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Canu E, Rugarli G, Coraglia F, Basaia S, Cecchetti G, Calloni SF, Vezzulli PQ, Spinelli EG, Santangelo R, Caso F, Falini A, Magnani G, Filippi M, Agosta F. Real-word application of the AT(N) classification and disease-modifying treatment eligibility in a hospital-based cohort. J Neurol 2024; 271:2716-2729. [PMID: 38381175 DOI: 10.1007/s00415-024-12221-7] [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] [Received: 12/06/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND AND OBJECTIVES The AT(N) classification system stratifies patients based on biomarker profiles, including amyloid-beta deposition (A), tau pathology (T), and neurodegeneration (N). This study aims to apply the AT(N) classification to a hospital-based cohort of patients with cognitive decline and/or dementia, within and outside the Alzheimer's disease (AD) continuum, to enhance our understanding of the multidimensional aspects of AD and related disorders. Furthermore, we wish to investigate how many cases from our cohort would be eligible for the available disease modifying treatments, such as aducanemab and lecanemab. METHODS We conducted a retrospective evaluation of 429 patients referred to the Memory Center of IRCCS San Raffaele Hospital in Milan. Patients underwent clinical/neuropsychological assessments, lumbar puncture, structural brain imaging, and positron emission tomography (FDG-PET). Patients were stratified according to AT(N) classification, group comparisons were performed and the number of eligible cases for anti-β amyloid monoclonal antibodies was calculated. RESULTS Sociodemographic and clinical features were similar across groups. The most represented group was A + T + N + accounting for 38% of cases, followed by A + T - N + (21%) and A - T - N + (20%). Although the clinical presentation was similar, the A + T + N + group showed more severe cognitive impairment in memory, language, attention, executive, and visuospatial functions compared to other AT(N) groups. Notably, T + patients demonstrated greater memory complaints compared to T - cases. FDG-PET outperformed MRI and CT in distinguishing A + from A - patients. Although 61% of the observed cases were A + , only 17% of them were eligible for amyloid-targeting treatments. DISCUSSION The AT(N) classification is applicable in a real-world clinical setting. The classification system provided insights into clinical management and treatment strategies. Low cognitive performance and specific regional FDG-PET hypometabolism at diagnosis are highly suggestive for A + T + or A - T + profiles. This work provides also a realistic picture of the proportion of AD patients eligible for disease modifying treatments emphasizing the need for early detection.
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Affiliation(s)
- Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Rugarli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Federico Coraglia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giordano Cecchetti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sonia Francesca Calloni
- Neuroradiology Unit and High Field MRI Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Edoardo Gioele Spinelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Santangelo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Caso
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Falini
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroradiology Unit and High Field MRI Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Magnani
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Therriault J, Schindler SE, Salvadó G, Pascoal TA, Benedet AL, Ashton NJ, Karikari TK, Apostolova L, Murray ME, Verberk I, Vogel JW, La Joie R, Gauthier S, Teunissen C, Rabinovici GD, Zetterberg H, Bateman RJ, Scheltens P, Blennow K, Sperling R, Hansson O, Jack CR, Rosa-Neto P. Biomarker-based staging of Alzheimer disease: rationale and clinical applications. Nat Rev Neurol 2024; 20:232-244. [PMID: 38429551 DOI: 10.1038/s41582-024-00942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/03/2024]
Abstract
Disease staging, whereby the spatial extent and load of brain pathology are used to estimate the severity of Alzheimer disease (AD), is pivotal to the gold-standard neuropathological diagnosis of AD. Current in vivo diagnostic frameworks for AD are based on abnormal concentrations of amyloid-β and tau in the cerebrospinal fluid or on PET scans, and breakthroughs in molecular imaging have opened up the possibility of in vivo staging of AD. Focusing on the key principles of disease staging shared across several areas of medicine, this Review highlights the potential for in vivo staging of AD to transform our understanding of preclinical AD, refine enrolment criteria for trials of disease-modifying therapies and aid clinical decision-making in the era of anti-amyloid therapeutics. We provide a state-of-the-art review of recent biomarker-based AD staging systems and highlight their contributions to the understanding of the natural history of AD. Furthermore, we outline hypothetical frameworks to stage AD severity using more accessible fluid biomarkers. In addition, by applying amyloid PET-based staging to recently published anti-amyloid therapeutic trials, we highlight how biomarker-based disease staging frameworks could illustrate the numerous pathological changes that have already taken place in individuals with mildly symptomatic AD. Finally, we discuss challenges related to the validation and standardization of disease staging and provide a forward-looking perspective on potential clinical applications.
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Affiliation(s)
- Joseph Therriault
- Translational Neuroimaging Laboratory, McGill Research Centre for Studies in Aging, Alzheimer's Disease Research Unit, Douglas Research Institute, Le Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Ouest-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
| | - Suzanne E Schindler
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Gemma Salvadó
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Tharick A Pascoal
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andréa Lessa Benedet
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation, London, UK
| | - Thomas K Karikari
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Liana Apostolova
- Department of Neurology, University of Indiana School of Medicine, Indianapolis, IN, USA
| | | | - Inge Verberk
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Jacob W Vogel
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Clinical Sciences, Malmö, SciLifeLab, Lund University, Lund, Sweden
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Serge Gauthier
- Translational Neuroimaging Laboratory, McGill Research Centre for Studies in Aging, Alzheimer's Disease Research Unit, Douglas Research Institute, Le Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Ouest-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Charlotte Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Randall J Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
- Tracy Family SILQ Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Philip Scheltens
- Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Reisa Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | | | - Pedro Rosa-Neto
- Translational Neuroimaging Laboratory, McGill Research Centre for Studies in Aging, Alzheimer's Disease Research Unit, Douglas Research Institute, Le Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Ouest-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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Chen Y, Li Z, Ge X, Lv H, Geng Z. Identification of novel hub genes for Alzheimer's disease associated with the hippocampus using WGCNA and differential gene analysis. Front Neurosci 2024; 18:1359631. [PMID: 38516314 PMCID: PMC10954837 DOI: 10.3389/fnins.2024.1359631] [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: 12/21/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
Background Alzheimer's disease (AD) is a common, refractory, progressive neurodegenerative disorder in which cognitive and memory deficits are highly correlated with abnormalities in hippocampal brain regions. There is still a lack of hippocampus-related markers for AD diagnosis and prevention. Methods Differently expressed genes were identified in the gene expression profile GSE293789 in the hippocampal brain region. Enrichment analyses GO, KEGG, and GSEA were used to identify biological pathways involved in the DEGs and AD-related group. WGCNA was used to identify the gene modules that are highly associated with AD in the samples. The intersecting genes of the genes in DEGs and modules were extracted and the top ten ranked hub genes were identified. Finally GES48350 was used as a validation cohort to predict the diagnostic efficacy of hub genes. Results From GSE293789, 225 DEGs were identified, which were mainly associated with calcium response, glutamatergic synapses, and calcium-dependent phospholipid-binding response. WGCNA analysis yielded dark green and bright yellow modular genes as the most relevant to AD. From these two modules, 176 genes were extracted, which were taken to be intersected with DEGs, yielding 51 intersecting genes. Then 10 hub genes were identified in them: HSPA1B, HSPB1, HSPA1A, DNAJB1, HSPB8, ANXA2, ANXA1, SOX9, YAP1, and AHNAK. Validation of these genes was found to have excellent diagnostic performance. Conclusion Ten AD-related hub genes in the hippocampus were identified, contributing to further understanding of AD development in the hippocampus and development of targets for therapeutic prevention.
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Affiliation(s)
- Yang Chen
- Graduate School, Hebei Medical University, Shijiazhuang, China
| | - Zhaoxiang Li
- Department of Immunology and Pathogenic Biology, Yanbian University Medical College, Yanji, China
| | - Xin Ge
- Science and Education Section, Baoding First Central Hospital, Baoding, China
| | - Huandi Lv
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zuojun Geng
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Miskovic R, Ljubicic J, Bonaci-Nikolic B, Petkovic A, Markovic V, Rankovic I, Djordjevic J, Stankovic A, Klaassen K, Pavlovic S, Stojanovic M. Case report: Rapidly progressive neurocognitive disorder with a fatal outcome in a patient with PU.1 mutated agammaglobulinemia. Front Immunol 2024; 15:1324679. [PMID: 38500873 PMCID: PMC10945545 DOI: 10.3389/fimmu.2024.1324679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction PU.1-mutated agammaglobulinemia (PU.MA) represents a recently described autosomal-dominant form of agammaglobulinemia caused by mutation of the SPI1 gene. This gene codes for PU.1 pioneer transcription factor important for the maturation of monocytes, B lymphocytes, and conventional dendritic cells. Only six cases with PU.MA, presenting with chronic sinopulmonary and systemic enteroviral infections, have been previously described. Accumulating literature evidence suggests a possible relationship between SPI1 mutation, microglial phagocytic dysfunction, and the development of Alzheimer's disease (AD). Case description We present a Caucasian female patient born from a non-consanguineous marriage, who was diagnosed with agammaglobulinemia at the age of 15 years when the immunoglobulin replacement therapy was started. During the following seventeen years, she was treated for recurrent respiratory and intestinal infections. At the age of 33 years, the diagnosis of celiac-like disease was established. Five years later progressive cognitive deterioration, unstable gait, speech disturbances, and behavioral changes developed. Comprehensive microbiological investigations were negative, excluding possible infective etiology. Brain MRI, 18FDG-PET-CT, and neuropsychological testing were suggestive for a diagnosis of a frontal variant of AD. Clinical exome sequencing revealed the presence of a novel frameshift heterozygous variant c.441dup in exon 4 of the SPI1 gene. Despite intensive therapy, the patient passed away a few months after the onset of the first neurological symptoms. Conclusion We describe the first case of PU.MA patient presenting with a rapidly progressive neurocognitive deterioration. The possible role of microglial dysfunction in patients with SPI1 mutation could explain their susceptibility to neurodegenerative diseases thus highlighting the importance of genetic testing in patients with inborn errors of immunity. Since PU.MA represents a newly described form of agammaglobulinemia, our case expands the spectrum of manifestations associated with SPI1 mutation.
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Affiliation(s)
- Rada Miskovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Ljubicic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Branka Bonaci-Nikolic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Petkovic
- Diagnostic Department, Center of Sterotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Vladana Markovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivan Rankovic
- Department of Gastroenterology and Liver Unit, Royal Cornwall Hospitals NHS Trust, University of Exeter, Truro, United Kingdom
| | - Jelena Djordjevic
- Clinic of Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Ana Stankovic
- Center for Radiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Kristel Klaassen
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Sonja Pavlovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Maja Stojanovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Rezaii N, Hochberg D, Quimby M, Wong B, McGinnis S, Dickerson BC, Putcha D. Language uncovers visuospatial dysfunction in posterior cortical atrophy: a natural language processing approach. Front Neurosci 2024; 18:1342909. [PMID: 38379764 PMCID: PMC10876777 DOI: 10.3389/fnins.2024.1342909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Posterior Cortical Atrophy (PCA) is a syndrome characterized by a progressive decline in higher-order visuospatial processing, leading to symptoms such as space perception deficit, simultanagnosia, and object perception impairment. While PCA is primarily known for its impact on visuospatial abilities, recent studies have documented language abnormalities in PCA patients. This study aims to delineate the nature and origin of language impairments in PCA, hypothesizing that language deficits reflect the visuospatial processing impairments of the disease. Methods We compared the language samples of 25 patients with PCA with age-matched cognitively normal (CN) individuals across two distinct tasks: a visually-dependent picture description and a visually-independent job description task. We extracted word frequency, word utterance latency, and spatial relational words for this comparison. We then conducted an in-depth analysis of the language used in the picture description task to identify specific linguistic indicators that reflect the visuospatial processing deficits of PCA. Results Patients with PCA showed significant language deficits in the visually-dependent task, characterized by higher word frequency, prolonged utterance latency, and fewer spatial relational words, but not in the visually-independent task. An in-depth analysis of the picture description task further showed that PCA patients struggled to identify certain visual elements as well as the overall theme of the picture. A predictive model based on these language features distinguished PCA patients from CN individuals with high classification accuracy. Discussion The findings indicate that language is a sensitive behavioral construct to detect visuospatial processing abnormalities of PCA. These insights offer theoretical and clinical avenues for understanding and managing PCA, underscoring language as a crucial marker for the visuospatial deficits of this atypical variant of Alzheimer's disease.
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Affiliation(s)
- Neguine Rezaii
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Daisy Hochberg
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Megan Quimby
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Bonnie Wong
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Scott McGinnis
- Center for Brain Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Bradford C. Dickerson
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
- Alzheimer’s Disease Research Center, Massachusetts General Hospital, Charlestown, MA, United States
| | - Deepti Putcha
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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Chapleau M, La Joie R, Yong K, Agosta F, Allen IE, Apostolova L, Best J, Boon BDC, Crutch S, Filippi M, Fumagalli GG, Galimberti D, Graff-Radford J, Grinberg LT, Irwin DJ, Josephs KA, Mendez MF, Mendez PC, Migliaccio R, Miller ZA, Montembeault M, Murray ME, Nemes S, Pelak V, Perani D, Phillips J, Pijnenburg Y, Rogalski E, Schott JM, Seeley W, Sullivan AC, Spina S, Tanner J, Walker J, Whitwell JL, Wolk DA, Ossenkoppele R, Rabinovici GD. Demographic, clinical, biomarker, and neuropathological correlates of posterior cortical atrophy: an international cohort study and individual participant data meta-analysis. Lancet Neurol 2024; 23:168-177. [PMID: 38267189 DOI: 10.1016/s1474-4422(23)00414-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/22/2023] [Accepted: 10/18/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Posterior cortical atrophy is a rare syndrome characterised by early, prominent, and progressive impairment in visuoperceptual and visuospatial processing. The disorder has been associated with underlying neuropathological features of Alzheimer's disease, but large-scale biomarker and neuropathological studies are scarce. We aimed to describe demographic, clinical, biomarker, and neuropathological correlates of posterior cortical atrophy in a large international cohort. METHODS We searched PubMed between database inception and Aug 1, 2021, for all published research studies on posterior cortical atrophy and related terms. We identified research centres from these studies and requested deidentified, individual participant data (published and unpublished) that had been obtained at the first diagnostic visit from the corresponding authors of the studies or heads of the research centres. Inclusion criteria were a clinical diagnosis of posterior cortical atrophy as defined by the local centre and availability of Alzheimer's disease biomarkers (PET or CSF), or a diagnosis made at autopsy. Not all individuals with posterior cortical atrophy fulfilled consensus criteria, being diagnosed using centre-specific procedures or before development of consensus criteria. We obtained demographic, clinical, biofluid, neuroimaging, and neuropathological data. Mean values for continuous variables were combined using the inverse variance meta-analysis method; only research centres with more than one participant for a variable were included. Pooled proportions were calculated for binary variables using a restricted maximum likelihood model. Heterogeneity was quantified using I2. FINDINGS We identified 55 research centres from 1353 papers, with 29 centres responding to our request. An additional seven centres were recruited by advertising via the Alzheimer's Association. We obtained data for 1092 individuals who were evaluated at 36 research centres in 16 countries, the other sites having not responded to our initial invitation to participate to the study. Mean age at symptom onset was 59·4 years (95% CI 58·9-59·8; I2=77%), 60% (56-64; I2=35%) were women, and 80% (72-89; I2=98%) presented with posterior cortical atrophy pure syndrome. Amyloid β in CSF (536 participants from 28 centres) was positive in 81% (95% CI 75-87; I2=78%), whereas phosphorylated tau in CSF (503 participants from 29 centres) was positive in 65% (56-75; I2=87%). Amyloid-PET (299 participants from 24 centres) was positive in 94% (95% CI 90-97; I2=15%), whereas tau-PET (170 participants from 13 centres) was positive in 97% (93-100; I2=12%). At autopsy (145 participants from 13 centres), the most frequent neuropathological diagnosis was Alzheimer's disease (94%, 95% CI 90-97; I2=0%), with common co-pathologies of cerebral amyloid angiopathy (71%, 54-88; I2=89%), Lewy body disease (44%, 25-62; I2=77%), and cerebrovascular injury (42%, 24-60; I2=88%). INTERPRETATION These data indicate that posterior cortical atrophy typically presents as a pure, young-onset dementia syndrome that is highly specific for underlying Alzheimer's disease pathology. Further work is needed to understand what drives cognitive vulnerability and progression rates by investigating the contribution of sex, genetics, premorbid cognitive strengths and weaknesses, and brain network integrity. FUNDING None.
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Affiliation(s)
- Marianne Chapleau
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Keir Yong
- Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, UK
| | - Federica Agosta
- Vita-Salute, San Raffaele University, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Insitute, Milan, Italy
| | - Isabel Elaine Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - John Best
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Baayla D C Boon
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Sebastian Crutch
- Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, UK
| | - Massimo Filippi
- Vita-Salute, San Raffaele University, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Insitute, Milan, Italy
| | | | - Daniela Galimberti
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Pathology, University of California San Francisco, San Francisco, CA, USA; Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - David J Irwin
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Mario F Mendez
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Patricio Chrem Mendez
- Memory Center, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Buenos Aires Argentina
| | - Raffaella Migliaccio
- Paris Brain Institute (ICM), FrontLab, Institut de la mémoire et de la maladie d'Alzheimer (IM2A), Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Maxime Montembeault
- Douglas Research Centre, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Sára Nemes
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Victoria Pelak
- Departments of Neurology and Ophthalmology, Divisions of Neuro-Ophthalmology and Behavioral Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniela Perani
- Vita-Salute, San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele, San Raffaele University, Milan, Italy
| | - Jeffrey Phillips
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, Netherlands; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology & Alzheimer's Disease, Northwestern University, Evanston, IL, USA
| | - Jonathan M Schott
- Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, UK; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - William Seeley
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - A Campbell Sullivan
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jeremy Tanner
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Jamie Walker
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | | | - David A Wolk
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, Netherlands; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands; Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
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7
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Rezaii N, Hochberg D, Quimby M, Wong B, McGinnis S, Dickerson BC, Putcha D. Language Uncovers Visuospatial Dysfunction in Posterior Cortical Atrophy: A Natural Language Processing Approach. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.21.23298864. [PMID: 38045263 PMCID: PMC10690359 DOI: 10.1101/2023.11.21.23298864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Introduction Posterior Cortical Atrophy (PCA) is a syndrome characterized by a progressive decline in higher-order visuospatial processing, leading to symptoms such as space perception deficit, simultanagnosia, and object perception impairment. While PCA is primarily known for its impact on visuospatial abilities, recent studies have documented language abnormalities in PCA patients. This study aims to delineate the nature and origin of language impairments in PCA, hypothesizing that language deficits reflect the visuospatial processing impairments of the disease. Methods We compared the language samples of 25 patients with PCA with age-matched cognitively normal (CN) individuals across two distinct tasks: a visually-dependent picture description and a visually-independent job description task. We extracted word frequency, word utterance latency, and spatial relational words for this comparison. We then conducted an in-depth analysis of the language used in the picture description task to identify specific linguistic indicators that reflect the visuospatial processing deficits of PCA. Results Patients with PCA showed significant language deficits in the visually-dependent task, characterized by higher word frequency, prolonged utterance latency, and fewer spatial relational words, but not in the visually-independent task. An in-depth analysis of the picture description task further showed that PCA patients struggled to identify certain visual elements as well as the overall theme of the picture. A predictive model based on these language features distinguished PCA patients from CN individuals with high classification accuracy. Discussion The findings indicate that language is a sensitive behavioral construct to detect visuospatial processing abnormalities of PCA. These insights offer theoretical and clinical avenues for understanding and managing PCA, underscoring language as a crucial marker for the visuospatial deficits of this atypical variant of Alzheimer's disease.
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Affiliation(s)
- Neguine Rezaii
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Daisy Hochberg
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Megan Quimby
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Bonnie Wong
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Scott McGinnis
- Center for Brain Mind Medicine, Department of Neurology, Brigham & Women’s Hospital, Boston, MA 02115
| | - Bradford C Dickerson
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129
- Alzheimer’s Disease Research Center, Massachusetts General Hospital, Charlestown, MA 02129
| | - Deepti Putcha
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
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8
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Bick A, McKyton A, Glick-Shames H, Rein N, Levin N. Abnormal network connections to early visual cortex in posterior cortical atrophy. J Neurol Sci 2023; 454:120826. [PMID: 37832379 DOI: 10.1016/j.jns.2023.120826] [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: 06/11/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Posterior Cortical Atrophy (PCA), a visual variant of Alzheimer's disease, initially manifests with higher-order visual disorders and parieto/temporo-occipital atrophy. Recent studies have shown remote functional impairment in both distant brain networks and along the calcarine sulcus (V1). Functional alteration in the calcarine differs along its length, reflecting center to periphery visual space differences. Herein, we aim to connect between these two sets of findings by looking at the retinotopic patterns of functional connectivity between large-scale brain networks and V1, comparing patients with normally sighted subjects. METHODS Resting state functional magnetic resonance imaging (fMRI) and T1 anatomical scans were obtained from 11 PCA patients and 17 age-matched healthy volunteers. Default mode network (DMN) and fronto parietal network (FPN) were defined and differences between the networks in patients and healthy controls were evaluated at the whole brain level, specifically their connectivity to V1. RESULTS Connectivity patterns within the DMN and the FPN were similar between the groups, although differences were found in regions within and beyond the networks. Focusing on V1, in the control group we identified the expected pattern of a distributed connectivity along eccentricity, with foveal regions showing stronger connectivity to the FPN and peripheral regions showing stronger connectivity to the DMN. However, in PCA patients we could not identify a clear difference in connectivity along the eccentricities. CONCLUSION Lost specialization of function along the calcarine in PCA patients may have further implications on large-scale networks or vice versa. This impairment, distant from the core pathology, might explain patients' visual disabilities.
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Affiliation(s)
- Atira Bick
- fMRI unit, Neurology department, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ayelet McKyton
- fMRI unit, Neurology department, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Haya Glick-Shames
- fMRI unit, Neurology department, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Netaniel Rein
- fMRI unit, Neurology department, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Netta Levin
- fMRI unit, Neurology department, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
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9
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Aiba I, Hayashi Y, Shimohata T, Yoshida M, Saito Y, Wakabayashi K, Komori T, Hasegawa M, Ikeuchi T, Tokumaru AM, Sakurai K, Murayama S, Hasegawa K, Uchihara T, Toyoshima Y, Saito Y, Yabe I, Tanikawa S, Sugaya K, Hayashi K, Sano T, Takao M, Sakai M, Fujimura H, Takigawa H, Adachi T, Hanajima R, Yokota O, Miki T, Iwasaki Y, Kobayashi M, Arai N, Ohkubo T, Yokota T, Mori K, Ito M, Ishida C, Tanaka M, Idezuka J, Kanazawa M, Aoki K, Aoki M, Hasegawa T, Watanabe H, Hashizume A, Niwa H, Yasui K, Ito K, Washimi Y, Mukai E, Kubota A, Toda T, Nakashima K. Clinical course of pathologically confirmed corticobasal degeneration and corticobasal syndrome. Brain Commun 2023; 5:fcad296. [PMID: 38090279 PMCID: PMC10715783 DOI: 10.1093/braincomms/fcad296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/01/2023] [Accepted: 11/02/2023] [Indexed: 12/28/2023] Open
Abstract
The clinical presentation of corticobasal degeneration is diverse, while the background pathology of corticobasal syndrome is also heterogeneous. Therefore, predicting the pathological background of corticobasal syndrome is extremely difficult. Herein, we investigated the clinical findings and course in patients with pathologically, genetically and biochemically verified corticobasal degeneration and corticobasal syndrome with background pathology to determine findings suggestive of background disorder. Thirty-two patients were identified as having corticobasal degeneration. The median intervals from the initial symptoms to the onset of key milestones were as follows: gait disturbance, 0.0 year; behavioural changes, 1.0 year; falls, 2.0 years; cognitive impairment, 2.0 years; speech impairment, 2.5 years; supranuclear gaze palsy, 3.0 years; urinary incontinence, 3.0 years; and dysphagia, 5.0 years. The median survival time was 7.0 years; 50% of corticobasal degeneration was diagnosed as corticobasal degeneration/corticobasal syndrome at the final presentation. Background pathologies of corticobasal syndrome (n = 48) included corticobasal degeneration (33.3%), progressive supranuclear palsy (29.2%) and Alzheimer's disease (12.5%). The common course of corticobasal syndrome was initial gait disturbance and early fall. In addition, corticobasal degeneration-corticobasal syndrome manifested behavioural change (2.5 years) and cognitive impairment (3.0 years), as the patient with progressive supranuclear palsy-corticobasal syndrome developed speech impairment (1.0 years) and supranuclear gaze palsy (6.0 years). The Alzheimer's disease-corticobasal syndrome patients showed cognitive impairment (1.0 years). The frequency of frozen gait at onset was higher in the corticobasal degeneration-corticobasal syndrome group than in the progressive supranuclear palsy-corticobasal syndrome group [P = 0.005, odds ratio (95% confidence interval): 31.67 (1.46-685.34)]. Dysarthria at presentation was higher in progressive supranuclear palsy-corticobasal syndrome than in corticobasal degeneration-corticobasal syndrome [P = 0.047, 6.75 (1.16-39.20)]. Pyramidal sign at presentation and personality change during the entire course were higher in Alzheimer's disease-corticobasal syndrome than in progressive supranuclear palsy-corticobasal syndrome [P = 0.011, 27.44 (1.25-601.61), and P = 0.013, 40.00 (1.98-807.14), respectively]. In corticobasal syndrome, decision tree analysis revealed that 'freezing at onset' or 'no dysarthria at presentation and age at onset under 66 years in the case without freezing at onset' predicted corticobasal degeneration pathology with a sensitivity of 81.3% and specificity of 84.4%. 'Dysarthria at presentation and age at onset over 61 years' suggested progressive supranuclear palsy pathology, and 'pyramidal sign at presentation and personality change during the entire course' implied Alzheimer's disease pathology. In conclusion, frozen gait at onset, dysarthria, personality change and pyramidal signs may be useful clinical signs for predicting background pathologies in corticobasal syndrome.
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Affiliation(s)
- Ikuko Aiba
- Department of Neurology, NHO Higashinagoya National Hospital, Nagoya, Aichi 465-8620, Japan
| | - Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
| | - Yuko Saito
- Department of Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo 173-0015, Japan
- Department of Pathology and Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Koichi Wakabayashi
- Department of Neuropathology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo 183-0042, Japan
| | - Masato Hasegawa
- Department of Brain & Neurosciences, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo 156-8506, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Chuo, Niigata 951-8585, Japan
| | - Aya M Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo 173-0015, Japan
| | - Keita Sakurai
- Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Shigeo Murayama
- Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, United Graduate School of Child Development, Osaka University, Suita, Osaka 565-0871, Japan
- Department of Neurology and Neuropathology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo 173-0015, Japan
| | - Kazuko Hasegawa
- Department of Neurology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa 252-0392, Japan
| | - Toshiki Uchihara
- Neurology Clinic with Neuromorphomics Laboratory, Nitobe-Memorial Nakano General Hospital, Nakano, Tokyo 164-8607, Japan
- Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo 156-8506, Japan
| | - Yasuko Toyoshima
- Department of Neurology, Brain Disease Center Agano Hospital, Agano, Niigata 959-2221, Japan
- Department of Pathology, Brain Research Institute, Niigata University, Chuo, Niigata 951-8585, Japan
| | - Yufuko Saito
- Department of Neurology, NHO Higashinagoya National Hospital, Nagoya, Aichi 465-8620, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Satoshi Tanikawa
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Hokkaido 001-0021, Japan
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo 183-0042, Japan
| | - Kentaro Hayashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo 183-0042, Japan
| | - Terunori Sano
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Masaki Takao
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Motoko Sakai
- Department of Neurology, NHO Suzuka National Hospital, Suzuka, Mie 513-8501, Japan
| | - Harutoshi Fujimura
- Department of Neurology, NHO Osaka Toneyama Medical Center, Toyonaka, Osaka 560-8552, Japan
| | - Hiroshi Takigawa
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Tadashi Adachi
- Division of Neuropathology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Ritsuko Hanajima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Osamu Yokota
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Okayama 714-0071, Japan
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita, Okayama 700-8558, Japan
| | - Tomoko Miki
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Okayama 714-0071, Japan
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita, Okayama 700-8558, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
| | - Michio Kobayashi
- Department of Neurology, NHO Akita National Hospital, Yurihonjo, Akita 018-1393, Japan
| | - Nobutaka Arai
- Laboratory of Neuropathology, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo 156-8506, Japan
| | - Takuya Ohkubo
- Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo 113-8519, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo 113-8519, Japan
| | - Keiko Mori
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Mie 512-1111, Japan
| | - Masumi Ito
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Mie 512-1111, Japan
| | - Chiho Ishida
- Department of Neurology, NHO Iou National Hospital, Kanazawa, Ishikawa 920-0192, Japan
| | - Masaharu Tanaka
- Department of Psychiatry, Mishima Hospital, Nagaoka, Niigata 940-2302, Japan
| | - Jiro Idezuka
- Department of Neurology, Ojiya Sakura Hospital, Ojiya, Niigata 947-0041, Japan
| | - Masato Kanazawa
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Chuo, Niigata 951-8585, Japan
| | - Kenju Aoki
- Department of Neurology, Brain Disease Center Agano Hospital, Agano, Niigata 959-2221, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Atsushi Hashizume
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
| | - Hisayoshi Niwa
- Department of Neurology, Kariya Toyota General Hospital, Kariya, Aichi 448-8505, Japan
| | - Keizo Yasui
- Department of Neurology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi 466-8650, Japan
| | - Keita Ito
- Department of Neurology, Hekinan Municipal Hospital, Hekinan, Aichi 447-8502, Japan
| | - Yukihiko Washimi
- Department of Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Eiichiro Mukai
- Department of Neurology, Aichi-pref Saiseikai Rehabilitation Hospital, Nagoya, Aichi 451-0052, Japan
| | - Akatsuki Kubota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo 113-8655, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo 113-8655, Japan
| | - Kenji Nakashima
- Department of Neurology, NHO Matsue Medical Center, Matsue, Shimane 690-8556, Japan
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10
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Llibre-Guerra JJ, Iaccarino L, Coble D, Edwards L, Li Y, McDade E, Strom A, Gordon B, Mundada N, Schindler SE, Tsoy E, Ma Y, Lu R, Fagan AM, Benzinger TLS, Soleimani-Meigooni D, Aschenbrenner AJ, Miller Z, Wang G, Kramer JH, Hassenstab J, Rosen HJ, Morris JC, Miller BL, Xiong C, Perrin RJ, Allegri R, Chrem P, Surace E, Berman SB, Chhatwal J, Masters CL, Farlow MR, Jucker M, Levin J, Fox NC, Day G, Gorno-Tempini ML, Boxer AL, La Joie R, Rabinovici GD, Bateman R. Longitudinal clinical, cognitive and biomarker profiles in dominantly inherited versus sporadic early-onset Alzheimer's disease. Brain Commun 2023; 5:fcad280. [PMID: 37942088 PMCID: PMC10629466 DOI: 10.1093/braincomms/fcad280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/02/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
Approximately 5% of Alzheimer's disease cases have an early age at onset (<65 years), with 5-10% of these cases attributed to dominantly inherited mutations and the remainder considered as sporadic. The extent to which dominantly inherited and sporadic early-onset Alzheimer's disease overlap is unknown. In this study, we explored the clinical, cognitive and biomarker profiles of early-onset Alzheimer's disease, focusing on commonalities and distinctions between dominantly inherited and sporadic cases. Our analysis included 117 participants with dominantly inherited Alzheimer's disease enrolled in the Dominantly Inherited Alzheimer Network and 118 individuals with sporadic early-onset Alzheimer's disease enrolled at the University of California San Francisco Alzheimer's Disease Research Center. Baseline differences in clinical and biomarker profiles between both groups were compared using t-tests. Differences in the rates of decline were compared using linear mixed-effects models. Individuals with dominantly inherited Alzheimer's disease exhibited an earlier age-at-symptom onset compared with the sporadic group [43.4 (SD ± 8.5) years versus 54.8 (SD ± 5.0) years, respectively, P < 0.001]. Sporadic cases showed a higher frequency of atypical clinical presentations relative to dominantly inherited (56.8% versus 8.5%, respectively) and a higher frequency of APOE-ε4 (50.0% versus 28.2%, P = 0.001). Compared with sporadic early onset, motor manifestations were higher in the dominantly inherited cohort [32.5% versus 16.9% at baseline (P = 0.006) and 46.1% versus 25.4% at last visit (P = 0.001)]. At baseline, the sporadic early-onset group performed worse on category fluency (P < 0.001), Trail Making Test Part B (P < 0.001) and digit span (P < 0.001). Longitudinally, both groups demonstrated similar rates of cognitive and functional decline in the early stages. After 10 years from symptom onset, dominantly inherited participants experienced a greater decline as measured by Clinical Dementia Rating Sum of Boxes [3.63 versus 1.82 points (P = 0.035)]. CSF amyloid beta-42 levels were comparable [244 (SD ± 39.3) pg/ml dominantly inherited versus 296 (SD ± 24.8) pg/ml sporadic early onset, P = 0.06]. CSF phosphorylated tau at threonine 181 levels were higher in the dominantly inherited Alzheimer's disease cohort (87.3 versus 59.7 pg/ml, P = 0.005), but no significant differences were found for t-tau levels (P = 0.35). In summary, sporadic and inherited Alzheimer's disease differed in baseline profiles; sporadic early onset is best distinguished from dominantly inherited by later age at onset, high frequency of atypical clinical presentations and worse executive performance at baseline. Despite these differences, shared pathways in longitudinal clinical decline and CSF biomarkers suggest potential common therapeutic targets for both populations, offering valuable insights for future research and clinical trial design.
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Affiliation(s)
| | - Leonardo Iaccarino
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Dean Coble
- Division of Biostatistics, Washington University in St Louis, St Louis, MO 63108, USA
| | - Lauren Edwards
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Yan Li
- Division of Biostatistics, Washington University in St Louis, St Louis, MO 63108, USA
| | - Eric McDade
- Department of Neurology, Washington University in St Louis, St Louis, MO 63108, USA
| | - Amelia Strom
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Brian Gordon
- Malinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63108, USA
| | - Nidhi Mundada
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Suzanne E Schindler
- Department of Neurology, Washington University in St Louis, St Louis, MO 63108, USA
| | - Elena Tsoy
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Yinjiao Ma
- Division of Biostatistics, Washington University in St Louis, St Louis, MO 63108, USA
| | - Ruijin Lu
- Division of Biostatistics, Washington University in St Louis, St Louis, MO 63108, USA
| | - Anne M Fagan
- Department of Neurology, Washington University in St Louis, St Louis, MO 63108, USA
| | - Tammie L S Benzinger
- Malinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63108, USA
| | - David Soleimani-Meigooni
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | | | - Zachary Miller
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Guoqiao Wang
- Division of Biostatistics, Washington University in St Louis, St Louis, MO 63108, USA
| | - Joel H Kramer
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Jason Hassenstab
- Department of Neurology, Washington University in St Louis, St Louis, MO 63108, USA
| | - Howard J Rosen
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - John C Morris
- Department of Neurology, Washington University in St Louis, St Louis, MO 63108, USA
| | - Bruce L Miller
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Chengjie Xiong
- Division of Biostatistics, Washington University in St Louis, St Louis, MO 63108, USA
| | - Richard J Perrin
- Department of Neurology, Washington University in St Louis, St Louis, MO 63108, USA
- Department of Pathology and Immunology, Washington University in St Louis, St. Louis, MO 63108, USA
| | - Ricardo Allegri
- Department of Cognitive Neurology, Institute for Neurological Research Fleni, Buenos Aires, Argentina
| | - Patricio Chrem
- Department of Cognitive Neurology, Institute for Neurological Research Fleni, Buenos Aires, Argentina
| | - Ezequiel Surace
- Department of Cognitive Neurology, Institute for Neurological Research Fleni, Buenos Aires, Argentina
| | - Sarah B Berman
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jasmeer Chhatwal
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Colin L Masters
- Florey Institute, The University of Melbourne, Melbourne 3052, Australia
| | - Martin R Farlow
- Neuroscience Center, Indiana University School of Medicine at Indianapolis, IN 46202, USA
| | - Mathias Jucker
- DZNE-German Center for Neurodegenerative Diseases, Tübingen 72076, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen 72076, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-University, Munich 80539, Germany
- German Center for Neurodegenerative Diseases, Munich 81377, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich 81377, Germany
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Institute of Neurology, London WC1N 3BG, UK
| | - Gregory Day
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL 33224, USA
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Adam L Boxer
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Renaud La Joie
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Gil D Rabinovici
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Randall Bateman
- Department of Neurology, Washington University in St Louis, St Louis, MO 63108, USA
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11
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Komatsu T, Takahashi M, Omoto S, Iguchi Y. Asymmetric focal cortical atrophy in CSF1R-related leukoencephalopathy; case report. Acta Neurol Belg 2023; 123:2001-2003. [PMID: 35980505 DOI: 10.1007/s13760-022-02065-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/10/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Teppei Komatsu
- Department of Neurology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Maki Takahashi
- Department of Neurology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shusaku Omoto
- Department of Neurology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
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12
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Collins JD, Henley SMD, Suárez-González A. A systematic review of the prevalence of depression, anxiety, and apathy in frontotemporal dementia, atypical and young-onset Alzheimer's disease, and inherited dementia. Int Psychogeriatr 2023; 35:457-476. [PMID: 32684177 DOI: 10.1017/s1041610220001118] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Depression, anxiety, and apathy are the most commonly reported neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD). Understanding their prevalence in rarer dementias such as frontotemporal dementia (FTD), primary progressive aphasia (PPA), posterior cortical atrophy (PCA), young-onset AD (YOAD), and inherited dementias has implications for both clinical practice and research. In this study, we aimed to examine the current state of knowledge of the prevalence of these three NPS in less prevalent dementias. DESIGN We conducted a systematic review based on searches of EMBASE, PsycINFO, and PubMed up to September 2019. RESULTS 47 articles meeting inclusion criteria were identified. Depression, anxiety, and apathy were commonly reported across the phenotypes studied but their prevalence showed large variation between studies. Apathy showed the highest reported frequency in FTD (50-100% across studies), behavioral variant frontotemporal dementia (bvFTD) (73-100%), and YOAD (44-100%). Anxiety was frequently reported in FTD (0-100%) and bvFTD (19-63%). Depression showed the highest prevalence in FTD (7-69%) and YOAD (11-55%). Among the three variants of PPA, sv-PPA is the one most investigated (seven articles). Three or fewer articles were identified examining NPS in the remaining PPA variants, PCA, familial AD, and familial FTD. Inconsistency in the tools used to measure symptoms and small sample sizes were common methodological limitations. CONCLUSIONS Future studies should consider the inclusion of larger sample sizes (e.g. through multicenter collaborations) and the use of harmonized protocols that include the combination of caregiver and patient-derived measures and symptom-specific questionnaires. More research is needed on the phenotype-specific barriers and facilitators for people living with dementia to successfully engage in self-reports of NPS.
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Affiliation(s)
- Jessica D Collins
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Susie M D Henley
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Aida Suárez-González
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
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13
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Ray NR, Ayodele T, Jean-Francois M, Baez P, Fernandez V, Bradley J, Crane PK, Dalgard CL, Kuzma A, Nicaretta H, Sims R, Williams J, Cuccaro ML, Pericak-Vance MA, Mayeux R, Wang LS, Schellenberg GD, Cruchaga C, Beecham GW, Reitz C. The Early-Onset Alzheimer's Disease Whole-Genome Sequencing Project: Study design and methodology. Alzheimers Dement 2023; 19:4187-4195. [PMID: 37390458 PMCID: PMC10527497 DOI: 10.1002/alz.13370] [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] [Received: 02/07/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Sequencing efforts to identify genetic variants and pathways underlying Alzheimer's disease (AD) have largely focused on late-onset AD although early-onset AD (EOAD), accounting for ∼10% of cases, is largely unexplained by known mutations, resulting in a lack of understanding of its molecular etiology. METHODS Whole-genome sequencing and harmonization of clinical, neuropathological, and biomarker data of over 5000 EOAD cases of diverse ancestries. RESULTS A publicly available genomics resource for EOAD with extensive harmonized phenotypes. Primary analysis will (1) identify novel EOAD risk loci and druggable targets; (2) assess local-ancestry effects; (3) create EOAD prediction models; and (4) assess genetic overlap with cardiovascular and other traits. DISCUSSION This novel resource complements over 50,000 control and late-onset AD samples generated through the Alzheimer's Disease Sequencing Project (ADSP). The harmonized EOAD/ADSP joint call will be available through upcoming ADSP data releases and will allow for additional analyses across the full onset range. HIGHLIGHTS Sequencing efforts to identify genetic variants and pathways underlying Alzheimer's disease (AD) have largely focused on late-onset AD although early-onset AD (EOAD), accounting for ∼10% of cases, is largely unexplained by known mutations. This results in a significant lack of understanding of the molecular etiology of this devastating form of the disease. The Early-Onset Alzheimer's Disease Whole-genome Sequencing Project is a collaborative initiative to generate a large-scale genomics resource for early-onset Alzheimer's disease with extensive harmonized phenotype data. Primary analyses are designed to (1) identify novel EOAD risk and protective loci and druggable targets; (2) assess local-ancestry effects; (3) create EOAD prediction models; and (4) assess genetic overlap with cardiovascular and other traits. The harmonized genomic and phenotypic data from this initiative will be available through NIAGADS.
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Affiliation(s)
- Nicholas R. Ray
- Gertrude H. Sergievsky Center, Columbia University, New
York, NY 10032, USA
- Taub Institute for Research on Alzheimer’s Disease
and the Aging Brain, Columbia University, New York, NY 10032, USA
| | - Temitope Ayodele
- Gertrude H. Sergievsky Center, Columbia University, New
York, NY 10032, USA
| | - Melissa Jean-Francois
- The John P. Hussman Institute for Human Genomics,
University of Miami, Miami, FL 33136, USA
- Dr. John T. MacDonald Foundation Department of Human
Genetics, University of Miami, Coral Gables, FL 33146, USA
| | - Penelope Baez
- Gertrude H. Sergievsky Center, Columbia University, New
York, NY 10032, USA
| | - Victoria Fernandez
- Department of Psychiatry, Neurology and Genetics,
Washington University School of Medicine, St. Louis, MO 63130, USA
- Neurogenomics and Informatic (NGI) Center, Washington
University School of Medicine, St. Louis, MO 63130, USA
| | - Joseph Bradley
- Department of Psychiatry, Neurology and Genetics,
Washington University School of Medicine, St. Louis, MO 63130, USA
- Neurogenomics and Informatic (NGI) Center, Washington
University School of Medicine, St. Louis, MO 63130, USA
| | - Paul K. Crane
- Division of General Internal Medicine, University of
Washington, Seattle, WA 98195, USA
| | - Clifton L. Dalgard
- Department of Anatomy, Physiology & Genetics,
Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- The American Genome Center, Uniformed Services University
of the Health Sciences, Bethesda, MD 20814, USA
| | - Amanda Kuzma
- Penn Neurodegeneration Genomics Center, Department of
Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of
Medicine, Philadelphia, PA 19104, USA
| | - Heather Nicaretta
- Penn Neurodegeneration Genomics Center, Department of
Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of
Medicine, Philadelphia, PA 19104, USA
| | - Rebecca Sims
- Division of Psychological Medicine and Clinical
Neurosciences, School of Medicine, Cardiff University, Cardiff CF10 3AT, UK
| | - Julie Williams
- UK Dementia Research Institute, Cardiff University,
Cardiff CF10 3AT, UK
- Division of Psychological Medicine and Clinical
Neurosciences, School of Medicine, Cardiff University, Cardiff CF10 3AT, UK
| | - Michael L. Cuccaro
- The John P. Hussman Institute for Human Genomics,
University of Miami, Miami, FL 33136, USA
- Dr. John T. MacDonald Foundation Department of Human
Genetics, University of Miami, Coral Gables, FL 33146, USA
| | - Margaret A. Pericak-Vance
- The John P. Hussman Institute for Human Genomics,
University of Miami, Miami, FL 33136, USA
- Dr. John T. MacDonald Foundation Department of Human
Genetics, University of Miami, Coral Gables, FL 33146, USA
| | - Richard Mayeux
- Gertrude H. Sergievsky Center, Columbia University, New
York, NY 10032, USA
- Taub Institute for Research on Alzheimer’s Disease
and the Aging Brain, Columbia University, New York, NY 10032, USA
- Department of Neurology, Columbia University, New York, NY
10032, USA
- Department of Epidemiology, Columbia University, New York,
NY 10032, USA
| | - Li-San Wang
- Penn Neurodegeneration Genomics Center, Department of
Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of
Medicine, Philadelphia, PA 19104, USA
| | - Gerard D. Schellenberg
- Penn Neurodegeneration Genomics Center, Department of
Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of
Medicine, Philadelphia, PA 19104, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Neurology and Genetics,
Washington University School of Medicine, St. Louis, MO 63130, USA
- Neurogenomics and Informatic (NGI) Center, Washington
University School of Medicine, St. Louis, MO 63130, USA
| | - Gary W. Beecham
- The John P. Hussman Institute for Human Genomics,
University of Miami, Miami, FL 33136, USA
- Dr. John T. MacDonald Foundation Department of Human
Genetics, University of Miami, Coral Gables, FL 33146, USA
| | - Christiane Reitz
- Gertrude H. Sergievsky Center, Columbia University, New
York, NY 10032, USA
- Taub Institute for Research on Alzheimer’s Disease
and the Aging Brain, Columbia University, New York, NY 10032, USA
- Department of Neurology, Columbia University, New York, NY
10032, USA
- Department of Epidemiology, Columbia University, New York,
NY 10032, USA
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14
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Donato L, Mordà D, Scimone C, Alibrandi S, D'Angelo R, Sidoti A. How Many Alzheimer-Perusini's Atypical Forms Do We Still Have to Discover? Biomedicines 2023; 11:2035. [PMID: 37509674 PMCID: PMC10377159 DOI: 10.3390/biomedicines11072035] [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] [Received: 06/28/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Alzheimer-Perusini's (AD) disease represents the most spread dementia around the world and constitutes a serious problem for public health. It was first described by the two physicians from whom it took its name. Nowadays, we have extensively expanded our knowledge about this disease. Starting from a merely clinical and histopathologic description, we have now reached better molecular comprehension. For instance, we passed from an old conceptualization of the disease based on plaques and tangles to a more modern vision of mixed proteinopathy in a one-to-one relationship with an alteration of specific glial and neuronal phenotypes. However, no disease-modifying therapies are yet available. It is likely that the only way to find a few "magic bullets" is to deepen this aspect more and more until we are able to draw up specific molecular profiles for single AD cases. This review reports the most recent classifications of AD atypical variants in order to summarize all the clinical evidence using several discrimina (for example, post mortem neurofibrillary tangle density, cerebral atrophy, or FDG-PET studies). The better defined four atypical forms are posterior cortical atrophy (PCA), logopenic variant of primary progressive aphasia (LvPPA), behavioral/dysexecutive variant and AD with corticobasal degeneration (CBS). Moreover, we discuss the usefulness of such classifications before outlining the molecular-genetic aspects focusing on microglial activity or, more generally, immune system control of neuroinflammation and neurodegeneration.
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Affiliation(s)
- Luigi Donato
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Department of Biomolecular Strategies, Genetics, Cutting-Edge Therapies, Euro-Mediterranean Institute of Science and Technology, Via Michele Miraglia, 98139 Palermo, Italy
| | - Domenico Mordà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Department of Biomolecular Strategies, Genetics, Cutting-Edge Therapies, Euro-Mediterranean Institute of Science and Technology, Via Michele Miraglia, 98139 Palermo, Italy
| | - Concetta Scimone
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Department of Biomolecular Strategies, Genetics, Cutting-Edge Therapies, Euro-Mediterranean Institute of Science and Technology, Via Michele Miraglia, 98139 Palermo, Italy
| | - Simona Alibrandi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres 31, 98166 Messina, Italy
| | - Rosalia D'Angelo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Antonina Sidoti
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
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15
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Semenkova A, Piguet O, Johnen A, Schroeter ML, Godulla J, Linnemann C, Mühlhauser M, Sauer T, Baumgartner M, Anderl-Straub S, Otto M, Felbecker A, Kressig RW, Berres M, Sollberger M. The Behavioural Dysfunction Questionnaire discriminates behavioural variant frontotemporal dementia from Alzheimer's disease dementia and major depressive disorder. J Neurol 2023:10.1007/s00415-023-11666-6. [PMID: 36952011 DOI: 10.1007/s00415-023-11666-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Early-stage behavioural variant frontotemporal dementia (bvFTD) is often misdiagnosed, highlighting the need for new diagnostic instruments. Based on the revised diagnostic criteria for bvFTD, we developed the Behavioural Dysfunction Questionnaire (BDQ). In this explorative study, we aimed to determine the best scoring and analytical method for the BDQ to discriminate between bvFTD and non-bvFTD patients. MATERIALS AND METHODS 34 patients with early-stage bvFTD, 56 with early-stage Alzheimer's disease dementia (ADD) and 41 with major depressive disorder (MDD) were recruited. We calculated BDQ-items with or without inclusion of a time criterion: (a) without time criterion, (b) with 10 years' time criterion (symptom presence less than 10 years), and (c) with 3 years' time criterion (symptom presentation within the first 3 years). Using these three differently calculated items, we generated six variables, i.e. 3*2 [BDQ-Global Score (BDQ-GS; domains average score); BDQ-Global Domain Score (BDQ-GDS; domains categorical score)]. Then, we performed univariate and bivariate (BDQ-GS and BDQ-GDS combined) ROC analyses. RESULTS Models including BDQ-GS, BDQ-GDS or both variables combined discriminated similarly between groups. In contrast, models without time criterion or with 10 years' time criterion discriminated better than models including variables with 3 years' time criterion. These models discriminated highly (AUC = 85.98-87.78) between bvFTD and MDD and bvFTD and ADD, respectively. CONCLUSION BDQ-scores without any time criterion discriminated highly between early-stage bvFTD and non-bvFTD groups, which could improve the early diagnosis of bvFTD. With its standardised procedure, the BDQ is also appropriate for repeated assessments.
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Affiliation(s)
- Anna Semenkova
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Olivier Piguet
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Andreas Johnen
- Clinic for Neurology, Münster University Hospital, Münster, Germany
| | - Matthias L Schroeter
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Jannis Godulla
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | | | - Thomas Sauer
- University Psychiatric Clinic, Basel, Switzerland
| | | | | | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
- Department of Neurology, University Hospital Halle, Halle, Germany
| | - Ansgar Felbecker
- Clinic of Neurology und Neurophysiology, Canton Hospital St. Gallen, St. Gallen, Switzerland
| | - Reto W Kressig
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Manfred Berres
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Koblenz, Germany
| | - Marc Sollberger
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland.
- Department of Neurology, University Hospital Basel, Basel, Switzerland.
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16
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Kopel J, Sehar U, Choudhury M, Reddy PH. Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias in African Americans: Focus on Caregivers. Healthcare (Basel) 2023; 11:healthcare11060868. [PMID: 36981525 PMCID: PMC10048201 DOI: 10.3390/healthcare11060868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
Alzheimer’s disease (AD) and Alzheimer’s Disease-Related Dementias (ADRD) are chronic illnesses that are highly prevalent in African Americans (AA). AD and ADRD are caused by multiple factors, such as genetic mutations, modifiable and non-modifiable risk factors, and lifestyle. Histopathological, morphological, and cellular studies revealed how multiple cellular changes are implicated in AD and ADRD, including synaptic damage, inflammatory responses, hormonal imbalance, mitochondrial abnormalities, and neuronal loss, in addition to the accumulation of amyloid beta and phosphorylated tau in the brain. The contributions of race, ethnicity, location and socioeconomic status all have a significant impact on the care and support services available to dementia patients. Furthermore, disparities in health care are entangled with social, economic, and environmental variables that perpetuate disadvantages among different groups, particularly African Americans. As such, it remains important to understand how various racial and ethnic groups perceive, access, and experience health care. Considering that the mounting data shows AA may be more susceptible to AD than white people, the demographic transition creates significant hurdles in providing adequate care from family caregivers. Furthermore, there is growing recognition that AD and ADRD pose a significant stress on AA caregivers compared to white people. In this review, we examine the current literature on racial disparities in AD and ADRD, particularly concerning AA caregivers.
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Affiliation(s)
- Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Moumita Choudhury
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P. Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
- Correspondence: ; Tel.: +1-806-743-3194
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17
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Best J, Chapleau M, Rabinovici GD. Posterior cortical atrophy: clinical, neuroimaging, and neuropathological features. Expert Rev Neurother 2023; 23:227-236. [PMID: 36920752 DOI: 10.1080/14737175.2023.2190885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Posterior Cortical Atrophy (PCA) is a neurodegenerative disorder characterized by impairment of higher-order visual processing in the setting of progressive atrophy of the parietal and occipital lobes. The underlying pathology is variable but most commonly Alzheimer's disease. The majority of individuals develop symptoms before 65 years of age; however, delayed diagnosis is common due to misattribution of symptoms to ocular rather than cortical pathology. AREAS COVERED The purpose of this review is to provide readers with an in-depth analysis of Posterior Cortical Atrophy syndrome, including clinical, imaging, pathological, and genetic features, management, and treatments. EXPERT OPINION Most patients present initially with a relatively pure visuoperceptual-visuospatial syndrome, though other cognitive domains become affected over time. Structural neuroimaging demonstrates parieto-occipital or temporo-occipital predominant atrophy. Cerebrospinal fluid Alzheimer's disease biomarkers, or amyloid/tau PET imaging can help evaluate for underlying Alzheimer's disease, which is the most common underlying neuropathology. The cornerstone of management is focused on nonpharmacologic measures. Early etiologic diagnosis is important with the arrival of disease-modifying therapies, especially for Alzheimer's disease.
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Affiliation(s)
- John Best
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Marianne Chapleau
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA.,Departments of Neurology, Radiology & Biomedical Imaging, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
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18
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Yong KXX, Graff-Radford J, Ahmed S, Chapleau M, Ossenkoppele R, Putcha D, Rabinovici GD, Suarez-Gonzalez A, Schott JM, Crutch S, Harding E. Diagnosis and Management of Posterior Cortical Atrophy. Curr Treat Options Neurol 2023; 25:23-43. [PMID: 36820004 PMCID: PMC9935654 DOI: 10.1007/s11940-022-00745-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 02/10/2023]
Abstract
Purpose of review The study aims to provide a summary of recent developments for diagnosing and managing posterior cortical atrophy (PCA). We present current efforts to improve PCA characterisation and recommendations regarding use of clinical, neuropsychological and biomarker methods in PCA diagnosis and management and highlight current knowledge gaps. Recent findings Recent multi-centre consensus recommendations provide PCA criteria with implications for different management strategies (e.g. targeting clinical features and/or disease). Studies emphasise the preponderance of primary or co-existing Alzheimer's disease (AD) pathology underpinning PCA. Evidence of approaches to manage PCA symptoms is largely derived from small studies. Summary PCA diagnosis is frequently delayed, and people are likely to receive misdiagnoses of ocular or psychological conditions. Current treatment of PCA is symptomatic - pharmacological and non-pharmacological - and the use of most treatment options is based on small studies or expert opinion. Recommendations for non-pharmacological approaches include interdisciplinary management tailored to the PCA clinical profile - visual-spatial - rather than memory-led, predominantly young onset - and psychosocial implications. Whilst emerging disease-modifying treatments have not been tested in PCA, an accurate and timely diagnosis of PCA and determining underlying pathology is of increasing importance in the advent of disease-modifying therapies for AD and other albeit rare causes of PCA.
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Affiliation(s)
- Keir X. X. Yong
- Dementia Research Centre, UCL Queen Square Institute of Neurology, Box 16, Queen Square, London, WC1N 3BG UK
| | | | - Samrah Ahmed
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire UK
| | - Marianne Chapleau
- Memory and Aging Center, University of California San Francisco, San Francisco, CA USA
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Netherlands
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Deepti Putcha
- Frontotemporal Disorders Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Gil D. Rabinovici
- Department of Neurology, Radiology, and Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - Aida Suarez-Gonzalez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, Box 16, Queen Square, London, WC1N 3BG UK
| | - Jonathan M. Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, Box 16, Queen Square, London, WC1N 3BG UK
| | - Sebastian Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, Box 16, Queen Square, London, WC1N 3BG UK
| | - Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, Box 16, Queen Square, London, WC1N 3BG UK
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19
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Ishihara K, Fukui T, Kawamura M, Shiota JI, Nakano I. Symptomatology and Neuropathology of patients presenting with focal cortical signs. Neuropathology 2023; 43:27-43. [PMID: 36328774 DOI: 10.1111/neup.12854] [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] [Received: 03/22/2022] [Revised: 06/05/2022] [Accepted: 07/10/2022] [Indexed: 11/06/2022]
Abstract
Here, we describe two patients who presented with focal cortical signs and underwent neuropathological examination. Case 1 was a 73-year-old woman with progressive speech disorder and abnormal behavior. She showed agraphia of the frontal lobe type, featured by the omission of kana letters when writing, other than pyramidal tract signs, pseudobulbar palsy, and frontal lobe dementia. Neuropathological examination, including TAR DNA-binding protein 43 (TDP-43) immunohistochemistry, revealed bilateral frontal and anterior temporal lobe lesions accentuated in the precentral gyrus and posterior part of the middle frontal gyrus. Both upper and lower motor neurons showed pathological changes compatible with amyotrophic lateral sclerosis. Case 2 was a 62-year-old man with progressive speech disorder and hand clumsiness. He had a motor speech disorder, compatible with apraxia of speech, and limb apraxia of the limb-kinetic and ideomotor type. Neuropathological examination revealed degeneration in the left frontal lobe, including the precentral gyrus, anterior temporal, and parietal lobe cortices. Moreover, numerous argyrophilic neuronal intracytoplasmic inclusions (Pick body) and ballooned neurons were observed in these lesions and the limbic system. The pathological diagnosis was Pick disease involving the peri-Rolandic area and parietal lobe. In these two cases, the distribution of neuropathological changes in the cerebral cortices correlated with the clinical symptoms observed.
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Affiliation(s)
- Kenji Ishihara
- Department of Neurology, Showa University School of Medicine, Tokyo, Japan.,Asahi Hospital of Neurology and Rehabilitation, Chiba, Japan
| | - Toshiya Fukui
- Department of Neurology, Showa University School of Medicine, Tokyo, Japan.,Kawasaki Memorial Hospital, Kawasaki, Japan
| | - Mitsuru Kawamura
- Department of Neurology, Showa University School of Medicine, Tokyo, Japan.,Okusawa Hospital, Tokyo, Japan
| | - Jun-Ichi Shiota
- Department of Neurology, Showa University School of Medicine, Tokyo, Japan.,Ushioda Home Clinic, Yokohama, Japan
| | - Imaharu Nakano
- Department of Neurology, Jichi Medical University, Tochigi, Japan
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20
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Cipriano L, Oliva M, Puoti G, Signoriello E, Bonavita S, Coppola C. Is the pathology of posterior cortical atrophy clinically predictable? Rev Neurosci 2022; 33:849-858. [PMID: 35659868 DOI: 10.1515/revneuro-2022-0003] [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: 01/14/2022] [Accepted: 04/01/2022] [Indexed: 12/14/2022]
Abstract
Posterior cortical atrophy (PCA) is a neurodegenerative disorder characterized by an early prominent deficit of visual functions associated with signs and symptoms that are the expression of dysfunction of posterior brain regions. Although PCA is commonly associated with Alzheimer's disease (AD), in recent years new pathological substrates have emerged. Among them, frontotemporal lobar degeneration (FTLD) is the most commonly reported but, to date, little is known about the clinical features of PCA due to FTLD. We conducted a systematic search in the main biomedical database MEDLINE. We searched for all clinical PCA reports that assessed the pathological basis of such syndrome with at least one of the following: (1) neuropathological examination, (2) cerebrospinal fluid biomarkers, (3) amyloid-PET imaging and (4) genetic testing. Of 369 potentially eligible studies, 40 fulfilled the inclusion criteria with an overall number of 144 patients (127 PCA-AD vs. 17 PCA-FTD/non-AD). We found that hallucinations/illusions were present in none of the probable PCA-FTD/non-AD subjects while were reported in 15 out of 97 PCA-AD individuals. Optic ataxia and Parkinsonism showed a significantly greater prevalence in probable PCA FTD/non-AD than in PCA-AD whereas myoclonus and disorientation in time and space were significantly more frequent in PCA-AD than in probable PCA FTD/non-AD. We also found a predominance of a left-side pattern of atrophy/hypometabolism in the probable PCA FTD/non-AD. Clinical features such as optic ataxia, Parkinsonism, myoclonus, hallucinations and disorientation in time and space suggest the underlying pathological basis of PCA and help in leading the diagnostic protocol consequently.
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Affiliation(s)
- Lorenzo Cipriano
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", P.zza L. Miraglia 2, 80138 Naples, Italy
| | - Mariano Oliva
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", P.zza L. Miraglia 2, 80138 Naples, Italy
| | - Gianfranco Puoti
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", P.zza L. Miraglia 2, 80138 Naples, Italy
| | - Elisabetta Signoriello
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", P.zza L. Miraglia 2, 80138 Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", P.zza L. Miraglia 2, 80138 Naples, Italy
| | - Cinzia Coppola
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", P.zza L. Miraglia 2, 80138 Naples, Italy.,Second Neurological Clinic, University of Campania "L. Vanvitelli", Isola 8, Edificio 10 Policlinico, "Federico II" via Pansini 5, 80131 Napoli, Italy
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21
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Arezoumandan S, Xie SX, Cousins KAQ, Mechanic-Hamilton DJ, Peterson CS, Huang CY, Ohm DT, Ittyerah R, McMillan CT, Wolk DA, Yushkevich P, Trojanowski JQ, Lee EB, Grossman M, Phillips JS, Irwin DJ. Regional distribution and maturation of tau pathology among phenotypic variants of Alzheimer's disease. Acta Neuropathol 2022; 144:1103-1116. [PMID: 35871112 PMCID: PMC9936795 DOI: 10.1007/s00401-022-02472-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/02/2022] [Accepted: 07/14/2022] [Indexed: 01/26/2023]
Abstract
Alzheimer's disease neuropathologic change (ADNC) is clinically heterogenous and can present with a classic multidomain amnestic syndrome or focal non-amnestic syndromes. Here, we investigated the distribution and burden of phosphorylated and C-terminally cleaved tau pathologies across hippocampal subfields and cortical regions among phenotypic variants of Alzheimer's disease (AD). In this study, autopsy-confirmed patients with ADNC, were classified into amnestic (aAD, N = 40) and non-amnestic (naAD, N = 39) groups based on clinical criteria. We performed digital assessment of tissue sections immunostained for phosphorylated-tau (AT8 detects pretangles and mature tangles), D421-truncated tau (TauC3, a marker for mature tangles and ghost tangles), and E391-truncated tau (MN423, a marker that primarily detects ghost tangles), in hippocampal subfields and three cortical regions. Linear mixed-effect models were used to test regional and group differences while adjusting for demographics. Both groups showed AT8-reactivity across hippocampal subfields that mirrored traditional Braak staging with higher burden of phosphorylated-tau in subregions implicated as affected early in Braak staging. The burden of phosphorylated-tau and TauC3-immunoreactive tau in the hippocampus was largely similar between the aAD and naAD groups. In contrast, the naAD group had lower relative distribution of MN423-reactive tangles in CA1 (β = - 0.2, SE = 0.09, p = 0.001) and CA2 (β = - 0.25, SE = 0.09, p = 0.005) compared to the aAD. While the two groups had similar levels of phosphorylated-tau pathology in cortical regions, there was higher burden of TauC3 reactivity in sup/mid temporal cortex (β = 0.16, SE = 0.07, p = 0.02) and MN423 reactivity in all cortical regions (β = 0.4-0.43, SE = 0.09, p < 0.001) in the naAD compared to aAD. In conclusion, AD clinical variants may have a signature distribution of overall phosphorylated-tau pathology within the hippocampus reflecting traditional Braak staging; however, non-amnestic AD has greater relative mature tangle pathology in the neocortex compared to patients with clinical amnestic AD, where the hippocampus had greatest relative burden of C-terminally cleaved tau reactivity. Thus, varying neuronal susceptibility to tau-mediated neurodegeneration may influence the clinical expression of ADNC.
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Affiliation(s)
- Sanaz Arezoumandan
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Katheryn A Q Cousins
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Dawn J Mechanic-Hamilton
- Department of Neurology, Penn Memory Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Neurology, Penn Alzheimer's Disease Research Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Claire S Peterson
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Camille Y Huang
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Daniel T Ohm
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Ranjit Ittyerah
- Penn Image Computing and Science Lab, Department of Radiology, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Corey T McMillan
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Neurology, Penn Alzheimer's Disease Research Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - David A Wolk
- Department of Neurology, Penn Memory Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Neurology, Penn Alzheimer's Disease Research Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Paul Yushkevich
- Department of Neurology, Penn Alzheimer's Disease Research Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Penn Image Computing and Science Lab, Department of Radiology, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - John Q Trojanowski
- Department of Neurology, Penn Alzheimer's Disease Research Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Edward B Lee
- Department of Neurology, Penn Alzheimer's Disease Research Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Jeffrey S Phillips
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - David J Irwin
- Digital Neuropathology Laboratory, Department of Neurology, Perelman School of Medicine, Philadelphia, PA, 19104, USA.
- Penn Frontotemporal Degeneration Center, Perelman School of Medicine, Philadelphia, PA, 19104, USA.
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22
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Liu KY, Thambisetty M, Howard R. How can secondary dementia prevention trials of Alzheimer's disease be clinically meaningful? Alzheimers Dement 2022; 19:10.1002/alz.12788. [PMID: 36161763 PMCID: PMC10039957 DOI: 10.1002/alz.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/06/2022] [Accepted: 08/09/2022] [Indexed: 11/08/2022]
Abstract
After clinical trial failures in symptomatic Alzheimer's disease (AD), our field has moved to earlier intervention in cognitively normal individuals with biomarker evidence of AD. This offers potential for dementia prevention, but mainly low and variable rates of progression to AD dementia reduce the usefulness of trials' data in decision making by potential prescribers. With results from several Phase 3 secondary prevention studies anticipated within the next few years and the Food and Drug Administration's recent endorsement of amyloid beta as a surrogate outcome biomarker for AD clinical trials, it is time to question the clinical significance of changes in biomarkers, adequacy of current trial durations, and criteria for treatment success if cognitively unimpaired patients and their doctors are to meaningfully evaluate the potential value of new agents. We argue for a change of direction toward trial designs that can unambiguously inform clinical decision making about dementia risk and progression.
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Affiliation(s)
- Kathy Y. Liu
- Division of Psychiatry, University College London, London, UK
| | - Madhav Thambisetty
- Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
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23
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Schilling LP, Balthazar MLF, Radanovic M, Forlenza OV, Silagi ML, Smid J, Barbosa BJAP, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Chaves MLF, Brucki SMD, Damasceno BP, Nitrini R. Diagnosis of Alzheimer’s disease: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-s102en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
ABSTRACT This paper presents the consensus of the Scientific Department of Cognitive Neurology and Aging from the Brazilian Academy of Neurology on the diagnostic criteria for Alzheimer’s disease (AD) in Brazil. The authors conducted a literature review regarding clinical and research criteria for AD diagnosis and proposed protocols for use at primary, secondary, and tertiary care levels. Within this clinical scenario, the diagnostic criteria for typical and atypical AD are presented as well as clinical, cognitive, and functional assessment tools and complementary propaedeutics with laboratory and neuroimaging tests. The use of biomarkers is also discussed for both clinical diagnosis (in specific conditions) and research.
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Affiliation(s)
- Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
| | | | | | | | - Marcela Lima Silagi
- Universidade Federal de São Paulo, Brasil; Universidade de São Paulo, Brasil
| | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brasil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
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24
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Schilling LP, Balthazar MLF, Radanovic M, Forlenza OV, Silagi ML, Smid J, Barbosa BJAP, Frota NAF, de Souza LC, Vale FAC, Caramelli P, Bertolucci PHF, Chaves MLF, Brucki SMD, Damasceno BP, Nitrini R. Diagnosis of Alzheimer's disease: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022; 16:25-39. [PMID: 36533157 PMCID: PMC9745995 DOI: 10.1590/1980-5764-dn-2022-s102pt] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/22/2021] [Accepted: 04/27/2022] [Indexed: 01/25/2023] Open
Abstract
This paper presents the consensus of the Scientific Department of Cognitive Neurology and Aging from the Brazilian Academy of Neurology on the diagnostic criteria for Alzheimer's disease (AD) in Brazil. The authors conducted a literature review regarding clinical and research criteria for AD diagnosis and proposed protocols for use at primary, secondary, and tertiary care levels. Within this clinical scenario, the diagnostic criteria for typical and atypical AD are presented as well as clinical, cognitive, and functional assessment tools and complementary propaedeutics with laboratory and neuroimaging tests. The use of biomarkers is also discussed for both clinical diagnosis (in specific conditions) and research.
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Affiliation(s)
- Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Escola de Medicina, Serviço de Neurologia, Porto Alegre RS, Brasil.,Pontifícia Universidade do Rio Grande do Sul, Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brasil.,Pontifícia Universidade do Rio Grande do Sul, Programa de Pós-Graduação em Gerontologia Biomédica, Porto Alegre RS, Brasil
| | | | - Márcia Radanovic
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Psiquiatria, Laboratório de Neurociências, São Paulo SP, Brasil
| | - Orestes Vicente Forlenza
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Psiquiatria, Laboratório de Neurociências, São Paulo SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brasil
| | - Marcela Lima Silagi
- Universidade Federal de São Paulo, Departamento de Fonoaudiologia, São Paulo SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil
| | - Jerusa Smid
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil
| | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil.,Universidade Federal de Pernambuco, Centro de Ciências Médicas, Área Acadêmica de Neuropsiquiatria, Recife PE, Brasil.,Instituto de Medicina Integral Prof. Fernando Figueira, Recife PE, Brasil
| | - Norberto Anízio Ferreira Frota
- Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza CE, Brasil.,Universidade de Fortaleza, Fortaleza CE, Brasil
| | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brasil
| | - Francisco Assis Carvalho Vale
- Universidade Federal de São Carlos, Centro de Ciências Biológicas e da Saúde, Departamento de Medicina, São Carlos SP, Brasil
| | - Paulo Caramelli
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brasil
| | | | - Márcia Lorena Fagundes Chaves
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Medicina Interna, Porto Alegre RS, Brasil
| | - Sonia Maria Dozzi Brucki
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil
| | - Benito Pereira Damasceno
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brasil
| | - Ricardo Nitrini
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil
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25
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GC-CNNnet: Diagnosis of Alzheimer’s Disease with PET Images Using Genetic and Convolutional Neural Network. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:7413081. [PMID: 35983158 PMCID: PMC9381254 DOI: 10.1155/2022/7413081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/01/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022]
Abstract
There is a wide variety of effects of Alzheimer's disease (AD), a neurodegenerative disease that can lead to cognitive decline, deterioration of daily life, and behavioral and psychological changes. A polymorphism of the ApoE gene ε 4 is considered a genetic risk factor for Alzheimer's disease. The purpose of this paper is to demonstrate that single-nucleotide polymorphic markers (SNPs) have a causal relationship with quantitative PET imaging traits. Additionally, the classification of AD is based on the frequency of brain tissue variations in PET images using a combination of k-nearest-neighbor (KNN), support vector machine (SVM), linear discrimination analysis (LDA), and convolutional neural network (CNN) techniques. According to the results, the suggested SNPs appear to be associated with quantitative traits more strongly than the SNPs in the ApoE genes. Regarding the classification result, the highest accuracy is obtained by the CNN with 91.1%. These results indicate that the KNN and CNN methods are beneficial in diagnosing AD. Nevertheless, the LDA and SVM are demonstrated with a lower level of accuracy.
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26
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Sirkis DW, Bonham LW, Johnson TP, La Joie R, Yokoyama JS. Dissecting the clinical heterogeneity of early-onset Alzheimer's disease. Mol Psychiatry 2022; 27:2674-2688. [PMID: 35393555 PMCID: PMC9156414 DOI: 10.1038/s41380-022-01531-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 12/14/2022]
Abstract
Early-onset Alzheimer's disease (EOAD) is a rare but particularly devastating form of AD. Though notable for its high degree of clinical heterogeneity, EOAD is defined by the same neuropathological hallmarks underlying the more common, late-onset form of AD. In this review, we describe the various clinical syndromes associated with EOAD, including the typical amnestic phenotype as well as atypical variants affecting visuospatial, language, executive, behavioral, and motor functions. We go on to highlight advances in fluid biomarker research and describe how molecular, structural, and functional neuroimaging can be used not only to improve EOAD diagnostic acumen but also enhance our understanding of fundamental pathobiological changes occurring years (and even decades) before the onset of symptoms. In addition, we discuss genetic variation underlying EOAD, including pathogenic variants responsible for the well-known mendelian forms of EOAD as well as variants that may increase risk for the much more common forms of EOAD that are either considered to be sporadic or lack a clear autosomal-dominant inheritance pattern. Intriguingly, specific pathogenic variants in PRNP and MAPT-genes which are more commonly associated with other neurodegenerative diseases-may provide unexpectedly important insights into the formation of AD tau pathology. Genetic analysis of the atypical clinical syndromes associated with EOAD will continue to be challenging given their rarity, but integration of fluid biomarker data, multimodal imaging, and various 'omics techniques and their application to the study of large, multicenter cohorts will enable future discoveries of fundamental mechanisms underlying the development of EOAD and its varied clinical presentations.
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Affiliation(s)
- Daniel W Sirkis
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Luke W Bonham
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 94158, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Taylor P Johnson
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Jennifer S Yokoyama
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 94158, USA.
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, 94158, USA.
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27
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Takada LT. Genetic investigation of dementias in clinical practice. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:36-41. [PMID: 35976293 PMCID: PMC9491423 DOI: 10.1590/0004-282x-anp-2022-s103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The field of neurodegenerative dementia genetics has advanced significantly over the past two decades, but there are still more to be discovered (such as the gene mutation in some familial forms of dementia). OBJECTIVE to provide a brief review of the most recent discoveries regarding monogenic dementia, and covering the most frequent genetic diseases that can cause dementia (neurodegenerative or not). METHODS a review of the literature will be carried out. RESULTS neurodegenerative dementias, vascular dementias and leukoencephalopathies caused by single pathogenic variants are presented. CONCLUSION The spectrum of clinical presentations for most of the genes discussed is wide, and hence genetic testing in clinic should try to cover as many genes as possible.
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Affiliation(s)
- Leonel Tadao Takada
- , Faculdade de Medicina, Hospital das Clinicas, Divisão de Clínica Neurológica, São Paulo SP, Brazil
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28
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Tisdall MD, Ohm DT, Lobrovich R, Das SR, Mizsei G, Prabhakaran K, Ittyerah R, Lim S, McMillan CT, Wolk DA, Gee J, Trojanowski JQ, Lee EB, Detre JA, Yushkevich P, Grossman M, Irwin DJ. Ex vivo MRI and histopathology detect novel iron-rich cortical inflammation in frontotemporal lobar degeneration with tau versus TDP-43 pathology. Neuroimage Clin 2022; 33:102913. [PMID: 34952351 PMCID: PMC8715243 DOI: 10.1016/j.nicl.2021.102913] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/28/2021] [Accepted: 12/08/2021] [Indexed: 02/08/2023]
Abstract
Comparative study of whole-hemisphere ex vivo T2*-weighted MRI and histopathology. Sample of FTLD-Tau and FTLD-TDP subtypes with reference to healthy and AD brain. Novel focal upper cortical-layer iron-rich pathology distinguishes FTLD-TDP from clinically-similar FTLD-Tau and AD. Distinct novel iron-rich FTLD-Tau pathology in mid-to-deep cortical-layers and WM. T2*-weighted MRI signatures offer in vivo biomarker targets for FTLD proteinopathy.
Frontotemporal lobar degeneration (FTLD) is a heterogeneous spectrum of age-associated neurodegenerative diseases that include two main pathologic categories of tau (FTLD-Tau) and TDP-43 (FTLD-TDP) proteinopathies. These distinct proteinopathies are often clinically indistinguishable during life, posing a major obstacle for diagnosis and emerging therapeutic trials tailored to disease-specific mechanisms. Moreover, MRI-derived measures have had limited success to date discriminating between FTLD-Tau or FTLD-TDP. T2*-weighted (T2*w) ex vivo MRI has previously been shown to be sensitive to non-heme iron in healthy intracortical lamination and myelin, and to pathological iron deposits in amyloid-beta plaques and activated microglia in Alzheimer’s disease neuropathologic change (ADNC). However, an integrated, ex vivo MRI and histopathology approach is understudied in FTLD. We apply joint, whole-hemisphere ex vivo MRI at 7 T and histopathology to the study autopsy-confirmed FTLD-Tau (n = 4) and FTLD-TDP (n = 3), relative to ADNC disease-control brains with antemortem clinical symptoms of frontotemporal dementia (n = 2), and an age-matched healthy control. We detect distinct laminar patterns of novel iron-laden glial pathology in both FTLD-Tau and FTLD-TDP brains. We find iron-positive ameboid and hypertrophic microglia and astrocytes largely in deeper GM and adjacent WM in FTLD-Tau. In contrast, FTLD-TDP presents prominent superficial cortical layer iron reactivity in astrocytic processes enveloping small blood vessels with limited involvement of adjacent WM, as well as more diffuse distribution of punctate iron-rich dystrophic microglial processes across all GM lamina. This integrated MRI/histopathology approach reveals ex vivo MRI features that are consistent with these pathological observations distinguishing FTLD-Tau and FTLD-TDP subtypes, including prominent irregular hypointense signal in deeper cortex in FTLD-Tau whereas FTLD-TDP showed upper cortical layer hypointense bands and diffuse cortical speckling. Moreover, differences in adjacent WM degeneration and iron-rich gliosis on histology between FTLD-Tau and FTLD-TDP were also readily apparent on MRI as hyperintense signal and irregular areas of hypointensity, respectively that were more prominent in FTLD-Tau compared to FTLD-TDP. These unique histopathological and radiographic features were distinct from healthy control and ADNC brains, suggesting that iron-sensitive T2*w MRI, adapted to in vivo application at sufficient resolution, may eventually offer an opportunity to improve antemortem diagnosis of FTLD proteinopathies using tissue-validated methods.
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Affiliation(s)
- M Dylan Tisdall
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States.
| | - Daniel T Ohm
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Rebecca Lobrovich
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Sandhitsu R Das
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Gabor Mizsei
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Karthik Prabhakaran
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Ranjit Ittyerah
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Sydney Lim
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Corey T McMillan
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - David A Wolk
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - James Gee
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - John Q Trojanowski
- Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, United States
| | - Edward B Lee
- Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, United States
| | - John A Detre
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States; Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Paul Yushkevich
- Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Murray Grossman
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - David J Irwin
- Neurology, Perelman School of Medicine, University of Pennsylvania, United States; Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, United States.
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Josephs KA, Pham NTT, Graff-Radford J, Machulda MM, Lowe VJ, Whitwell JL. Medial Temporal Atrophy in Posterior Cortical Atrophy and Its Relationship to the Cingulate Island Sign. J Alzheimers Dis 2022; 86:491-498. [DOI: 10.3233/jad-215263] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: It has been hypothesized that medial temporal sparing may be related to preserved posterior cingulate metabolism and the cingulate island sign (CIS) on [18F]fluorodeoxyglucose (FDG) PET in posterior cortical atrophy (PCA). Objective: To assess the severity of medial temporal atrophy in PCA and determine whether the presence of a CIS is related to medial temporal sparing. Methods: Fifty-five PCA patients underwent MRI and FDG-PET. The degree and symmetry of medial temporal atrophy on MRI was visually assessed using a five-point scale for both hemispheres. Visual assessments of FDG-PET coded the presence/absence of a CIS and whether the CIS was symmetric or asymmetric. Hippocampal volumes and a quantitative CIS were also measured. Results: Medial temporal atrophy was most commonly mild or moderate, was symmetric in 55% of patients, and when asymmetric was most commonly worse on the right (76%). Older age and worse memory performance were associated with greater medial temporal atrophy. The CIS was observed in 44% of the PCA patients and was asymmetric in 50% of these. The patients with a CIS showed greater medial temporal asymmetry, but did not show lower medial temporal atrophy scores, compared to those without a CIS. Hippocampal volumes were not associated with quantitative CIS. Conclusion: Mild medial temporal atrophy is a common finding in PCA and is associated with memory impairment. However, medial temporal sparing was not related to the presence of a CIS in PCA.
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Affiliation(s)
| | | | | | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Marterstock DC, Knott MFX, Hoelter P, Lang S, Oberstein T, Kornhuber J, Doerfler A, Schmidt MA. Pulsed Arterial Spin Labeling and Segmented Brain Volumetry in the Diagnostic Evaluation of Frontotemporal Dementia, Alzheimer’s Disease and Mild Cognitive Impairment. Tomography 2022; 8:229-244. [PMID: 35076603 PMCID: PMC8788517 DOI: 10.3390/tomography8010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Previous studies suggest that brain atrophy can not only be defined by its morphological extent, but also by the cerebral blood flow (CBF) within a certain area of the brain, including white and gray matter. The aim of this study is to investigate known atrophy patterns in different forms of dementia and to compare segmented brain volumetrics and pulsed arterial spin labeling (pASL) data to explore the correlation between brain maps with atrophy and this non-contrast-enhanced brain-perfusion method. Methods: Our study comprised 17 patients with diagnosed cognitive impairment (five Alzheimer’s disease = AD, five frontotemporal dementia = FTD, seven mild cognitive impairment = MCI) and 19 healthy control subjects (CO). All patients and controls underwent 4D-pASL brain-perfusion MR imaging and T1w MPRAGE. The data were assessed regarding relative brain volume on the basis of 286 brain regions, and absolute and relative cerebral blood flow (CBF/rCBF) were derived from pASL data in the corresponding brain regions. Mini-Mental State Examination (MMSE) was performed to assess cognitive functions. Results: FTD patients demonstrated significant brain atrophy in 43 brain regions compared to CO. Patients with MCI showed significant brain atrophy in 18 brain regions compared to CO, whereas AD patients only showed six brain regions with significant brain atrophy compared to CO. There was good correlation of brain atrophy and pASL perfusion data in five brain regions of patients with diagnosed FTD, especially in the superior temporal gyrus (r = 0.900, p = 0.037), the inferior frontal white matter (pars orbitalis; r = 0.968, p = 0.007) and the thalami (r = 0.810, p = 0.015). Patients with MCI demonstrated a correlation in one brain region (left inferior fronto-occipital fasciculus; r = 0.786, p = 0.036), whereas patients with diagnosed AD revealed no correlation. Conclusions: pASL can detect affected brain regions in cognitive impairment and corresponds with brain atrophy, especially for patients suffering from FTD and MCI. However, there was no correlation of perfusion alterations and brain atrophy in AD. pASL perfusion might thus represent a promising tool for noninvasive brain-perfusion evaluation in specific dementia subtypes as a complimentary imaging-based bio marker in addition to brain volumetry.
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Affiliation(s)
- Dominique Cornelius Marterstock
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Franz Xaver Knott
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Philip Hoelter
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stefan Lang
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Timo Oberstein
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Manuel A Schmidt
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
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31
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Migliaccio R, Cacciamani F. The temporal lobe in typical and atypical Alzheimer disease. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:449-466. [PMID: 35964987 DOI: 10.1016/b978-0-12-823493-8.00004-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Alzheimer disease (AD) is defined neuropathologically by abnormal extra-cellular β-amyloid plaques combined with intraneuronal tau aggregation. Patients sharing the same neuropathological features but presenting different clinical manifestations and evolutions have led to the notion of AD spectrum. This spectrum encompasses typical and atypical forms of AD. For all of them, specific parts of the temporal lobes, as well as their structural and functional connections with other brain regions, are affected. In typical amnestic late-onset Alzheimer's disease (>65 years old; LOAD), tau pathology gradually spreads to the brain from the medial temporal lobe (MTL). MTL is an inhomogeneous structure consisting of several subregions densely connected to each other and to other cortical and subcortical brain regions. These regions play a crucial role in the storage of information in episodic memory. In less common early-onset AD (<65 years old; EOAD), a large proportion of patients presents atypical clinical manifestations, in which memory impairment is not inaugural and predominant. Instead, these patients have predominant and/or isolated deficits in language, visuospatial, motor, or executive/behavioral functions. In atypical variants, brain damage is mainly centered on the posterior regions, with relative sparing of the MTL. However, the temporal lobe also appears to be variably and specifically damaged in some subtypes of EOAD. For example, the left superior temporal gyrus is the core of brain damage in the language variant, as well as the ventral regions of the temporal lobe play an important role in the clinic of the visual variant.
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Affiliation(s)
- Raffaella Migliaccio
- Paris Brain Institute, INSERM U1127, Hôpital de la Pitié-Salpêtrière, Paris, France; Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer, Hôpital de la Pitié-Salpêtrière, Paris, France.
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McGinnis SM, Stern AM, Woods JK, Torre M, Feany MB, Miller MB, Silbersweig DA, Gale SA, Daffner KR. Case Study 1: A 55-Year-Old Woman With Progressive Cognitive, Perceptual, and Motor Impairments. J Neuropsychiatry Clin Neurosci 2022; 34:8-15. [PMID: 34763525 PMCID: PMC8813898 DOI: 10.1176/appi.neuropsych.21040114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Scott M. McGinnis
- Department of Neurology, Division of Cognitive and Behavioral Neurology, Center for Brain/Mind Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston
| | - Andrew M. Stern
- Department of Neurology, Division of Cognitive and Behavioral Neurology, Center for Brain/Mind Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston
| | - Jared K. Woods
- Department of Pathology, Division of Neuropathology, Brigham and Women’s Hospital, Harvard Medical School, Boston
| | - Matthew Torre
- Department of Pathology, Division of Neuropathology, Brigham and Women’s Hospital, Harvard Medical School, Boston
| | - Mel B. Feany
- Department of Pathology, Division of Neuropathology, Brigham and Women’s Hospital, Harvard Medical School, Boston
| | - Michael B. Miller
- Department of Pathology, Division of Neuropathology, Brigham and Women’s Hospital, Harvard Medical School, Boston
| | - David A. Silbersweig
- Department of Psychiatry, Center for Brain/Mind Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston
| | - Seth A. Gale
- Department of Neurology, Division of Cognitive and Behavioral Neurology, Center for Brain/Mind Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston
| | - Kirk R. Daffner
- Department of Neurology, Division of Cognitive and Behavioral Neurology, Center for Brain/Mind Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston
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33
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Tippett DC, Keser Z. Clinical and neuroimaging characteristics of primary progressive aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:81-97. [PMID: 35078612 PMCID: PMC9951770 DOI: 10.1016/b978-0-12-823384-9.00016-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The chapter covers the clinical syndrome of a primary progressive aphasia (PPA), the demographics of this rare neurodegenerative disease, defining clinical and neuroanatomic characteristics of each PPA variant, disease progression, and behavioral features. The chapter begins with a brief introduction that includes references to seminal papers that defined this clinical syndrome and its three variants. The classic PPA subtypes discussed in the chapter are semantic variant PPA (svPPA), nonfluent/agrammatic PPA (nfaPPA), and logopenic variant PPA (lvPPA). The key language and cognitive characteristics, and language tasks that can elicit these language impairments, are detailed. Overlap in the clinical profiles of the PPA variants, which make differential diagnosis challenging, are explained. Disease progression is described, revealing that the PPA variants become more similar over time. Although PPA is language-predominant dementia, there are behavioral manifestations, particularly in svPPA. Changes in behavior in this variant are addressed as well as behavioral changes in nfaPPA and lvPPA that are less well recognized. The patterns of atrophy in the left temporal, parietal, and/or frontal cortices unique to each PPA variant are described. The underlying neuropathologies of the PPA variants are discussed, specifically tauopathies and non-tauopathies associated with svPPA and nfaPPA and Alzheimer's disease pathology in lvPPA.
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Affiliation(s)
- Donna C. Tippett
- Departments of Neurology, Otolaryngology—Head and Neck Surgery, and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Zafer Keser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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34
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Shebani Z, Nestor PJ, Pulvermüller F. What's "up"? Impaired Spatial Preposition Processing in Posterior Cortical Atrophy. Front Hum Neurosci 2021; 15:731104. [PMID: 34924976 PMCID: PMC8671304 DOI: 10.3389/fnhum.2021.731104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
This study seeks to confirm whether lesions in posterior regions of the brain involved in visuo-spatial processing are of functional relevance to the processing of words with spatial meaning. We investigated whether patients with Posterior Cortical Atrophy (PCA), an atypical form of Alzheimer’s Disease which predominantly affects parieto-occipital brain regions, is associated with deficits in working memory for spatial prepositions. Case series of patients with PCA and matched healthy controls performed tests of immediate and delayed serial recall on words from three lexico-semantic word categories: number words (twelve), spatial prepositions (behind) and function words (e.g., shall). The three word categories were closely matched for a number of psycholinguistic and semantic variables including length, bi-/tri-gram frequency, word frequency, valence and arousal. Relative to controls, memory performance of PCA patients on short word lists was significantly impaired on spatial prepositions in the delayed serial recall task. These results suggest that lesions in posterior parieto-occipital regions specifically impair the processing of spatial prepositions. Our findings point to a pertinent role of posterior cortical regions in the semantic processing of words with spatial meaning and provide strong support for modality-specific semantic theories that recognize the necessary contributions of sensorimotor regions to conceptual semantic processing.
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Affiliation(s)
- Zubaida Shebani
- Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom.,Psychology Department, Sultan Qaboos University, Muscat, Oman
| | - Peter J Nestor
- QLD Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Friedemann Pulvermüller
- Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom.,Brain Language Laboratory, Department of Philosophy and Humanities, WE4, Freie Universität Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Berlin, Germany.,Einstein Center for Neurosciences, Charité University Medicine Berlin, Berlin, Germany
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35
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Ossenkoppele R, Singleton EH, Groot C, Dijkstra AA, Eikelboom WS, Seeley WW, Miller B, Laforce RJ, Scheltens P, Papma JM, Rabinovici GD, Pijnenburg YAL. Research Criteria for the Behavioral Variant of Alzheimer Disease: A Systematic Review and Meta-analysis. JAMA Neurol 2021; 79:48-60. [PMID: 34870696 PMCID: PMC8649917 DOI: 10.1001/jamaneurol.2021.4417] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance The behavioral variant of Alzheimer disease (bvAD) is characterized by early and predominant behavioral deficits caused by AD pathology. This AD phenotype is insufficiently understood and lacks standardized clinical criteria, limiting reliability and reproducibility of diagnosis and scientific reporting. Objective To perform a systematic review and meta-analysis of the bvAD literature and use the outcomes to propose research criteria for this syndrome. Data Sources A systematic literature search in PubMed/MEDLINE and Web of Science databases (from inception through April 7, 2021) was performed in duplicate. Study Selection Studies reporting on behavioral, neuropsychological, or neuroimaging features in bvAD and, when available, providing comparisons with typical amnestic-predominant AD (tAD) or behavioral variant frontotemporal dementia (bvFTD). Data Extraction and Synthesis This analysis involved random-effects meta-analyses on group-level study results of clinical data and systematic review of the neuroimaging literature. The study was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Main Outcomes and Measures Behavioral symptoms (neuropsychiatric symptoms and bvFTD core clinical criteria), cognitive function (global cognition, episodic memory, and executive functioning), and neuroimaging features (structural magnetic resonance imaging, [18F]fluorodeoxyglucose-positron emission tomography, perfusion single-photon emission computed tomography, amyloid positron emission tomography, and tau positron emission tomography). Results The search led to the assessment of 83 studies, including 13 suitable for meta-analysis. Data were collected for 591 patients with bvAD. There was moderate to substantial heterogeneity and moderate risk of bias across studies. Cases with bvAD showed more severe behavioral symptoms than tAD (standardized mean difference [SMD], 1.16 [95% CI, 0.74-1.59]; P < .001) and a trend toward less severe behavioral symptoms compared with bvFTD (SMD, -0.22 [95% CI, -0.47 to 0.04]; P = .10). Meta-analyses of cognitive data indicated worse executive performance in bvAD vs tAD (SMD, -1.03 [95% CI, -1.74 to -0.32]; P = .008) but not compared with bvFTD (SMD, -0.61 [95% CI, -1.75 to 0.53]; P = .29). Cases with bvAD showed a nonsignificant difference of worse memory performance compared with bvFTD (SMD, -1.31 [95% CI, -2.75 to 0.14]; P = .08) but did not differ from tAD (SMD, 0.43 [95% CI, -0.46 to 1.33]; P = .34). The neuroimaging literature revealed 2 distinct bvAD neuroimaging phenotypes: an AD-like pattern with relative frontal sparing and a relatively more bvFTD-like pattern characterized by additional anterior involvement, with the AD-like pattern being more prevalent. Conclusions and Relevance These data indicate that bvAD is clinically most similar to bvFTD, while it shares most pathophysiological features with tAD. Based on these insights, we propose research criteria for bvAD aimed at improving the consistency and reliability of future research and aiding the clinical assessment of this AD phenotype.
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Affiliation(s)
- Rik Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.,Lund University, Clinical Memory Research Unit, Lund, Sweden
| | - Ellen H Singleton
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Colin Groot
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anke A Dijkstra
- Department of Pathology, Amsterdam Neuroscience, Amsterdam University Medical Centre, Location VUMC, Amsterdam, the Netherlands
| | - Willem S Eikelboom
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Bruce Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Robert Jr Laforce
- Clinique Interdisciplinaire de Mémoire, Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Janne M Papma
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco, San Francisco.,Associate Editor, JAMA Neurology
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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Apostolova LG, Aisen P, Eloyan A, Fagan A, Fargo KN, Foroud T, Gatsonis C, Grinberg LT, Jack CR, Kramer J, Koeppe R, Kukull WA, Murray ME, Nudelman K, Rumbaugh M, Toga A, Vemuri P, Trullinger A, Iaccarino L, Day GS, Graff‐Radford NR, Honig LS, Jones DT, Masdeu J, Mendez M, Musiek E, Onyike CU, Rogalski E, Salloway S, Wolk DA, Wingo TS, Carrillo MC, Dickerson BC, Rabinovici GD. The Longitudinal Early-onset Alzheimer's Disease Study (LEADS): Framework and methodology. Alzheimers Dement 2021; 17:2043-2055. [PMID: 34018654 PMCID: PMC8939858 DOI: 10.1002/alz.12350] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Abstract
Patients with early-onset Alzheimer's disease (EOAD) are commonly excluded from large-scale observational and therapeutic studies due to their young age, atypical presentation, or absence of pathogenic mutations. The goals of the Longitudinal EOAD Study (LEADS) are to (1) define the clinical, imaging, and fluid biomarker characteristics of EOAD; (2) develop sensitive cognitive and biomarker measures for future clinical and research use; and (3) establish a trial-ready network. LEADS will follow 400 amyloid beta (Aβ)-positive EOAD, 200 Aβ-negative EOnonAD that meet National Institute on Aging-Alzheimer's Association (NIA-AA) criteria for mild cognitive impairment (MCI) or AD dementia, and 100 age-matched controls. Participants will undergo clinical and cognitive assessments, magnetic resonance imaging (MRI), [18 F]Florbetaben and [18 F]Flortaucipir positron emission tomography (PET), lumbar puncture, and blood draw for DNA, RNA, plasma, serum and peripheral blood mononuclear cells, and post-mortem assessment. To develop more effective AD treatments, scientists need to understand the genetic, biological, and clinical processes involved in EOAD. LEADS will develop a public resource that will enable future planning and implementation of EOAD clinical trials.
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37
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Andersen E, Casteigne B, Chapman WD, Creed A, Foster F, Lapins A, Shatz R, Sawyer RP. Diagnostic biomarkers in Alzheimer’s disease. Biomark Neuropsychiatry 2021. [DOI: 10.1016/j.bionps.2021.100041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Day BL, Ocal D, Peters A, Bancroft MJ, Cash D, Kaski D, Crutch SJ, Yong KXX. Altered visual and haptic verticality perception in posterior cortical atrophy and Alzheimer's disease. J Physiol 2021; 600:373-391. [PMID: 34841531 DOI: 10.1113/jp282289] [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: 08/23/2021] [Accepted: 11/26/2021] [Indexed: 12/21/2022] Open
Abstract
There is increasing theoretical and empirical support for the brain combining multisensory information to determine the direction of gravity and hence uprightness. A fundamental part of the process is the spatial transformation of sensory signals between reference frames: eye-centred, head-centred, body-centred, etc. The question 'Am I the right way up?' posed by a patient with posterior cortical atrophy (PCA) suggests disturbances in upright perception, subsequently investigated in PCA and typical Alzheimer's disease (tAD) based on what looks or feels upright. Participants repeatedly aligned to vertical a rod presented either visually (visual-vertical) or haptically (haptic-vertical). Visual-vertical involved orienting a projected rod presented without or with a visual orientation cue (circle, tilted square (±18°)). Haptic-vertical involved orientating a grasped rod with eyes closed using a combination of side (left, right) and hand (unimanual, bimanual) configurations. Intraindividual uncertainty and bias defined verticality perception. Uncertainty was consistently greater in both patient groups than in control groups, and greater in PCA than tAD. Bias in the frontal plane was strongly directionally affected by visual cue tilt (visual-vertical) and grip side (haptic-vertical). A model was developed that assumed verticality information from multiple sources is combined in a statistically optimal way to produce observed uncertainties and biases. Model results suggest the mechanism that spatially transforms graviceptive information between body parts is disturbed in both patient groups. Despite visual dysfunction being typically considered the primary feature of PCA, disturbances were greater in PCA than tAD particularly for haptic-vertical, and are considered in light of posterior parietal vulnerability. KEY POINTS: The perception of upright requires accurate and precise estimates of orientation based on multiple noisy sensory signals. The question 'Am I the right way up?' posed by a patient with posterior cortical atrophy (PCA; purported 'visual variant Alzheimer's') suggests disturbances in the perception of upright. What looks or feels upright in PCA and typical Alzheimer's disease (tAD) was investigated by asking participants to repeatedly align to vertical a rod presented visually (visual-vertical) or haptically (haptic-vertical). PCA and tAD groups exhibited not only greater perceptual uncertainty than controls, but also exaggerated bias induced by tilted visual orientation cues (visual-vertical) and grip side (haptic-vertical). When modelled, these abnormalities, which were particularly evident in PCA haptic-vertical performance, were compatible with disruption of a mechanism that spatially transforms verticality information between body parts. The findings suggest an important role of posterior parietal cortex in verticality perception, and have implications for understanding spatial disorientation in dementia.
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Affiliation(s)
- Brian L Day
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Dilek Ocal
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, DE
| | - Amy Peters
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Matthew J Bancroft
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - David Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Diego Kaski
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Keir X X Yong
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
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Bergeron D, Beauregard JM, Soucy JP, Verret L, Poulin S, Matias-Guiu JA, Cabrera-Martín MN, Bouchard RW, Laforce R. Posterior Cingulate Cortex Hypometabolism in Non-Amnestic Variants of Alzheimer's Disease. J Alzheimers Dis 2021; 77:1569-1577. [PMID: 32925054 DOI: 10.3233/jad-200567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hypometabolism of the posterior cingulate cortex (PCC) is an important diagnostic feature of late-onset, amnestic Alzheimer's disease (AD) measured with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). However, it is unclear whether PCC hypometabolism has diagnostic value in young-onset, non-amnestic variants of AD, which exhibit less pathology in the hippocampus and default mode network. OBJECTIVE Evaluate the prevalence and diagnostic value of PCC hypometabolism in non-amnestic variants of AD. METHODS We retrospectively identified 60 patients with young-onset, atypical dementia who have undergone a detailed clinical evaluation, FDG-PET, and an amyloid biomarker (amyloid-PET or cerebrospinal fluid analysis). We quantitatively analyzed regional hypometabolism in 70 regions of interest (ROI) using the MIMneuro® software. RESULTS Based on a cut-off of z-score < -1.5 for significant PCC hypometabolism, the prevalence of PCC hypometabolism in non-amnestic variants of AD was 65% compared to 28% in clinical variants of frontotemporal dementia (FTD). The ROI with the maximal hypometabolism was the dominant middle temporal gyrus in the language variant of AD (mean z score -2.28), middle occipital gyrus in PCA (-3.24), middle temporal gyrus in frontal AD (-2.70), and angular gyrus in corticobasal syndrome due to AD (-2.31). The PCC was not among the 10 most discriminant regions between non-amnestic variants of AD versus clinical variants of FTD. CONCLUSION We conclude that PCC hypometabolism is not a discriminant feature to distinguish non-amnestic variants of AD from clinical variants of FTD-and should be interpreted with caution in patients with young-onset, non-amnestic dementia.
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Affiliation(s)
- David Bergeron
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, Québec, Canada
| | | | - Jean-Paul Soucy
- Department of Nuclear Medicine, Montreal Neurological Institute (MNI), Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Louis Verret
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, Québec, Canada
| | - Stéphane Poulin
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, Québec, Canada
| | - Jordi A Matias-Guiu
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - María Nieves Cabrera-Martín
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Rémi W Bouchard
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, Québec, Canada
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Panegyres PK. The Clinical Spectrum of Young Onset Dementia Points to Its Stochastic Origins. J Alzheimers Dis Rep 2021; 5:663-679. [PMID: 34632303 PMCID: PMC8461730 DOI: 10.3233/adr-210309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dementia is a major global health problem and the search for improved therapies is ongoing. The study of young onset dementia (YOD)-with onset prior to 65 years-represents a challenge owing to the variety of clinical presentations, pathology, and gene mutations. The advantage of the investigation of YOD is the lack of comorbidities that complicate the clinical picture in older adults. Here we explore the origins of YOD. OBJECTIVE To define the clinical diversity of YOD in terms of its demography, range of presentations, neurological examination findings, comorbidities, medical history, cognitive findings, imaging abnormalities both structural and functional, electroencephagraphic (EEG) data, neuropathology, and genetics. METHODS A prospective 20-year study of 240 community-based patients referred to specialty neurology clinics established to elucidate the nature of YOD. RESULTS Alzheimer's disease (AD; n = 139) and behavioral variant frontotemporal (bvFTD; n = 58) were the most common causes with a mean age of onset of 56.5 years for AD (±1 SD 5.45) and 57.1 years for bvFTD (±1 SD 5.66). Neuropathology showed a variety of diagnoses from multiple sclerosis, Lewy body disease, FTD-MND, TDP-43 proteinopathy, adult-onset leukoencephalopathy with axonal steroids and pigmented glia, corticobasal degeneration, unexplained small vessel disease, and autoimmune T-cell encephalitis. Non-amnestic forms of AD and alternative forms of FTD were discovered. Mutations were only found in 11 subjects (11/240 = 4.6%). APOE genotyping was not divergent between the two populations. CONCLUSION There are multiple kinds of YOD, and most are sporadic. These observations point to their stochastic origins.
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Affiliation(s)
- Peter K Panegyres
- Neurodegenerative Disorders Research Pty Ltd, West Perth, Australia
- The University of Western Australia, Nedlands, Australia
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41
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Benvenutto A, Guedj E, Felician O, Eusebio A, Azulay JP, Ceccaldi M, Koric L. Clinical Phenotypes in Corticobasal Syndrome with or without Amyloidosis Biomarkers. J Alzheimers Dis 2021; 74:331-343. [PMID: 32039846 DOI: 10.3233/jad-190961] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Corticobasal syndrome (CBS) is a neuropathologically heterogeneous entity. The use of cerebrospinal fluid and amyloid biomarkers enables detection of underlying Alzheimer's disease (AD) pathology. We thus compared clinical, eye movement, and 18FDG-PET imaging characteristics in CBS in two groups of patients divided according to their amyloid biomarkers profile. Fourteen patients presenting with CBS and amyloidosis (CBS-A+) were compared with 16 CBS patients without amyloidosis (CBS-A-). The two groups showed similar motor abnormalities (parkinsonism, dystonia) and global cognitive functions. Unlike CBS-A+ patients who displayed more posterior cortical abnormalities, CBS-A- patients demonstrated more anterior cortical and brain stem dysfunctions on the basis of neuropsychological testing, study of saccade velocities and brain hypometabolism areas on 18FDG-PET. Interestingly, Dopamine Transporter SPECT imaging showed similar levels of dopaminergic degeneration in both groups. These findings confirm common and distinct brain abnormalities between the different neurodegenerative diseases that result in CBS. We demonstrate the importance of a multidisciplinary approach to improve diagnosis in vivo in particular on oculomotor examination.
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Affiliation(s)
- Agnès Benvenutto
- Department of Neurology and Neuropsychology, and CMMR PACA Ouest, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Eric Guedj
- Department of Nuclear Medecine, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,CERIMED, Aix-Marseille Univ, Marseille, France.,Aix Marseille Univ, UMR 7249, CNRS, Centrale Marseille, Institut Fresnel, Marseille, France
| | - Olivier Felician
- Department of Neurology and Neuropsychology, and CMMR PACA Ouest, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille Univ, INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
| | - Alexandre Eusebio
- Department of Neurology and Movement Disorders Department, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille Univ, CNRS, INT, Institut Neurosciences Timone, Marseille, France
| | - Jean-Philippe Azulay
- Department of Neurology and Movement Disorders Department, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille Univ, CNRS, INT, Institut Neurosciences Timone, Marseille, France
| | - Mathieu Ceccaldi
- Department of Neurology and Neuropsychology, and CMMR PACA Ouest, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille Univ, INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
| | - Lejla Koric
- Department of Neurology and Neuropsychology, and CMMR PACA Ouest, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix Marseille Univ, UMR 7249, CNRS, Centrale Marseille, Institut Fresnel, Marseille, France
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42
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Cerami C, Dodich A, Iannaccone S, Magnani G, Marcone A, Guglielmo P, Vanoli G, Cappa SF, Perani D. Individual Brain Metabolic Signatures in Corticobasal Syndrome. J Alzheimers Dis 2021; 76:517-528. [PMID: 32538847 DOI: 10.3233/jad-200153] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Corticobasal syndrome (CBS) is the usual clinical presentation of patients with corticobasal degeneration pathology. Nevertheless, there are CBS individuals with postmortem neuropathology typical of Alzheimer's disease (AD). OBJECTIVE In this study, we aim to detect FDG-PET metabolic signatures at the single-subject level in a CBS sample, also evaluated with cerebrospinal fluid (CSF) markers for AD pathology. METHODS 21 patients (68.9±6.4 years; MMSE score = 21.7±6.3) fulfilling current criteria for CBS were enrolled. All underwent a clinical-neuropsychological assessment and an instrumental evaluation for biomarkers of neurodegeneration, amyloid and tau pathology (i.e., FDG-PET imaging and CSF Aβ42 and tau levels) at close intervals. CBS subjects were classified according to the presence or absence of CSF markers of AD pathology (i.e., low Aβ42 and high phosphorylated tau levels). Optimized voxel-based SPM procedures provided FDG-PET metabolic patterns at the single-subject and group levels. RESULTS Eight CBS had an AD-like CSF profile (CBS-AD), while thirteen were negative (CBS-noAD). The two subgroups did not differ in demographic characteristics or global cognitive impairment. FDG-PET SPM t-maps identified different metabolic signatures. Namely, all CBS-AD patients showed the typical AD-like hypometabolic pattern involving posterior cingulate cortex, precuneus and temporo-parietal cortex, whereas CBS-noAD cases showed bilateral hypometabolism in fronto-insular cortex and basal ganglia that is typical of the frontotemporal lobar degeneration spectrum. DISCUSSION These results strongly suggest the inclusion of FDG-PET imaging in the diagnostic algorithm of individuals with CBS clinical phenotype in order to early identify functional metabolic signatures due to different neuropathological substrates, thus improving the diagnostic accuracy.
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Affiliation(s)
- Chiara Cerami
- Dipartimento di Scienze Umane e della Vita, Scuola Universitaria di Studi Superiori IUSS Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Alessandra Dodich
- CeRiN, Centre for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | | | | | | | | | | | - Stefano F Cappa
- Dipartimento di Scienze Umane e della Vita, Scuola Universitaria di Studi Superiori IUSS Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Daniela Perani
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy.,Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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43
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Smirnov DS, Galasko D, Hiniker A, Edland SD, Salmon DP. Age-at-Onset and APOE-Related Heterogeneity in Pathologically Confirmed Sporadic Alzheimer Disease. Neurology 2021; 96:e2272-e2283. [PMID: 33722993 PMCID: PMC8166435 DOI: 10.1212/wnl.0000000000011772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/28/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize age-related clinical heterogeneity in Alzheimer disease (AD) and determine whether it is modified by APOE genotype or concomitant non-AD pathology, we analyzed data from 1,750 patients with sporadic, pathologically confirmed severe AD. METHODS In this retrospective cohort study, regression and mixed effects models assessed effects of estimated age at onset, APOE genotype, and their interaction on standardized clinical, cognitive, and pathologic outcome measures from the National Alzheimer's Coordinating Center database. RESULTS A bimodal distribution of age at onset frequency in APOE ε4- cases showed best separation at age 63. Using this age cutoff, cases were grouped as ε4- early-onset AD (EOAD) (n = 169), ε4+ EOAD (n = 273), ε4- late-onset AD (LOAD) (n = 511), and ε4+ LOAD (n = 797). Patients with EOAD were more likely than patients with LOAD to present with noncognitive behavioral or motor symptoms or nonmemory cognitive complaints, and had more executive dysfunction, but less language impairment on objective cognitive testing. Age at onset and ε4- genotype were independently associated with lower baseline Mini-Mental State Examination scores and greater functional impairment and patients with EOAD had faster cognitive and functional decline than patients with LOAD regardless of APOE genotype. Patients with EOAD were more likely than patients with LOAD to receive a non-AD clinical diagnosis even though they were more likely to have pure AD without concomitant vascular or other non-AD neurodegenerative pathology. CONCLUSIONS Early-onset sporadic AD is associated with a greater likelihood of an atypical, non-memory-dominant clinical presentation, especially in the absence of the APOE ε4 allele, which may lead to misattribution to non-AD underlying pathology.
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Affiliation(s)
- Denis S Smirnov
- From the Departments of Neurosciences (D. Smirnov, D.G., A.H., D. Salmon), Pathology (A.H.), and Family Medicine and Public Health (S. Edland), University of California San Diego
| | - Douglas Galasko
- From the Departments of Neurosciences (D. Smirnov, D.G., A.H., D. Salmon), Pathology (A.H.), and Family Medicine and Public Health (S. Edland), University of California San Diego
| | - Annie Hiniker
- From the Departments of Neurosciences (D. Smirnov, D.G., A.H., D. Salmon), Pathology (A.H.), and Family Medicine and Public Health (S. Edland), University of California San Diego
| | - Steven D Edland
- From the Departments of Neurosciences (D. Smirnov, D.G., A.H., D. Salmon), Pathology (A.H.), and Family Medicine and Public Health (S. Edland), University of California San Diego
| | - David P Salmon
- From the Departments of Neurosciences (D. Smirnov, D.G., A.H., D. Salmon), Pathology (A.H.), and Family Medicine and Public Health (S. Edland), University of California San Diego.
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44
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Bastin C, Bahri MA, Bernard C, Hustinx R, Salmon E. Frontal hypometabolism in neurocognitive disorder with behavioral disturbance. J Nucl Med 2021; 62:jnumed.120.260497. [PMID: 33789936 PMCID: PMC8612193 DOI: 10.2967/jnumed.120.260497] [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: 11/17/2020] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
Criteria for the behavioral variant of frontotemporal dementia (bvFTD) include decreased frontal metabolism. FDG-PET was used to investigate whether patients with neurocognitive disorder and behavioral disturbance (bvNCD) who did not fulfill three bvFTD criteria had characteristic brain metabolic pattern. Methods: Patients were referred from memory clinic to nuclear medicine for differential diagnosis of NCD with dysexecutive syndrome and predominant mild frontal atrophy. Patients were classified into two groups before FDG-PET, probable bvFTD (n = 25) or bvNCD (n = 27) when only two bvFTD criteria were met. Results: Voxel-based and multivariate PLS analyses of FDG-PET did not show significant between-group difference at inclusion. After 4.8 years of follow-up, most patients with probable bvFTD received the same diagnosis, 3 remained very stable and one participant was given a psychiatric diagnosis. Five patients with bvNCD fulfilled criteria for probable bvFTD at 4.4 years mean follow up, while 2 participants remained very stable and 3 received alternative neurological or psychiatric diagnoses. When initial FDG-PET were compared between groups stratified at follow up (26 bvFTD versus 17 bvNCD), there was a trend (p<.001uncorrected) for lower prefrontal with relatively preserved premotor metabolism in bvFTD compared to bvNCD. Twelve bvNCD participants had neuropsychological testing before inclusion. They all presented executive dysfunction and normal visuospatial performance, and most (n = 9) had memory encoding impairment. Conclusion: Frontal hypometabolism was observed in a dysexecutive presentation of frontal neurodegenerative disorder (bvNCD) that did not fulfill all clinical criteria for bvFTD.
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Affiliation(s)
- Christine Bastin
- GIGA Cyclotron Research Centre, University of Liege, Liege, Belgium
| | | | - Claire Bernard
- Nuclear Medicine Department, CHU Liege, Liege, Belgium; and
| | - Roland Hustinx
- GIGA Cyclotron Research Centre, University of Liege, Liege, Belgium
- Nuclear Medicine Department, CHU Liege, Liege, Belgium; and
| | - Eric Salmon
- GIGA Cyclotron Research Centre, University of Liege, Liege, Belgium
- Memory Clinic, Department of Neurology, CHU Liege, Liege, Belgium
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45
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Graff-Radford J, Yong KXX, Apostolova LG, Bouwman FH, Carrillo M, Dickerson BC, Rabinovici GD, Schott JM, Jones DT, Murray ME. New insights into atypical Alzheimer's disease in the era of biomarkers. Lancet Neurol 2021; 20:222-234. [PMID: 33609479 PMCID: PMC8056394 DOI: 10.1016/s1474-4422(20)30440-3] [Citation(s) in RCA: 189] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
Most patients with Alzheimer's disease present with amnestic problems; however, a substantial proportion, over-represented in young-onset cases, have atypical phenotypes including predominant visual, language, executive, behavioural, or motor dysfunction. In the past, these individuals often received a late diagnosis; however, availability of CSF and PET biomarkers of Alzheimer's disease pathologies and incorporation of atypical forms of Alzheimer's disease into new diagnostic criteria increasingly allows them to be more confidently diagnosed early in their illness. This early diagnosis in turn allows patients to be offered tailored information, appropriate care and support, and individualised treatment plans. These advances will provide improved access to clinical trials, which often exclude atypical phenotypes. Research into atypical Alzheimer's disease has revealed previously unrecognised neuropathological heterogeneity across the Alzheimer's disease spectrum. Neuroimaging, genetic, biomarker, and basic science studies are providing key insights into the factors that might drive selective vulnerability of differing brain networks, with potential mechanistic implications for understanding typical late-onset Alzheimer's disease.
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Affiliation(s)
| | - Keir X. X. Yong
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Liana G. Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Femke H. Bouwman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam University Medical Center
| | | | - Bradford C. Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gil D. Rabinovici
- Departments of Neurology, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Jonathan M. Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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46
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Possible clinical anatomical features of right Alzheimer's disease (RAD). Aging Clin Exp Res 2021; 33:669-671. [PMID: 32358731 DOI: 10.1007/s40520-020-01564-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
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47
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Ishihara K, Kaneko S, Takahashi N, Asahi T. [A case suspected of Alzheimer type dementia showing multimodal (face and voice) person recognition disorder from face and voice]. Rinsho Shinkeigaku 2021; 61:182-187. [PMID: 33627581 DOI: 10.5692/clinicalneurol.cn-001510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 90-year-old woman presented with a multimodal (face and voice) person recognition disorder. Although she had moderate general cognitive impairment, her visual cognitive capacity, other than face recognition, was well preserved. She could identify the faces and voices of family members but could not recall the names and voices of relatives whom she met infrequently, famous individuals, or the medical staff. She could remember the first names and some information about prominent individuals when supplied with their surnames. Therefore, we thought that her person-specific semantic memory was intact but she was unable to access it through their faces and voices. MRI revealed predominantly right-sided bilateral anterior temporal lobe and hippocampal atrophy. SPECT images showed decreased blood flow in the bilateral anterior temporal lobes and inferior parietal lobule (heavily and predominantly right-sided), right posterior cingulate gyrus, and precuneus. Progressive person recognition disorder or prosopagnosia has been considered a right temporal variant of frontotemporal lobar degeneration because abnormal behaviors and psychiatric symptoms frequently coexist. However, no such symptoms were observed in this case, therefore we suspected dementia of the Alzheimer type.
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Affiliation(s)
- Kenji Ishihara
- Department of Neurology, Asahi Hospital of Neurology and Rehabilitation
| | - Sayaka Kaneko
- Department of Rehabilitation, Asahi Hospital of Neurology and Rehabilitation
| | | | - Toshiomi Asahi
- Department of Neurology, Asahi Hospital of Neurology and Rehabilitation
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48
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Frontal Variant of Alzheimer Disease Differentiated From Frontotemporal Dementia Using in Vivo Amyloid and Tau Imaging. Cogn Behav Neurol 2021; 33:288-293. [PMID: 33264158 DOI: 10.1097/wnn.0000000000000251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The frontal variant of Alzheimer disease (fvAD) is characterized by behavioral and/or dysexecutive impairments that can resemble those of behavioral-variant frontotemporal dementia (bvFTD). This overlap, in addition to the lack of consensus clinical criteria for fvAD, complicates its identification. We provide the first case report of fvAD differentiated in vivo from bvFTD using amyloid-beta and tau PET imaging. The patient, a right-handed woman, presented with forgetfulness at age 60. Cognitive testing at that time revealed mild impairments in memory, attention, and executive functions. Three years later, her family reported that she was displaying socially inappropriate behaviors, inertia, diminished social interest, and altered food preferences-the sum of which met the criteria for possible bvFTD. PET using an amyloid-beta tracer (F-AZD4694) identified diffuse amyloid plaques across the cerebral cortex. PET using a tau tracer specific for neurofibrillary tangles (F-MK6240) identified substantial tau pathology in the brain's frontal lobes. Together with the clinical findings, these images supported the diagnosis of fvAD rather than bvFTD. Considering past and emerging evidence that tau topography in Alzheimer disease (AD) matches the clinical features of AD, we discuss the potential utility of in vivo tau imaging using F-MK6240 for identifying fvAD.
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49
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Wisse LEM, Ungrady MB, Ittyerah R, Lim SA, Yushkevich PA, Wolk DA, Irwin DJ, Das SR, Grossman M. Cross-sectional and longitudinal medial temporal lobe subregional atrophy patterns in semantic variant primary progressive aphasia. Neurobiol Aging 2021; 98:231-241. [PMID: 33341654 PMCID: PMC8018475 DOI: 10.1016/j.neurobiolaging.2020.11.012] [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] [Received: 01/27/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
T1-magnetic resonance imaging (MRI) studies report early atrophy in the left anterior temporal lobe, especially the perirhinal cortex, in semantic variant primary progressive aphasia (svPPA). Improved segmentation protocols using high-resolution T2-MRI have enabled fine-grained medial temporal lobe (MTL) subregional measurements, which may provide novel information on the atrophy pattern and disease progression in svPPA. We aimed to investigate the MTL subregional atrophy pattern cross-sectionally and longitudinally in patients with svPPA as compared with controls and patients with Alzheimer's disease (AD). MTL subregional volumes were obtained using the Automated Segmentation for Hippocampal Subfields software from high-resolution T2-MRIs in 15 svPPA, 37 AD, and 23 healthy controls. All MTL volumes were corrected for intracranial volume and parahippocampal cortices for slice number. Longitudinal atrophy rates of all subregions were obtained using an unbiased deformation-based morphometry pipeline in 6 svPPA patients, 9 controls, and 12 AD patients. Cross-sectionally, significant volume loss was observed in svPPA compared with controls in the left MTL, right cornu ammonis 1 (CA1), Brodmann area (BA)35, and BA36 (subdivisions of the perirhinal cortex). Compared with AD patients, svPPA patients had significantly smaller left CA1, BA35, and left and right BA36 volumes. Longitudinally, svPPA patients had significantly greater atrophy rates of left and right BA36 than controls but not relative to AD patients. Fine-grained analysis of MTL atrophy patterns provides information about the evolution of atrophy in svPPA. These results indicate that MTL subregional measures might be useful markers to track disease progression or for clinical trials in svPPA.
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Affiliation(s)
- Laura E M Wisse
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA; Department of Diagnostic Radiology, Lund University, Lund, Sweden.
| | - Molly B Ungrady
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Ranjit Ittyerah
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sydney A Lim
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A Yushkevich
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Department of Neurology, Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA
| | - David J Irwin
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine Center for Neurodegenerative Disease Research (CNDR), University of Pennsylvania, Philadelphia, PA, USA
| | - Sandhitsu R Das
- Department of Neurology, Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Murray Grossman
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
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50
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Abstract
The history of Alzheimer's disease (AD) started in 1907, but we needed to wait until the end of the century to identify the components of pathological hallmarks and genetic subtypes and to formulate the first pathogenic hypothesis. Thanks to biomarkers and new technologies, the concept of AD then rapidly changed from a static view of an amnestic dementia of the presenium to a biological entity that could be clinically manifested as normal cognition or dementia of different types. What is clearly emerging from studies is that AD is heterogeneous in each aspect, such as amyloid composition, tau distribution, relation between amyloid and tau, clinical symptoms, and genetic background, and thus it is probably impossible to explain AD with a single pathological process. The scientific approach to AD suffers from chronological mismatches between clinical, pathological, and technological data, causing difficulty in conceiving diagnostic gold standards and in creating models for drug discovery and screening. A recent mathematical computer-based approach offers the opportunity to study AD in real life and to provide a new point of view and the final missing pieces of the AD puzzle.
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Affiliation(s)
- Camilla Ferrari
- Department of Neuroscience, Psychology, Drug Research, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research, and Child Health (NEUROFARBA), University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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