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Wu CY, Yu K, Arnold SE, Das S, Dodge HH. Who Benefited Most from the Internet-Based Conversational Engagement RCT (I-CONECT)? Application of the Personalized Medicine Approach to a Behavioral Intervention Study. J Prev Alzheimers Dis 2024; 11:639-648. [PMID: 38706280 PMCID: PMC11061034 DOI: 10.14283/jpad.2024.41] [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: 09/27/2023] [Accepted: 01/09/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Many Alzheimer's Disease (AD) clinical trials have failed to demonstrate treatment efficacy on cognition. It is conceivable that a complex disease like AD may not have the same treatment effect due to many heterogeneities of disease processes and individual traits. OBJECTIVES We employed an individual-level treatment response (ITR) approach to determine the characteristics of treatment responders and estimated time saved in cognitive decline using the Internet-based Conversational Engagement Clinical Trial (I-CONECT) behavioral intervention study as a model. DESIGN AND SETTING I-CONECT is a multi-site, single-blind, randomized controlled trial aimed to improve cognitive functions through frequent conversational interactions via internet/webcam. The experimental group engaged in video chats with study staff 4 times/week for 6 months; the control group received weekly 10-minute check-in phone calls. PARTICIPANTS Out of 186 randomized participants, current study used 139 participants with complete information on both baseline and 6-month follow-up (73 with mild cognitive impairment (MCI), 66 with normal cognition; 64 in the experimental group, and 75 in the control group). MEASUREMENTS ITR scores were generated for the Montreal Cognitive Assessment (MoCA) (global cognition, primary outcome) and Category Fluency Animals (CFA) (semantic fluency, secondary outcome) that showed significant efficacy in the trial. ITR scores were generated through 300 iterations of 3-fold cross-validated random forest models. The average treatment difference (ATD) curve and the area between the curves (ABC) were estimated to measure the heterogeneity of treatment responses. Responder traits were identified using SHapley Additive exPlanations (SHAP) and decision tree models. The time saved in cognitive decline was explored to gauge clinical meaningfulness. RESULTS ABC statistics showed substantial heterogeneity in treatment response with MoCA but modest heterogeneity in treatment response with CFA. Age, cognitive status, time spent with family and friends, education, and personality were important characteristics that influenced treatment responses. Intervention group participants in the upper 30% of ITR scores demonstrated potential delays of 3 months in semantic fluency (CFA) and 6 months in global cognition (MoCA), assuming a 5-fold faster natural cognitive decline compared to the control group during the post-treatment period. CONCLUSIONS ITR-based analyses are valuable in profiling treatment responders for features that can inform future trial design and clinical practice. Reliably measuring time saved in cognitive decline is an area of ongoing research to gain insight into the clinical meaningfulness of treatment.
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Affiliation(s)
- C-Y Wu
- Chao-Yi Wu, 149 13th floor, 10-003C, Boston, MA, USA, , 02129; 617-724-2428
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Kaddurah-Daouk R, Zhu H, Sharma S, Bogdanov M, Rozen SG, Matson W, Oki NO, Motsinger-Reif AA, Churchill E, Lei Z, Appleby D, Kling MA, Trojanowski JQ, Doraiswamy PM, Arnold SE. Alterations in metabolic pathways and networks in Alzheimer's disease. Transl Psychiatry 2013; 3:e244. [PMID: 23571809 PMCID: PMC3641405 DOI: 10.1038/tp.2013.18] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [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] [Received: 10/04/2012] [Revised: 12/07/2012] [Accepted: 01/01/2013] [Indexed: 02/07/2023] Open
Abstract
The pathogenic mechanisms of Alzheimer's disease (AD) remain largely unknown and clinical trials have not demonstrated significant benefit. Biochemical characterization of AD and its prodromal phase may provide new diagnostic and therapeutic insights. We used targeted metabolomics platform to profile cerebrospinal fluid (CSF) from AD (n=40), mild cognitive impairment (MCI, n=36) and control (n=38) subjects; univariate and multivariate analyses to define between-group differences; and partial least square-discriminant analysis models to classify diagnostic groups using CSF metabolomic profiles. A partial correlation network was built to link metabolic markers, protein markers and disease severity. AD subjects had elevated methionine (MET), 5-hydroxyindoleacetic acid (5-HIAA), vanillylmandelic acid, xanthosine and glutathione versus controls. MCI subjects had elevated 5-HIAA, MET, hypoxanthine and other metabolites versus controls. Metabolite ratios revealed changes within tryptophan, MET and purine pathways. Initial pathway analyses identified steps in several pathways that appear altered in AD and MCI. A partial correlation network showed total tau most directly related to norepinephrine and purine pathways; amyloid-β (Ab42) was related directly to an unidentified metabolite and indirectly to 5-HIAA and MET. These findings indicate that MCI and AD are associated with an overlapping pattern of perturbations in tryptophan, tyrosine, MET and purine pathways, and suggest that profound biochemical alterations are linked to abnormal Ab42 and tau metabolism. Metabolomics provides powerful tools to map interlinked biochemical pathway perturbations and study AD as a disease of network failure.
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Affiliation(s)
- R Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
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Taylor MB, Bromham NR, Arnold SE. Carcinoma of unknown primary: key radiological issues from the recent National Institute for Health and Clinical Excellence guidelines. Br J Radiol 2012; 85:661-71. [PMID: 22374278 PMCID: PMC3474101 DOI: 10.1259/bjr/75018360] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 07/08/2011] [Accepted: 07/12/2011] [Indexed: 12/21/2022] Open
Abstract
Carcinoma of unknown primary origin (CUP) accounts for 3-5% of cancer cases and is the fourth most common cause of cancer death in the UK. CUP management is challenging, partly owing to the heterogeneity of the condition and its presentation, but also owing to the lack of dedicated clinical services for these patients. The recent National Institute for Health and Clinical Excellence (NICE) guidelines on metastatic malignancy of unknown primary origin were developed to improve the co-ordination of diagnostic and clinical services at hospitals treating cancer patients in England and Wales, in particular by the setting up of CUP teams to manage these patients. Radiologists have a vital role in the diagnosis of these patients and should work closely with the CUP team to streamline the diagnostic pathway. This article summarises areas of the NICE guidelines relevant to radiology and discusses the radiological management of patients with CUP, including initial investigation, the importance of biopsy, the management of specific presentations, special investigations and organisational issues.
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Affiliation(s)
- M B Taylor
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK.
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Arnold SE, Xie SX, Leung YY, Wang LS, Kling MA, Han X, Kim EJ, Wolk DA, Bennett DA, Chen-Plotkin A, Grossman M, Hu W, Lee VMY, Mackin RS, Trojanowski JQ, Wilson RS, Shaw LM. Plasma biomarkers of depressive symptoms in older adults. Transl Psychiatry 2012; 2:e65. [PMID: 22832727 PMCID: PMC3309547 DOI: 10.1038/tp.2011.63] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The pathophysiology of negative affect states in older adults is complex, and a host of central nervous system and peripheral systemic mechanisms may play primary or contributing roles. We conducted an unbiased analysis of 146 plasma analytes in a multiplex biochemical biomarker study in relation to number of depressive symptoms endorsed by 566 participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI) at their baseline and 1-year assessments. Analytes that were most highly associated with depressive symptoms included hepatocyte growth factor, insulin polypeptides, pregnancy-associated plasma protein-A and vascular endothelial growth factor. Separate regression models assessed contributions of past history of psychiatric illness, antidepressant or other psychotropic medicine, apolipoprotein E genotype, body mass index, serum glucose and cerebrospinal fluid (CSF) τ and amyloid levels, and none of these values significantly attenuated the main effects of the candidate analyte levels for depressive symptoms score. Ensemble machine learning with Random Forests found good accuracy (~80%) in classifying groups with and without depressive symptoms. These data begin to identify biochemical biomarkers of depressive symptoms in older adults that may be useful in investigations of pathophysiological mechanisms of depression in aging and neurodegenerative dementias and as targets of novel treatment approaches.
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Affiliation(s)
- S E Arnold
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - S X Xie
- Department of Biostatistics and
Epidemiology, University of Pennsylvania, Philadelphia,
PA, USA
| | - Y-Y Leung
- Department of Pathology and
Laboratory Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - L-S Wang
- Department of Pathology and
Laboratory Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - M A Kling
- Department of Psychiatry, University
of Pennsylvania, Philadelphia, PA,
USA
| | - X Han
- Department of Biostatistics and
Epidemiology, University of Pennsylvania, Philadelphia,
PA, USA
| | - E J Kim
- Department of Pathology and
Laboratory Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - D A Wolk
- Department of Neurology, University
of Pennsylvania, Philadelphia, PA,
USA
| | - D A Bennett
- Rush Alzheimer's Disease Center,
Rush University Medical Center, Chicago,
IL, USA
| | - A Chen-Plotkin
- Department of Neurology, University
of Pennsylvania, Philadelphia, PA,
USA
| | - M Grossman
- Department of Neurology, University
of Pennsylvania, Philadelphia, PA,
USA
| | - W Hu
- Department of Neurology, Emory
University, Atlanta, GA,
USA
| | - V M-Y Lee
- Department of Pathology and
Laboratory Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - R Scott Mackin
- Department of Psychiatry, University
of California, San Francisco, San Francisco,
CA, USA
| | - J Q Trojanowski
- Department of Pathology and
Laboratory Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - R S Wilson
- Rush Alzheimer's Disease Center,
Rush University Medical Center, Chicago,
IL, USA
| | - L M Shaw
- Department of Pathology and
Laboratory Medicine, University of Pennsylvania,
Philadelphia, PA, USA
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Chen Y, Wolk DA, Reddin JS, Korczykowski M, Martinez PM, Musiek ES, Newberg AB, Julin P, Arnold SE, Greenberg JH, Detre JA. Voxel-level comparison of arterial spin-labeled perfusion MRI and FDG-PET in Alzheimer disease. Neurology 2011; 77:1977-85. [PMID: 22094481 DOI: 10.1212/wnl.0b013e31823a0ef7] [Citation(s) in RCA: 184] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We compared the ability of arterial spin labeling (ASL), an MRI method that measures cerebral blood flow (CBF), to that of FDG-PET in distinguishing patients with Alzheimer disease (AD) from healthy, age-matched controls. METHODS Fifteen patients with AD (mean age 72 ± 6 years, Mini-Mental State Examination score [MMSE] 20 ± 6) and 19 age-matched controls (mean age 68 ± 6 years, MMSE 29 ± 1) underwent structural MRI. Participants were injected with 5 mCi of FDG during pseudocontinuous ASL scan, which was followed by PET scanning. Statistical parametric mapping and regions of interest (ROI) analysis were used to compare the ability of the 2 modalities in distinguishing patients from controls. Similarity between the 2 modalities was further assessed with linear correlation maps of CBF and metabolism to neuropsychological test scores. RESULTS Good agreement between hypoperfusion and hypometabolism patterns was observed, with overlap primarily in bilateral angular gyri and posterior cingulate. ROI results showed similar scales of functional deficit between patients and controls in both modalities. Both ASL and FDG-PET were able to distinguish neural networks associated with different neuropsychological tests with good overlap between modalities. CONCLUSIONS Our voxel-wise results indicated that ASL-MRI provides largely overlapping information with FDG-PET. ROI analysis demonstrated that both modalities detected similar degrees of functional deficits in affected areas. Given its ease of acquisition and noninvasiveness, ASL-MRI may be an appealing alternative for AD studies.
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Affiliation(s)
- Y Chen
- Department of Neurology, University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St., Philadelphia, PA 19104, USA
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Negash S, A. Bennett D, S. Wilson R, A. Schneider J, E. Arnold S. Cognition and Neuropathology in Aging: Multidimensional Perspectives from the Rush Religious Orders Study and Rush Memory and Aging Project. Curr Alzheimer Res 2011; 8:336-40. [DOI: 10.2174/156720511795745302] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 12/22/2010] [Indexed: 11/22/2022]
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Hu WT, Chen-Plotkin A, Grossman M, Arnold SE, Clark CM, Shaw LM, McCluskey L, Elman L, Hurtig HI, Siderowf A, Lee VMY, Soares H, Trojanowski JQ. Novel CSF biomarkers for frontotemporal lobar degenerations. Neurology 2010; 75:2079-86. [PMID: 21048198 DOI: 10.1212/wnl.0b013e318200d78d] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To identify antemortem CSF diagnostic biomarkers that can potentially distinguish between the 2 main causes of frontotemporal lobar degeneration (FTLD), i.e., FTLD with TDP-43 pathology (FTLD-TDP) and FTLD with tau pathology (FTLD-tau). METHODS CSF samples were collected antemortem from 23 patients with FTLD with known pathology to form a autopsy cohort as part of a comparative biomarker study that additionally included 33 living cognitively normal subjects and 66 patients with autopsy-confirmed Alzheimer disease (AD). CSF samples were also collected from 80 living patients clinically diagnosed with frontotemporal dementia (FTD). Levels of 151 novel analytes were measured via a targeted multiplex panel enriched in neuropeptides, cytokines, and growth factors, along with levels of CSF biomarkers for AD. RESULTS CSF levels of multiple analytes differed between FTLD-TDP and FTLD-tau, including Fas, neuropeptides (agouti-related peptide and adrenocorticotropic hormone), and chemokines (IL-23, IL-17). Classification by random forest analysis achieved high sensitivity for FTLD-TDP (86%) with modest specificity (78%) in the autopsy cohort. When the classification algorithm was applied to a living FTD cohort, semantic dementia was the phenotype with the highest predicted proportion of FTLD-TDP. When living patients with behavioral variant FTD were examined in detail, those predicted to have FTLD-TDP demonstrated neuropsychological differences vs those predicted to have FTLD-tau in a pattern consistent with previously reported trends in autopsy-confirmed cases. CONCLUSIONS Clinical cases with FTLD-TDP and FTLD-tau pathology can be potentially identified antemortem by assaying levels of specific analytes that are well-known and readily measurable in CSF.
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Affiliation(s)
- W T Hu
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia 19104-4283, USA.
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8
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Xie SX, Forman MS, Farmer J, Moore P, Wang Y, Wang X, Clark CM, Coslett HB, Chatterjee A, Arnold SE, Rosen H, Karlawish JHT, Van Deerlin VM, Lee VMY, Trojanowski JQ, Grossman M. Factors associated with survival probability in autopsy-proven frontotemporal lobar degeneration. J Neurol Neurosurg Psychiatry 2008; 79:126-9. [PMID: 17615171 DOI: 10.1136/jnnp.2006.110288] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [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] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the clinical and pathological factors associated with survival in autopsy-confirmed frontotemporal lobar degeneration (FTLD). METHODS The final analysis cohort included 71 patients with pathologically proven FTLD, excluding patients with clinical motor neuron disease (MND), evaluated at the University of Pennsylvania or at the University of California, San Francisco. We assessed clinical and demographic features; cognitive functioning at presentation; genetic markers of disease; and graded anatomical distribution of tau, ubiquitin and amyloid pathology. RESULTS The tau-negative group (n = 35) had a median survival time of 96 months (95% CI: 72-114 months), whereas the tau-positive group (n = 36) had a median survival time of 72 months (95% CI: 60-84 months). Patients with tau-positive pathology across all brain regions had shorter survival than those with tau-negative pathology in univariate Cox regression analyses (Hazard ratio of dying = 2.003, 95% CI = 1.209-3.318, p = 0.007). CONCLUSIONS Tau-positive pathology represents a significant risk to survival in FTLD, whereas tau-negative pathology is associated with a longer survival time when clinical MND is excluded.
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Affiliation(s)
- S X Xie
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine Philadelphia, PA, USA
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Abstract
OBJECTIVE Mild cognitive impairment (MCI) is associated with increased morbidity and mortality but its development is not well understood. Here we test the hypothesis that chronic psychological distress is associated with increased incidence of MCI in old age. METHODS Participants are older persons from two cohort studies with uniform annual clinical evaluations which included detailed cognitive testing and clinical classification of MCI. We excluded persons with dementia or MCI at baseline; follow-up data were available on 1,256 persons without cognitive impairment (95% of those eligible). At baseline, they completed a six-item measure of neuroticism (mean = 15.6, SD = 6.6), an indicator of the tendency to experience psychological distress. RESULTS During up to 12 years of follow-up, 482 persons (38%) developed MCI. Risk of MCI increased by about 2% for each one unit increase on the distress scale (relative risk [RR] = 1.02; 95% CI: 1.01, 1.04), with the association slightly stronger in men than women. Overall, a distress-prone person (score = 24, 90th percentile) was about 40% more likely to develop MCI than someone not prone to distress (score = 8, 10th percentile). Adjustment for depressive symptomatology at baseline did not substantially change results (RR = 1.02; 95% CI: 1.00, 1.03). Depressive symptoms were also related to risk of MCI but not after controlling for distress score. In mixed-effects models, higher distress score was associated with lower level of function in multiple cognitive domains at baseline and more rapid cognitive decline, especially in episodic memory. CONCLUSION Among older persons without manifest cognitive impairment, higher level of chronic psychological distress is associated with increased incidence of mild cognitive impairment.
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Affiliation(s)
- R S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA.
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Arvanitakis Z, Schneider JA, Wilson RS, Li Y, Arnold SE, Wang Z, Bennett DA. Diabetes is related to cerebral infarction but not to AD pathology in older persons. Neurology 2007; 67:1960-5. [PMID: 17159101 DOI: 10.1212/01.wnl.0000247053.45483.4e] [Citation(s) in RCA: 217] [Impact Index Per Article: 12.8] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the potential relation of diabetes to common neuropathologic causes of dementia, cerebral infarction and Alzheimer disease (AD) neuropathology. METHODS Subjects were 233 older Catholic clergy in the Religious Orders Study, who underwent detailed annual evaluations, including neuropsychological testing, and brain autopsy at time of death (mean age 86 years, 45% men). Diabetes was identified by annual direct medication inspection and history. Cognitive function proximate to death was summarized into five cognitive domains, based on 19 neuropsychological tests. Macroscopic cerebral infarctions were recorded from 1 cm coronal slabs. Neuritic plaques, diffuse plaques, and neurofibrillary tangles were counted in Bielschowsky silver-stained sections and summarized to yield composite measures of neuritic plaques, diffuse plaques, tangles, and overall AD pathology. We also used immunohistochemistry with antibodies to amyloid-beta and PHF-tau to obtain quantitative measures of amyloid burden and neurofibrillary tangle density. Multiple logistic and linear regression analyses were used to examine the relation of diabetes to cerebral infarctions and AD pathology, controlling for age, sex, and education. RESULTS AD pathology was related to all five cognitive domains (p < 0.01) and infarctions were related to perceptual speed (p < 0.001). Diabetes (present in 15% subjects) was associated with an increased odds of infarction (OR = 2.47, 95% CI: 1.16, 5.24). Diabetes was not related to global AD pathology score, or to specific measures of neuritic plaques, diffuse plaques or tangles, or to amyloid burden or tangle density. CONCLUSION We found a relation between diabetes and cerebral infarction but not between diabetes and Alzheimer disease pathology in older persons.
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Affiliation(s)
- Z Arvanitakis
- Rush Alzheimer's Disease Center, 600 S. Paulina, Suite 1020, Rush University Medical Center, Chicago, IL 60612, USA
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11
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Wilson RS, Arnold SE, Schneider JA, Tang Y, Bennett DA. The relationship between cerebral Alzheimer's disease pathology and odour identification in old age. J Neurol Neurosurg Psychiatry 2007; 78:30-5. [PMID: 17012338 PMCID: PMC2117790 DOI: 10.1136/jnnp.2006.099721] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Olfactory dysfunction is common in old age, but its basis is uncertain. OBJECTIVE To test the hypothesis that difficulty in identifying odours in old age is related to the accumulation of Alzheimer's disease pathology. METHODS As part of the Rush Memory and Aging Project, participants completed the 12-item Brief Smell Identification Test, a standard measure of odour identification. During a mean (standard deviation (SD)) of 2.2 (1.2) years of follow-up (range 0.2-4.9), 166 people died, with brain autopsies performed on 129 (77.7%) people and neuropathological examinations completed on 77 (mean (SD) age at death 87.5 (5.9) years; median postmortem interval 6.1 h). From a uniform postmortem examination of multiple brain regions, summary measures of plaque and tangle pathology were derived on the basis of silver staining, and those of amyloid beta burden, tangle density and Lewy bodies on the basis of immunohistochemistry. RESULTS Odour identification performance ranged from 0 to 12 correct (mean (SD) 8.0 (2.6)). In analyses adjusted for age, sex and education, a composite measure of plaques and tangles accounted for >12% of the variation in odour identification. The association remained after controlling for dementia or semantic memory. Density of tau tangles was inversely related to odour identification. A similar effect for amyloid burden was attenuated after controlling for tangles. The association with odour identification was robust for tangles in the entorhinal cortex and CA1/subiculum area of the hippocampus, but not for tangles in other cortical sites. Lewy bodies, identified in 12.5%, were not related to odour identification, probably partly due to to their relative infrequency. CONCLUSION The results suggest that difficulty in identifying familiar odours in old age is partly due to the accumulation of neurofibrillar pathology in central olfactory regions.
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Affiliation(s)
- R S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 South Paulina, Suite 1038, Chicago, IL 60612, USA.
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12
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Abstract
The authors quantified amyloid and tau tangles in Religious Orders Study participants. In separate analyses, amyloid and tangles were related to level of cognition. When terms for education's interaction with amyloid and tangles were added, education dampened the association of amyloid with level of cognition (p = 0.02) but not the association of neurofibrillary tangles with level of cognition, suggesting that education is related to factors that reduce the effect of amyloid on cognition.
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Affiliation(s)
- D A Bennett
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
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Cairns NJ, Grossman M, Arnold SE, Burn DJ, Jaros E, Perry RH, Duyckaerts C, Stankoff B, Pillon B, Skullerud K, Cruz-Sanchez FF, Bigio EH, Mackenzie IRA, Gearing M, Juncos JL, Glass JD, Yokoo H, Nakazato Y, Mosaheb S, Thorpe JR, Uryu K, Lee VMY, Trojanowski JQ. Clinical and neuropathologic variation in neuronal intermediate filament inclusion disease. Neurology 2006; 63:1376-84. [PMID: 15505152 PMCID: PMC3516854 DOI: 10.1212/01.wnl.0000139809.16817.dd] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Recently described neuronal intermediate filament inclusion disease (NIFID) shows considerable clinical heterogeneity. OBJECTIVE To assess the spectrum of the clinical and neuropathological features in 10 NIFID cases. METHODS Retrospective chart and comprehensive neuropathological review of these NIFID cases was conducted. RESULTS The mean age at onset was 40.8 (range 23 to 56) years, mean disease duration was 4.5 (range 2.7 to 13) years, and mean age at death was 45.3 (range 28 to 61) years. The most common presenting symptoms were behavioral and personality changes in 7 of 10 cases and, less often, memory loss, cognitive impairment, language deficits, and motor weakness. Extrapyramidal features were present in 8 of 10 patients. Language impairment, perseveration, executive dysfunction, hyperreflexia, and primitive reflexes were frequent signs, whereas a minority had buccofacial apraxia, supranuclear ophthalmoplegia, upper motor neuron disease (MND), and limb dystonia. Frontotemporal and caudate atrophy were common. Histologic changes were extensive in many cortical areas, deep gray matter, cerebellum, and spinal cord. The hallmark lesions of NIFID were unique neuronal IF inclusions detected most robustly by antibodies to neurofilament triplet proteins and alpha-internexin. CONCLUSION NIFID is a neuropathologically distinct, clinically heterogeneous variant of frontotemporal dementia (FTD) that may include parkinsonism or MND. Neuronal IF inclusions are the neuropathological signatures of NIFID that distinguish it from all other FTD variants including FTD with MND and FTD tauopathies.
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Affiliation(s)
- N J Cairns
- Center for Neurodegenerative Disease Research, Department University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Bennett DA, Schneider JA, Wilson RS, Bienias JL, Berry-Kravis E, Arnold SE. Amyloid mediates the association of apolipoprotein E e4 allele to cognitive function in older people. J Neurol Neurosurg Psychiatry 2005; 76:1194-9. [PMID: 16107349 PMCID: PMC1739810 DOI: 10.1136/jnnp.2004.054445] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND The neurobiological changes underlying the association of the apolipoprotein E (APOE) e4 allele with level of cognition are poorly understood. OBJECTIVE To test the hypothesis that amyloid load can account for (mediate) the association of the APOE e4 allele with level of cognition assessed proximate to death. METHODS There were 44 subjects with clinically diagnosed Alzheimer's disease and 50 without dementia, who had participated in the Religious Orders Study. They underwent determination of APOE allele status, had comprehensive cognitive testing in the last year of life, and brain autopsy at death. The percentage area of cortex occupied by amyloid beta and the density of tau positive neurofibrillary tangles were quantified from six brain regions and averaged to yield summary measures of amyloid load and neurofibrillary tangles. Multiple regression analyses were used to examine whether amyloid load could account for the effect of allele status on level of cognition, controlling for age, sex, and education. RESULTS Possession of at least one APOE e4 allele was associated with lower level of cognitive function proximate to death (p = 0.04). The effect of the e4 allele was reduced by nearly 60% and was no longer significant after controlling for the effect of amyloid load, whereas there was a robust inverse association between amyloid and cognition (p = 0.001). Because prior work had suggested that neurofibrillary tangles could account for the association of amyloid on cognition, we next examined whether amyloid could account for the effect of allele status on tangles. In a series of regression analyses, e4 was associated with density of tangles (p = 0.002), but the effect of the e4 allele was reduced by more than 50% and was no longer significant after controlling for the effect of amyloid load. CONCLUSION These findings are consistent with a sequence of events whereby the e4 allele works through amyloid deposition and subsequent tangle formation to cause cognitive impairment.
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Affiliation(s)
- D A Bennett
- Rush Alzheimer's Disease Center, Armour Academic Center, 600 South Paulina, Suite 1028; Chicago, IL 60612, USA.
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Abstract
BACKGROUND Depressive symptoms in old age have been associated with risk of Alzheimer disease (AD), but it is uncertain whether they are an independent risk factor for disease or an early clinical sign of its underlying pathology. METHODS A group of 130 older Catholic nuns, priests, and brothers underwent detailed annual clinical evaluations and brain autopsy at death. The evaluations included administration of a modified 10-item Center for Epidemiologic Studies Depression Scale (CES-D) and 19 cognitive performance tests and clinical classification of dementia and AD. On postmortem examination, neuritic plaques, diffuse plaques, and neurofibrillary tangles in tissue samples from four cortical regions were counted, and a previously established composite measure of cortical plaque and tangle density (range 0 to 2.98) was derived. All analyses were adjusted for age, sex, and education. RESULTS Participants reported a mean 1.5 depressive symptoms (SD 1.6) on the CES-D scale averaged across evaluations. In a logistic regression model, the odds of clinically diagnosed AD proximate to death increased by 1.33 (95% CI 1.01 to 1.76) for each depressive symptom and by 8.41 (95% CI 3.49 to 20.26) for each unit on the composite measure of pathology. In subsequent analyses, depressive symptoms were not related to level of pathology and did not modify the relation of pathology to clinical AD. In a series of linear regression models that controlled for pathology, depressive symptoms were related to level of cognitive function proximate to death and did not modify the association of pathology with cognition. CONCLUSION The association of depressive symptoms with clinical AD and cognitive impairment appears to be independent of cortical plaques and tangles.
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Affiliation(s)
- R S Wilson
- Rush Alzheimer's Disease Center and Rush Institute for Healthy Aging, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
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Bennett DA, Wilson RS, Schneider JA, Evans DA, Mendes de Leon CF, Arnold SE, Barnes LL, Bienias JL. Education modifies the relation of AD pathology to level of cognitive function in older persons. Neurology 2003; 60:1909-15. [PMID: 12821732 DOI: 10.1212/01.wnl.0000069923.64550.9f] [Citation(s) in RCA: 396] [Impact Index Per Article: 18.9] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that years of formal education modifies the relation of AD pathology to level of cognitive function. METHODS A total of 130 older Catholic clergy participating in the Religious Orders Study underwent annual cognitive function testing and brain autopsy at the time of death. Individual cognitive function tests were z-scored and averaged to yield a global measure of cognitive function and summary measures of five different cognitive abilities. Neuritic and diffuse plaques and neurofibrillary tangles were counted in separate 1 mm(2) areas of maximal density. Counts were converted to standard scores by dividing by their SD, and combined to yield a global AD pathology score and summary scores of each postmortem index. Linear regression was used to examine the relation of education and AD pathology scores to level of cognitive function proximate to death, controlling for age and sex. Subsequent analyses tested the interaction between education and each AD pathology score to determine whether education modified the relation of AD pathology to level of cognitive function. Additional analyses examined these associations on five specific cognitive abilities. RESULTS Both years of formal education (regression coefficient = 0.073, p = 0.0001) and the global AD pathology score (regression coefficient = -0.689, p < 0.0001) were related to level of cognitive function. When an interaction term between education and AD pathology was added to the model, the association between a unit of AD pathology and level of cognitive function was 0.088 (p = 0.0078) standard unit less for each year of education than the level predicted from the model without the interaction term. Whereas neuritic plaques, diffuse plaques, and neurofibrillary tangles were all strongly related to cognitive function, education only modified the relation of neuritic plaques (p = 0.002) and diffuse plaques (p = 0.03) to cognition, but not neurofibrillary tangles. In analyses examining five different cognitive abilities, the interaction between education and the neuritic plaque score was strongest for perceptual speed and weakest for episodic memory. CONCLUSIONS These data provide strong evidence that the relation between senile plaques and level of cognitive function differs by years of formal education.
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Affiliation(s)
- D A Bennett
- Rush Alzheimer's Disease Center and Rush Institute for Healthy Aging, Chicago, IL 60612, USA.
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Schneider JA, Wilson RS, Cochran EJ, Bienias JL, Arnold SE, Evans DA, Bennett DA. Relation of cerebral infarctions to dementia and cognitive function in older persons. Neurology 2003; 60:1082-8. [PMID: 12682310 DOI: 10.1212/01.wnl.0000055863.87435.b2] [Citation(s) in RCA: 219] [Impact Index Per Article: 10.4] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cerebral infarctions are common in older persons but their relationship with dementia and cognitive function remains controversial. METHODS Participants were 164 older Catholic nuns, priests, and brothers who underwent annual clinical evaluation and brain autopsy at death. The authors quantified number and volume of old cerebral infarctions on postmortem examination and determined the association with dementia and cognitive function proximate to death. Analyses controlled for age, sex, and education. RESULTS A total of 58 (35.4%) subjects had cerebral infarctions: 29 had one infarction and 29 had multiple infarctions. In logistic regression analyses, infarctions increased the odds of dementia twofold (OR 2.12; 95% CI 1.06 to 4.25). The odds of dementia increased by 2.67-fold for multiple infarctions (95% CI 1.08 to 6.61), whereas the odds of dementia with single infarctions increased by 69% (95% CI 0.70 to 4.09). In linear regression analyses, there was a trend for multiple infarctions to be associated with lower global cognitive scores (-0.44 standard units, p = 0.057). Multiple infarctions were related to perceptual speed, visuospatial skills, and working memory, but not to episodic or semantic memory. The authors found similar results with infarction volume. In secondary analyses, only infarctions that were clinically evident during life were associated with dementia and cognitive function. CONCLUSION Cerebral infarctions are associated with a twofold increase in odds of dementia. Odds are higher in persons with multiple, large, or clinically evident infarctions. In addition, cerebral infarctions do not affect all cognitive systems equally, showing the strongest association with perceptual speed and the weakest with episodic memory.
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Affiliation(s)
- J A Schneider
- Rush AD Center and Rush Institute for Healthy Aging, Chicago, IL 60612, USA.
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Bennett DA, Wilson RS, Schneider JA, Evans DA, Aggarwal NT, Arnold SE, Cochran EJ, Berry-Kravis E, Bienias JL. Apolipoprotein E epsilon4 allele, AD pathology, and the clinical expression of Alzheimer's disease. Neurology 2003; 60:246-52. [PMID: 12552039 DOI: 10.1212/01.wnl.0000042478.08543.f7] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.0] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that the APOE epsilon4 allele is associated with the clinical manifestations of AD through an association with the pathologic hallmarks of disease. METHODS Participants were older Catholic nuns, priests, and brothers who agreed to annual neurologic and neuropsychological evaluation for AD and other common neurologic conditions and brain autopsy at the time of death. There were 77 persons without dementia and 51 with probable AD; 38 participants had one or more epsilon4 alleles. RESULTS In logistic regression analyses, controlling for age, sex, and education, the epsilon4 allele was strongly associated with the likelihood of clinical AD (odds = 3.46, 95% CI = 1.44 to 8.33). However, controlling for the effect of AD pathology, the association of the epsilon allele with clinical AD was reduced by >50% and was no longer significant (odds = 1.58, 95% CI = 0.56 to 4.43). Similarly, in linear regression analyses, controlling for age, sex, and education, the epsilon4 allele was strongly associated with level of cognitive function proximate to death (regression coefficient = -0.477, p = 0.005). However, after controlling for the effect of AD pathology, the association of the epsilon4 allele with level of cognition was reduced by >80% and was no longer significant (regression coefficient = -0.093). Similar results were found in analyses using separate measures of neuritic plaques, diffuse plaques, and neurofibrillary tangles, and in analyses of five different cognitive systems (episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability). CONCLUSIONS The APOE epsilon4 allele appears to be associated with the clinical manifestations of AD through an association with the pathologic hallmarks of AD rather than another mechanism.
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Affiliation(s)
- D A Bennett
- Rush Alzheimer's Disease Center, Chicago, Illinois 60612, USA.
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Wilson RS, Barnes LL, Mendes de Leon CF, Aggarwal NT, Schneider JS, Bach J, Pilat J, Beckett LA, Arnold SE, Evans DA, Bennett DA. Depressive symptoms, cognitive decline, and risk of AD in older persons. Neurology 2002; 59:364-70. [PMID: 12177369 DOI: 10.1212/wnl.59.3.364] [Citation(s) in RCA: 336] [Impact Index Per Article: 15.3] [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: 11/15/2022] Open
Abstract
BACKGROUND Cross-sectional and retrospective case-control studies suggest an association of depression symptoms with cognitive impairment and AD, but there have been few prospective studies and their results have been inconsistent. METHODS Participants are Catholic clergy members who were aged > or =65 years and who did not have clinical evidence of AD. During a 7-year period, they underwent annual clinical evaluations that included clinical classification of AD and detailed cognitive function testing from which global and specific measures of cognition were derived. Number of depressive symptoms was assessed at baseline with a modified, 10-item Center for Epidemiologic Studies Depression Scale (CES-D). The association of CES-D score with incident AD, using proportional hazards models, and cognitive decline, using random effects models, was examined. RESULTS At baseline, participants reported an average of about one depressive symptom on the CES-D scale (range, 0 to 8). During the 7 years of follow-up, 108 persons developed AD. In analyses that controlled for selected demographic and clinical variables including baseline level of cognitive function, CES-D score was associated with both risk of AD and rate of cognitive decline. For each depressive symptom, risk of developing AD increased by an average of 19%, and annual decline on a global cognitive measure increased by an average of 24%. CONCLUSIONS The results raise the possibility that depressive symptoms in older persons may be associated with risk of developing AD.
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Affiliation(s)
- Robert S Wilson
- Rush Alzheimer's Disease Center and Rush Institute for Healthy Aging, Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center, 1645 West Jackson Boulevard, Suite 675, Chicago, IL 60612, USA.
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Abstract
Neurodevelopmental theories of the pathoetiology of schizophrenia have been at the forefront of schizophrenia research in recent years. Support for these theories is substantial and growing. Epidemiological, phenomenological, and clinical neurobiological research have provided compelling though still circumstantial evidence. Neuropathological investigations also have provided some evidence; however, these have yet to actualize their potential for revealing the cellular and molecular nature of developmental aberrancies in this disease. This article summarizes the clinical evidence suggesting abnormal neurodevelopment in schizophrenia, outlines some of the important anatomic, cellular, and molecular mechanisms of normal central nervous system development, reviews current neuropathological findings relevant to neurodevelopment in schizophrenia, and suggests some new directions and opportunities for discovering the molecular neurodevelopmental basis of the disorder.
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Affiliation(s)
- S E Arnold
- Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia 19104, USA.
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Arnold SE, Han LY, Moberg PJ, Turetsky BI, Gur RE, Trojanowski JQ, Hahn CG. Dysregulation of olfactory receptor neuron lineage in schizophrenia. Arch Gen Psychiatry 2001; 58:829-35. [PMID: 11545665 DOI: 10.1001/archpsyc.58.9.829] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Growing evidence implicates abnormal neurodevelopment in schizophrenia. While neuron birth and differentiation is largely completed by the end of gestation, the olfactory epithelium (OE) is a unique part of the central nervous system that undergoes regeneration throughout life, thus offering an opportunity to investigate cellular and molecular events of neurogenesis and development postmortem. We hypothesized that OE neurons exhibit deviant progress through neurodevelopment in schizophrenia characterized by an increase in immature neurons. METHODS Olfactory epithelium was removed at autopsy from 13 prospectively assessed elderly subjects who had schizophrenia and 10 nonpsychiatric control subjects. Sections were immunolabeled with antibodies that distinguish OE neurons in different stages of development, including basal cells (low-affinity nerve growth factor receptor, p75NGFR), postmitotic immature neurons (growth-associated protein 43 [GAP43]), and mature olfactory receptor neurons (olfactory marker protein). Absolute and relative densities of each cell type were determined. RESULTS We observed a significantly lower density of p75NGFR basal cells (37%) in schizophrenia and increases in GAP43 + postmitotic immature neurons (316%) and ratios of GAP43 + postmitotic immature neurons to p75NGFR + cells (665%) and olfactory marker protein + mature neurons to p75NGFR + basal cells (328%). Neuroleptic-free schizophrenia subjects exhibited the highest GAP43 + postmitotic immature neuron values. CONCLUSIONS Abnormal densities and ratios of OE neurons at different stages of development indicate dysregulation of OE neuronal lineage in schizophrenia. This could be because of intrinsic factors controlling differentiation or an inability to gain trophic support from axonal targets in the olfactory bulb. While caution is necessary in extrapolating developmental findings in mature OE to early brain development, similarities in molecular events suggest that such studies may be instructive.
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Affiliation(s)
- S E Arnold
- Center for Neurobiology and Behavior, University of Pennsylvania, 142 Clinical Research Bldg, 415 Curie Blvd, Philadelphia, PA 19104, USA.
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Kurtz MM, Moberg PJ, Mozley LH, Hickey T, Arnold SE, Bilker WB, Gur RE. Cognitive impairment and functional status in elderly institutionalized patients with schizophrenia. Int J Geriatr Psychiatry 2001; 16:631-8. [PMID: 11424173 DOI: 10.1002/gps.394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The relationship of cognitive impairment to functional status in older adults with schizophrenia was investigated. PATIENTS Ninety-three psychiatric inpatients with schizophrenia between the ages of 65 and 88 years. Two subsets of this sample, consisting of 48 and 24 patients, were studied with a greater number of assessment instruments. MEASURES The Mini-Mental State Examination (MMSE) was used for brief assessment of overall cognitive functioning, and the Psychogeriatric Dependency Rating Scale (PGDRS) was administered to assess functional status. The cognitive test battery from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) and/or an expanded neuropsychological battery, was given to a subset of the patients. RESULTS In the overall sample, patients with greater global cognitive impairment had higher levels of rated impairment on the individual items that comprised the Orientation and Physical, but not Behavior, subscales of the PGDRS. Furthermore, in the two subsamples, specific neuropsychological measures of problem-solving, word list learning, naming and constructional praxis were related to overall measures of outcome. CONCLUSIONS Neuropsychological deficit and psychosocial outcome are multi-dimensional entities that relate to one another in complex ways.
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Affiliation(s)
- M M Kurtz
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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23
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Abstract
The neurobiological basis of cognitive and functional deterioration commonly observed in elderly persons with schizophrenia is unclear. Despite superficial similarities in the clinical and neuropsychological profiles of schizophrenia in late life with neurodegenerative dementias, extensive neuropathological investigations have failed to find any evidence of neurodegeneration or neural injury beyond what is typically observed in brains of individuals without neuropsychiatric illness. In contrast, growing neuropathological data indicate aberrant brain development and connectivity in schizophrenia (including abnormalities in cytoarchitecture, innervation, and synaptic integrity) and abnormal molecular signaling pathways important in the formation of the nervous system and ongoing plasticity in maturity. These developmental abnormalities may represent a state of decreased cerebral reserve that causes persons with schizophrenia to be more vulnerable to the toxic effects of even "normal" accumulations of age-related neurodegenerative lesions.
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Affiliation(s)
- S E Arnold
- Laboratory of Cellular and Molecular Neuropathology, Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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Zhukareva V, Vogelsberg-Ragaglia V, Van Deerlin VM, Bruce J, Shuck T, Grossman M, Clark CM, Arnold SE, Masliah E, Galasko D, Trojanowski JQ, Lee VM. Loss of brain tau defines novel sporadic and familial tauopathies with frontotemporal dementia. Ann Neurol 2001; 49:165-75. [PMID: 11220736 DOI: 10.1002/1531-8249(20010201)49:2<165::aid-ana36>3.0.co;2-3] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.1] [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: 11/10/2022]
Abstract
Dementia lacking distinctive histopathology (DLDH) or frontotemporal lobe degeneration (FTLD) is the most common neuropathological diagnosis for sporadic frontotemporal dementias (FTDs). The hallmarks of DLDH are neuron loss and gliosis in the absence of any disease-specific brain lesion. Similar brain pathology is also seen in a familial FTD pedigree known as hereditary dysphasic disinhibition dementia 2 (HDDD2). Abnormality in the function or isoform composition of the microtubule binding protein tau is a prominent feature in the brains of many patients with sporadic and hereditary FTDs. Therefore, we studied the tau protein in different brain regions from DLDH and HDDD2 patients. Our results indicate that a selective loss of all six tau isoforms, but not tau mRNA, occurs in these brains compared to normal control and Alzheimer's disease brains. Loss of tau protein was identified by Western blot analysis of protein extracts from DLDH and HDDD2 brains in regions both with and without neuronal degeneration. Functionally, this loss of tau protein may be equivalent to pathogenic mutations in the tau gene identified in familial FTD with parkinsonism linked to chromosome 17 (FTDP-17). Thus, DLDH and HDDD2 are novel tauopathies with a unique mechanism of pathogenesis. The presence of tau mRNA in these brains suggests that the level of tau protein may be controlled posttranscriptionally, at the level of either translation or mRNA stability.
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Affiliation(s)
- V Zhukareva
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA
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Mitchell TW, Nissanov J, Han LY, Mufson EJ, Schneider JA, Cochran EJ, Bennett DA, Lee VM, Trojanowski JQ, Arnold SE. Novel method to quantify neuropil threads in brains from elders with or without cognitive impairment. J Histochem Cytochem 2000; 48:1627-38. [PMID: 11101631 DOI: 10.1177/002215540004801206] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [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] [Indexed: 11/16/2022] Open
Abstract
Pathological alterations in dendrites and axons (i.e., neuritic pathologies) occur in the normal aging brain as well as in brains from elders with mild cognitive impairment and neurodegenerative dementia. These alterations may correlate with clinical measures of cognitive abilities, but the contribution of neuropil threads (NTs), which constitute 85-90% of cortical tau pathology, has not been clear because of the lack of quantitative methodologies. We combined quantitative fractionation and image analysis to devise a strategy for measuring the burden of tau-rich NTs in the entorhinal and perirhinal cortex of brains from elders with and without cognitive impairment, including dementia due to Alzheimer's disease (AD). On the basis of data presented here using this novel strategy, we conclude that this quantitative imaging technique will facilitate efforts to determine the behavioral correlations of neuritic lesions in AD and other brain disorders.
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Affiliation(s)
- T W Mitchell
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Abstract
Frontotemporal degeneration (FTD) is a neurodegenerative condition that has been principally associated with frontal lobe dementia. In this study, we compared neuropathological abnormalities in frontal, hippocampal, and calcarine cortices from patients assigned a diagnosis of FTD, normal elderly and Alzheimer's disease (AD). Densities of Nissl-stained neurons and lesions which were immunolabeled for tau, beta-amyloid (Abeta), alpha- and beta-synuclein, ubiquitin, glial fibrillary acidic protein (GFAP) and CD68 antigen were determined using computer-assisted, non-biased quantitative microscopy. We found that FTD frontal and hippocampal regions exhibited marked neuron loss, abundant ubiquitin-immunoreactive (ir) dystrophic neurites, GFAP-ir astrocytes, and CD68-ir microglia, while calcarine cortex was spared. No alpha- or beta-synuclein-ir lesions were observed, and neither the density of tau-ir neurofibrillary tangles nor that of Abeta-ir plaques in FTD exceeded normal controls. In addition, there were no neuropathological differences between FTD subjects who presented clinically with a frontal lobe dementia versus an AD-like dementia. These findings indicate that FTD is a category of neurodegnerative dementias with varying clinical presentations that is characterized by the progressive degeneration of select populations of cortical neurons. The molecular neurodegenerative mechanisms that lead to FTD remain to be elucidated.
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Affiliation(s)
- S E Arnold
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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27
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Affiliation(s)
- S E Arnold
- Laboratory for Cellular and Molecular Neuropathology, University of Pennsylvania, Philadelphia
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Gur RE, Turetsky BI, Cowell PE, Finkelman C, Maany V, Grossman RI, Arnold SE, Bilker WB, Gur RC. Temporolimbic volume reductions in schizophrenia. Arch Gen Psychiatry 2000; 57:769-75. [PMID: 10920465 DOI: 10.1001/archpsyc.57.8.769] [Citation(s) in RCA: 260] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Neuroanatomic studies of schizophrenia have reported temporolimbic abnormalities. Most magnetic resonance imaging studies have evaluated small samples of primarily men with chronic schizophrenia. Our goal was to evaluate sex differences in segmented temporal lobe subregions with reliable parcellation methods, relating volume with clinical and neurocognitive parameters. METHODS Magnetic resonance imaging was performed in 100 patients with schizophrenia (58 men, 42 women; 39 neuroleptic naive, 61 previously treated) and 110 healthy controls (51 men, 59 women). Gray and white matter volumes of temporolimbic (hippocampus and amygdala) and neocortical regions (superior temporal gyrus and temporal pole) were examined. Symptoms, functioning, and neurocognition were assessed concurrently. RESULTS Hippocampal gray matter volume was reduced in men (7%) and women (8.5%) with schizophrenia. In the amygdala, however, decreased volume was evident for men (8%) whereas women (10.5%) had increased volume. Magnetic resonance imaging of the temporal pole showed decreased gray matter in men (10%) and women (8.5%). For the superior temporal gyrus, the decrease exceeded that of whole-brain only in men (11.5%). Volumes were largely uncorrelated with clinical measures, but higher hippocampal volumes were associated with better memory performance for all groups. Cortical volumes were associated with better memory performance in healthy women. CONCLUSIONS Schizophrenia is associated with reduced gray matter volume in temporolimbic structures. In men, reduction was manifested in all regions, whereas women showed decreased hippocampal volumes but increased amygdala volumes. The abnormalities are evident in patients with first-episode schizophrenia and correlate more strongly with cognitive performance than with symptom severity.
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Affiliation(s)
- R E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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Gur RE, Cowell PE, Latshaw A, Turetsky BI, Grossman RI, Arnold SE, Bilker WB, Gur RC. Reduced dorsal and orbital prefrontal gray matter volumes in schizophrenia. Arch Gen Psychiatry 2000; 57:761-8. [PMID: 10920464 DOI: 10.1001/archpsyc.57.8.761] [Citation(s) in RCA: 282] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Converging neuroanatomic, neurophysiological, and neurobehavioral evidence implicate prefrontal subregions in schizophrenia. Neuroanatomic studies with magnetic resonance (MR) imaging enable regional volume parcellation. Inconsistent reports may relate to variable methods and small samples. We attempted to resolve volume differences within sectors of the prefrontal lobe in a large sample, relating volumes to clinical and neurocognitive features. METHODS Magnetic resonance imaging was performed in 70 patients with schizophrenia (40 men and 30 women; 29 neuroleptic naive and 41 previously treated) and 81 healthy controls (34 men and 47 women). Gray and white matter volumes of the dorsolateral, dorsomedial, orbitolateral, and orbitomedial prefrontal cortex were quantified. Symptoms, functioning, and neurocognition were assessed concurrently. RESULTS Reduced prefrontal gray matter volume was observed in patients. The reduction was evident for the dorsolateral area in men (9%) and women (11%), for the dorsomedial area only in men (9%), and for orbital regions only in women (23% and 10% for lateral and medial, respectively). The reduction of orbital volume in women was associated with poorer premorbid functioning, more severe negative symptoms, and depression. Volume of dorsal cortex was positively associated with better performance on abstraction and attention tasks across all groups. CONCLUSIONS Schizophrenia is associated with reduced gray matter volume in prefrontal cortex, which affects men and women in the dorsolateral sector. The effects are moderated by sex for dorsomedial and orbital regions and are related to symptom severity and cognitive function. This is not a by-product of treatment, since the differences are evident in neuroleptic-naive patients.
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Affiliation(s)
- R E Gur
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
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30
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Abstract
The entorhinal cortex, subiculum, and hippocampus have been regions of great interest in both clinical and neuropathological investigations of schizophrenia. Postmortem studies have identified numerous abnormalities, although many remain controversial or unconfirmed. Among the cellular and molecular neuropathological findings are (1) abnormal cytoarchitecture of the entorhinal cortex characterized by poorly formed layer II neuron clusters and laminar disorganization; (2) normal neuron density but smaller neuron size in the superficial lamina of the entorhinal cortex and subiculum; (3) abnormal expression of the microtubule-associated protein MAP2 in the entorhinal cortex and subiculum; (4) aberrant glutamatergic and catecholaminergic innervation of the entorhinal cortex; (5) abnormal mRNA expression of various transcription factors, ion channels, and neurosecretory pathway-related proteins in entorhinal stellate neurons; and (6) an absence of any neurodegeneration. Altogether, these findings suggest that aberrant neurodevelopmental processes play a key role in the pathobiology of schizophrenia and provide a neuroanatomic basis for understanding many of the clinical and neuropsychological abnormalities in the disorder.
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Affiliation(s)
- S E Arnold
- Department of Psychiatry, University of Pennsylvania, Philadelphia 19104, USA.
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Hurtig HI, Trojanowski JQ, Galvin J, Ewbank D, Schmidt ML, Lee VM, Clark CM, Glosser G, Stern MB, Gollomp SM, Arnold SE. Alpha-synuclein cortical Lewy bodies correlate with dementia in Parkinson's disease. Neurology 2000; 54:1916-21. [PMID: 10822429 DOI: 10.1212/wnl.54.10.1916] [Citation(s) in RCA: 446] [Impact Index Per Article: 18.6] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dementia is a frequent complication of idiopathic parkinsonism or PD, usually occurring later in the protracted course of the illness. The primary site of neuropathologic change in PD is the substantia nigra, but the neuropathologic and molecular basis of dementia in PD is less clear. Although Alzheimer's pathology has been a frequent finding, recent advances in immunostaining of alpha-synuclein have suggested the possible importance of cortical Lewy bodies (CLBs) in the brains of demented patients with PD. METHODS The brains of 22 demented and 20 nondemented patients with a clinical and neuropathologic diagnosis of PD were evaluated with standard neuropathologic techniques. In addition, CLBs and dystrophic neurites were identified immunohistochemically with antibodies specific for alpha-synuclein and ubiquitin; plaques and tangles were identified by staining with thioflavine S. Associations between dementia status and pathologic markers were tested with logistic regression. RESULTS CLBs positive for alpha-synuclein are highly sensitive (91%) and specific (90%) neuropathologic markers of dementia in PD and slightly more sensitive than ubiquitin-positive CLBs. They are better indicators of dementia than neurofibrillary tangles, amyloid plaques, or dystrophic neurites. CONCLUSION CLBs detected by alpha-synuclein antibodies in patients with PD are a more sensitive and specific correlate of dementia than the presence of Alzheimer's pathology, which was present in a minority of the cases in this series.
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Affiliation(s)
- H I Hurtig
- Department of Neurology, University of Pennsylvania, PA, USA.
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32
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Abstract
OBJECTIVE The authors' goal in this study was to compare the size of olfactory bulbs of patients with schizophrenia and those of healthy subjects. METHOD Magnetic resonance imaging scans of olfactory bulbs were obtained from 26 patients with schizophrenia and 22 healthy comparison subjects. A reliable region of interest procedure was used to measure olfactory bulb volume. RESULTS Patients exhibited 23% smaller bilateral bulb volume than comparison subjects, independent of acute clinical, demographic, or treatment measures. Bulb volume correlated with odor detection sensitivity in healthy subjects but not in patients with schizophrenia. CONCLUSIONS Patients with schizophrenia exhibit structural olfactory deficits as well as functional olfactory deficits. The olfactory system may be a model system in which to study the neurobiology of the disorder.
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Affiliation(s)
- B I Turetsky
- Department of Psychiatry, Radiology, and Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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33
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Abstract
The cognitive and functional deterioration observed in many 'poor-outcome' patients with schizophrenia suggests an ongoing neurodegenerative process. Diagnostic neuropathologic studies have excluded known neurodegenerative diseases as the cause of this dementia, and in a previous quantitative investigation of neurodegeneration and neural injury in this population we found no abnormalities in the cerebral cortex. However, it is possible that the deterioration observed in these patients could be due to subcortical neurodegenerative processes. Neurodegeneration and neural injury in the caudate nucleus and mediodorsal nucleus of the thalamus were investigated in a postmortem study of 11 prospectively accrued, clinically well-characterized elderly people with schizophrenia, 11 elderly control subjects with no neuropsychiatric illness, and 12 subjects with Alzheimer's disease. Traditional and immunohistochemical staining and unbiased computerized counting methods were used to quantify common markers of neurodegeneration and neural injury (neuron loss, neurofibrillary tangles, astrocytosis, microgliosis). No statistically significant differences were found between schizophrenia and control subjects for the densities of any markers. There is no evidence that abnormal neurodegeneration occurs in these two important subcortical structures.
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Affiliation(s)
- E Falke
- Laboratory for Cellular and Molecular Neuropathology, Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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Duda JE, Shah U, Arnold SE, Lee VM, Trojanowski JQ. The expression of alpha-, beta-, and gamma-synucleins in olfactory mucosa from patients with and without neurodegenerative diseases. Exp Neurol 1999; 160:515-22. [PMID: 10619569 DOI: 10.1006/exnr.1999.7228] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.2] [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: 11/22/2022]
Abstract
A family of homologous proteins known as alpha-, beta-, and gamma-synuclein are abundantly expressed in brain, especially in the presynaptic terminal of neurons. Although the precise function of these proteins remains unknown, alpha-synuclein has been implicated in synaptic plasticity associated with avian song learning as well as in the pathogenesis of Parkinson's disease (PD), dementia with LBs (DLB), some forms of Alzheimer's disease (AD), and multiple system atrophy (MSA). Since olfactory dysfunction is a common feature of these disorders and the olfactory receptor neurons (ORNs) of the olfactory epithelium (OE) regenerate throughout the lifespan, we used antibodies specific for alpha-, beta-, and gamma-synucleins to examine the olfactory mucosa of patients with PD, DLB, AD, MSA, and controls without a neurological disorder. Although antibodies to alpha- and beta-synucleins detected abnormal dystrophic neurites in the OE of patients with neurodegenerative disorders, similar pathology was also seen in the OE of controls. More significantly, we show here for the first time that alpha-, beta-, and gamma-synucleins are differentially expressed in cells of the OE and respiratory epithelium and that alpha-synuclein is the most abundant synuclein in the olfactory mucosa, where it is prominently expressed in ORNs. Moreover, alpha- and gamma-synucleins also were prominent in the OE basal cells, which include the progenitor cells of the ORNs in the OE. Thus, our data on synuclein expression within the OE may signify that synuclein plays a role in the regeneration and plasticity of ORNs in the adult human OE.
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Affiliation(s)
- J E Duda
- Department of Pathology and Laboratory Medicine, The Center for Neurodegenerative Disease Research, Philadelphia, Pennsylvania, USA
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35
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Abstract
Growing epidemiological, genetic, and clinical neurobiological evidence indicates that abnormalities in brain development play determining roles in the pathobiology of schizophrenia. Neuropathological research has made significant progress in delineating cellular and molecular abnormalities in schizophrenia that have relevance to neurodevelopment. This paper reviews the neurodevelopmental processes of neurogenesis, neuronal migration, differentiation, synaptogenesis, neuron and synaptic pruning, and myelination and the reported neuropathological findings in schizophrenia that may be a consequence of disturbances in these processes. While many neuropathological findings in schizophrenia are controversial or await confirmation, reported abnormalities in neuron density, number and morphology, cytoarchitecture, dendritic arbors and spines, synapse-related proteins, and the well-established absence of gliosis or any other evidence of neurodegeneration or neural injury all provide support for the neurodevelopmental model of schizophrenia.
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Affiliation(s)
- S E Arnold
- Center for Neurobiology and Behavior, University of Pennsylvania.
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36
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Abstract
The proportion of prefrontal cortex in humans was compared to the proportion of prefrontal cortex in baboons (Papio anubis). Prefrontal cortex, dorsal prefrontal, orbital prefrontal cortex and total brain volumes were determined from magnetic resonance images of 20 healthy adult human females and 5 adult female baboons. Results showed that the proportion of prefrontal cortex volume relative to total brain volume in humans was significantly larger in humans than in baboons. The percentage of prefrontal cortex relative to total brain volume was 12.51 for humans and 10.68 for baboons. Similarly, the proportion of both dorsal and orbital prefrontal cortex volumes is larger in human brains. Relative to total brain volume, the percentages of dorsal and orbital prefrontal cortex was 8.22% and 4.29% respectively in humans and 7.21% and 3.47% in baboons. A regression analysis showed that the human prefrontal cortex was larger than would be predicted for a baboon of equal total brain volume. These results suggest that increased prefrontal lobe volume could underlie some of the differences between human and hominoid primates. On the other hand, the small magnitude of the difference might underlie similarities between the species and should encourage a search for other structures that are disproportionately larger in humans.
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Affiliation(s)
- T McBride
- Brain Behavior Laboratory, Department of Psychiatry, The University of Pennsylvania, Philadelphia, PA 19104, USA.
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37
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Abstract
Clinical, neuropsychological and neuropathological avenues of research have advanced in concert to increase our understanding of schizophrenia. Progress in four general areas of investigation will be reviewed: (i) fronto-temporal-limbic dysfunction; (ii) abnormal connectivity or 'miswiring'; (iii) aberrant neurodevelopment; and (iv) neurodegeneration and neural injury. The challenge for post-mortem research is to identify the molecular pathways in which abnormalities culminate in the highly diverse features of the disorder. Candidate pathways must be able to account for the developmental and deteriorative clinical profiles and the global and focal neuropsychological deficits, as well as the various patho-anatomical abnormalities that indicate aberrant cytoarchitecture and connectivity in the absence of neurodegeneration or other obvious evidence of postmaturational neural injury.
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Affiliation(s)
- S E Arnold
- Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
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38
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Abstract
Various clinical and epidemiological data have suggested the possibility of infectious mechanisms in schizophrenia. In addition, lengthy prodromal psychiatric symptoms can presage the development of Creutzfeldt-Jakob disease, a prototypical prion disorder. Accordingly, the presence of human protease resistant prion proteins (PrPres) was assessed in postmortem frontal cortical and thalamic tissues from a prospectively accrued and well characterised sample of elderly patients with chronic, sporadic, "poor outcome" schizophrenia using a sensitive immunoblot assay. No PrPres was found in the brains of any of the cases, providing evidence against a role for abnormal prion proteins in the pathogenesis of schizophrenia.
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Affiliation(s)
- S E Arnold
- Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania, Philadelphia, USA.
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McBride T, Moberg P, Mahr R, Arnold SE, Gur RE. Neuropsychological functioning in elderly patients with schizophrenia and Alzheimer's disease. Arch Clin Neuropsychol 1999. [DOI: 10.1093/arclin/14.1.57] [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: 11/13/2022] Open
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40
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Arnold SE, Smutzer GS, Trojanowski JQ, Moberg PJ. Cellular and molecular neuropathology of the olfactory epithelium and central olfactory pathways in Alzheimer's disease and schizophrenia. Ann N Y Acad Sci 1998; 855:762-75. [PMID: 9929682 DOI: 10.1111/j.1749-6632.1998.tb10656.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [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: 11/27/2022]
Abstract
Specific deficits in odor detection threshold, identification, and memory have been recognized in a variety of disorders including the neurodegenerative disorder, Alzheimer's disease (AD), and the psychiatric illness, schizophrenia, which is likely due to abnormalities in neurodevelopment. Neuropathological abnormalities in peripheral and central olfactory systems have been described in both disorder. In the olfactory, epithelium, dystrophic neurites that are immunoreactive for tau, neurofilaments and other polypeptides, as well as deposits of beta-amyloid have been observed, and these findings have been thought to contribute to the olfactory dysfunction of these disorders. However, similar findings also occur in the olfactory epithelium of many normal individuals and those with various other neurodegenerative diseases. In contrast, neuropathological studies have reported selective vulnerability of central olfactory pathways for the accumulation of neurofibrillary pathology in AD, and for cytoarchitectural, neuronal morphometric, and cytoskeletal protein abnormalities suggestive of abnormal neurodevelopment in schizophrenia. Thus, it is likely that the olfactory impairments associated with these diseases are due to damage within central olfactory pathways, and that they are further amplified by the less specific impairments associated with age-related sensory neuroepithelial abnormalities. Finally, both the olfactory epithelium and central olfactory pathways represent model systems in which to study the neurobiology of these disorders, which ultimately may yield clues with diagnostic and therapeutic utility.
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Affiliation(s)
- S E Arnold
- Department of Psychiatry, University of Pennsylvania, Philadelphia 19104, USA.
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41
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Abstract
OBJECTIVE The authors' goal was to compare the size and linear density of Purkinje cells in the cerebellar vermis of subjects with and without schizophrenia. METHOD Blocks of alcohol-fixed cerebellar vermis were dissected at autopsy from the brains of 14 elderly patients with schizophrenia and 13 elderly subjects with no history of neuropsychiatric illness. The blocks of vermis were sectioned and stained with 1% cresyl violet. The linear density and cross-sectional area of Purkinje cells were measured by using computer-assisted image analysis. The subjects with schizophrenia had been assessed with clinical rating scales within 1 year prior to death. RESULTS The average cross-sectional areas of Purkinje cells of the patients with schizophrenia were significantly smaller (by 8.3%) than those of the subjects without neuropsychiatric illness. No difference in Purkinje cell linear density was observed between the two groups. Significant correlations were seen between Purkinje cell size and scores on the Mini-Mental State, the Brief Psychiatric Rating Scale, and the antipsychotic drug dose. CONCLUSIONS These data indicate cerebellar involvement in schizophrenia; they are also consistent with reports of reduced neuronal size in other brain regions of patients with schizophrenia. These findings support a model of wide-spread central nervous system abnormality in schizophrenia.
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Affiliation(s)
- K D Tran
- Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104-4283, USA
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42
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Abstract
Recent evidence indicates that developmental anomalies may underlie some symptoms of schizophrenia, while psychophysical studies have demonstrated olfactory deficits in this disease. The postmortem olfactory mucosa of elderly schizophrenic patients was examined to characterize the molecular phenotype of this tissue. The distribution of developmentally regulated cytoskeletal proteins, a synaptic vesicle protein, a neural marker protein, a receptor for trophic molecules, axonal guidance and cell migration proteins, and neuronal and glial cytoskeletal proteins of various degrees of phosphorylation was examined by immunohistochemistry. Both schizophrenic and control subjects exhibited dystrophic neurites that were immunoreactive for synaptophysin, microtubule-associated proteins (MAP1B), and neurofilament proteins. No major histochemical or morphologic differences in either the expression or distribution of these proteins were observed in the olfactory epithelium of schizophrenic compared to control subjects. These studies indicated that dystrophic neurites frequently occurred in the olfactory mucosa of both schizophrenics and neurologically normal adults. The absence of major immunocytochemical abnormalities suggested that olfactory deficits in schizophrenia may be due to more subtle cellular or molecular differences or to abnormalities in olfactory regions of the central nervous system rather than in the olfactory epithelium.
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Affiliation(s)
- G Smutzer
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
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43
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Arnold SE, Trojanowski JQ, Gur RE, Blackwell P, Han LY, Choi C. Absence of neurodegeneration and neural injury in the cerebral cortex in a sample of elderly patients with schizophrenia. Arch Gen Psychiatry 1998; 55:225-32. [PMID: 9510216 DOI: 10.1001/archpsyc.55.3.225] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The cognitive and functional deterioration that is observed in many "poor-outcome" patients with schizophrenia suggests a neurodegenerative process extending into late life. Previous diagnostic studies have excluded known neurodegenerative diseases as explanations for this dementia. However, we hypothesized that relatively small accumulations of age- or disease-related neurodegenerative lesions occurring in an otherwise abnormal brain could result in deterioration in schizophrenia. METHODS Postmortem studies were conducted using 23 prospectively accrued elderly persons with chronic schizophrenia for whom clinical ratings had been determined before death, 14 elderly control patients with no neuropsychiatric disease, and 10 control patients with Alzheimer disease. Immunohistochemistry and unbiased stereological counting methods were used to quantify common neurodegenerative lesions (ie, neurofibrillary tangles, amyloid plaques, and Lewy bodies) and cellular reactions to a variety of noxious stimuli (ubiquitinated dystrophic neurites, astrocytosis, and microglial infiltrates) in the ventromedial temporal lobe and the frontal and the calcarine (primary visual) cortices. RESULTS No statistically significant differences were found between the patients with schizophrenia and the control patients without neuropsychiatric disease for the densities of any of the markers, while both groups exhibited fewer lesions than did the control group with Alzheimer disease. Correlation analyses in the schizophrenia sample failed to identify significant correlations between cognitive and psychiatric ratings and densities of any of the neuropathologic markers. CONCLUSIONS No significant evidence of neurodegeneration or ongoing neural injury in the cerebral cortex was found in this sample of elderly persons with schizophrenia. Furthermore, the behavioral and cognitive deterioration observed in late life did not correlate with age-related degenerative phenomena.
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Affiliation(s)
- S E Arnold
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
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44
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Abstract
Previous studies have reported cytoarchitectural abnormalities in superficial laminae of rostral portions of the entorhinal cortex in schizophrenia, including decreased densities of neurons, poorly formed layer II neuron islands, and apparent displacement of layer II-type neurons deep into layer III; however, findings have been controversial, given the qualitative nature of the descriptions and the normal heterogeneity of cytoarchitecture of the region. The x, y coordinates of Nissl-stained neurons were mapped in layers II, III, and V of entorhinal subdivision ER in 8 prospectively accrued patients with schizophrenia and 8 nonneuropsychiatric controls. Indices of neuron dispersion, nearest neighbor distances, and effective radius were determined. An abnormally clustered dispersion of neurons in layer III was present in schizophrenics compared to controls along with a reduced neuron effective radius, whereas the mean nearest-neighbor distance was normal. In layer II, there was a significantly increased effective radius, whereas other indices were normal. No between-group differences were noted in layer V for any variable. These data provide further evidence for subtle aberrant cytoarchitecture in superficial laminae of the entorhinal cortex in schizophrenia and are consistent with neurodevelopmental models of abnormal neuronal pruning, "miswiring," and/or migration in the illness.
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Affiliation(s)
- S E Arnold
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
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45
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Smutzer G, Zimmerman JE, Han LY, Ruscheinsky DD, Arnold SE, Yu X, Kratskin I. Inositol 1,4,5-trisphosphate receptor expression in odontoblast cells. Biochim Biophys Acta 1997; 1358:221-8. [PMID: 9366253 DOI: 10.1016/s0167-4889(97)00075-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The cellular distribution of inositol 1,4,5-trisphosphate receptors was examined in rodent maxillary incisor teeth. In situ hybridization studies with a transmembrane probe of type I inositol 1,4,5-trisphosphate receptor indicated that this receptor/channel was highly expressed in odontoblast cells of incisor teeth. In contrast, very low labeling was observed in dental pulp. Northern analysis showed a message size of approximately 9.5 kilobases for this receptor, and demonstrated that type III inositol 1,4,5-trisphosphate receptor was expressed in incisor teeth. Immunocytochemical studies confirmed that types I and III inositol 1,4,5-trisphosphate receptors were both highly expressed in odontoblasts while very low expression was detected in dental pulp. Finally, antibodies that recognized alpha subunits of the Gq class of GTP binding proteins also stained odontoblasts. These results indicate that receptor-mediated regulation of calcium release through inositol 1,4,5-trisphosphate receptors may occur in odontoblasts of rat incisor teeth. These findings also suggest that inositol 1,4,5-trisphosphate receptor/channels regulate calcium flux in odontoblasts during mineralization of dentin, or in growth and differentiation of incisor tissue.
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Affiliation(s)
- G Smutzer
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
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46
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Abstract
Despite recognition that Alzheimer's disease (AD) is a polygenic and heterogeneous dementing neurodegenerative disorder, there is continued merit in defining the AD phenotype by the presence of progressive cognitive impairments and the pathological brain lesions (senile plaques, neurofibrillary tangles) as originally formulated by Alois Alzheimer. This position paper discusses the rationale for emphasizing the detection of both beta amyloid-rich plaques and tau-rich tangles in the next iteration of the neuropathological criteria for the postmortem diagnosis of AD that has been recommended by the Working Group on Consensus Criteria for the Postmortem Diagnosis of AD. Further, it also underlines the need to exploit continuing advances in understanding the pathobiology of plaques and tangles in subsequent iterations of these criteria. It is expected that such efforts, now and in the future, will hasten the development of strategies for the early and accurate antemortem diagnosis of AD as well as the discovery of effective treatments for this common dementing illness of the elderly.
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Affiliation(s)
- J Q Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
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47
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Moberg PJ, Doty RL, Turetsky BI, Arnold SE, Mahr RN, Gur RC, Bilker W, Gur RE. Olfactory identification deficits in schizophrenia: correlation with duration of illness. Am J Psychiatry 1997; 154:1016-8. [PMID: 9210756 DOI: 10.1176/ajp.154.7.1016] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.9] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The authors examined the relationship between deficits in olfactory identification and duration of illness in young and elderly patients with schizophrenia. METHOD Olfactory identification performance of 38 patients with schizophrenia and 40 normal subjects was compared by using the University of Pennsylvania Smell Identification Test. RESULTS The schizophrenic patients demonstrated olfactory deficits relative to the comparison group, and the elderly schizophrenic patients displayed a greater magnitude of olfactory deficit than the younger patients. Independent of normal aging effects and cognitive deficit, patients with schizophrenia showed a strong relationship between olfactory identification scores and duration of illness, which suggests that olfactory abilities decline progressively over the course of the disorder. CONCLUSIONS In contrast to other neuropsychological measures that have been reported to be stable over the course of illness, olfactory identification abilities deteriorate steadily in patients with schizophrenia, even for those with relatively recent onset.
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Affiliation(s)
- P J Moberg
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA
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48
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Abstract
Evidence from diverse avenues of research has highlighted abnormalities in the anatomy, physiology, and function of medial temporal lobe structures in schizophrenia. Clinical similarities between schizophrenia and psychotic disorders associated with temporal lobe lesions have been recognized for decades. Neuropsychological studies have found selective impairments in learning and memory in schizophrenia consistent with medial temporal lobe dysfunction. Neuroimaging studies have identified medial temporal lobe abnormalities that have been correlated with clinical features. Postmortem findings in the hippocampus and entorhinal cortex have included differences in neuron density, size, and arrangement; abnormalities in synapse-related proteins; alterations in monoaminergic and glutamatergic innervation and receptor distribution; and abnormalities in the expression of cytoskeletal proteins. These findings appear most consistent with models of aberrant development of medial temporal lobe structures in schizophrenia.
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Affiliation(s)
- S E Arnold
- Department of Psychiatry, University of Pennsylvania, Philadelphia 19104, USA.
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Arnold SE, Joo E, Martinoli MG, Roy N, Trojanowski JQ, Gur RE, Cannon T, Price RA. Apolipoprotein E genotype in schizophrenia: frequency, age of onset, and neuropathologic features. Neuroreport 1997; 8:1523-6. [PMID: 9172167 DOI: 10.1097/00001756-199704140-00040] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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] [Indexed: 02/04/2023]
Abstract
Apolipoprotein E (ApoE) genotype has been found to affect the expression of a variety of neuropsychiatric disorders. We determined ApoE genotype frequencies and their relationship to clinical and pathological features in a diverse cohort of individuals with schizophrenia. There were no differences in ApoE genotype frequencies between schizophrenics and controls. However, the ApoE epsilon 4 genotype was associated with a younger age of onset of schizophrenia, and in an elderly subsample, individuals with the epsilon 4 allele more frequently exhibited co-existent dementia and had more neurofibrillary pathology (although none of the cases met criteria for Alzheimer's disease). This examination of ApoE in relation to clinical and neurobiological features of schizophrenia suggests that it modifies the phenotypic expression of the disease.
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Affiliation(s)
- S E Arnold
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
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Smutzer G, Zimmerman JE, Hahn CG, Ruscheinsky DD, Rodríguez A, Han LY, Arnold SE. Inositol 1,4,5-trisphosphate receptor expression in mammalian olfactory tissue. Brain Res Mol Brain Res 1997; 44:347-54. [PMID: 9073177 DOI: 10.1016/s0169-328x(96)00282-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Two cDNAs encoding inositol 1,4,5-trisphosphate (IP3) receptors were amplified from rat olfactory tissue, and both exhibited 100% sequence identity to the short (Segment II - ) variant of type I IP3 receptor. Type III IP3 receptor was also expressed in olfactory tissue. The distribution of IP3 receptors included the olfactory epithelium, lamina propria, and glandular tissue. These results demonstrate the co-expression of multiple IP3 receptor subtypes in olfactory cells, and suggest multiple functions for IP3 receptors in this tissue.
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Affiliation(s)
- G Smutzer
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
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