1
|
Chandrasekaran G, Xie SX. Improving Regression Analysis with Imputation in a Longitudinal Study of Alzheimer's Disease. J Alzheimers Dis 2024:JAD231047. [PMID: 38640151 DOI: 10.3233/jad-231047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Background Missing data is prevalent in the Alzheimer's Disease Neuroimaging Initiative (ADNI). It is common to deal with missingness by removing subjects with missing entries prior to statistical analysis; however, this can lead to significant efficiency loss and sometimes bias. It has yet to be demonstrated that the imputation approach to handling this issue can be valuable in some longitudinal regression settings. Objective The purpose of this study is to demonstrate the importance of imputation and how imputation is correctly done in ADNI by analyzing longitudinal Alzheimer's Disease Assessment Scale -Cognitive Subscale 13 (ADAS-Cog 13) scores and their association with baseline patient characteristics. Methods We studied 1,063 subjects in ADNI with mild cognitive impairment. Longitudinal ADAS-Cog 13 scores were modeled with a linear mixed-effects model with baseline clinical and demographic characteristics as predictors. The model estimates obtained without imputation were compared with those obtained after imputation with Multiple Imputation by Chained Equations (MICE). We justify application of MICE by investigating the missing data mechanism and model assumptions. We also assess robustness of the results to the choice of imputation method. Results The fixed-effects estimates of the linear mixed-effects model after imputation with MICE yield valid, tighter confidence intervals, thus improving the efficiency of the analysis when compared to the analysis done without imputation. Conclusions Our study demonstrates the importance of accounting for missing data in ADNI. When deciding to perform imputation, care should be taken in choosing the approach, as an invalid one can compromise the statistical analyses.
Collapse
Affiliation(s)
- Ganesh Chandrasekaran
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
2
|
Ohm DT, Xie SX, Capp N, Arezoumandan S, Cousins KAQ, Rascovsky K, Wolk DA, Van Deerlin VM, Lee EB, McMillan CT, Irwin DJ. Cytoarchitectonic gradients of laminar degeneration in behavioral variant frontotemporal dementia. bioRxiv 2024:2024.04.05.588259. [PMID: 38644997 PMCID: PMC11030243 DOI: 10.1101/2024.04.05.588259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Behavioral variant frontotemporal dementia (bvFTD) is a clinical syndrome primarily caused by either tau (bvFTD-tau) or TDP-43 (bvFTD-TDP) proteinopathies. We previously found lower cortical layers and dorsolateral regions accumulate greater tau than TDP-43 pathology; however, patterns of laminar neurodegeneration across diverse cytoarchitecture in bvFTD is understudied. We hypothesized that bvFTD-tau and bvFTD-TDP have distinct laminar distributions of pyramidal neurodegeneration along cortical gradients, a topologic order of cytoarchitectonic subregions based on increasing pyramidal density and laminar differentiation. Here, we tested this hypothesis in a frontal cortical gradient consisting of five cytoarchitectonic types (i.e., periallocortex, agranular mesocortex, dysgranular mesocortex, eulaminate-I isocortex, eulaminate-II isocortex) spanning anterior cingulate, paracingulate, orbitofrontal, and mid-frontal gyri in bvFTD-tau (n=27), bvFTD-TDP (n=47), and healthy controls (HC; n=32). We immunostained all tissue for total neurons (NeuN; neuronal-nuclear protein) and pyramidal neurons (SMI32; non-phosphorylated neurofilament) and digitally quantified NeuN-immunoreactivity (ir) and SMI32-ir in supragranular II-III, infragranular V-VI, and all I-VI layers in each cytoarchitectonic type. We used linear mixed-effects models adjusted for demographic and biologic variables to compare SMI32-ir between groups and examine relationships with the cortical gradient, long-range pathways, and clinical symptoms. We found regional and laminar distributions of SMI32-ir expected for HC, validating our measures within the cortical gradient framework. While SMI32-ir loss was not related to the cortical gradient in bvFTD-TDP, SMI32-ir progressively decreased along the cortical gradient of bvFTD-tau and included greater SMI32-ir loss in supragranular eulaminate-II isocortex in bvFTD-tau vs bvFTD-TDP ( p =0.039). In a structural model for long-range laminar connectivity between infragranular mesocortex and supragranular isocortex, we found a larger laminar ratio of mesocortex-to-isocortex SMI32-ir in bvFTD-tau vs bvFTD-TDP ( p =0.019), suggesting select long-projecting pathways may contribute to isocortical-predominant degeneration in bvFTD-tau. In cytoarchitectonic types with the highest NeuN-ir, we found lower SMI32-ir in bvFTD-tau vs bvFTD-TDP ( p =0.047), suggesting pyramidal neurodegeneration may occur earlier in bvFTD-tau. Lastly, we found that reduced SMI32-ir related to behavioral severity and frontal-mediated letter fluency, not temporal-mediated confrontation naming, demonstrating the clinical relevance and specificity of frontal pyramidal neurodegeneration to bvFTD-related symptoms. Our data suggest loss of neurofilament-rich pyramidal neurons is a clinically relevant feature of bvFTD that selectively worsens along a frontal cortical gradient in bvFTD-tau, not bvFTD-TDP. Therefore, tau-mediated degeneration may preferentially involve pyramidal-rich layers that connect more distant cytoarchitectonic types. Moreover, the hierarchical arrangement of cytoarchitecture along cortical gradients may be an important neuroanatomical framework for identifying which types of cells and pathways are differentially involved between proteinopathies.
Collapse
|
3
|
Kim B, Yannatos I, Blam K, Wiebe D, Xie SX, McMillan CT, Mechanic‐Hamilton D, Wolk DA, Lee EB. Neighborhood disadvantage reduces cognitive reserve independent of neuropathologic change. Alzheimers Dement 2024; 20:2707-2718. [PMID: 38400524 PMCID: PMC11032541 DOI: 10.1002/alz.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Individuals in socioeconomically disadvantaged neighborhoods exhibit increased risk for impaired cognitive function. Whether this association relates to the major dementia-related neuropathologies is unknown. METHODS This cross-sectional study included 469 autopsy cases from 2011 to 2023. The relationships between neighborhood disadvantage measured by Area Deprivation Index (ADI) percentiles categorized into tertiles, cognition evaluated by the last Mini-Mental State Examination (MMSE) scores before death, and 10 dementia-associated proteinopathies and cerebrovascular disease were assessed using regression analyses. RESULTS Higher ADI was significantly associated with lower MMSE score. This was mitigated by increasing years of education. ADI was not associated with an increase in dementia-associated neuropathologic change. Moreover, the significant association between ADI and cognition remained even after controlling for changes in major dementia-associated proteinopathies or cerebrovascular disease. DISCUSSION Neighborhood disadvantage appears to be associated with decreased cognitive reserve. This association is modified by education but is independent of the major dementia-associated neuropathologies.
Collapse
Affiliation(s)
- Boram Kim
- Translational Neuropathology Research LaboratoryDepartment of Pathology and Laboratory MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Isabel Yannatos
- Penn Frontotemporal Degeneration CenterDepartment of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kaitlin Blam
- Translational Neuropathology Research LaboratoryDepartment of Pathology and Laboratory MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Douglas Wiebe
- Department of Emergency MedicineDepartment of EpidemiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Sharon X. Xie
- Department of BiostatisticsEpidemiology and InformaticsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Corey T. McMillan
- Penn Frontotemporal Degeneration CenterDepartment of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dawn Mechanic‐Hamilton
- Penn Memory CenterDepartment of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - David A. Wolk
- Penn Memory CenterDepartment of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Edward B. Lee
- Translational Neuropathology Research LaboratoryDepartment of Pathology and Laboratory MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
4
|
Lyu X, Duong MT, Xie L, de Flores R, Richardson H, Hwang G, Wisse LEM, DiCalogero M, McMillan CT, Robinson JL, Xie SX, Lee EB, Irwin DJ, Dickerson BC, Davatzikos C, Nasrallah IM, Yushkevich PA, Wolk DA, Das SR. Tau-neurodegeneration mismatch reveals vulnerability and resilience to comorbidities in Alzheimer's continuum. Alzheimers Dement 2024; 20:1586-1600. [PMID: 38050662 PMCID: PMC10984442 DOI: 10.1002/alz.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Variability in relationship of tau-based neurofibrillary tangles (T) and neurodegeneration (N) in Alzheimer's disease (AD) arises from non-specific nature of N, modulated by non-AD co-pathologies, age-related changes, and resilience factors. METHODS We used regional T-N residual patterns to partition 184 patients within the Alzheimer's continuum into data-driven groups. These were compared with groups from 159 non-AD (amyloid "negative") patients partitioned using cortical thickness, and groups in 98 patients with ante mortem MRI and post mortem tissue for measuring N and T, respectively. We applied the initial T-N residual model to classify 71 patients in an independent cohort into predefined groups. RESULTS AD groups displayed spatial T-N mismatch patterns resembling neurodegeneration patterns in non-AD groups, similarly associated with non-AD factors and diverging cognitive outcomes. In the autopsy cohort, limbic T-N mismatch correlated with TDP-43 co-pathology. DISCUSSION T-N mismatch may provide a personalized approach for determining non-AD factors associated with resilience/vulnerability in AD.
Collapse
Affiliation(s)
- Xueying Lyu
- Departments of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Michael Tran Duong
- Departments of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Long Xie
- Departments of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Hayley Richardson
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Gyujoon Hwang
- Departments of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Michael DiCalogero
- Departments of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Corey T. McMillan
- Departments of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - John L. Robinson
- Departments of Pathology and Laboratory MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sharon X. Xie
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Edward B. Lee
- Departments of Pathology and Laboratory MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - David J. Irwin
- Departments of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Christos Davatzikos
- Departments of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ilya M. Nasrallah
- Departments of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Paul A. Yushkevich
- Departments of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - David A. Wolk
- Departments of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sandhitsu R. Das
- Departments of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | |
Collapse
|
5
|
Nevler N, Cho S, Cousins KAQ, Ash S, Olm CA, Shellikeri S, Agmon G, Gonzalez-Recober C, Xie SX, Barker MS, Manoochehri M, Mcmillan CT, Irwin DJ, Massimo L, Dratch L, Cheran G, Huey ED, Cosentino SA, Van Deerlin VM, Liberman MY, Grossman M. Changes in Digital Speech Measures in Asymptomatic Carriers of Pathogenic Variants Associated With Frontotemporal Degeneration. Neurology 2024; 102:e207926. [PMID: 38165329 DOI: 10.1212/wnl.0000000000207926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Clinical trials developing therapeutics for frontotemporal degeneration (FTD) focus on pathogenic variant carriers at preclinical stages. Objective, quantitative clinical assessment tools are needed to track stability and delayed disease onset. Natural speech can serve as an accessible, cost-effective assessment tool. We aimed to identify early changes in the natural speech of FTD pathogenic variant carriers before they become symptomatic. METHODS In this cohort study, speech samples of picture descriptions were collected longitudinally from healthy participants in observational studies at the University of Pennsylvania and Columbia University between 2007 and 2020. Participants were asymptomatic but at risk for familial FTD. Status as "carrier" or "noncarrier" was based on screening for known pathogenic variants in the participant's family. Thirty previously validated digital speech measures derived from automatic speech processing pipelines were selected a priori based on previous studies in patients with FTD and compared between asymptomatic carriers and noncarriers cross-sectionally and longitudinally. RESULTS A total of 105 participants, all asymptomatic, included 41 carriers: 12 men [30%], mean age 43 ± 13 years; education, 16 ± 2 years; MMSE 29 ± 1; and 64 noncarriers: 27 men [42%]; mean age, 48 ± 14 years; education, 15 ± 3 years; MMSE 29 ± 1. We identified 4 speech measures that differed between carriers and noncarriers at baseline: mean speech segment duration (mean difference -0.28 seconds, 95% CI -0.55 to -0.02, p = 0.04); word frequency (mean difference 0.07, 95% CI 0.008-0.14, p = 0.03); word ambiguity (mean difference 0.02, 95% CI 0.0008-0.05, p = 0.04); and interjection count per 100 words (mean difference 0.33, 95% CI 0.07-0.59, p = 0.01). Three speech measures deteriorated over time in carriers only: particle count per 100 words per month (β = -0.02, 95% CI -0.03 to -0.004, p = 0.009); total narrative production time in seconds per month (β = -0.24, 95% CI -0.37 to -0.12, p < 0.001); and total number of words per month (β = -0.48, 95% CI -0.78 to -0.19, p = 0.002) including in 3 carriers who later converted to symptomatic disease. DISCUSSION Using automatic processing pipelines, we identified early changes in the natural speech of FTD pathogenic variant carriers in the presymptomatic stage. These findings highlight the potential utility of natural speech as a digital clinical outcome assessment tool in FTD, where objective and quantifiable measures for abnormal behavior and language are lacking.
Collapse
Affiliation(s)
- Naomi Nevler
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Sunghye Cho
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Katheryn A Q Cousins
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Sharon Ash
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Christopher A Olm
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Sanjana Shellikeri
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Galit Agmon
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Carmen Gonzalez-Recober
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Sharon X Xie
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Megan S Barker
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Masood Manoochehri
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Corey T Mcmillan
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - David J Irwin
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Lauren Massimo
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Laynie Dratch
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Gayathri Cheran
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Edward D Huey
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Stephanie A Cosentino
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Vivianna M Van Deerlin
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Mark Y Liberman
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| | - Murray Grossman
- From the Frontotemporal Degeneration Center, Department of Neurology, (N.N., K.A.Q.C., S.A., C.A.O., S.S., G.A., C.G.-R., C.T.M., D.J.I., L.M., L.D., M.G.), Linguistic Data Consortium, Department of Linguistics (S.C., M.Y.L.), Penn Image Computing and Science Laboratory, Department of Radiology (C.A.O.), Department of Biostatistics, Epidemiology and Informatics (S.X.X.), and Department of Pathology and Laboratory Medicine (V.M.V.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.S.B.,M.M., G.C., E.D.H., S.A.C.); and Department of Neurology (G.C., E.D.H., S.A.C.) and Gertrude H. Sergievsky Center (S.A.C.), Columbia University Irving Medical Center, New York
| |
Collapse
|
6
|
Yannatos I, Stites SD, Boen C, Xie SX, Brown RT, McMillan CT. Epigenetic age and socioeconomic status contribute to racial disparities in cognitive and functional aging between Black and White older Americans. medRxiv 2023:2023.09.29.23296351. [PMID: 37873230 PMCID: PMC10592997 DOI: 10.1101/2023.09.29.23296351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Epigenetic age, a biological aging marker measured by DNA methylation, is a potential mechanism by which social factors drive disparities in age-related health. Epigenetic age gap is the residual between epigenetic age measures and chronological age. Previous studies showed associations between epigenetic age gap and age-related outcomes including cognitive capacity and performance on some functional measures, but whether epigenetic age gap contributes to disparities in these outcomes is unknown. We use data from the Health and Retirement Study to examine the role of epigenetic age gap in racial disparities in cognitive and functional outcomes and consider the role of socioeconomic status (SES). Epigenetic age measures are GrimAge or Dunedin Pace of Aging methylation (DPoAm). Cognitive outcomes are cross-sectional score and two-year change in Telephone Interview for Cognitive Status (TICS). Functional outcomes are prevalence and incidence of limitations performing Instrumental Activities of Daily Living (IADLs). We find, relative to White participants, Black participants have lower scores and greater decline in TICS, higher prevalence and incidence rates of IADL limitations, and higher epigenetic age gap. Age- and gender-adjusted analyses reveal that higher GrimAge and DPoAm gap are both associated with worse cognitive and functional outcomes and mediate 6-11% of racial disparities in cognitive outcomes and 19-39% of disparities in functional outcomes. Adjusting for SES attenuates most DPoAm associations and most mediation effects. These results support that epigenetic age gap contributes to racial disparities in cognition and functioning and may be an important mechanism linking social factors to disparities in health outcomes.
Collapse
Affiliation(s)
- Isabel Yannatos
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - Shana D. Stites
- Department of Psychiatry, Perelman School of Medicine, Philadelphia, USA
| | - Courtney Boen
- Department of Sociology, University of Pennsylvania, Philadelphia, USA
| | - Sharon X. Xie
- Deptartment of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA
| | - Rebecca T. Brown
- Division of Geriatric Medicine, Perelman School of Medicine, Philadelphia, USA
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Corey T. McMillan
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
7
|
Gallagher J, Mamikonyan E, Xie SX, Tran B, Shaw S, Weintraub D. Validating virtual administration of neuropsychological testing in Parkinson disease: a pilot study. Sci Rep 2023; 13:16243. [PMID: 37758767 PMCID: PMC10533878 DOI: 10.1038/s41598-023-42934-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
COVID-19 has highlighted the need for remote cognitive testing, but the reliability and validity of virtual cognitive testing in Parkinson disease (PD) is unknown. Therefore, we assessed PD participants enrolled in an observational, cognition-focused study with an extensive cognitive battery completed both in-person and via video conference close in time. Data for 35 PD participants with normal cognition to mild dementia were analyzed. Only one test (semantic verbal fluency) demonstrated a difference in score by administration type, with a significantly better score virtually. Only three tests demonstrated good reliability for in-person versus virtual testing, but reliability values for visit 1 versus visit 2 were similarly low overall. Trail Making Test B was successfully administered virtually to only 18 participants due to technical issues. Virtual and in-person cognitive testing generate similar scores at the group level, but with poor to moderate reliability for most tests. Mode of test administration, learning effects, and technical difficulties explained little of the low test-retest reliability, indicating possible significant short-term variability in cognitive performance in PD in general, which has implications for clinical care and research. In-person cognitive testing with a neuropsychologist remains the gold standard, and it remains to be determined if virtual cognitive testing is feasible in PD.
Collapse
Affiliation(s)
- Julia Gallagher
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, 3615 Chestnut St., Philadelphia, PA, 19104, USA
| | - Eugenia Mamikonyan
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Baochan Tran
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, 3615 Chestnut St., Philadelphia, PA, 19104, USA
| | - Sarah Shaw
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, 3615 Chestnut St., Philadelphia, PA, 19104, USA
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, 3615 Chestnut St., Philadelphia, PA, 19104, USA.
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veteran's Affairs Medical Center, Philadelphia, PA, USA.
| |
Collapse
|
8
|
Xie K, Gallagher RS, Shinohara RT, Xie SX, Hill CE, Conrad EC, Davis KA, Roth D, Litt B, Ellis CA. Long-term epilepsy outcome dynamics revealed by natural language processing of clinic notes. Epilepsia 2023; 64:1900-1909. [PMID: 37114472 PMCID: PMC10523917 DOI: 10.1111/epi.17633] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Electronic medical records allow for retrospective clinical research with large patient cohorts. However, epilepsy outcomes are often contained in free text notes that are difficult to mine. We recently developed and validated novel natural language processing (NLP) algorithms to automatically extract key epilepsy outcome measures from clinic notes. In this study, we assessed the feasibility of extracting these measures to study the natural history of epilepsy at our center. METHODS We applied our previously validated NLP algorithms to extract seizure freedom, seizure frequency, and date of most recent seizure from outpatient visits at our epilepsy center from 2010 to 2022. We examined the dynamics of seizure outcomes over time using Markov model-based probability and Kaplan-Meier analyses. RESULTS Performance of our algorithms on classifying seizure freedom was comparable to that of human reviewers (algorithm F1 = .88 vs. human annotatorκ = .86). We extracted seizure outcome data from 55 630 clinic notes from 9510 unique patients written by 53 unique authors. Of these, 30% were classified as seizure-free since the last visit, 48% of non-seizure-free visits contained a quantifiable seizure frequency, and 47% of all visits contained the date of most recent seizure occurrence. Among patients with at least five visits, the probabilities of seizure freedom at the next visit ranged from 12% to 80% in patients having seizures or seizure-free at the prior three visits, respectively. Only 25% of patients who were seizure-free for 6 months remained seizure-free after 10 years. SIGNIFICANCE Our findings demonstrate that epilepsy outcome measures can be extracted accurately from unstructured clinical note text using NLP. At our tertiary center, the disease course often followed a remitting and relapsing pattern. This method represents a powerful new tool for clinical research with many potential uses and extensions to other clinical questions.
Collapse
Affiliation(s)
- Kevin Xie
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ryan S. Gallagher
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Russell T. Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sharon X. Xie
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Chloe E. Hill
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Erin C. Conrad
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kathryn A. Davis
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Dan Roth
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Brian Litt
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Colin A. Ellis
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| |
Collapse
|
9
|
James JG, Park J, Oliver A, Xie SX, Siderowf A, Spindler M, Wechsler LR, Tropea TF. Linked Patient and Provider Impressions of Outpatient Teleneurology Encounters. Neurol Clin Pract 2023; 13:e200159. [PMID: 37153752 PMCID: PMC10155606 DOI: 10.1212/cpj.0000000000200159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/27/2023] [Indexed: 05/10/2023]
Abstract
Background and Objectives Teleneurology is common in clinical practice partly due to the SARS CoV-2 pandemic. Impressions about teleneurology from patients and providers alike are generally favorable; some of the reported benefits include ease of access to specialized health care, savings of time and money, and similar quality of care as an in-person visit. However, comparisons between patient and provider impressions about the same teleneurology encounter have not been described. In this study, we describe patient impressions about a teleneurology encounter and evaluate concordance with provider impressions about the same encounter. Methods Patients and providers at the University of Pennsylvania Hospital Neurology Department were surveyed about their impressions of teleneurology between April 27, 2020, and June 16, 2020. A convenience sample of patients, whose providers completed a questionnaire, were contacted by telephone to solicit their impressions about the same encounter. Unique questionnaires for patients and providers focused on similar themes, such as adequacy of technology, assessment of history obtained, and overall quality of the visit. Summaries of patient responses are reported with the raw percent agreement between patients and providers for similar questions. Results One hundred thirty-seven patients completed the survey; 64 (47%) were male and 73 (53%) were female. Sixty-six (47%) patients had a primary diagnosis of PD, 42 (30%) a non-PD/parkinsonism movement disorder, and 29 (21%) a nonmovement disorder neurologic disease. One hundred one (76%) were established patient visits and 36 (26%) were new patient visits. Provider responses from 8 different physicians were included. Most of the patients responded that the ease of joining their visit, their comfort engaging with their physicians during their visit, understanding their plan of care after their visit, and the quality of care from their teleneurology visit were satisfactory. Patients and providers agreed about their impressions of the quality of the history obtained (87% agreement), patient-provider relationship (88% agreement), and overall quality of their experience (70% agreement). Discussion Patients had favorable impressions about their clinical experience with teleneurology and expressed an interest in incorporating telemedicine visits into their ongoing care. Patients and providers were highly concordant for the history obtained, patient-provider relationship, and overall quality.
Collapse
Affiliation(s)
- Justin G James
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jane Park
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alexandria Oliver
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Sharon X Xie
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Andrew Siderowf
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Meredith Spindler
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Lawrence R Wechsler
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Thomas F Tropea
- Department of Neurology (JGJ, JP, AO, AS, MS, LRW, TFT), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; CW Psychological Services (JP), King of Prussia, PA; and Department of Biostatistics (SXX), Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| |
Collapse
|
10
|
Mechanic-Hamilton D, Lydon S, Xie SX, Zhang P, Miller A, Rascovsky K, Rhodes E, Massimo L. Turning apathy into action in neurodegenerative disease: Development and pilot testing of a goal-directed behaviour app. Neuropsychol Rehabil 2023:1-16. [PMID: 37128648 PMCID: PMC10600325 DOI: 10.1080/09602011.2023.2203403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
This study aims to design and pilot an empirically based mobile application (ActiviDaily) to increase daily activity in persons with apathy and ADRD and test its feasibility and preliminary efficacy. ActiviDaily was developed to address impairments in goal-directed behaviour, including difficulty with initiation, planning, and motivation that contribute to apathy. Participants included patients with apathy and MCI, mild bvFTD, or mild AD and their caregivers. In Phase I, 6 patient-caregiver dyads participated in 1-week pilot testing and focus groups. In Phase II, 24 dyads completed 4 weeks of at-home ActiviDaily use. Baseline and follow-up visits included assessments of app usability, goal attainment, global cognition and functioning, apathy, and psychological symptoms. App use did not differ across diagnostic groups and was not associated with age, sex, education, global functioning or neuropsychiatric symptoms. Patients and care-partners reported high levels of satisfaction and usability, and care-partner usability rating predicted app use. At follow-up, participants showed significant improvement in goal achievement for all goal types combined. Participant goal-directed behaviour increased after 4 weeks of ActiviDaily use. Patients and caregivers reported good usability and user satisfaction. Our findings support the feasibility and efficacy of mobile-health applications to increase goal-directed behaviour in ADRD.
Collapse
Affiliation(s)
- Dawn Mechanic-Hamilton
- Penn Memory Center, Perelman School of Medicine, University of Pennsylvania
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Sean Lydon
- Penn Memory Center, Perelman School of Medicine, University of Pennsylvania
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Sharon X. Xie
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
| | - Panpan Zhang
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
| | - Alex Miller
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Katya Rascovsky
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Emma Rhodes
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Lauren Massimo
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania
- School of Nursing, University of Pennsylvania
| |
Collapse
|
11
|
Robinson JL, Xie SX, Baer DR, Suh E, Van Deerlin VM, Loh NJ, Irwin D, McMillan CT, Wolk D, Chen-Plotkin A, Weintraub D, Schuck T, Lee VMY, Trojanowski JQ, Lee EB. Pathological combinations in neurodegenerative disease are heterogeneous and disease-associated. Brain 2023:7067885. [PMID: 36864661 PMCID: PMC10232273 DOI: 10.1093/brain/awad059] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 03/04/2023] Open
Abstract
Pathologies that are causative for neurodegenerative disease (ND) are also frequently present in unimpaired, older individuals. In this retrospective study of 1,647 autopsied individuals, we report the incidence of ten pathologies across ND and normal ageing in attempt to clarify which pathological combinations are disease-associated and which are ageing-related. Eight clinically defined groups were examined including unimpaired individuals and those with clinical Alzheimer's disease, mixed dementia, amyotrophic lateral sclerosis, frontotemporal degeneration, multiple system atrophy, probable Lewy body disease, or probable tauopathies. Up to seven pathologies were observed concurrently resulting in a heterogenous mix of 161 pathological combinations. The presence of multiple, additive pathologies associated with older age, increasing disease duration, APOE e4 allele, and presence of dementia across the clinical groups. 15-67 combinations occurred in each group with the unimpaired group defined by 35 combinations. Most combinations occurred at a < 5% prevalence included 86 that were present in only 1-2 individuals. To better understand this heterogeneity, we organized the pathologic combinations into five broad categories based on their age-related frequency: 1) Ageing only for the unimpaired group combinations, 2) ND only if only the expected pathology for that individual's clinical phenotype was present, 3) Other ND if the expected pathology was not present, 4) ND + ageing if the expected pathology was present together with aging-related pathologies at a similar prevalence as the unimpaired group, and 5) ND + associated if the expected pathology was present together with other pathologies either not observed in the unimpaired group or observed at a greater frequency. ND only cases comprised a minority of cases (19-45%) except in the amyotrophic lateral sclerosis (56%) and multiple system atrophy (65%) groups. The ND + ageing category represented 9-28% of each group, but was rare in Alzheimer's disease (1%). ND + associated combinations were common in Alzheimer's disease (58%) and Lewy body disease (37%) and were observed in all groups. The Ageing only and Other ND categories accounted for a minority of individuals in each group. This observed heterogeneity indicates that the total pathological burden in ND is frequently more than a primary expected clinicopathological correlation with a high frequency of additional disease- or age-associated pathologies.
Collapse
Affiliation(s)
- John L Robinson
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sharon X Xie
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Daniel R Baer
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - EunRan Suh
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Vivianna M Van Deerlin
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nicholas J Loh
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David Irwin
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Corey T McMillan
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David Wolk
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alice Chen-Plotkin
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Daniel Weintraub
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Theresa Schuck
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Virginia M-Y Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Edward B Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
12
|
Lyu X, Duong MT, Xie L, de Flores R, Richardson H, Hwang G, Wisse LEM, DiCalogero M, McMillan CT, Robinson JL, Xie SX, Grossman M, Lee EB, Irwin DJ, Dickerson BC, Davatzikos C, Nasrallah IM, Yushkevich PA, Wolk DA, Das SR. Tau-Neurodegeneration mismatch reveals vulnerability and resilience to comorbidities in Alzheimer's continuum. medRxiv 2023:2023.02.12.23285594. [PMID: 36824762 PMCID: PMC9949174 DOI: 10.1101/2023.02.12.23285594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Variability in the relationship of tau-based neurofibrillary tangles (T) and degree of neurodegeneration (N) in Alzheimer's Disease (AD) is likely attributable to the non-specific nature of N, which is also modulated by such factors as other co-pathologies, age-related changes, and developmental differences. We studied this variability by partitioning patients within the Alzheimer's continuum into data-driven groups based on their regional T-N dissociation, which reflects the residuals after the effect of tau pathology is "removed". We found six groups displaying distinct spatial T-N mismatch and thickness patterns despite similar tau burden. Their T-N patterns resembled the neurodegeneration patterns of non-AD groups partitioned on the basis of z-scores of cortical thickness alone and were similarly associated with surrogates of non-AD factors. In an additional sample of individuals with antemortem imaging and autopsy, T-N mismatch was associated with TDP-43 co-pathology. Finally, T-N mismatch training was then applied to a separate cohort to determine the ability to classify individual patients within these groups. These findings suggest that T-N mismatch may provide a personalized approach for determining non-AD factors associated with resilience/vulnerability to Alzheimer's disease.
Collapse
|
13
|
Tropea TF, Waligorska T, Xie SX, Nasrallah IM, Cousins KAQ, Trojanowski JQ, Grossman M, Irwin DJ, Weintraub D, Lee EB, Wolk DA, Chen‐Plotkin AS, Shaw LM. Plasma phosphorylated tau181 predicts cognitive and functional decline. Ann Clin Transl Neurol 2022; 10:18-31. [PMID: 36518085 PMCID: PMC9852389 DOI: 10.1002/acn3.51695] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine if plasma tau phosphorylated at threonine 181 (p-tau181) distinguishes pathology-confirmed Alzheimer's disease (AD) from normal cognition (NC) adults, to test if p-tau181 predicts cognitive and functional decline, and to validate findings in an external cohort. METHODS Thirty-one neuropathology-confirmed AD cases, participants with clinical diagnoses of mild cognitive impairment (MCI, N = 91) or AD dementia (N = 64), and NC (N = 241) had plasma collected at study entry. The clinical diagnosis groups had annual cognitive (Mini-Mental State Examination, MMSE) and functional (Clinical Dementia Rating Scale, CDR) measures. NC (N = 70), MCI (N = 75), and AD dementia (N = 50) cases from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were used as a validation cohort. Plasma p-tau181 was measured using the Quanterix SiMoA HD-X platform. RESULTS Plasma p-tau181 differentiated pathology-confirmed AD from NC with negative amyloid PET scans with an AUC of 0.93. A cut point of 3.44 pg/mL (maximum Youden Index) had a sensitivity of 0.77, specificity of 0.96. p-Tau181 values above the cut point were associated with the faster rate of decline in MMSE in AD dementia and MCI and a shorter time to a clinically significant functional decline in all groups. In a subset of MCI cases from ADNI, p-tau181 values above the cut point associated with faster rate of decline in MMSE, and a shorter time to a clinically significant functional decline and conversion to dementia. INTERPRETATION Plasma p-tau181 differentiates AD pathology cases from NC with high accuracy. Higher levels of plasma p-tau181 are associated with faster cognitive and functional decline.
Collapse
Affiliation(s)
- Thomas F. Tropea
- Department of NeurologyPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Teresa Waligorska
- Department of Pathology and Laboratory MedicinePerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sharon X. Xie
- Department of Biostatistics, Epidemiology, and InformaticsPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ilya M. Nasrallah
- Department of RadiologyPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Katheryn A. Q. Cousins
- Department of NeurologyPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - John Q. Trojanowski
- Department of Pathology and Laboratory MedicinePerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Murray Grossman
- Department of NeurologyPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - David J. Irwin
- Department of NeurologyPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Daniel Weintraub
- Department of PsychiatryPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA,Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Edward B. Lee
- Department of Pathology and Laboratory MedicinePerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - David A. Wolk
- Department of NeurologyPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Alice S. Chen‐Plotkin
- Department of NeurologyPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Leslie M. Shaw
- Department of Pathology and Laboratory MedicinePerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | |
Collapse
|
14
|
Sadaghiani S, Trotman W, Lim SA, Chung E, Ittyerah R, Ravikumar S, Khandelwal P, Prabhakaran K, Lavery ML, Ohm DT, Gabrielyan M, Das SR, Schuck T, Capp N, Peterson CS, Migdal E, Artacho-Pérula E, Jiménez MDMA, Rabal MDPM, Sánchez SC, Prieto CDLR, Parada MC, Insausti R, Robinson JL, McMillan C, Grossman M, Lee EB, Detre JA, Xie SX, Trojanowski JQ, Tisdall MD, Wisse LEM, Irwin DJ, Wolk DA, Yushkevich PA. Associations of phosphorylated tau pathology with whole-hemisphere ex vivo morphometry in 7 tesla MRI. Alzheimers Dement 2022. [PMID: 36464907 DOI: 10.1002/alz.12884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/29/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Neurodegenerative disorders are associated with different pathologies that often co-occur but cannot be measured specifically with in vivo methods. METHODS Thirty-three brain hemispheres from donors with an Alzheimer's disease (AD) spectrum diagnosis underwent T2-weighted magnetic resonance imaging (MRI). Gray matter thickness was paired with histopathology from the closest anatomic region in the contralateral hemisphere. RESULTS Partial Spearman correlation of phosphorylated tau and cortical thickness with TAR DNA-binding protein 43 (TDP-43) and α-synuclein scores, age, sex, and postmortem interval as covariates showed significant relationships in entorhinal and primary visual cortices, temporal pole, and insular and posterior cingulate gyri. Linear models including Braak stages, TDP-43 and α-synuclein scores, age, sex, and postmortem interval showed significant correlation between Braak stage and thickness in the parahippocampal gyrus, entorhinal cortex, and Broadman area 35. CONCLUSION We demonstrated an association of measures of AD pathology with tissue loss in several AD regions despite a limited range of pathology in these cases. HIGHLIGHTS Neurodegenerative disorders are associated with co-occurring pathologies that cannot be measured specifically with in vivo methods. Identification of the topographic patterns of these pathologies in structural magnetic resonance imaging (MRI) may provide probabilistic biomarkers. We demonstrated the correlation of the specific patterns of tissue loss from ex vivo brain MRI with underlying pathologies detected in postmortem brain hemispheres in patients with Alzheimer's disease (AD) spectrum disorders. The results provide insight into the interpretation of in vivo structural MRI studies in patients with AD spectrum disorders.
Collapse
Affiliation(s)
- Shokufeh Sadaghiani
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Winifred Trotman
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sydney A Lim
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eunice Chung
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ranjit Ittyerah
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sadhana Ravikumar
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pulkit Khandelwal
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karthik Prabhakaran
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Madigan L Lavery
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel T Ohm
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marianna Gabrielyan
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sandhitsu R Das
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Theresa Schuck
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Noah Capp
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Claire S Peterson
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elyse Migdal
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emilio Artacho-Pérula
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla-La Mancha, Albacete, Spain
| | | | | | - Sandra Cebada Sánchez
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla-La Mancha, Albacete, Spain
| | - Carlos de la Rosa Prieto
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla-La Mancha, Albacete, Spain
| | - Marta Córcoles Parada
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla-La Mancha, Albacete, Spain
| | - Ricardo Insausti
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla-La Mancha, Albacete, Spain
| | - John L Robinson
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Corey McMillan
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Murray Grossman
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M Dylan Tisdall
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura E M Wisse
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Diagnostic Radiology, Lund University, Lund, Sweden
| | - David J Irwin
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul A Yushkevich
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
15
|
Yannatos I, Xie SX, Brown R, McMillan CT. Social epigenetics of racial disparities in aging. Alzheimers Dement 2022. [DOI: 10.1002/alz.067179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Isabel Yannatos
- Perelman School of Medicine, University of Pennsylvania Philadelphia PA USA
| | - Sharon X Xie
- Perelman School of Medicine, University of Pennsylvania Philadelphia PA USA
| | - Rebecca Brown
- Perelman School of Medicine, University of Pennsylvania Philadelphia PA USA
| | | |
Collapse
|
16
|
Arezoumandan S, Xie SX, Cousins KAQ, Mechanic-Hamilton DJ, Peterson CS, Huang CY, Ohm DT, Ittyerah R, McMillan CT, Wolk DA, Yushkevich P, Trojanowski JQ, Lee EB, Grossman M, Phillips JS, Irwin DJ. Regional distribution and maturation of tau pathology among phenotypic variants of Alzheimer's disease. Acta Neuropathol 2022; 144:1103-1116. [PMID: 35871112 PMCID: PMC9936795 DOI: 10.1007/s00401-022-02472-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/02/2022] [Accepted: 07/14/2022] [Indexed: 01/26/2023]
Abstract
Alzheimer's disease neuropathologic change (ADNC) is clinically heterogenous and can present with a classic multidomain amnestic syndrome or focal non-amnestic syndromes. Here, we investigated the distribution and burden of phosphorylated and C-terminally cleaved tau pathologies across hippocampal subfields and cortical regions among phenotypic variants of Alzheimer's disease (AD). In this study, autopsy-confirmed patients with ADNC, were classified into amnestic (aAD, N = 40) and non-amnestic (naAD, N = 39) groups based on clinical criteria. We performed digital assessment of tissue sections immunostained for phosphorylated-tau (AT8 detects pretangles and mature tangles), D421-truncated tau (TauC3, a marker for mature tangles and ghost tangles), and E391-truncated tau (MN423, a marker that primarily detects ghost tangles), in hippocampal subfields and three cortical regions. Linear mixed-effect models were used to test regional and group differences while adjusting for demographics. Both groups showed AT8-reactivity across hippocampal subfields that mirrored traditional Braak staging with higher burden of phosphorylated-tau in subregions implicated as affected early in Braak staging. The burden of phosphorylated-tau and TauC3-immunoreactive tau in the hippocampus was largely similar between the aAD and naAD groups. In contrast, the naAD group had lower relative distribution of MN423-reactive tangles in CA1 (β = - 0.2, SE = 0.09, p = 0.001) and CA2 (β = - 0.25, SE = 0.09, p = 0.005) compared to the aAD. While the two groups had similar levels of phosphorylated-tau pathology in cortical regions, there was higher burden of TauC3 reactivity in sup/mid temporal cortex (β = 0.16, SE = 0.07, p = 0.02) and MN423 reactivity in all cortical regions (β = 0.4-0.43, SE = 0.09, p < 0.001) in the naAD compared to aAD. In conclusion, AD clinical variants may have a signature distribution of overall phosphorylated-tau pathology within the hippocampus reflecting traditional Braak staging; however, non-amnestic AD has greater relative mature tangle pathology in the neocortex compared to patients with clinical amnestic AD, where the hippocampus had greatest relative burden of C-terminally cleaved tau reactivity. Thus, varying neuronal susceptibility to tau-mediated neurodegeneration may influence the clinical expression of ADNC.
Collapse
Affiliation(s)
- Sanaz Arezoumandan
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Katheryn A Q Cousins
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Dawn J Mechanic-Hamilton
- Department of Neurology, Penn Memory Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Neurology, Penn Alzheimer's Disease Research Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Claire S Peterson
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Camille Y Huang
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Daniel T Ohm
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Ranjit Ittyerah
- Penn Image Computing and Science Lab, Department of Radiology, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Corey T McMillan
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Neurology, Penn Alzheimer's Disease Research Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - David A Wolk
- Department of Neurology, Penn Memory Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Neurology, Penn Alzheimer's Disease Research Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Paul Yushkevich
- Department of Neurology, Penn Alzheimer's Disease Research Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Penn Image Computing and Science Lab, Department of Radiology, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - John Q Trojanowski
- Department of Neurology, Penn Alzheimer's Disease Research Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Edward B Lee
- Department of Neurology, Penn Alzheimer's Disease Research Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Jeffrey S Phillips
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - David J Irwin
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, Philadelphia, PA, 19104, USA.
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA.
| |
Collapse
|
17
|
Lyu X, Duong MT, Xie L, Richardson H, de Flores R, DiCalogero M, McMillan CT, Robinson J, Trojanowski JQ, Grossman M, Lee EB, Irwin DJ, Dickerson BC, Xie SX, Nasrallah IM, Yushkevich PA, Wolk DA, Das SR. Tau‐Neurodegeneration mismatch reveals vulnerability and resilience in Alzheimer’s continuum and Non‐Alzheimer’s pathophysiology. Alzheimers Dement 2022. [DOI: 10.1002/alz.062542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Xueying Lyu
- University of Pennsylvania Philadelphia PA USA
| | | | - Long Xie
- Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania Philadelphia PA USA
| | | | - Robin de Flores
- Normandie University, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen‐Normandie, Cyceron Caen France
| | | | | | | | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania Philadelphia PA USA
| | - Murray Grossman
- Penn FTD Center, Perelman School of Medicine, University of Pennsylvania Philadelphia PA USA
| | - Eddie B Lee
- Center for Neurodegenerative Disease Research, University of Pennsylvania Philadelphia PA USA
| | - David J. Irwin
- Penn FTD Center, Perelman School of Medicine, University of Pennsylvania Philadelphia PA USA
| | | | - Sharon X Xie
- Perelman School of Medicine, University of Pennsylvania Philadelphia PA USA
| | | | - Paul A. Yushkevich
- Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania Philadelphia PA USA
| | - David A. Wolk
- Penn Alzheimer’s Disease Research Center, University of Pennsylvania Philadelphia PA USA
| | | |
Collapse
|
18
|
Nissim NR, Harvey DY, Haslam C, Friedman L, Bharne P, Litz G, Phillips JS, Cousins KAQ, Xie SX, Grossman M, Hamilton RH. Through Thick and Thin: Baseline Cortical Volume and Thickness Predict Performance and Response to Transcranial Direct Current Stimulation in Primary Progressive Aphasia. Front Hum Neurosci 2022; 16:907425. [PMID: 35874157 PMCID: PMC9302040 DOI: 10.3389/fnhum.2022.907425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives We hypothesized that measures of cortical thickness and volume in language areas would correlate with response to treatment with high-definition transcranial direct current stimulation (HD-tDCS) in persons with primary progressive aphasia (PPA). Materials and Methods In a blinded, within-group crossover study, PPA patients (N = 12) underwent a 2-week intervention HD-tDCS paired with constraint-induced language therapy (CILT). Multi-level linear regression (backward-fitted models) were performed to assess cortical measures as predictors of tDCS-induced naming improvements, measured by the Western Aphasia Battery-naming subtest, from baseline to immediately after and 6 weeks post-intervention. Results Greater baseline thickness of the pars opercularis significantly predicted naming gains (p = 0.03) immediately following intervention, while greater thickness of the middle temporal gyrus (MTG) and lower thickness of the superior temporal gyrus (STG) significantly predicted 6-week naming gains (p's < 0.02). Thickness did not predict naming gains in sham. Volume did not predict immediate gains for active stimulation. Greater volume of the pars triangularis and MTG, but lower STG volume significantly predicted 6-week naming gains in active stimulation. Greater pars orbitalis and MTG volume, and lower STG volume predicted immediate naming gains in sham (p's < 0.05). Volume did not predict 6-week naming gains in sham. Conclusion Cortical thickness and volume were predictive of tDCS-induced naming improvement in PPA patients. The finding that frontal thickness predicted immediate active tDCS-induced naming gains while temporal areas predicted naming changes at 6-week suggests that a broader network of regions may be important for long-term maintenance of treatment gains. The finding that volume predicted immediate naming performance in the sham condition may reflect the benefits of behavioral speech language therapy and neural correlates of its short-lived treatment gains. Collectively, thickness and volume were predictive of treatment gains in the active condition but not sham, suggesting that pairing HD-tDCS with CILT may be important for maintaining treatment effects.
Collapse
Affiliation(s)
- Nicole R. Nissim
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Moss Rehabilitation Research Institute, Elkins Park, PA, United States
| | - Denise Y. Harvey
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Christopher Haslam
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Leah Friedman
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Pandurang Bharne
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Geneva Litz
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeffrey S. Phillips
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Katheryn A. Q. Cousins
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Sharon X. Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Murray Grossman
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Roy H. Hamilton
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
19
|
Shen J, Amari N, Zack R, Skrinak RT, Unger TL, Posavi M, Tropea TF, Xie SX, Van Deerlin VM, Dewey RB, Weintraub D, Trojanowski JQ, Chen-Plotkin AS. Plasma MIA, CRP, and Albumin Predict Cognitive Decline in Parkinson's Disease. Ann Neurol 2022; 92:255-269. [PMID: 35593028 PMCID: PMC9329215 DOI: 10.1002/ana.26410] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Using a multi-cohort, discovery-replication-validation design, we sought new plasma biomarkers that predict which individuals with Parkinson's disease (PD) will experience cognitive decline. METHODS In 108 discovery cohort PD individuals and 83 replication cohort PD individuals, we measured 940 plasma proteins on an aptamer-based platform. Using proteins associated with subsequent cognitive decline in both cohorts, we trained a logistic regression model to predict which patients with PD showed fast (> = 1 point drop/year on Montreal Cognitive Assessment [MoCA]) versus slow (< 1 point drop/year on MoCA) cognitive decline in the discovery cohort, testing it in the replication cohort. We developed alternate assays for the top 3 proteins and confirmed their ability to predict cognitive decline - defined by change in MoCA or development of incident mild cognitive impairment (MCI) or dementia - in a validation cohort of 118 individuals with PD. We investigated the top plasma biomarker for causal influence by Mendelian randomization (MR). RESULTS A model with only 3 proteins (melanoma inhibitory activity protein [MIA], C-reactive protein [CRP], and albumin) separated fast versus slow cognitive decline subgroups with an area under the curve (AUC) of 0.80 in the validation cohort. The individuals with PD in the validation cohort in the top quartile of risk for cognitive decline based on this model were 4.4 times more likely to develop incident MCI or dementia than those in the lowest quartile. Genotypes at MIA single nucleotide polymorphism (SNP) rs2233154 associated with MIA levels and cognitive decline, providing evidence for MIA's causal influence. CONCLUSIONS An easily obtained plasma-based predictor identifies individuals with PD at risk for cognitive decline. MIA may participate causally in development of cognitive decline. ANN NEUROL 2022.
Collapse
Affiliation(s)
- Junchao Shen
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Noor Amari
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rebecca Zack
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - R Tyler Skrinak
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Travis L Unger
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Marijan Posavi
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas F Tropea
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sharon X Xie
- Departments of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Vivianna M Van Deerlin
- Departments of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Richard B Dewey
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Daniel Weintraub
- Departments of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - John Q Trojanowski
- Departments of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alice S Chen-Plotkin
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
20
|
Duong MT, Das SR, Lyu X, Xie L, Richardson H, Xie SX, Yushkevich PA, Wolk DA, Nasrallah IM. Dissociation of tau pathology and neuronal hypometabolism within the ATN framework of Alzheimer's disease. Nat Commun 2022; 13:1495. [PMID: 35314672 PMCID: PMC8938426 DOI: 10.1038/s41467-022-28941-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/11/2022] [Indexed: 11/08/2022] Open
Abstract
Alzheimer's disease (AD) is defined by amyloid (A) and tau (T) pathologies, with T better correlated to neurodegeneration (N). However, T and N have complex regional relationships in part related to non-AD factors that influence N. With machine learning, we assessed heterogeneity in 18F-flortaucipir vs. 18F-fluorodeoxyglucose positron emission tomography as markers of T and neuronal hypometabolism (NM) in 289 symptomatic patients from the Alzheimer's Disease Neuroimaging Initiative. We identified six T/NM clusters with differing limbic and cortical patterns. The canonical group was defined as the T/NM pattern with lowest regression residuals. Groups resilient to T had less hypometabolism than expected relative to T and displayed better cognition than the canonical group. Groups susceptible to T had more hypometabolism than expected given T and exhibited worse cognitive decline, with imaging and clinical measures concordant with non-AD copathologies. Together, T/NM mismatch reveals distinct imaging signatures with pathobiological and prognostic implications for AD.
Collapse
Affiliation(s)
- Michael Tran Duong
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandhitsu R Das
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Alzheimer's Disease Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xueying Lyu
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Long Xie
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hayley Richardson
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Alzheimer's Disease Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A Yushkevich
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA
- Alzheimer's Disease Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Alzheimer's Disease Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Ilya M Nasrallah
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA.
- Alzheimer's Disease Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
21
|
Robinson JL, Richardson H, Xie SX, Alfaro B, Loh N, Lee VMY, Lee EB, Trojanowski JQ. Cerebrovascular disease lesions are additive and tied to vascular risk factors and cognitive impairment. Free Neuropathol 2022; 3:7. [PMID: 37250748 PMCID: PMC10209856 DOI: 10.17879/freeneuropathology-2022-3792] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cerebrovascular lesions are prevalent in late life and frequently co-occur but the relationship to cognitive impairment is complicated by the lack of consensus around which lesions represent hallmark pathologies for vascular impairment, particularly in the presence of Alzheimer's disease (AD). We developed an easily applicable model of cerebrovascular disease (CVD), defined as the presence of two or more lesions: moderate to severe cerebral amyloid angiopathy, moderate to severe arteriolosclerosis, infarcts (large, lacunar, or micro), and/or hemorrhages. AD was defined as intermediate or high AD neuropathologic change. The contribution of vascular risk factors such as atherosclerosis and/or a health history of heart disease, hyperlipidemia, stroke events, diabetes, or hypertension was also assessed. Logistic regression analysis reported the association of CVD with increasing age, vascular risk factors, AD, and cognitive impairment in this study of 1,485 autopsied individuals. Cerebrovascular lesions were present in 48% and 16% had CVD. Increasing age associated with all lesions (p<0.001), except hemorrhages (p=0.41). CVD was more likely in individuals with vascular risk factors or AD (p<0.01). CVD, but not individual cerebrovascular lesions, associated with impairment in cases without AD (p<0.01), but not in cases with AD (p>0.61). From this, we conclude that a simple, additive model of CVD is 1) age and AD-associated, 2) is associated with vascular risk factors, and 3) clinically correlates with cognitive decline independent of AD.
Collapse
Affiliation(s)
- John L Robinson
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hayley Richardson
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sharon X Xie
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Brian Alfaro
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nicholas Loh
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Virginia M-Y Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Edward B Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Institute on Aging (JLR, SXX, BA, NL, VMYL), Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine (EBL), Department of Biostatistics, Epidemiology and Informatics (HR, SXX), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
22
|
Zuroff L, Wisse LEM, Glenn T, Xie SX, Nasrallah IM, Habes M, Dubroff J, de Flores R, Xie L, Yushkevich P, Doshi J, Davatsikos C, Shaw LM, Tropea TF, Chen-Plotkin AS, Wolk DA, Das S, Mechanic-Hamilton D. Self- and Partner-Reported Subjective Memory Complaints: Association with Objective Cognitive Impairment and Risk of Decline. J Alzheimers Dis Rep 2022; 6:411-430. [PMID: 36072364 PMCID: PMC9397901 DOI: 10.3233/adr-220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background Episodic memory decline is a hallmark of Alzheimer's disease (AD). Subjective memory complaints (SMCs) may represent one of the earliest signs of impending cognitive decline. The degree to which self- or partner-reported SMCs predict cognitive change remains unclear. Objective We aimed to evaluate the relationship between self- and partner-reported SMCs, objective cognitive performance, AD biomarkers, and risk of future decline in a well-characterized longitudinal memory center cohort. We also evaluated whether study partner characteristics influence reports of SMCs. Methods 758 participants and 690 study partners were recruited from the Penn Alzheimer's Disease Research Center Clinical Core. Participants included those with Normal Cognition, Mild Cognitive Impairment, and AD. SMCs were measured using the Prospective and Retrospective Memory Questionnaire (PRMQ), and were evaluated for their association with cognition, genetic, plasma, and neuroimaging biomarkers of AD, cognitive and functional decline, and diagnostic progression over an average of four years. Results We found that partner-reported SMCs were more consistent with cognitive test performance and increasing symptom severity than self-reported SMCs. Partner-reported SMCs showed stronger correlations with AD-associated brain atrophy, plasma biomarkers of neurodegeneration, and longitudinal cognitive and functional decline. A 10-point increase on baseline PRMQ increased the annual risk of diagnostic progression by approximately 70%. Study partner demographics and relationship to participants influenced reports of SMCs in AD participants only. Conclusion Partner-reported SMCs, using the PRMQ, have a stronger relationship with the neuroanatomic and cognitive changes associated with AD than patient-reported SMCs. Further work is needed to evaluate whether SMCs could be used to screen for future decline.
Collapse
Affiliation(s)
- Leah Zuroff
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura EM Wisse
- Department of Diagnostic Radiology, Lund University, Lund, Sweden
| | - Trevor Glenn
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sharon X. Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Ilya M. Nasrallah
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mohamad Habes
- Neuroimage Analytics Laboratory (NAL) and the Biggs Institute Neuroimaging Core (BINC), Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center San Antonio (UTHSCSA), San Antonio, TX, USA
| | - Jacob Dubroff
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robin de Flores
- Université de Caen Normandie, INSERM UMRS U1237, Caen, France
| | - Long Xie
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Yushkevich
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jimit Doshi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, USA
| | - Christos Davatsikos
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, USA
| | - Leslie M. Shaw
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas F. Tropea
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alice S. Chen-Plotkin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandhitsu Das
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dawn Mechanic-Hamilton
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Correspondence to: Dawn Mechanic-Hamilton, PCAM-2 South, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA. Tel.: +1 215 662 4516; E-mail:
| |
Collapse
|
23
|
Uemura MT, Robinson JL, Cousins KAQ, Tropea TF, Kargilis DC, McBride JD, Suh E, Xie SX, Xu Y, Porta S, Uemura N, Van Deerlin VM, Wolk DA, Irwin DJ, Brunden KR, Lee VMY, Lee EB, Trojanowski JQ. Distinct characteristics of limbic-predominant age-related TDP-43 encephalopathy in Lewy body disease. Acta Neuropathol 2022; 143:15-31. [PMID: 34854996 PMCID: PMC9136643 DOI: 10.1007/s00401-021-02383-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/13/2022]
Abstract
Limbic-predominant age-related TDP-43 encephalopathy (LATE) is characterized by the accumulation of TAR-DNA-binding protein 43 (TDP-43) aggregates in older adults. LATE coexists with Lewy body disease (LBD) as well as other neuropathological changes including Alzheimer's disease (AD). We aimed to identify the pathological, clinical, and genetic characteristics of LATE in LBD (LATE-LBD) by comparing it with LATE in AD (LATE-AD), LATE with mixed pathology of LBD and AD (LATE-LBD + AD), and LATE alone (Pure LATE). We analyzed four cohorts of autopsy-confirmed LBD (n = 313), AD (n = 282), LBD + AD (n = 355), and aging (n = 111). We assessed the association of LATE with patient profiles including LBD subtype and AD neuropathologic change (ADNC). We studied the morphological and distributional differences between LATE-LBD and LATE-AD. By frequency analysis, we staged LATE-LBD and examined the association with cognitive impairment and genetic risk factors. Demographic analysis showed LATE associated with age in all four cohorts and the frequency of LATE was the highest in LBD + AD followed by AD, LBD, and Aging. LBD subtype and ADNC associated with LATE in LBD or AD but not in LBD + AD. Pathological analysis revealed that the hippocampal distribution of LATE was different between LATE-LBD and LATE-AD: neuronal cytoplasmic inclusions were more frequent in cornu ammonis 3 (CA3) in LATE-LBD compared to LATE-AD and abundant fine neurites composed of C-terminal truncated TDP-43 were found mainly in CA2 to subiculum in LATE-LBD, which were not as numerous in LATE-AD. Some of these fine neurites colocalized with phosphorylated α-synuclein. LATE-LBD staging showed LATE neuropathological changes spread in the dentate gyrus and brainstem earlier than in LATE-AD. The presence and prevalence of LATE in LBD associated with cognitive impairment independent of either LBD subtype or ADNC; LATE-LBD stage also associated with the genetic risk variants of TMEM106B rs1990622 and GRN rs5848. These data highlight clinicopathological and genetic features of LATE-LBD.
Collapse
Affiliation(s)
- Maiko T Uemura
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Maloney Building, 3rd Floor, 3600 Spruce Street, Philadelphia, PA, 19104-2676, USA.
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - John L Robinson
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Maloney Building, 3rd Floor, 3600 Spruce Street, Philadelphia, PA, 19104-2676, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Katheryn A Q Cousins
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas F Tropea
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel C Kargilis
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer D McBride
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Maloney Building, 3rd Floor, 3600 Spruce Street, Philadelphia, PA, 19104-2676, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - EunRan Suh
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Maloney Building, 3rd Floor, 3600 Spruce Street, Philadelphia, PA, 19104-2676, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Alzheimer's Disease Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Yan Xu
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Maloney Building, 3rd Floor, 3600 Spruce Street, Philadelphia, PA, 19104-2676, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sílvia Porta
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Maloney Building, 3rd Floor, 3600 Spruce Street, Philadelphia, PA, 19104-2676, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Norihito Uemura
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Maloney Building, 3rd Floor, 3600 Spruce Street, Philadelphia, PA, 19104-2676, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Vivianna M Van Deerlin
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Maloney Building, 3rd Floor, 3600 Spruce Street, Philadelphia, PA, 19104-2676, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Alzheimer's Disease Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Alzheimer's Disease Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Institute on Aging, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA, USA
- Penn Memory Center at the Penn Neuroscience Center, Perelman Center for Advanced Medicine, Philadelphia, USA
| | - David J Irwin
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
- Penn Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104-4283, USA
- Institute on Aging, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA, USA
- Penn Lewy Body Dementia Association Research Center of Excellence, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104-4283, USA
| | - Kurt R Brunden
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Maloney Building, 3rd Floor, 3600 Spruce Street, Philadelphia, PA, 19104-2676, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Virginia M-Y Lee
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Maloney Building, 3rd Floor, 3600 Spruce Street, Philadelphia, PA, 19104-2676, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Alzheimer's Disease Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Alzheimer's Disease Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Maloney Building, 3rd Floor, 3600 Spruce Street, Philadelphia, PA, 19104-2676, USA.
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Alzheimer's Disease Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
24
|
Weinshel S, Irwin DJ, Zhang P, Weintraub D, Shaw LM, Siderowf A, Xie SX. Appropriateness of Applying Cerebrospinal Fluid Biomarker Cutoffs from Alzheimer's Disease to Parkinson's Disease. J Parkinsons Dis 2022; 12:1155-1167. [PMID: 35431261 PMCID: PMC9934950 DOI: 10.3233/jpd-212989] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND While cutoffs for abnormal levels of the cerebrospinal fluid (CSF) biomarkers amyloid-β 1-42 (Aβ142), total tau (t-tau), phosphorylated tau (p-tau), and the ratios of t-tau/Aβ142 and p-tau/Aβ142, have been established in Alzheimer's disease (AD), biologically relevant cutoffs have not been studied extensively in Parkinson's disease (PD). OBJECTIVE Assess the suitability and diagnostic accuracy of established AD-derived CSF biomarker cutoffs in the PD population. METHODS Baseline and longitudinal data on CSF biomarkers, cognitive diagnoses, and PET amyloid imaging in 423 newly diagnosed patients with PD from the Parkinson's Progression Markers Initiative (PPMI) cohort were used to evaluate established AD biomarker cutoffs compared with optimal cutoffs derived from the PPMI cohort. RESULTS Using PET amyloid imaging as the gold standard for AD pathology, the optimal cutoff of Aβ142 was higher than the AD cutoff, the optimal cutoffs of t-tau/Aβ142 and p-tau/Aβ142 were lower than the AD cutoffs, and their confidence intervals (CIs) did not overlap with the AD cutoffs. Optimal cutoffs for t-tau and p-tau to predict cognitive impairment were significantly lower than the AD cutoffs, and their CIs did not overlap with the AD cutoffs. CONCLUSION Optimal cutoffs for the PPMI cohort for Aβ142, t-tau/Aβ142, and p-tau/Aβ142 to predict amyloid-PET positivity and for t-tau and p-tau to predict cognitive impairment differ significantly from cutoffs derived from AD populations. The presence of additional pathologies such as alpha-synuclein in PD may lead to disease-specific CSF biomarker characteristics.
Collapse
Affiliation(s)
- Sarah Weinshel
- Swarthmore College, Swarthmore, PA, USA;,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David J. Irwin
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Panpan Zhang
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA;,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA;,Michael J. Crescenz VA Medical Center, Parkinson’s Disease Research, Education, and Clinical Center, Philadelphia, PA, USA
| | - Leslie M. Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X. Xie
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
25
|
Franzmeier N, Brendel M, Beyer L, Arzberger T, Kovacs GG, Rubinski A, Palleis C, Katzdobler S, Finze A, Song M, Biechele G, Kern M, Scheifele M, Rauchmann B, Perneczky R, Rullmann M, Schildan A, Barthel H, Sabri O, Classen J, Lukic MJ, Irwin DJ, Lee EB, Coughlin D, Giese A, Grossman M, Kurz C, McMillan CT, Gelpi E, Compta Y, Swieten JC, Troakes C, Al‐Sarraj S, Roeber S, Xie SX, Lee VM, Herms J, Bartenstein P, Haass C, Dichgans M, Trojanowski JQ, Levin J, Höglinger G, Ewers M. Tau spreads across connected brain regions in progressive supranuclear palsy and corticobasal syndrome. Alzheimers Dement 2021. [DOI: 10.1002/alz.051668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Matthias Brendel
- Department of Nuclear Medicine University Hospital LMU Munich Munich Germany
- Department of Nuclear Medicine University Hospital LMU Munich Munich Germany
| | | | | | | | - Anna Rubinski
- Institute for Stroke and Dementia Research (ISD) University Hospital LMU Munich Munich Germany
| | | | | | - Anika Finze
- University Hospital LMU Munich Munich Germany
| | - Mengmeng Song
- Ludwig‐Maximilians‐Universität Munich Munich Germany
| | | | - Maike Kern
- University Hospital of Munich Munich Germany
| | | | | | | | - Michael Rullmann
- Department of Nuclear Medicine University of Leipzig Leipzig Germany
| | - Andreas Schildan
- Department of Nuclear Medicine University of Leipzig Leipzig Germany
| | - Henryk Barthel
- Department of Nuclear Medicine University of Leipzig Leipzig Germany
| | - Osama Sabri
- Department of Nuclear Medicine University of Leipzig Leipzig Germany
| | | | | | - David J. Irwin
- Digital Neuropathology Laboratory Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
| | - Eddie B. Lee
- Center for Neurodegenerative Disease Research University of Pennsylvania Philadelphia PA USA
| | | | | | - Murray Grossman
- Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
| | - Carolin Kurz
- German Center for Neurodegenerative Diseases (DZNE) Munich Germany
| | | | - Ellen Gelpi
- Neurological Tissue Bank‐IDIBAPS/Hospital Clínic Barcelona Barcelona Spain
| | | | - John C. Swieten
- Department of Neurology Erasmus Medical Center Rotterdam Netherlands
| | - Claire Troakes
- King's College London MRC London Neurodegenerative Diseases Brain Bank London United Kingdom
| | - Safa Al‐Sarraj
- Kings College NHS Foundation Trust London United Kingdom
| | | | | | - Virginia M‐Y Lee
- Perelman School of Medicine at the University of Pennsylvania Philadelphia PA USA
| | | | | | - Christian Haass
- German Center for Neurodegenerative Diseases (DZNE) Munich Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD) University Hospital LMU Munich Munich Germany
| | | | | | - Günter Höglinger
- German Center for Neurodegenerative Diseases (DZNE) Munich Germany
| | - Michael Ewers
- Institute for Stroke and Dementia Research Klinikum der Universität München Munich Germany
| |
Collapse
|
26
|
Hackett K, Ferrara MJ, Newman S, Kelley M, Schankel L, McCoubrey H, Best S, Peskin SM, O’Brien K, Xie SX, Wolk DA, Mechanic‐Hamilton D. Remote neuropsychological assessment using the UDS v3.0 T‐Cog: Preliminary data among participants at the Penn ADRC. Alzheimers Dement 2021. [DOI: 10.1002/alz.056540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | - Sharon Best
- University of Pennsylvania Philadelphia PA USA
| | | | | | | | | | | |
Collapse
|
27
|
Devlin KN, Brennan L, Saad L, Giovannetti T, Hamilton RH, Wolk DA, Xie SX, Mechanic-Hamilton D. Diagnosing Mild Cognitive Impairment Among Racially Diverse Older Adults: Comparison of Consensus, Actuarial, and Statistical Methods. J Alzheimers Dis 2021; 85:627-644. [PMID: 34864658 DOI: 10.3233/jad-210455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Actuarial and statistical methods have been proposed as alternatives to conventional methods of diagnosing mild cognitive impairment (MCI), with the aim of enhancing diagnostic and prognostic validity, but have not been compared in racially diverse samples. OBJECTIVE We compared the agreement of consensus, actuarial, and statistical MCI diagnostic methods, and their relationship to race and prognostic indicators among diverse older adults. METHODS Participants (N = 354; M age = 71; 68% White, 29% Black) were diagnosed with MCI or normal cognition (NC) according to clinical consensus, actuarial neuropsychological criteria (Jak/Bondi), and latent class analysis (LCA). We examined associations with race/ethnicity, longitudinal cognitive and functional change, and incident dementia. RESULTS MCI rates by consensus, actuarial criteria, and LCA were 44%, 53%, and 41%, respectively. LCA identified three MCI subtypes (memory; memory/language; memory/executive) and two NC classes (low normal; high normal). Diagnostic agreement was substantial, but agreement of the actuarial method with consensus and LCA was weaker than the agreement between consensus and LCA. Among cases classified as MCI by actuarial criteria only, Black participants were over-represented, and outcomes were generally similar to those of NC participants. Consensus diagnoses best predicted longitudinal outcomes overall, whereas actuarial diagnoses best predicted longitudinal functional change among Black participants. CONCLUSION Consensus diagnoses optimize specificity in predicting dementia, but among Black older adults, actuarial diagnoses may be more sensitive to early signs of decline. Results highlight the need for cross-cultural validity in MCI diagnosis and should be explored in community- and population-based samples.
Collapse
Affiliation(s)
- Kathryn N Devlin
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Laura Brennan
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Laura Saad
- Department of Psychology, Rutgers University, New Brunswick, NJ, USA
| | | | - Roy H Hamilton
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Dawn Mechanic-Hamilton
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
28
|
Aamodt WW, Waligorska T, Shen J, Tropea TF, Siderowf A, Weintraub D, Grossman M, Irwin D, Wolk DA, Xie SX, Trojanowski JQ, Shaw LM, Chen-Plotkin AS. Neurofilament Light Chain as a Biomarker for Cognitive Decline in Parkinson Disease. Mov Disord 2021; 36:2945-2950. [PMID: 34480363 DOI: 10.1002/mds.28779] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/22/2021] [Accepted: 07/30/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Neurofilament light chain protein (NfL) is a promising biomarker of neurodegeneration. OBJECTIVES To determine whether plasma and CSF NfL (1) associate with motor or cognitive status in Parkinson's disease (PD) and (2) predict future motor or cognitive decline in PD. METHODS Six hundred and fifteen participants with neurodegenerative diseases, including 152 PD and 200 healthy control participants, provided a plasma and/or cerebrospinal fluid (CSF) NfL sample. Diagnostic groups were compared using the Kruskal-Wallis rank test. Within PD, cross-sectional associations between NfL and Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) and Mattis Dementia Rating Scale (DRS-2) scores were assessed by linear regression; longitudinal analyses were performed using linear mixed-effects models and Cox regression. RESULTS Plasma and CSF NfL levels correlated substantially (Spearman r = 0.64, P < 0.001); NfL was highest in neurocognitive disorders. PD participants with high plasma NfL were more likely to develop incident cognitive impairment (HR 5.34, P = 0.005). CONCLUSIONS Plasma NfL is a useful prognostic biomarker for PD, predicting clinical conversion to mild cognitive impairment or dementia. © 2021 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Whitley W Aamodt
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Teresa Waligorska
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Junchao Shen
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas F Tropea
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Weintraub
- Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Parkinson's Disease and Mental Illness Research, Education, and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Irwin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Wolk
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alice S Chen-Plotkin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
29
|
McCollum LE, Das SR, Xie L, de Flores R, Wang J, Xie SX, Wisse LEM, Yushkevich PA, Wolk DA. Oh brother, where art tau? Amyloid, neurodegeneration, and cognitive decline without elevated tau. Neuroimage Clin 2021; 31:102717. [PMID: 34119903 PMCID: PMC8207301 DOI: 10.1016/j.nicl.2021.102717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/21/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022]
Abstract
Amyloid, tau and neurodegeneration are Alzheimer’s disease (AD) biomarkers. Mild cognitive impairment (MCI) cases were grouped using the “A/T/(N)” model. A+T-N+ MCI had less episodic memory loss and slower decline than A+T+N+ MCI. A+T-N+ MCI was more like A-T-N+ than A+T+N+ MCI on whole brain cortical thickness. A+T-N+ MCI’s less “AD-like” profile suggests that non-AD pathologies drive symptoms.
Mild cognitive impairment (MCI) can be an early manifestation of Alzheimer’s disease (AD) pathology, other pathologic entities [e.g., cerebrovascular disease, Lewy body disease, LATE (limbic-predominant age-related TDP-43 encephalopathy)], or mixed pathologies, with concomitant AD- and non-AD pathology being particularly common, albeit difficult to identify, in living MCI patients. The National Institute on Aging and Alzheimer’s Association (NIA-AA) A/T/(N) [β-Amyloid/Tau/(Neurodegeneration)] AD research framework, which classifies research participants according to three binary biomarkers [β-amyloid (A+/A-), tau (T+/T-), and neurodegeneration (N+/N-)], provides an indirect means of identifying such cases. Individuals with A+T-(N+) MCI are thought to have both AD pathologic change, given the presence of β-amyloid, and non-AD pathophysiology, given neurodegeneration without tau, because in typical AD it is tau accumulation that is most tightly linked to neuronal injury and cognitive decline. Thus, in A+T-(N+) MCI (hereafter referred to as “mismatch MCI” for the tau-neurodegeneration mismatch), non-AD pathology is hypothesized to drive neurodegeneration and symptoms, because β-amyloid, in the absence of tau, likely reflects a preclinical stage of AD. We compared a group of individuals with mismatch MCI to groups with A+T+(N+) MCI (or “prodromal AD”) and A-T-(N+) MCI (or “neurodegeneration-only MCI”) on cross-sectional and longitudinal cognition and neuroimaging characteristics. β-amyloid and tau status were determined by CSF assays, while neurodegeneration status was based on hippocampal volume on MRI. Overall, mismatch MCI was less “AD-like” than prodromal AD and generally, with some exceptions, more closely resembled the neurodegeneration-only group. At baseline, mismatch MCI had less episodic memory loss compared to prodromal AD. Longitudinally, mismatch MCI declined more slowly than prodromal AD across all included cognitive domains, while mismatch MCI and neurodegeneration-only MCI declined at comparable rates. Prodromal AD had smaller baseline posterior hippocampal volume than mismatch MCI, and whole brain analyses demonstrated cortical thinning that was widespread in prodromal AD but largely restricted to the medial temporal lobes (MTLs) for the mismatch and neurodegeneration-only MCI groups. Longitudinally, mismatch MCI had slower rates of volume loss than prodromal AD throughout the MTLs. Differences in cross-sectional and longitudinal cognitive and neuroimaging measures between mismatch MCI and prodromal AD may reflect disparate underlying pathologic processes, with the mismatch group potentially being driven by non-AD pathologies on a background of largely preclinical AD. These findings suggest that β-amyloid status alone in MCI may not reveal the underlying driver of symptoms with important implications for enrollment in clinical trials and prognosis.
Collapse
Affiliation(s)
- Lauren E McCollum
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
| | - Sandhitsu R Das
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA, USA
| | - Long Xie
- Department of Radiology, Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA, USA
| | - Robin de Flores
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA, USA; INSERM UMR-S U1237, Université de Caen Normandie, Caen, Normandy, USA
| | - Jieqiong Wang
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Laura E M Wisse
- Department of Radiology, Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA, USA; Department of Diagnostic Radiology, Lund University, Lund, Sweden
| | - Paul A Yushkevich
- Department of Radiology, Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | | |
Collapse
|
30
|
Gallagher J, Rick J, Xie SX, Martinez-Martin P, Mamikonyan E, Chen-Plotkin A, Dahodwala N, Morley J, Duda JE, Trojanowski JQ, Siderowf A, Weintraub D. Psychometric Properties of the Clinical Dementia Rating Scale Sum of Boxes in Parkinson's Disease. J Parkinsons Dis 2021; 11:737-745. [PMID: 33386814 PMCID: PMC8058172 DOI: 10.3233/jpd-202390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A composite measure that assesses both cognitive and functional abilities in Parkinson's disease (PD) would be useful for diagnosing mild cognitive impairment (MCI) and PD dementia (PDD) and as an outcome measure in randomized controlled trials. The Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) was designed to assess both cognition and basic-instrumental activities of daily living in Alzheimer's disease but has not yet been validated in PD. OBJECTIVE To validate the CDR-SOB as a composite cognitive-functional measure for PD patients, as well as to assess its sensitivity to change. METHODS The CDR-SOB and a comprehensive cognitive and functional battery was administered to 101 PD patients at baseline (39 normal cognition [NC], 41 MCI and 21 PDD by expert consensus panel), and re-administered to 64 patients after 1-2 years follow-up (32 NC and 32 cognitive impairment [CI] at baseline). RESULTS Cross-sectionally, CDR-SOB and domain scores were correlated with corresponding neuropsychological or functional measures and were significantly different between cognitive subgroups both at baseline and at follow-up. In addition, CDR-SOB ROC curves distinguished between normal cognition and dementia with high sensitivity, but did not distinguish well between NC and MCI. Longitudinal changes in the CDR-SOB and domain scores were not significant and were inconsistent in predicting change in commonly-used cognitive and functional tests. CONCLUSION The CDR-SOB detects dementia-level cognitive impairment in PD but may not be appropriate for predicting longitudinal combined cognitive-functional changes in patients without significant cognitive impairment at baseline.
Collapse
Affiliation(s)
- Julia Gallagher
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jacqueline Rick
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Eugenia Mamikonyan
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alice Chen-Plotkin
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nabila Dahodwala
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - James Morley
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veteran's Affairs Medical Center, Philadelphia, PA, USA
| | - John E Duda
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veteran's Affairs Medical Center, Philadelphia, PA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veteran's Affairs Medical Center, Philadelphia, PA, USA
| |
Collapse
|
31
|
Robinson JL, Richardson H, Xie SX, Suh E, Van Deerlin VM, Alfaro B, Loh N, Porras-Paniagua M, Nirschl JJ, Wolk D, Lee VMY, Lee EB, Trojanowski JQ. The development and convergence of co-pathologies in Alzheimer's disease. Brain 2021; 144:953-962. [PMID: 33449993 PMCID: PMC8041349 DOI: 10.1093/brain/awaa438] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/15/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA), limbic-predominant age-related TDP-43 encephalopathy neuropathological change (LATE-NC) and Lewy bodies occur in the absence of clinical and neuropathological Alzheimer's disease, but their prevalence and severity dramatically increase in Alzheimer's disease. To investigate how plaques, tangles, age and apolipoprotein E ε4 (APOE ε4) interact with co-pathologies in Alzheimer's disease, we analysed 522 participants ≥50 years of age with and without dementia from the Center for Neurodegenerative Disease Research (CNDR) autopsy program and 1340 participants in the National Alzheimer's Coordinating Center (NACC) database. Consensus criteria were applied for Alzheimer's disease using amyloid phase and Braak stage. Co-pathology was staged for CAA (neocortical, allocortical, and subcortical), LATE-NC (amygdala, hippocampal, and cortical), and Lewy bodies (brainstem, limbic, neocortical, and amygdala predominant). APOE genotype was determined for all CNDR participants. Ordinal logistic regression was performed to quantify the effect of independent variables on the odds of having a higher stage after checking the proportional odds assumption. We found that without dementia, increasing age associated with all pathologies including CAA (odds ratio 1.63, 95% confidence interval 1.38-1.94, P < 0.01), LATE-NC (1.48, 1.16-1.88, P < 0.01), and Lewy bodies (1.45, 1.15-1.83, P < 0.01), but APOE ε4 only associated with CAA (4.80, 2.16-10.68, P < 0.01). With dementia, increasing age associated with LATE-NC (1.30, 1.15-1.46, P < 0.01), while Lewy bodies associated with younger ages (0.90, 0.81-1.00, P = 0.04), and APOE ε4 only associated with CAA (2.36, 1.52-3.65, P < 0.01). A longer disease course only associated with LATE-NC (1.06, 1.01-1.11, P = 0.01). Dementia in the NACC cohort associated with the second and third stages of CAA (2.23, 1.50-3.30, P < 0.01), LATE-NC (5.24, 3.11-8.83, P < 0.01), and Lewy bodies (2.41, 1.51-3.84, P < 0.01). Pathologically, increased Braak stage associated with CAA (5.07, 2.77-9.28, P < 0.01), LATE-NC (5.54, 2.33-13.15, P < 0.01), and Lewy bodies (4.76, 2.07-10.95, P < 0.01). Increased amyloid phase associated with CAA (2.27, 1.07-4.80, P = 0.03) and Lewy bodies (6.09, 1.66-22.33, P = 0.01). In summary, we describe widespread distributions of CAA, LATE-NC and Lewy bodies that progressively accumulate alongside plaques and tangles in Alzheimer's disease dementia. CAA interacted with plaques and tangles especially in APOE ε4 positive individuals; LATE-NC associated with tangles later in the disease course; most Lewy bodies associated with moderate to severe plaques and tangles.
Collapse
Affiliation(s)
- John L Robinson
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Hayley Richardson
- Department of Biostatistics, Epidemiology and Informatics, University of
Pennsylvannia, Philadelphia, PA, USA
| | - Sharon X Xie
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of
Pennsylvannia, Philadelphia, PA, USA
| | - EunRan Suh
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Vivianna M Van Deerlin
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Brian Alfaro
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Nicholas Loh
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Matias Porras-Paniagua
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Jeffrey J Nirschl
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - David Wolk
- Department of Neurology, University of Pennsylvania Perelman School of
Medicine, Philadelphia, PA, USA
| | - Virginia M -Y Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and
Laboratory Medicine, Institute on Aging, University of Pennsylvannia,
Philadelphia, PA, USA
| | - Edward B Lee
- Department of Neurology, University of Pennsylvania Perelman School of
Medicine, Philadelphia, PA, USA
| | - John Q Trojanowski
- Department of Neurology, University of Pennsylvania Perelman School of
Medicine, Philadelphia, PA, USA
| |
Collapse
|
32
|
Rennert L, Xie SX. Cox regression model under dependent truncation. Biometrics 2021; 78:460-473. [PMID: 33687064 DOI: 10.1111/biom.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/07/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022]
Abstract
Truncation is a statistical phenomenon that occurs in many time-to-event studies. For example, autopsy-confirmed studies of neurodegenerative diseases are subject to an inherent left and right truncation, also known as double truncation. When the goal is to study the effect of risk factors on survival, the standard Cox regression model cannot be used when the survival time is subject to truncation. Existing methods that adjust for both left and right truncation in the Cox regression model require independence between the survival times and truncation times, which may not be a reasonable assumption in practice. We propose an expectation-maximization algorithm to relax the independence assumption in the Cox regression model under left, right, or double truncation to an assumption of conditional independence on the observed covariates. The resulting regression coefficient estimators are consistent and asymptotically normal. We demonstrate through extensive simulations that the proposed estimator has little bias and has a similar or lower mean-squared error compared to existing estimators. We implement our approach to assess the effect of occupation on survival in subjects with autopsy-confirmed Alzheimer's disease.
Collapse
Affiliation(s)
- Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
33
|
Giannini LAA, Peterson C, Ohm D, Xie SX, McMillan CT, Raskovsky K, Massimo L, Suh E, Van Deerlin VM, Wolk DA, Trojanowski JQ, Lee EB, Grossman M, Irwin DJ. Frontotemporal lobar degeneration proteinopathies have disparate microscopic patterns of white and grey matter pathology. Acta Neuropathol Commun 2021; 9:30. [PMID: 33622418 PMCID: PMC7901087 DOI: 10.1186/s40478-021-01129-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 01/10/2023] Open
Abstract
Frontotemporal lobar degeneration proteinopathies with tau inclusions (FTLD-Tau) or TDP-43 inclusions (FTLD-TDP) are associated with clinically similar phenotypes. However, these disparate proteinopathies likely differ in cellular severity and regional distribution of inclusions in white matter (WM) and adjacent grey matter (GM), which have been understudied. We performed a neuropathological study of subcortical WM and adjacent GM in a large autopsy cohort (n = 92; FTLD-Tau = 37, FTLD-TDP = 55) using a validated digital image approach. The antemortem clinical phenotype was behavioral-variant frontotemporal dementia (bvFTD) in 23 patients with FTLD-Tau and 42 with FTLD-TDP, and primary progressive aphasia (PPA) in 14 patients with FTLD-Tau and 13 with FTLD-TDP. We used linear mixed-effects models to: (1) compare WM pathology burden between proteinopathies; (2) investigate the relationship between WM pathology burden and WM degeneration using luxol fast blue (LFB) myelin staining; (3) study regional patterns of pathology burden in clinico-pathological groups. WM pathology burden was greater in FTLD-Tau compared to FTLD-TDP across regions (beta = 4.21, SE = 0.34, p < 0.001), and correlated with the degree of WM degeneration in both FTLD-Tau (beta = 0.32, SE = 0.10, p = 0.002) and FTLD-TDP (beta = 0.40, SE = 0.08, p < 0.001). WM degeneration was greater in FTLD-Tau than FTLD-TDP particularly in middle-frontal and anterior cingulate regions (p < 0.05). Distinct regional patterns of WM and GM inclusions characterized FTLD-Tau and FTLD-TDP proteinopathies, and associated in part with clinical phenotype. In FTLD-Tau, WM pathology was particularly severe in the dorsolateral frontal cortex in nonfluent-variant PPA, and GM pathology in dorsolateral and paralimbic frontal regions with some variation across tauopathies. Differently, FTLD-TDP had little WM regional variability, but showed severe GM pathology burden in ventromedial prefrontal regions in both bvFTD and PPA. To conclude, FTLD-Tau and FTLD-TDP proteinopathies have distinct severity and regional distribution of WM and GM pathology, which may impact their clinical presentation, with overall greater severity of WM pathology as a distinguishing feature of tauopathies.
Collapse
Affiliation(s)
- Lucia A A Giannini
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
- Department of Neurology, Alzheimer Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Claire Peterson
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Daniel Ohm
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Corey T McMillan
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Katya Raskovsky
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - Lauren Massimo
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - EunRah Suh
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David A Wolk
- Department of Pathology and Laboratory Medicine, Alzheimer's Disease Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Alzheimer's Disease Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, Alzheimer's Disease Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA
| | - David J Irwin
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Department of Neurology, Perelman School of Medicine, Penn Frontotemporal Degeneration Center (FTDC), Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, 19104, USA.
| |
Collapse
|
34
|
Robinson JL, Porta S, Garrett FG, Zhang P, Xie SX, Suh E, Van Deerlin VM, Abner EL, Jicha GA, Barber JM, Lee VMY, Lee EB, Trojanowski JQ, Nelson PT. Limbic-predominant age-related TDP-43 encephalopathy differs from frontotemporal lobar degeneration. Brain 2021; 143:2844-2857. [PMID: 32830216 DOI: 10.1093/brain/awaa219] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/01/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022] Open
Abstract
TAR-DNA binding protein-43 (TDP-43) proteinopathy is seen in multiple brain diseases. A standardized terminology was recommended recently for common age-related TDP-43 proteinopathy: limbic-predominant, age-related TDP-43 encephalopathy (LATE) and the underlying neuropathological changes, LATE-NC. LATE-NC may be co-morbid with Alzheimer's disease neuropathological changes (ADNC). However, there currently are ill-defined diagnostic classification issues among LATE-NC, ADNC, and frontotemporal lobar degeneration with TDP-43 (FTLD-TDP). A practical challenge is that different autopsy cohorts are composed of disparate groups of research volunteers: hospital- and clinic-based cohorts are enriched for FTLD-TDP cases, whereas community-based cohorts have more LATE-NC cases. Neuropathological methods also differ across laboratories. Here, we combined both cases and neuropathologists' diagnoses from two research centres-University of Pennsylvania and University of Kentucky. The study was designed to compare neuropathological findings between FTLD-TDP and pathologically severe LATE-NC. First, cases were selected from the University of Pennsylvania with pathological diagnoses of either FTLD-TDP (n = 33) or severe LATE-NC (mostly stage 3) with co-morbid ADNC (n = 30). Sections from these University of Pennsylvania cases were cut from amygdala, anterior cingulate, superior/mid-temporal, and middle frontal gyrus. These sections were stained for phospho-TDP-43 immunohistochemically and evaluated independently by two University of Kentucky neuropathologists blinded to case data. A simple set of criteria hypothesized to differentiate FTLD-TDP from LATE-NC was generated based on density of TDP-43 immunoreactive neuronal cytoplasmic inclusions in the neocortical regions. Criteria-based sensitivity and specificity of differentiating severe LATE-NC from FTLD-TDP cases with blind evaluation was ∼90%. Another proposed neuropathological feature related to TDP-43 proteinopathy in aged individuals is 'Alpha' versus 'Beta' in amygdala. Alpha and Beta status was diagnosed by neuropathologists from both universities (n = 5 raters). There was poor inter-rater reliability of Alpha/Beta classification (mean κ = 0.31). We next tested a separate cohort of cases from University of Kentucky with either FTLD-TDP (n = 8) or with relatively 'pure' severe LATE-NC (lacking intermediate or severe ADNC; n = 14). The simple criteria were applied by neuropathologists blinded to the prior diagnoses at University of Pennsylvania. Again, the criteria for differentiating LATE-NC from FTLD-TDP was effective, with sensitivity and specificity ∼90%. If more representative cases from each cohort (including less severe TDP-43 proteinopathy) had been included, the overall accuracy for identifying LATE-NC was estimated at >98% for both cohorts. Also across both cohorts, cases with FTLD-TDP died younger than those with LATE-NC (P < 0.0001). We conclude that in most cases, severe LATE-NC and FTLD-TDP can be differentiated by applying simple neuropathological criteria.
Collapse
Affiliation(s)
- John L Robinson
- Alzheimer's Disease Core Center, University of Pennsyvania, Philadelphia, PA, USA.,Center for Neurodegenerative Disease Research, University of Pennsyvania, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsyvania, Philadelphia, PA, USA
| | - Sílvia Porta
- Alzheimer's Disease Core Center, University of Pennsyvania, Philadelphia, PA, USA.,Center for Neurodegenerative Disease Research, University of Pennsyvania, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsyvania, Philadelphia, PA, USA
| | - Filip G Garrett
- Department of Pathology, University of Kentucky, Lexington, KY, USA
| | - Panpan Zhang
- Alzheimer's Disease Core Center, University of Pennsyvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsyvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Alzheimer's Disease Core Center, University of Pennsyvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsyvania, Philadelphia, PA, USA
| | - EunRan Suh
- Alzheimer's Disease Core Center, University of Pennsyvania, Philadelphia, PA, USA.,Center for Neurodegenerative Disease Research, University of Pennsyvania, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsyvania, Philadelphia, PA, USA
| | - Vivianna M Van Deerlin
- Alzheimer's Disease Core Center, University of Pennsyvania, Philadelphia, PA, USA.,Center for Neurodegenerative Disease Research, University of Pennsyvania, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsyvania, Philadelphia, PA, USA
| | - Erin L Abner
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA.,Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Gregory A Jicha
- Department of Neurology, University of Kentucky, Lexington, KY, USA.,Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Justin M Barber
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Virginia M-Y Lee
- Alzheimer's Disease Core Center, University of Pennsyvania, Philadelphia, PA, USA.,Center for Neurodegenerative Disease Research, University of Pennsyvania, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsyvania, Philadelphia, PA, USA
| | - Edward B Lee
- Alzheimer's Disease Core Center, University of Pennsyvania, Philadelphia, PA, USA.,Center for Neurodegenerative Disease Research, University of Pennsyvania, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsyvania, Philadelphia, PA, USA
| | - John Q Trojanowski
- Alzheimer's Disease Core Center, University of Pennsyvania, Philadelphia, PA, USA.,Center for Neurodegenerative Disease Research, University of Pennsyvania, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsyvania, Philadelphia, PA, USA
| | - Peter T Nelson
- Department of Pathology, University of Kentucky, Lexington, KY, USA.,Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
35
|
Forbes E, Tropea TF, Mantri S, Xie SX, Morley JF. Modifiable Comorbidities Associated with Cognitive Decline in Parkinson's Disease. Mov Disord Clin Pract 2021; 8:254-263. [PMID: 33553496 DOI: 10.1002/mdc3.13143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/23/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background Cognitive impairment (CI) is one of the most feared and debilitating complications of PD. No therapy has been shown to slow or prevent CI in PD. Objective To determine associations between modifiable comorbidities, including cardiovascular disease risk factors, mood disorders, and sleep characteristics, and rate of cognitive decline in Parkinson's disease (PD). Methods Data from the Parkinson's Progression Markers Initiative (PPMI) cohort was queried for baseline cardiovascular disease risk factors, mood disorders, and sleep characteristics. Linear mixed- effects models (LME) were used to examine the association between baseline factors and change in cognition, evaluated by the Montreal Cognitive Assessment (MoCA) over time. Baseline comorbidities found to affect MoCA decline were assessed for an association with focal cognitive domains using LME. Results Higher Body Mass Index (BMI) (β = -0.009, P = 0.039), State Trait Anxiety Inventory (STAI) (β = -0.005, P < 0.001), Geriatric Depression Scale (GDS) (β = -0.034, P < 0.001), Epworth Sleepiness Scale (ESS) (β = -0.017, P = 0.003), and REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) (β = -0.037, P < 0.001) were associated with faster rates of MoCA decline. Using established cut-offs for clinically significant symptoms, being overweight, or the presence of depression, excessive day time sleepiness (EDS), and possible REM sleep behavior disorder (pRBD), were all associated with faster rate of cognitive decline. Conclusion Several modifiable baseline comorbidities are associated with faster rate of CI over time in patients with PD. These associations identify potential opportunities for early intervention that could influence CI in PD.
Collapse
Affiliation(s)
- Emily Forbes
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USA.,Department of Neurology Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Thomas F Tropea
- Department of Neurology Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Sneha Mantri
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USA.,Department of Neurology Duke University School of Medicine Durham North Carolina USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology, and Informatics University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA
| | - James F Morley
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USA.,Department of Neurology Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| |
Collapse
|
36
|
McCollum L, Das SR, Wang J, Xie L, de Flores R, Wisse L, Xie SX, Yushkevich P, Wolk DA. Cognitive and neurodegenerative profile differences between “mismatch MCI” (A+T‐N+ MCI) And “prodromal AD” (A+T+N+ MCI) increase with time. Alzheimers Dement 2020. [DOI: 10.1002/alz.046030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - Long Xie
- University of Pennsylvania Philadelphia PA USA
| | - Robin de Flores
- Inserm UMR‐S U1237, Université de Caen‐Normandie, GIP Cyceron Caen France
| | | | - Sharon X. Xie
- Perelman School of Medicine, University of Pennsylvania Philadelphia PA USA
| | | | | |
Collapse
|
37
|
Acton EK, Gelfand MA, Hennessy S, Xie SX, Pollard JR, Kasner SE, Willis AW. Trends in oral anticoagulant co-prescription with antiepileptic drugs among adults with epilepsy, 2010-2018. Epilepsy Behav 2020; 113:107550. [PMID: 33242772 PMCID: PMC7780425 DOI: 10.1016/j.yebeh.2020.107550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022]
Abstract
Treatment considerations for epilepsy patients requiring anticoagulation are changing, and actual prescribing practices have not been characterized. We used the 2010-2018 Optum Clinformatics® Data Mart Database to estimate the annual prevalence and distinguish the patterns of oral anticoagulants (OACs) co-dispensed with antiepileptic drugs (AEDs) among adults with epilepsy. Monotonic trends were assessed using the Spearman rank correlation coefficient (ρ). Multivariable logistic regression models were built to evaluate the associations of sociodemographic characteristics. Among 345,892 adults with epilepsy (56.5% female; median age 61, IQR 46-74) on studied AEDs, the prevalence per thousand of concurrent OACs increased from 58.4 in 2010 to 92.0 in 2018 (OR 1.63, CI 1.58-1.69). Direct-acting oral anticoagulant (DOAC) use rapidly increased from 2010 to 2018 (ρ = 1.00; P < 0.001), with a corresponding decrease in warfarin use (ρ = -0.97; P < 0.001). Among OAC/AED dispensings in 2018, warfarin was more likely to be co-dispensed with potentially interacting, enzyme-inducing antiepileptic drugs (EI-AEDs) versus presumably non-interacting, non-enzyme inducing antiepileptic drugs (OR 1.48, CI 1.38-1.59). Characteristics independently associated with concurrent OAC/EI-AED use included younger age, female sex, white race, net worth <$250 K, and lower education levels. Our findings demonstrate the expanding use and evolving patterns of OAC/AED co-dispensing, and ensuing critical need to further understanding regarding postulated interactions.
Collapse
Affiliation(s)
- Emily K. Acton
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, US,Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania School of Medicine, Philadelphia, PA, US,Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, US
| | | | - Sean Hennessy
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, US,Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, US,Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, US
| | - Sharon X. Xie
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, US
| | | | - Scott E. Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Allison W. Willis
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, US,Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania School of Medicine, Philadelphia, PA, US,Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, US,Department of Neurology, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
38
|
Breazzano MP, Shen J, Abdelhakim AH, Glass LRD, Horowitz JD, Xie SX, de Moraes CG, Chen-Plotkin A, Chen RW. New York City COVID-19 resident physician exposure during exponential phase of pandemic. J Clin Invest 2020; 130:4726-4733. [PMID: 32463802 PMCID: PMC7456242 DOI: 10.1172/jci139587] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/21/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUNDFrom March 2, 2020, to April 12, 2020, New York City (NYC) experienced exponential growth of the COVID-19 pandemic due to novel coronavirus (SARS-CoV-2). Little is known regarding how physicians have been affected. We aimed to characterize the COVID-19 impact on NYC resident physicians.METHODSIRB-exempt and expedited cross-sectional analysis through survey to NYC residency program directors April 3-12, 2020, encompassing events from March 2, 2020, to April 12, 2020.RESULTSFrom an estimated 340 residency programs around NYC, recruitment yielded 91 responses, representing 24 specialties and 2306 residents. In 45.1% of programs, at least 1 resident with confirmed COVID-19 was reported. One hundred one resident physicians were confirmed COVID-19-positive, with an additional 163 residents presumed positive for COVID-19 based on symptoms but awaiting or unable to obtain testing. Two COVID-19-positive residents were hospitalized, with 1 in intensive care. Among specialties with more than 100 residents represented, negative binomial regression indicated that infection risk differed by specialty (P = 0.039). In 80% of programs, quarantining a resident was reported. Ninety of 91 programs reported reuse or extended mask use, and 43 programs reported that personal protective equipment (PPE) was suboptimal. Sixty-five programs (74.7%) redeployed residents elsewhere to support COVID-19 efforts.CONCLUSIONMany resident physicians around NYC have been affected by COVID-19 through direct infection, quarantine, or redeployment. Lack of access to testing and concern regarding suboptimal PPE are common among residency programs. Infection risk may differ by specialty.FUNDINGNational Eye Institute Core Grant P30EY019007; Research to Prevent Blindness Unrestricted Grant; Parker Family Chair; University of Pennsylvania.
Collapse
Affiliation(s)
- Mark P. Breazzano
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
- Department of Ophthalmology, New York University School of Medicine, New York University Langone Health, New York, New York, USA
- Manhattan Eye, Ear and Throat Hospital, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | | | - Aliaa H. Abdelhakim
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
- Department of Ophthalmology, New York University School of Medicine, New York University Langone Health, New York, New York, USA
- Manhattan Eye, Ear and Throat Hospital, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Lora R. Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Jason D. Horowitz
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Sharon X. Xie
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C. Gustavo de Moraes
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | | | - Royce W.S. Chen
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | | |
Collapse
|
39
|
Robinson JL, Yan N, Caswell C, Xie SX, Suh E, Van Deerlin VM, Gibbons G, Irwin DJ, Grossman M, Lee EB, Lee VMY, Miller B, Trojanowski JQ. Primary Tau Pathology, Not Copathology, Correlates With Clinical Symptoms in PSP and CBD. J Neuropathol Exp Neurol 2020; 79:296-304. [PMID: 31999351 DOI: 10.1093/jnen/nlz141] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/25/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022] Open
Abstract
Distinct neuronal and glial tau pathologies define corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP). Additional Alzheimer disease, TDP-43, and Lewy body copathologies are also common. The interplay of these pathologies with clinical symptoms remains unclear as individuals can present with corticobasal syndrome, frontotemporal dementia, PSP, or atypical Parkinsonism and may have additional secondary impairments. We report clinical, pathological, and genetic interactions in a cohort of CBD and PSP cases. Neurofibrillary tangles and plaques were common. Apolipoprotein E (APOE)ε4 carriers had more plaques while PSP APOEε2 carriers had fewer plaques. TDP-43 copathology was present and age-associated in 14% of PSP, and age-independent in 33% of CBD. Lewy body copathology varied from 9% to 15% and was not age-associated. The primary FTD-Tau burden-a sum of the neuronal, astrocytic and oligodendrocytic tau-was not age-, APOE-, or MAPT-related. In PSP, FTD-Tau, independent of copathology, associated with executive, language, motor, and visuospatial impairments, while PSP with Parkinsonism had a lower FTD-Tau burden, but this was not the case in CBD. Taken together, our results indicate that the primary tauopathy burden is the strongest correlate of clinical PSP, while copathologies are principally determined by age and genetic risk factors.
Collapse
Affiliation(s)
- John L Robinson
- From the Penn Alzheimer's Disease Core Center.,Penn Center for Neurodegenerative Disease Research.,Department of Pathology and Laboratory Medicine
| | - Ning Yan
- From the Penn Alzheimer's Disease Core Center.,Penn Center for Neurodegenerative Disease Research.,Department of Pathology and Laboratory Medicine.,Philadelphia, Pennsylvania; University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Carrie Caswell
- Penn Center for Neurodegenerative Disease Research.,Department of Biostatistics and Epidemiology, and Informatics
| | - Sharon X Xie
- From the Penn Alzheimer's Disease Core Center.,Penn Center for Neurodegenerative Disease Research.,Department of Pathology and Laboratory Medicine.,Department of Biostatistics and Epidemiology, and Informatics
| | - EunRan Suh
- From the Penn Alzheimer's Disease Core Center.,Penn Center for Neurodegenerative Disease Research.,Department of Pathology and Laboratory Medicine
| | - Vivianna M Van Deerlin
- From the Penn Alzheimer's Disease Core Center.,Penn Center for Neurodegenerative Disease Research.,Department of Pathology and Laboratory Medicine
| | - Garrett Gibbons
- From the Penn Alzheimer's Disease Core Center.,Penn Center for Neurodegenerative Disease Research.,Department of Pathology and Laboratory Medicine
| | - David J Irwin
- From the Penn Alzheimer's Disease Core Center.,Penn Center for Neurodegenerative Disease Research.,Department of Pathology and Laboratory Medicine.,Penn Frontotemporal Degeneration Center.,Department of Neurology, University of California San Francisco, San Francisco, California
| | - Murray Grossman
- From the Penn Alzheimer's Disease Core Center.,Penn Center for Neurodegenerative Disease Research.,Penn Frontotemporal Degeneration Center.,Department of Neurology, University of California San Francisco, San Francisco, California
| | - Edward B Lee
- From the Penn Alzheimer's Disease Core Center.,Penn Center for Neurodegenerative Disease Research.,Department of Pathology and Laboratory Medicine
| | - Virginia M-Y Lee
- From the Penn Alzheimer's Disease Core Center.,Penn Center for Neurodegenerative Disease Research.,Department of Pathology and Laboratory Medicine.,Department of Neurology, University of California San Francisco, San Francisco, California
| | - Bruce Miller
- Department of Neurology, University of California San Francisco, San Francisco, California
| | - John Q Trojanowski
- From the Penn Alzheimer's Disease Core Center.,Penn Center for Neurodegenerative Disease Research.,Department of Pathology and Laboratory Medicine.,Department of Neurology, University of California San Francisco, San Francisco, California
| |
Collapse
|
40
|
Pan SB, Wu CL, Hou H, Zhou DC, Cui X, He L, Gu J, Wang L, Yu ZF, Dong GY, Xie SX, Xiong QR, Geng XP. [Open hepatectomy versus laparoscopic in the treatment of primary left-sided hepatolithiasis: a propensity, long-term follow-up analysis at a single center]. Zhonghua Wai Ke Za Zhi 2020; 58:530-538. [PMID: 32610424 DOI: 10.3760/cma.j.cn112139-20191114-00561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To compare short-term and long-term efficacy after laparoscopic left hepatectomy(LLR) to open left hepatectomy(OLH) for primary left-sided hepatolithiasis. Methods: Clinical data of 187 patients with left-sided hepatolithiasis and underwent laparoscopically or open left-sided hepatectomy from October 2014 to October 2019 at the Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed in this propensity score matching (PSM) study and were matched in terms of age, sex, body mass index, liver function, ASA score, comorbidities, history of biliary surgery, and smoking history on the ratio of 1∶1.There were 47 cases in each group and the mean age were (54.7±12.3)years old(range:34 to 75 years old) and (53.2±12.6) years old (range: 34 to 75 years old) in open and laparoscopically group respectively. The data of operation time, intraoperative blood loss, postoperative hospital-stay, complication rate, biliary fistula rate, stone clearance rate, and stone recurrence rate were compared. The quantitative data were compared using t-test or rank-sum test. Count data were analyzed with χ(2) test or Fisher test. Results: No significant difference was observed in the clinical characteristics of included 94 patients in this study(all P>0.05).The length of the postoperative hospital-stay after OLH was significantly higher than that in the LLH group((10.8±3.1) days vs.(8.5±2.2)days, t=4.085, P=0.000). LLR significantly decreased the incidence of postoperative biliary fistula compared with the OLH (6.3% vs.21.2%, χ(2)=4.374, P=0.036) and the rates of postoperative complications in the OLH group was significantly higher than that in the LLH group (48.9% vs.27.6%, χ(2)=4.502, P=0.034). Moreover, the stone recurrence rates in the LLH group was significantly lower than that after OLR (4.2% vs. 17.0%, χ(2)=4.029, P=0.045). OLH (95% CI: 1.55 to 10.75, P=0.004) and postoperative complications (95% CI: 1.29 to 9.52, P=0.013) were independent risk factors for prolonged hospital stay. OLH (95% CI: 1.428 to 44.080, P=0.018) and residual stones (95% CI: 1.580 to 62.379, P=0.014) were independent risk factors for the occurrence of postoperative biliary fistula. Biliary fistula (95% CI: 1.078 to 24.517, P=0.040) was an independent risk factor for the recurrence of stones. Conclusion: Compared with OLH, LLH is safe and effective for the treatment of the primary left-sided hepatolithiasis with the clinical benefits of shorter hospital stay, fewer morbidity and biliary fistula occurrence, and lower stone recurrence rates.
Collapse
Affiliation(s)
- S B Pan
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - C L Wu
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - H Hou
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - D C Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - X Cui
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - L He
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - J Gu
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - L Wang
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Z F Yu
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - G Y Dong
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - S X Xie
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Q R Xiong
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - X P Geng
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| |
Collapse
|
41
|
Abstract
As the COVID-19 pandemic has strongly disrupted people's daily work and life, a great amount of scientific research has been conducted to understand the key characteristics of this new epidemic. In this manuscript, we focus on four crucial epidemic metrics with regard to the COVID-19, namely the basic reproduction number, the incubation period, the serial interval and the epidemic doubling time. We collect relevant studies based on the COVID-19 data in China and conduct a meta-analysis to obtain pooled estimates on the four metrics. From the summary results, we conclude that the COVID-19 has stronger transmissibility than SARS, implying that stringent public health strategies are necessary.
Collapse
Affiliation(s)
- Panpan Zhang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, U.S.A
| | - Tiandong Wang
- Department of Statistics, Texas A&M University, College Station, TX 77843, U.S.A
| | - Sharon X. Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, U.S.A
| |
Collapse
|
42
|
Garland SN, Xie SX, DuHamel K, Bao T, Li Q, Barg FK, Song S, Kantoff P, Gehrman P, Mao JJ. Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial. J Natl Cancer Inst 2020; 111:1323-1331. [PMID: 31081899 DOI: 10.1093/jnci/djz050] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/21/2019] [Accepted: 03/29/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Insomnia is a common and debilitating disorder experienced by cancer survivors. Although cancer survivors express a preference for using nonpharmacological treatment to manage insomnia, the comparative effectiveness between acupuncture and Cognitive Behavioral Therapy for Insomnia (CBT-I) for this disorder is unknown. METHODS This randomized trial compared 8 weeks of acupuncture (n = 80) and CBT-I (n = 80) in cancer survivors. Acupuncture involved stimulating specific points on the body with needles. CBT-I included sleep restriction, stimulus control, cognitive restructuring, relaxation training, and education. We measured insomnia severity (primary outcome), pain, fatigue, mood, and quality of life posttreatment (8 weeks) with follow-up until 20 weeks. We used linear mixed-effects models for analyses. All statistical tests were two-sided. RESULTS The mean age was 61.5 years and 56.9% were women. CBT-I was more effective than acupuncture posttreatment (P < .001); however, both acupuncture and CBT-I produced clinically meaningful reductions in insomnia severity (acupuncture: -8.31 points, 95% confidence interval = -9.36 to -7.26; CBT-I: -10.91 points, 95% confidence interval = -11.97 to -9.85) and maintained improvements up to 20 weeks. Acupuncture was more effective for pain at the end of treatment; both groups had similar improvements in fatigue, mood, and quality of life and reduced prescription hypnotic medication use. CBT-I was more effective for those who were male (P < .001), white (P = .003), highly educated (P < .001), and had no pain at baseline (P < .001). CONCLUSIONS Although both treatments produced meaningful and durable improvements, CBT-I was more effective and should be the first line of therapy. The relative differences in the comparative effectiveness between the two interventions for specific groups should be confirmed in future adequately powered trials to guide more tailored interventions for insomnia.
Collapse
|
43
|
Purri R, Brennan L, Rick J, Xie SX, Deck BL, Chahine LM, Dahodwala N, Chen-Plotkin A, Duda JE, Morley JF, Akhtar RS, Trojanowski JQ, Siderowf A, Weintraub D. Subjective Cognitive Complaint in Parkinson's Disease Patients With Normal Cognition: Canary in the Coal Mine? Mov Disord 2020; 35:1618-1625. [PMID: 32520435 DOI: 10.1002/mds.28115] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the frequency and impact of subjective cognitive complaint (SCC) in Parkinson's disease (PD) patients with normal cognition. METHODS Patients with PD with expert consensus-determined normal cognition at baseline were asked a single question regarding the presence of SCC. Baseline (N = 153) and longitudinal (up to 4 follow-up visits during a 5-year period; N = 121) between-group differences in patients with PD with (+SCC) and without (-SCC) cognitive complaint were examined, including cognitive test performance and self-rated and informant-rated functional abilities. RESULTS A total of 81 (53%) participants reported a cognitive complaint. There were no between-group differences in global cognition at baseline. Longitudinally, the +SCC group declined more than the -SCC group on global cognition (Mattis Dementia Rating Scale-2 total score, F1,431 = 5.71, P = 0.02), processing speed (Symbol Digit Modalities Test, F1,425 = 7.52, P = 0.006), and executive function (Trail Making Test Part B, F1,419 = 4.48, P = 0.04), although the results were not significant after correction for multiple testing. In addition, the +SCC group was more likely to progress to a diagnosis of cognitive impairment over time (hazard ratio = 2.61, P = 0.02). The +SCC group also demonstrated significantly lower self-reported and knowledgeable informant-reported cognition-related functional abilities at baseline, and declined more on an assessment of global functional abilities longitudinally. CONCLUSIONS Patients with PD with normal cognition, but with SCC, report poorer cognition-specific functional abilities, and are more likely to be diagnosed with cognitive impairment and experience global functional ability decline long term. These findings suggest that SCC and worse cognition-related functional abilities may be sensitive indicators of initial cognitive decline in PD. © 2020 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Rachael Purri
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Laura Brennan
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jacqueline Rick
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Benjamin L Deck
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nabila Dahodwala
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alice Chen-Plotkin
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - John E Duda
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.,Parkinson's Disease Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - James F Morley
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.,Parkinson's Disease Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Rizwan S Akhtar
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew Siderowf
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.,Parkinson's Disease Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
44
|
Abstract
As the COVID-19 pandemic has strongly disrupted people's daily work and life, a great amount of scientific research has been conducted to understand the key characteristics of this new epidemic. In this manuscript, we focus on four crucial epidemic metrics with regard to the COVID-19, namely the basic reproduction number, the incubation period, the serial interval and the epidemic doubling time. We collect relevant studies based on the COVID-19 data in China and conduct a meta-analysis to obtain pooled estimates on the four metrics. From the summary results, we conclude that the COVID-19 has stronger transmissibility than SARS, implying that stringent public health strategies are necessary.
Collapse
Affiliation(s)
- Panpan Zhang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104
| | - Tiandong Wang
- Department of Statistics, Texas A&M University, College Station, TX 77843
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104
| |
Collapse
|
45
|
Breazzano MP, Shen J, Abdelhakim AH, Glass LRD, Horowitz JD, Xie SX, de Moraes CG, Chen-Plotkin A, Chen RWS. Resident physician exposure to novel coronavirus (2019-nCoV, SARS-CoV-2) within New York City during exponential phase of COVID-19 pandemic: Report of the New York City Residency Program Directors COVID-19 Research Group. medRxiv 2020:2020.04.23.20074310. [PMID: 32511652 PMCID: PMC7277008 DOI: 10.1101/2020.04.23.20074310] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background From March 2-April 12, 2020, New York City (NYC) experienced exponential growth of the COVID-19 pandemic due to novel coronavirus (SARS-CoV-2). Little is known regarding how physicians have been affected. We aimed to characterize COVID-19 impact on NYC resident physicians. Methods IRB-exempt and expedited cross-sectional analysis through survey to NYC residency program directors (PDs) April 3-12, 2020, encompassing events from March 2-April 12, 2020. Findings From an estimated 340 residency programs around NYC, recruitment yielded 91 responses, representing 24 specialties and 2,306 residents. 45.1% of programs reported at least one resident with confirmed COVID-19: 101 resident physicians were confirmed COVID-19-positive, with additional 163 residents presumed positive for COVID-19 based on symptoms but awaiting or unable to obtain testing. 56.5% of programs had a resident waiting for, or unable to obtain, COVID-19 testing. Two COVID-19-positive residents were hospitalized, with one in intensive care. Among specialties with >100 residents represented, negative binomial regression indicated that infection risk differed by specialty (p=0.039). Although most programs (80%) reported quarantining a resident, with 16.8% of residents experiencing quarantine, 14.9% of COVID-19-positive residents were not quarantined. 90 programs, encompassing 99.2% of the resident physicians, reported reuse or extended mask use, and 43 programs, encompassing 60.4% of residents, felt that personal protective equipment (PPE) was suboptimal. 65 programs (74.7%) have redeployed residents elsewhere to support COVID-19 efforts. Interpretation Many resident physicians around NYC have been affected by COVID-19 through direct infection, quarantine, or redeployment. Lack of access to testing and concern regarding suboptimal PPE are common among residency programs. Infection risk may differ by specialty. Funding AHA, MPB, RWSC, CGM, LRDG, and JDH are supported by NEI Core Grant P30EY019007, and unrestricted grant from RPB. ACP and JS are supported by Parker Family Chair. SXX is supported by University of Pennsylvania.
Collapse
|
46
|
Phillips JS, Da Re F, Irwin DJ, McMillan CT, Vaishnavi SN, Xie SX, Lee EB, Cook PA, Gee JC, Shaw LM, Trojanowski JQ, Wolk DA, Grossman M. Longitudinal progression of grey matter atrophy in non-amnestic Alzheimer's disease. Brain 2020; 142:1701-1722. [PMID: 31135048 PMCID: PMC6585881 DOI: 10.1093/brain/awz091] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/21/2019] [Accepted: 02/11/2019] [Indexed: 12/12/2022] Open
Abstract
Recent models of Alzheimer's disease progression propose that disease may be transmitted between brain areas either via local diffusion or long-distance transport via white matter fibre pathways. However, it is unclear whether such models are applicable in non-amnestic Alzheimer's disease, which is associated with domain-specific cognitive deficits and relatively spared episodic memory. To date, the anatomical progression of disease in non-amnestic patients remains understudied. We used longitudinal imaging to differentiate earlier atrophy and later disease spread in three non-amnestic variants, including logopenic-variant primary progressive aphasia (n = 25), posterior cortical atrophy (n = 20), and frontal-variant Alzheimer's disease (n = 12), as well as 17 amnestic Alzheimer's disease patients. Patients were compared to 37 matched controls. All patients had autopsy (n = 7) or CSF (n = 67) evidence of Alzheimer's disease pathology. We first assessed atrophy in suspected sites of disease origin, adjusting for age, sex, and severity of cognitive impairment; we then performed exploratory whole-brain analysis to investigate longitudinal disease spread both within and outside these regions. Additionally, we asked whether each phenotype exhibited more rapid change in its associated disease foci than other phenotypes. Finally, we investigated whether atrophy was related to structural brain connectivity. Each non-amnestic phenotype displayed unique patterns of initial atrophy and subsequent neocortical change that correlated with cognitive decline. Longitudinal atrophy included areas both proximal to and distant from sites of initial atrophy, suggesting heterogeneous mechanisms of disease spread. Moreover, regional rates of neocortical change differed by phenotype. Logopenic-variant patients exhibited greater initial atrophy and more rapid longitudinal change in left lateral temporal areas than other groups. Frontal-variant patients had pronounced atrophy in left insula and middle frontal gyrus, combined with more rapid atrophy of left insula than other non-amnestic patients. In the medial temporal lobes, non-amnestic patients had less atrophy at their initial scan than amnestic patients, but longitudinal rate of change did not differ between patient groups. Medial temporal sparing in non-amnestic Alzheimer's disease may thus be due in part to later onset of medial temporal degeneration than in amnestic patients rather than different rates of atrophy over time. Finally, the magnitude of longitudinal atrophy was predicted by structural connectivity, measured in terms of node degree; this result provides indirect support for the role of long-distance fibre pathways in the spread of neurodegenerative disease. 10.1093/brain/awz091_video1 awz091media1 6041544065001.
Collapse
Affiliation(s)
- Jeffrey S Phillips
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fulvio Da Re
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA.,PhD Program in Neuroscience, University of Milano-Bicocca, Milan, Italy.,School of Medicine and Surgery, Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
| | - David J Irwin
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Corey T McMillan
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjeev N Vaishnavi
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward B Lee
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Philip A Cook
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - James C Gee
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Leslie M Shaw
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
47
|
Amsterdam JD, Li QS, Xie SX, Mao JJ. Putative Antidepressant Effect of Chamomile ( Matricaria chamomilla L.) Oral Extract in Subjects with Comorbid Generalized Anxiety Disorder and Depression. J Altern Complement Med 2019; 26:813-819. [PMID: 31808709 DOI: 10.1089/acm.2019.0252] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives: This exploratory analysis examined the putative antidepressant effect of Matricaria chamomilla L. (chamomile) extract in subjects with generalized anxiety disorder (GAD) with or without comorbid depression. It was hypothesized that chamomile extract would demonstrate similar anxiolytic activity in both subgroups, but superior antidepressant activity in GAD subjects with comorbid depression. Design: As part of a randomized double-blind placebo-controlled trial of chamomile extract for relapse prevention of GAD, 179 subjects received initial therapy with open-label chamomile extract 1500 mg daily for 8 weeks. Linear mixed-effect models were used to identify clinically meaningful changes in anxiety and depression symptoms between diagnostic subgroups. Settings/Location: The study took place at the University of Pennsylvania in Philadelphia, PA. Subjects: Subjects were ≥18 years old with a primary DSM IV-TR diagnosis of GAD. They were subcategorized into two diagnostic groups: GAD without comorbid depression (n = 100) and GAD with comorbid depression (n = 79). Interventions: Open-label chamomile extract 1500 mg was given daily for 8 weeks. Outcome measures: Generalized anxiety disorder (GAD-7), Hamilton rating scale for anxiety, Beck anxiety inventory, Hamilton rating scale for depression (HRSD), the six-item core HRSD (items 1, 2, 3, 7, 8, and 13), and the Beck depression inventory (BDI). Results: The authors observed similar anxiolytic effects over time in both diagnostic subgroups. However, there was a greater reduction in HRSD core symptom scores (p < 0.023), and a trend level reduction in HRSD total scores (p = 0.14) and in BPI total scores (p = 0.060) in subjects with comorbid depression. Conclusions: M. chamomilla L. may produce clinically meaningful antidepressant effects in addition to its anxiolytic activity in subjects with GAD and comorbid depression. Future controlled trials in subjects with primary major depressive disorder are needed to validate this preliminary observation.
Collapse
Affiliation(s)
- Jay D Amsterdam
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Qing S Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
48
|
Horn S, Richardson H, Xie SX, Weintraub D, Dahodwala N. Pimavanserin versus quetiapine for the treatment of psychosis in Parkinson's disease and dementia with Lewy bodies. Parkinsonism Relat Disord 2019; 69:119-124. [PMID: 31751863 PMCID: PMC7061324 DOI: 10.1016/j.parkreldis.2019.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/03/2019] [Accepted: 11/09/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Psychosis is common among patients with Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Limited data exist on the most effective therapies. METHODS Retrospective cohort study comparing patients with PD or DLB initiated on quetiapine or pimavanserin for psychosis. Primary outcome was time to discontinuation of pimavanserin or quetiapine using Kaplan-Meier survival analysis. We hypothesized the rate of antipsychotic discontinuation would be lower in the pimavanserin group. Subjects were included if the indication for treatment was psychosis and excluded if there was a history of major mental illness or no follow up data were available. RESULTS Forty-seven patients were included in the quetiapine cohort and 45 in the pimavanserin cohort. Patients in the pimavanserin cohort were more likely to have a diagnosis of DLB (33% vs. 11%, P = 0.01) and to have been prescribed an antipsychotic previously (62% vs. 6%, P < 0.01); otherwise, the groups were similar. Time to discontinuation analysis, which accounts for efficacy, safety and tolerability, revealed a lower early pimavanserin discontinuation rate and a higher late pimavanserin discontinuation rate (HR < 1 before day 43, HR > 1 after day 43; P = 0.04). There was no difference in mortality in the pimavanserin group compared to the quetiapine group (HR 0.37, 95% CI 0.06 to 2.45; P = 0.88). More individuals had a documented secondary indication for taking quetiapine than pimavanserin (38% vs. 4%; P = 0.001). CONCLUSION Accounting for efficacy, safety and tolerability, pimavanserin may be more clinically useful for promptly managing psychosis, while quetiapine may confer additional secondary benefits long-term.
Collapse
Affiliation(s)
- Sarah Horn
- University of Pennsylvania, 330 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Hayley Richardson
- University of Pennsylvania, 330 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Sharon X Xie
- University of Pennsylvania, 330 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Daniel Weintraub
- University of Pennsylvania, 330 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Nabila Dahodwala
- University of Pennsylvania, 330 South 9th Street, Philadelphia, PA, 19107, USA.
| |
Collapse
|
49
|
Caswell C, McMillan CT, Xie SX, Van Deerlin VM, Suh E, Lee EB, Trojanowski JQ, Lee VMY, Irwin DJ, Grossman M, Massimo LM. Genetic predictors of survival in behavioral variant frontotemporal degeneration. Neurology 2019; 93:e1707-e1714. [PMID: 31537715 DOI: 10.1212/wnl.0000000000008387] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine autosomal dominant genetic predictors of survival in individuals with behavioral variant frontotemporal degeneration (bvFTD). METHODS A retrospective chart review of 174 cases with a clinical phenotype of bvFTD but no associated elementary neurologic features was performed, with diagnosis either autopsy-confirmed (n = 57) or supported by CSF evidence of non-Alzheimer pathology (n = 117). Genetic analysis of the 3 most common genes with pathogenic autosomal dominant mutations associated with frontotemporal degeneration was performed in all patients, which identified cases with C9orf72 expansion (n = 28), progranulin (GRN) mutation (n = 12), and microtubule-associated protein tau (MAPT) mutation (n = 10). Cox proportional hazards regressions were used to test for associations between survival and mutation status, sex, age at symptom onset, and education. RESULTS Across all patients with bvFTD, the presence of a disease-associated pathogenic mutation was associated with shortened survival (hazard ratio [HR] 2.164, 95% confidence interval [CI] 1.391, 3.368). In separate models, a GRN mutation (HR 2.423, 95% CI 1.237, 4.744), MAPT mutation (HR 8.056, 95% CI 2.938, 22.092), and C9orf72 expansion (HR 1.832, 95% CI 1.034, 3.244) were each individually associated with shorter survival relative to sporadic bvFTD. A mutation on the MAPT gene results in an earlier age at onset than a C9orf72 expansion or mutation on the GRN gene (p = 0.016). CONCLUSIONS Our findings suggest that autosomal dominantly inherited mutations, modulated by age at symptom onset, associate with shorter survival among patients with bvFTD. We suggest that clinical trials and clinical management should consider mutation status and age at onset when evaluating disease progression.
Collapse
Affiliation(s)
- Carrie Caswell
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Corey T McMillan
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sharon X Xie
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Vivianna M Van Deerlin
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - EunRan Suh
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Edward B Lee
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - John Q Trojanowski
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Virginia M-Y Lee
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David J Irwin
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Murray Grossman
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lauren M Massimo
- From the Department of Biostatistics, Epidemiology, and Informatics (C.C., S.X.X.), Department of Neurology (C.T.M., D.J.I., M.G., L.M.M.), Penn Frontotemporal Degeneration Center (C.T.M., D.J.I., M.G., L.M.M.), Translational Neuropathology Research Laboratory (E.B.L.), Department of Pathology and Laboratory Medicine (V.M.V.D., E.B.L., J.Q.T., V.M.-Y.L.), and Center for Neurodegenerative Disease Research (V.M.V.D., E.S., E.B.L., J.Q.T., V.M.-Y.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| |
Collapse
|
50
|
Giannini LAA, Xie SX, Peterson C, Zhou C, Lee EB, Wolk DA, Grossman M, Trojanowski JQ, McMillan CT, Irwin DJ. Empiric Methods to Account for Pre-analytical Variability in Digital Histopathology in Frontotemporal Lobar Degeneration. Front Neurosci 2019; 13:682. [PMID: 31333403 PMCID: PMC6616086 DOI: 10.3389/fnins.2019.00682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/14/2019] [Indexed: 12/12/2022] Open
Abstract
Digital pathology is increasingly prominent in neurodegenerative disease research, but variability in immunohistochemical staining intensity between staining batches prevents large-scale comparative studies. Here we provide a statistically rigorous method to account for staining batch effects in a large sample of brain tissue with frontotemporal lobar degeneration with tau inclusions (FTLD-Tau, N = 39) or TDP-43 inclusions (FTLD-TDP, N = 53). We analyzed the relationship between duplicate measurements of digital pathology, i.e., percent area occupied by pathology (%AO) for grey matter (GM) and white matter (WM), from two distinct staining batches. We found a significant difference in duplicate measurements from distinct staining batches in FTLD-Tau (mean difference: GM = 1.13 ± 0.44, WM = 1.28 ± 0.56; p < 0.001) and FTLD-TDP (GM = 0.95 ± 0.66, WM = 0.90 ± 0.77; p < 0.001), and these measurements were linearly related (R-squared [Rsq]: FTLD-Tau GM = 0.92, WM = 0.92; FTLD-TDP GM = 0.75, WM = 0.78; p < 0.001 all). We therefore used linear regression to transform %AO from distinct staining batches into equivalent values. Using a train-test set design, we examined transformation prerequisites (i.e., Rsq) from linear-modeling in training sets, and we applied equivalence factors (i.e., beta, intercept) to independent testing sets to determine transformation outcomes (i.e., intraclass correlation coefficient [ICC]). First, random iterations (×100) of linear regression showed that smaller training sets (N = 12–24), feasible for prospective use, have acceptable transformation prerequisites (mean Rsq: FTLD-Tau ≥0.9; FTLD-TDP ≥0.7). When cross-validated on independent complementary testing sets, in FTLD-Tau, N = 12 training sets resulted in 100% of GM and WM transformations with optimal transformation outcomes (ICC ≥ 0.8), while in FTLD-TDP N = 24 training sets resulted in optimal ICC in testing sets (GM = 72%, WM = 98%). We therefore propose training sets of N = 12 in FTLD-Tau and N = 24 in FTLD-TDP for prospective transformations. Finally, the transformation enabled us to significantly reduce batch-related difference in duplicate measurements in FTLD-Tau (GM/WM: p < 0.001 both) and FTLD-TDP (GM/WM: p < 0.001 both), and to decrease the necessary sample size estimated in a power analysis in FTLD-Tau (GM:-40%; WM: -34%) and FTLD-TDP (GM: -20%; WM: -30%). Finally, we tested generalizability of our approach using a second, open-source, image analysis platform and found similar results. We concluded that a small sample of tissue stained in duplicate can be used to account for pre-analytical variability such as staining batch effects, thereby improving methods for future studies.
Collapse
Affiliation(s)
- Lucia A A Giannini
- Penn Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Neurology, University Medical Center Groningen - University of Groningen, Groningen, Netherlands
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Claire Peterson
- Penn Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Cecilia Zhou
- Penn Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Edward B Lee
- Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Alzheimer's Disease Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David A Wolk
- Alzheimer's Disease Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - John Q Trojanowski
- Alzheimer's Disease Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Corey T McMillan
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David J Irwin
- Penn Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|