1
|
Morgan AE, Mc Auley MT. Vascular dementia: From pathobiology to emerging perspectives. Ageing Res Rev 2024; 96:102278. [PMID: 38513772 DOI: 10.1016/j.arr.2024.102278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/16/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
Vascular dementia (VaD) is the second most common type of dementia. VaD is synonymous with ageing, and its symptoms place a significant burden on the health and wellbeing of older people. Despite the identification of a substantial number of risk factors for VaD, the pathological mechanisms underpinning this disease remain to be fully elucidated. Consequently, a biogerontological imperative exists to highlight the modifiable lifestyle factors which can mitigate against the risk of developing VaD. This review will critically examine some of the factors which have been revealed to modulate VaD risk. The survey commences by providing an overview of the putative mechanisms which are associated with the pathobiology of VaD. Next, the factors which influence the risk of developing VaD are examined. Finally, emerging treatment avenues including epigenetics, the gut microbiome, and pro-longevity pharmaceuticals are discussed. By drawing this key evidence together, it is our hope that it can be used to inform future experimental investigations in this field.
Collapse
Affiliation(s)
- Amy Elizabeth Morgan
- School of Health and Sports Sciences, Hope Park, Liverpool Hope University, Liverpool L16 9JD, United Kingdom.
| | - Mark Tomás Mc Auley
- School of Science, Engineering and Environment, University of Salford Manchester, Salford M5 4NT, United Kingdom
| |
Collapse
|
2
|
Sin MK, Cheng Y, Roseman J, Zamrini E, Ahmed A. Relationship between Cerebral Microinfarcts and Dementia by Sex: Findings from a community-based Autopsy Study. INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASE AND STROKE 2024; 7:171. [PMID: 38689945 PMCID: PMC11060706 DOI: 10.29011/2688-8734.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Cerebral microinfarcts are common in older adults and are associated with cognitive impairment. Less is known about sex-related variation in the relationship between cerebral microinfarcts and dementia in older adults, the examination of which was the objective of this study. This case-control study was based on the 727 participants (419 women) in the Adult Changes in Thought (ACT) autopsy data. Microinfarcts were ascertained by blinded board-certified neuropathologists, and dementia diagnoses were made by the ACT Consensus Diagnosis Conference per DSM-IV. Multivariable logistic regression models were used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI). Microinfarcts were present in 49% (356/727) of the participants, which was numerically higher in women: 51% (213/419) vs 46% (143/308). aOR (95% CI) for dementia associated with any microinfarct for female and male participants were 1.45 (0.91-2.30) and 1.24 (0.75-2.06), respectively (p for interaction, 0.34). Respective aORs (95%CIs) associated with ≥2 microinfarcts were 1.37 (0.79-2.36) and 1.53 (0.84-2.78), with interaction p, 0.84. Subcortical microinfarcts were present in 36% (138/381) and 23% (78/346) of patients with and without dementia (aOR, 1.65; 95% CI, 1.14-2.38). Respective aOR (95% CI) in female and male participants were 1.70 (1.03-2.82) and 1.59 (0.90-2.80), (p for interaction, 0.55). There was no association with cortical microinfarcts (aOR, 1.19; 95% CI, 0.83-1.69). These findings suggest that association between microinfarcts and dementia is primarily mediated by subcortical microinfarcts, but we found no evidence of sex-related variation. Future studies with greater power are needed to determine if the associations we found are replicable.
Collapse
Affiliation(s)
- Mo-Kyung Sin
- College of Nursing, Seattle University, Seattle, USA
| | - Yan Cheng
- Biomedical Informatics Center, School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
| | - Jeffrey Roseman
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Zamrini
- Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA; Irvine Clinical Research, Irvine, CA, USA
| | - Ali Ahmed
- Veterans Affairs Medical Center, George Washington University, and School of Medicine, Georgetown University, Washington, DC, USA
| |
Collapse
|
3
|
Wang L, Liu Q, Yue D, Liu J, Fu Y. Cerebral Amyloid Angiopathy: An Undeniable Small Vessel Disease. J Stroke 2024; 26:1-12. [PMID: 38326703 PMCID: PMC10850457 DOI: 10.5853/jos.2023.01942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 02/09/2024] Open
Abstract
Cerebral amyloid angiopathy (CAA) has been proven to be the most common pathological change in cerebral small vessel disease except arteriosclerosis. In recent years, with the discovery of imaging technology and new imaging markers, the diagnostic rate of CAA has greatly improved. CAA plays an important role in non-hypertensive cerebral hemorrhage and cognitive decline. This review comprehensively describes the etiology, epidemiology, pathophysiological mechanisms, clinical features, imaging manifestations, imaging markers, diagnostic criteria, and treatment of CAA to facilitate its diagnosis and treatment and reduce mortality.
Collapse
Affiliation(s)
- Litao Wang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiong Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongqi Yue
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Fu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
4
|
Davidson CG, Woodford SJ, Mathur S, Valle DB, Foster D, Kioutchoukova I, Mahmood A, Lucke-Wold B. Investigation into the vascular contributors to dementia and the associated treatments. EXPLORATION OF NEUROSCIENCE 2023; 2:224-237. [PMID: 37981945 PMCID: PMC10655228 DOI: 10.37349/en.2023.00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/20/2023] [Indexed: 11/21/2023]
Abstract
As the average lifespan has increased, memory disorders have become a more pressing public health concern. However, dementia in the elderly population is often neglected in light of other health priorities. Therefore, expanding the knowledge surrounding the pathology of dementia will allow more informed decision-making regarding treatment within elderly and older adult populations. An important emerging avenue in dementia research is understanding the vascular contributors to dementia. This review summarizes potential causes of vascular cognitive impairment like stroke, microinfarction, hypertension, atherosclerosis, blood-brain-barrier dysfunction, and cerebral amyloid angiopathy. Also, this review address treatments that target these vascular impairments that also show promising results in reducing patient's risk for and experience of dementia.
Collapse
Affiliation(s)
| | | | - Shreya Mathur
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | | | - Devon Foster
- University of Central Florida, Orlando, FL 32816, USA
| | | | - Arman Mahmood
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
| |
Collapse
|
5
|
Bodryzlova Y, Mehrabi F, Bosson A, Maïano C, André C, Bélanger E, Moullec G. The Potential of Social Policies in Preventing Dementia: An Ecological Study Using Systematic Review and Meta-Analysis. J Aging Soc Policy 2023:1-22. [PMID: 37622436 DOI: 10.1080/08959420.2023.2245672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 08/26/2023]
Abstract
Social policies determine the distribution of factors (e.g. education, cardiovascular health) protecting against the development of dementia in Alzheimer's disease (AD). However, the association between social policies and the likelihood of AD without dementia (ADw/oD) has yet to be evaluated. We estimated this association in an ecological study using systematic review and meta-analysis. Four reference databases were consulted; 18 studies were included in the final analysis. ADw/oD was defined as death without dementia in people with clinically significant AD brain pathology. The indicators of social policy were extracted from the Organisation for Economic Co-operation and Development database (OECD). The probability of ADw/oD with moderate AD brain pathology was inversely associated with the Gini index for disposable income, poverty rate, and certain public expenditures on healthcare. ADw/oD with advanced AD brain pathology was only associated with public expenditures for long-term care. Social policies may play a role in maintaining and sustaining cognitive health among older people with AD.
Collapse
Affiliation(s)
| | - Fereshteh Mehrabi
- École de santé publique, Université de Montréal, Montreal, Canada
- Centre de Recherche En santé Publique (CReSp), Université de Montréal Et CIUSSS du Centre-Sud-de-L'île-de-Montréal, Montreal, Canada
| | - Anthony Bosson
- Université de Montréal, Département de Neurosciences, Pavillon Paul-G.-Desmarais, Montreal, Canada
| | - Christophe Maïano
- Campus de Saint-Jérôme, Département de Psychoéducation Et de Psychologie, Université du Québec En Outaouais, Saint-Jérôme, Canada
| | - Claire André
- Centre de recherche, CIUSSS du Nord-de-l'Ile-de-Montréal, Department of Psychology, Université de Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI, USA
| | - Grégory Moullec
- École de santé publique, Université de Montréal, Montreal, Canada
- Centre de recherche, CIUSSS du Nord-de-l'Ile-de-Montréal, Department of Psychology, Université de Montréal, Montreal, Canada
| |
Collapse
|
6
|
Gao H, Findeis EL, Culmone L, Powell B, Landschoot-Ward J, Zacharek A, Wu T, Lu M, Chopp M, Venkat P. Early therapeutic effects of an Angiopoietin-1 mimetic peptide in middle-aged rats with vascular dementia. Front Aging Neurosci 2023; 15:1180913. [PMID: 37304071 PMCID: PMC10248134 DOI: 10.3389/fnagi.2023.1180913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/04/2023] [Indexed: 06/13/2023] Open
Abstract
Background Vascular Dementia (VaD) refers to dementia caused by cerebrovascular disease and/or reduced blood flow to the brain and is the second most common form of dementia after Alzheimer's disease. We previously found that in middle-aged rats subjected to a multiple microinfarction (MMI) model of VaD, treatment with AV-001, a Tie2 receptor agonist, significantly improves short-term memory, long-term memory, as well as improves preference for social novelty compared to control MMI rats. In this study, we tested the early therapeutic effects of AV-001 on inflammation and glymphatic function in rats subjected to VaD. Methods Male, middle-aged Wistar rats (10-12 m), subjected to MMI, were randomly assigned to MMI and MMI + AV-001 treatment groups. A sham group was included as reference group. MMI was induced by injecting 800 ± 200, 70-100 μm sized, cholesterol crystals into the internal carotid artery. Animals were treated with AV-001 (1 μg/Kg, i.p.) once daily starting at 24 h after MMI. At 14 days after MMI, inflammatory factor expression was evaluated in cerebrospinal fluid (CSF) and brain. Immunostaining was used to evaluate white matter integrity, perivascular space (PVS) and perivascular Aquaporin-4 (AQP4) expression in the brain. An additional set of rats were prepared to test glymphatic function. At 14 days after MMI, 50 μL of 1% Tetramethylrhodamine (3 kD) and FITC conjugated dextran (500 kD) at 1:1 ratio were injected into the CSF. Rats (4-6/group/time point) were sacrificed at 30 min, 3 h, and 6 h from the start of tracer infusion, and brain coronal sections were imaged using a Laser scanning confocal microscope to evaluate tracer intensities in the brain. Result Treatment of MMI with AV-001 significantly improves white matter integrity in the corpus callosum at 14 days after MMI. MMI induces significant dilation of the PVS, reduces AQP4 expression and impairs glymphatic function compared to Sham rats. AV-001 treatment significantly reduces PVS, increases perivascular AQP4 expression and improves glymphatic function compared to MMI rats. MMI significantly increases, while AV-001 significantly decreases the expression of inflammatory factors (tumor necrosis factor-α (TNF-α), chemokine ligand 9) and anti-angiogenic factors (endostatin, plasminogen activator inhibitor-1, P-selectin) in CSF. MMI significantly increases, while AV-001 significantly reduces brain tissue expression of endostatin, thrombin, TNF-α, PAI-1, CXCL9, and interleukin-6 (IL-6). Conclusion AV-001 treatment of MMI significantly reduces PVS dilation and increases perivascular AQP4 expression which may contribute to improved glymphatic function compared to MMI rats. AV-001 treatment significantly reduces inflammatory factor expression in the CSF and brain which may contribute to AV-001 treatment induced improvement in white matter integrity and cognitive function.
Collapse
Affiliation(s)
- Huanjia Gao
- Department of Neurology, Henry Ford Health, Detroit, MI, United States
| | | | - Lauren Culmone
- Department of Neurology, Henry Ford Health, Detroit, MI, United States
| | - Brianna Powell
- Department of Neurology, Henry Ford Health, Detroit, MI, United States
| | | | - Alex Zacharek
- Department of Neurology, Henry Ford Health, Detroit, MI, United States
| | - Trueman Wu
- Public Health Sciences, Henry Ford Health, Detroit, MI, United States
| | - Mei Lu
- Public Health Sciences, Henry Ford Health, Detroit, MI, United States
| | - Michael Chopp
- Department of Neurology, Henry Ford Health, Detroit, MI, United States
- Department of Physics, Oakland University, Rochester, MI, United States
- Department of Physiology, Michigan State University, East Lansing, MI, United States
| | - Poornima Venkat
- Department of Neurology, Henry Ford Health, Detroit, MI, United States
- Department of Physiology, Michigan State University, East Lansing, MI, United States
| |
Collapse
|
7
|
Biswas R, Kawas C, Montine TJ, Bukhari SA, Jiang L, Corrada MM. Superior Global Cognition in Oldest-Old Is Associated with Resistance to Neurodegenerative Pathologies: Results from The 90+ Study. J Alzheimers Dis 2023; 93:561-575. [PMID: 37066908 DOI: 10.3233/jad-221062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Some oldest-old individuals can maintain superior cognition despite advanced age. Little is known about the neuropathological changes in the brains of oldest-old superior cognitive performers. OBJECTIVE Our objective was to examine the associations between Alzheimer's disease (AD) and non-AD neuropathologic features in relation to superior cognitive performance in oldest-old individuals. METHODS We analyzed brain autopsy data from 102 participants with normal cognition from The 90+ Study. Superior global cognitive performers (SGCP) were defined as having Mini-Mental State Examination (MMSE) score ≥28 in the last visit 12 to 2 months before death. To examine the associations between individual and multiple comorbid neuropathologic features with SGCP status we used multiple logistic regression models adjusting for age, sex, and education. RESULTS Alzheimer's disease neuropathological change (ADNC) and low levels of vascular pathologic change were not associated with superior cognition. In contrast, participants with limbic (OR = 8.37; 95% CI: 1.48-47.44) and neocortical (OR = 10.80;95% CI: 1.03-113.82) Lewy body disease (LBD), or with hippocampal sclerosis (HS) (OR = 5.28; 95% CI: 1.10-25.47) were more likely to be non-SGCP. High total burden of multiple comorbid neuropathologic features was associated with a lower likelihood of being SGCP. CONCLUSION Oldest-old superior cognitive performers were resilient to ADNC and low levels of vascular pathologic change and were resistant to non-AD neurodegenerative changes and multiple comorbid neuropathologic features. Understanding the factors underlying the ability of superior cognitive performers to resist these changes might provide useful insights on maintenance of superior cognition despite advanced age.
Collapse
Affiliation(s)
- Roshni Biswas
- Department of Neurology, University of California, Irvine, CA, USA
| | - Claudia Kawas
- Department of Neurology, University of California, Irvine, CA, USA
- Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
| | - Thomas J Montine
- Department of Pathology, Stanford University, Palo Alto, CA, USA
| | - Syed A Bukhari
- Department of Pathology, Stanford University, Palo Alto, CA, USA
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
| | - Maria M Corrada
- Department of Neurology, University of California, Irvine, CA, USA
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
| |
Collapse
|
8
|
Abstract
Dementias encompass a range of debilitating neurologic conditions. Here, we summarize the neuropathology of common forms of dementia, focusing on Alzheimer disease (AD) and related dementias. AD is part of a spectrum of neurodegenerative diseases that consists of various protein inclusions (ie, proteinopathies) but other brain abnormalities are also related to dementia. Beta-amyloid and tau aggregates are hallmarks of AD. Other tissue substrates include Lewy bodies, TDP-43 inclusions, vascular brain lesions, and mixed pathologies. This review highlights the complexity of neurodegenerative and other disease substrates and summarizes topography of these lesions and concepts of mixed brain pathologies, resistance, and resilience.
Collapse
Affiliation(s)
- Rupal I Mehta
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA; Department of Pathology, Rush University Medical Center, 1750 West Harrison Street, Chicago, IL 60612, USA.
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA; Department of Pathology, Rush University Medical Center, 1750 West Harrison Street, Chicago, IL 60612, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| |
Collapse
|
9
|
Sullivan KJ, Griswold ME, Ghelani K, Rajesh A, Shrestha S, Gottesman RF, Knopman D, Mosley TH, Windham BG. Late Midlife Subclinical Infarct Burden and Risk of Dementia: The Atherosclerosis Risk in Communities Neurocognitive Study. J Alzheimers Dis 2023; 91:543-549. [PMID: 36463445 PMCID: PMC10168700 DOI: 10.3233/jad-220746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
At visit 3 (1993-1995) of the ARIC Study, 1.5T brain MRI was completed in 1,881 stroke-free participants (Mean age = 62.9±4.9, 50% Black). Cox regression examined associations between infarct group [infarct-free (referent; n = 1,611), smaller only (<3 mm; n = 50), larger only (≥3 mm but <20 mm; n = 185), both (n = 35)] and up to 25-year incident dementia (n = 539). Participants with both infarcts were over 2.5 times more likely to develop dementia [HR = 2.61; 95% CI = 1.44, 4.72]. Smaller only (HR = 1.22; 95% CI = 0.70, 2.13) and larger only (HR = 1.27; 95% CI = 0.92, 1.74) groups showed associations with wide confidence intervals, unsupported statistically. A late midlife infarct profile including smaller and larger infarcts may represent particular vulnerability to dementia risk.
Collapse
Affiliation(s)
- Kevin J Sullivan
- The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS
| | - Michael E Griswold
- The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS
| | - Kunali Ghelani
- The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS
| | - Aishwarya Rajesh
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Srishti Shrestha
- The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD
| | | | - Thomas H Mosley
- The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS
| | - B Gwen Windham
- The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, MS
| |
Collapse
|
10
|
White LR, Corrada MM, Kawas CH, Cholerton BA, Edland SE, Flanagan ME, Montine TJ. Neuropathologic Changes of Alzheimer's Disease and Related Dementias: Relevance to Future Prevention. J Alzheimers Dis 2023; 95:307-316. [PMID: 37522210 PMCID: PMC10851925 DOI: 10.3233/jad-230331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Decedents with late-life dementia are often found at autopsy to have vascular pathology, cortical Lewy bodies, hippocampal sclerosis, and/or TDP-43 encephalopathy alone or with concurrent Alzheimer's disease (AD) lesions. Nonetheless, it is commonly believed that AD neuropathologic changes (NC) are the dominant or exclusive drivers of late-life dementia. OBJECTIVE Assess associations of end-of-life cognitive impairment with any one or any combination of five distinct NC. Assess impairment prevalence among subjects having natural resistance to each type of NC. METHODS Brains from 1,040 autopsied participants of the Honolulu-Asia Study, the Nun Study, and the 90 + Study were examined for NC of AD, Lewy body dementia, microvascular brain injury, hippocampal sclerosis, and limbic predominate TDP-43 encephalopathy. Associations with impairment were assessed for each NC and for NC polymorbidity (variable combinations of 2-5 concurrent NC). RESULTS Among 387 autopsied decedents with severe cognitive impairment, 20.4% had only AD lesions (ADNC), 25.3% had ADNC plus 1 other NC, 11.1% had ADNC plus 2 or more other NC, 28.7% had no ADNC but 1-4 other NC, and 14.5% had no/negligible NC. Combinations of any two, three, or four NC were highly frequent among the impaired. Natural resistance to ADNC or any other single NC had a modest impact on overall cohort impairment levels. CONCLUSION Polymorbidity involving 1-5 types of concurrent NC is a dominant neuropathologic feature of AD and related dementias. This represents a daunting challenge to future prevention and could explain failures of prior preventive intervention trials and of efforts to identify risk factors.
Collapse
Affiliation(s)
- Lon R. White
- Pacific Health Research and Education Institute, Honolulu, USA
| | | | | | | | - Steve E. Edland
- University of California at San Diego, School of Public Health, La Jolla, USA
| | - Margaret E Flanagan
- University of Texas Health San Antonio, Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Pathology, San Antonio, TX, USA
| | | |
Collapse
|
11
|
Mecca AP, O'Dell RS, Sharp ES, Banks ER, Bartlett HH, Zhao W, Lipior S, Diepenbrock NG, Chen M, Naganawa M, Toyonaga T, Nabulsi NB, Vander Wyk BC, Arnsten AFT, Huang Y, Carson RE, van Dyck CH. Synaptic density and cognitive performance in Alzheimer's disease: A PET imaging study with [ 11 C]UCB-J. Alzheimers Dement 2022; 18:2527-2536. [PMID: 35174954 PMCID: PMC9381645 DOI: 10.1002/alz.12582] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION For 30 years synapse loss has been referred to as the major pathological correlate of cognitive impairment in Alzheimer's disease (AD). However, this statement is based on remarkably few patients studied by autopsy or biopsy. With the recent advent of synaptic vesicle glycoprotein 2A (SV2A) positron emission tomography (PET) imaging, we have begun to evaluate the consequences of synaptic alterations in vivo. METHODS We examined the relationship between synaptic density measured by [11 C]UCB-J PET and neuropsychological test performance in 45 participants with early AD. RESULTS Global synaptic density showed a significant positive association with global cognition and performance on five individual cognitive domains in participants with early AD. Synaptic density was a stronger predictor of cognitive performance than gray matter volume. CONCLUSION These results confirm neuropathologic studies demonstrating a significant association between synaptic density and cognitive performance, and suggest that this correlation extends to the early stages of AD.
Collapse
Affiliation(s)
- Adam P. Mecca
- Alzheimer's Disease Research UnitYale University School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | - Ryan S. O'Dell
- Alzheimer's Disease Research UnitYale University School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | - Emily S. Sharp
- Alzheimer's Disease Research UnitYale University School of MedicineNew HavenConnecticutUSA
- Department of NeurologyYale University School of MedicineNew HavenConnecticutUSA
| | - Emmie R. Banks
- Alzheimer's Disease Research UnitYale University School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | - Hugh H. Bartlett
- Alzheimer's Disease Research UnitYale University School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | - Wenzhen Zhao
- Alzheimer's Disease Research UnitYale University School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | - Sylwia Lipior
- Alzheimer's Disease Research UnitYale University School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | - Nina G. Diepenbrock
- Alzheimer's Disease Research UnitYale University School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | - Ming‐Kai Chen
- Department of Radiology and Biomedical ImagingYale University School of MedicineNew HavenConnecticutUSA
| | - Mika Naganawa
- Department of Radiology and Biomedical ImagingYale University School of MedicineNew HavenConnecticutUSA
| | - Takuya Toyonaga
- Department of Radiology and Biomedical ImagingYale University School of MedicineNew HavenConnecticutUSA
| | - Nabeel B. Nabulsi
- Department of Radiology and Biomedical ImagingYale University School of MedicineNew HavenConnecticutUSA
| | | | - Amy F. T. Arnsten
- Alzheimer's Disease Research UnitYale University School of MedicineNew HavenConnecticutUSA
- Department of NeuroscienceYale University School of MedicineNew HavenConnecticutUSA
| | - Yiyun Huang
- Program on AgingYale University School of MedicineNew HavenConnecticutUSA
| | - Richard E. Carson
- Program on AgingYale University School of MedicineNew HavenConnecticutUSA
| | - Christopher H. van Dyck
- Alzheimer's Disease Research UnitYale University School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
- Department of NeurologyYale University School of MedicineNew HavenConnecticutUSA
- Department of NeuroscienceYale University School of MedicineNew HavenConnecticutUSA
| |
Collapse
|
12
|
Lang AL, Eulalio T, Fox E, Yakabi K, Bukhari SA, Kawas CH, Corrada MM, Montgomery SB, Heppner FL, Capper D, Nachun D, Montine TJ. Methylation differences in Alzheimer's disease neuropathologic change in the aged human brain. Acta Neuropathol Commun 2022; 10:174. [PMID: 36447297 PMCID: PMC9710143 DOI: 10.1186/s40478-022-01470-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/24/2022] [Indexed: 12/05/2022] Open
Abstract
Alzheimer's disease (AD) is the most common cause of dementia with advancing age as its strongest risk factor. AD neuropathologic change (ADNC) is known to be associated with numerous DNA methylation changes in the human brain, but the oldest old (> 90 years) have so far been underrepresented in epigenetic studies of ADNC. Our study participants were individuals aged over 90 years (n = 47) from The 90+ Study. We analyzed DNA methylation from bulk samples in eight precisely dissected regions of the human brain: middle frontal gyrus, cingulate gyrus, entorhinal cortex, dentate gyrus, CA1, substantia nigra, locus coeruleus and cerebellar cortex. We deconvolved our bulk data into cell-type-specific (CTS) signals using computational methods. CTS methylation differences were analyzed across different levels of ADNC. The highest amount of ADNC related methylation differences was found in the dentate gyrus, a region that has so far been underrepresented in large scale multi-omic studies. In neurons of the dentate gyrus, DNA methylation significantly differed with increased burden of amyloid beta (Aβ) plaques at 5897 promoter regions of protein-coding genes. Amongst these, higher Aβ plaque burden was associated with promoter hypomethylation of the Presenilin enhancer 2 (PEN-2) gene, one of the rate limiting genes in the formation of gamma-secretase, a multicomponent complex that is responsible in part for the endoproteolytic cleavage of amyloid precursor protein into Aβ peptides. In addition to novel ADNC related DNA methylation changes, we present the most detailed array-based methylation survey of the old aged human brain to date. Our open-sourced dataset can serve as a brain region reference panel for future studies and help advance research in aging and neurodegenerative diseases.
Collapse
Affiliation(s)
- Anna-Lena Lang
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Tiffany Eulalio
- grid.168010.e0000000419368956Department of Biomedical Data Science, Stanford University, Stanford, CA 94305 USA
| | - Eddie Fox
- grid.168010.e0000000419368956Department of Pathology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
| | - Koya Yakabi
- grid.168010.e0000000419368956Department of Pathology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
| | - Syed A. Bukhari
- grid.168010.e0000000419368956Department of Pathology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
| | - Claudia H. Kawas
- grid.266093.80000 0001 0668 7243Department of Neurology, University of California Irvine, Orange, CA 92868-4280 USA ,grid.266093.80000 0001 0668 7243Department of Neurobiology and Behavior, University of California, Irvine, CA 92697 USA
| | - Maria M. Corrada
- grid.266093.80000 0001 0668 7243Department of Neurology, University of California Irvine, Orange, CA 92868-4280 USA ,grid.266093.80000 0001 0668 7243Department of Epidemiology, University of California, Irvine, CA 92617 USA
| | - Stephen B. Montgomery
- grid.168010.e0000000419368956Department of Pathology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Department of Genetics, Stanford University, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Department of Biomedical Data Science, Stanford University, Stanford, CA 94305 USA
| | - Frank L. Heppner
- grid.6363.00000 0001 2218 4662Department of Neuropathology, Charité–Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE), 10117 Berlin, Germany ,grid.6363.00000 0001 2218 4662Cluster of Excellence, NeuroCure, 10117 Berlin, Germany
| | - David Capper
- grid.6363.00000 0001 2218 4662Department of Neuropathology, Charité–Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Daniel Nachun
- grid.168010.e0000000419368956Department of Genetics, Stanford University, Stanford, CA 94305 USA
| | - Thomas J. Montine
- grid.168010.e0000000419368956Department of Pathology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
| |
Collapse
|
13
|
Kuller LH, Snitz BE, Hughes TM, Chang Y, Cohen AD, Mathis CA, Aizenstein HJ, Lopez OL. Low untreated systolic blood pressure over 18 years is associated with survival free of dementia age 90. Alzheimers Dement 2022; 18:2176-2187. [PMID: 35089640 PMCID: PMC9787390 DOI: 10.1002/alz.12493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/11/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We hypothesized that lower untreated systolic blood pressure (SBP) would be associated with a lower risk of dementia and death up to age 95. METHODS SBP measured between 2000 and 2006 was evaluated in relationship to dementia risk and brain biomarkers from 2009-2020 (n = 177) in the Gingko Evaluation of Memory Study (GEMS), mean age 95 in 2020. Participants had measurements of brain amyloid beta (Aβ) and repeat clinical-cognitive evaluations every 6 months. RESULTS By 2020, only 9 of 177 patients (5%) were alive and cognitively unimpaired (CU). Mean SBP from 2000 to 2006 was 120 mm Hg for nine alive/CU, 125 mm Hg for alive/mild cognitive impairment (MCI), and 130 mm Hg for alive/dementia (P = .03). The amount of Aβ was directly related to SBP levels. In multivariate analysis, Aβ+ in 2009 and thinner cortex were significant predictors of dementia. Excluding Aβ, SBP became a significant predictor of dementia. DISCUSSION Low SBP untreated by antihypertensive medications was associated with significant decreased risk of dementia and less Aβ.
Collapse
Affiliation(s)
- Lewis H. Kuller
- Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Beth E. Snitz
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Timothy M. Hughes
- Department of Internal MedicineSection on Gerontology and Geriatric MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Yuefang Chang
- Department of NeurosurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Ann D. Cohen
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Chester A. Mathis
- Department of RadiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - Oscar L. Lopez
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| |
Collapse
|
14
|
Agrawal S, Schneider JA. Vascular pathology and pathogenesis of cognitive impairment and dementia in older adults. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100148. [PMID: 36324408 PMCID: PMC9616381 DOI: 10.1016/j.cccb.2022.100148] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/25/2022] [Accepted: 06/23/2022] [Indexed: 12/24/2022]
Abstract
It is well recognized that brains of older people often harbor cerebrovascular disease pathology including vessel disease and vascular-related tissue injuries and that this is associated with vascular cognitive impairment and contributes to dementia. Here we review vascular pathologies, cognitive impairment, and dementia. We highlight the importance of mixed co-morbid AD/non-AD neurodegenerative and vascular pathology that has been collected in multiple clinical pathologic studies, especially in community-based studies. We also provide an update of vascular pathologies from the Rush Memory and Aging Project and Religious Orders Study cohorts with special emphasis on the differences across age in persons with and without dementia. Finally, we discuss neuropathological perspectives on the interpretation of clinical-pathological studies and emerging data in community-based studies.
Collapse
Affiliation(s)
- Sonal Agrawal
- Rush Alzheimer's Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison Street, Chicago 60612, IL, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Julie A. Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison Street, Chicago 60612, IL, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
15
|
Gómez-Isla T, Frosch MP. Lesions without symptoms: understanding resilience to Alzheimer disease neuropathological changes. Nat Rev Neurol 2022; 18:323-332. [PMID: 35332316 PMCID: PMC10607925 DOI: 10.1038/s41582-022-00642-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 12/12/2022]
Abstract
Since the original description of amyloid-β plaques and tau tangles more than 100 years ago, these lesions have been considered the neuropathological hallmarks of Alzheimer disease (AD). The prevalence of plaques, tangles and dementia increases with age, and the lesions are considered to be causally related to the cognitive symptoms of AD. Current schemes for assessing AD lesion burden examine the distribution, abundance and characteristics of plaques and tangles at post mortem, yielding an estimate of the likelihood of cognitive impairment. Although this approach is highly predictive for most individuals, in some instances, a striking mismatch between lesions and symptoms can be observed. A small subset of individuals harbour a high burden of plaques and tangles at autopsy, which would be expected to have had devastating clinical consequences, but remain at their cognitive baseline, indicating 'resilience'. The study of these brains might provide the key to understanding the 'black box' between the accumulation of plaques and tangles and cognitive impairment, and show the way towards disease-modifying treatments for AD. In this Review, we begin by considering the heterogeneity of clinical manifestations associated with the presence of plaques and tangles, and then focus on insights derived from the rare yet informative individuals who display high amounts of amyloid and tau deposition in their brains (observed directly at autopsy) without manifesting dementia during life. The resilient response of these individuals to the gradual accumulation of plaques and tangles has potential implications for assessing an individual's risk of AD and for the development of interventions aimed at preserving cognition.
Collapse
Affiliation(s)
- Teresa Gómez-Isla
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
- Massachusetts Alzheimer's Disease Research Center, Boston, MA, USA.
| | - Matthew P Frosch
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Massachusetts Alzheimer's Disease Research Center, Boston, MA, USA
- C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
16
|
Lecordier S, Pons V, Rivest S, ElAli A. Multifocal Cerebral Microinfarcts Modulate Early Alzheimer’s Disease Pathology in a Sex-Dependent Manner. Front Immunol 2022; 12:813536. [PMID: 35173711 PMCID: PMC8841345 DOI: 10.3389/fimmu.2021.813536] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022] Open
Abstract
Alzheimer’s disease (AD) constitutes a major cause of dementia, affecting more women than men. It is characterized by amyloid-β (Aβ) deposition and neurofibrillary tangles (NFTs) formation, associated with a progressive cognitive decline. Evidence indicates that AD onset increases the prevalence of cerebral microinfarcts caused by vascular pathologies, which occur in approximately in half of AD patients. In this project, we postulated that multifocal cerebral microinfarcts decisively influence early AD-like pathology progression in a sex dependent manner in young APP/PS1 mice. For this purpose, we used a novel approach to model multifocal microinfarcts in APP/PS1 mice via the sporadic occlusions of the microvasculature. Our findings indicate that microinfarcts reduced Aβ deposits without affecting soluble Aβ levels in the brain of male and female APP/PS1 mice, while causing rapid and prolonged cognitive deficits in males, and a mild and transient cognitive decline in females. In male APP/PS1 mice, microinfarcts triggered an acute hypoperfusion followed by a chronic hyperperfusion. Whereas in female APP/PS1 mice, microinfarcts caused an acute hypoperfusion, which was recovered in the chronic phase. Microinfarcts triggered a robust microglial activation and recruitment of peripheral monocytes to the lesion sites and Aβ plaques more potently in female APP/PS1 mice, possibly accounting for the reduced Aβ deposition. Finally, expression of Dickkopf-1 (DKK1), which plays a key role in mediating synaptic and neuronal dysfunction in AD, was strongly induced at the lesion sites of male APP/PS1 mice, while its expression was reduced in females. Our findings suggest that multifocal microinfarcts accelerate AD pathology more potently in young males compared to young females independently upon Aβ pathology via modulation of neurovascular coupling, inflammatory response, and DKK1 expression. Our results suggest that the effects of microinfarcts should be taken into consideration in AD diagnosis, prognosis, and therapies.
Collapse
Affiliation(s)
- Sarah Lecordier
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Vincent Pons
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Serge Rivest
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Ayman ElAli
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- *Correspondence: Ayman ElAli,
| |
Collapse
|
17
|
Sonnen JA. Autopsy Human Brain Dissection Protocol for Common Age-Related Neurodegenerative Disorders. Methods Mol Biol 2022; 2515:255-279. [PMID: 35776357 DOI: 10.1007/978-1-0716-2409-8_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Age-related neurodegenerative disorders are common causes of dementia-associated morbidity and mortality in populations throughout the world. Standardized, protocol-based methods for the examination and diagnosis of these disorders allow direct comparison between human cohorts and play a key role in understanding how these disorders impact our population. Further understanding of these protocols and harmonization with animal and in vitro investigative techniques is imperative to demonstrate relevance to human disease. The following is a concise protocol for the examination of human whole brain autopsy samples, with and without spinal cord, for the examination of neurodegenerative disorders. The following protocol is designed to provide samples appropriate for most neurodegenerative diseases. The collection of both fresh-frozen and formalin-fixed tissues is described.This guide presumes general knowledge of neuroanatomy of the human central nervous system. Tissue processing, detailed histological techniques and complete diagnostic examination of the brain is beyond the scope of this chapter; however, a limited evaluation appropriate for the evaluation of neurodegenerative disease is described here. Diagnostic protocols for the most common causes of dementia-associated, age-related neurodegenerative disorders are also summarized.
Collapse
Affiliation(s)
- Joshua A Sonnen
- Department of Pathology, McGill University, Montréal, QC, Canada.
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada.
| |
Collapse
|
18
|
Zhao Y, Zhang X, Chen X, Wei Y. Neuronal injuries in cerebral infarction and ischemic stroke: From mechanisms to treatment (Review). Int J Mol Med 2021; 49:15. [PMID: 34878154 PMCID: PMC8711586 DOI: 10.3892/ijmm.2021.5070] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
Stroke is the leading cause of disabilities and cognitive deficits, accounting for 5.2% of all mortalities worldwide. Transient or permanent occlusion of cerebral vessels leads to ischemic strokes, which constitutes the majority of strokes. Ischemic strokes induce brain infarcts, along with cerebral tissue death and focal neuronal damage. The infarct size and neurological severity after ischemic stroke episodes depends on the time period since occurrence, the severity of ischemia, systemic blood pressure, vein systems and location of infarcts, amongst others. Ischemic stroke is a complex disease, and neuronal injuries after ischemic strokes have been the focus of current studies. The present review will provide a basic pathological background of ischemic stroke and cerebral infarcts. Moreover, the major mechanisms underlying ischemic stroke and neuronal injuries are summarized. This review will also briefly summarize some representative clinical trials and up-to-date treatments that have been applied to stroke and brain infarcts.
Collapse
Affiliation(s)
- Yunfei Zhao
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA 94720, USA
| | - Xiaojing Zhang
- Shanghai Licheng Bio‑Technique Co. Ltd., Shanghai 201900, P.R. China
| | - Xinye Chen
- Shanghai Licheng Bio‑Technique Co. Ltd., Shanghai 201900, P.R. China
| | - Yun Wei
- Shanghai Licheng Bio‑Technique Co. Ltd., Shanghai 201900, P.R. China
| |
Collapse
|
19
|
Das M, Mao W, Shao E, Tamhankar S, Yu GQ, Yu X, Ho K, Wang X, Wang J, Mucke L. Interdependence of neural network dysfunction and microglial alterations in Alzheimer's disease-related models. iScience 2021; 24:103245. [PMID: 34755090 PMCID: PMC8561005 DOI: 10.1016/j.isci.2021.103245] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 11/26/2022] Open
Abstract
Nonconvulsive epileptiform activity and microglial alterations have been detected in people with Alzheimer's disease (AD) and related mouse models. However, the relationship between these abnormalities remains to be elucidated. We suppressed epileptiform activity by treatment with the antiepileptic drug levetiracetam or by genetic ablation of tau and found that these interventions reversed or prevented aberrant microglial gene expression in brain tissues of aged human amyloid precursor protein transgenic mice, which simulate several key aspects of AD. The most robustly modulated genes included multiple factors previously implicated in AD pathogenesis, including TREM2, the hypofunction of which increases disease risk. Genetic reduction of TREM2 exacerbated epileptiform activity after mice were injected with kainate. We conclude that AD-related epileptiform activity markedly changes the molecular profile of microglia, inducing both maladaptive and adaptive alterations in their activities. Increased expression of TREM2 seems to support microglial activities that counteract this type of network dysfunction.
Collapse
Affiliation(s)
- Melanie Das
- Gladstone Institute of Neurological Disease, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Wenjie Mao
- Gladstone Institute of Neurological Disease, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Eric Shao
- Gladstone Institute of Neurological Disease, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Soniya Tamhankar
- Gladstone Institute of Neurological Disease, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Gui-Qiu Yu
- Gladstone Institute of Neurological Disease, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Xinxing Yu
- Gladstone Institute of Neurological Disease, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Kaitlyn Ho
- Gladstone Institute of Neurological Disease, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Xin Wang
- Gladstone Institute of Neurological Disease, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Jiaming Wang
- Gladstone Institute of Neurological Disease, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Lennart Mucke
- Gladstone Institute of Neurological Disease, Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| |
Collapse
|
20
|
Chen CD, Joseph-Mathurin N, Sinha N, Zhou A, Li Y, Friedrichsen K, McCullough A, Franklin EE, Hornbeck R, Gordon B, Sharma V, Cruchaga C, Goate A, Karch C, McDade E, Xiong C, Bateman RJ, Ghetti B, Ringman JM, Chhatwal J, Masters CL, McLean C, Lashley T, Su Y, Koeppe R, Jack C, Klunk WE, Morris JC, Perrin RJ, Cairns NJ, Benzinger TLS. Comparing amyloid-β plaque burden with antemortem PiB PET in autosomal dominant and late-onset Alzheimer disease. Acta Neuropathol 2021; 142:689-706. [PMID: 34319442 PMCID: PMC8815340 DOI: 10.1007/s00401-021-02342-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 12/31/2022]
Abstract
Pittsburgh compound B (PiB) radiotracer for positron emission tomography (PET) imaging can bind to different types of amyloid-β plaques and blood vessels (cerebral amyloid angiopathy). However, the relative contributions of different plaque subtypes (diffuse versus cored/compact) to in vivo PiB PET signal on a region-by-region basis are incompletely understood. Of particular interest is whether the same staging schemes for summarizing amyloid-β burden are appropriate for both late-onset and autosomal dominant forms of Alzheimer disease (LOAD and ADAD). Here, we compared antemortem PiB PET with follow-up postmortem estimation of amyloid-β burden using stereologic methods to estimate the relative area fraction of diffuse and cored/compact amyloid-β plaques across 16 brain regions in 15 individuals with ADAD and 14 individuals with LOAD. In ADAD, we found that PiB PET correlated with diffuse plaques in the frontal, parietal, temporal, and striatal regions commonly used to summarize amyloid-β burden in PiB PET, and correlated with both diffuse and cored/compact plaques in the occipital lobe and parahippocampal gyrus. In LOAD, we found that PiB PET correlated with both diffuse and cored/compact plaques in the anterior cingulate, frontal lobe (middle frontal gyrus), and parietal lobe, and showed additional correlations with diffuse plaque in the amygdala and occipital lobe, and with cored/compact plaque in the temporal lobe. Thus, commonly used PiB PET summary regions predominantly reflect diffuse plaque burden in ADAD and a mixture of diffuse and cored/compact plaque burden in LOAD. In direct comparisons of ADAD and LOAD, postmortem stereology identified much greater mean amyloid-β plaque burdens in ADAD versus LOAD across almost all brain regions studied. However, standard PiB PET did not recapitulate these stereologic findings, likely due to non-trivial amyloid-β plaque burdens in ADAD within the cerebellum and brainstem-commonly used reference regions in PiB PET. Our findings suggest that PiB PET summary regions correlate with amyloid-β plaque burden in both ADAD and LOAD; however, they might not be reliable in direct comparisons of regional amyloid-β plaque burden between the two forms of AD.
Collapse
Affiliation(s)
- Charles D Chen
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Nelly Joseph-Mathurin
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Namita Sinha
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Pathology, University of Manitoba, Shared Health, Winnipeg, MB, Canada
| | - Aihong Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Karl Friedrichsen
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Austin McCullough
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Erin E Franklin
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
| | - Russ Hornbeck
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Brian Gordon
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Vijay Sharma
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Alison Goate
- Department of Genetics and Genomic Sciences, Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Celeste Karch
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Eric McDade
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Chengjie Xiong
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Randall J Bateman
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John M Ringman
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jasmeer Chhatwal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Colin L Masters
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Catriona McLean
- Department of Anatomic Pathology, Alfred Hospital, Melbourne, VIC, Australia
| | - Tammaryn Lashley
- UCL Queen Square Institute of Neurology, University College London, London, UK
- Queen Square Brain Bank for Neurological Disorders, University College London, London, UK
| | - Yi Su
- Banner Alzheimer's Institute, Banner Health, Phoenix, AZ, USA
- Arizona Alzheimer's Consortium, Banner Health, Phoenix, AZ, USA
| | - Robert Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Clifford Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - William E Klunk
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - John C Morris
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Richard J Perrin
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Nigel J Cairns
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Tammie L S Benzinger
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA.
| |
Collapse
|
21
|
Lecordier S, Manrique-Castano D, El Moghrabi Y, ElAli A. Neurovascular Alterations in Vascular Dementia: Emphasis on Risk Factors. Front Aging Neurosci 2021; 13:727590. [PMID: 34566627 PMCID: PMC8461067 DOI: 10.3389/fnagi.2021.727590] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/05/2021] [Indexed: 12/25/2022] Open
Abstract
Vascular dementia (VaD) constitutes the second most prevalent cause of dementia in the world after Alzheimer’s disease (AD). VaD regroups heterogeneous neurological conditions in which the decline of cognitive functions, including executive functions, is associated with structural and functional alterations in the cerebral vasculature. Among these cerebrovascular disorders, major stroke, and cerebral small vessel disease (cSVD) constitute the major risk factors for VaD. These conditions alter neurovascular functions leading to blood-brain barrier (BBB) deregulation, neurovascular coupling dysfunction, and inflammation. Accumulation of neurovascular impairments over time underlies the cognitive function decline associated with VaD. Furthermore, several vascular risk factors, such as hypertension, obesity, and diabetes have been shown to exacerbate neurovascular impairments and thus increase VaD prevalence. Importantly, air pollution constitutes an underestimated risk factor that triggers vascular dysfunction via inflammation and oxidative stress. The review summarizes the current knowledge related to the pathological mechanisms linking neurovascular impairments associated with stroke, cSVD, and vascular risk factors with a particular emphasis on air pollution, to VaD etiology and progression. Furthermore, the review discusses the major challenges to fully elucidate the pathobiology of VaD, as well as research directions to outline new therapeutic interventions.
Collapse
Affiliation(s)
- Sarah Lecordier
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Québec City, QC, Canada.,Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Daniel Manrique-Castano
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Québec City, QC, Canada.,Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Yara El Moghrabi
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Québec City, QC, Canada.,Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Ayman ElAli
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Québec City, QC, Canada.,Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| |
Collapse
|
22
|
Iida MA, Farrell K, Walker JM, Richardson TE, Marx GA, Bryce CH, Purohit D, Ayalon G, Beach TG, Bigio EH, Cortes EP, Gearing M, Haroutunian V, McMillan CT, Lee EB, Dickson DW, McKee AC, Stein TD, Trojanowski JQ, Woltjer RL, Kovacs GG, Kofler JK, Kaye J, White CL, Crary JF. Predictors of cognitive impairment in primary age-related tauopathy: an autopsy study. Acta Neuropathol Commun 2021; 9:134. [PMID: 34353357 PMCID: PMC8340493 DOI: 10.1186/s40478-021-01233-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/16/2021] [Indexed: 12/14/2022] Open
Abstract
Primary age-related tauopathy (PART) is a form of Alzheimer-type neurofibrillary degeneration occurring in the absence of amyloid-beta (Aβ) plaques. While PART shares some features with Alzheimer disease (AD), such as progressive accumulation of neurofibrillary tangle pathology in the medial temporal lobe and other brain regions, it does not progress extensively to neocortical regions. Given this restricted pathoanatomical pattern and variable symptomatology, there is a need to reexamine and improve upon how PART is neuropathologically assessed and staged. We performed a retrospective autopsy study in a collection (n = 174) of post-mortem PART brains and used logistic regression to determine the extent to which a set of clinical and neuropathological features predict cognitive impairment. We compared Braak staging, which focuses on hierarchical neuroanatomical progression of AD tau and Aβ pathology, with quantitative assessments of neurofibrillary burden using computer-derived positive pixel counts on digitized whole slide images of sections stained immunohistochemically with antibodies targeting abnormal hyperphosphorylated tau (p-tau) in the entorhinal region and hippocampus. We also assessed other factors affecting cognition, including aging-related tau astrogliopathy (ARTAG) and atrophy. We found no association between Braak stage and cognitive impairment when controlling for age (p = 0.76). In contrast, p-tau burden was significantly correlated with cognitive impairment even when adjusting for age (p = 0.03). The strongest correlate of cognitive impairment was cerebrovascular disease, a well-known risk factor (p < 0.0001), but other features including ARTAG (p = 0.03) and hippocampal atrophy (p = 0.04) were also associated. In contrast, sex, APOE, psychiatric illness, education, argyrophilic grains, and incidental Lewy bodies were not. These findings support the hypothesis that comorbid pathologies contribute to cognitive impairment in subjects with PART. Quantitative approaches beyond Braak staging are critical for advancing our understanding of the extent to which age-related tauopathy changes impact cognitive function.
Collapse
Affiliation(s)
- Megan A Iida
- Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine At Mount Sinai, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, 1 Gustave L. Levy Place Box 1194, New York, NY, 10029, USA
| | - Kurt Farrell
- Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine At Mount Sinai, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, 1 Gustave L. Levy Place Box 1194, New York, NY, 10029, USA
| | - Jamie M Walker
- Department of Pathology and Laboratory Medicine and The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Timothy E Richardson
- Department of Pathology and Laboratory Medicine and The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Gabriel A Marx
- Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine At Mount Sinai, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, 1 Gustave L. Levy Place Box 1194, New York, NY, 10029, USA
| | - Clare H Bryce
- Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine At Mount Sinai, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, 1 Gustave L. Levy Place Box 1194, New York, NY, 10029, USA
| | - Dushyant Purohit
- Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine At Mount Sinai, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, 1 Gustave L. Levy Place Box 1194, New York, NY, 10029, USA
| | - Gai Ayalon
- Ultragenyx Pharmaceuticals, Novato, CA, USA
| | | | - Eileen H Bigio
- Department of Pathology, Northwestern Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Etty P Cortes
- Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine At Mount Sinai, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, 1 Gustave L. Levy Place Box 1194, New York, NY, 10029, USA
| | - Marla Gearing
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Vahram Haroutunian
- Departments of Psychiatry and Neuroscience, Alzheimer's Disease Research Center, Icahn School of Medicine At Mount Sinai, New York, NY, USA
- JJ Peters VA Medical Center (MIRECC), Bronx, NY, USA
| | - Corey T McMillan
- Department of Neurology, Perelman School of Medicine, Penn FTD Center, Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, Translational Neuropathology Research Laboratory, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ann C McKee
- Department of Pathology, VA Medical Center & Boston University School of Medicine, Boston, MA, USA
| | - Thor D Stein
- Department of Pathology, VA Medical Center & Boston University School of Medicine, Boston, MA, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Randall L Woltjer
- Department of Pathology, Oregon Health Sciences University, Portland, OR, USA
| | - Gabor G Kovacs
- Laboratory Medicine Program, Krembil Brain Institute University Health Network Toronto Ontario, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Julia K Kofler
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, USA
| | - Charles L White
- Neuropathology Laboratory, Department of Pathology, University of Texas Southwestern Medical Center, Dallas, USA
| | - John F Crary
- Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine At Mount Sinai, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, 1 Gustave L. Levy Place Box 1194, New York, NY, 10029, USA.
| |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW People over 90 are the fastest growing segment of the population with the highest rates of dementia. This review highlights recent findings that provide insight to our understanding of dementia and cognition at all ages. RECENT FINDINGS Risk factors for Alzheimer's disease (AD) and dementia differ by age, with some factors, like the development of hypertension, actually becoming protective in the oldest-old. At least half of all dementia in this age group is due to non AD pathologies, including microinfarcts, hippocampal sclerosis and TDP-43. The number of pathologic changes found in the brain is related to both risk and severity of dementia, but many people in this age group appear to be 'resilient' to these pathologies. Resilience to Alzheimer pathology, in part, may be related to absence of other pathologies, and imaging and spinal fluid biomarkers for AD have limited utility in this age group. SUMMARY Studies of dementia in the oldest-old are important for our understanding and eventual treatment or prevention of dementia at all ages.
Collapse
Affiliation(s)
- Claudia H. Kawas
- Department of Neurology and Department of Neurobiology & Behavior, University of California, Irvine, Irvine, California, USA
| | - Nienke Legdeur
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC and Department of Internal Medicine, Spaarne Gasthuis, Haarlem, the Netherlands
| | - María M. Corrada
- Department of Neurology and Department of Epidemiology, University of California, Irvine, Irvine, California, USA
| |
Collapse
|
24
|
Kapasi A, Leurgans SE, Arvanitakis Z, Barnes LL, Bennett DA, Schneider JA. Aβ (Amyloid Beta) and Tau Tangle Pathology Modifies the Association Between Small Vessel Disease and Cortical Microinfarcts. Stroke 2021; 52:1012-1021. [PMID: 33567873 DOI: 10.1161/strokeaha.120.031073] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE There is increasing recognition of the importance of cortical microinfarcts to overall brain health, cognition, and Alzheimer dementia. Cerebral small vessel pathologies are associated with microinfarcts and frequently coexist with Alzheimer disease; however, the extent to which Aβ (amyloid beta) and tau pathology modulates microvascular pathogenesis is not fully understood. Study objective was to examine the relationship of small vessel pathologies, arteriolosclerosis, and cerebral amyloid angiopathy, with cortical microinfarcts in people with differing levels of Aβ or tau tangle burden. METHODS Participants were 1489 autopsied older people (mean age at death, 89 years; 67% women) from 1 of 3 ongoing clinical-pathological cohort studies of aging. Neuropathological evaluation identified cortical Aβ and tau tangle burden using immunohistochemistry in 8 brain regions, provided semiquantitative grading of cerebral vessel pathologies, and identified the presence of cortical microinfarcts. Logistic regression models adjusted for demographics and atherosclerosis and examined whether Aβ or tau tangle burden modified relations between small vessel pathologies and cortical microinfarcts. RESULTS Cortical microinfarcts were present in 17% of older people, moderate-to-severe cerebral amyloid angiopathy pathology in 36%, and arteriolosclerosis in 34%. In logistic regression models, we found interactions with Aβ and tau tangles, reflecting that the association between arteriolosclerosis and cortical microinfarcts was stronger in the context of greater Aβ (estimate, 0.15; SE=0.07; P=0.02) and tau tangle burden (estimate, 0.13; SE=0.06; P=0.02). Interactions also emerged for cerebral amyloid angiopathy, suggesting that the association between cerebral amyloid angiopathy and cortical microinfarcts is more robust in the presence of higher Aβ (estimate, 0.27; SE=0.07; P<0.001) and tangle burden (estimate, 0.16; SE=0.06; P=0.005). CONCLUSIONS These findings suggest that in the presence of elevated Aβ or tangle pathology, small vessel pathologies are associated with greater microvascular tissue injury, highlighting a potential link between neurodegenerative and vascular mechanisms.
Collapse
Affiliation(s)
- A Kapasi
- Rush Alzheimer's Disease Center (A.K., S.E.L., Z.A., L.L.B., D.A.B., J.A.S.), Rush University Medical Center, Chicago, IL.,Department of Pathology (A.K., J.A.S.), Rush University Medical Center, Chicago, IL
| | - S E Leurgans
- Rush Alzheimer's Disease Center (A.K., S.E.L., Z.A., L.L.B., D.A.B., J.A.S.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.E.L., Z.A., L.L.B., D.A.B., J.A.S.), Rush University Medical Center, Chicago, IL
| | - Z Arvanitakis
- Rush Alzheimer's Disease Center (A.K., S.E.L., Z.A., L.L.B., D.A.B., J.A.S.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.E.L., Z.A., L.L.B., D.A.B., J.A.S.), Rush University Medical Center, Chicago, IL
| | - L L Barnes
- Rush Alzheimer's Disease Center (A.K., S.E.L., Z.A., L.L.B., D.A.B., J.A.S.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.E.L., Z.A., L.L.B., D.A.B., J.A.S.), Rush University Medical Center, Chicago, IL.,Department of Behavioral Sciences (L.L.B.), Rush University Medical Center, Chicago, IL
| | - D A Bennett
- Rush Alzheimer's Disease Center (A.K., S.E.L., Z.A., L.L.B., D.A.B., J.A.S.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.E.L., Z.A., L.L.B., D.A.B., J.A.S.), Rush University Medical Center, Chicago, IL
| | - J A Schneider
- Rush Alzheimer's Disease Center (A.K., S.E.L., Z.A., L.L.B., D.A.B., J.A.S.), Rush University Medical Center, Chicago, IL.,Department of Pathology (A.K., J.A.S.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.E.L., Z.A., L.L.B., D.A.B., J.A.S.), Rush University Medical Center, Chicago, IL
| |
Collapse
|
25
|
Beach TG, Malek-Ahmadi M. Alzheimer's Disease Neuropathological Comorbidities are Common in the Younger-Old. J Alzheimers Dis 2021; 79:389-400. [PMID: 33285640 PMCID: PMC8034496 DOI: 10.3233/jad-201213] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinicopathological studies have demonstrated that Alzheimer's disease dementia (ADD) is often accompanied by clinically undetectable comorbid neurodegenerative and cerebrovascular disease that alter the rate of cognitive decline. Aside from causing increased variability in clinical response, it is possible that the major ADD comorbidities may not respond to ADD-specific molecular therapeutics. OBJECTIVE As most reports have focused on comorbidity in the oldest-old, its extent in younger age groups that are more likely to be involved in clinical trials is largely unknown; our objective is to provide this information. METHODS We conducted a survey of neuropathological comorbidities in sporadic ADD using data from the US National Alzheimer's Coordinating Center. Subject data was restricted to those with dementia and meeting National Institute on Aging-Alzheimer's Association intermediate or high AD Neuropathological Change levels, excluding those with known autosomal dominant AD-related mutations. RESULTS Highly prevalent ADD comorbidities are not restricted to the oldest-old but are common even in early-onset ADD. The percentage of cases with ADD as the sole major neuropathological diagnosis is highest in the under-60 group, where "pure" ADD cases are still in the minority at 44%. After this AD as a sole major pathology in ADD declines to roughly 20%in the 70s and beyond. Lewy body disease is the most common comorbidity at younger ages but actually is less common at later ages, while for most others, their prevalence increases with age. CONCLUSION Alzheimer's disease neuropathological comorbidities are highly prevalent even in the younger-old.
Collapse
|
26
|
Ii Y, Ishikawa H, Shindo A, Matsuyama H, Matsuura K, Matsuda K, Yoshimaru K, Satoh M, Kogue R, Umino M, Maeda M, Tomimoto H. Association between cortical microinfarcts and total small vessel disease burden in cerebral amyloid angiopathy on 3-Tesla magnetic resonance imaging. Eur J Neurol 2020; 28:794-799. [PMID: 33098163 DOI: 10.1111/ene.14610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Cortical microinfarcts (CMIs) are frequently found in the brains of patients with advanced cerebral amyloid angiopathy (CAA) at autopsy. The small vessel disease (SVD) score for CAA (i.e., the CAA-SVD score) has been proposed to evaluate the severity of CAA-associated vasculopathic changes by a combination of magnetic resonance imaging (MRI) markers. The aim of this study was to examine the association between total CAA-SVD score and features of CMIs on in vivo 3-Tesla MRI. METHODS Eighty patients with probable CAA were retrospectively analyzed. Lobar cerebral microbleeds, cortical superficial siderosis, enlargement of perivascular space in the centrum semiovale and white matter hyperintensity were collectively assessed, and the total CAA-SVD score was calculated. The presence of CMI was also examined. RESULTS Of the 80 patients, 13 (16.25%) had CMIs. CMIs were detected more frequently in the parietal and occipital lobes. A positive correlation was found between total CAA-SVD score and prevalence of CMI (ρ = 0.943; p = 0.005). Total CAA-SVD score was significantly higher in patients with CMIs than in those without (p = 0.009). In a multivariable logistic regression analysis, the presence of CMIs was significantly associated with total CAA-SVD score (odds ratio 2.318 [95% confidence interval 1.228-4.376]; p = 0.01, per each additional point). CONCLUSIONS The presence of CMIs with a high CAA-SVD score could be an indicator of more severe amyloid-associated vasculopathic changes in patients with probable CAA.
Collapse
Affiliation(s)
- Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hirofumi Matsuyama
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kana Matsuda
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kimiko Yoshimaru
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Mie, Japan
| | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Mie, Japan
| | - Ryota Kogue
- Department of Radiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Maki Umino
- Department of Radiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Masayuki Maeda
- Department of Neuroradiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| |
Collapse
|
27
|
Wei Y, Pu Y, Pan Y, Nie X, Duan W, Liu D, Yan H, Lu Q, Zhang Z, Yang Z, Wen M, Gu W, Hou X, Ma N, Leng X, Miao Z, Liu L. Cortical Microinfarcts Associated With Worse Outcomes in Patients With Acute Ischemic Stroke Receiving Endovascular Treatment. Stroke 2020; 51:2742-2751. [PMID: 32811382 DOI: 10.1161/strokeaha.120.030895] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the impact of cortical microinfarcts (CMIs) on functional outcome after endovascular treatment in patients with acute ischemic stroke. METHODS In a multicenter registration study for RESCUE-RE (a registration study for Critical Care of Acute Ischemic Stroke After Recanalization), eligible patients with large vessel occlusion stroke receiving endovascular treatment, who had undergone 3T magnetic resonance imaging on admission or within 24 hours after endovascular treatment were analyzed. We evaluated the presence and numbers of CMIs with assessment of axial T1, T2-weighted images, and fluid-attenuated inversion recovery images. The primary outcome was functional dependence or death defined as modified Rankin Scale scores of 3 to 6 at 90 days. Secondary outcomes included early neurological improvement, any intracranial hemorrhage, symptomatic intracranial hemorrhage, and mortality. We investigated the independent associations of CMIs with the outcomes using multivariable logistic regression in overall patients and in subgroups. RESULTS Among 414 patients (enrolled from July 2018 to May 2019) included in the analyses, 96 (23.2%) patients had at least one CMI (maximum 6). Patients with CMI(s) were more likely to be functionally dependent or dead at 90 days, compared with those without (55.2% versus 37.4%; P<0.01). In multivariable logistic regression analyses, presence of CMI(s) (adjusted odds ratio, 1.78 [95% CI, 1.04-3.07]; P=0.04) and multiple CMIs (CMIs ≥2; adjusted odds ratio, 7.41 [95% CI, 2.48-22.17]; P<0.001) were independently, significantly associated with the primary outcome. There was no significant difference between subgroups in the associations between CMI presence and the primary outcome. CONCLUSIONS Acute large vessel occlusion stroke patients receiving endovascular treatment with CMI(s) were more likely to have a poor functional outcome at 90 days, independent of patients' characteristics. Such associations may be dose-dependent. Registration: URL: http://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.
Collapse
Affiliation(s)
- Yufei Wei
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Yuehua Pu
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Yuesong Pan
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Ximing Nie
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Wanying Duan
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Dacheng Liu
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Hongyi Yan
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Qixuan Lu
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Zhe Zhang
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Zhonghua Yang
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Miao Wen
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | - Weibin Gu
- Department of Radiology (W.G., X.H.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xinyi Hou
- Department of Radiology (W.G., X.H.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Ning Ma
- Department of Interventional Neurology (N.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (X.L.)
| | - Zhongrong Miao
- Department of Interventional Neurology (N.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Liping Liu
- Department of Neurology (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.W., Y. Pu, Y. Pan, X.N., W.D., D.L., H.Y., Q.L., Z.Z., Z.Y., M.W., L.L.)
| | | |
Collapse
|
28
|
Muhire G, Iulita MF, Vallerand D, Youwakim J, Gratuze M, Petry FR, Planel E, Ferland G, Girouard H. Arterial Stiffness Due to Carotid Calcification Disrupts Cerebral Blood Flow Regulation and Leads to Cognitive Deficits. J Am Heart Assoc 2020; 8:e011630. [PMID: 31057061 PMCID: PMC6512142 DOI: 10.1161/jaha.118.011630] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Arterial stiffness is associated with cognitive decline and dementia; however, the precise mechanisms by which it affects the brain remain unclear. Methods and Results Using a mouse model based on carotid calcification this study characterized mechanisms that could contribute to brain degeneration due to arterial stiffness. At 2 weeks postcalcification, carotid stiffness attenuated resting cerebral blood flow in several brain regions including the perirhinal/entorhinal cortex, hippocampus, and thalamus, determined by autoradiography (P<0.05). Carotid calcification impaired cerebral autoregulation and diminished cerebral blood flow responses to neuronal activity and to acetylcholine, examined by laser Doppler flowmetry (P<0.05, P<0.01). Carotid stiffness significantly affected spatial memory at 3 weeks (P<0.05), but not at 2 weeks, suggesting that cerebrovascular impairments precede cognitive dysfunction. In line with the endothelial deficits, carotid stiffness led to increased blood‐brain barrier permeability in the hippocampus (P<0.01). This region also exhibited reductions in vessel number containing collagen IV (P<0.01), as did the somatosensory cortex (P<0.05). No evidence of cerebral microhemorrhages was present. Carotid stiffness did not affect the production of mouse amyloid‐β (Aβ) or tau phosphorylation, although it led to a modest increase in the Aβ40/Aβ42 ratio in frontal cortex (P<0.01). Conclusions These findings suggest that carotid stiffness alters brain microcirculation and increases blood‐brain barrier permeability associated with cognitive impairments. Therefore, arterial stiffness should be considered a relevant target to protect the brain and prevent cognitive dysfunctions.
Collapse
Affiliation(s)
- Gervais Muhire
- 1 Département de Pharmacologie et Physiologie Université de Montréal Québec Canada
| | - M Florencia Iulita
- 2 Groupe de Recherche sur le Système Nerveux Central Université de Montréal Québec Canada.,3 Département de Neurosciences Université de Montréal Québec Canada
| | - Diane Vallerand
- 1 Département de Pharmacologie et Physiologie Université de Montréal Québec Canada
| | - Jessica Youwakim
- 1 Département de Pharmacologie et Physiologie Université de Montréal Québec Canada
| | - Maud Gratuze
- 4 Département de Psychiatrie et Neurosciences Université Laval Québec Québec Canada
| | - Franck R Petry
- 4 Département de Psychiatrie et Neurosciences Université Laval Québec Québec Canada
| | - Emmanuel Planel
- 4 Département de Psychiatrie et Neurosciences Université Laval Québec Québec Canada.,5 Centre de Recherche du CHU de Québec Québec Canada
| | - Guylaine Ferland
- 6 Département de Nutrition Université de Montréal Québec Canada.,7 Centre de Recherche de l'Institut de Cardiologie de Montréal Montréal Québec Canada
| | - Hélène Girouard
- 1 Département de Pharmacologie et Physiologie Université de Montréal Québec Canada.,2 Groupe de Recherche sur le Système Nerveux Central Université de Montréal Québec Canada.,8 Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal Montréal Québec Canada
| |
Collapse
|
29
|
Montandon ML, Haller S, Scheffler M, Giannakopoulos P, Herrmann FR, Gold G, Kövari E. Medial temporal lobe volume is associated with neuronal loss but not with hippocampal microinfarcts despite their high frequency in aging brains. Neurobiol Aging 2020; 95:9-14. [PMID: 32739558 DOI: 10.1016/j.neurobiolaging.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
Medial temporal lobe (MTL) atrophy is an important marker for the clinical diagnosis of Alzheimer's disease at its prodromal stages. Several brain lesions have been associated with MTL atrophy including hippocampal sclerosis, neurodegenerative neuronal loss, and vascular pathology. To better explore the relationship between MTL volume on MRI and age-related degenerative and microvascular hippocampal pathology, we compared MTL volume on postmortem whole brain MRI and stereological estimates of the total number of neurons, cortical microinfarcts (CMIs), and neurofibrillary tangles (NFTs) in a consecutive autopsy series of 21 older individuals (11 females and 10 males, mean age 83.3 ± 5.8; range: 74-93 years, 7 demented and 14 nondemented). Our results revealed a very high percentage of cases with hippocampal CMIs (52%), particularly in the CA1 field. MTL volume was closely related to neuronal loss in both the CA1 area of the hippocampus (p = 0.0109) and the entorhinal cortex (p = 0.0272). MTL volume was not related to total CMI volume or to the total number of NFTs in our sample. In conclusion, hippocampal CMIs are very common in old age. MTL volume is determined essentially by the number of neurons in the hippocampus and does not appear to be related to the presence of NFTs or CMIs in this region.
Collapse
Affiliation(s)
- Marie-Louise Montandon
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Thônex, Switzerland; Department of Psychiatry, Geneva University Hospitals and University of Geneva, Chêne-Bourg, Switzerland
| | - Sven Haller
- CIRD Centre d'Imagerie Rive Droite, Geneva, Switzerland; Department of Surgical Sciences, Radiology, Uppsala University, Sweden
| | - Max Scheffler
- Department of Radiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Panteleimon Giannakopoulos
- Department of Psychiatry, Geneva University Hospitals and University of Geneva, Chêne-Bourg, Switzerland; Division of Institutional Measures, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - François R Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Thônex, Switzerland
| | - Gabriel Gold
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Thônex, Switzerland
| | - Enikö Kövari
- Department of Psychiatry, Geneva University Hospitals and University of Geneva, Chêne-Bourg, Switzerland.
| |
Collapse
|
30
|
Determinants of incident dementia in different old age groups: results of the prospective AgeCoDe/AgeQualiDe study. Int Psychogeriatr 2020; 32:645-659. [PMID: 31865929 DOI: 10.1017/s1041610219001935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To examine the impact of determinants of incident dementia in three different old age groups (75-79, 80-84, 85+years) in Germany. DESIGN Multicenter prospective AgeCoDe/AgeQualiDe cohort study with baseline and nine follow-up assessments at 1.5-year intervals. SETTING Primary care medical record registry sample. PARTICIPANTS General practitioners' (GPs) patients aged 75+years at baseline. MEASUREMENTS Conduction of standardized interviews including neuropsychological assessment and collection of GP information at each assessment wave. We used age-stratified competing risk regression models (accounting for the competing event of mortality) to assess determinants of incident dementia and age-stratified ordinary least square regressions to quantify the impact of identified determinants on the age at dementia onset. RESULTS Among 3027 dementia-free GP patients, n = 704 (23.3%) developed dementia during the 13-year study period. Worse cognitive performance and subjective memory decline with related worries at baseline, and the APOE ε4 allele were associated independently with increased dementia risk in all three old age groups. Worse cognitive performance at baseline was also associated with younger age at dementia onset in all three age groups. Other well-known determinants were associated with dementia risk and age at dementia onset only in some or in none of the three old age groups. CONCLUSIONS This study provides further evidence for the age-specific importance of determinants of incident dementia in old age. Such specifics have to be considered more strongly particularly with regard to potential approaches of early detection and prevention of dementia.
Collapse
|
31
|
Verny M, Duyckaerts C. Cognitive deficit, and neuropathological correlates, in the oldest-old. Rev Neurol (Paris) 2020; 176:670-676. [PMID: 32178879 DOI: 10.1016/j.neurol.2020.01.355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/14/2022]
Abstract
Several disorders are usually involved in the cognitive deficit of the oldest old. Alzheimer disease is the commonest. It is usually characterized by progressive memory impairment - neocortical symptoms occurring much later in the course of the disease. Alzheimer disease should not be considered any more as the single cause of a cognitive deficit in a very old patient. Vascular alterations, possibly causing microinfarcts, are commonly associated, especially in cerebral amyloid angiopathy. A slowly progressive memory deficit with negative CSF biomarkers of Alzheimer's disease may be due to hippocampal sclerosis that may be the consequence of multiple causes: in most of the cases, it is associated with neuronal TDP-43 inclusions. Recently, a distribution of these inclusions to a territory more extensive than the hippocampus has been reported and attributed to a new entity, called Limbic-predominant Age-related TDP-43 Encephalopathy (LATE) with or without hippocampal sclerosis. The presence of cortical Lewy bodies may cause an intellectual deficit or contribute to it. The prevalence of dementia with cortical Lewy bodies in the oldest old is discussed. Tau inclusions in cortical glia have also been shown to participate to the intellectual deficit. Association of neurodegenerative and vascular changes is the most frequent situation in the very old patients. Systemic diseases such as diabetes or heart failure, prescription drugs (when misused), or toxic such as alcohol may also contribute to the cognitive impairment and be amenable to treatment.
Collapse
Affiliation(s)
- M Verny
- Centre de gériatrie, pavillon Marguerite-Bottard, hôpital de la Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83, boulevard de l'Hôpital, 75651 Paris cedex, France; Team Neuronal Cell Biology & Pathology, Sorbonne University and UMR8256 (CNRS), Paris, France.
| | - C Duyckaerts
- Département de Neuropathologie Escourolle, AP-HP Sorbonne Université, Paris, France; ICM, équipe Alzheimer-Prions, Paris, France
| |
Collapse
|
32
|
Suemoto CK, Leite RE, Ferretti‐Rebustini RE, Rodriguez RD, Nitrini R, Pasqualucci CA, Jacob‐Filho W, Grinberg LT. Neuropathological lesions in the very old: results from a large Brazilian autopsy study. Brain Pathol 2019; 29:771-781. [PMID: 30861605 PMCID: PMC6742578 DOI: 10.1111/bpa.12719] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/28/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare neuropathological correlates of cognitive impairment between very old and younger individuals from a Brazilian clinicopathological study. METHODS We assessed the frequency of neuropathological lesions and their association with cognitive impairment (Clinical Dementia Rating scale ≥0.5) in the 80 or over age group compared to younger participants, using logistic regression models adjusted for sex, race and education. RESULTS Except for infarcts and siderocalcinosis, all neuropathological lesions were more common in the 80 or over age group (n = 412) compared to 50-79 year olds (n = 677). Very old participants had more than twice the likelihood of having ≥2 neuropathological diagnoses than younger participants (OR = 2.66, 95% CI = 2.03-3.50). Neurofibrillary tangles, infarcts and hyaline arteriolosclerosis were associated with cognitive impairment in the two age groups. Siderocalcinosis was associated with cognitive impairment in the younger participants only, while Lewy body disease was associated with cognitive impairment in the very old only. In addition, we found that the association of infarcts and multiple pathologies with cognitive impairment was attenuated in very old adults (Infarcts: P for interaction = 0.04; and multiple pathologies: P = 0.05). However, the predictive value for the aggregate model with all neuropathological lesions showed similar discrimination in both age groups [Area under Receiver Operating Characteristic curve (AUROC) = 0.778 in younger participants and AUROC = 0.765 in the very old]. CONCLUSION AND RELEVANCE Despite a higher frequency of neuropathological findings in the very old group, as found in studies with high-income populations, we found attenuation of the effect of infarcts rather than neurofibrillary tangles and plaques as reported previously.
Collapse
Affiliation(s)
- Claudia K. Suemoto
- Division of GeriatricsUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Renata E.P. Leite
- Division of GeriatricsUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | | | | | - Ricardo Nitrini
- Department of NeurologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | | | - Wilson Jacob‐Filho
- Division of GeriatricsUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Lea T. Grinberg
- Department of PathologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
- Department of Neurology, Memory and Aging CenterUniversity of California San FranciscoSan FranciscoCA
| |
Collapse
|
33
|
Graff-Radford J, Raman MR, Rabinstein AA, Przybelski SA, Lesnick TG, Boeve BF, Murray ME, Dickson DW, Reichard RR, Parisi JE, Knopman DS, Petersen RC, Jack CR, Kantarci K. Association Between Microinfarcts and Blood Pressure Trajectories. JAMA Neurol 2019; 75:212-218. [PMID: 29204605 DOI: 10.1001/jamaneurol.2017.3392] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Cerebral microinfarcts are associated with increased risk of cognitive impairment and may have different risk factors than macroinfarcts. Subcortical microinfarcts are associated with declining blood pressure (BP) in elderly individuals. Objective To investigate BP slopes as a risk factor for microinfarcts. Design, Setting, and Participants From the population-based Mayo Clinic Study of Aging, 303 of 1158 individuals (26.2%) in this cohort study agreed to have an autopsy between November 1, 2004, and March 31, 2016. Cerebral microinfarcts were identified and classified as cortical or subcortical. Baseline and BP trajectories were compared for groups with no microinfarcts, subcortical microinfarcts, and cortical microinfarcts. A secondary logistic regression analysis was performed to assess associations of subcortical microinfarcts with midlife hypertension, as well as systolic and diastolic BP slopes. Main Outcomes and Measures The presence of cerebral microinfarcts using BP slopes. Results Of the 303 participants who underwent autopsy, 297 had antemortem BP measurements. Of these, 177 (59.6%) were men; mean (SD) age at death was 87.2 (5.3) years. The autopsied individuals and the group who died but were not autopsied were similar for all demographics except educational level with autopsied participants having a mean of 1 more year of education (1.06; 95% CI, 0.66-1.47 years; P < .01). Among 297 autopsied individuals with antemortem BP measurements, 47 (15.8%) had chronic microinfarcts; 30 (63.8%) of these participants were men. Thirty (63.8%) had cortical microinfarcts, 19 (40.4%) had subcortical microinfarcts, and 4 (8.5%) had only infratentorial microinfarcts. Participants with microinfarcts did not differ significantly on baseline systolic (mean difference, -1.48; 95% CI, -7.30 to 4.34; P = .62) and diastolic (mean difference of slope, -0.90; 95% CI, -3.93 to 2.13; P = .56) BP compared with those with no microinfarcts. However, participants with subcortical microinfarcts had a greater annual decline (negative slope) of systolic (mean difference of slope, 4.66; 95% CI, 0.13 to 9.19; P = .04) and diastolic (mean difference, 3.33; 95% CI, 0.61 to 6.06; P = .02) BP. Conclusions and Relevance Subcortical microinfarcts were associated with declining BP. Future studies should investigate whether declining BP leads to subcortical microinfarcts or whether subcortical microinfarcts are a factor leading to declining BP.
Collapse
Affiliation(s)
| | - Mekala R Raman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Scott A Przybelski
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Timothy G Lesnick
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
34
|
Bairey Merz CN, Cheng S, Raggi P, Wei J. End-organ ischemia in the absence of proximal obstructive arterial disease: Déjà vu or jamais vu? Atherosclerosis 2019; 287:162-164. [PMID: 31213292 PMCID: PMC7388694 DOI: 10.1016/j.atherosclerosis.2019.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Affiliation(s)
- C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
| | - Susan Cheng
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Paolo Raggi
- Division of Cardiology and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| |
Collapse
|
35
|
Latimer CS, Burke BT, Liachko NF, Currey HN, Kilgore MD, Gibbons LE, Henriksen J, Darvas M, Domoto-Reilly K, Jayadev S, Grabowski TJ, Crane PK, Larson EB, Kraemer BC, Bird TD, Keene CD. Resistance and resilience to Alzheimer's disease pathology are associated with reduced cortical pTau and absence of limbic-predominant age-related TDP-43 encephalopathy in a community-based cohort. Acta Neuropathol Commun 2019; 7:91. [PMID: 31174609 PMCID: PMC6556006 DOI: 10.1186/s40478-019-0743-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease neuropathologic change (ADNC) is defined by progressive accumulation of β-amyloid plaques and hyperphosphorylated tau (pTau) neurofibrillary tangles across diverse regions of brain. Non-demented individuals who reach advanced age without significant ADNC are considered to be resistant to AD, while those burdened with ADNC are considered to be resilient. Understanding mechanisms underlying ADNC resistance and resilience may provide important clues to treating and/or preventing AD associated dementia. ADNC criteria for resistance and resilience are not well-defined, so we developed stringent pathologic cutoffs for non-demented subjects to eliminate cases of borderline pathology. We identified 14 resistant (85+ years old, non-demented, Braak stage ≤ III, CERAD absent) and 7 resilient (non-demented, Braak stage VI, CERAD frequent) individuals out of 684 autopsies from the Adult Changes in Thought study, a long-standing community-based cohort. We matched each resistant or resilient subject to a subject with dementia and severe ADNC (Braak stage VI, CERAD frequent) by age, sex, year of death, and post-mortem interval. We expanded the neuropathologic evaluation to include quantitative approaches to assess neuropathology and found that resilient participants had lower neocortical pTau burden despite fulfilling criteria for Braak stage VI. Moreover, limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) was robustly associated with clinical dementia and was more prevalent in cases with high pTau burden, supporting the notion that resilience to ADNC may depend, in part, on resistance to pTDP-43 pathology. To probe for interactions between tau and TDP-43, we developed a C. elegans model of combined human (h) Tau and TDP-43 proteotoxicity, which exhibited a severe degenerative phenotype most compatible with a synergistic, rather than simply additive, interaction between hTau and hTDP-43 neurodegeneration. Pathways that underlie this synergy may present novel therapeutic targets for the prevention and treatment of AD.
Collapse
Affiliation(s)
- Caitlin S Latimer
- Division of Neuropathology, Department of Pathology, University of Washington, Seattle, WA, 98104, USA.
| | - Bridget T Burke
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Nicole F Liachko
- Geriatrics Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Heather N Currey
- Geriatrics Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Mitchell D Kilgore
- Division of Neuropathology, Department of Pathology, University of Washington, Seattle, WA, 98104, USA
| | - Laura E Gibbons
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jonathan Henriksen
- Division of Neuropathology, Department of Pathology, University of Washington, Seattle, WA, 98104, USA
| | - Martin Darvas
- Division of Neuropathology, Department of Pathology, University of Washington, Seattle, WA, 98104, USA
| | | | - Suman Jayadev
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Tom J Grabowski
- Department of Neurology, University of Washington, Seattle, Washington, USA
- Deparment of Radiology, University of Washington, Seattle, Washington, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Brian C Kraemer
- Geriatrics Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Thomas D Bird
- Geriatrics Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, Washington, USA
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA, USA
| | - C Dirk Keene
- Division of Neuropathology, Department of Pathology, University of Washington, Seattle, WA, 98104, USA
| |
Collapse
|
36
|
Robinson JL, Corrada MM, Kovacs GG, Dominique M, Caswell C, Xie SX, Lee VMY, Kawas CH, Trojanowski JQ. Non-Alzheimer's contributions to dementia and cognitive resilience in The 90+ Study. Acta Neuropathol 2018; 136:377-388. [PMID: 29916037 DOI: 10.1007/s00401-018-1872-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
Abstract
The diagnosis of Alzheimer's disease (AD) in the oldest-old is complicated by the increasing prevalence of age-related neurofibrillary tangles, plaques and non-AD pathologies such as cerebrovascular disease (CVD), hippocampal sclerosis (HS), aging-related tau astrogliopathy (ARTAG), as well as TDP-43 and Lewy pathology. The contribution of these non-AD pathologies to dementia and cognitive resilience is unclear. We assessed the level of AD neuropathologic change (ADNPC) and non-AD pathology in 185 participants enrolled in The 90+ Study with available cognitive assessments and brain tissue. Logistic regression models-adjusting for age, sex and education-determined the association between each pathology and dementia or between subgroups. 53% had dementia, primarily AD or mixed AD; 23% had cognitive impairment without dementia (CIND); 23% were not impaired. Both AD and non-AD pathology was prevalent. 100% had tangles, 81% had plaques, and both tangles and plaques associated with dementia. ARTAG distributed across limbic (70%), brainstem (39%) and cortical regions (24%). 49% had possible CVD and 26% had definite CVD, while HS was noted in 15%. Cortical ARTAG, CVD and HS were each associated with dementia, but limbic and brainstem ARTAGs were not. TDP-43 and Lewy pathologies were found in 36 and 17% and both associated with dementia. No pathology distinguished CIND and the not impaired. By NIA-AA criteria and dementia status, the cohort was subdivided into four groups: those with minimal ADNPC included the not dementia (ND) and Not AD dementia groups; and those with significant ADNPC included the Resilient without dementia and AD dementia groups. Compared to the ND group, the Not AD dementia group had more HS, cortical ARTAG, TDP-43, and Lewy pathology. Compared to the AD dementia group, the Resilient group had less CVD, no HS and less cortical ARTAG, TDP-43 and Lewy pathology. Our findings imply that reductions in non-AD pathologies including CVD contribute to cognitive resilience in the oldest-old.
Collapse
Affiliation(s)
- John L Robinson
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Institute on Aging, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria M Corrada
- Department of Neurology, Department of Epidemiology, Institute for Memory Impairments and Neurological Disorders, University of California at Irvine, Irvine, CA, USA
| | - Gabor G Kovacs
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Institute on Aging, University of Pennsylvania, Philadelphia, PA, USA
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Myrna Dominique
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Institute on Aging, University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie Caswell
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Virginia M-Y Lee
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Institute on Aging, University of Pennsylvania, Philadelphia, PA, USA
| | - Claudia H Kawas
- Department of Neurology, Department of Neurobiology and Behavior, Institute for Memory Impairments and Neurological Disorders, University of California at Irvine, Irvine, CA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Institute on Aging, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
37
|
Power MC, Mormino E, Soldan A, James BD, Yu L, Armstrong NM, Bangen KJ, Delano-Wood L, Lamar M, Lim YY, Nudelman K, Zahodne L, Gross AL, Mungas D, Widaman KF, Schneider J. Combined neuropathological pathways account for age-related risk of dementia. Ann Neurol 2018; 84:10-22. [PMID: 29944741 PMCID: PMC6119518 DOI: 10.1002/ana.25246] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Our objectives were to characterize the inter-relation of known dementia-related neuropathologies in one comprehensive model and quantify the extent to which accumulation of neuropathologies accounts for the association between age and dementia. METHODS We used data from 1,362 autopsied participants of three community-based clinicopathological cohorts: the Religious Orders Study, the Rush Memory and Aging Project, and the Minority Aging Research Study. We estimated a series of structural equation models summarizing a priori hypothesized neuropathological pathways between age and dementia risk individually and collectively. RESULTS At time of death (mean age, 89 years), 44% of our sample had a clinical dementia diagnosis. When considered individually, our vascular, amyloid/tau, neocortical Lewy body, and TAR DNA-binding protein 43 (TDP-43)/hippocampal sclerosis pathology pathways each accounted for a substantial proportion of the association between age and dementia. When considered collectively, the four pathways fully accounted for all variance in dementia risk previously attributable to age. Pathways involving amyloid/tau, neocortical Lewy bodies, and TDP-43/hippocampal sclerosis were interdependent, attributable to the importance of amyloid beta plaques in all three. The importance of the pathways varied, with the vascular pathway accounting for 32% of the association between age and dementia, wheraes the remaining three inter-related degenerative pathways together accounted for 68% (amyloid/tau, 24%; the Lewy body, 1%; and TDP-43/hippocampal sclerosis, 43%). INTERPRETATION Age-related increases in dementia risk can be attributed to accumulation of multiple pathologies, each of which contributes to dementia risk. Multipronged approaches may be necessary if we are to develop effective therapies. Ann Neurol 2018;84:10-22.
Collapse
Affiliation(s)
- Melinda C Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Elizabeth Mormino
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anja Soldan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bryan D James
- Rush Alzheimer's Disease Center, Rush University, Chicago, IL.,Department of Internal Medicine, Rush University, Chicago, IL
| | - Lei Yu
- Department of Neurological Sciences, Rush University, Chicago, IL
| | - Nicole M Armstrong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA.,Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System, San Diego, CA.,Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University, Chicago, IL.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Yen Ying Lim
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Kelly Nudelman
- Department of Radiology and Imaging Sciences, Indiana University-Purdue University at Indianapolis, Indianapolis, IN
| | - Laura Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Center on Aging and Health, Baltimore, MD.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dan Mungas
- Department of Neurology, University of California-Davis, Davis, CA
| | - Keith F Widaman
- Graduate School of Education, University of California Riverside, Riverside, CA
| | - Julie Schneider
- Rush Alzheimer's Disease Center, Rush University, Chicago, IL.,Department of Neurological Sciences, Rush University, Chicago, IL.,Department of Pathology, Rush University Medical Center, Chicago, IL
| |
Collapse
|
38
|
Lim EY, Yang DW, Kim JS, Cho AH. Safety and Efficacy of Anti-dementia Agents in the Extremely Elderly Patients with Dementia. J Korean Med Sci 2018; 33:e133. [PMID: 29736156 PMCID: PMC5934516 DOI: 10.3346/jkms.2018.33.e133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There are debates on representation and generalizability of previous randomized controlled trials about anti-dementia agents in the oldest old population. In this context, we aimed to investigate the efficacy and safety of anti-dementia agents in the very elderly patients with dementia. METHODS We conducted a retrospective study of patients with dementia 1) who were 85 years or older, 2) got started anti-dementia agents, and 3) went through follow-up evaluation about one year thereafter. As a control, patients with dementia who were less than 85 years old with similar inclusion criteria were randomly selected during the same period. The adverse drug effects and discontinuation rates were investigated with self-reported complaint after starting or increasing anti-dementia drugs. For efficacy outcome, we also analyzed the change in neuropsychological results during follow-up period. RESULTS A total of 77 dementia patients who were at least 85 years were enrolled. As a control group, 78 patients with dementia who were younger than 85 was analyzed. The adverse drug effects were observed in 26 (33.3%) patients in the younger old and in 26 (33.8%) in the oldest old (P = 0.095). Twenty-one patients (26.9%) in the younger old group and 13 patients (16.9%) in the oldest old group discontinued their medication (P = 0.131). There were no differences between the two groups about changes of Mini-Mental State Examination and Instrumental Activity of Daily Living scores over time. CONCLUSION The use of anti-dementia agents in the oldest old dementia patients may be safe and effective as the younger old dementia patients.
Collapse
Affiliation(s)
- Eun-Ye Lim
- Department of Neurology, The Catholic University of Korea, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Won Yang
- Department of Neurology, The Catholic University of Korea, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Seok Kim
- Department of Neurology, The Catholic University of Korea, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - A-Hyun Cho
- Department of Neurology, The Catholic University of Korea, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
39
|
Vinters HV, Zarow C, Borys E, Whitman JD, Tung S, Ellis WG, Zheng L, Chui HC. Review: Vascular dementia: clinicopathologic and genetic considerations. Neuropathol Appl Neurobiol 2018; 44:247-266. [DOI: 10.1111/nan.12472] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/13/2018] [Indexed: 12/21/2022]
Affiliation(s)
- H. V. Vinters
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - C. Zarow
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
| | - E. Borys
- Department of Pathology; University of California Davis School of Medicine; Sacramento CA USA
- Department of Pathology; Loyola University Medical Center; Maywood IL USA
| | - J. D. Whitman
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
- Departments of Pathology & Laboratory Medicine; UC San Francisco Medical Center; San Francisco CA USA
| | - S. Tung
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - W. G. Ellis
- Department of Pathology; University of California Davis School of Medicine; Sacramento CA USA
| | - L. Zheng
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
| | - H. C. Chui
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
| |
Collapse
|
40
|
Brenowitz WD, Hubbard RA, Keene CD, Hawes SE, Longstreth WT, Woltjer RL, Kukull WA. Mixed neuropathologies and associations with domain-specific cognitive decline. Neurology 2017; 89:1773-1781. [PMID: 28939667 DOI: 10.1212/wnl.0000000000004567] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 07/31/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test whether decline in specific cognitive domains associated with Alzheimer disease neuropathologic change (ADNC) is modified by co-occurrence of other neuropathologies such as Lewy body disease (LBD) or vascular brain injury (VBI). METHODS Data came from 1,603 autopsied participants evaluated at US Alzheimer's Disease Centers. Standardized z scores in memory, attention, language, and executive function were derived from neuropsychological test scores assessed at each annual visit. Multivariable linear mixed-effects models assessed associations between neuropathologies and longitudinal trajectories of domain scores. RESULTS Compared to other participants, those with ADNC + LBD generally had worse cognitive trajectories, particularly lower initial executive function and faster attention decline. Participants with ADNC + VBI typically had less impairment and slower decline. Interactions were significant between LBD and ADNC for memory (p = 0.046) and between VBI and ADNC for language (p = 0.03); decline was slower than expected if these neuropathologies acted additively on the rate of decline. In secondary models, these interactions were limited to those with high ADNC (but not intermediate ADNC). In a subset of 260 participants with data on microinfarct location, cortical and subcortical microinfarcts were associated with decline in memory, language, and executive function in those without ADNC, but this effect was reduced among those with ADNC. CONCLUSIONS ADNC + LBD (but not ADNC + VBI) was associated with poorer executive function and attention compared to other pathology groupings. However, the effect of co-occurring pathologies on cognitive trajectories may depend on the severity of ADNC. Future studies using antemortem biomarkers should seek to replicate these neuropathologic observations.
Collapse
Affiliation(s)
- Willa D Brenowitz
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco.
| | - Rebecca A Hubbard
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - C Dirk Keene
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Stephen E Hawes
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - W T Longstreth
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Randy L Woltjer
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Walter A Kukull
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| |
Collapse
|
41
|
van Veluw SJ, Shih AY, Smith EE, Chen C, Schneider JA, Wardlaw JM, Greenberg SM, Biessels GJ. Detection, risk factors, and functional consequences of cerebral microinfarcts. Lancet Neurol 2017; 16:730-740. [PMID: 28716371 PMCID: PMC5861500 DOI: 10.1016/s1474-4422(17)30196-5] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/17/2017] [Accepted: 06/01/2017] [Indexed: 02/07/2023]
Abstract
Cerebral microinfarcts are small lesions that are presumed to be ischaemic. Despite the small size of these lesions, affected individuals can have hundreds to thousands of cerebral microinfarcts, which cause measurable disruption to structural brain connections, and are associated with dementia that is independent of Alzheimer's disease pathology or larger infarcts (ie, lacunar infarcts, and large cortical and non-lacunar subcortical infarcts). Substantial progress has been made with regard to understanding risk factors and functional consequences of cerebral microinfarcts, partly driven by new in-vivo detection methods and the development of animal models that closely mimic multiple aspects of cerebral microinfarcts in human beings. Evidence from these advances suggests that cerebral microinfarcts can be manifestations of both small vessel and large vessel disease, that cerebral microinfarcts are independently associated with cognitive impairment, and that these lesions are likely to cause damage to brain structure and function that extends beyond their actual lesion boundaries. Criteria for the identification of cerebral microinfarcts with in-vivo MRI are provided to support further studies of the association between these lesions and cerebrovascular disease and dementia.
Collapse
Affiliation(s)
- Susanne J van Veluw
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andy Y Shih
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Chen
- Memory Ageing and Cognition Centre, National University Health System, Singapore
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
| |
Collapse
|
42
|
Kapasi A, DeCarli C, Schneider JA. Impact of multiple pathologies on the threshold for clinically overt dementia. Acta Neuropathol 2017; 134:171-186. [PMID: 28488154 PMCID: PMC5663642 DOI: 10.1007/s00401-017-1717-7] [Citation(s) in RCA: 385] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 12/14/2022]
Abstract
Longitudinal clinical-pathological studies have increasingly recognized the importance of mixed pathologies (the coexistence of one or more neurodegenerative and cerebrovascular disease pathologies) as important factors in the development of Alzheimer's disease (AD) and other forms of dementia. Older persons with AD pathology, often have concomitant cerebrovascular disease pathologies (macroinfarcts, microinfarcts, atherosclerosis, arteriolosclerosis, cerebral amyloid angiopathy) as well as other concomitant neurodegenerative disease pathologies (Lewy bodies, TDP-43, hippocampal sclerosis). These additional pathologies lower the threshold for clinical diagnosis of AD. Many of these findings from pathologic studies, especially for CVD, have been confirmed using sophisticated neuroimaging technologies. In vivo biomarker studies are necessary to provide an understanding of specific pathologic contributions and time course relationships along the spectrum of accumulating pathologies. In this review, we provide a clinical-pathological perspective on the role of multiple brain pathologies in dementia followed by a review of the available clinical and biomarker data on some of the mixed pathologies.
Collapse
Affiliation(s)
- Alifiya Kapasi
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, USA
- Department of Pathology, Rush University Medical Center, Chicago, USA
| | - Charles DeCarli
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, USA.
- Department of Pathology, Rush University Medical Center, Chicago, USA.
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA.
| |
Collapse
|
43
|
Abstract
The oldest-old represent the fastest growing segment of society, and the risk of developing dementia continues to increase with advancing age into the 9th and 10th decades of life. The most common form of dementia in the oldest-old is Alzheimer disease (AD), although there are often mixed pathologies contributing to dementia in addition to amyloid plaques and neurofibrillary tangles. Diagnosing AD in the oldest-old is challenging due to cognitive and physical changes associated with aging. Treatment remains supportive, with current approved medications able to provide modest symptomatic benefit but unable to slow the progression of disease.
Collapse
Affiliation(s)
- Aimee L Pierce
- Department of Neurology and Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, 1100 Medical Plaza Drive, Irvine, CA 92697, USA.
| | - Szofia S Bullain
- Department of Neurology and Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, 1515 Hewitt Hall, Irvine, CA 92697, USA
| | - Claudia H Kawas
- Departments of Neurology, Neurobiology & Behavior, Epidemiology, and Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, 1121 Gillespie, Irvine, CA 92697, USA
| |
Collapse
|
44
|
Abstract
In a Perspective, Aimee Pierce and Claudia Kawas discuss risk factors and pathologies of dementia in the oldest-old.
Collapse
|
45
|
Brenowitz WD, Hubbard RA, Keene CD, Hawes SE, Longstreth WT, Woltjer RL, Kukull WA. Mixed neuropathologies and estimated rates of clinical progression in a large autopsy sample. Alzheimers Dement 2016; 13:654-662. [PMID: 27870939 DOI: 10.1016/j.jalz.2016.09.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/27/2016] [Accepted: 09/29/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Whether co-occurring neuropathologies interact or independently affect clinical disease progression is uncertain. We estimated rates of clinical progression and tested whether associations between clinical progression and Alzheimer's disease neuropathology (ADNP) were modified by co-occurring Lewy body disease (LBD) or vascular brain injury (VBI). METHODS Linear mixed effects models evaluated longitudinal trends in the Clinical Dementia Rating Scale Sum of Boxes on 2046 autopsied participants seen at a U.S. Alzheimer's Disease Center. RESULTS Annual clinical progression was slightly faster for ADNP + LBD compared with ADNP only (P = .06) and slightly slower for ADNP + VBI (P = .003). Differences in progression were less than expected if each neuropathology independently contributed to progression; ADNP interacted with LBD (P = .002) and VBI (P = .003). In secondary models, the effect of additional pathologies on clinical progression was greater in those with intermediate compared with high levels of ADNP. DISCUSSION The impact of co-occurring pathologies on progression may depend on severity of ADNP.
Collapse
Affiliation(s)
- Willa D Brenowitz
- National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA.
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - W T Longstreth
- National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Randy L Woltjer
- Department of Pathology, Oregon Health and Science University, Portland, OR, USA
| | - Walter A Kukull
- National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA
| |
Collapse
|