauer
- Minnesota Department of Health, St. Paul, Minnesota, USA
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caroline A Schrodt
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Malia Ireland
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Carrie Klumb
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Melanie J Firestone
- Minnesota Department of Health, St. Paul, Minnesota, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gongping Liu
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Katie Harry
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Min Z Levine
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lillian A Orciari
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kimberly Wilkins
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James A Ellison
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hui Zhao
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Niezgoda
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Panayampalli S Satheshkumar
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brett W Petersen
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Agam K Rao
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - W Robert Bell
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Wangcai Gao
- Allina Health, The Commons at Midtown Exchange, Minneapolis, Minnesota, USA
| | | | | | | | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kirk E Smith
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Joni Scheftel
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Ryan M Wallace
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jesse Bonwitt
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Shir D, Pham NTT, Botha H, Koga S, Kouri N, Ali F, Knopman DS, Petersen RC, Boeve BF, Kremers WK, Nguyen AT, Murray ME, Reichard RR, Dickson DW, Graff-Radford N, Josephs KA, Whitwell J, Graff-Radford J. Clinicoradiologic and Neuropathologic Evaluation of Corticobasal Syndrome. Neurology 2023; 101:e289-e299. [PMID: 37268436 PMCID: PMC10382268 DOI: 10.1212/wnl.0000000000207397] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/23/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Corticobasal syndrome (CBS) is a clinical phenotype characterized by asymmetric parkinsonism, rigidity, myoclonus, and apraxia. Originally believed secondary to corticobasal degeneration (CBD), mounting clinicopathologic studies have revealed heterogenous neuropathologies. The objectives of this study were to determine the pathologic heterogeneity of CBS, the clinicoradiologic findings associated with different underlying pathologies causing CBS, and the positive predictive value (PPV) of current diagnostic criteria for CBD among patients with a CBS. METHODS Clinical data, brain MRI, and neuropathologic data of patients followed at Mayo Clinic and diagnosed with CBS antemortem were reviewed according to neuropathology category at autopsy. RESULTS The cohort consisted of 113 patients with CBS, 61 (54%) female patients. Mean ± SD disease duration was 7 ± 3.7 years; mean ± SD age at death was 70.5 ± 9.1 years. The primary neuropathologic diagnoses were 43 (38%) CBD, 27 (24%) progressive supranuclear palsy (PSP), 17 (15%) Alzheimer disease (AD), 10 (9%) frontotemporal lobar degeneration (FTLD) with TAR DNA-binding protein 43 (TDP) inclusions, 7 (6%) diffuse Lewy body disease (DLBD)/AD, and 9 (8%) with other diagnoses. Patients with CBS-AD or CBS-DLBD/AD were youngest at death (median [interquartile range]: 64 [13], 64 [11] years) while CBS-PSP were oldest (77 [12.5] years, p = 0.024). Patients with CBS-DLBD/AD had the longest disease duration (9 [6] years), while CBS-other had the shortest (3 [4.25] years, p = 0.04). Posterior cortical signs and myoclonus were more characteristic of patients with CBS-AD and patients with CBS-DLBD/AD. Patients with CBS-DLBD/AD displayed more features of Lewy body dementia. Voxel-based morphometry revealed widespread cortical gray matter loss characteristic of CBS-AD, while CBS-CBD and CBS-PSP predominantly involved premotor regions with greater amount of white matter loss. Patients with CBS-DLBD/AD showed atrophy in a focal parieto-occipital region, and patients with CBS-FTLD-TDP had predominant prefrontal cortical loss. Patients with CBS-PSP had the lowest midbrain/pons ratio (p = 0.012). Of 67 cases meeting clinical criteria for possible CBD at presentation, 27 were pathology-proven CBD, yielding a PPV of 40%. DISCUSSION A variety of neurodegenerative disorders can be identified in patients with CBS, but clinical and regional imaging differences aid in predicting underlying neuropathology. PPV analysis of the current CBD diagnostic criteria revealed suboptimal performance. Biomarkers adequately sensitive and specific for CBD are needed.
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Affiliation(s)
- Dror Shir
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Nha Trang Thu Pham
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Hugo Botha
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Shunsuke Koga
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Naomi Kouri
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Farwa Ali
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - David S Knopman
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Ronald C Petersen
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Brad F Boeve
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Walter K Kremers
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Aivi T Nguyen
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Melissa E Murray
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - R Ross Reichard
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Dennis W Dickson
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Neill Graff-Radford
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL.
| | - Keith Anthony Josephs
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Jennifer Whitwell
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Jonathan Graff-Radford
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL.
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15
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Bermudez C, Graff-Radford J, Syrjanen JA, Stricker NH, Algeciras-Schimnich A, Kouri N, Kremers WK, Petersen RC, Jack CR, Knopman DS, Dickson DW, Nguyen AT, Reichard RR, Murray ME, Mielke MM, Vemuri P. Plasma biomarkers for prediction of Alzheimer's disease neuropathologic change. Acta Neuropathol 2023; 146:13-29. [PMID: 37269398 PMCID: PMC10478071 DOI: 10.1007/s00401-023-02594-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/14/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
While plasma biomarkers for Alzheimer's disease (AD) are increasingly being evaluated for clinical diagnosis and prognosis, few population-based autopsy studies have evaluated their utility in the context of predicting neuropathological changes. Our goal was to investigate the utility of clinically available plasma markers in predicting Braak staging, neuritic plaque score, Thal phase, and overall AD neuropathological change (ADNC).We utilized a population-based prospective study of 350 participants with autopsy and antemortem plasma biomarker testing using clinically available antibody assay (Quanterix) consisting of Aβ42/40 ratio, p-tau181, GFAP, and NfL. We utilized a variable selection procedure in cross-validated (CV) logistic regression models to identify the best set of plasma predictors along with demographic variables, and a subset of neuropsychological tests comprising the Mayo Clinic Preclinical Alzheimer Cognitive Composite (Mayo-PACC). ADNC was best predicted with plasma GFAP, NfL, p-tau181 biomarkers along with APOE ε4 carrier status and Mayo-PACC cognitive score (CV AUC = 0.798). Braak staging was best predicted using plasma GFAP, p-tau181, and cognitive scores (CV AUC = 0.774). Neuritic plaque score was best predicted using plasma Aβ42/40 ratio, p-tau181, GFAP, and NfL biomarkers (CV AUC = 0.770). Thal phase was best predicted using GFAP, NfL, p-tau181, APOE ε4 carrier status and Mayo-PACC cognitive score (CV AUC = 0.754). We found that GFAP and p-tau provided non-overlapping information on both neuritic plaque and Braak stage scores whereas Aβ42/40 and NfL were mainly useful for prediction of neuritic plaque scores. Separating participants by cognitive status improved predictive performance, particularly when plasma biomarkers were included. Plasma biomarkers can differentially inform about overall ADNC pathology, Braak staging, and neuritic plaque score when combined with demographics and cognitive variables and have significant utility for earlier detection of AD.
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Affiliation(s)
- Camilo Bermudez
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA.
| | | | - Jeremy A Syrjanen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Nikki H Stricker
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Naomi Kouri
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | | | - David S Knopman
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | | | - Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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16
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Eschbacher KL, Larsen RA, Reichard RR. Authors' reply to: "Neuropathologic findings in COVID-19 patients should be correlated with clinical neurologic abnormalities". J Neuropathol Exp Neurol 2023; 82:278-279. [PMID: 36625551 DOI: 10.1093/jnen/nlac129] [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: 01/11/2023] Open
Affiliation(s)
- Kathryn L Eschbacher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel A Larsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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17
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Gatto RG, Carlos AF, Reichard RR, Lowe VJ, Whitwell JL, Josephs KA. Comparative assessment of regional tau distribution by Tau-PET and Post-mortem neuropathology in a representative set of Alzheimer's & frontotemporal lobar degeneration patients. PLoS One 2023; 18:e0284182. [PMID: 37167210 PMCID: PMC10174492 DOI: 10.1371/journal.pone.0284182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/24/2023] [Indexed: 05/13/2023] Open
Abstract
Flortaucipir (FTP) PET is a key imaging technique to evaluate tau burden indirectly. However, it appears to have greater utility for 3R+4R tau found in Alzheimer's disease (AD), compared to other non-AD tauopathies. The purpose of this study is to determine how flortaucipir uptake links to neuropathologically determined tau burden in AD and non-AD tauopathies. We identified nine individuals who had undergone antemortem tau-PET and postmortem neuropathological analyses. The cohort included three patients with low, moderate, and high AD neuropathologic changes (ADNC), five patients with a non-AD tauopathy (one Pick's disease, three progressive supranuclear palsies, and one globular glial tauopathy), and one control without ADNC. We compared regional flortaucipir PET uptake with tau burden using an anti-AT8 antibody. There was a very good correlation between flortaucipir uptake and tau burden in those with ADNC although, in one ADNC patient, flortaucipir uptake and tau burden did not match due to the presence of argyrophilic grains disease. Non-AD patients showed lower flortaucipir uptake globally compared to ADNC patients. In the non-AD patients, some regional associations between flortaucipir uptake and histopathological tau burden were observed. Flortaucipir uptake is strongly linked to underlying tau burden in patients with ADNC but there are instances where they do not match. On-the-other hand, flortaucipir has a limited capacity to represent histopathological tau burden in non-AD patients although there are instances where regional uptake correlates with regional tau burden. There is a definite need for the development of future generations of tau-PET ligands that can detect non-AD tau.
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Affiliation(s)
- Rodolfo G Gatto
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Arenn F Carlos
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Jennifer L Whitwell
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
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18
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Lilek J, Ajroud K, Feldman AZ, Krishnamachari S, Ghourchian S, Gefen T, Spencer CL, Kawles A, Mao Q, Tranovich JF, Jack CR, Mesulam MM, Reichard RR, Zhang H, Murray ME, Knopman D, Dickson DW, Petersen RC, Smith B, Ashe KH, Mielke MM, Nelson KM, Flanagan ME. Accumulation of pTau231 at the Postsynaptic Density in Early Alzheimer's Disease. J Alzheimers Dis 2023; 92:241-260. [PMID: 36744338 PMCID: PMC10041451 DOI: 10.3233/jad-220848] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Phosphorylated cytoplasmic tau inclusions correlate with and precede cognitive deficits in Alzheimer's disease (AD). However, pathological tau accumulation and relationships to synaptic changes remain unclear. OBJECTIVE To address this, we examined postmortem brain from 50 individuals with the full spectrum of AD (clinically and neuropathologically). Total tau, pTau231, and AMPA GluR1 were compared across two brain regions (entorhinal and middle frontal cortices), as well as clinically stratified groups (control, amnestic mild cognitive impairment, AD dementia), NIA-AA Alzheimer's Disease Neuropathologic Change designations (Not, Low, Intermediate, High), and Braak tangle stages (1-6). Significant co-existing pathology was excluded to isolate changes attributed to pathologic AD. METHODS Synaptosomal fractionation and staining were performed to measure changes in total Tau, pTau231, and AMPA GluR1. Total Tau and pTau231 were quantified in synaptosomal fractions using Quanterix Simoa HD-X. RESULTS Increasing pTau231 in frontal postsynaptic fractions correlated positively with increasing clinical and neuropathological AD severity. Frontal cortex is representative of early AD, as it does not become involved by tau tangles until late in AD. Entorhinal total tau was significantly higher in the amnestic mild cognitive impairment group when compared to AD, but only after accounting for AD associated synaptic changes. Alterations in AMPA GluR1 observed in the entorhinal cortex, but not middle frontal cortex, suggest that pTau231 mislocalization and aggregation in postsynaptic structures may impair glutamatergic signaling by promoting AMPA receptor dephosphorylation and internalization. CONCLUSION Results highlight the potential effectiveness of early pharmacological interventions targeting pTau231 accumulation at the postsynaptic density.
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Affiliation(s)
- Jaclyn Lilek
- Department of Pathology, Northwestern University, Illinois, USA
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
| | - Kaouther Ajroud
- Department of Pathology, Northwestern University, Illinois, USA
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
| | | | | | | | - Tamar Gefen
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Illinois, USA
| | - Callen L. Spencer
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
| | - Allegra Kawles
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
| | - Qinwen Mao
- Department of Pathology, Northwestern University, Illinois, USA
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
| | | | | | - M-Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
- Department of Neurology, Northwestern University, Illinois, USA
| | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Minnesota, USA
| | - Hui Zhang
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
- Division of Biostatistics, Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Illinois, USA
| | | | - David Knopman
- Department of Neurology, Mayo Clinic, Minnesota, USA
| | | | | | - Benjamin Smith
- Department of Neurology, University of Minnesota, Minnesota, USA
- N. Bud Grossman Center for Memory Research and Care, University of Minnesota, Minnesota, USA
| | - Karen H. Ashe
- Department of Neurology, University of Minnesota, Minnesota, USA
- N. Bud Grossman Center for Memory Research and Care, University of Minnesota, Minnesota, USA
- Institute for Translational Neuroscience, University of Minnesota, Minnesota, USA
- Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Minnesota, USA
| | - Michelle M. Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kathryn M. Nelson
- Department of Medicinal Chemistry, Institute for Therapeutics Discovery and Development, University of Minnesota, Minnesota, USA
| | - Margaret E. Flanagan
- Department of Pathology, Northwestern University, Illinois, USA
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Illinois, USA
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19
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Carlos AF, Machulda MM, Rutledge MH, Nguyen AT, Reichard RR, Baker MC, Rademakers R, Dickson DW, Petersen RC, Josephs KA. Comparison of Clinical, Genetic, and Pathologic Features of Limbic and Diffuse Transactive Response DNA-Binding Protein 43 Pathology in Alzheimer's Disease Neuropathologic Spectrum. J Alzheimers Dis 2023; 93:1521-1535. [PMID: 37182869 PMCID: PMC10923399 DOI: 10.3233/jad-221094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Increasing evidence suggests that TAR DNA-binding protein 43 (TDP-43) pathology in Alzheimer's disease (AD), or AD-TDP, can be diffuse or limbic-predominant. Understanding whether diffuse AD-TDP has genetic, clinical, and pathological features that differ from limbic AD-TDP could have clinical and research implications. OBJECTIVE To better characterize the clinical and pathologic features of diffuse AD-TDP and differentiate it from limbic AD-TDP. METHODS 363 participants from the Mayo Clinic Study of Aging, Alzheimer's Disease Research Center, and Neurodegenerative Research Group with autopsy confirmed AD and TDP-43 pathology were included. All underwent genetic, clinical, neuropsychologic, and neuropathologic evaluations. AD-TDP pathology distribution was assessed using the Josephs 6-stage scale. Stages 1-3 were classified as Limbic, those 4-6 as Diffuse. Multivariable logistic regression was used to identify clinicopathologic features that independently predicted diffuse pathology. RESULTS The cohort was 61% female and old at onset (median: 76 years [IQR:70-82]) and death (median: 88 years [IQR:82-92]). Fifty-four percent were Limbic and 46% Diffuse. Clinically, ∼10-20% increases in odds of being Diffuse associated with 5-year increments in age at onset (p = 0.04), 1-year longer disease duration (p = 0.02), and higher Neuropsychiatric Inventory scores (p = 0.03), while 15-second longer Trailmaking Test-B times (p = 0.02) and higher Block Design Test scores (p = 0.02) independently decreased the odds by ~ 10-15%. There was evidence for association of APOEɛ4 allele with limbic AD-TDP and of TMEM106B rs3173615 C allele with diffuse AD-TDP. Pathologically, widespread amyloid-β plaques (Thal phases: 3-5) decreased the odds of diffuse TDP-43 pathology by 80-90%, while hippocampal sclerosis increased it sixfold (p < 0.001). CONCLUSION Diffuse AD-TDP shows clinicopathologic and genetic features different from limbic AD-TDP.
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Affiliation(s)
- Arenn F. Carlos
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mary M. Machulda
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Aivi T. Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew C. Baker
- Department of Neuroscience (Neuropathology), Mayo Clinic, Jacksonville, FL 32224, USA
| | - Rosa Rademakers
- Department of Neuroscience (Neuropathology), Mayo Clinic, Jacksonville, FL 32224, USA
- VIB Center for Molecular Neurology, VIB, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Flanders 2000, Belgium
| | - Dennis W. Dickson
- Department of Neuroscience (Neuropathology), Mayo Clinic, Jacksonville, FL 32224, USA
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20
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Murray ME, Moloney CM, Kouri N, Syrjanen JA, Matchett BJ, Rothberg DM, Tranovich JF, Sirmans TNH, Wiste HJ, Boon BDC, Nguyen AT, Reichard RR, Dickson DW, Lowe VJ, Dage JL, Petersen RC, Jack CR, Knopman DS, Vemuri P, Graff-Radford J, Mielke MM. Global neuropathologic severity of Alzheimer's disease and locus coeruleus vulnerability influences plasma phosphorylated tau levels. Mol Neurodegener 2022; 17:85. [PMID: 36575455 PMCID: PMC9795667 DOI: 10.1186/s13024-022-00578-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/26/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Advances in ultrasensitive detection of phosphorylated tau (p-tau) in plasma has enabled the use of blood tests to measure Alzheimer's disease (AD) biomarker changes. Examination of postmortem brains of participants with antemortem plasma p-tau levels remains critical to understanding comorbid and AD-specific contribution to these biomarker changes. METHODS We analyzed 35 population-based Mayo Clinic Study of Aging participants with plasma p-tau at threonine 181 and threonine 217 (p-tau181, p-tau217) available within 3 years of death. Autopsied participants included cognitively unimpaired, mild cognitive impairment, AD dementia, and non-AD neurodegenerative disorders. Global neuropathologic scales of tau, amyloid-β, TDP-43, and cerebrovascular disease were examined. Regional digital pathology measures of tau (phosphorylated threonine 181 and 217 [pT181, pT217]) and amyloid-β (6F/3D) were quantified in hippocampus and parietal cortex. Neurotransmitter hubs reported to influence development of tangles (nucleus basalis of Meynert) and amyloid-β plaques (locus coeruleus) were evaluated. RESULTS The strongest regional associations were with parietal cortex for tau burden (p-tau181 R = 0.55, p = 0.003; p-tau217 R = 0.66, p < 0.001) and amyloid-β burden (p-tau181 R = 0.59, p < 0.001; p-tau217 R = 0.71, p < 0.001). Linear regression analysis of global neuropathologic scales explained 31% of variability in plasma p-tau181 (Adj. R2 = 0.31) and 59% in plasma p-tau217 (Adj. R2 = 0.59). Neither TDP-43 nor cerebrovascular disease global scales independently contributed to variability. Global scales of tau pathology (β-coefficient = 0.060, p = 0.016) and amyloid-β pathology (β-coefficient = 0.080, p < 0.001) independently predicted plasma p-tau217 when modeled together with co-pathologies, but only amyloid-β (β-coefficient = 0.33, p = 0.021) significantly predicted plasma p-tau181. While nucleus basalis of Meynert neuron count/mm2 was not associated with plasma p-tau levels, a lower locus coeruleus neuron count/mm2 was associated with higher plasma p-tau181 (R = -0.50, p = 0.007) and higher plasma p-tau217 (R = -0.55, p = 0.002). Cognitive scores (Adj. R2 = 0.25-0.32) were predicted by the global tau scale, but not by the global amyloid-β scale or plasma p-tau when modeled simultaneously. CONCLUSIONS Higher soluble plasma p-tau levels may be the result of an intersection between insoluble deposits of amyloid-β and tau accumulation in brain, and may be associated with locus coeruleus degeneration.
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Affiliation(s)
- Melissa E. Murray
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Christina M. Moloney
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Naomi Kouri
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Jeremy A. Syrjanen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Billie J. Matchett
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Darren M. Rothberg
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Jessica F. Tranovich
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Tiffany N. Hicks Sirmans
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Heather J. Wiste
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Baayla D. C. Boon
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Aivi T. Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Dennis W. Dickson
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN USA
| | - Jeffrey L. Dage
- Department of Neurology, Indiana University, Indianapolis, IN USA
| | | | | | | | | | | | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
- Wake Forest University School of Medicine, Winston-Salem, NC USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, 525 Vine, 5th floor, Winston-Salem, NC 27157 USA
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21
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McCoy RG, Campbell RL, Mullan AF, Bucks CM, Clements CM, Reichard RR, Jeffery MM. Changes in all-cause and cause-specific mortality during the first year of the COVID-19 pandemic in Minnesota: population-based study. BMC Public Health 2022; 22:2291. [PMID: 36474190 PMCID: PMC9727873 DOI: 10.1186/s12889-022-14743-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in unprecedented increases in mortality in the U.S. and worldwide. To better understand the impact of the COVID-19 pandemic on mortality in the state of Minnesota, U.S.A., we characterize the changes in the causes of death during 2020 (COVID-19 period), compared to 2018-2019 (baseline period), assessing for differences across ages, races, ethnicities, sexes, and geographic characteristics. METHODS Longitudinal population-based study using Minnesota death certificate data, 2018-2020. Using Poisson regression models adjusted for age and sex, we calculated all-cause and cause-specific (by underlying causes of death) mortality rates per 100,000 Minnesotans, the demographics of the deceased, and years of life lost (YLL) using the Chiang's life table method in 2020 relative to 2018-2019. RESULTS We identified 89,910 deaths in 2018-2019 and 52,030 deaths in 2020. The mean daily mortality rate increased from 123.1 (SD 11.7) in 2018-2019 to 144.2 (SD 22.1) in 2020. COVID-19 comprised 9.9% of deaths in 2020. Other categories of causes of death with significant increases in 2020 compared to 2018-2019 included assault by firearms (RR 1.68, 95% CI 1.34-2.11), accidental poisonings (RR 1.49, 95% CI 1.37-1.61), malnutrition (RR 1.48, 95% CI 1.17-1.87), alcoholic liver disease (RR, 95% CI 1.14-1.40), and cirrhosis and other chronic liver diseases (RR 1.28, 95% CI 1.09-1.50). Mortality rates due to COVID-19 and non-COVID-19 causes were higher among racial and ethnic minority groups, older adults, and non-rural residents. CONCLUSIONS The COVID-19 pandemic was associated with a 17% increase in the death rate in Minnesota relative to 2018-2019, driven by both COVID-19 and non-COVID-19 causes. As the COVID-19 pandemic enters its third year, it is imperative to examine and address the factors contributing to excess mortality in the short-term and monitor for additional morbidity and mortality in the years to come.
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Affiliation(s)
- Rozalina G. McCoy
- grid.66875.3a0000 0004 0459 167XDivision of Community Internal Medicine, Geriatrics, and Palliative Care. Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA ,grid.66875.3a0000 0004 0459 167XMayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN 55905 USA ,Mayo Clinic Ambulance, Rochester, MN 55905 USA ,grid.66875.3a0000 0004 0459 167XDivision of Health Care Delivery Research, Mayo Clinic, Rochester, MN 55905 USA
| | - Ronna L. Campbell
- grid.66875.3a0000 0004 0459 167XDepartment of Emergency Medicine, Mayo Clinic, Rochester, MN 55905 USA
| | - Aidan F. Mullan
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905 USA
| | - Colin M. Bucks
- grid.66875.3a0000 0004 0459 167XDepartment of Emergency Medicine, Mayo Clinic, Rochester, MN 55905 USA
| | - Casey M. Clements
- grid.66875.3a0000 0004 0459 167XDepartment of Emergency Medicine, Mayo Clinic, Rochester, MN 55905 USA
| | - R. Ross Reichard
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905 USA
| | - Molly M. Jeffery
- grid.66875.3a0000 0004 0459 167XDivision of Health Care Delivery Research, Mayo Clinic, Rochester, MN 55905 USA ,grid.66875.3a0000 0004 0459 167XDepartment of Emergency Medicine, Mayo Clinic, Rochester, MN 55905 USA
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22
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Carlos AF, Tosakulwong N, Weigand SD, Senjem ML, Schwarz CG, Knopman DS, Boeve BF, Petersen RC, Nguyen AT, Reichard RR, Dickson DW, Jack CR, Lowe V, Whitwell JL, Josephs KA. TDP-43 pathology effect on volume and flortaucipir uptake in Alzheimer's disease. Alzheimers Dement 2022. [PMID: 36463537 DOI: 10.1002/alz.12878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/18/2022] [Revised: 09/18/2022] [Accepted: 10/21/2022] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Alzheimer's disease (AD) patients ≥70 years show smaller medial temporal volumes despite less 18 F-flortaucipir-positron emission tomography (PET) uptake than younger counterparts. We investigated whether TAR DNA-binding protein 43 (TDP-43) was contributing to this volume-uptake mismatch. METHODS Seventy-seven participants with flortaucipir-PET and volumetric magnetic resonance imaging underwent postmortem AD and TDP-43 pathology assessments. Bivariate-response linear regression estimated the effect of age and TDP-43 pathology on volume and/or flortaucipir standardized uptake volume ratios of the hippocampus, amygdala, entorhinal, inferior temporal, and midfrontal cortices. RESULTS Older participants had lower hippocampal volumes and overall flortaucipir uptake. TDP-43-immunoreactivity correlated with reduced medial temporal volumes but was unrelated to flortaucipir uptake. TDP-43 effect size was consistent across the age spectrum. However, at older ages, the cohort mean volumes moved toward those of TDP-43-positives, reflecting the increasing TDP-43 pathology frequency with age. DISCUSSION TDP-43 pathology is a relevant contributor driving the volume-uptake mismatch in older AD participants. HIGHLIGHTS TDP-43 pathology affects medial temporal volume loss but not tau radiotracer uptake. Greater TDP-43 pathology effect is seen in old age due to its increasing frequency. TDP-43 pathology is a relevant driver of the volume-uptake mismatch in old AD patients.
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Affiliation(s)
- Arenn F Carlos
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nirubol Tosakulwong
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen D Weigand
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Information Technology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Val Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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23
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Nguyen AT, Kouri N, Labuzan SA, Przybelski SA, Lesnick TG, Raghavan S, Reid RI, Reichard RR, Knopman DS, Petersen RC, Jack CR, Mielke MM, Dickson DW, Graff-Radford J, Murray ME, Vemuri P. Neuropathologic scales of cerebrovascular disease associated with diffusion changes on MRI. Acta Neuropathol 2022; 144:1117-1125. [PMID: 35841412 PMCID: PMC9637622 DOI: 10.1007/s00401-022-02465-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 01/26/2023]
Abstract
Summarizing the multiplicity and heterogeneity of cerebrovascular disease (CVD) features into a single measure has been difficult in both neuropathology and imaging studies. The objective of this work was to evaluate the association between neuroimaging surrogates of CVD and two available neuropathologic CVD scales in those with both antemortem imaging CVD measures and postmortem CVD evaluation. Individuals in the Mayo Clinic Study of Aging with MRI scans within 5 years of death (N = 51) were included. Antemortem CVD measures were computed from diffusion MRI (dMRI), FLAIR, and T2* GRE imaging modalities and compared with postmortem neuropathologic findings using Kalaria and Strozyk Scales. Of all the neuroimaging measures, both regional and global dMRI measures were associated with Kalaria and Strozyk Scales (p < 0.05) and modestly correlated with global cognitive performance. The major conclusions from this study were: (i) microstructural white matter injury measurements using dMRI may be meaningful surrogates of neuropathologic CVD scales, because they aid in capturing diffuse (and early) changes to white matter and secondary neurodegeneration due to lesions; (ii) vacuolation in the corpus callosum may be associated with white matter changes measured on antemortem dMRI imaging; (iii) Alzheimer's disease neuropathologic change did not associate with neuropathologic CVD scales; and (iv) future work should be focused on developing better quantitative measures utilizing dMRI to optimally assess CVD-related neuropathologic changes.
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Affiliation(s)
- Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Naomi Kouri
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Sydney A Labuzan
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Scott A Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Timothy G Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Sheelakumari Raghavan
- Department of Radiology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Robert I Reid
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Clifford R Jack
- Department of Radiology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michelle M Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN, 55905, USA.
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24
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Lachner C, Day GS, Camsari GB, Kouri N, Ertekin-Taner N, Boeve BF, Labuzan SA, Lucas JA, Thompson EA, Siddiqui H, Crook JE, Cabrera-Rodriguez JN, Josephs KA, Petersen RC, Dickson DW, Reichard RR, Mielke MM, Knopman DS, Graff-Radford NR, Murray ME. Cancer and Vascular Comorbidity Effects on Dementia Risk and Neuropathology in the Oldest-Old. J Alzheimers Dis 2022; 90:405-417. [PMID: 36213996 PMCID: PMC9661335 DOI: 10.3233/jad-220440] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 01/28/2023]
Abstract
BACKGROUND Dementia, vascular disease, and cancer increase with age, enabling complex comorbid interactions. Understanding vascular and cancer contributions to dementia risk and neuropathology in oldest-old may improve risk modification and outcomes. OBJECTIVE Investigate the contributions of vascular factors and cancer to dementia and neuropathology. METHODS Longitudinal clinicopathologic study of prospectively followed Mayo Clinic participants dying≥95 years-old who underwent autopsy. Participants were stratified by dementia status and compared according to demographics, vascular risk factors, cancer, and neuropathology. RESULTS Participants (n = 161; 83% female; 99% non-Hispanic whites)≥95 years (95-106 years-old) with/without dementia did not differ based on demographics. APOE ɛ2 frequency was higher in no dementia (20/72 [28%]) versus dementia (11/88 [12%]; p = 0.03), but APOE ɛ4 frequency did not differ. Coronary artery disease was more frequent in no dementia (31/72 [43%]) versus dementia (23/89 [26%]; p = 0.03) associated with 56% lower dementia odds (odds ratio [OR] = 0.44 [confidence interval (CI) = 0.19-0.98]; p = 0.04) and fewer neuritic/diffuse plaques. Diabetes had an 8-fold increase in dementia odds (OR = 8.42 [CI = 1.39-163]; p = 0.02). Diabetes associated with higher cerebrovascular disease (Dickson score; p = 0.05). Cancer associated with 63% lower dementia odds (OR = 0.37 [CI = 0.17-0.78]; p < 0.01) and lower Braak stage (p = 0.01). CONCLUSION Cancer exposure in the oldest-old was associated with lower odds of dementia and tangle pathology, whereas history of coronary artery disease was associated with lower odds of dementia and amyloid-β plaque pathology. History of diabetes mellitus was associated with increased odds of dementia and cerebrovascular disease pathology. Cancer-related mechanisms and vascular risk factor reduction strategies may alter dementia risk and neuropathology in oldest-old.
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Affiliation(s)
- Christian Lachner
- Departments of Neurology, Mayo Clinic, Jacksonville, FL, USA,
Departments of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Gregory S. Day
- Departments of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Naomi Kouri
- Departments of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Nilüfer Ertekin-Taner
- Departments of Neurology, Mayo Clinic, Jacksonville, FL, USA,
Departments of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - John A. Lucas
- Departments of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Habeeba Siddiqui
- Departments of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Julia E. Crook
- Departments of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | | | - R. Ross Reichard
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michelle M. Mielke
- Departments of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Melissa E. Murray
- Departments of Neuroscience, Mayo Clinic, Jacksonville, FL, USA,Correspondence to: Melissa E. Murray, PhD, Associate Professor, Translational Neuropathology Laboratory, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA. Tel.: +1 904 953 1083; Fax: +1 904 953 7117; E-mail:
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25
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Valentino RR, Ramnarine C, Heckman MG, Johnson PW, Soto-Beasley AI, Walton RL, Koga S, Kasanuki K, Murray ME, Uitti RJ, Fields JA, Botha H, Ramanan VK, Kantarci K, Lowe VJ, Jack CR, Ertekin-Taner N, Savica R, Graff-Radford J, Petersen RC, Parisi JE, Reichard RR, Graff-Radford NR, Ferman TJ, Boeve BF, Wszolek ZK, Dickson DW, Ross OA. Mitochondrial genomic variation in dementia with Lewy bodies: association with disease risk and neuropathological measures. Acta Neuropathol Commun 2022; 10:103. [PMID: 35836284 PMCID: PMC9281088 DOI: 10.1186/s40478-022-01399-4] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022] Open
Abstract
Dementia with Lewy bodies (DLB) is clinically diagnosed when patients develop dementia less than a year after parkinsonism onset. Age is the primary risk factor for DLB and mitochondrial health influences ageing through effective oxidative phosphorylation (OXPHOS). Patterns of stable polymorphisms in the mitochondrial genome (mtDNA) alter OXPHOS efficiency and define individuals to specific mtDNA haplogroups. This study investigates if mtDNA haplogroup background affects clinical DLB risk and neuropathological disease severity. 360 clinical DLB cases, 446 neuropathologically confirmed Lewy body disease (LBD) cases with a high likelihood of having DLB (LBD-hDLB), and 910 neurologically normal controls had European mtDNA haplogroups defined using Agena Biosciences MassARRAY iPlex technology. 39 unique mtDNA variants were genotyped and mtDNA haplogroups were assigned to mitochondrial phylogeny. Striatal dopaminergic degeneration, neuronal loss, and Lewy body counts were also assessed in different brain regions in LBD-hDLB cases. Logistic regression models adjusted for age and sex were used to assess associations between mtDNA haplogroups and risk of DLB or LBD-hDLB versus controls in a case-control analysis. Additional appropriate regression models, adjusted for age at death and sex, assessed associations of haplogroups with each different neuropathological outcome measure. No mtDNA haplogroups were significantly associated with DLB or LBD-hDLB risk after Bonferroni correction.Haplogroup H suggests a nominally significant reduced risk of DLB (OR=0.61, P=0.006) but no association of LBD-hDLB (OR=0.87, P=0.34). The haplogroup H observation in DLB was consistent after additionally adjusting for the number of APOE ε4 alleles (OR=0.59, P=0.004). Haplogroup H also showed a suggestive association with reduced ventrolateral substantia nigra neuronal loss (OR=0.44, P=0.033). Mitochondrial haplogroup H may be protective against DLB risk and neuronal loss in substantia nigra regions in LBD-hDLB cases but further validation is warranted.
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Affiliation(s)
- Rebecca R Valentino
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Chloe Ramnarine
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Patrick W Johnson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, 32224, USA
| | | | - Ronald L Walton
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Koji Kasanuki
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
- Department of Neuropsychiatry, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Vijay K Ramanan
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nilufer Ertekin-Taner
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
- Department of Neurology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | | | - Joseph E Parisi
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - R Ross Reichard
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, 32224, USA.
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26
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Londoño DP, Arumaithurai K, Constantopoulos E, Basso MR, Reichard RR, Flanagan EP, Keegan BM. Diagnosis of coexistent neurodegenerative dementias in multiple sclerosis. Brain Commun 2022; 4:fcac167. [PMID: 35822102 PMCID: PMC9272064 DOI: 10.1093/braincomms/fcac167] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/21/2022] [Accepted: 06/20/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Among people with multiple sclerosis, cognitive impairment occurs commonly and is a potent predictor of disability. Some multiple sclerosis patients present with severe cognitive impairment, and distinguishing multiple sclerosis-related cognitive impairment from co-existent progressive neurodegenerative diseases such as Alzheimer disease poses a diagnostic challenge. The use of biomarkers such as PET and CSF proteins may facilitate this distinction. The study was a retrospective, descriptive study on convenience samples of separate cohorts, one of cognitively impaired multiple sclerosis patients evaluated on autopsy to demonstrate coincidence of both multiple sclerosis and neurodegenerative cognitive diseases. The second cohort were cognitively impaired multiple sclerosis patients evaluated by biomarker to investigate possible additional neurodegenerative cognitive disorders contributing to the cognitive impairment. We investigated selected biomarkers among 31 severely impaired patients (biomarker cohort) and 12 severely impaired patients assessed at autopsy and selected 24 (23 biomarker cohort, 1 autopsy cohort) had comprehensive neurocognitive testing. Biomarker cohort investigations included 18F-Fluorodeoxyglucose PET and/or CSF amyloid Aβ1-42, phospho-tau and total tau levels. The autopsy cohort was evaluated with comprehensive neuropathological assessment for aetiology of cognitive impairment. The cohorts shared similar sex, age at multiple sclerosis onset and multiple sclerosis clinical course. The autopsy-cohort patients were older at diagnosis (69.5 versus 57 years, P = 0.006), had longer disease duration [median (range) 20 years (3–59) versus 9 (1–32), P = 0.001] and had more impaired bedside mental status scores at last follow-up [Kokmen median (range) 23 (1–38) versus 31 (9–34) P = 0.01]. Autopsy-cohort patients confirmed, or excluded, coexistent neurogenerative disease by neuropathology gold standard. Most biomarker-cohort patients had informative results evaluating coexistent neurogenerative disease. Biomarkers may be useful in indicating a coexistent neurodegenerative disease earlier, and in life, in patients with multiple sclerosis and significant cognitive impairment.
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Affiliation(s)
- Diana P Londoño
- Department of Neurology, Mayo Clinic , Rochester, MN 55905 , USA
- Department of Neurology, OSF St. Paul Medical Center , Peoria, IL 61603 , USA
| | | | - Eleni Constantopoulos
- Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester, MN 55905 , USA
| | - Michael R Basso
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic , Rochester, MN 55905 , USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester, MN 55905 , USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic , Rochester, MN 55905 , USA
| | - B Mark Keegan
- Department of Neurology, Mayo Clinic , Rochester, MN 55905 , USA
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27
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Nelson PT, Brayne C, Flanagan ME, Abner EL, Agrawal S, Attems J, Castellani RJ, Corrada MM, Cykowski MD, Di J, Dickson DW, Dugger BN, Ervin JF, Fleming J, Graff-Radford J, Grinberg LT, Hokkanen SRK, Hunter S, Kapasi A, Kawas CH, Keage HAD, Keene CD, Kero M, Knopman DS, Kouri N, Kovacs GG, Labuzan SA, Larson EB, Latimer CS, Leite REP, Matchett BJ, Matthews FE, Merrick R, Montine TJ, Murray ME, Myllykangas L, Nag S, Nelson RS, Neltner JH, Nguyen AT, Petersen RC, Polvikoski T, Reichard RR, Rodriguez RD, Suemoto CK, Wang SHJ, Wharton SB, White L, Schneider JA. Frequency of LATE neuropathologic change across the spectrum of Alzheimer's disease neuropathology: combined data from 13 community-based or population-based autopsy cohorts. Acta Neuropathol 2022; 144:27-44. [PMID: 35697880 PMCID: PMC9552938 DOI: 10.1007/s00401-022-02444-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/04/2022] [Accepted: 05/22/2022] [Indexed: 02/02/2023]
Abstract
Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) and Alzheimer's disease neuropathologic change (ADNC) are each associated with substantial cognitive impairment in aging populations. However, the prevalence of LATE-NC across the full range of ADNC remains uncertain. To address this knowledge gap, neuropathologic, genetic, and clinical data were compiled from 13 high-quality community- and population-based longitudinal studies. Participants were recruited from United States (8 cohorts, including one focusing on Japanese-American men), United Kingdom (2 cohorts), Brazil, Austria, and Finland. The total number of participants included was 6196, and the average age of death was 88.1 years. Not all data were available on each individual and there were differences between the cohorts in study designs and the amount of missing data. Among those with known cognitive status before death (n = 5665), 43.0% were cognitively normal, 14.9% had MCI, and 42.4% had dementia-broadly consistent with epidemiologic data in this age group. Approximately 99% of participants (n = 6125) had available CERAD neuritic amyloid plaque score data. In this subsample, 39.4% had autopsy-confirmed LATE-NC of any stage. Among brains with "frequent" neuritic amyloid plaques, 54.9% had comorbid LATE-NC, whereas in brains with no detected neuritic amyloid plaques, 27.0% had LATE-NC. Data on LATE-NC stages were available for 3803 participants, of which 25% had LATE-NC stage > 1 (associated with cognitive impairment). In the subset of individuals with Thal Aβ phase = 0 (lacking detectable Aβ plaques), the brains with LATE-NC had relatively more severe primary age-related tauopathy (PART). A total of 3267 participants had available clinical data relevant to frontotemporal dementia (FTD), and none were given the clinical diagnosis of definite FTD nor the pathological diagnosis of frontotemporal lobar degeneration with TDP-43 inclusions (FTLD-TDP). In the 10 cohorts with detailed neurocognitive assessments proximal to death, cognition tended to be worse with LATE-NC across the full spectrum of ADNC severity. This study provided a credible estimate of the current prevalence of LATE-NC in advanced age. LATE-NC was seen in almost 40% of participants and often, but not always, coexisted with Alzheimer's disease neuropathology.
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Affiliation(s)
- Peter T Nelson
- University of Kentucky, Rm 311 Sanders-Brown Center on Aging, Lexington, KY, USA.
| | | | | | - Erin L Abner
- University of Kentucky, Rm 311 Sanders-Brown Center on Aging, Lexington, KY, USA
| | | | | | | | | | | | - Jing Di
- University of Kentucky, Rm 311 Sanders-Brown Center on Aging, Lexington, KY, USA
| | | | | | | | | | | | - Lea T Grinberg
- University of California, San Francisco, CA, USA
- University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | | | - Mia Kero
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | | | | | | | | | | | - Liisa Myllykangas
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sukriti Nag
- Rush University Medical Center, Chicago, IL, USA
| | | | - Janna H Neltner
- University of Kentucky, Rm 311 Sanders-Brown Center on Aging, Lexington, KY, USA
| | | | | | | | | | | | | | | | - Stephen B Wharton
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Lon White
- Pacific Health Research and Education Institute, Honolulu, HI, USA
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28
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Carlos AF, Tosakulwong N, Weigand SD, Boeve BF, Knopman DS, Petersen RC, Nguyen A, Reichard RR, Murray ME, Dickson DW, Josephs KA. Frequency and distribution of TAR DNA-binding protein 43 (TDP-43) pathology increase linearly with age in a large cohort of older adults with and without dementia. Acta Neuropathol 2022; 144:159-160. [PMID: 35536384 PMCID: PMC9943023 DOI: 10.1007/s00401-022-02434-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/30/2022]
Affiliation(s)
| | | | - Stephen D. Weigand
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Aivi Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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29
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Kummer T, Maldonado G, Reichard RR. Intraosseus administration of an ultrasound contrast agent in a case of pediatric blunt abdominal trauma. Journal of Pediatric Surgery Case Reports 2022. [DOI: 10.1016/j.epsc.2022.102264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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30
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Buciuc M, Martin PR, Tosakulwong N, Murray ME, Petrucelli L, Senjem ML, Spychalla AJ, Knopman DS, Boeve BF, Petersen RC, Parisi JE, Reichard RR, Dickson DW, Jack CR, Whitwell JL, Josephs KA. TDP-43-associated atrophy in brains with and without frontotemporal lobar degeneration. Neuroimage Clin 2022; 34:102954. [PMID: 35168140 PMCID: PMC8850800 DOI: 10.1016/j.nicl.2022.102954] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/21/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
Rates of anterolateral temporal lobe atrophy are faster in FTLD-TDP versus AD-TDP. Older age is associated with slower frontal lobe atrophy in FTLD-TDP. AD-TDP type-α showed faster medial temporal atrophy than type-β. Pure-TDP was associated with slowest rates and less atrophy in all brain regions.
Transactive response DNA-binding protein of ∼43 kDa (TDP-43), a primary pathologic substrate in tau-negative frontotemporal lobar degeneration (FTLD), is also often found in the brains of elderly individuals without FTLD and is a key player in the process of neurodegeneration in brains with and without FTLD. It is unknown how rates and trajectories of TDP-43-associated brain atrophy compare between these two groups. Additionally, non-FTLD TDP-43 inclusions are not homogeneous and can be divided into two morphologic types: type-α and neurofibrillary tangle-associated type-β. Therefore, we explored whether neurodegeneration also varies due to the morphologic type. In this longitudinal retrospective study of 293 patients with 843 MRI scans spanning over ∼10 years, we used a Bayesian hierarchical linear model to quantify similarities and differences between the non-FTLD TDP-43 (type-α/type-β) and FTLD-TDP (n = 68) in both regional volume at various timepoints before death and annualized rate of atrophy. Since Alzheimer’s disease (AD) is a frequent co-pathology in non-FTLD TDP-43, we further divided types α/β based on presence/absence of intermediate-high likelihood AD: AD-TDP type-β (n = 90), AD-TDP type-α (n = 104), and Pure-TDP (n = 31, all type-α). FTLD-TDP was associated with faster atrophy rates in the inferior temporal lobe and temporal pole compared to all non-FTLD TDP-43 groups. The atrophy rate in the frontal lobe was modulated by age with younger FTLD-TDP having the fastest rates. Older FTLD-TDP showed a limbic predominant pattern of neurodegeneration. AD-TDP type-α showed faster rates of hippocampal atrophy and smaller volumes of amygdala, temporal pole, and inferior temporal lobe compared to AD-TDP type-β. Pure-TDP was associated with slowest rates and less atrophy in all brain regions. The results suggest that there are differences and similarities in longitudinal brain volume loss between FTLD-TDP and non-FTLD TDP-43. Within FTLD-TDP age plays a role in which brain regions are the most affected. Additionally, brain atrophy regional rates also vary by non-FTLD TDP-43 type.
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Affiliation(s)
- Marina Buciuc
- Department of Neurology, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
| | - Peter R Martin
- Department of Quantitative Health Sciences, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
| | - Nirubol Tosakulwong
- Department of Quantitative Health Sciences, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
| | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA.
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA.
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
| | - Anthony J Spychalla
- Department of Radiology, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
| | - David S Knopman
- Department of Neurology, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA.
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
| | - Jennifer L Whitwell
- Department of Radiology, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, 200 1(st) Street NW, Rochester, MN 55905, USA.
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31
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Coburn RP, Botha H, Graff-Radford J, Reichard RR, Jones DT, Ramanan VK. Dysexecutive Alzheimer's Disease with Lewy Body Disease Co-Pathology. Curr Alzheimer Res 2022; 19:330-333. [PMID: 35260054 DOI: 10.2174/1567205019666220308152219] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alzheimer's disease can present atypically as a progressive dysexecutive syndrome (dAD), an entity which preferentially affects younger individuals and is frequently misdiagnosed, highlighting the imperative for additional research. OBJECTIVE To characterize the clinical, antemortem neuroimaging, and postmortem neuropathologic features of two cases of young-onset dAD who displayed evidence of Lewy body disease (LBD) co-pathology at autopsy. METHODS Clinical histories, antemortem MRI and PET imaging, and postmortem neuropathologic data were reviewed for each patient. Case Descriptions/Results: Canonical features of dAD were observed in both cases, including progressive and predominant impairment in tasks related to working memory and cognitive flexibility, a lack of major behavioral/personality changes, and evidence of abnormal amyloid and tau deposition by antemortem amyloid and tau PET and postmortem neuropathology. Relative sparing of hippocampal involvement was observed in both individuals, in keeping with many cases of clinically atypical AD. One of the patients developed subtle parkinsonian signs as well as paranoia and irritability in the years prior to passing. In both cases, transitional (brainstem and limbic) LBD co-pathology was observed at autopsy. DISCUSSION Although LBD co-pathology is not uncommon in AD overall, the presence of LBD pathology in these young-onset cases of dAD (including a case with apparent symptomatic correlate) warrants further investigation for broader frequency and underlying pathophysiology. CONCLUSION A better understanding of which specific young-onset AD phenotypes are associated with LBD co-pathology would have important implications for counseling, treatment, clinical trial enrollment, and knowledge on disease mechanisms.
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Affiliation(s)
- Ryan P Coburn
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | | | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, 55905, USA
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Vijay K Ramanan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, 55905, USA
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32
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Raghavan S, Przybelski SA, Reid RI, Lesnick TG, Ramanan VK, Botha H, Matchett BJ, Murray ME, Reichard RR, Knopman DS, Graff-Radford J, Jones DT, Lowe VJ, Mielke MM, Machulda MM, Petersen RC, Kantarci K, Whitwell JL, Josephs KA, Jack CR, Vemuri P. White matter damage due to vascular, tau, and TDP-43 pathologies and its relevance to cognition. Acta Neuropathol Commun 2022; 10:16. [PMID: 35123591 PMCID: PMC8817561 DOI: 10.1186/s40478-022-01319-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 12/27/2022] Open
Abstract
Multi-compartment modelling of white matter microstructure using Neurite Orientation Dispersion and Density Imaging (NODDI) can provide information on white matter health through neurite density index and free water measures. We hypothesized that cerebrovascular disease, Alzheimer's disease, and TDP-43 proteinopathy would be associated with distinct NODDI readouts of white matter damage which would be informative for identifying the substrate for cognitive impairment. We identified two independent cohorts with multi-shell diffusion MRI, amyloid and tau PET, and cognitive assessments: specifically, a population-based cohort of 347 elderly randomly sampled from the Olmsted county, Minnesota, population and a clinical research-based cohort of 61 amyloid positive Alzheimer's dementia participants. We observed an increase in free water and decrease in neurite density using NODDI measures in the genu of the corpus callosum associated with vascular risk factors, which we refer to as the vascular white matter component. Tau PET signal reflective of 3R/4R tau deposition was associated with worsening neurite density index in the temporal white matter where we measured parahippocampal cingulum and inferior temporal white matter bundles. Worsening temporal white matter neurite density was associated with (antemortem confirmed) FDG TDP-43 signature. Post-mortem neuropathologic data on a small subset of this sample lend support to our findings. In the community-dwelling cohort where vascular disease was more prevalent, the NODDI vascular white matter component explained variability in global cognition (partial R2 of free water and neurite density = 8.3%) and MMSE performance (8.2%) which was comparable to amyloid PET (7.4% for global cognition and 6.6% for memory). In the AD dementia cohort, tau deposition was the greatest contributor to cognitive performance (9.6%), but there was also a non-trivial contribution of the temporal white matter component (8.5%) to cognitive performance. The differences observed between the two cohorts were reflective of their distinct clinical composition. White matter microstructural damage assessed using advanced diffusion models may add significant value for distinguishing the underlying substrate (whether cerebrovascular disease versus neurodegenerative disease caused by tau deposition or TDP-43 pathology) for cognitive impairment in older adults.
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Affiliation(s)
| | - Scott A. Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905 USA
| | - Robert I. Reid
- Department of Information Technology, Mayo Clinic, Rochester, MN 55905 USA
| | - Timothy G. Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905 USA
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905 USA
| | | | | | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905 USA
| | | | | | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, MN 55905 USA
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905 USA
- Department of Neurology, Mayo Clinic, Rochester, MN 55905 USA
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905 USA
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Jennifer L. Whitwell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | | | - Clifford R. Jack
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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Kantarci K, Nedelska Z, Chen Q, Senjem ML, Schwarz CG, Gunter JL, Przybelski SA, Lesnick TG, Kremers WK, Fields JA, Graff-Radford J, Savica R, Jones D, Botha H, Knopman DS, Lowe V, Graff-Radford NR, Murray MM, Dickson DW, Reichard RR, Jack CR, Petersen RC, Ferman TJ, Boeve BF. OUP accepted manuscript. Brain Commun 2022; 4:fcac013. [PMID: 35415608 PMCID: PMC8994111 DOI: 10.1093/braincomms/fcac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/10/2021] [Accepted: 02/02/2022] [Indexed: 12/02/2022] Open
Abstract
Mild cognitive impairment with the core clinical features of dementia with Lewy bodies is recognized as a prodromal stage of dementia with Lewy bodies. Although grey matter atrophy has been demonstrated in prodromal dementia with Lewy bodies, longitudinal rates of atrophy during progression to probable dementia with Lewy bodies are unknown. We investigated the regional patterns of cross-sectional and longitudinal rates of grey matter atrophy in prodromal dementia with Lewy bodies, including those who progressed to probable dementia with Lewy bodies. Patients with mild cognitive impairment with at least one core clinical feature of dementia with Lewy bodies (mean age = 70.5; 95% male), who were enrolled in the Mayo Clinic Alzheimer’s Disease Research Center and followed for at least two clinical evaluations and MRI examinations, were included (n = 56). A cognitively unimpaired control group (n = 112) was matched 2:1 to the patients with mild cognitive impairment by age and sex. Patients either remained stable (n = 28) or progressed to probable dementia with Lewy bodies (n = 28) during a similar follow-up period and pathologic confirmation was available in a subset of cases (n = 18). Cross-sectional and longitudinal rates of grey matter atrophy were assessed using voxel-based and atlas-based region of interest analyses. At baseline, prodromal dementia with Lewy bodies was characterized by atrophy in the nucleus basalis of Meynert both in those who remained stable and those who progressed to probable dementia with Lewy bodies (P < 0.05 false discovery rate corrected). Increase in longitudinal grey matter atrophy rates were widespread, with greatest rates of atrophy observed in the enthorhinal and parahippocampal cortices, temporoparietal association cortices, thalamus and the basal ganglia, in mild cognitive impairment patients who progressed to probable dementia with Lewy bodies at follow-up (P < 0.05 false discovery rate corrected). Rates of inferior temporal atrophy were associated with greater rates of worsening on the clinical dementia rating–sum of boxes. Seventeen of the 18 (94%) autopsied cases had Lewy body disease. Results show that atrophy in the nucleus basalis of Meynert is a feature of prodromal dementia with Lewy bodies regardless of proximity to progression to probable dementia with Lewy bodies. Longitudinally, grey matter atrophy progresses in regions with significant cholinergic innervation, in alignment with clinical disease progression, with widespread and accelerated rates of atrophy in patients who progress to probable dementia with Lewy bodies. Given the prominent neurodegeneration in the cholinergic system, patients with prodromal dementia with Lewy bodies may be candidates for cholinesterase inhibitor treatment.
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Affiliation(s)
- Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Correspondence to: Kejal Kantarci, MD, MS Department of Radiology Mayo Clinic 200 First Street SW Rochester, MN 55905, USA E-mail:
| | - Zuzana Nedelska
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Charles University, Prague, Czech Republic
| | - Qin Chen
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | | | | | | | | | | | - Walter K. Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Julie A. Fields
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA
| | | | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - David Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Val Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Melissa M. Murray
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Dennis W. Dickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Tanis J. Ferman
- Department of Psychology and Psychiatry, Mayo Clinic, Jacksonville, FL, USA
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Hokelekli FO, Duffy JR, Clark HM, Utianski RL, Botha H, Ali F, Stierwalt JA, Machulda MM, Reichard RR, Dickson DW, Whitwell JL, Josephs KA. Autopsy Validation of Progressive Supranuclear Palsy-Predominant Speech/Language Disorder Criteria. Mov Disord 2022; 37:213-218. [PMID: 34632629 PMCID: PMC8770531 DOI: 10.1002/mds.28822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/12/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) may present as a speech/language disorder (PSP-SL). OBJECTIVE We assessed pathological correlates of patients with PSP-SL who retained the suggestive of PSP-SL (s.o. PSP-SL) diagnosis versus those who progressed to possible/probable (poss./prob.) PSP. METHODS Thirty-four prospectively recruited patient with s.o. PSP-SL completed comprehensive speech/language and neurological assessments longitudinally, died, and underwent autopsy. RESULTS Twelve patients (35%) evolved to poss./prob PSP, while 22 (65%) remained as s.o. PSP-SL. Pathological diagnoses differed across the groups (P = 0.025). Patients with s.o. PSP-SL had four different neuropathologies (corticobasal degeneration [59%], PSP [13%], Pick's disease [14%], and frontotemporal lobar degeneration with TDP-43 [14%]), while all patients with poss./prob. PSP had a 4R-tauopathy (PSP [67%] and corticobasal degeneration [33%]). Development of poss./prob. PSP increased the chance of having PSP pathology by 2.38 times. CONCLUSIONS PSP-SL is associated with heterogenous pathologies. Evolution of PSP-SL into poss./prob. PSP is more predictive of underlying PSP pathology than s.o. PSP-SL. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | | | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic Rochester, Minnesota
| | - Farwa Ali
- Department of Neurology, Mayo Clinic Rochester, Minnesota
| | | | | | - R. Ross Reichard
- Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota
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Chahal CAA, Tester DJ, Fayyaz AU, Jaliparthy K, Khan NA, Lu D, Khan M, Sahoo A, Rajendran A, Knight JA, Simpson MA, Behr ER, So EL, St. Louis EK, Reichard RR, Edwards WD, Ackerman MJ, Somers VK. Confirmation of Cause of Death Via Comprehensive Autopsy and Whole Exome Molecular Sequencing in People With Epilepsy and Sudden Unexpected Death. J Am Heart Assoc 2021; 10:e021170. [PMID: 34816733 PMCID: PMC9075361 DOI: 10.1161/jaha.121.021170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Sudden cardiac arrest is the leading mode of death in the United States. Epilepsy affects 1% of Americans; yet epidemiological data show a prevalence of 4% in cases of sudden cardiac arrest. Sudden unexpected death in epilepsy (SUDEP) may share features with sudden cardiac arrest. The objective of this study was to report autopsy and genomic findings in a large cohort of SUDEP cases. Methods and Results Mayo Clinic Sudden Death Registry containing cases (ages 0–90 years) of sudden unexpected and unexplained deaths 1960 to present was queried. Exome sequencing performed on decedent cases. From 13 687 cases of sudden death, 656 (4.8%) had a history of seizures, including 368 confirmed by electroencephalography, 96 classified as SUDEP, 58 as non‐SUDEP, and 214 as unknown (insufficient records). Mean age of death in SUDEP was 37 (±19.7) years; 56 (58.3%) were male; 65% of deaths occurred at night; 54% were found in bed; and 80.6% were prone. Autopsies were obtained in 83 cases; bystander coronary artery disease was frequently reported as cause of death; nonspecific fibrosis was seen in 32.6% of cases, in structurally normal hearts. There were 4 cases of Dravet syndrome with pathogenic variants in SCN1A gene. Using whole exome sequencing in 11 cases, 18 ultrarare nonsynonymous variants were identified in 6 cases including CACNB2, RYR2, CLNB, CACNA1H, and CLCN2. Conclusions This study examined one of the largest single‐center US series of SUDEP cases. Several cases were reclassified as SUDEP, 15% had an ECG when alive, and 11 (11.4%) had blood for whole exome sequencing analysis. The most frequent antemortem genetic finding was pathogenic variants in SCN1A; postmortem whole exome sequencing identified 18 ultrarare variants.
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Affiliation(s)
- C. Anwar A. Chahal
- Mayo Clinic Graduate School of Biomedical SciencesMayo ClinicRochesterMN
- WellSpan Center for Inherited Cardiovascular DiseasesWellSpan HealthPA
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Division of CardiologyDepartment of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - David J. Tester
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Department of Molecular Pharmacology & Experimental TherapeuticsWindland Smith Rice Sudden Death Genomic LaboratoryMayo ClinicRochesterMN
| | - Ahmed U. Fayyaz
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Department of Laboratory Medicine & PathologyMayo ClinicRochesterMN
| | - Keerthi Jaliparthy
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Department of MedicineMayo ClinicRochesterMN
- Mayo Clinic College of MedicineMayo ClinicRochesterMN
| | | | - Dongmei Lu
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Mayo Clinic College of MedicineMayo ClinicRochesterMN
| | - Mariha Khan
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | | | | | | | | | - Elijah R. Behr
- Cardiology Section and Cardiovascular Clinical Academic GroupSt George’s, University of LondonLondonUnited Kingdom
- St George’s University Hospitals’ NHS Foundation TrustLondonUnited Kingdom
| | - Elson L. So
- Department of NeurologyMayo ClinicRochesterMN
| | - Erik K. St. Louis
- Mayo Clinic College of MedicineMayo ClinicRochesterMN
- Department of NeurologyMayo ClinicRochesterMN
- Mayo Center for Sleep MedicineMayo ClinicRochesterMN
| | - R. Ross Reichard
- Department of Laboratory Medicine & PathologyMayo ClinicRochesterMN
| | | | | | - Virend K. Somers
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Mayo Clinic College of MedicineMayo ClinicRochesterMN
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Choudhury P, Graff-Radford J, Aakre JA, Wurtz L, Knopman DS, Graff-Radford NR, Kantarci K, Forsberg LK, Fields JA, Pedraza O, Chen Q, Miyagawa T, Day GS, Tipton P, Savica R, Botha H, Lachner C, Dredla B, Reichard RR, Petersen RC, Dickson DW, Boeve BF, Ferman TJ. The temporal onset of the core features in dementia with Lewy bodies. Alzheimers Dement 2021; 18:591-601. [PMID: 34761850 PMCID: PMC8986606 DOI: 10.1002/alz.12411] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/11/2020] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023]
Abstract
Introduction We examined the temporal sequence of the core features in probable dementia with Lewy bodies (DLB). Methods In 488 patients with probable DLB, the onset of each core feature and time to diagnosis was determined for men and women, and a pathologic subgroup (n = 209). Results REM sleep behavior disorder (RBD) developed before the other core features in men and women. Men were more likely to have RBD and were diagnosed with probable DLB earlier than women. Visual hallucinations developed after the other core features in men, but in women, they appeared earlier and concurrently with fluctuations and parkinsonism. Women were older and more cognitively impaired at first visit, were less likely to have RBD, more likely to be diagnosed with probable DLB later than men, and more likely to have neocortical tangles. Discussion An earlier latency to probable DLB was associated with men, RBD, and Lewy body disease without neocortical tangles.
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Affiliation(s)
| | | | - Jeremiah A Aakre
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Lincoln Wurtz
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Leah K Forsberg
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Otto Pedraza
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Qin Chen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, West China Hospital of Sichuan University, Sichuan, China
| | - Toji Miyagawa
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Philip Tipton
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christian Lachner
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Brynn Dredla
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
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McCarter SJ, Lesnick TG, Lowe V, Mielke MM, Constantopoulos E, Rabinstein AA, Przybelski SA, Botha H, Jones DT, Ramanan VK, Jack CR, Petersen RC, Knopman D, Boeve BF, Murray ME, Dickson DW, Vemuri P, Kantarci K, Reichard RR, Graff-Radford J. Cerebral Amyloid Angiopathy Pathology and Its Association With Amyloid-β PET Signal. Neurology 2021; 97:e1799-e1808. [PMID: 34504022 PMCID: PMC8610626 DOI: 10.1212/wnl.0000000000012770] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/12/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the contribution of cerebral amyloid angiopathy (CAA) to Pittsburgh compound B (PiB)-PET tracer retention. METHODS Participants from the Mayo Clinic Study of Aging and Mayo Clinic Alzheimer's Disease Research Center with antemortem PiB-PET imaging for β-amyloid (Aβ) who later underwent autopsy were included in this study. Pathologic regional leptomeningeal, parenchymal, capillary CAA, and Aβ plaque burden were calculated from one hemisphere. Regional lobar amyloid standardized uptake value ratio (SUVR) on PET was calculated from the same hemisphere sampled at autopsy. Single- and multiple-predictor linear regression models were used to evaluate the relative contributions of pathologically determined regional CAA and Aβ plaques to antemortem PiB-PET SUVR. RESULTS Forty-one participants (30 male, 11 female) with a mean (SD) age at death of 75.7 (10.6) years were included. Twenty-seven (66%) had high PiB signal with a mean (SD) of 2.3 (1.2) years from time of PET scan to death; 24 (59%) had a pathologic diagnosis of Alzheimer disease. On multivariate analysis, CAA was not associated with PiB-PET SUVR, while plaques remained associated with PiB-PET SUVR in all regions (all p < 0.05). In patients without frequent amyloid plaques, CAA was not associated with PiB-PET in any region. DISCUSSION We did not find evidence that pathologically confirmed regional CAA burden contributes significantly to proximal antemortem regional PiB-PET signal, suggesting that amyloid PET imaging for measurement of cortical amyloid burden is unconfounded by CAA on a lobar level. Whether CAA burden contributes to PiB-PET signal in patients with severe CAA phenotypes, such as lobar hemorrhage, requires further investigation.
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Affiliation(s)
- Stuart J McCarter
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL.
| | - Timothy G Lesnick
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Val Lowe
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Michelle M Mielke
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Eleni Constantopoulos
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Alejandro A Rabinstein
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Scott A Przybelski
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Hugo Botha
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - David T Jones
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Vijay K Ramanan
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Clifford R Jack
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Ronald C Petersen
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - David Knopman
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Bradley F Boeve
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Melissa E Murray
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Dennis W Dickson
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Prashanthi Vemuri
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Kejal Kantarci
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - R Ross Reichard
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Jonathan Graff-Radford
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
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Buciuc M, Tosakulwong N, Machulda MM, Whitwell JL, Weigand SD, Murray ME, Reichard RR, Parisi JE, Dickson DW, Boeve BF, Knopman DS, Petersen RC, Josephs KA. TAR DNA-Binding Protein 43 Is Associated with Rate of Memory, Functional and Global Cognitive Decline in the Decade Prior to Death. J Alzheimers Dis 2021; 80:683-693. [PMID: 33579840 PMCID: PMC8020877 DOI: 10.3233/jad-201166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 12/25/2022]
Abstract
Background: Transactive response DNA-binding protein of 43 kDa (TDP-43) is associated with memory impairment and overall cognitive decline. It is unclear how TDP-43 contributes to the rate of clinical decline. Objective: To determine whether cross-sectional and longitudinal cognitive and functional decline are associated with anatomical distribution of TDP-43 in the brain. Methods: Longitudinal clinical-neuropathologic autopsy cohort study of 385 initially cognitively normal/mildly impaired older adults prospectively followed until death. We investigated how TDP-43, amyloid-β (Aβ), tau neurofibrillary tangles (NFT), Lewy body disease (LBD), age, sex, and genetics are associated with clinical scores and rates of their longitudinal decline. Results: Of 385 participants, 260 (68%) had no TDP-43, 32 (8%) had TDP-43 limited to amygdala, and 93 (24%) had TDP-43 in the hippocampus and beyond. Higher TDP-43 and Braak NFT stages independently were associated with faster decline in global cognition, functional performance measured by Clinical Dementia Rating scale, and naming and episodic memory, whereas older age was associated with slower rate of cognitive, psychiatric, and functional decline. Cross-sectionally the following associations were found: higher TDP-43 and Braak NFT - worse performance; higher Aβ burden - worse global cognition, more behavioral changes, the latter also with higher LBD; older age - worse naming, lower frequency of behavioral changes; female sex - more impaired naming and better preserved episodic memory. There were no genetic associations. Conclusion: The association of TDP-43 distribution with decline in cognitive and functional performance suggests that TDP-43 is playing a role in the clinical progression to dementia. Further characterization of clinical features associated with TDP-43 can facilitate establishment of antemortem diagnosis.
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Affiliation(s)
- Marina Buciuc
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Stephen D Weigand
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Buciuc M, Whitwell JL, Kasanuki K, Graff-Radford J, Machulda MM, Duffy JR, Strand EA, Lowe VJ, Graff-Radford NR, Rush BK, Franczak MB, Flanagan ME, Baker MC, Rademakers R, Ross OA, Ghetti BF, Parisi JE, Raghunathan A, Reichard RR, Bigio EH, Dickson DW, Josephs KA. Lewy Body Disease is a Contributor to Logopenic Progressive Aphasia Phenotype. Ann Neurol 2021; 89:520-533. [PMID: 33274526 PMCID: PMC8040336 DOI: 10.1002/ana.25979] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of this study was to describe clinical features, [18 F]-fluorodeoxyglucose (FDG)-positron emission tomography (PET) metabolism and digital pathology in patients with logopenic progressive aphasia (LPA) and pathologic diagnosis of diffuse Lewy body disease (DLBD) and compare to patients with LPA with other pathologies, as well as patients with classical features of probable dementia with Lewy bodies (pDLB). METHODS This is a clinicopathologic case-control study of 45 patients, including 20 prospectively recruited patients with LPA among whom 6 were diagnosed with LPA-DLBD. We analyzed clinical features and compared FDG-PET metabolism in LPA-DLBD to an independent group of patients with clinical pDLB and regional α-synuclein burden on digital pathology to a second independent group of autopsied patients with DLBD pathology and antemortem pDLB (DLB-DLBD). RESULTS All patients with LPA-DLBD were men. Neurological, speech, and neuropsychological characteristics were similar across LPA-DLBD, LPA-Alzheimer's disease (LPA-AD), and LPA-frontotemporal lobar degeneration (LPA-FTLD). Genetic screening of AD, DLBD, and FTLD linked genes were negative with the exception of APOE ε4 allele present in 83% of LPA-DLBD patients. Seventy-five percent of the patients with LPA-DLBD showed a parietal-dominant pattern of hy pometabolism; LPA-FTLD - temporal-dominant pattern, whereas LPA-AD showed heterogeneous patterns of hypometabolism. LPA-DLBD had more asymmetrical hypometabolism affecting frontal lobes, with relatively spared occipital lobe in the nondominantly affected hemisphere, compared to pDLB. LPA-DLBD had minimal atrophy on gross brain examination, higher cortical Lewy body counts, and higher α-synuclein burden in the middle frontal and inferior parietal cortices compared to DLB-DLBD. INTERPRETATION Whereas AD is the most frequent underlying pathology of LPA, DLBD can also be present and may contribute to the LPA phenotype possibly due to α-synuclein-associated functional impairment of the dominant parietal lobe. ANN NEUROL 2021;89:520-533.
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Affiliation(s)
- Marina Buciuc
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Koji Kasanuki
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Department of Neuropsychiatry, St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Beth K. Rush
- Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Margaret E. Flanagan
- Department of Pathology, Cognitive Neurology and Alzheimer’s Disease Centre, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Owen A. Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Bernardino F. Ghetti
- Department of Pathology & Laboratory Medicine, Indiana University, Indianapolis, IN, USA
| | - Joseph E. Parisi
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Aditya Raghunathan
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R. Ross Reichard
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Eileen H. Bigio
- Department of Pathology, Cognitive Neurology and Alzheimer’s Disease Centre, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Juskewitch JE, Griffin JM, Maleszewski JJ, Asiedu GB, Paolini MA, Regnier AK, Yrjo ML, Kendall ML, Comfere NI, Cheville AL, Carey EC, Amirahmadi F, Rabatin JT, Moynihan TJ, Reichard RR, Aubry MC. Resurrecting the Hospital Autopsy: Impact of an Office of Decedent Affairs on Consent Rates, Providers, and Next-of-Kin. Arch Pathol Lab Med 2021; 145:55-65. [PMID: 33367663 DOI: 10.5858/arpa.2019-0571-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Autopsy rates have decreased dramatically despite providing important clinical information to medical practices and social benefits to decedents' families. OBJECTIVE.— To assess the impact of an institutional Office of Decedent Affairs (ODA), a direct communication link between pathology and decedents' families, on hospital autopsy consent rates, autopsy-related communication, practitioner views, and next-of-kin experiences. DESIGN.— A before and after study involving all hospital decedents whose deaths did not fall within the jurisdiction of the medical examiner's office from 2013 to 2018. A pathology-run ODA launched in May 2016 to guide next-of-kin through the hospital death process (including autopsy-related decisions) and serve as the next-of-kin's contact for any subsequent autopsy-related communication. Critical care and hematology/oncology practitioners were assessed for their autopsy-related views and decedents' next-of-kin were assessed for their autopsy-related experiences. Autopsy consent rates for non-medical examiner hospital deaths, autopsy-related communication rates, practitioner views on the role and value of autopsy, and next-of-kin autopsy experiences and decisions factors were compared prior to and after ODA launch. RESULTS.— Autopsy consent rates significantly increased from 13.2% to 17.3% (480 of 3647 deaths versus 544 of 3148 deaths; P < .001). There were significant increases in the rate of autopsy-related discussions and bereavement counseling provided to decedents' families. Practitioner views on the positive role of autopsy for any hospital death and those with advanced stage cancer also significantly increased. Next-of-kin indicated more consistent autopsy-related discussions with the potential benefits of autopsy discussed becoming key decision factors. CONCLUSIONS.— An ODA improves hospital autopsy consent rates, autopsy-related communication, providers' autopsy-related views, and next-of-kins autopsy experiences.
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Affiliation(s)
- Justin E Juskewitch
- The Department of Laboratory Medicine & Pathology (Juskewitch, Maleszewski, Paolini II, Amirahmadi, Reichard, Aubry, Regnier, Yrjo, Kendall), Mayo Clinic, Rochester, Minnesota
| | - Joan M Griffin
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (Griffin, Asiedu, Comfere, Cheville), Mayo Clinic, Rochester, Minnesota.,The Division of Health Care Policy and Research (Griffin, Comfere, Cheville), Mayo Clinic, Rochester, Minnesota
| | - Joseph J Maleszewski
- The Department of Laboratory Medicine & Pathology (Juskewitch, Maleszewski, Paolini II, Amirahmadi, Reichard, Aubry, Regnier, Yrjo, Kendall), Mayo Clinic, Rochester, Minnesota
| | - Gladys B Asiedu
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (Griffin, Asiedu, Comfere, Cheville), Mayo Clinic, Rochester, Minnesota
| | - Michael A Paolini
- The Department of Laboratory Medicine & Pathology (Juskewitch, Maleszewski, Paolini II, Amirahmadi, Reichard, Aubry, Regnier, Yrjo, Kendall), Mayo Clinic, Rochester, Minnesota
| | - Angela K Regnier
- The Department of Laboratory Medicine & Pathology (Juskewitch, Maleszewski, Paolini II, Amirahmadi, Reichard, Aubry, Regnier, Yrjo, Kendall), Mayo Clinic, Rochester, Minnesota
| | - Melanie L Yrjo
- The Department of Laboratory Medicine & Pathology (Juskewitch, Maleszewski, Paolini II, Amirahmadi, Reichard, Aubry, Regnier, Yrjo, Kendall), Mayo Clinic, Rochester, Minnesota
| | - Monica L Kendall
- The Department of Laboratory Medicine & Pathology (Juskewitch, Maleszewski, Paolini II, Amirahmadi, Reichard, Aubry, Regnier, Yrjo, Kendall), Mayo Clinic, Rochester, Minnesota
| | - Nneka I Comfere
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (Griffin, Asiedu, Comfere, Cheville), Mayo Clinic, Rochester, Minnesota.,The Division of Health Care Policy and Research (Griffin, Comfere, Cheville), Mayo Clinic, Rochester, Minnesota.,The Department of Dermatology (Comfere), Mayo Clinic, Rochester, Minnesota
| | - Andrea L Cheville
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (Griffin, Asiedu, Comfere, Cheville), Mayo Clinic, Rochester, Minnesota.,The Division of Health Care Policy and Research (Griffin, Comfere, Cheville), Mayo Clinic, Rochester, Minnesota
| | - Elise C Carey
- The Division of General Internal Medicine in the Department of Medicine (Carey), Mayo Clinic, Rochester, Minnesota
| | - Fazlollaah Amirahmadi
- The Department of Laboratory Medicine & Pathology (Juskewitch, Maleszewski, Paolini II, Amirahmadi, Reichard, Aubry, Regnier, Yrjo, Kendall), Mayo Clinic, Rochester, Minnesota
| | - Jeffrey T Rabatin
- The Division of Pulmonary and Critical Care Medicine in the Department of Internal Medicine (Rabatin), Mayo Clinic, Rochester, Minnesota
| | - Timothy J Moynihan
- The Division of Medical Oncology in the Department of Oncology (Moynihan), Mayo Clinic, Rochester, Minnesota
| | - R Ross Reichard
- The Department of Laboratory Medicine & Pathology (Juskewitch, Maleszewski, Paolini II, Amirahmadi, Reichard, Aubry, Regnier, Yrjo, Kendall), Mayo Clinic, Rochester, Minnesota
| | - Marie-Christine Aubry
- The Department of Laboratory Medicine & Pathology (Juskewitch, Maleszewski, Paolini II, Amirahmadi, Reichard, Aubry, Regnier, Yrjo, Kendall), Mayo Clinic, Rochester, Minnesota
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Graff-Radford J, Lesnick TG, Mielke MM, Constantopoulos E, Rabinstein A, Przybelski SA, Vemuri P, Botha H, Jones DT, Ramanan VK, Petersen RC, Knopman DS, Boeve BF, Murray ME, Dickson DW, Jack CR, Kantarci K, Reichard RR. Cerebral Amyloid Angiopathy Burden and Cerebral Microbleeds: Pathological Evidence for Distinct Phenotypes. J Alzheimers Dis 2021; 81:113-122. [PMID: 33720897 PMCID: PMC8113155 DOI: 10.3233/jad-201536] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The relationship between cerebral microbleeds (CMBs) on hemosiderin-sensitive MRI sequences and cerebral amyloid angiopathy (CAA) remains unclear in population-based participants or in individuals with dementia. OBJECTIVE To determine whether CMBs on antemortem MRI correlate with CAA. METHODS We reviewed 54 consecutive participants with antemortem T2*GRE-MRI sequences and subsequent autopsy. CMBs were quantified on MRIs closest to death. Autopsy CAA burden was quantified in each region including leptomeningeal/cortical and capillary CAA. By a clustering approach, we examined the relationship among CAA variables and performed principal component analysis (PCA) for dimension reduction to produce two scores from these 15 interrelated predictors. Hurdle models assessed relationships between principal components and lobar CMBs. RESULTS MRI-based CMBs appeared in 20/54 (37%). 10 participants had ≥2 lobar-only CMBs. The first two components of the PCA analysis of the CAA variables explained 74% variability. The first rotated component (RPC1) consisted of leptomeningeal and cortical CAA and the second rotated component of capillary CAA (RPC2). Both the leptomeningeal and cortical component and the capillary component correlated with lobar-only CMBs. The capillary CAA component outperformed the leptomeningeal and cortical CAA component in predicting lobar CMBs. Both capillary and the leptomeningeal/cortical components correlated with number of lobar CMBs. CONCLUSION Capillary and leptomeningeal/cortical scores correlated with lobar CMBs on MRI but lobar CMBs were more closely associated with the capillary component. The capillary component correlated with APOEɛ4, highlighting lobar CMBs as one aspect of CAA phenotypic diversity. More CMBs also increase the probability of underlying CAA.
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Affiliation(s)
| | | | - Michelle M. Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Department of Health Sciences Research
| | | | | | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Melissa E. Murray
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, Florida
| | - Dennis W. Dickson
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - R. Ross Reichard
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota
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Miyagawa T, Przybelski SA, Maltais D, Min HK, Jordan L, Lesnick TG, Chen Q, Graff-Radford J, Jones D, Savica R, Knopman D, Petersen R, Kremers WK, Forsberg LK, Fields JA, Ferman TJ, Allen L, Parisi J, Reichard RR, Murray M, Dickson D, Boeve BF, Kantarci K, Lowe VJ. The value of multimodal imaging with 123I-FP-CIT SPECT in differential diagnosis of dementia with Lewy bodies and Alzheimer's disease dementia. Neurobiol Aging 2020; 99:11-18. [PMID: 33422890 DOI: 10.1016/j.neurobiolaging.2020.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/13/2020] [Accepted: 12/05/2020] [Indexed: 11/17/2022]
Abstract
Reduced nigrostriatal uptake on N-(3-fluoropropyl)-2β-carbomethoxy-3β-(4-[123I]iodophenyl) nortropane (123I-FP-CIT) SPECT reflects dopamine dysfunction, while other imaging markers could be complementary when used together. We assessed how well 123I-FP-CIT SPECT differentiates dementia with Lewy bodies (DLBs) from Alzheimer's disease dementia (ADem) and whether multimodal imaging provides additional value. 123I-FP-CIT SPECT, magnetic resonance imaging, [18F]2-fluoro-deoxy-D-glucose-positron emission tomography (PET), and 11C-Pittsburgh compound B (PiB)-PET were assessed in 35 participants with DLBs and 14 participants with ADem (autopsy confirmation in 9 DLBs and 4 ADem). Nigrostriatal dopamine transporter uptake was evaluated with 123I-FP-CIT SPECT using DaTQUANT software. Hippocampal volume was calculated with magnetic resonance imaging, cingulate island sign ratio with FDG-PET, and global cortical PiB retention with PiB-PET. The DaTQUANT z-scores of the putamen showed the highest c-statistic of 0.916 in differentiating DLBs from ADem among the analyzed imaging biomarkers. Adding another imaging modality to 123I-FP-CIT SPECT had c-statistics ranging from 0.968 to 0.975, and 123I-FP-CIT SPECT in combination with 2 other imaging modalities presented c-statistics ranging from 0.987 to 0.996. These findings suggest that multimodal imaging with 123I-FP-CIT SPECT aids in differentiating DLBs and ADem and in detecting comorbid Lewy-related and Alzheimer's disease pathology in patients with DLBs and ADem.
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Affiliation(s)
- Toji Miyagawa
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Hoon-Ki Min
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Lennon Jordan
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Timothy G Lesnick
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Qin Chen
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - David Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Walter K Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Laura Allen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Joseph Parisi
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - R Ross Reichard
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Melissa Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Dennis Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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Walker LE, Heaton HA, Monroe RJ, Reichard RR, Kendall M, Mullan AF, Goyal DG. Impact of the SARS-CoV-2 Pandemic on Emergency Department Presentations in an Integrated Health System. Mayo Clin Proc 2020; 95:2395-2407. [PMID: 33153630 PMCID: PMC7501771 DOI: 10.1016/j.mayocp.2020.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To quantify the impact of the severe acute respiratory syndrome coronavirus 2 pandemic on emergency department volumes and patient presentations and evaluate changes in community mortality for the purpose of characterizing new patterns of emergency care use. PATIENTS AND METHODS This is an observational cross-sectional study using electronic health records for emergency department visits in an integrated multihospital system with academic and community practices across 4 states for visits between March 17 and April 21, 2019, and February 9 and April 21, 2020. We compared numbers and proportions of common and critical chief symptoms and diagnoses, triage assessments, throughput, disposition, and selected hospital lengths of stay and out-of-hospital deaths. RESULTS In the period of interest, emergency department visits decreased by nearly 50% (35037 to 18646). Total numbers of patients with myocardial infarctions, stroke, appendicitis, and cholecystitis diagnosed decreased. The percentage of visits for mental health symptoms increased. There was an increase in deaths, driven by out-of-hospital mortality. CONCLUSION Fewer patients presenting with acute and time-sensitive diagnoses suggests that patients are deferring care. This may be further supported by an increase in out-of-hospital mortality. Understanding which patients are deferring care and why will allow us to develop outreach strategies and ensure that those in need of rapid assessment and treatment will do so, preventing downstream morbidity and mortality.
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Key Words
- covid-19, coronavirus disease 2019
- ed, emergency department
- ehr, electronic health record
- esi, emergency severity index
- los, length of stay
- me, medical examiner
- mi, myocardial infarction
- mn, minnesota
- nstemi, non–st-elevation myocardial infarction
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- smrmeo, southern minnesota regional medical examiner’s office
- stemi, st-elevation myocardial infarction
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Affiliation(s)
- Laura E Walker
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN.
| | | | - Ryan J Monroe
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Monica Kendall
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Aidan F Mullan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Deepi G Goyal
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
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Crandall LG, Lee JH, Friedman D, Lear K, Maloney K, Pinckard JK, Lin P, Andrew T, Roman K, Landi K, Jarrell H, Williamson AK, Downs JCU, Pinneri K, William C, Maleszewski JJ, Reichard RR, Devinsky O. Evaluation of Concordance Between Original Death Certifications and an Expert Panel Process in the Determination of Sudden Unexplained Death in Childhood. JAMA Netw Open 2020; 3:e2023262. [PMID: 33125496 PMCID: PMC7599447 DOI: 10.1001/jamanetworkopen.2020.23262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The true incidence of sudden unexplained death in childhood (SUDC), already the fifth leading category of death among toddlers by current US Centers for Disease Control and Prevention estimates, is potentially veiled by the varied certification processes by medicolegal investigative offices across the United States. OBJECTIVE To evaluate the frequency of SUDC incidence, understand its epidemiology, and assess the consistency of death certification among medical examiner and coroner offices in the US death investigation system. DESIGN, SETTING, AND PARTICIPANTS In this case series, 2 of 13 forensic pathologists (FPs) conducted masked reviews of 100 cases enrolled in the SUDC Registry and Research Collaborative (SUDCRRC). Children who died aged 11 months to 18 years from 36 US states, Canada, and the United Kingdom had been posthumously enrolled in the SUDCRRC by family members from 2014 to 2017. Comprehensive data from medicolegal investigative offices, clinical offices, and family members were reviewed. Data analysis was conducted from December 2014 to June 2020. MAIN OUTCOMES AND MEASURES Certified cause of death (COD) characterized as explained (accidental or natural) or unexplained, as determined by SUDCRRC masked review process. RESULTS In this study of 100 cases of SUDC (mean [SD] age, 32.1 [31.8] months; 58 [58.0%] boys; 82 [82.0%] White children; 92 [92.0%] from the United States), the original pathologist certified 43 cases (43.0%) as explained COD and 57 (57.0%) as unexplained COD. The SUDCRRC review process led to the following certifications: 16 (16.0%) were explained, 7 (7.0%) were undetermined because of insufficient data, and 77 (77.0%) were unexplained. Experts disagreed with the original COD in 40 cases (40.0%). These data suggest that SUDC incidence is higher than the current Centers for Disease Control and Prevention estimate (ie, 392 deaths in 2018). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first comprehensive masked forensic pathology review process of sudden unexpected pediatric deaths, and it suggests that SUDC may often go unrecognized in US death investigations. Some unexpected pediatric deaths may be erroneously attributed to a natural or accidental COD, negatively affecting surveillance, research, public health funding, and medical care of surviving family members. To further address the challenges of accurate and consistent death certification in SUDC, future studies are warranted.
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Affiliation(s)
| | - Joyce H. Lee
- NYU Grossman School of Medicine, New York, New York
| | | | - Kelly Lear
- Arapahoe County Coroner’s Office, Centennial, Colorado
| | - Katherine Maloney
- Erie County Medical Examiner's Office, Buffalo, New York
- University at Buffalo School of Medicine, Buffalo, New York
| | | | | | - Thomas Andrew
- White Mountain Forensic Consulting Services, Concord, New Hampshire
| | | | | | | | | | | | - Kathy Pinneri
- Montgomery County Forensic Services Department, Conroe, Texas
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Reichard RR, Kashani KB, Boire NA, Constantopoulos E, Guo Y, Lucchinetti CF. Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology. Acta Neuropathol 2020; 140:1-6. [PMID: 32449057 PMCID: PMC7245994 DOI: 10.1007/s00401-020-02166-2] [Citation(s) in RCA: 346] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 10/31/2022]
Abstract
We report the neuropathological findings of a patient who died from complications of COVID-19. The decedent was initially hospitalized for surgical management of underlying coronary artery disease. He developed post-operative complications and was evaluated with chest imaging studies. The chest computed tomography (CT) imaging results were indicative of COVID-19 and he was subsequently tested for SARS-CoV-2, which was positive. His condition worsened and he died after more than 2 weeks of hospitalization and aggressive treatment. The autopsy revealed a range of neuropathological lesions, with features resembling both vascular and demyelinating etiologies. Hemorrhagic white matter lesions were present throughout the cerebral hemispheres with surrounding axonal injury and macrophages. The subcortical white matter had scattered clusters of macrophages, a range of associated axonal injury, and a perivascular acute disseminated encephalomyelitis (ADEM)-like appearance. Additional white matter lesions included focal microscopic areas of necrosis with central loss of white matter and marked axonal injury. Rare neocortical organizing microscopic infarcts were also identified. Imaging and clinical reports have demonstrated central nervous system complications in patients' with COVID-19, but there is a gap in our understanding of the neuropathology. The lesions described in this case provide insight into the potential parainfectious processes affecting COVID-19 patients, which may direct clinical management and ongoing research into the disease. The clinical course of the patient also illustrates that during prolonged hospitalizations neurological complications of COVID may develop, which are particularly difficult to evaluate and appreciate in the critically ill.
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Ferman TJ, Aoki N, Boeve BF, Aakre JA, Kantarci K, Graff-Radford J, Parisi JE, Van Gerpen JA, Graff-Radford NR, Uitti RJ, Pedraza O, Murray ME, Wszolek ZK, Reichard RR, Fields JA, Ross OA, Knopman DS, Petersen RC, Dickson DW. Subtypes of dementia with Lewy bodies are associated with α-synuclein and tau distribution. Neurology 2020; 95:e155-e165. [PMID: 32561678 DOI: 10.1212/wnl.0000000000009763] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/17/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To determine whether Lewy body disease subgroups have different clinical profiles. METHODS Participants had dementia, autopsy-confirmed transitional or diffuse Lewy body disease (TLBD or DLBD) (n = 244), or Alzheimer disease (AD) (n = 210), and were seen at least twice (mean follow-up 6.2 ± 3.8 years). TLBD and DLBD groups were partitioned based on the presence or absence of neocortical neurofibrillary tangles using Braak staging. Four Lewy body disease subgroups and AD were compared on clinical features, dementia trajectory, and onset latency of probable dementia with Lewy bodies (DLB) or a DLB syndrome defined as probable DLB or dementia with one core feature of parkinsonism or probable REM sleep behavior disorder. RESULTS In TLBD and DLBD without neocortical tangles, diagnostic sensitivity was strong for probable DLB (87% TLBD, 96% DLBD) and the DLB syndrome (97% TLBD, 98% DLBD) with median latencies <1 year from cognitive onset, and worse baseline attention-visual processing but better memory-naming scores than AD. In DLBD with neocortical tangles, diagnostic sensitivity was 70% for probable DLB and 77% for the DLB syndrome with respective median latencies of 3.7 years and 2.7 years from cognitive onset, each associated with tangle distribution. This group had worse baseline attention-visual processing than AD, but comparable memory-naming impairment. TLBD with neocortical tangles had 48% diagnostic sensitivity for probable DLB and 52% for the DLB syndrome, with median latencies >6 years from cognitive onset, and were cognitively similar to AD. Dementia trajectory was slowest for TLBD without neocortical tangles, and fastest for DLBD with neocortical tangles. CONCLUSIONS The phenotypic expression of DLB was associated with the distribution of α-synuclein and tau pathology.
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Affiliation(s)
- Tanis J Ferman
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN.
| | - Naoya Aoki
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Bradley F Boeve
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Jeremiah A Aakre
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Kejal Kantarci
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Jonathan Graff-Radford
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Joseph E Parisi
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Jay A Van Gerpen
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Neill R Graff-Radford
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Ryan J Uitti
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Otto Pedraza
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Melissa E Murray
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Zbigniew K Wszolek
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - R Ross Reichard
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Julie A Fields
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Owen A Ross
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - David S Knopman
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
| | - Dennis W Dickson
- From the Departments of Psychiatry and Psychology (T.J.F., O.P.), Neurology (J.A.V.G., N.R.G.-R., R.J.U., Z.K.W.), and Neuroscience (M.E.M., O.A.R., D.W.D.) Mayo Clinic, Jacksonville, FL; Department of Psychiatry (N.A.), Yokohama University Medical Center, Japan; and Departments of Neurology (B.F.B., J.G.-R., D.S.K., R.C.P.), Health Sciences Research (J.A.A.), Radiology (K.K.), Laboratory Medicine and Pathology (J.E.P., R.R.R.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN
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Abstract
The legal system of the United States is complex, with nuances that are particular to its many jurisdictions. The neuropathologist may professionally interact with the legal system in both criminal and civil proceedings as either a fact or expert witness, and in rare instances as a defendant. The nature of the legal issue at hand will define the pathologist's role and determine what actions are required or requested. The intersection of neuropathology and the laws governing quality assurance may be less defined as legal statutes vary by state; although, the general principles of privilege, peer review, and confidentiality remain similar. Aside from a forensic pathology fellowship, there is often little in the way of our training to prepare us for our potential roles in the courtroom. This article serves as a review for the neuropathologist's role as a witness, the legal proceedings that you may participate in, and the intersection between quality assurance and law.
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Affiliation(s)
- Jesse Lee Kresak
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | | | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Lowe VJ, Lundt ES, Albertson SM, Min HK, Fang P, Przybelski SA, Senjem ML, Schwarz CG, Kantarci K, Boeve B, Jones DT, Reichard RR, Tranovich JF, Hanna Al-Shaikh FS, Knopman DS, Jack CR, Dickson DW, Petersen RC, Murray ME. Tau-positron emission tomography correlates with neuropathology findings. Alzheimers Dement 2020; 16:561-571. [PMID: 31784374 DOI: 10.1016/j.jalz.2019.09.079] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Comparison of tau (flortaucipir) positron emission tomography (FTP-PET) to autopsy is important to demonstrate the relationship of FTP-PET to neuropathologic findings. METHODS Autopsies were performed on 26 participants who had antemortem FTP-PET. FTP-PET standardized uptake value ratios (SUVRs) were compared to autopsy diagnoses and Braak tangle stage. Quantitative tau burden was compared to regional FTP-PET signal. RESULTS Participants with Braak stages of IV or greater had elevated FTP-PET signal. FTP-PET was elevated in participants with Alzheimer's disease. An FTP-PET SUVR cut point of 1.29 was determined to be optimal. Quantitative measurements of hippocampal and temporal lobe tau burden were highly correlated to FTP-PET signal (rho's from 0.61 to 0.70, P ≤ .02). DISCUSSION Elevated FTP-PET reflects Braak IV or greater neuropathology. Participants with primary age-related tauopathy and hippocampal sclerosis did not show elevated FTP-PET signal. Secondary neuropathologic diagnoses of Alzheimer's disease neuropathologic change can lead to borderline elevated FTP-PET signal.
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Affiliation(s)
- Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Emily S Lundt
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Hoon-Ki Min
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ping Fang
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Bradley Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
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Bieniek KF, Blessing MM, Heckman MG, Diehl NN, Serie AM, Paolini MA, Boeve BF, Savica R, Reichard RR, Dickson DW. Association between contact sports participation and chronic traumatic encephalopathy: a retrospective cohort study. Brain Pathol 2020; 30:63-74. [PMID: 31199537 PMCID: PMC6916416 DOI: 10.1111/bpa.12757] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/08/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy is a debilitating neurodegenerative disorder associated with repetitive traumatic brain injuries often sustained through prior contact sport participation. The frequency of this disorder in a diverse population, including amateur athletes, is unknown. Primary historical obituary and yearbook records were queried for 2566 autopsy cases in the Mayo Clinic Tissue Registry resulting in identification of 300 former athletes and 450 non-athletes. In these cases, neocortical tissue was screened for tau pathology with immunohistochemistry, including pathology consistent with chronic traumatic encephalopathy, blinded to exposure or demographic information. Using research infrastructure of the Rochester Epidemiology Project, a comprehensive and established medical records-linkage system of care providers in southern Minnesota and western Wisconsin, medical diagnostic billing codes pertaining to head trauma, dementia, movement disorders, substance abuse disorders and psychiatric disorders were recorded for cases and controls in a blinded manner. A total of 42 individuals had pathology consistent with, or features of, chronic traumatic encephalopathy. It was more frequent in athletes compared to non-athletes (27 cases versus 15 cases) and was largely observed in men (except for one woman). For contact sports, American football had the highest frequency of chronic traumatic encephalopathy pathology (15% of cases) and an odds ratio of 2.62 (P-value = 0.005). Cases with chronic traumatic encephalopathy pathology had higher frequencies of antemortem clinical features of dementia, psychosis, movement disorders and alcohol abuse compared to cases without chronic traumatic encephalopathy pathology. Understanding the frequency of chronic traumatic encephalopathy pathology in a large autopsy cohort with diverse exposure backgrounds provides a baseline for future prospective studies assessing the epidemiology and public health impact of chronic traumatic encephalopathy and sports-related repetitive head trauma.
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Affiliation(s)
- Kevin F. Bieniek
- Department of NeuroscienceMayo ClinicJacksonvilleFL
- Department of Pathology and Laboratory Medicine, Long School of MedicineUT Health San AntonioSan AntonioTX
| | | | - Michael G. Heckman
- Division of Biomedical Statistics and InformaticsMayo ClinicJacksonvilleFL
| | - Nancy N. Diehl
- Division of Biomedical Statistics and InformaticsMayo ClinicJacksonvilleFL
| | | | | | | | - Rodolfo Savica
- Department of NeurologyMayo ClinicRochesterMN
- Division of Epidemiology, Department of Health Sciences ResearchMayo ClinicRochesterMN
| | - R. Ross Reichard
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMN
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Graff-Radford J, Raman MR, Rabinstein AA, Przybelski SA, Lesnick TG, Boeve BF, Murray ME, Dickson DW, Reichard RR, Parisi JE, Knopman DS, Petersen RC, Jack CR, Kantarci K. Association Between Microinfarcts and Blood Pressure Trajectories. JAMA Neurol 2019; 75:212-218. [PMID: 29204605 DOI: 10.1001/jamaneurol.2017.3392] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Cerebral microinfarcts are associated with increased risk of cognitive impairment and may have different risk factors than macroinfarcts. Subcortical microinfarcts are associated with declining blood pressure (BP) in elderly individuals. Objective To investigate BP slopes as a risk factor for microinfarcts. Design, Setting, and Participants From the population-based Mayo Clinic Study of Aging, 303 of 1158 individuals (26.2%) in this cohort study agreed to have an autopsy between November 1, 2004, and March 31, 2016. Cerebral microinfarcts were identified and classified as cortical or subcortical. Baseline and BP trajectories were compared for groups with no microinfarcts, subcortical microinfarcts, and cortical microinfarcts. A secondary logistic regression analysis was performed to assess associations of subcortical microinfarcts with midlife hypertension, as well as systolic and diastolic BP slopes. Main Outcomes and Measures The presence of cerebral microinfarcts using BP slopes. Results Of the 303 participants who underwent autopsy, 297 had antemortem BP measurements. Of these, 177 (59.6%) were men; mean (SD) age at death was 87.2 (5.3) years. The autopsied individuals and the group who died but were not autopsied were similar for all demographics except educational level with autopsied participants having a mean of 1 more year of education (1.06; 95% CI, 0.66-1.47 years; P < .01). Among 297 autopsied individuals with antemortem BP measurements, 47 (15.8%) had chronic microinfarcts; 30 (63.8%) of these participants were men. Thirty (63.8%) had cortical microinfarcts, 19 (40.4%) had subcortical microinfarcts, and 4 (8.5%) had only infratentorial microinfarcts. Participants with microinfarcts did not differ significantly on baseline systolic (mean difference, -1.48; 95% CI, -7.30 to 4.34; P = .62) and diastolic (mean difference of slope, -0.90; 95% CI, -3.93 to 2.13; P = .56) BP compared with those with no microinfarcts. However, participants with subcortical microinfarcts had a greater annual decline (negative slope) of systolic (mean difference of slope, 4.66; 95% CI, 0.13 to 9.19; P = .04) and diastolic (mean difference, 3.33; 95% CI, 0.61 to 6.06; P = .02) BP. Conclusions and Relevance Subcortical microinfarcts were associated with declining BP. Future studies should investigate whether declining BP leads to subcortical microinfarcts or whether subcortical microinfarcts are a factor leading to declining BP.
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Affiliation(s)
| | - Mekala R Raman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Scott A Przybelski
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Timothy G Lesnick
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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