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Akrobetu DY, Robbins CB, Ma JP, Soundararajan S, Quist MS, Stinnett SS, Moore KPL, Johnson KG, Liu AJ, Grewal DS, Fekrat S. Intrasession Repeatability of OCT Angiography Parameters in Neurodegenerative Disease. Ophthalmol Sci 2023; 3:100275. [PMID: 36950088 PMCID: PMC10025280 DOI: 10.1016/j.xops.2023.100275] [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] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/09/2023] [Accepted: 01/20/2023] [Indexed: 02/02/2023]
Abstract
Purpose To assess the intrasession repeatability of macular OCT angiography (OCTA) parameters in Alzheimer's disease (AD), mild cognitive impairment (MCI), Parkinson's disease (PD), and normal cognition (NC). Design Cross sectional study. Subjects Patients with a clinical diagnosis of AD, PD, MCI, or NC were imaged. Images with poor quality and of those with diabetes mellitus, glaucoma, or vitreoretinal disease were excluded from analysis. Methods Intervention or Testing All participants were imaged using the Zeiss Cirrus HD-5000 with AngioPlex (Carl Zeiss Meditec, Software Version 11.0.0.29946) and repeat OCTA images were obtained for both eyes. Perfusion density (PFD), vessel density (VD), and Foveal avascular zone (FAZ) area were measured from 3 × 3 mm and 6 × 6 mm OCTA images centered on the fovea using an ETDRS grid overlay. Main Outcome Measures Intraclass correlation coefficients were used to quantify repeatability of PFD, VD, and FAZ area measurements obtained from imaging. Results 3 × 3 mm scans of 22 AD, 40 MCI, 21 PD, and 26 NC participants and 6 × 6 mm scans of 29 AD, 44 MCI, 29 PD, and 30 NC participants were analyzed. Repeatability values ranged from 0.64 (0.49-0.82) for 6 × 6 mm PFD in AD participants to 0.87 (0.67-0.92) for 3 × 3 mm PFD in AD participants. No significant differences were observed in repeatability between NC participants and those with neurodegenerative disease. Conclusions Overall, similar OCTA repeatability was observed between NC participants and those with neurodegeneration. Regardless of diagnostic group, macular OCTA metrics demonstrated moderate to good repeatability. Financial Disclosures The authors have no proprietary or commercial interest in any materials discussed in this article.
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Key Words
- AD, Alzheimer's disease
- Alzheimer
- CI, confidence interval
- D, diopters
- FAZ, Foveal avascular zone
- ICC, intraclass correlation
- MCI, mild cognitive impairment
- MSE, mean square error
- Mild cognitive impairment
- NC, normal cognition
- OCTA
- OCTA, OCT angiography
- PD, Parkinson's disease
- PFD, Perfusion density
- Parkinson
- Repeatability
- SSI, strength signal index
- VD, vessel density
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Affiliation(s)
- Dennis Y Akrobetu
- iMIND Research Group, Duke University School of Medicine, Durham, North Carolina
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Cason B Robbins
- iMIND Research Group, Duke University School of Medicine, Durham, North Carolina
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Justin P Ma
- iMIND Research Group, Duke University School of Medicine, Durham, North Carolina
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Srinath Soundararajan
- iMIND Research Group, Duke University School of Medicine, Durham, North Carolina
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Michael S Quist
- iMIND Research Group, Duke University School of Medicine, Durham, North Carolina
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Sandra S Stinnett
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Kathryn P L Moore
- iMIND Research Group, Duke University School of Medicine, Durham, North Carolina
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina
| | - Kim G Johnson
- iMIND Research Group, Duke University School of Medicine, Durham, North Carolina
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina
| | - Andy J Liu
- iMIND Research Group, Duke University School of Medicine, Durham, North Carolina
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina
| | - Dilraj S Grewal
- iMIND Research Group, Duke University School of Medicine, Durham, North Carolina
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Sharon Fekrat
- iMIND Research Group, Duke University School of Medicine, Durham, North Carolina
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina
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Mano T, Kinugawa K, Ozaki M, Kataoka H, Sugie K. Neural synchronization analysis of electroencephalography coherence in patients with Parkinson's disease-related mild cognitive impairment. Clin Park Relat Disord 2022; 6:100140. [PMID: 35308256 PMCID: PMC8928128 DOI: 10.1016/j.prdoa.2022.100140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/13/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022] Open
Abstract
We studied brain functional connectivity in 20 patients with PD-MCI and 10 MCI patients without Parkinsonism. Cognitive impairment was related to decreased coherence in the alpha range [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]. Regional coherence in left FP had a higher correlation with cognitive function. Differences in EEG coherence may reflect a compensatory response to PD-MCI.
Introduction The underlying pathophysiology of slight cognitive dysfunction in Parkinson’s disease-related mild cognitive impairment (PD-MCI) is yet to be elucidated. Our study aimed to evaluate the association between cognitive function and brain functional connectivity (FC) in patients with PD-MCI. Methods Twenty patients with sporadic PD-MCI were evaluated for FC in the brain network. Further, electroencephalography (EEG) coherence analysis in the whole-brain and quantified regional coherence using phase coupling were performed for each frequency, and motor and cognitive function were assessed in the whole-brain. Results The degree of cognitive impairment was related to a decrease in the coherence in the alpha ranges. The regional coherence in the left frontal-left parietal region rather than the right frontal-right parietal region showed a higher correlation with the cognitive function scores. Conclusion The differences in EEG coherence across different types of cognitive dysfunction reflect a compensatory response to the heterogeneous and complex clinical presentation of PD-MCI. Our findings indicate decreased brain efficiency and impaired neural synchronization in PD-MCI; these results may be crucial in elucidating the pathological exacerbation of PD-MCI.
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Key Words
- Coherence analysis
- EEG, electroencephalography
- Electroencephalography
- FAB, Frontal Assessment Battery
- FC, functional connectivity
- FF, frontal-frontal
- FP, frontal-parietal
- FPL, left frontal-left parietal
- FPR, right frontal-right parietal
- FT, frontal-temporal
- HDS-R, Revised Hasegawa Dementia Score
- LEDD, levodopa-equivalent daily dose
- MCI, Mild Cognitive Impairment
- MCI, mild cognitive impairment
- MDS-UPDRS, Movement Disorder Society Unified Parkinson's Disease Rating Scale
- MMSE, Mini-Mental State Examination
- Mild cognitive impairment
- PD, Parkinson’s disease
- PO, parietal-occipital
- PT, parietal-temporal
- Parkinson's disease
- RBD, rapid eye movement sleep behavior disorder
- TT, temporal-temporal
- Time–frequency analysis
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Affiliation(s)
- Tomoo Mano
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan.,Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Kaoru Kinugawa
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Maki Ozaki
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Hiroshi Kataoka
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
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Trushina E, Trushin S, Hasan MF. Mitochondrial complex I as a therapeutic target for Alzheimer's disease. Acta Pharm Sin B 2022; 12:483-495. [PMID: 35256930 PMCID: PMC8897152 DOI: 10.1016/j.apsb.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/01/2021] [Accepted: 10/25/2021] [Indexed: 02/08/2023] Open
Abstract
Alzheimer's disease (AD), the most prominent form of dementia in the elderly, has no cure. Strategies focused on the reduction of amyloid beta or hyperphosphorylated Tau protein have largely failed in clinical trials. Novel therapeutic targets and strategies are urgently needed. Emerging data suggest that in response to environmental stress, mitochondria initiate an integrated stress response (ISR) shown to be beneficial for healthy aging and neuroprotection. Here, we review data that implicate mitochondrial electron transport complexes involved in oxidative phosphorylation as a hub for small molecule-targeted therapeutics that could induce beneficial mitochondrial ISR. Specifically, partial inhibition of mitochondrial complex I has been exploited as a novel strategy for multiple human conditions, including AD, with several small molecules being tested in clinical trials. We discuss current understanding of the molecular mechanisms involved in this counterintuitive approach. Since this strategy has also been shown to enhance health and life span, the development of safe and efficacious complex I inhibitors could promote healthy aging, delaying the onset of age-related neurodegenerative diseases.
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Key Words
- AD, Alzheimer's disease
- ADP, adenosine diphosphate
- AIDS, acquired immunodeficiency syndrome
- AMP, adenosine monophosphate
- AMPK, AMP-activated protein kinase
- APP/PS1, amyloid precursor protein/presenilin 1
- ATP, adenosine triphosphate
- Alzheimer's disease
- Aβ, amyloid beta
- BBB, blood‒brain barrier
- BDNF, brain-derived neurotrophic factor
- CP2, tricyclic pyrone compound two
- Complex I inhibitors
- ER, endoplasmic reticulum
- ETC, electron transport chain
- FADH2, flavin adenine dinucleotide
- FDG-PET, fluorodeoxyglucose-positron emission tomography
- GWAS, genome-wide association study
- HD, Huntington's disease
- HIF-1α, hypoxia induced factor 1 α
- Healthy aging
- ISR, integrated stress response
- Integrated stress response
- LTP, long term potentiation
- MCI, mild cognitive impairment
- MPTP, 1-methyl 4-phenyl-1,2,3,6-tetrahydropyridine
- Mitochondria
- Mitochondria signaling
- Mitochondria targeted therapeutics
- NAD+ and NADH, nicotinamide adenine dinucleotide
- NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells
- NRF2, nuclear factor E2-related factor 2
- Neuroprotection
- OXPHOS, oxidative phosphorylation
- PD, Parkinson's disease
- PGC1α, peroxisome proliferator-activated receptor gamma coactivator 1 alpha
- PMF, proton-motive force
- RNAi, RNA interference
- ROS, reactive oxygen species
- T2DM, type II diabetes mellitus
- TCA, the tricarboxylic acid cycle
- mtDNA, mitochondrial DNA
- mtUPR, mitochondrial unfolded protein response
- pTau, hyper-phosphorylated Tau protein
- ΔpH, proton gradient
- Δψm, mitochondrial membrane potential
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Austad SN, Ballinger S, Buford TW, Carter CS, Smith DL, Darley-Usmar V, Zhang J. Targeting whole body metabolism and mitochondrial bioenergetics in the drug development for Alzheimer's disease. Acta Pharm Sin B 2022; 12:511-531. [PMID: 35256932 PMCID: PMC8897048 DOI: 10.1016/j.apsb.2021.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 03/31/2021] [Revised: 05/26/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023] Open
Abstract
Aging is by far the most prominent risk factor for Alzheimer's disease (AD), and both aging and AD are associated with apparent metabolic alterations. As developing effective therapeutic interventions to treat AD is clearly in urgent need, the impact of modulating whole-body and intracellular metabolism in preclinical models and in human patients, on disease pathogenesis, have been explored. There is also an increasing awareness of differential risk and potential targeting strategies related to biological sex, microbiome, and circadian regulation. As a major part of intracellular metabolism, mitochondrial bioenergetics, mitochondrial quality-control mechanisms, and mitochondria-linked inflammatory responses have been considered for AD therapeutic interventions. This review summarizes and highlights these efforts.
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Key Words
- ACE2, angiotensin I converting enzyme (peptidyl-dipeptidase A) 2
- AD, Alzheimer's disease
- ADP, adenosine diphosphate
- ADRD, AD-related dementias
- Aβ, amyloid β
- CSF, cerebrospinal fluid
- Circadian regulation
- DAMPs
- DAMPs, damage-associated molecular patterns
- Diabetes
- ER, estrogen receptor
- ETC, electron transport chain
- FCCP, trifluoromethoxy carbonylcyanide phenylhydrazone
- FPR-1, formyl peptide receptor 1
- GIP, glucose-dependent insulinotropic polypeptide
- GLP-1, glucagon-like peptide-1
- HBP, hexoamine biosynthesis pathway
- HTRA, high temperature requirement A
- Hexokinase biosynthesis pathway
- I3A, indole-3-carboxaldehyde
- IRF-3, interferon regulatory factor 3
- LC3, microtubule associated protein light chain 3
- LPS, lipopolysaccharide
- LRR, leucine-rich repeat
- MAVS, mitochondrial anti-viral signaling
- MCI, mild cognitive impairment
- MRI, magnetic resonance imaging
- MRS, magnetic resonance spectroscopy
- Mdivi-1, mitochondrial division inhibitor 1
- Microbiome
- Mitochondrial DNA
- Mitochondrial electron transport chain
- Mitochondrial quality control
- NLRP3, leucine-rich repeat (LRR)-containing protein (NLR)-like receptor family pyrin domain containing 3
- NOD, nucleotide-binding oligomerization domain
- NeuN, neuronal nuclear protein
- PET, fluorodeoxyglucose (FDG)-positron emission tomography
- PKA, protein kinase A
- POLβ, the base-excision repair enzyme DNA polymerase β
- ROS, reactive oxygen species
- Reactive species
- SAMP8, senescence-accelerated mice
- SCFAs, short-chain fatty acids
- SIRT3, NAD-dependent deacetylase sirtuin-3
- STING, stimulator of interferon genes
- STZ, streptozotocin
- SkQ1, plastoquinonyldecyltriphenylphosphonium
- T2D, type 2 diabetes
- TCA, Tricarboxylic acid
- TLR9, toll-like receptor 9
- TMAO, trimethylamine N-oxide
- TP, tricyclic pyrone
- TRF, time-restricted feeding
- cAMP, cyclic adenosine monophosphate
- cGAS, cyclic GMP/AMP synthase
- hAPP, human amyloid precursor protein
- hPREP, human presequence protease
- i.p., intraperitoneal
- mTOR, mechanistic target of rapamycin
- mtDNA, mitochondrial DNA
- αkG, alpha-ketoglutarate
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Affiliation(s)
- Steven N. Austad
- Department of Biology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Scott Ballinger
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Thomas W. Buford
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Christy S. Carter
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Daniel L. Smith
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Victor Darley-Usmar
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Jianhua Zhang
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Corresponding author. Tel.: +1 205 996 5153.
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Ito D, Kawakami M, Narita Y, Yoshida T, Mori N, Kondo K. Cognitive Function is a Predictor of the Daily Step Count in Patients With Subacute Stroke With Independent Walking Ability: A Prospective Cohort Study. Arch Rehabil Res Clin Transl 2021; 3:100132. [PMID: 34589683 PMCID: PMC8463495 DOI: 10.1016/j.arrct.2021.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cognition at admission may predict daily step count. Cognitive impairment may increase risk of poor ambulation after subacute stroke. Ambulation poststroke is influenced by both physical and cognitive factors.
Objectives To investigate the physical, cognitive, and psychological factors related to daily step count in patients with subacute stroke. Design Prospective cohort study. Setting A subacute rehabilitation ward with 160 beds. Participants Patients with subacute stroke who could walk independently (N=101). Among the 101 participants enrolled in this study (mean age, 64.5±13.5y), 64.4% (n=65) were men and 69.3% (n=70) were patients with cerebral infarction. Interventions We assessed ambulatory activity using a pedometer placed in the pants pocket on the nonparalyzed side continuously for 7 consecutive days. We also obtained demographic and clinical information and recorded the following measurement scores: Stroke Impairment Assessment Set, FIM, Mini-Mental State Examination (MMSE), Self-Rating Depression Scale, and Apathy Scale. All measurements were collected at admission and discharge. Main Outcome Measures The outcomes assessed were ambulatory activity, motor and sensory functions, functional disability, cognitive function, depressive symptoms, and motivation. Results The median daily steps ambulated at admission and discharge were 5584 steps (interquartile range, 3763-7096 steps) and 5991 steps (interquartile range, 4329-8204 steps), respectively. In the univariate regression analysis, age, sex, serum albumin level, affected side of the brain, and MMSE score at admission were significantly associated with the daily step count at discharge. Multiple regression analysis using these 5 items as independent variables revealed that the MMSE score at admission (reference, 28-30 points; B, −2.07; 95% confidence interval, −3.89 to −0.35; β, −0.22; P=.027) was significantly associated with the daily step count at discharge. Conclusions Cognitive function at admission had a significant association with the daily step count at discharge in patients with subacute stroke who could walk independently.
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Affiliation(s)
- Daisuke Ito
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Corresponding author Daisuke Ito, OT, MSc, Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, 4-1-1, Yatsu, Narashino City, Chiba 275-0026, Japan.
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuya Narita
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Taiki Yoshida
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Graduate School of Human Sciences, Waseda University, Tokorozawa City, Saitama, Japan
| | - Naoki Mori
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
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Locke DEC, Khayoun R, Shandera-Ochsner AL, Cuc A, Eilertsen J, Caselli M, Abrew K, Chandler MJ. Innovation Inspired by COVID: A Virtual Treatment Program for Patients With Mild Cognitive Impairment at Mayo Clinic. Mayo Clin Proc Innov Qual Outcomes 2021; 5:820-826. [PMID: 34423257 PMCID: PMC8372500 DOI: 10.1016/j.mayocpiqo.2021.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Limited access to mental health and behavioral interventions is a public health issue that predated and is further worsened by coronavirus disease 2019 (COVID-19) social distancing restrictions. The Healthy Action to Benefit Independence and Thinking (HABIT) program is a cognitive rehabilitation and wellness program for patients with a diagnosis of mild cognitive impairment and their partners that involves groups of up to 32 people (16 dyads) at a time. Thus, the public health recommendation to avoid groups at the start of the COVID-19 pandemic immediately impacted our ability to offer this treatment protocol. This brief report provides patient and partner satisfaction data as well as clinical outcomes with a virtual adaptation of the HABIT program developed because of the COVID-19 pandemic. At the time of their participation, patients who attended in-person sessions had an average age of 74.4 years and those who attended virtual sessions had an average age of 75.4 years (P=.60). Both groups had an average of 16.3 years of education (P=.95). Approximately half of the patients in both groups were male (30 of 57 [53%]), most were White (54 of 57 [95%]) and were accompanied to the program by a spouse (50 of 57 [88%]). Overall, patient and partner satisfaction with the HABIT program remained high, ranging from a mean score of 5.8 to 6.6 on a rating scale of 1 to 7 for patients and partners, and clinical outcomes remained consistent with our face-to-face formatting when compared with pre–COVID pandemic sessions. The most notable changes across both formats were improvements in patient anxiety (Cohen's d=0.25 face-to-face; d=0.39 virtual), partner anxiety (d=0.37 face-to-face; d=0.34 virtual), and partner depression (d=0.37 face-to-face; d=0.35 virtual). This preliminary program evaluation suggests that transitioning the HABIT program to virtual formatting provides high-quality care similar to our in-person care models. Ongoing program evaluation is planned as we continue using virtual treatment for safety. Even after COVID-19 pandemic public health restrictions are lifted, these findings will have continued relevance to ongoing demand for telehealth.
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Affiliation(s)
- Dona E C Locke
- Division of Neuropsychology, Mayo Clinic, Scottsdale, AZ
| | - Renata Khayoun
- Division of Neuropsychology, Mayo Clinic, Scottsdale, AZ
| | | | - Andrea Cuc
- Division of Clinical Health Psychology, Mayo Clinic, Scottsdale, AZ
| | | | - Maria Caselli
- Department of Integrative Medicine, Mayo Clinic, Scottsdale, AZ
| | - Karina Abrew
- Physical Therapy Services, Mayo Clinic, Scottsdale, AZ
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Wafford KA. Aberrant waste disposal in neurodegeneration: why improved sleep could be the solution. Cereb Circ Cogn Behav 2021; 2:100025. [PMID: 36324713 PMCID: PMC9616228 DOI: 10.1016/j.cccb.2021.100025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/14/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 06/16/2023]
Abstract
Sleep takes up a large percentage of our lives and the full functions of this state are still not understood. However, over the last 10 years a new and important function has emerged as a mediator of brain clearance. Removal of toxic metabolites and proteins from the brain parenchyma generated during waking activity and high levels of synaptic processing is critical to normal brain function and only enabled during deep sleep. Understanding of this process is revealing how impaired sleep contributes an important and likely causative role in the accumulation and aggregation of aberrant proteins such as β-amyloid and phosphorylated tau, as well as inflammation and neuronal damage. We are also beginning to understand how brain slow-wave activity interacts with vascular function allowing the flow of CSF and interstitial fluid to drain into the body's lymphatic system. New methodology is enabling visualization of this process in both animals and humans and is revealing how these processes break down during ageing and disease. With this understanding we can begin to envisage novel therapeutic approaches to the treatment of neurodegeneration, and how reversing sleep impairment in the correct manner may provide a way to slow these processes and improve brain function.
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Key Words
- AQP4, aquaporin-4
- Alzheimer's disease
- Amyloid
- Aquaporin-4
- Astrocyte
- Aβ, beta amyloid
- BOLD, blood-oxygen level dependent imaging
- CAA, cerebral amyloid angiopathy
- CSF, Cerebrospinal fluid
- Clearance
- EEG, electroencephalography
- EMG, electromyography
- Glymphatic
- ISF, interstitial fluid
- MCI, mild cognitive impairment
- MRI, magnetic resonance imaging
- NOS, nitric oxide synthase
- NREM, non-rapid eye movement
- OSA, obstructive sleep apnea
- PET, positron emission tomography
- REM, rapid-eye movement
- SWA, slow wave activity
- SWS, slow-wave sleep
- Slow-wave sleep
- iNPH, idiopathic normal pressure hydrocephalus
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Zhang L, Hu K, Shao T, Hou L, Zhang S, Ye W, Josephson L, Meyer JH, Zhang MR, Vasdev N, Wang J, Xu H, Wang L, Liang SH. Recent developments on PET radiotracers for TSPO and their applications in neuroimaging. Acta Pharm Sin B 2021; 11:373-393. [PMID: 33643818 PMCID: PMC7893127 DOI: 10.1016/j.apsb.2020.08.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
The 18 kDa translocator protein (TSPO), previously known as the peripheral benzodiazepine receptor, is predominately localized to the outer mitochondrial membrane in steroidogenic cells. Brain TSPO expression is relatively low under physiological conditions, but is upregulated in response to glial cell activation. As the primary index of neuroinflammation, TSPO is implicated in the pathogenesis and progression of numerous neuropsychiatric disorders and neurodegenerative diseases, including Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), Parkinson's disease (PD), multiple sclerosis (MS), major depressive disorder (MDD) and obsessive compulsive disorder (OCD). In this context, numerous TSPO-targeted positron emission tomography (PET) tracers have been developed. Among them, several radioligands have advanced to clinical research studies. In this review, we will overview the recent development of TSPO PET tracers, focusing on the radioligand design, radioisotope labeling, pharmacokinetics, and PET imaging evaluation. Additionally, we will consider current limitations, as well as translational potential for future application of TSPO radiopharmaceuticals. This review aims to not only present the challenges in current TSPO PET imaging, but to also provide a new perspective on TSPO targeted PET tracer discovery efforts. Addressing these challenges will facilitate the translation of TSPO in clinical studies of neuroinflammation associated with central nervous system diseases.
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Key Words
- AD, Alzheimer's disease
- ALS, amyotrophic lateral sclerosis
- AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid
- ANT, adenine nucleotide transporter
- Am, molar activities
- BBB, blood‒brain barrier
- BMSC, bone marrow stromal cells
- BP, binding potential
- BPND, non-displaceable binding potential
- BcTSPO, Bacillus cereus TSPO
- CBD, corticobasal degeneration
- CNS disorders
- CNS, central nervous system
- CRAC, cholesterol recognition amino acid consensus sequence
- DLB, Lewy body dementias
- EP, epilepsy
- FTD, frontotemporal dementia
- HAB, high-affinity binding
- HD, Huntington's disease
- HSE, herpes simplex encephalitis
- IMM, inner mitochondrial membrane
- KA, kainic acid
- LAB, low-affinity binding
- LPS, lipopolysaccharide
- MAB, mixed-affinity binding
- MAO-B, monoamine oxidase B
- MCI, mild cognitive impairment
- MDD, major depressive disorder
- MMSE, mini-mental state examination
- MRI, magnetic resonance imaging
- MS, multiple sclerosis
- MSA, multiple system atrophy
- Microglial activation
- NAA/Cr, N-acetylaspartate/creatine
- Neuroinflammation
- OCD, obsessive compulsive disorder
- OMM, outer mitochondrial membrane
- P2X7R, purinergic receptor P2X7
- PAP7, RIa-associated protein
- PBR, peripheral benzodiazepine receptor
- PCA, posterior cortical atrophy
- PD, Parkinson's disease
- PDD, PD dementia
- PET, positron emission tomography
- PKA, protein kinase A
- PRAX-1, PBR-associated protein 1
- PSP, progressive supranuclear palsy
- Positron emission tomography (PET)
- PpIX, protoporphyrin IX
- QA, quinolinic acid
- RCYs, radiochemical yields
- ROS, reactive oxygen species
- RRMS, relapsing remitting multiple sclerosis
- SA, specific activity
- SAH, subarachnoid hemorrhage
- SAR, structure–activity relationship
- SCIDY, spirocyclic iodonium ylide
- SNL, selective neuronal loss
- SNR, signal to noise ratio
- SUV, standard uptake volume
- SUVR, standard uptake volume ratio
- TBAH, tetrabutyl ammonium hydroxide
- TBI, traumatic brain injury
- TLE, temporal lobe epilepsy
- TSPO
- TSPO, translocator protein
- VDAC, voltage-dependent anion channel
- VT, distribution volume
- d.c. RCYs, decay-corrected radiochemical yields
- dMCAO, distal middle cerebral artery occlusion
- fP, plasma free fraction
- n.d.c. RCYs, non-decay-corrected radiochemical yields
- p.i., post-injection
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Kishimoto T, Takamiya A, Liang KC, Funaki K, Fujita T, Kitazawa M, Yoshimura M, Tazawa Y, Horigome T, Eguchi Y, Kikuchi T, Tomita M, Bun S, Murakami J, Sumali B, Warnita T, Kishi A, Yotsui M, Toyoshiba H, Mitsukura Y, Shinoda K, Sakakibara Y, Mimura M; PROMPT collaborators. The project for objective measures using computational psychiatry technology (PROMPT): Rationale, design, and methodology. Contemp Clin Trials Commun 2020; 19:100649. [PMID: 32913919 DOI: 10.1016/j.conctc.2020.100649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/06/2020] [Accepted: 08/16/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction Depressive and neurocognitive disorders are debilitating conditions that account for the leading causes of years lived with disability worldwide. However, there are no biomarkers that are objective or easy-to-obtain in daily clinical practice, which leads to difficulties in assessing treatment response and developing new drugs. New technology allows quantification of features that clinicians perceive as reflective of disorder severity, such as facial expressions, phonic/speech information, body motion, daily activity, and sleep. Methods Major depressive disorder, bipolar disorder, and major and minor neurocognitive disorders as well as healthy controls are recruited for the study. A psychiatrist/psychologist conducts conversational 10-min interviews with participants ≤10 times within up to five years of follow-up. Interviews are recorded using RGB and infrared cameras, and an array microphone. As an option, participants are asked to wear wrist-band type devices during the observational period. Various software is used to process the raw video, voice, infrared, and wearable device data. A machine learning approach is used to predict the presence of symptoms, severity, and the improvement/deterioration of symptoms. Discussion The overall goal of this proposed study, the Project for Objective Measures Using Computational Psychiatry Technology (PROMPT), is to develop objective, noninvasive, and easy-to-use biomarkers for assessing the severity of depressive and neurocognitive disorders in the hopes of guiding decision-making in clinical settings as well as reducing the risk of clinical trial failure. Challenges may include the large variability of samples, which makes it difficult to extract the features that commonly reflect disorder severity. Trial Registration UMIN000021396, University Hospital Medical Information Network (UMIN).
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Key Words
- AMED, Japan Agency for Medical Research and Development
- Adabag, Adaptive Bagging
- Adaboost, Adaptive Boosting
- BD, Bipolar disorder
- BDI-II, Beck Depression Inventory, Second Edition
- BNN, Bayesian Neural Networks
- CDR, Clinical Dementia Rating
- CDT, Clock Drawing Test
- CNN, Convolutional Neural Networks
- CPP, cepstral peak prominence
- DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
- Depression
- F0, fundamental frequency
- F1, F2, F3, first, second, and third formant frequencies
- FedRAMP, Federal Risk and Authorization Management Program
- GCNN, Gated Convolutional Neural Networks
- GDS, Geriatric Depression Scale
- HAM-D, Hamilton Depression Rating Scale
- IEC, International Electrotechnical Commission
- ISO, International Organization for Standardization
- LM, Wechsler Memory Scale-Revised Logical Memory
- LSTM, Long Short-Term Memory Networks
- M.I.N.I., Mini-International Neuropsychiatric Interview
- MADRS, Montgomery-Asberg Depression Rating Scale
- MARS, Motor Agitation and Retardation Scale
- MCI, mild cognitive impairment
- MDD, Major depressive disorder
- MFCC, mel-frequency cepstrum coefficients
- MMSE, Mini-Mental State Examination
- MRI, magnetic resonance imaging
- Machine learning
- MoCA, Montreal Cognitive Assessment
- NPI, Neuropsychiatric Inventory
- Natural language processing
- Neurocognitive disorder
- PET, positron emission tomography
- PROMPT, Project for Objective Measures Using Computational Psychiatry Technology
- PSQI, Pittsburgh Sleep Quality Index
- RF, Random Forest
- RGB, red, green, blue
- SCID, Structural Clinical Interview for DSM-5
- SVM, Support Vector Machine
- SVR, Support Vector Regression
- Screening
- UI, uncertainty interval
- UMIN, University Hospital Medical Information Network
- UV, ultraviolet
- YLDs, years lived with disability
- YMRS, Young Mania Rating Scale
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Yang X, Yu D, Xue L, Li H, Du J. Probiotics modulate the microbiota-gut-brain axis and improve memory deficits in aged SAMP8 mice. Acta Pharm Sin B 2020; 10:475-487. [PMID: 32140393 PMCID: PMC7049608 DOI: 10.1016/j.apsb.2019.07.001] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/08/2019] [Accepted: 05/15/2019] [Indexed: 12/12/2022] Open
Abstract
ProBiotic-4 is a probiotic preparation composed of Bifidobacterium lactis, Lactobacillus casei, Bifidobacterium bifidum, and Lactobacillus acidophilus. This study aims to investigate the effects of ProBiotic-4 on the microbiota–gut–brain axis and cognitive deficits, and to explore the underlying molecular mechanism using senescence-accelerated mouse prone 8 (SAMP8) mice. ProBiotic-4 was orally administered to 9-month-old SAMP8 mice for 12 weeks. We observed that ProBiotic-4 significantly improved the memory deficits, cerebral neuronal and synaptic injuries, glial activation, and microbiota composition in the feces and brains of aged SAMP8 mice. ProBiotic-4 substantially attenuated aging-related disruption of the intestinal barrier and blood–brain barrier, decreased interleukin-6 and tumor necrosis factor-α at both mRNA and protein levels, reduced plasma and cerebral lipopolysaccharide (LPS) concentration, toll-like receptor 4 (TLR4) expression, and nuclear factor-κB (NF-κB) nuclear translocation in the brain. In addition, not only did ProBiotic-4 significantly decreased the levels of γ-H2AX, 8-hydroxydesoxyguanosine, and retinoic-acid-inducible gene-I (RIG-I), it also abrogated RIG-I multimerization in the brain. These findings suggest that targeting gut microbiota with probiotics may have a therapeutic potential for the deficits of the microbiota–gut–brain axis and cognitive function in aging, and that its mechanism is associated with inhibition of both TLR4-and RIG-I-mediated NF-κB signaling pathway and inflammatory responses.
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Key Words
- 8-OHdG, 8-hydroxydesoxyguanosine
- AAMI, age-associated memory impairment
- AD, Alzheimer's disease
- BBB, blood–brain barrier
- CFU, colony-forming units
- Cognitive decline
- ELISA, enzyme-linked immunosorbent assay
- F/B, Firmicutes/Bacteroidetes
- GFAP, glial fibrillary acidic protein
- HE, hematoxylin and eosin
- IHC, immunohistochemistry
- IL-6, interleukin-6
- Iba-1, ionized calcium binding adaptor molecule-1
- LPS, lipopolysaccharide
- MCI, mild cognitive impairment
- Microbiota–gut–brain axis
- NF-κB
- NF-κB, nuclear factor-κB
- NMDS, non-metric multidimensional scaling
- OTU, operational taxonomic unit
- PAMP, pathogen-associated molecular pattern
- Probiotics
- RIG-I
- RIG-I, retinoic-acid-inducible gene-I
- SAMP8 mice
- SAMP8, senescence-accelerated mouse prone 8
- SYN, synaptophysin
- TEM, transmission electron microscopy
- TLR4
- TLR4, toll-like receptor 4
- TNF-α, tumor necrosis factor-α
- VE-cadherin, vascular endothelial-cadherin
- ZO-1, zona occluden-1
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van der Kleij LA, Petersen ET, Siebner HR, Hendrikse J, Frederiksen KS, Sobol NA, Hasselbalch SG, Garde E. The effect of physical exercise on cerebral blood flow in Alzheimer's disease. Neuroimage Clin 2018; 20:650-4. [PMID: 30211001 DOI: 10.1016/j.nicl.2018.09.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 07/20/2018] [Accepted: 09/02/2018] [Indexed: 12/11/2022]
Abstract
In recent years there has been an increasing focus on the relation between cerebrovascular health, physical exercise and Alzheimer's disease. The aim of the current study was to determine the effect of moderate-to-high-intensity aerobic exercise on cerebral blood flow in patients with mild to moderate Alzheimer's disease. Fifty-one patients were randomized to either usual care or moderate-to-high intensity aerobic exercise for 16 weeks. Exercise had no consistent effect on whole brain or regional cerebral blood flow. Sixteen weeks of exercise are, therefore, not sufficient to produce a consistent increase in cerebral blood flow in a relatively small sample of Alzheimer's patients.
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12
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Rijpma A, van der Graaf M, Meulenbroek O, Olde Rikkert MGM, Heerschap A. Altered brain high-energy phosphate metabolism in mild Alzheimer's disease: A 3-dimensional 31P MR spectroscopic imaging study. Neuroimage Clin 2018; 18:254-261. [PMID: 29876246 PMCID: PMC5987799 DOI: 10.1016/j.nicl.2018.01.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 06/30/2017] [Revised: 12/15/2017] [Accepted: 01/24/2018] [Indexed: 12/20/2022]
Abstract
In Alzheimer's disease (AD), defects in essential metabolic processes for energy supply and phospholipid membrane function have been implicated in the pathological process. However, post-mortem investigations are generally limited to late stage disease and prone to tissue decay artifacts. In vivo assessments of high energy phosphates, tissue pH and phospholipid metabolites are possible by phosphorus MR spectroscopy (31P–MRS), but so far only small studies, mostly focusing on single brain regions, have been performed. Therefore, we assessed phospholipid and energy metabolism in multiple brain regions of 31 early stage AD patients and 31 age- and gender-matched controls using 31P–MRS imaging. An increase of phosphocreatine (PCr) was found in AD patients compared with controls in the retrosplenial cortex, and both hippocampi, but not in the anterior cingulate cortex. While PCr/inorganic phosphate and pH were also increased in AD, no changes were found for phospholipid metabolites. This study showed that PCr levels are specifically increased in regions that show early degeneration in AD. Together with an increased pH, this indicates an altered energy metabolism in mild AD. Phosphocreatine and pH are increased in mild Alzheimer's disease. Phosphocreatine increase occurs in early affected brain regions. Brain energy metabolism may be altered in mild Alzheimer's disease. Phospholipid and energy metabolites as well as pH, differ across brain regions.
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Key Words
- 1H, proton
- 31P–MRS, phosphorus magnetic resonance spectroscopy
- AC, anterior commissure
- ACC, anterior cingulate cortex
- AD, Alzheimer's disease
- ADP, adenosine diphosphate
- ATP, adenosine triphosphate
- Alzheimer's disease
- CK, creatine kinase
- CSF, cerebrospinal fluid
- Cr, creatine
- Dementia
- Energy metabolism
- GM, grey matter
- GPCh, glycerophosphocholine
- GPEth, glycerophosphoethanolamine
- HL, left hippocampus
- HR, right hippocampus
- LS, least square
- MCI, mild cognitive impairment
- MMSE, Mini Mental State Examination
- MRSI, magnetic resonance spectroscopic imaging
- NAD(H), nicotinamide adenine dinucleotide
- OXPHOS, oxidative phosphorylation
- PC, posterior commissure
- PCh, phosphocholine
- PCr, phosphocreatine
- PDE, phosphodiesters
- PEth, phosphoethanolamine
- PME, phosphomonoesters
- Phospholipid metabolism
- Phosphorus magnetic resonance spectroscopic imaging
- Pi, inorganic phosphate
- ROI, region of interest
- RSC, retrosplenial cortex
- WM, white matter
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Affiliation(s)
- Anne Rijpma
- Department of Geriatric Medicine, Radboud university medical center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands.
| | - Marinette van der Graaf
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands; Department of Paediatrics, Radboud university medical center, Nijmegen, The Netherlands
| | - Olga Meulenbroek
- Department of Geriatric Medicine, Radboud university medical center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboud university medical center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Arend Heerschap
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
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Heller J, Mirzazade S, Romanzetti S, Habel U, Derntl B, Freitag NM, Schulz JB, Dogan I, Reetz K. Impact of gender and genetics on emotion processing in Parkinson's disease - A multimodal study. Neuroimage Clin 2018; 18:305-314. [PMID: 29876251 PMCID: PMC5987844 DOI: 10.1016/j.nicl.2018.01.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 01/25/2018] [Accepted: 01/28/2018] [Indexed: 01/07/2023]
Abstract
Understanding of the phenotypic heterogeneity of Parkinson's disease is needed. Gender and genetics determine manifestation and progression of Parkinson's disease. Altered emotion processing in Parkinson's disease is specific to male patients. This is influenced by endocrinal and genetic factors in both genders. This finding may impact the diagnosis and treatment of emerging clinical features.
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Key Words
- BAI, Beck anxiety inventory
- BDI-II, Beck depression inventory version II
- BFRT, Benton facial recognition test
- BOLD, blood‑oxygen-level dependent
- COMT, catechol-O-methyltransferase
- EPI, echo planar imaging
- Emotion
- Functional magnetic resonance imaging (fMRI)
- GM, gray matter
- Gender
- Genetics
- H&Y, Hoehn and Yahr rating scale
- HC, healthy controls
- LEDD, levodopa equivalence daily dose
- MCI, mild cognitive impairment
- MMSE, Mini-Mental State Examination
- MRI, magnetic resonance imaging
- MoCA, Montreal Cognitive Assessment
- NMS, non-motor symptoms
- PD, Parkinson's disease
- Parkinson's disease (PD)
- UPDRS, Unified Parkinson's disease rating scale
- VBM, voxel-based morphometry
- fMRI, functional magnetic resonance imaging
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Affiliation(s)
- Julia Heller
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
| | - Shahram Mirzazade
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
| | - Sandro Romanzetti
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at Systemic Levels, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, University of Tübingen, Osianderstraße 24, Tübingen, Germany
| | - Nils M Freitag
- II. Institute of Physics B and JARA-FIT, RWTH Aachen University, Otto-Blumenthal-Straße, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany.
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14
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Caminiti SP, Ballarini T, Sala A, Cerami C, Presotto L, Santangelo R, Fallanca F, Vanoli EG, Gianolli L, Iannaccone S, Magnani G, Perani D. FDG-PET and CSF biomarker accuracy in prediction of conversion to different dementias in a large multicentre MCI cohort. Neuroimage Clin 2018; 18:167-177. [PMID: 29387532 PMCID: PMC5790816 DOI: 10.1016/j.nicl.2018.01.019] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/15/2017] [Accepted: 01/18/2018] [Indexed: 01/29/2023]
Abstract
Background/aims In this multicentre study in clinical settings, we assessed the accuracy of optimized procedures for FDG-PET brain metabolism and CSF classifications in predicting or excluding the conversion to Alzheimer's disease (AD) dementia and non-AD dementias. Methods We included 80 MCI subjects with neurological and neuropsychological assessments, FDG-PET scan and CSF measures at entry, all with clinical follow-up. FDG-PET data were analysed with a validated voxel-based SPM method. Resulting single-subject SPM maps were classified by five imaging experts according to the disease-specific patterns, as "typical-AD", "atypical-AD" (i.e. posterior cortical atrophy, asymmetric logopenic AD variant, frontal-AD variant), "non-AD" (i.e. behavioural variant FTD, corticobasal degeneration, semantic variant FTD; dementia with Lewy bodies) or "negative" patterns. To perform the statistical analyses, the individual patterns were grouped either as "AD dementia vs. non-AD dementia (all diseases)" or as "FTD vs. non-FTD (all diseases)". Aβ42, total and phosphorylated Tau CSF-levels were classified dichotomously, and using the Erlangen Score algorithm. Multivariate logistic models tested the prognostic accuracy of FDG-PET-SPM and CSF dichotomous classifications. Accuracy of Erlangen score and Erlangen Score aided by FDG-PET SPM classification was evaluated. Results The multivariate logistic model identified FDG-PET "AD" SPM classification (Expβ = 19.35, 95% C.I. 4.8-77.8, p < 0.001) and CSF Aβ42 (Expβ = 6.5, 95% C.I. 1.64-25.43, p < 0.05) as the best predictors of conversion from MCI to AD dementia. The "FTD" SPM pattern significantly predicted conversion to FTD dementias at follow-up (Expβ = 14, 95% C.I. 3.1-63, p < 0.001). Overall, FDG-PET-SPM classification was the most accurate biomarker, able to correctly differentiate either the MCI subjects who converted to AD or FTD dementias, and those who remained stable or reverted to normal cognition (Expβ = 17.9, 95% C.I. 4.55-70.46, p < 0.001). Conclusions Our results support the relevant role of FDG-PET-SPM classification in predicting progression to different dementia conditions in prodromal MCI phase, and in the exclusion of progression, outperforming CSF biomarkers.
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Key Words
- AD, Alzheimer's disease
- AUC, area under curve
- Alzheimer's disease dementia
- CBD, corticobasal degeneration
- CDR, Clinical Dementia Rating
- CSF, cerebrospinal fluid
- Clinical setting
- DLB, dementia with Lewy bodies
- EANM, European Association of Nuclear Medicine
- Erlangen Score
- FDG, fluorodeoxyglucose
- FTD, frontotemporal dementia
- Frontotemporal dementia
- LR+, positive likelihood ratio
- LR-, negative likelihood ratio
- MCI, mild cognitive impairment
- PET, positron emission tomography
- PSP, progressive supranuclear palsy
- Prognosis
- aMCI, single-domain amnestic mild cognitive impairment
- bvFTD, behavioral variant of frontotemporal dementia
- md aMCI, multi-domain amnestic mild cognitive impairment
- md naMCI, multi-domain non-amnestic mild cognitive impairment
- naMCI, single-domain non-amnestic mild cognitive impairment
- p-tau, phosphorylated tau
- t-tau, total tau
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Affiliation(s)
- Silvia Paola Caminiti
- Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Tommaso Ballarini
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Arianna Sala
- Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Cerami
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Clinical Neuroscience Department, San Raffaele Turro Hospital, Milan, Italy
| | - Luca Presotto
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Santangelo
- Department of Neurology and INSPE, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Luigi Gianolli
- Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Sandro Iannaccone
- Clinical Neuroscience Department, San Raffaele Turro Hospital, Milan, Italy
| | - Giuseppe Magnani
- Department of Neurology and INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy.
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Henf J, Grothe MJ, Brueggen K, Teipel S, Dyrba M. Mean diffusivity in cortical gray matter in Alzheimer's disease: The importance of partial volume correction. Neuroimage Clin 2017; 17:579-586. [PMID: 29201644 PMCID: PMC5702878 DOI: 10.1016/j.nicl.2017.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 02/20/2017] [Revised: 09/06/2017] [Accepted: 10/03/2017] [Indexed: 01/08/2023]
Abstract
Mean diffusivity (MD) measured by diffusion tensor imaging can reflect microstructural alterations of the brain's gray matter (GM). Therefore, GM MD may be a sensitive marker of neurodegeneration related to Alzheimer's Disease (AD). However, due to partial volume effects (PVE), differences in MD may be overestimated because of a higher degree of brain atrophy in AD patients and in cases with mild cognitive impairment (MCI). Here, we evaluated GM MD changes in AD and MCI compared with healthy controls, and the effect of partial volume correction (PVC) on diagnostic utility of MD. We determined region of interest (ROI) and voxel-wise group differences and diagnostic accuracy of MD and volume measures between matched samples of 39 AD, 39 MCI and 39 healthy subjects before and after PVC. Additionally, we assessed whether effects of GM MD values on diagnosis were mediated by volume. ROI and voxel-wise group differences were reduced after PVC. When using these ROIs for predicting group separation in logistic models, both PVE corrected and uncorrected GM MD values yielded a poorer diagnostic accuracy in single predictor models than regional volume. For the discrimination of AD patients and healthy controls, the effect of GM MD on diagnosis was significantly mediated by volume of hippocampus and posterior cingulate ROIs. Our results suggest that GM MD measurements are strongly confounded by PVE in the presence of brain atrophy, underlining the necessity of PVC when using these measurements as specific metrics of microstructural tissue degeneration. Independently of PVC, regional MD was not superior to regional volume in separating prodromal and clinical stages of AD from healthy controls.
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Key Words
- AD, Alzheimer's Disease
- Alzheimer's disease
- DTI, diffusion tensor imaging
- Diffusion tensor imaging
- FLAIR, fluid-attenuated inversion recovery
- GM, gray matter
- Gray matter
- MCI, mild cognitive impairment
- MD, mean diffusivity
- Mean diffusivity
- Mild cognitive impairment
- PCC, posterior cingulate cortex
- PVC, partial volume correction
- PVE, partial volume effects
- Partial volume effects
- ROI, region of interest
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Affiliation(s)
- Judith Henf
- DZNE, German Center for Neurodegenerative Diseases, Rostock, Germany; Department for Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany.
| | - Michel J Grothe
- DZNE, German Center for Neurodegenerative Diseases, Rostock, Germany
| | | | - Stefan Teipel
- DZNE, German Center for Neurodegenerative Diseases, Rostock, Germany; Department for Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Martin Dyrba
- DZNE, German Center for Neurodegenerative Diseases, Rostock, Germany; MMIS Group, University of Rostock, Rostock, Germany
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16
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Mayo CD, Mazerolle EL, Ritchie L, Fisk JD, Gawryluk JR. Longitudinal changes in microstructural white matter metrics in Alzheimer's disease. Neuroimage Clin 2016; 13:330-338. [PMID: 28066707 PMCID: PMC5200876 DOI: 10.1016/j.nicl.2016.12.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [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: 09/15/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 11/17/2022]
Abstract
Background Alzheimer's disease (AD) is a progressive neurodegenerative disorder. Current avenues of AD research focus on pre-symptomatic biomarkers that will assist with early diagnosis of AD. The majority of magnetic resonance imaging (MRI) based biomarker research to date has focused on neuronal loss in grey matter and there is a paucity of research on white matter. Methods Longitudinal DTI data from the Alzheimer's Disease Neuroimaging Initiative 2 database were used to examine 1) the within-group microstructural white matter changes in individuals with AD and healthy controls at baseline and year one; and 2) the between-group microstructural differences in individuals with AD and healthy controls at both time points. Results 1) Within-group: longitudinal Tract-Based Spatial Statistics revealed that individuals with AD and healthy controls both had widespread reduced fractional anisotropy (FA) and increased mean diffusivity (MD) with changes in the hippocampal cingulum exclusive to the AD group. 2) Between-group: relative to healthy controls, individuals with AD had lower FA and higher MD in the hippocampal cingulum, as well as the corpus callosum, internal and external capsule; corona radiata; posterior thalamic radiation; superior and inferior longitudinal fasciculus; fronto-occipital fasciculus; cingulate gyri; fornix; uncinate fasciculus; and tapetum. Conclusion The current results indicate that sensitivity to white matter microstructure is a promising avenue for AD biomarker research. Additional longitudinal studies on both white and grey matter are warranted to further evaluate potential clinical utility. Longitudinal white matter research in Alzheimer's disease. Diffusion tensor imaging used to assess microstructural white matter changes. Decreased fractional anisotropy and increased mean diffusivity over one year. Widespread changes in Alzheimer's disease include the hippocampal cingulum. DTI holds potential as Alzheimer's disease biomarker.
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Key Words
- AD, Alzheimer's disease
- ADNI, Alzheimer's Disease Neuroimaging Initiative
- Aging
- Alzheimer's disease
- DTI, diffusion tensor imaging
- Diffusion tensor imaging
- FA, fractional anisotropy
- FSL, Functional MRI of the Brain Software Library
- HC, healthy controls
- MCI, mild cognitive impairment
- MD, mean diffusivity
- MMSE, Mini Mental Status Exam
- MRI, magnetic resonance imaging
- Magnetic resonance imaging
- ROI, region of interest
- TBSS, Tract-Based Spatial Statistics
- WMS, Wechsler Memory Scale
- White matter
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Affiliation(s)
- Chantel D Mayo
- Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
| | - Erin L Mazerolle
- Department of Radiology and the Hotchkiss Brain Institute, University of Calgary, HSC 2905, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada
| | - Lesley Ritchie
- Department of Clinical Health Psychology, University of Manitoba, 350-771 Bannatyne Avenue, Winnipeg, MB R3E 3N4, Canada
| | - John D Fisk
- Psychology, Nova Scotia Health Authority, Queen Elizabeth II Health Centre, 4066, 4th Floor, Abbie J. Lane Memorial Building, 5909 Veterans' Memorial Lane, Halifax, NS B3H 2E2, Canada; Department of Psychiatry, Dalhousie University, 4066, Abbie J. Lane Memorial Building, 5909 Veterans' Memorial Lane, Halifax, NS B3H 2E2, Canada; Department of Psychology & Neuroscience, Dalhousie University, 4066, Abbie J. Lane Memorial Building, 5909 Veterans' Memorial Lane, Halifax, NS B3H 2E2, Canada; Department of Medicine, Dalhousie University, 4066, Abbie J. Lane Memorial Building, 5909 Veterans' Memorial Lane, Halifax, NS B3H 2E2, Canada
| | - Jodie R Gawryluk
- Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
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Daerr S, Brendel M, Zach C, Mille E, Schilling D, Zacherl MJ, Bürger K, Danek A, Pogarell O, Schildan A, Patt M, Barthel H, Sabri O, Bartenstein P, Rominger A. Evaluation of early-phase [ 18F]-florbetaben PET acquisition in clinical routine cases. Neuroimage Clin 2016; 14:77-86. [PMID: 28138429 PMCID: PMC5257027 DOI: 10.1016/j.nicl.2016.10.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [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: 06/23/2016] [Revised: 09/29/2016] [Accepted: 10/06/2016] [Indexed: 11/24/2022]
Abstract
Objectives In recent years several [18F]-labelled amyloid PET tracers have been developed and have obtained clinical approval. There is accumulating evidence that early (post injection) acquisitions with these tracers are equally informative as conventional blood flow and metabolism studies for diagnosis of Alzheimer's disease, but there have been few side-by-side studies. Therefore, we investigated the performance of early acquisitions of [18F]-florbetaben (FBB) PET compared to [18F]-fluorodeoxyglucose (FDG) PET in a clinical setting. Methods All subjects were recruited with clinical suspicion of dementia due to neurodegenerative disease. FDG PET was undertaken by conventional methods, and amyloid PET was performed with FBB, with early recordings for the initial 10 min (early-phase FBB), and late recordings at 90–110 min p.i. (late-phase FBB). Regional SUVR with cerebellar and global mean normalization were calculated for early-phase FBB and FDG PET. Pearson correlation coefficients between FDG and early-phase FBB were calculated for predefined cortical brain regions. Furthermore, a visual interpretation of disease pattern using 3-dimensional stereotactic surface projections (3D-SSP) was performed, with assessment of intra-reader agreement. Results Among a total of 33 patients (mean age 67.5 ± 11.0 years) included in the study, 18 were visually rated amyloid-positive, and 15 amyloid-negative based on late-phase FBB scans. Correlation coefficients for early-phase FBB vs. FDG scans displayed excellent agreement in all target brain regions for global mean normalization. Cerebellar normalization gave strong, but significantly lower correlations. 3D representations of early-phase FBB visually resembled the corresponding FDG PET images, irrespective of the amyloid-status of the late FBB scans. Conclusions Early-phase FBB acquisitions correlate on a relative quantitative and visual level with FDG PET scans, irrespective of the amyloid plaque density assessed in late FBB imaging. Thus, early-phase FBB uptake depicts a metabolism-like image, suggesting it as a valid surrogate marker for synaptic dysfunction, which could ultimately circumvent the need for additional FDG PET investigation in diagnosis of dementia. Early-phase [18F]-florbetaben uptake depicts a metabolism-like image Strong relative quantitative and visual correlations of early-phase [18F]-florbetaben uptake with FDG images A two-phase [18F]-florbetaben protocol might give combined neurodegeneration and amyloid pathology biomarker information Early-phase [18F]-florbetaben PET could ultimately circumvent the need for an additional FDG-PET in the dementia work-up.
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Key Words
- 3D-SSP, 3-dimensional stereotactic surface projections
- AD, Alzheimer's disease
- Alzheimer's disease
- CBF, cerebral blood flow
- CBL, cerebellum
- CN, cognitively normal
- FBB, [18F]florbetaben
- FDG Pet
- FDG, [18F]-fluorodeoxyglucose
- FTLD, frontotemporal lobar degeneration
- GLM, global mean
- L, left
- MCI, mild cognitive impairment
- MNI, Montreal Neurological Institute
- Metabolism
- PCC, posterior cingulate cortex
- PET, Positron emission tomography
- Perfusion
- R, right
- SPECT, single photon emission computed tomography
- SUVR, standardized uptake value ratio
- VOI, volume of interest
- [18F]-florbetaben PET
- p.i., post injection
- ß-amyloid
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Affiliation(s)
- Sonja Daerr
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany
| | - Matthias Brendel
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany
| | - Christian Zach
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany
| | - Erik Mille
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany
| | - Dorothee Schilling
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany
| | | | - Katharina Bürger
- ISD, Ludwig-Maximilians-Universität München, München, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Adrian Danek
- Dept. of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - Oliver Pogarell
- Dept. of Psychiatry, Ludwig-Maximilians-Universität München, München, Germany
| | - Andreas Schildan
- Dept. of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Marianne Patt
- Dept. of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Henryk Barthel
- Dept. of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Osama Sabri
- Dept. of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Peter Bartenstein
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany; SyNergy, Ludwig-Maximilians-Universität München, München, Germany
| | - Axel Rominger
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany; SyNergy, Ludwig-Maximilians-Universität München, München, Germany
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Xie L, Dolui S, Das SR, Stockbower GE, Daffner M, Rao H, Yushkevich PA, Detre JA, Wolk DA. A brain stress test: Cerebral perfusion during memory encoding in mild cognitive impairment. Neuroimage Clin 2016; 11:388-397. [PMID: 27222794 PMCID: PMC4821452 DOI: 10.1016/j.nicl.2016.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 02/16/2016] [Accepted: 03/01/2016] [Indexed: 11/24/2022]
Abstract
Arterial spin labeled perfusion magnetic resonance imaging (ASL MRI) provides non-invasive quantification of cerebral blood flow, which can be used as a biomarker of brain function due to the tight coupling between cerebral blood flow (CBF) and brain metabolism. A growing body of literature suggests that regional CBF is altered in neurodegenerative diseases. Here we examined ASL MRI CBF in subjects with amnestic mild cognitive impairment (n = 65) and cognitively normal healthy controls (n = 62), both at rest and during performance of a memory-encoding task. As compared to rest, task-enhanced ASL MRI improved group discrimination, which supports the notion that physiologic measures during a cognitive challenge, or “stress test”, may increase the ability to detect subtle functional changes in early disease stages. Further, logistic regression analysis demonstrated that ASL MRI and concomitantly acquired structural MRI provide complementary information of disease status. The current findings support the potential utility of task-enhanced ASL MRI as a biomarker in early Alzheimer's disease. We examined ASL MRI in MCI and normal control during rest & a memory encoding task. Task-enhanced ASL MRI increases sensitivity for discriminating MCI. Both ASL and structural MRI provide complementary information of disease status. This work supports the potential utility of ASL MRI as an early biomarker for AD.
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Key Words
- AAL, Anatomical Automatic Labeling
- ASL, arterial spin labeled
- Alzheimer's disease
- Arterial spin labeling
- BOLD, blood oxygen level dependent
- Biomarker
- CBF, cerebral blood flow
- CSF, cerebrospinal fluid
- FDG PET, flourodeoyglucose positron emission tomography
- FWER, familywise error rate
- HC, health control
- MCI, mild cognitive impairment
- MMSE, mini-mental status exam
- MNI, Montreal Neurological Institute
- MTL, medial temporal lobe
- Medial temporal lobe
- PASL, pulsed ASL
- PCC, posterior cingulate cortex
- ROI, region of interest
- SCORE, structural correlation based outlier rejection
- Scene-encoding memory task
- a-MCI, amnestic mild cognitive impairment
- aCBF, absolute cerebral blood flow
- pCASL, pseudo-continuous ASL
- rCBF, relative cerebral blood flow
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Affiliation(s)
- Long Xie
- Penn Image Computing and Science Laboratory (PICSL), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.
| | - Sudipto Dolui
- Center for Functional Neuroimaging, Department of Neurology, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandhitsu R Das
- Penn Image Computing and Science Laboratory (PICSL), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Grace E Stockbower
- Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Molly Daffner
- Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hengyi Rao
- Center for Functional Neuroimaging, Department of Neurology, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A Yushkevich
- Penn Image Computing and Science Laboratory (PICSL), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - John A Detre
- Center for Functional Neuroimaging, Department of Neurology, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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19
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Xu ZP, Yang SL, Zhao S, Zheng CH, Li HH, Zhang Y, Huang RX, Li MZ, Gao Y, Zhang SJ, Zhan PY, Zhang LF, Deng L, Wei S, Liu YC, Ye JW, Ren HJ, Li N, Kong CX, Wang X, Fang L, Zhou QZ, Jiang HW, Li JR, Wang Q, Ke D, Liu GP, Wang JZ. Biomarkers for Early Diagnostic of Mild Cognitive Impairment in Type-2 Diabetes Patients: A Multicentre, Retrospective, Nested Case-Control Study. EBioMedicine 2016; 5:105-13. [PMID: 27077117 PMCID: PMC4816853 DOI: 10.1016/j.ebiom.2016.02.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 12/12/2022] Open
Abstract
Background Both type 2 diabetes mellitus (T2DM) and Alzheimer's disease (AD) are common age-associated disorders and T2DM patients show an increased risk to suffer from AD, however, there is currently no marker to identify who in T2DM populations will develop AD. Since glycogen synthase kinase-3β (GSK-3β) activity, ApoE genotypes and olfactory function are involved in both T2DM and AD pathogenesis, we investigate whether alterations of these factors can identify cognitive impairment in T2DM patients. Methods The cognitive ability was evaluated using Minimum Mental State Examination (MMSE) and Clinical Dementia Rating (CDR), and the mild cognitive impairment (MCI) was diagnosed by Petersen's criteria. GSK-3β activity in platelet, ApoE genotypes in leucocytes and the olfactory function were detected by Western/dot blotting, the amplification refractory mutation system (ARMS) PCR and the Connecticut Chemosensory Clinical Research Center (CCCRC) test, respectively. The odds ratio (OR) and 95% confidence intervals (95% CI) of the biomarkers for MCI diagnosis were calculated by logistic regression. The diagnostic capability of the biomarkers was evaluated by receiver operating characteristics (ROC) analyses. Findings We recruited 694 T2DM patients from Jan. 2012 to May. 2015 in 5 hospitals (Wuhan), and 646 of them met the inclusion criteria and were included in this study. 345 patients in 2 hospitals were assigned to the training set, and 301 patients in another 3 hospitals assigned to the validation set. Patients in each set were randomly divided into two groups: T2DM without MCI (termed T2DM-nMCI) or with MCI (termed T2DM-MCI). There were no significant differences for sex, T2DM years, hypertension, hyperlipidemia, coronary disease, complications, insulin treatment, HbA1c, ApoE ε2, ApoE ε3, tGSK3β and pS9GSK3β between the two groups. Compared with the T2DM-nMCI group, T2DM-MCI group showed lower MMSE score with older age, ApoE ε4 allele, higher olfactory score and higher rGSK-3β (ratio of total GSK-3β to Ser9-phosphorylated GSK-3β) in the training set and the validation set. The OR values of age, ApoE ε4 gene, olfactory score and rGSK-3β were 1.09, 2.09, 1.51, 10.08 in the training set, and 1.06, 2.67, 1.47, 7.19 in the validation set, respectively. The diagnostic accuracy of age, ApoE ε4 gene, olfactory score and rGSK-3β were 0.76, 0.72, 0.66, 0.79 in the training set, and 0.70, 0.68, 0.73, 0.79 in the validation set, respectively. These four combined biomarkers had the area under the curve (AUC) of 82% and 86%, diagnostic accuracy of 83% and 81% in the training set and the validation set, respectively. Interpretation Aging, activation of peripheral circulating GSK-3β, expression of ApoE ε4 and increase of olfactory score are diagnostic for the mild cognitive impairment in T2DM patients, and combination of these biomarkers can improve the diagnostic accuracy. ApoE ε4 gene, platelet GSK-3β activation, olfactory dysfunction and aging are non-invasive, affordable and accessible biomarkers for diagnosing mild cognitive impairment in type 2 diabetes mellitus patients, and the combination of these non-invasive, affordable and accessible biomarkers can improve the accuracy of the diagnosis.
Epidemiological studies show that type 2 diabetes mellitus is an independent risk factor of Alzheimer disease, and a large proportion of diabetic patients will develop Alzheimer disease, but no early diagnostic tool to identify them. We find that ApoE ε4 gene, platelet GSK-3β activation, olfactory dysfunction and aging are early markers for dementia in type 2 diabetes patients, and combination of these non-invasive markers can improve the diagnostic accuracy. These findings shed light on the early identification in type 2 diabetes population who will develop Alzheimer disease and thus enable early intervention to this currently incurable neurodegenerative disorder.
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Key Words
- AD, Alzheimer's disease
- ARMS, amplification refractory mutation system
- AUC, the area under the curve
- Alzheimer's disease
- ApoE gene
- ApoE, apolipoprotein E
- CCCRC, Connecticut Chemosensory Clinical Research Center
- CDR, clinical dementia rating
- CI, confidence intervals
- GSK-3β, glycogen synthase kinase-3β
- Glycogen synthase kinase-3β
- HbA1c, hemoglobin A1c
- MCI, mild cognitive impairment
- MMSE, minimum mental state examination
- Mild cognitive impairment
- OR, odds ratio
- Olfactory score
- ROC, receiver operating characteristics
- T2DM, type 2 diabetes mellitus
- Type 2 diabetes mellitus
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Affiliation(s)
- Zhi-Peng Xu
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Department of Neurology, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
| | - Su-Lian Yang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shi Zhao
- Department of Endocrinology, The Central Hospital of Wuhan, Wuhan 430014, China
| | - Cheng-Hong Zheng
- Department of Endocrinology, Wuhan Hospital of Traditional Chinese Medicine, Wuhan 430014, China
| | - Hong-Hua Li
- Department of Neurology, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
| | - Yao Zhang
- Li-Yuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
| | - Rong-Xi Huang
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Meng-Zhu Li
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yuan Gao
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shu-Juan Zhang
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Pei-Yan Zhan
- Department of Neurology, The Central Hospital of Wuhan, Wuhan 430014, China
| | - Li-Fang Zhang
- Department of Endocrinology, Wuhan Hospital of Traditional Chinese Medicine, Wuhan 430014, China
| | - Lin Deng
- Department of Endocrinology, The Central Hospital of Wuhan, Wuhan 430014, China
| | - Sheng Wei
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yan-Chao Liu
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jing-Wang Ye
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hu-Jun Ren
- Department of Endocrinology, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
| | - Na Li
- Department of Endocrinology, The Central Hospital of Wuhan, Wuhan 430014, China
| | - Cai-Xia Kong
- Department of Endocrinology, The First Hospital of Wuhan, Wuhan 430022, China
| | - Xin Wang
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Lin Fang
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qiu-Zhi Zhou
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hong-Wei Jiang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jing-Rong Li
- Health Service Center of Jianghan District, Wuhan 430014, China
| | - Qun Wang
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226000, China
| | - Dan Ke
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226000, China
| | - Gong-Ping Liu
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226000, China
| | - Jian-Zhi Wang
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226000, China
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Haris M, Yadav SK, Rizwan A, Singh A, Cai K, Kaura D, Wang E, Davatzikos C, Trojanowski JQ, Melhem ER, Marincola FM, Borthakur A. T1rho MRI and CSF biomarkers in diagnosis of Alzheimer's disease. Neuroimage Clin 2015; 7:598-604. [PMID: 25844314 PMCID: PMC4375645 DOI: 10.1016/j.nicl.2015.02.016] [Citation(s) in RCA: 18] [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: 09/29/2014] [Revised: 02/22/2015] [Accepted: 02/23/2015] [Indexed: 01/14/2023]
Abstract
In the current study, we have evaluated the performance of magnetic resonance (MR) T1rho (T1ρ) imaging and CSF biomarkers (T-tau, P-tau and Aβ-42) in characterization of Alzheimer's disease (AD) patients from mild cognitive impairment (MCI) and control subjects. With informed consent, AD (n = 27), MCI (n = 17) and control (n = 17) subjects underwent a standardized clinical assessment and brain MRI on a 1.5-T clinical-scanner. T1ρ images were obtained at four different spin-lock pulse duration (10, 20, 30 and 40 ms). T1ρ maps were generated by pixel-wise fitting of signal intensity as a function of the spin-lock pulse duration. T1ρ values from gray matter (GM) and white matter (WM) of medial temporal lobe were calculated. The binary logistic regression using T1ρ and CSF biomarkers as variables was performed to classify each group. T1ρ was able to predict 77.3% controls and 40.0% MCI while CSF biomarkers predicted 81.8% controls and 46.7% MCI. T1ρ and CSF biomarkers in combination predicted 86.4% controls and 66.7% MCI. When comparing controls with AD, T1ρ predicted 68.2% controls and 73.9% AD, while CSF biomarkers predicted 77.3% controls and 78.3% for AD. Combination of T1ρ and CSF biomarkers improved the prediction rate to 81.8% for controls and 82.6% for AD. Similarly, on comparing MCI with AD, T1ρ predicted 35.3% MCI and 81.9% AD, whereas CSF biomarkers predicted 53.3% MCI and 83.0% AD. Collectively CSF biomarkers and T1ρ were able to predict 59.3% MCI and 84.6% AD. On receiver operating characteristic analysis T1ρ showed higher sensitivity while CSF biomarkers showed greater specificity in delineating MCI and AD from controls. No significant correlation between T1ρ and CSF biomarkers, between T1ρ and age, and between CSF biomarkers and age was observed. The combined use of T1ρ and CSF biomarkers have promise to improve the early and specific diagnosis of AD. Furthermore, disease progression form MCI to AD might be easily tracked using these two parameters in combination. Increased T1rho was observed in MCI and AD compared to controls. Increased T-tau and P-tau and decreased Aβ1-42 were observed in MCI and AD. Combined biomarkers have promise to improve early and specific diagnosis of AD. MCI to AD progression might be tracked using these two biomarkers in combination.
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Key Words
- AD, Alzheimer's disease
- Alzheimer's disease
- Aβ1-42, amyloid beta 42
- CSF biomarkers
- CSF, cerebrospinal fluid
- FOV, field of view
- GM, gray matter
- MCI, mild cognitive impairment
- MMSE, Mini-Mental State Examination
- MPRAGE, magnetization prepared rapid acquisition gradient-echo
- MRI, magnetic resonance imaging
- MTL, medial temporal lobe
- Medial temporal lobe
- Mild cognitive impairment
- PET, positron emission tomography
- ROC, receiver operating characteristic.
- T-tau, total tau
- T1rho
- T1ρ, T1rho
- TE, echo time
- TI, inversion time
- TR, repetition time
- TSL, total spin lock
- WM, white matter
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Affiliation(s)
- Mohammad Haris
- Research Branch, Sidra Medical and Research Center, Doha, Qatar ; Center for Magnetic Resonance and Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Santosh K Yadav
- Research Branch, Sidra Medical and Research Center, Doha, Qatar
| | - Arshi Rizwan
- All India Institute of Medical Science, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Anup Singh
- Center for Magnetic Resonance and Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA ; Center for Biomedical Engineering, Indian institute of Technology, New Delhi, India
| | - Kejia Cai
- Center for Magnetic Resonance and Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA ; Center for Magnetic Resonance Research, Radiology Department, University of Illinois at Chicago, IL, USA
| | - Deepak Kaura
- Research Branch, Sidra Medical and Research Center, Doha, Qatar
| | - Ena Wang
- Research Branch, Sidra Medical and Research Center, Doha, Qatar
| | - Christos Davatzikos
- Section of Biomedical Image Analysis, University of Pennsylvania, Philadelphia, PA, USA
| | - John Q Trojanowski
- Department of Pathology & Lab Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elias R Melhem
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Arijitt Borthakur
- Center for Magnetic Resonance and Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
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21
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Kerbler GM, Fripp J, Rowe CC, Villemagne VL, Salvado O, Rose S, Coulson EJ. Basal forebrain atrophy correlates with amyloid β burden in Alzheimer's disease. Neuroimage Clin 2014; 7:105-13. [PMID: 25610772 PMCID: PMC4299972 DOI: 10.1016/j.nicl.2014.11.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [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: 02/10/2014] [Revised: 06/11/2014] [Accepted: 11/18/2014] [Indexed: 12/11/2022]
Abstract
The brains of patients suffering from Alzheimer's disease (AD) have three classical pathological hallmarks: amyloid-beta (Aβ) plaques, tau tangles, and neurodegeneration, including that of cholinergic neurons of the basal forebrain. However the relationship between Aβ burden and basal forebrain degeneration has not been extensively studied. To investigate this association, basal forebrain volumes were determined from magnetic resonance images of controls, subjects with amnestic mild cognitive impairment (aMCI) and AD patients enrolled in the longitudinal Alzheimer's Disease Neuroimaging Initiative (ADNI) and Australian Imaging, Biomarkers and Lifestyle (AIBL) studies. In the AIBL cohort, these volumes were correlated within groups to neocortical gray matter retention of Pittsburgh compound B (PiB) from positron emission tomography images as a measure of Aβ load. The basal forebrain volumes of AD and aMCI subjects were significantly reduced compared to those of control subjects. Anterior basal forebrain volume was significantly correlated to neocortical PiB retention in AD subjects and aMCI subjects with high Aβ burden, whereas posterior basal forebrain volume was significantly correlated to neocortical PiB retention in control subjects with high Aβ burden. Therefore this study provides new evidence for a correlation between neocortical Aβ accumulation and basal forebrain degeneration. In addition, cluster analysis showed that subjects with a whole basal forebrain volume below a determined cut-off value had a 7 times higher risk of having a worse diagnosis within ~18 months. The link between amyloid (Aβ) and basal forebrain degeneration in AD is unclear. We find that basal forebrain volumes are correlated with neocortical Aβ burden. Basal forebrain volume correlates with Aβ burden in at-risk control subjects. Basal forebrain atrophy delineates subjects at increased risk of progressing to AD.
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Key Words
- 3D, 3-dimensional
- AD, Alzheimer's disease
- ADNI, Alzheimer's Disease Neuroimaging Initiative
- AIBL, Australian Imaging, Biomarkers and Lifestyle Flagship Study of Aging
- Alzheimer's disease
- Amyloid
- Aβ, amyloid-beta
- Basal forebrain
- CSF, cerebrospinal fluid
- GM, gray matter
- HC, healthy control
- MCI, mild cognitive impairment
- MNI, Montreal Neurological Institute
- MPM, maximum probability maps
- MPRAGE, magnetization prepared rapid gradient echo
- MRI, magnetic resonance imaging
- Magnetic resonance imaging
- OR, odds ratio
- PET
- PET, positron emission tomography
- PiB, Pittsburgh compound B
- SPSS, statistics software package for the social sciences
- SUVR, standard uptake value ratio
- SyN, symmetric normalization
- T1W, T1-weighted
- TG-ROC, two-graph receiver operating characteristic
- WM, white matter
- aMCI, amnestic mild cognitive impairment
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Affiliation(s)
- Georg M Kerbler
- Queensland Brain Institute, Clem Jones Centre for Ageing Dementia Research, The University of Queensland, Brisbane, Qld 4072, Australia
| | - Jürgen Fripp
- Commonwealth Scientific and Industrial Research Organisation, Computational Informatics, Brisbane, Qld 4029, Australia
| | - Christopher C Rowe
- Department of Nuclear Medicine and Centre for PET, Austin Health, Melbourne, Vic. 3084, Australia
| | - Victor L Villemagne
- Department of Nuclear Medicine and Centre for PET, Austin Health, Melbourne, Vic. 3084, Australia ; Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Vic. 3084, Australia
| | - Olivier Salvado
- Commonwealth Scientific and Industrial Research Organisation, Computational Informatics, Brisbane, Qld 4029, Australia
| | - Stephen Rose
- Commonwealth Scientific and Industrial Research Organisation, Computational Informatics, Brisbane, Qld 4029, Australia
| | - Elizabeth J Coulson
- Queensland Brain Institute, Clem Jones Centre for Ageing Dementia Research, The University of Queensland, Brisbane, Qld 4072, Australia
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22
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Al-Bachari S, Parkes LM, Vidyasagar R, Hanby MF, Tharaken V, Leroi I, Emsley HCA. Arterial spin labelling reveals prolonged arterial arrival time in idiopathic Parkinson's disease. Neuroimage Clin 2014; 6:1-8. [PMID: 25379411 PMCID: PMC4215519 DOI: 10.1016/j.nicl.2014.07.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 06/05/2014] [Revised: 07/24/2014] [Accepted: 07/29/2014] [Indexed: 12/30/2022]
Abstract
Idiopathic Parkinson's disease (IPD) is the second most common neurodegenerative disease, yet effective disease modifying treatments are still lacking. Neurodegeneration involves multiple interacting pathological pathways. The extent to which neurovascular mechanisms are involved is not well defined in IPD. We aimed to determine whether novel magnetic resonance imaging (MRI) techniques, including arterial spin labelling (ASL) quantification of cerebral perfusion, can reveal altered neurovascular status (NVS) in IPD. Fourteen participants with IPD (mean ± SD age 65.1 ± 5.9 years) and 14 age and cardiovascular risk factor matched control participants (mean ± SD age 64.6 ± 4.2 years) underwent a 3T MRI scan protocol. ASL images were collected before, during and after a 6 minute hypercapnic challenge. FLAIR images were used to determine white matter lesion score. Quantitative images of cerebral blood flow (CBF) and arterial arrival time (AAT) were calculated from the ASL data both at rest and during hypercapnia. Cerebrovascular reactivity (CVR) images were calculated, depicting the change in CBF and AAT relative to the change in end-tidal CO2. A significant (p = 0.005) increase in whole brain averaged baseline AAT was observed in IPD participants (mean ± SD age 1532 ± 138 ms) compared to controls (mean ± SD age 1335 ± 165 ms). Voxel-wise analysis revealed this to be widespread across the brain. However, there were no statistically significant differences in white matter lesion score, CBF, or CVR between patients and controls. Regional CBF, but not AAT, in the IPD group was found to correlate positively with Montreal cognitive assessment (MoCA) scores. These findings provide further evidence of alterations in NVS in IPD. Investigation of neurovascular status (NVS) in IPD using arterial spin labelling Diffuse prolonged arterial arrival time in IPD compared to controls Reduced regional CBF in the IPD group correlated with cognitive impairment. Clinical evidence of altered NVS in IPD warrants further research.
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Key Words
- 3T, 3 Tesla
- AAT, arterial arrival time
- AD, Alzheimer’s disease
- ASL, arterial spin labelling
- Arterial arrival time
- Arterial spin labelling
- CBF, cerebral blood flow
- CO2, carbon dioxide
- CV, cerebrovascular
- CVD, cerebrovascular disease
- CVR, cerebrovascular reactivity
- CVRAAT, cerebrovascular reactivity measures of arterial arrival time
- CVRCBF, cerebrovascular reactivity measures of cerebral blood flow
- Cerebral blood flow
- Cerebrovascular reactivity
- DS, digit span
- DSST, digit symbol substitution test
- DWMH, deep white matter hyperintensity
- EPI, echo planar imaging
- ETCO2, end-tidal carbon dioxide
- FAS, (verbal) fluency assessment scale
- FLAIR, fluid attenuation inversion recovery
- FWE, family-wise error
- HAM-D, Hamilton depression rating scale
- IPD, idiopathic Parkinson's disease
- Idiopathic Parkinson's disease
- L-dopa, levodopa
- LARS, Lille apathy rating scale
- LEDD, levodopa equivalent daily dose
- MCI, mild cognitive impairment
- MRI, magnetic resonance imaging
- MoCA
- MoCA, Montreal cognitive assessment
- NPI, neuropsychiatric inventory
- NVU, Neurovascular unit
- O2−, oxygen
- PET, positron emission tomography
- PIGD, Postural instability and gait disorder
- PL, parietal lobe
- PVH, periventricular hyperintensity
- ROI, region of interest
- SPECT, single positron emission computed tomography
- SPM, statistical parametric mapping
- STAR, signal targeting with alternating radiofrequency
- TD, tremor dominant
- TE, echo time
- TI, inversion time
- TL, temporal lobe
- TMT-B, trail making test B
- TR, repetition time
- UKPDS BB, United Kingdom Parkinson's Disease Society Brain Bank
- UPDRS, Unified Parkinson's disease Rating Scale
- WAIS-R, Wechsler adult intelligence scale-revised
- WML, white matter lesion
- fMRI, functional magnetic resonance imaging
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Affiliation(s)
- Sarah Al-Bachari
- Department of Neurology, Royal Preston Hospital, Preston, UK ; Centre for Imaging Science, Institute of Population Health, University of Manchester, UK
| | - Laura M Parkes
- Centre for Imaging Science, Institute of Population Health, University of Manchester, UK
| | - Rishma Vidyasagar
- Centre for Imaging Science, Institute of Population Health, University of Manchester, UK
| | - Martha F Hanby
- Department of Neurology, Royal Preston Hospital, Preston, UK
| | - Vivek Tharaken
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Iracema Leroi
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Hedley C A Emsley
- Department of Neurology, Royal Preston Hospital, Preston, UK ; School of Medicine, University of Manchester, UK
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23
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Ranasinghe KG, Hinkley LB, Beagle AJ, Mizuiri D, Dowling AF, Honma SM, Finucane MM, Scherling C, Miller BL, Nagarajan SS, Vossel KA. Regional functional connectivity predicts distinct cognitive impairments in Alzheimer's disease spectrum. Neuroimage Clin 2014; 5:385-95. [PMID: 25180158 PMCID: PMC4145532 DOI: 10.1016/j.nicl.2014.07.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 02/19/2014] [Revised: 06/27/2014] [Accepted: 07/17/2014] [Indexed: 11/12/2022]
Abstract
Understanding neural network dysfunction in neurodegenerative disease is imperative to effectively develop network-modulating therapies. In Alzheimer’s disease (AD), cognitive decline associates with deficits in resting-state functional connectivity of diffuse brain networks. The goal of the current study was to test whether specific cognitive impairments in AD spectrum correlate with reduced functional connectivity of distinct brain regions. We recorded resting-state functional connectivity of alpha-band activity in 27 patients with AD spectrum − 22 patients with probable AD (5 logopenic variant primary progressive aphasia, 7 posterior cortical atrophy, and 10 early-onset amnestic/dysexecutive AD) and 5 patients with mild cognitive impairment due to AD. We used magnetoencephalographic imaging (MEGI) to perform an unbiased search for regions where patterns of functional connectivity correlated with disease severity and cognitive performance. Functional connectivity measured the strength of coherence between a given region and the rest of the brain. Decreased neural connectivity of multiple brain regions including the right posterior perisylvian region and left middle frontal cortex correlated with a higher degree of disease severity. Deficits in executive control and episodic memory correlated with reduced functional connectivity of the left frontal cortex, whereas visuospatial impairments correlated with reduced functional connectivity of the left inferior parietal cortex. Our findings indicate that reductions in region-specific alpha-band resting-state functional connectivity are strongly correlated with, and might contribute to, specific cognitive deficits in AD spectrum. In the future, MEGI functional connectivity could be an important biomarker to map and follow defective networks in the early stages of AD. Magnetoencephalographic imaging (MEGI) measures brain functional connectivity. We investigated MEGIalpha-band connectivity in a cohort with Alzheimer’s disease spectrum. Decreased connectivity of multiple brain regions correlates with disease severity. Decreased connectivity of focal brain regions correlates with cognitive deficits. MEGI is a novel, unbiased approach to map neural network defects in dementia.
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Affiliation(s)
- Kamalini G Ranasinghe
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Leighton B Hinkley
- Department of Radiology and Biomedical Imaging, Biomagnetic Imaging Laboratory, University of California San Francisco, San Francisco, CA 94143, USA
| | - Alexander J Beagle
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Danielle Mizuiri
- Department of Radiology and Biomedical Imaging, Biomagnetic Imaging Laboratory, University of California San Francisco, San Francisco, CA 94143, USA
| | - Anne F Dowling
- Department of Radiology and Biomedical Imaging, Biomagnetic Imaging Laboratory, University of California San Francisco, San Francisco, CA 94143, USA
| | - Susanne M Honma
- Department of Radiology and Biomedical Imaging, Biomagnetic Imaging Laboratory, University of California San Francisco, San Francisco, CA 94143, USA
| | - Mariel M Finucane
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA
| | - Carole Scherling
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Srikantan S Nagarajan
- Department of Radiology and Biomedical Imaging, Biomagnetic Imaging Laboratory, University of California San Francisco, San Francisco, CA 94143, USA
| | - Keith A Vossel
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA ; Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA
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24
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Younes L, Albert M, Miller MI; BIOCARD Research Team. Inferring changepoint times of medial temporal lobe morphometric change in preclinical Alzheimer's disease. Neuroimage Clin 2014; 5:178-87. [PMID: 25101236 DOI: 10.1016/j.nicl.2014.04.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 11/21/2022]
Abstract
This paper uses diffeomorphometry methods to quantify the order in which statistically significant morphometric change occurs in three medial temporal lobe regions, the amygdala, entorhinal cortex (ERC), and hippocampus among subjects with symptomatic and preclinical Alzheimer's disease (AD). Magnetic resonance imaging scans were examined in subjects who were cognitively normal at baseline, some of whom subsequently developed clinical symptoms of AD. The images were mapped to a common template, using shape-based diffeomorphometry. The multidimensional shape markers indexed through the temporal lobe structures were modeled using a changepoint model with explicit parameters, specifying the number of years preceding clinical symptom onset. Our model assumes that the atrophy rate of a considered brain structure increases years before detectable symptoms. The results demonstrate that the atrophy changepoint in the ERC occurs first, indicating significant change 8–10 years prior to onset, followed by the hippocampus, 2–4 years prior to onset, followed by the amygdala, 3 years prior to onset. The ERC is significant bilaterally, in both our local and global measures, with estimates of ERC surface area loss of 2.4% (left side) and 1.6% (right side) annually. The same changepoint model for ERC volume gives 3.0% and 2.7% on the left and right sides, respectively. Understanding the order in which changes in the brain occur during preclinical AD may assist in the design of intervention trials aimed at slowing the evolution of the disease. We use diffeomorphometry to quantify the order in which statistically significant morphometric change occurs in three medial temporal lobe regions, the amygdala, entorhinal cortex (ERC), and hippocampus among subjects with symptomatic and preclinical Alzheimer's disease (AD). We introduce a model on anatomical shape change in which changepoint is inferred, taking place some period of time before cognitive onset of AD. The analysis uses a dataset arising from the BIOCARD study, in which all subjects were cognitively normal at baseline, some of whom subsequently developed clinical symptoms of AD. The results demonstrate that the atrophy changepoint in the ERC occurs first, indicating significant change 8-10 years prior to onset, followed by hippocampus, 2-4 years prior to onset, followed by amygdala, 3 years prior to onset. The ERC is significant bilaterally, in both our local and global measures, with estimates of ERC surface area loss of 2.4% (left side) and 1.6% (right side) annually. Understanding the order in which changes in the brain occur during preclinical AD may assist in the design of intervention trials aimed at slowing the evolution of the disease.
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Key Words
- AD, Alzheimer's disease
- CDR, clinical dementia rating
- ERC, entorhinal cortex
- FWER, family-wise error rate
- GPB, Geriatric Psychiatry Branch
- MCI, mild cognitive impairment
- MMSE, mini-mental state exam
- NIA, National Institute on Aging
- NIH, Clinical Center of the National Institutes of Health
- NIMH, National Institute for Mental Health
- ROI-LDDMM, region-of-interest large deformation diffeomorphic metric mapping
- RSS, residual sum of squares
- SPGR, spoiled gradient echo
- diffeomorphometry, study of shape using a metric on the diffeomorphic connections between structures
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25
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Apostolova LG, Hwang KS, Kohannim O, Avila D, Elashoff D, Jack CR, Shaw L, Trojanowski JQ, Weiner MW, Thompson PM. ApoE4 effects on automated diagnostic classifiers for mild cognitive impairment and Alzheimer's disease. Neuroimage Clin 2014; 4:461-72. [PMID: 24634832 PMCID: PMC3952354 DOI: 10.1016/j.nicl.2013.12.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 03/26/2013] [Revised: 12/24/2013] [Accepted: 12/24/2013] [Indexed: 01/30/2023]
Abstract
Biomarkers are the only feasible way to detect and monitor presymptomatic Alzheimer's disease (AD). No single biomarker can predict future cognitive decline with an acceptable level of accuracy. In addition to designing powerful multimodal diagnostic platforms, a careful investigation of the major sources of disease heterogeneity and their influence on biomarker changes is needed. Here we investigated the accuracy of a novel multimodal biomarker classifier for differentiating cognitively normal (NC), mild cognitive impairment (MCI) and AD subjects with and without stratification by ApoE4 genotype. 111 NC, 182 MCI and 95 AD ADNI participants provided both structural MRI and CSF data at baseline. We used an automated machine-learning classifier to test the ability of hippocampal volume and CSF Aβ, t-tau and p-tau levels, both separately and in combination, to differentiate NC, MCI and AD subjects, and predict conversion. We hypothesized that the combined hippocampal/CSF biomarker classifier model would achieve the highest accuracy in differentiating between the three diagnostic groups and that ApoE4 genotype will affect both diagnostic accuracy and biomarker selection. The combined hippocampal/CSF classifier performed better than hippocampus-only classifier in differentiating NC from MCI and NC from AD. It also outperformed the CSF-only classifier in differentiating NC vs. AD. Our amyloid marker played a role in discriminating NC from MCI or AD but not for MCI vs. AD. Neurodegenerative markers contributed to accurate discrimination of AD from NC and MCI but not NC from MCI. Classifiers predicting MCI conversion performed well only after ApoE4 stratification. Hippocampal volume and sex achieved AUC = 0.68 for predicting conversion in the ApoE4-positive MCI, while CSF p-tau, education and sex achieved AUC = 0.89 for predicting conversion in ApoE4-negative MCI. These observations support the proposed biomarker trajectory in AD, which postulates that amyloid markers become abnormal early in the disease course while markers of neurodegeneration become abnormal later in the disease course and suggests that ApoE4 could be at least partially responsible for some of the observed disease heterogeneity. Multimodal classifiers have better predictive power than unimodal classifier. ApoE4 significantly affects diagnostic discriminability in the MCI and dementia stages. Our data supports the hypothesized biomarker trajectory in AD.
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Key Words
- AD, Alzheimer's disease
- ADNI
- ADNI, Alzheimer's Disease Neuroimaging Initiative
- AUC, area under the curve
- Abeta
- Alzheimer's disease
- ApoE, apolipoprotein E
- Aβ, Amyloid beta
- Aβ42, Amyloid beta with 42 amino acid residues
- CSF, cerebrospinal fluid
- Diagnosis
- Hippocampus atrophy
- ICBM, International Consortium for Brain Mapping
- MCI, mild cognitive impairment
- MCIc, MCI converters
- MCInc, MCI nonconverters
- MMSE, Mini-Mental State Examination
- NC, normal control
- ROC, receiver operating curve
- SVM, support vector machine
- Tau
- p-tau, phosphorylated tau protein
- t-tau, total tau protein
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Affiliation(s)
- Liana G Apostolova
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Kristy S Hwang
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Omid Kohannim
- Imaging genetics Center, Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, CA, USA
| | - David Avila
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - David Elashoff
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA, USA
| | - Clifford R Jack
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA
| | - Leslie Shaw
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Michael W Weiner
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA ; Department of Veteran's Affairs Medical Center, San Francisco, CA, USA
| | - Paul M Thompson
- Imaging genetics Center, Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, CA, USA
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