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Kamondi A, Grigg-Damberger M, Löscher W, Tanila H, Horvath AA. Epilepsy and epileptiform activity in late-onset Alzheimer disease: clinical and pathophysiological advances, gaps and conundrums. Nat Rev Neurol 2024; 20:162-182. [PMID: 38356056 DOI: 10.1038/s41582-024-00932-4] [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: 01/17/2024] [Indexed: 02/16/2024]
Abstract
A growing body of evidence has demonstrated a link between Alzheimer disease (AD) and epilepsy. Late-onset epilepsy and epileptiform activity can precede cognitive deterioration in AD by years, and its presence has been shown to predict a faster disease course. In animal models of AD, amyloid and tau pathology are linked to cortical network hyperexcitability that precedes the first signs of memory decline. Thus, detection of epileptiform activity in AD has substantial clinical importance as a potential novel modifiable risk factor for dementia. In this Review, we summarize the epidemiological evidence for the complex bidirectional relationship between AD and epilepsy, examine the effect of epileptiform activity and seizures on cognition in people with AD, and discuss the precision medicine treatment strategies based on the latest research in human and animal models. Finally, we outline some of the unresolved questions of the field that should be addressed by rigorous research, including whether particular clinicopathological subtypes of AD have a stronger association with epilepsy, and the sequence of events between epileptiform activity and amyloid and tau pathology.
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Affiliation(s)
- Anita Kamondi
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.
- Department of Neurology, Semmelweis University, Budapest, Hungary.
| | | | - Wolfgang Löscher
- Department of Experimental Otology of the ENT Clinics, Hannover Medical School, Hannover, Germany
| | - Heikki Tanila
- A. I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Andras Attila Horvath
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
- Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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Scambray KA, Nguyen HL, Sajjadi SA. Association of vascular and degenerative brain pathologies and past medical history from the National Alzheimer's Coordinating Center Database. J Neuropathol Exp Neurol 2023; 82:390-401. [PMID: 36947583 PMCID: PMC10117154 DOI: 10.1093/jnen/nlad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
The relationship between past medical histories (PMH) and dementia-related neuropathologies is not well understood. Using the National Alzheimer's Coordinating Center (NACC) database, we explored the relationship between patient-reported PMH and various vascular and degenerative neuropathologies. We examined the following PMH: transient ischemic attack (TIA), stroke, traumatic brain injury, seizures, hypertension, cardiovascular events, hypercholesterolemia, B12 deficiency, diabetes mellitus, and thyroid disease. We dichotomized the following neuropathologies: atherosclerosis, arteriolosclerosis, cerebral amyloid angiopathy (CAA), Alzheimer disease neuropathology (ADNP), Lewy bodies (LB), hippocampal sclerosis, frontotemporal lobar degeneration (FTLD), and TAR DNA-binding protein-43 (TDP-43). Separate logistic regression models assessed the relationship between the outcome of individual neuropathologies and all PMHs. Additional logistic regressions were stratified by sex to further examine these associations. Hypertension history was associated with an increased likelihood of atherosclerosis (OR = 1.7) and arteriolosclerosis (OR = 1.3), but decreased odds of ADNP (OR = 0.81), CAA (OR = 0.79), and LB (OR = 0.78). History of TIA was associated with an increased likelihood of atherosclerosis (OR = 1.3) and arteriolosclerosis (OR = 1.4) and lower odds of ADNP (OR = 0.72). Seizure history was associated with an increased likelihood of ADNP (OR = 1.9) and lower odds of FTLD (OR = 0.49). Hypertension history was associated with a greater likelihood of vascular pathologies yet a lower likelihood of ADNP and other neurodegenerative pathologies.
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Affiliation(s)
- Kiana A Scambray
- Department of Neurology, University of California, Irvine, Irvine, California, USA
| | - Hannah L Nguyen
- Department of Neurology, University of California, Irvine, Irvine, California, USA
| | - S Ahmad Sajjadi
- Department of Neurology, University of California, Irvine, Irvine, California, USA
- Department of Pathology, University of California, Irvine, Irvine, California, USA
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Negi D, Granak S, Shorter S, O'Leary VB, Rektor I, Ovsepian SV. Molecular Biomarkers of Neuronal Injury in Epilepsy Shared with Neurodegenerative Diseases. Neurotherapeutics 2023; 20:767-778. [PMID: 36884195 PMCID: PMC10275849 DOI: 10.1007/s13311-023-01355-7] [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] [Accepted: 02/08/2023] [Indexed: 03/09/2023] Open
Abstract
In neurodegenerative diseases, changes in neuronal proteins in the cerebrospinal fluid and blood are viewed as potential biomarkers of the primary pathology in the central nervous system (CNS). Recent reports suggest, however, that level of neuronal proteins in fluids also alters in several types of epilepsy in various age groups, including children. With increasing evidence supporting clinical and sub-clinical seizures in Alzheimer's disease, Lewy body dementia, Parkinson's disease, and in other less common neurodegenerative conditions, these findings call into question the specificity of neuronal protein response to neurodegenerative process and urge analysis of the effects of concomitant epilepsy and other comorbidities. In this article, we revisit the evidence for alterations in neuronal proteins in the blood and cerebrospinal fluid associated with epilepsy with and without neurodegenerative diseases. We discuss shared and distinctive characteristics of changes in neuronal markers, review their neurobiological mechanisms, and consider the emerging opportunities and challenges for their future research and diagnostic use.
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Affiliation(s)
- Deepika Negi
- Faculty of Engineering and Science, University of Greenwich London, Chatham Maritime, Kent, ME4 4TB, UK
| | - Simon Granak
- National Institute of Mental Health, Topolova 748, Klecany, 25067, Czech Republic
| | - Susan Shorter
- Faculty of Engineering and Science, University of Greenwich London, Chatham Maritime, Kent, ME4 4TB, UK
| | - Valerie B O'Leary
- Department of Medical Genetics, Third Faculty of Medicine, Charles University, Ruská 87, Prague, 10000, Czech Republic
| | - Ivan Rektor
- First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Saak V Ovsepian
- Faculty of Engineering and Science, University of Greenwich London, Chatham Maritime, Kent, ME4 4TB, UK.
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Vöglein J, Franzmeier N, Morris JC, Dieterich M, McDade E, Simons M, Preische O, Hofmann A, Hassenstab J, Benzinger TL, Fagan A, Noble JM, Berman SB, Graff-Radford NR, Ghetti B, Farlow MR, Chhatwal JP, Salloway S, Xiong C, Karch CM, Cairns N, Perrin RJ, Day G, Martins R, Sanchez-Valle R, Mori H, Shimada H, Ikeuchi T, Suzuki K, Schofield PR, Masters CL, Goate A, Buckles V, Fox NC, Chrem P, Allegri R, Ringman JM, Yakushev I, Laske C, Jucker M, Höglinger G, Bateman RJ, Danek A, Levin J. Pattern and implications of neurological examination findings in autosomal dominant Alzheimer disease. Alzheimers Dement 2023; 19:632-645. [PMID: 35609137 PMCID: PMC9684350 DOI: 10.1002/alz.12684] [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: 09/21/2021] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION As knowledge about neurological examination findings in autosomal dominant Alzheimer disease (ADAD) is incomplete, we aimed to determine the frequency and significance of neurological examination findings in ADAD. METHODS Frequencies of neurological examination findings were compared between symptomatic mutation carriers and non mutation carriers from the Dominantly Inherited Alzheimer Network (DIAN) to define AD neurological examination findings. AD neurological examination findings were analyzed regarding frequency, association with and predictive value regarding cognitive decline, and association with brain atrophy in symptomatic mutation carriers. RESULTS AD neurological examination findings included abnormal deep tendon reflexes, gait disturbance, pathological cranial nerve examination findings, tremor, abnormal finger to nose and heel to shin testing, and compromised motor strength. The frequency of AD neurological examination findings was 65.1%. Cross-sectionally, mutation carriers with AD neurological examination findings showed a more than two-fold faster cognitive decline and had greater parieto-temporal atrophy, including hippocampal atrophy. Longitudinally, AD neurological examination findings predicted a significantly greater decline over time. DISCUSSION ADAD features a distinct pattern of neurological examination findings that is useful to estimate prognosis and may inform clinical care and therapeutic trial designs.
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Affiliation(s)
- Jonathan Vöglein
- Department of Neurology, Ludwig-Maximilians-Universität München, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-Universität München, Germany
| | - John C. Morris
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
| | - Marianne Dieterich
- Department of Neurology, Ludwig-Maximilians-Universität München, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Germany
| | - Eric McDade
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
| | - Mikael Simons
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Oliver Preische
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Anna Hofmann
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Jason Hassenstab
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
| | - Tammie L. Benzinger
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
| | - Anne Fagan
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
| | - James M. Noble
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, and Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, 710 West 168 Street Box 176, New York, NY 10032, USA
| | - Sarah B. Berman
- University of Pittsburgh, 3471 Fifth Ave #900, Pittsburgh, PA 15213, USA
| | | | | | - Martin R. Farlow
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Jasmeer P. Chhatwal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Stephen Salloway
- Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA
| | - Chengjie Xiong
- Division of Biostatistics, Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
| | - Celeste M. Karch
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
| | - Nigel Cairns
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
- Medical School and Living Systems Institute, University of Exeter, Stocker Road, Exeter, EX4 4QD, United Kingdom
| | - Richard J. Perrin
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
| | - Gregory Day
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Ralph Martins
- Edith Cowan University, 270 Joondalup Drive, Joondalup WA 6027, Australia
| | - Raquel Sanchez-Valle
- Alzheimer’s disease and other cognitive disorders group. Service of Neurology, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Hiroshi Mori
- Osaka City University Medical School, Asahimachi, Abenoku, Osaka 545-8585, Japan
| | - Hiroyuki Shimada
- Osaka City University Medical School, Asahimachi, Abenoku, Osaka 545-8585, Japan
| | - Takeshi Ikeuchi
- Brain Research Institute, Niigata University, 1-757 Asahimachi, Niigata 951-8585, Japan
| | | | - Peter R. Schofield
- Neuroscience Research Australia, Sydney 2031 Australia
- School of Medical Sciences, University of New South Wales, Sydney 2052 Australia
| | - Colin L. Masters
- Florey Institute, University of Melbourne, Level 5, Kenneth Myer Building, 30 Royal Parade, Parkville, Victoria, 3010, Australia
| | - Alison Goate
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, B1065, New York, NY 10029,USA
| | - Virginia Buckles
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
| | - Nick C. Fox
- Dementia Research Centre, Institute of Neurology, University College London, Queen Square, London WC1 3BG United Kingdom
| | | | | | - John M. Ringman
- Keck School of Medicine of University of Southern California, Center for the Health Professionals, 1540 Alcazar Street, Suite 209F, Los Angeles, CA 90089, USA
| | - Igor Yakushev
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany
| | - Mathias Jucker
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Günter Höglinger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Randall J. Bateman
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians-Universität München, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Levin J, Vöglein J, Quiroz YT, Bateman RJ, Ghisays V, Lopera F, McDade E, Reiman E, Tariot PN, Morris JC. Testing the amyloid cascade hypothesis: Prevention trials in autosomal dominant Alzheimer disease. Alzheimers Dement 2022; 18:2687-2698. [PMID: 35212149 PMCID: PMC9399299 DOI: 10.1002/alz.12624] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The amyloid cascade hypothesis of Alzheimer disease (AD) has been increasingly challenged. Here, we aim to refocus the amyloid cascade hypothesis on its original premise that the accumulation of amyloid beta (Aβ) peptide is the primary and earliest event in AD pathogenesis as based on current evidence, initiating several pathological events and ultimately leading to AD dementia. BACKGROUND An ongoing debate about the validity of the amyloid cascade hypothesis for AD has been triggered by clinical trials with investigational disease-modifying drugs targeting Aβ that have not demonstrated consistent clinically meaningful benefits. UPDATED HYPOTHESIS It is an open question if monotherapy targeting Aβ pathology could be markedly beneficial at a stage when the brain has been irreversibly damaged by a cascade of pathological changes. Interventions in cognitively unimpaired individuals at risk for dementia, during amyloid-only and pre-amyloid stages, are more appropriate for proving or refuting the amyloid hypothesis. Our updated hypothesis states that anti-Aβ investigational therapies are likely to be most efficacious when initiated in the preclinical (asymptomatic) stages of AD and specifically when the disease is driven primarily by amyloid pathology. Given the young age at symptom onset and the deterministic nature of the mutations, autosomal dominant AD (ADAD) mutation carriers represent the ideal population to evaluate the efficacy of putative disease-modifying Aβ therapies. MAJOR CHALLENGES FOR THE HYPOTHESIS Key challenges of the amyloid hypothesis include the recognition that disrupted Aβ homeostasis alone is insufficient to produce the AD pathophysiologic process, poor correlation of Aβ with cognitive impairment, and inconclusive data regarding clinical efficacy of therapies targeting Aβ. Challenges of conducting ADAD research include the rarity of the disease and uncertainty of the generalizability of ADAD findings for the far more common "sporadic" late-onset AD. LINKAGE TO OTHER MAJOR THEORIES The amyloid cascade hypothesis, modified here to pertain to the preclinical stage of AD, still needs to be integrated with the development and effects of tauopathy and other co-pathologies, including neuroinflammation, vascular insults, synucleinopathy, and many others.
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Affiliation(s)
- Johannes Levin
- Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81541 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE) site Munich, Feodor-Lynen-Str. 17, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Jonathan Vöglein
- Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81541 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE) site Munich, Feodor-Lynen-Str. 17, 81377 Munich, Germany
| | - Yakeel T. Quiroz
- Harvard Medical School and Massachusetts General Hospital, 39 1 Avenue, Suite 101, Charlestown, MA 02129, USA
- Grupo de Neurociencias, Universidad de Antioquia, Antioquia, Colombia
| | - Randall J. Bateman
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
| | - Valentina Ghisays
- Banner Alzheimer’s Institute, 901 E Willetta St, Phoenix, AZ 85006, USA
| | - Francisco Lopera
- Grupo de Neurociencias, Universidad de Antioquia, Antioquia, Colombia
| | - Eric McDade
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
| | - Eric Reiman
- Banner Alzheimer’s Institute, 901 E Willetta St, Phoenix, AZ 85006, USA
| | - Pierre N. Tariot
- Banner Alzheimer’s Institute, 901 E Willetta St, Phoenix, AZ 85006, USA
| | - John C. Morris
- Washington University School of Medicine, 660 South Euclid, Saint Louis, MO 63110, USA
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