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Haeger A, Muising J, Romanzetti S, Fimm B, Matz O, Schulz JB, Heim S, Reetz K. Communicative impairment and its neural correlates in Alzheimer's disease and frontotemporal dementia. Brain Behav 2024; 14:e3420. [PMID: 38494763 PMCID: PMC10945087 DOI: 10.1002/brb3.3420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE Communication skills can deteriorate in neurodegenerative diseases such as Alzheimer's disease (AD) and frontotemporal dementia (FTD); however, their clinical assessment and treatment in patient care can be challenging. In the present study, we aimed to quantify the distinctive communication resources and barriers reported by patients and their relatives in AD and FTD and associated these communicative characteristics with clinical parameters, such as the degree of cognitive impairment and atrophy in language-associated brain areas. METHODS We assessed self-reported communication barriers and resources in 33 individuals with AD and FTD through an interview on daily-life communication, using the Aachener KOMPASS questionnaire. We correlated reported communication barriers and resources with atrophy from high-resolution 3T brain magnetic resonance imaging, neuropsychological assessment, and neurodegenerative markers from cerebrospinal fluid. RESULTS Communicative impairment was higher in FTD compared to AD. Increased reported communication barriers in our whole sample were associated with the atrophy rate in the left middle temporal lobe, a critical site within the neuronal language network, and with depressive symptoms as well as the semantic word fluency from neuropsychological assessment. The best model for prediction of communicative impairment included the diagnosis (AD or FTD), semantic word fluency, and depressive symptoms. CONCLUSIONS Our study demonstrates that communication barriers and resources can be successfully assessed via a structured interview based on self-report and report of patients' relatives in practice and are reflected in neuroimaging specific for AD and FTD as well as in further clinical parameters specific for these neurodegenerative diseases. This can potentially open new treatment options for clinical practice and patient care.
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Affiliation(s)
- Alexa Haeger
- Department of NeurologyRWTH Aachen UniversityAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and NeuroimagingForschungszentrum Jülich GmbH and RWTH Aachen UniversityAachenGermany
| | - Janka Muising
- Department of NeurologyRWTH Aachen UniversityAachenGermany
| | - Sandro Romanzetti
- Department of NeurologyRWTH Aachen UniversityAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and NeuroimagingForschungszentrum Jülich GmbH and RWTH Aachen UniversityAachenGermany
| | - Bruno Fimm
- Department of NeurologyRWTH Aachen UniversityAachenGermany
| | - Oliver Matz
- Department of NeurologyRWTH Aachen UniversityAachenGermany
| | - Jörg B. Schulz
- Department of NeurologyRWTH Aachen UniversityAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and NeuroimagingForschungszentrum Jülich GmbH and RWTH Aachen UniversityAachenGermany
| | - Stefan Heim
- Department of NeurologyRWTH Aachen UniversityAachenGermany
- Institute of Neuroscience and Medicine (INM‐1)Research Centre JülichJülichGermany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical FacultyRWTH Aachen UniversityAachenGermany
| | - Kathrin Reetz
- Department of NeurologyRWTH Aachen UniversityAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and NeuroimagingForschungszentrum Jülich GmbH and RWTH Aachen UniversityAachenGermany
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Congdon EE, Ji C, Tetlow AM, Jiang Y, Sigurdsson EM. Tau-targeting therapies for Alzheimer disease: current status and future directions. Nat Rev Neurol 2023; 19:715-736. [PMID: 37875627 PMCID: PMC10965012 DOI: 10.1038/s41582-023-00883-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/26/2023]
Abstract
Alzheimer disease (AD) is the most common cause of dementia in older individuals. AD is characterized pathologically by amyloid-β (Aβ) plaques and tau neurofibrillary tangles in the brain, with associated loss of synapses and neurons, which eventually results in dementia. Many of the early attempts to develop treatments for AD focused on Aβ, but a lack of efficacy of these treatments in terms of slowing disease progression led to a change of strategy towards targeting of tau pathology. Given that tau shows a stronger correlation with symptom severity than does Aβ, targeting of tau is more likely to be efficacious once cognitive decline begins. Anti-tau therapies initially focused on post-translational modifications, inhibition of tau aggregation and stabilization of microtubules. However, trials of many potential drugs were discontinued because of toxicity and/or lack of efficacy. Currently, the majority of tau-targeting agents in clinical trials are immunotherapies. In this Review, we provide an update on the results from the initial immunotherapy trials and an overview of new therapeutic candidates that are in clinical development, as well as considering future directions for tau-targeting therapies.
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Affiliation(s)
- Erin E Congdon
- Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, USA
- Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, USA
| | - Changyi Ji
- Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, USA
- Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, USA
| | - Amber M Tetlow
- Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, USA
- Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, USA
| | - Yixiang Jiang
- Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, USA
- Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, USA
| | - Einar M Sigurdsson
- Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, USA.
- Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA.
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Schröder S, Bönig L, Proskynitopoulos PJ, Janke E, Heck J, Mahmoudi N, Groh A, Berding G, Wedegärtner F, Deest-Gaubatz S, Maier HB, Bleich S, Frieling H, Schulze Westhoff M. Bifrontal electroconvulsive therapy leads to improvement of cerebral glucose hypometabolism in frontotemporal dementia with comorbid psychotic depression - a case report. BMC Psychiatry 2023; 23:279. [PMID: 37081424 PMCID: PMC10120124 DOI: 10.1186/s12888-023-04759-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Differentiating depression and dementia in elderly patients represents a major clinical challenge for psychiatrists. Pharmacological and non-pharmacological treatment options for both conditions are often used cautiously due to fear of adverse effects. If a clinically indicated therapy is not initiated due to fear of adverse effects, the quality of life of affected patients may significantly be reduced. CASE PRESENTATION Here, we describe the case of a 65-year-old woman who presented to the department of psychiatry of a university hospital with depressed mood, pronounced anxiety, and nihilistic thoughts. While several pharmacological treatments remained without clinical response, further behavioral observation in conjunction with 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed the diagnosis of frontotemporal dementia (FTD). To counter the pharmacological treatment resistance of psychotic depression, we decided to perform electroconvulsive therapy (ECT). Remarkably, ten sessions of ECT yielded an almost complete remission of depressive symptoms. In addition, the patient's delusional ideas disappeared. A follow-up 18F-FDG PET/CT after the ECT series still showed a frontally and parieto-temporally accentuated hypometabolism, albeit with a clear regression compared to the previous image. The follow-up 18F-FDG PET/CT thus corroborated the diagnosis of FTD, while on the other hand it demonstrated the success of ECT. CONCLUSIONS In this case, ECT was a beneficial treatment option for depressive symptoms in FTD. Also, 18F-FDG PET/CT should be discussed as a valuable tool in differentiating depression and dementia and as an indicator of treatment response.
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Affiliation(s)
- Sebastian Schröder
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lena Bönig
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Phileas Johannes Proskynitopoulos
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Eva Janke
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Nima Mahmoudi
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Georg Berding
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Felix Wedegärtner
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stephanie Deest-Gaubatz
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hannah Benedictine Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Martin Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Constantinides VC, Paraskevas GP, Boufidou F, Bourbouli M, Pyrgelis ES, Stefanis L, Kapaki E. CSF Aβ42 and Aβ42/Aβ40 Ratio in Alzheimer's Disease and Frontotemporal Dementias. Diagnostics (Basel) 2023; 13:diagnostics13040783. [PMID: 36832271 PMCID: PMC9955886 DOI: 10.3390/diagnostics13040783] [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: 01/10/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Alzheimer's disease dementia (ADD) may manifest with atypical phenotypes, resembling behavioral variant frontotemporal dementia (bvFTD) and corticobasal syndrome (CBS), phenotypes which typically have an underlying frontotemporal lobar degeneration with tau proteinopathy (FTLD-tau), such as Pick's disease, corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), or FTLD with TDP-43 proteinopathy (FTLD-TDP). CSF biomarkers total and phosphorylated tau (τT and τP-181), and amyloid beta with 42 and 40 amino acids (Aβ42 and Aβ40) are biomarkers of AD pathology. The primary aim of this study was to compare the diagnostic accuracy of Aβ42 to Aβ42/Aβ40 ratio in: (a) differentiating ADD vs. frontotemporal dementias; (b) patients with AD pathology vs. non-AD pathologies; (c) compare biomarker ratios and composite markers to single CSF biomarkers in the differentiation of AD from FTD; Methods: In total, 263 subjects were included (ADD: n = 98; bvFTD: n = 49; PSP: n = 50; CBD: n = 45; controls: n = 21). CSF biomarkers were measured by commercially available ELISAs (EUROIMMUN). Multiple biomarker ratios (Aβ42/Aβ40; τT/τP-181; τT/Aβ42; τP-181/Aβ42) and composite markers (t-tau: τT/(Aβ42/Aβ40); p-tau: τP-181/(Aβ42/Aβ40) were calculated. ROC curve analysis was performed to compare AUCs of Aβ42 and Aβ42/Aβ40 ratio and relevant composite markers between ADD and FTD, as defined clinically. BIOMARKAPD/ABSI criteria (abnormal τT, τP-181 Aβ42, and Aβ42/Aβ40 ratio) were used to re-classify all patients into AD pathology vs. non-AD pathologies, and ROC curve analysis was repeated to compare Aβ42 and Aβ42/Aβ40; Results: Aβ42 did not differ from Aβ42/Aβ40 ratio in the differentiation of ADD from FTD (AUCs 0.752 and 0.788 respectively; p = 0.212). The τT/Aβ42 ratio provided maximal discrimination between ADD and FTD (AUC:0.893; sensitivity 88.8%, specificity 80%). BIOMARKAPD/ABSI criteria classified 60 patients as having AD pathology and 211 as non-AD. A total of 22 had discrepant results and were excluded. Aβ42/Aβ40 ratio was superior to Aβ42 in the differentiation of AD pathology from non-AD pathology (AUCs: 0.939 and 0.831, respectively; p < 0.001). In general, biomarker ratios and composite markers were superior to single CSF biomarkers in both analyses. CONCLUSIONS Aβ42/Aβ40 ratio is superior to Aβ42 in identifying AD pathology, irrespective of the clinical phenotype. CSF biomarker ratios and composite markers provide higher diagnostic accuracy compared to single CSF biomarkers.
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Affiliation(s)
- Vasilios C. Constantinides
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
- Neurochemistry and Biological Markers Unit, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-21-0728-9285
| | - George P. Paraskevas
- Neurochemistry and Biological Markers Unit, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Rimini 1, 12462 Athens, Greece
| | - Fotini Boufidou
- Neurochemistry and Biological Markers Unit, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Mara Bourbouli
- Neurochemistry and Biological Markers Unit, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Efstratios-Stylianos Pyrgelis
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Leonidas Stefanis
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Elisabeth Kapaki
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
- Neurochemistry and Biological Markers Unit, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
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Constantinides VC, Boufidou F, Bourbouli M, Pyrgelis ES, Ghika A, Koros C, Liakakis G, Papageorgiou S, Stefanis L, Paraskevas GP, Kapaki E. Application of the AT(N) and Other CSF Classification Systems in Behavioral Variant Frontotemporal Dementia. Diagnostics (Basel) 2023; 13:diagnostics13030332. [PMID: 36766437 PMCID: PMC9914032 DOI: 10.3390/diagnostics13030332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients with a frontotemporal lobar degeneration (FTLD) usually manifest with behavioral variant frontotemporal dementia (bvFTD). Alzheimer's disease (AD) may also manifest with a predominant behavioral-dysexecutive syndrome, similar to bvFTD. Cerebrospinal fluid (CSF) biomarkers, such as total tau (τT), phosphorylated tau (τP-181) and amyloid beta with 42 amino-acids (Aβ42), can predict AD pathology in vivo. The aim of this study was to compare the τT/Aβ42 and τP-181/Aβ42 ratios, the BIOMARKAPD/ABSI criteria and the AT(N) classification system in a cohort of bvFTD patients. METHODS A total of 105 bvFTD patients (21 possible bvFTD; 20%) with CSF data, examined from 2008 to 2022, were included. Seventy-eight AD patients and 62 control subjects were included. The CSF biomarkers were measured with Innotest (2008-2017 subcohort) and EUROIMMUN (2017-2022 subcohort) ELISAs. RESULTS Depending on the classification system, 7.6 to 28.6% of bvFTD had an AD biochemical profile. The τT/Aβ42 and τP-181/Aβ42 ratios classified more patients as AD compared to the BIOMARKAPD/ABSI and AT(N) systems. The patients with possible bvFTD had higher frequencies of AD compared to the probable bvFTD patients. CONCLUSIONS The four classification criteria of CSF AD biomarkers resulted in differences in AD allocation in this bvFTD cohort. A consensus on the optimal classification criteria of CSF AD biomarkers is pivotal.
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Affiliation(s)
- Vasilios C. Constantinides
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
- Neurochemistry and Biological Markers Unit, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-21-0728-9285
| | - Fotini Boufidou
- Neurochemistry and Biological Markers Unit, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Mara Bourbouli
- Neurochemistry and Biological Markers Unit, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Efstratios-Stylianos Pyrgelis
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
- Neurochemistry and Biological Markers Unit, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Apostolia Ghika
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Christos Koros
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - George Liakakis
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Sokratis Papageorgiou
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Leonidas Stefanis
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - George P. Paraskevas
- Neurochemistry and Biological Markers Unit, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Rimini 1, 12462 Athens, Greece
| | - Elisabeth Kapaki
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
- Neurochemistry and Biological Markers Unit, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
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Dilcher R, Malpas CB, O'Brien TJ, Vivash L. Social Cognition in Behavioral Variant Frontotemporal Dementia and Pathological Subtypes: A Narrative Review. J Alzheimers Dis 2023; 94:19-38. [PMID: 37212100 DOI: 10.3233/jad-221171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Behavioral variant frontotemporal dementia (bvFTD) belongs to the spectrum of frontotemporal lobar degeneration (FTLD) and is characterized by frontal dysfunction with executive deficits and prominent socioemotional impairments. Social cognition, such as emotion processing, theory of mind, and empathy may significantly impact daily behavior in bvFTD. Abnormal protein accumulation of tau or TDP-43 are the main causes of neurodegeneration and cognitive decline. Differential diagnosis is difficult due to the heterogeneous pathology in bvFTD and the high clinicopathological overlap with other FTLD syndromes, especially in late disease stages. Despite recent advances, social cognition in bvFTD has not yet received sufficient attention, nor has its association with underlying pathology. This narrative review evaluates social behavior and social cognition in bvFTD, by relating these symptoms to neural correlates and underlying molecular pathology or genetic subtypes. Negative and positive behavioral symptoms, such as apathy and disinhibition, share similar brain atrophy and reflect social cognition. More complex social cognitive impairments are probably caused by the interference of executive impairments due to increasing neurodegeneration. Evidence suggests that underlying TDP-43 is associated with neuropsychiatric and early social cognitive dysfunction, while patients with underlying tau pathology are marked by strong cognitive dysfunction with increasing social impairments in later stages. Despite many current research gaps and controversies, finding distinct social cognitive markers in association to underlying pathology in bvFTD is essential for validating biomarkers, for clinical trials of novel therapies, and for clinical practice.
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Affiliation(s)
- Roxane Dilcher
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
| | - Charles B Malpas
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Australia
| | - Terence J O'Brien
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Australia
| | - Lucy Vivash
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Australia
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Biomarkers and non-motor symptoms as a function of motor symptom asymmetry in early Parkinson's disease. Neuropsychologia 2022; 177:108419. [PMID: 36375651 DOI: 10.1016/j.neuropsychologia.2022.108419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/19/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The longitudinal trajectories of cognitive-neuropsychiatric symptoms from the early stages of Parkinson's disease, as a function of motor symptom asymmetry at the onset of the disease, remain to be fully explored. Moreover, the relationship to biomarkers warrants further investigation. METHODOLOGY Non-motor and biospecimen data from 413 patients with Parkinson's disease, dissociating predominantly left-sided motor symptoms patients (n = 179), predominantly right-sided motor symptoms patients (n = 234), and matched healthy controls (n = 196), were extracted from the Parkinson's Progression Marker Initiative database during a 3-Year follow-up. Non-parametric and conservative corrections for multivariate comparisons were carried out on neuropsychiatric and biomarker data. RESULTS A decline for global cognitive efficiency scores in predominantly right-sided motor symptoms patients was observed, whereas depressive and anxiety symptoms were greater overtime for predominantly left-sided motor symptoms patients. Biomarker analysis revealed that predominantly right-sided patients expressed decreased levels of total-tau and phospho-tau over time, while left-sided patients didn't differ from healthy controls. CONCLUSION From the early course of the disease, the existence of different clinical phenotypes is proposed, associated to emerging evidences of distinct pathological pathways and a left-hemispheric vulnerability for cognitive decline.
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Olm CA, Burke SE, Peterson C, Lee EB, Trojanowski JQ, Massimo L, Irwin DJ, Grossman M, Gee JC. Event-based modeling of T1-weighted MRI is related to pathology in frontotemporal lobar degeneration due to tau and TDP. Neuroimage Clin 2022; 37:103285. [PMID: 36508888 PMCID: PMC9763503 DOI: 10.1016/j.nicl.2022.103285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND In previous studies of patients with frontotemporal lobar degeneration due to tau (FTLD-tau) and FTLD due to TDP (FTLD-TDP), cortical volumes derived from T1-weighted MRI have been used to identify a sequence of volume loss according to arbitrary volumetric criteria. Event-based modeling (EBM) is a probabilistic, generative machine learning model that determines the characteristic sequence of changes, or "events", occurring during disease progression. EBM also estimates an individual patient's disease "stage" by identifying which events have already occurred. In the present study, we use an EBM analysis to derive stages of regional anatomic atrophy in FTLD-tau and FTLD-TDP, and validated these stages against pathologic burden. METHODS Sporadic autopsy-confirmed patients with FTLD-tau (N = 42) and FTLD-TDP (N = 21), and 167 healthy controls with available T1-weighted images were identified. A subset of patients had quantitative digital histopathology of cortex performed at autopsy (FTLD-tau = 30, FTLD-TDP = 17). MRI images were processed, producing regional measures of cortical volumes. K-means clustering was used to find cortical regions with similar amounts of GM volume changes (n = 5 clusters). EBM was used to determine the characteristic sequence of cortical atrophy of identified clusters in autopsy-confirmed FTLD-tau and FTLD-TDP, and estimate each patient's disease stage by cortical volume biomarkers. Linear regressions related pathologic burden to EBM-estimated disease stages. RESULTS EBM for cortical volume biomarkers generated statistically robust characteristic sequences of cortical atrophy in each group of patients. Cortical volume-based EBM-estimated disease stage was associated with pathologic burden in FTLD-tau (R2 = 0.16, p = 0.017) and FTLD-TDP (R2 = 0.51, p = 0.0008). CONCLUSIONS We provide evidence that EBM can identify sequences of pathologically-confirmed cortical atrophy in sporadic FTLD-tau and FTLD-TDP.
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Affiliation(s)
- Christopher A Olm
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States; Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
| | - Sarah E Burke
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
| | - Claire Peterson
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States; Digital Neuropathology Laboratory, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Lauren Massimo
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
| | - David J Irwin
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States; Digital Neuropathology Laboratory, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
| | - James C Gee
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States.
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Cousins KAQ, Arezoumandan S, Shellikeri S, Ohm D, Shaw LM, Grossman M, Wolk D, McMillan CT, Chen-Plotkin A, Lee E, Trojanowski JQ, Zetterberg H, Blennow K, Irwin DJ. CSF Biomarkers of Alzheimer Disease in Patients With Concomitant α-Synuclein Pathology. Neurology 2022; 99:e2303-e2312. [PMID: 36041863 PMCID: PMC9694837 DOI: 10.1212/wnl.0000000000201202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES CSF biomarkers β-amyloid 1-42 (Aβ42), phosphorylated tau 181 (p-tau181), total tau (t-tau), and neurogranin (Ng) can diagnose Alzheimer disease (AD) in life. However, it is unknown whether CSF concentrations, and thus their accuracies, are affected by concomitant pathologies common in AD, such as α-synuclein (αSyn). Our primary goal was to test whether biomarkers in patients with AD are altered by concomitant αSyn. We compared CSF Aβ42, p-tau181, t-tau, and Ng levels across autopsy-confirmed AD and concomitant AD and αSyn (AD + αSyn). Antemortem CSF levels were related to postmortem accumulations of αSyn. Finally, we tested how concommitant AD + αSyn affected the diagnostic accuracy of 2 CSF-based strategies: the amyloid/tau/neurodegeneration (ATN) framework and the t-tau/Aβ42 ratio. METHODS Inclusion criteria were neuropathologic diagnoses of AD, mixed AD + αSyn, and αSyn. A convenience sample of nonimpaired controls was selected with available CSF and a Mini-Mental State Examination (MMSE) ≥ 27. αSyn without AD and controls were included as reference groups. Analyses of covariance (ANCOVAs) tested planned comparisons were CSF Aβ42, p-tau181, t-tau, and Ng differences across AD and AD + αSyn. Linear models tested how biomarkers were altered by αSyn accumulation in AD, accounting for pathologic β-amyloid and tau. Receiver operating characteristic and area under the curve (AUC), including 95% CI, evaluated diagnostic accuracy. RESULTS Participants were 61 patients with AD, 39 patients with mixed AD + αSyn, 20 patients with αSyn, and 61 controls. AD had similar median age (73 [interquartile range {IQR} = 12] years), MMSE (23 [IQR = 9]), and sex distribution (male = 49%) compared with AD + αSyn age (70 [IQR = 13] years; p = 0.3), MMSE (25 [IQR = 9.5]; p = 0.19), and sex distribution (male = 69%; p = 0.077). ANCOVAs showed that AD + αSyn had lower p-tau181 (F(1,94) = 17, p < 2.6e-16), t-tau (F(1,93) = 11, p = 0.0004), and Ng levels (F(1,50) = 12, p = 0.0004) than AD; there was no difference in Aβ42 (p = 0.44). Models showed increasing αSyn related to lower p-tau181 (β = -0.26, SE = 0.092, p = 0.0065), t-tau (β = -0.19, SE = 0.092, p = 0.041), and Ng levels (β = -0.2, SE = 0.066, p = 0.0046); αSyn was not a significant factor for Aβ42 (p = 1). T-tau/Aβ42 had the highest accuracy when detecting AD, including mixed AD + αSyn cases (AUC = 0.95; CI 0.92-0.98). DISCUSSION Findings demonstrate that concomitant αSyn pathology in AD is associated with lower CSF p-tau181, t-tau, and Ng levels and can affect diagnostic accuracy in patients with AD.
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Affiliation(s)
- Katheryn Alexandra Quilico Cousins
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK.
| | - Sanaz Arezoumandan
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
| | - Sanjana Shellikeri
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
| | - Daniel Ohm
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
| | - Leslie M Shaw
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
| | - Murray Grossman
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
| | - David Wolk
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
| | - Corey T McMillan
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
| | - Alice Chen-Plotkin
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
| | - Edward Lee
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
| | - John Q Trojanowski
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
| | - Henrik Zetterberg
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
| | - Kaj Blennow
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
| | - David John Irwin
- From the Departments of Neurology (K.A.Q.C., S.A., S.S., D.O., M.G., D.W., C.T.M., A.C.-P., D.J.I.), Pathology and Laboratory Medicine (L.M.S., E.L., J.Q.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Neurodegenerative Disease (H.Z.), Institute of Neurology, University College London, UK
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Saunders TS, Gadd DA, Spires‐Jones TL, King D, Ritchie C, Muniz‐Terrera G. Associations between cerebrospinal fluid markers and cognition in ageing and dementia: A systematic review. Eur J Neurosci 2022; 56:5650-5713. [PMID: 35338546 PMCID: PMC9790745 DOI: 10.1111/ejn.15656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/08/2022] [Accepted: 03/13/2022] [Indexed: 12/30/2022]
Abstract
A biomarker associated with cognition in neurodegenerative dementias would aid in the early detection of disease progression, complement clinical staging and act as a surrogate endpoint in clinical trials. The current systematic review evaluates the association between cerebrospinal fluid protein markers of synapse loss and neuronal injury and cognition. We performed a systematic search which revealed 67 studies reporting an association between cerebrospinal fluid markers of interest and neuropsychological performance. Despite the substantial heterogeneity between studies, we found some evidence for an association between neurofilament-light and worse cognition in Alzheimer's diseases, frontotemporal dementia and typical cognitive ageing. Moreover, there was an association between cerebrospinal fluid neurogranin and cognition in those with an Alzheimer's-like cerebrospinal fluid biomarker profile. Some evidence was found for cerebrospinal fluid neuronal pentraxin-2 as a correlate of cognition across dementia syndromes. Due to the substantial heterogeneity of the field, no firm conclusions can be drawn from this review. Future research should focus on improving standardization and reporting as well as establishing the importance of novel markers such as neuronal pentraxin-2 and whether such markers can predict longitudinal cognitive decline.
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Affiliation(s)
- Tyler S. Saunders
- UK Dementia Research InstituteThe University of EdinburghEdinburghUK,Center for Discovery Brain SciencesThe University of EdinburghEdinburghUK,Center for Clinical Brain SciencesThe University of EdinburghEdinburghUK,Center for Dementia PreventionThe University of EdinburghEdinburghUK
| | - Danni A. Gadd
- Center for Genomic and Experimental Medicine, Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUK
| | - Tara L. Spires‐Jones
- UK Dementia Research InstituteThe University of EdinburghEdinburghUK,Center for Discovery Brain SciencesThe University of EdinburghEdinburghUK
| | - Declan King
- UK Dementia Research InstituteThe University of EdinburghEdinburghUK,Center for Discovery Brain SciencesThe University of EdinburghEdinburghUK
| | - Craig Ritchie
- Center for Clinical Brain SciencesThe University of EdinburghEdinburghUK,Center for Dementia PreventionThe University of EdinburghEdinburghUK
| | - Graciela Muniz‐Terrera
- Center for Clinical Brain SciencesThe University of EdinburghEdinburghUK,Center for Dementia PreventionThe University of EdinburghEdinburghUK
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11
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Congdon EE, Pan R, Jiang Y, Sandusky-Beltran LA, Dodge A, Lin Y, Liu M, Kuo MH, Kong XP, Sigurdsson EM. Single domain antibodies targeting pathological tau protein: Influence of four IgG subclasses on efficacy and toxicity. EBioMedicine 2022; 84:104249. [PMID: 36099813 PMCID: PMC9475275 DOI: 10.1016/j.ebiom.2022.104249] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Eleven tau immunoglobulin G (IgG) antibodies have entered clinical trials to treat tauopathies, including Alzheimer's disease, but it is unclear which IgG subclass/subtype has the ideal efficacy and safety profile. Only two subtypes, with or without effector function, have been examined in the clinic and not for the same tau antibody. The few preclinical studies on this topic have only compared two subtypes of one antibody each and have yielded conflicting results. METHODS We selected two single domain antibodies (sdAbs) derived from a llama immunized with tau proteins and utilized them to generate an array of Fc-(sdAb)2 subclasses containing identical tau binding domains but differing Fc region. Unmodified sdAbs and their IgG subclasses were tested for efficacy in primary cultures and in vivo microdialysis using JNPL3 tauopathy mice. FINDINGS Unmodified sdAbs were non-toxic, blocked tau toxicity and promoted tau clearance. However, the efficacy/safety profile of their Fc-(sdAb)2 subclasses varied greatly within and between sdAbs. For one of them, all its subtypes were non-toxic, only those with effector function cleared tau, and were more effective in vivo than unmodified sdAb. For the other sdAb, all its subtypes were toxic in tauopathy cultures but not in wild-type cells, suggesting that bivalent binding of its tau epitope stabilizes a toxic conformation of tau, with major implications for tau pathogenesis. Likewise, its subclasses were less effective than the unmodified sdAb in clearing tau in vivo. INTERPRETATION These findings indicate that tau antibodies with effector function are safe and better at clearing pathological tau than effectorless antibodies, Furthermore, tau antibodies can provide a valuable insight into tau pathogenesis, and some may aggravate it. FUNDING Funding for these studies was provided by the National Institute of Health (R01 AG032611, R01 NS077239, RF1 NS120488, R21 AG 069475, R21 AG 058282, T32AG052909), and the NYU Alzheimer's Disease Center Pilot Grant Program (via P30 AG008051).
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Affiliation(s)
- Erin E Congdon
- Department of Neuroscience and Physiology, and the Neuroscience Institute, New York University Grossman School of Medicine, 435 East 30th Street, New York, NY 10016, USA
| | - Ruimin Pan
- Department of Biochemistry and Molecular Pharmacology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Yixiang Jiang
- Department of Neuroscience and Physiology, and the Neuroscience Institute, New York University Grossman School of Medicine, 435 East 30th Street, New York, NY 10016, USA
| | - Leslie A Sandusky-Beltran
- Department of Neuroscience and Physiology, and the Neuroscience Institute, New York University Grossman School of Medicine, 435 East 30th Street, New York, NY 10016, USA
| | - Andie Dodge
- Department of Neuroscience and Physiology, and the Neuroscience Institute, New York University Grossman School of Medicine, 435 East 30th Street, New York, NY 10016, USA
| | - Yan Lin
- Department of Neuroscience and Physiology, and the Neuroscience Institute, New York University Grossman School of Medicine, 435 East 30th Street, New York, NY 10016, USA
| | - Mengyu Liu
- Department of Biochemistry and Molecular Biology, Michigan State University, 603 Wilson Road, Room 401, East Lansing, MI, 48824, USA
| | - Min-Hao Kuo
- Department of Biochemistry and Molecular Biology, Michigan State University, 603 Wilson Road, Room 401, East Lansing, MI, 48824, USA
| | - Xiang-Peng Kong
- Department of Biochemistry and Molecular Pharmacology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Einar M Sigurdsson
- Department of Neuroscience and Physiology, and the Neuroscience Institute, New York University Grossman School of Medicine, 435 East 30th Street, New York, NY 10016, USA; Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA.
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12
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Dilcher R, Malpas CB, Walterfang M, Velakoulis D, O’Brien TJ, Vivash L. Sodium selenate as a therapeutic for tauopathies: A hypothesis paper. Front Aging Neurosci 2022; 14:915460. [PMID: 35992608 PMCID: PMC9389397 DOI: 10.3389/fnagi.2022.915460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
In a large proportion of individuals with fronto-temporal lobar degeneration (FTLD), the underlying pathology is associated with the misfolding and aggregation of the microtubule associated protein tau (FTLD-tau). With disease progression, widespread protein accumulation throughout cortical and subcortical brain regions may be responsible for neurodegeneration. One of the syndromes of FTLD is the behavioral variant of frontotemporal dementia (bvFTD), in which the underlying pathology is heterogenous, with half of the cases being related to FTLD-tau. Currently, there are no approved disease-modifying treatments for FTLD-tau, therefore representing a major unmet therapeutic need. These descriptive, preliminary findings of the phase 1 open-label trial provide data to support the potential of sodium selenate to halt the cognitive and behavioral decline, as well as to reduce tau levels in a small group of participants with bvFTD (N = 11). All participants were treated with sodium selenate over a period of 52 weeks. Cognition was assessed with the Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG, total scores), social cognition with the Revised Self-Monitoring Scale (RSMS, total scores), behavior with the Cambridge Behavioral Inventory (CBI), and carer burden with the Caregiver Buden Scale (CBS). Fluid biomarker measures include cerebrospinal fluid of total tau (t-tau), phosphorylated tau (p-tau181), NfL, p-tau181/t-tau, t-tau/Aβ1–42, and p-tau181/Aβ1–42 levels. After treatment at follow-up, cognition and behavior showed further negative change (based on a reliable change criterion cut-off of annual NUCOG decline) in the “progressors,” but not in the “non-progressors.” “Non-progressors” also showed elevated baseline CSF tau levels and no increase after treatment, indicating underlying tau pathology and a positive response to sodium selenate treatment. Significant changes in MRI were not observed. The findings provide useful information for future clinical trials to systematically assess the disease-modifying treatment effects of sodium selenate in randomized controlled designs for bvFTD and FTLD-tau pathologies.
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Affiliation(s)
- Roxane Dilcher
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Charles B. Malpas
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Medicine and Radiology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Clinical Outcomes Research Unit (CORe), Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Psychiatry and Melbourne Neuropsychiatry Center, University of Melbourne, Melbourne, VIC, Australia
| | - Dennis Velakoulis
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Psychiatry and Melbourne Neuropsychiatry Center, University of Melbourne, Melbourne, VIC, Australia
| | - Terence J. O’Brien
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Medicine and Radiology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
| | - Lucy Vivash
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Medicine and Radiology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
- *Correspondence: Lucy Vivash,
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13
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Gambogi LB, de Souza LC, Caramelli P. How to differentiate behavioral variant frontotemporal dementia from primary psychiatric disorders: practical aspects for the clinician. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:7-14. [PMID: 35976330 PMCID: PMC9491418 DOI: 10.1590/0004-282x-anp-2022-s140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Due to the early and prominent behavioral changes which characterize behavioral variant frontotemporal dementia (bvFTD), patients are more likely to seek psychiatric help and are often initially diagnosed with a primary psychiatric disorder (PPD). Differentiating these conditions is critical because of the dramatically different outcomes, differences in patient management, family counseling and caregiver education. OBJECTIVE To propose a practical guide to distinguish between bvFTD and PDD. METHODS We conducted a non-systematic review of the published manuscripts in the field, including some previous investigations from our own group and work on which we have collaborated, and summarized the main findings and proposals that may be useful for neurological practice. RESULTS The reviewed literature suggests that a comprehensive clinical history, brief cognitive and neuropsychological evaluations, detailed neurological examination with special attention to motor alterations related to bvFTD, structural and functional neuroimaging evaluation, genetic investigation in selected cases, and assistance from a multidisciplinary team, including a neurologist and a psychiatrist with expertise in bvFTD, are very helpful in differentiating these conditions. CONCLUSIONS Although the clinician may commonly face great difficulty in differentiating between bvFTD and PPD, the use of appropriate tools in a systematic way and the availability of a well-trained multidisciplinary group can significantly increase diagnostic accuracy.
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Affiliation(s)
- Leandro Boson Gambogi
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Neurologia Cognitiva e Comportamental, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
| | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Neurologia Cognitiva e Comportamental, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
| | - Paulo Caramelli
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Neurologia Cognitiva e Comportamental, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
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14
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Mattsson-Carlgren N, Grinberg LT, Boxer A, Ossenkoppele R, Jonsson M, Seeley W, Ehrenberg A, Spina S, Janelidze S, Rojas-Martinex J, Rosen H, La Joie R, Lesman-Segev O, Iaccarino L, Kollmorgen G, Ljubenkov P, Eichenlaub U, Gorno-Tempini ML, Miller B, Hansson O, Rabinovici GD. Cerebrospinal Fluid Biomarkers in Autopsy-Confirmed Alzheimer Disease and Frontotemporal Lobar Degeneration. Neurology 2022; 98:e1137-e1150. [PMID: 35173015 PMCID: PMC8935438 DOI: 10.1212/wnl.0000000000200040] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 01/03/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To determine how fully automated Elecsys CSF immunoassays for β-amyloid (Aβ) and tau biomarkers and an ultrasensitive Simoa assay for neurofilament light chain (NFL) correlate with neuropathologic changes of Alzheimer disease (AD) and frontotemporal lobar degeneration (FTLD). METHODS We studied 101 patients with antemortem CSF and neuropathology data. CSF samples were collected a mean of 2.9 years before death (range 0.2-7.5 years). CSF was analyzed for Aβ40, Aβ42, total tau (T-tau), tau phosphorylated at amino acid residue 181 (P-tau), P-tau/Aβ42 and Aβ42/Aβ40 ratios, and NFL. Neuropathology measures included Thal phases, Braak stages, Consortium to Establish a Registry for Alzheimer's Disease (CERAD) scores, AD neuropathologic change (ADNC), and primary and contributory pathologic diagnoses. Associations between CSF biomarkers and neuropathologic features were tested in regression models adjusted for age, sex, and time from sampling to death. RESULTS CSF biomarkers were associated with neuropathologic measures of Aβ (Thal, CERAD score), tau (Braak stage), and overall ADNC. The CSF P-tau/Aβ42 and Aβ42/Aβ40 ratios had high sensitivity, specificity, and overall diagnostic performance for intermediate-high ADNC (area under the curve range 0.95-0.96). Distinct biomarker patterns were seen in different FTLD subtypes, with increased NFL and reduced P-tau/T-tau in FTLD-TAR DNA-binding protein 43 and reduced T-tau in progressive supranuclear palsy compared to other FTLD variants. DISCUSSION CSF biomarkers, including P-tau, T-tau, Aβ42, Aβ40, and NFL, support in vivo identification of AD neuropathology and correlate with FTLD neuropathology. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that distinct CSF biomarker patterns, including for P-tau, T-tau, Aβ42, Aβ40, and NFL, are associated with AD and FTLD neuropathology.
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Affiliation(s)
- Niklas Mattsson-Carlgren
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden.
| | - Lea T Grinberg
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Adam Boxer
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Rik Ossenkoppele
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Magnus Jonsson
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - William Seeley
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Alexander Ehrenberg
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Salvatore Spina
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Shorena Janelidze
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Julio Rojas-Martinex
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Howard Rosen
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Renaud La Joie
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Orit Lesman-Segev
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Leonardo Iaccarino
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Gwendlyn Kollmorgen
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Peter Ljubenkov
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Udo Eichenlaub
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Maria Luisa Gorno-Tempini
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Bruce Miller
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Oskar Hansson
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Gil Dan Rabinovici
- From the Clinical Memory Research Unit (N.M.-C., R.O., S.J., O.H.), Faculty of Medicine, Department of Neurology (N.M.-C.), Skåne University Hospital, and Wallenberg Center for Molecular Medicine (N.M.-C.), Lund University, Sweden; Department of Neurology (L.T.G., A.B., W.S., A.E., S.S., J.R.-M., H.R., R L.J., O.L.-S., L.I., P.L., M.L.G.-T., B.M., G.D.R.), Memory and Aging Center, Department of Pathology (L.T.G., W.S.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Alzheimer Center Amsterdam (R.O.), Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; Department of Clinical Chemistry (M.J.), Skåne University Hospital, Malmö, Sweden; Department of Integrative Biology (A.E.), University of California, Berkeley; Roche Diagnostics GmbH (G.K., U.E.), Penzberg, Germany; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
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Mahaman YAR, Embaye KS, Huang F, Li L, Zhu F, Wang JZ, Liu R, Feng J, Wang X. Biomarkers used in Alzheimer's disease diagnosis, treatment, and prevention. Ageing Res Rev 2022; 74:101544. [PMID: 34933129 DOI: 10.1016/j.arr.2021.101544] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD), being the number one in terms of dementia burden, is an insidious age-related neurodegenerative disease and is presently considered a global public health threat. Its main histological hallmarks are the Aβ senile plaques and the P-tau neurofibrillary tangles, while clinically it is marked by a progressive cognitive decline that reflects the underlying synaptic loss and neurodegeneration. Many of the drug therapies targeting the two pathological hallmarks namely Aβ and P-tau have been proven futile. This is probably attributed to the initiation of therapy at a stage where cognitive alterations are already obvious. In other words, the underlying neuropathological changes are at a stage where these drugs lack any therapeutic value in reversing the damage. Therefore, there is an urgent need to start treatment in the very early stage where these changes can be reversed, and hence, early diagnosis is of primordial importance. To this aim, the use of robust and informative biomarkers that could provide accurate diagnosis preferably at an earlier phase of the disease is of the essence. To date, several biomarkers have been established that, to a different extent, allow researchers and clinicians to evaluate, diagnose, and more specially exclude other related pathologies. In this study, we extensively reviewed data on the currently explored biomarkers in terms of AD pathology-specific and non-specific biomarkers and highlighted the recent developments in the diagnostic and theragnostic domains. In the end, we have presented a separate elaboration on aspects of future perspectives and concluding remarks.
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16
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Congdon EE, Jiang Y, Sigurdsson EM. Targeting tau only extracellularly is likely to be less efficacious than targeting it both intra- and extracellularly. Semin Cell Dev Biol 2021; 126:125-137. [PMID: 34896021 DOI: 10.1016/j.semcdb.2021.12.002] [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: 09/10/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 12/11/2022]
Abstract
Aggregation of the tau protein is thought to be responsible for the neurodegeneration and subsequent functional impairments in diseases that are collectively named tauopathies. Alzheimer's disease is the most common tauopathy, but the group consists of over 20 different diseases, many of which have tau pathology as their primary feature. The development of tau therapies has mainly focused on preventing the formation of and/or clearing these aggregates. Of these, immunotherapies that aim to either elicit endogenous tau antibodies or deliver exogenous ones are the most common approach in clinical trials. While their mechanism of action can involve several pathways, both extra- and intracellular, pharmaceutical companies have primarily focused on antibody-mediated clearance of extracellular tau. As we have pointed out over the years, this is rather surprising because it is well known that most of pathological tau protein is found intracellularly. It has been repeatedly shown by several groups over the past decades that antibodies can enter neurons and that their cellular uptake can be enhanced by various means, particularly by altering their charge. Here, we will briefly describe the potential extra- and intracellular mechanisms involved in antibody-mediated clearance of tau pathology, discuss these in the context of recent failures of some of the tau antibody trials, and finally provide a brief overview of how the intracellular efficacy of tau antibodies can potentially be further improved by certain modifications that aim to enhance tau clearance via specific intracellular degradation pathways.
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Affiliation(s)
- Erin E Congdon
- Department of Neuroscience and Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY 10016, United States.
| | - Yixiang Jiang
- Department of Neuroscience and Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY 10016, United States
| | - Einar M Sigurdsson
- Department of Neuroscience and Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY 10016, United States; Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, United States.
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17
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Lagarde J, Olivieri P, Bottlaender M, Sarazin M. Diagnosi clinicolaboratoristica della malattia di Alzheimer. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Ji C, Sigurdsson EM. Current Status of Clinical Trials on Tau Immunotherapies. Drugs 2021; 81:1135-1152. [PMID: 34101156 DOI: 10.1007/s40265-021-01546-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/12/2022]
Abstract
Tau immunotherapies have advanced from proof-of-concept studies to over a dozen clinical trials for Alzheimer's disease (AD) and other tauopathies. Mechanistic studies in animal and culture models have provided valuable insight into how these therapies may work but multiple pathways are likely involved. Different groups have emphasized the importance of intracellular vs extracellular antibody-mediated clearance of the tau protein and there is no consensus on which pool of tau should ideally be targeted. Likewise, various normal and disease-selective epitopes are being targeted, and the antibody isotypes either favor phagocytosis of the tau-antibody complex or are neutral in that aspect. Most of the clinical trials are in early stages, thus their efficacy is not yet known, but all have been without any major adverse effects and some have reported target engagement. A few have been discontinued. One in phase I, presumably because of a poor pharmacokinetic profile, and three in phase II for a lack of efficacy although this trial stage is not well powered for efficacy measures. In these phase II studies, trials with two antibodies in patients with progressive supranuclear palsy or other primary tauopathies were halted but are continuing in patients with AD, and one antibody trial was stopped in early-stage AD but is continuing in moderate AD. These three antibodies have been reported to only work extracellularly and tau is not increased in the cerebrospinal fluid of primary tauopathies, which may explain the failures of two of them. In the discontinued AD trial, there are some concerns about how much of extracellular tau contains the N-terminal epitope that is being targeted. In addition, extracellular tau is only a small part of total tau, compared to intracellular tau. Targeting only the former may not be sufficient for functional benefits. Given these outcomes, decision makers within the pharmaceutical companies who green light these trials should attempt to target tau not only extracellularly but also intracellularly to increase their chances of success. Hopefully, some of the ongoing trials will provide some functional benefits to the large number of patients with tauopathies.
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Affiliation(s)
- Changyi Ji
- Department of Neuroscience and Physiology, Neuroscience Institute, New York University Grossman School of Medicine, Science Building, 11th floor, 435 East 30th Street, New York, NY, 10016, USA
| | - Einar M Sigurdsson
- Department of Neuroscience and Physiology, Neuroscience Institute, New York University Grossman School of Medicine, Science Building, 11th floor, 435 East 30th Street, New York, NY, 10016, USA. .,Department of Psychiatry, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, USA.
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19
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Autopsy-diagnosed neurodegenerative dementia cases support the use of cerebrospinal fluid protein biomarkers in the diagnostic work-up. Sci Rep 2021; 11:10837. [PMID: 34035398 PMCID: PMC8149718 DOI: 10.1038/s41598-021-90366-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/10/2021] [Indexed: 01/09/2023] Open
Abstract
Various proteins play a decisive role in the pathology of different neurodegenerative diseases. Nonetheless, most of these proteins can only be detected during a neuropathological assessment, although some non-specific biomarkers are routinely tested for in the cerebrospinal fluid (CSF) as a part of the differential diagnosis of dementia. In antemortem CSF samples from 117 patients with different types of neuropathologically confirmed neurodegenerative disease with dementia, we assessed total-tau (t-tau), phosphorylated-tau (181P) (p-tau), amyloid-beta (1–42) (Aβ42), TAR DNA binding protein (TDP)-43, progranulin (PGRN), and neurofilament light (NfL) chain levels, and positivity of protein 14-3-3. We found t-tau levels and the t-tau/p-tau ratios were significantly higher in prion diseases compared to the other neurodegenerative diseases. Statistically significant differences in the t-tau/Aβ42 ratio predominantly corresponded to t-tau levels in prion diseases and Aβ42 levels in AD. TDP-43 levels were significantly lower in prion diseases. Additionally, the TDP-43/Aβ42 ratio was better able to distinguish Alzheimer’s disease from other neurodegenerative diseases compared to using Aβ42 alone. In frontotemporal lobar degeneration, PRGN levels were significantly higher in comparison to other neurodegenerative diseases. There is an increasing need for biomarkers suitable for diagnostic workups for neurodegenerative diseases. It appears that adding TDP-43 and PGRN to the testing panel for neurodegenerative diseases could improve the resolution of differential diagnoses.
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20
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Xu MM, Zhou MT, Li SW, Zhen XC, Yang S. Glycoproteins as diagnostic and prognostic biomarkers for neurodegenerative diseases: A glycoproteomic approach. J Neurosci Res 2021; 99:1308-1324. [PMID: 33634546 DOI: 10.1002/jnr.24805] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/21/2020] [Accepted: 01/15/2021] [Indexed: 12/12/2022]
Abstract
Neurodegenerative diseases (NDs) are incurable and can develop progressively debilitating disorders, including dementia and ataxias. Alzheimer's disease and Parkinson's disease are the most common NDs that mainly affect the elderly people. There is an urgent need to develop new diagnostic tools so that patients can be accurately stratified at an early stage. As a common post-translational modification, protein glycosylation plays a key role in physiological and pathological processes. The abnormal changes in glycosylation are associated with the altered biological pathways in NDs. The pathogenesis-related proteins, like amyloid-β and microtubule-associated protein tau, have altered glycosylation. Importantly, specific glycosylation changes in cerebrospinal fluid, blood and urine are valuable for revealing neurodegeneration in the early stages. This review describes the emerging biomarkers based on glycoproteomics in NDs, highlighting the potential applications of glycoprotein biomarkers in the early detection of diseases, monitoring of the disease progression, and measurement of the therapeutic responses. The mass spectrometry-based strategies for characterizing glycoprotein biomarkers are also introduced.
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Affiliation(s)
- Ming-Ming Xu
- Center for Clinical Mass Spectrometry, College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | | | - Shu-Wei Li
- Nanjing Apollomics Biotech, Inc., Nanjing, China
| | - Xue-Chu Zhen
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | - Shuang Yang
- Center for Clinical Mass Spectrometry, College of Pharmaceutical Sciences, Soochow University, Suzhou, China
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21
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Fluid Biomarkers of Frontotemporal Lobar Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:123-139. [PMID: 33433873 DOI: 10.1007/978-3-030-51140-1_9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A timely diagnosis of frontotemporal degeneration (FTD) is frequently challenging due to the heterogeneous symptomatology and poor phenotype-pathological correlation. Fluid biomarkers that reflect FTD pathophysiology could be instrumental in both clinical practice and pharmaceutical trials. In recent years, significant progress has been made in developing biomarkers of neurodegenerative diseases: amyloid-β and tau in cerebrospinal fluid (CSF) can be used to exclude Alzheimer's disease, while neurofilament light chain (NfL) is emerging as a promising, albeit nonspecific, marker of neurodegeneration in both CSF and blood. Gene-specific biomarkers such as PGRN in GRN mutation carriers and dipeptide repeat proteins in C9orf72 mutation carriers are potential target engagement markers in genetic FTD trials. Novel techniques capable of measuring very low concentrations of brain-derived proteins in peripheral fluids are facilitating studies of blood biomarkers as a minimally invasive alternative to CSF. A major remaining challenge is the identification of a biomarker that can be used to predict the neuropathological substrate in sporadic FTD patients.
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22
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Bjorkli C, Sandvig A, Sandvig I. Bridging the Gap Between Fluid Biomarkers for Alzheimer's Disease, Model Systems, and Patients. Front Aging Neurosci 2020; 12:272. [PMID: 32982716 PMCID: PMC7492751 DOI: 10.3389/fnagi.2020.00272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/06/2020] [Indexed: 12/12/2022] Open
Abstract
Alzheimer’s disease (AD) is a debilitating neurodegenerative disease characterized by the accumulation of two proteins in fibrillar form: amyloid-β (Aβ) and tau. Despite decades of intensive research, we cannot yet pinpoint the exact cause of the disease or unequivocally determine the exact mechanism(s) underlying its progression. This confounds early diagnosis and treatment of the disease. Cerebrospinal fluid (CSF) biomarkers, which can reveal ongoing biochemical changes in the brain, can help monitor developing AD pathology prior to clinical diagnosis. Here we review preclinical and clinical investigations of commonly used biomarkers in animals and patients with AD, which can bridge translation from model systems into the clinic. The core AD biomarkers have been found to translate well across species, whereas biomarkers of neuroinflammation translate to a lesser extent. Nevertheless, there is no absolute equivalence between biomarkers in human AD patients and those examined in preclinical models in terms of revealing key pathological hallmarks of the disease. In this review, we provide an overview of current but also novel AD biomarkers and how they relate to key constituents of the pathological cascade, highlighting confounding factors and pitfalls in interpretation, and also provide recommendations for standardized procedures during sample collection to enhance the translational validity of preclinical AD models.
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Affiliation(s)
- Christiana Bjorkli
- Sandvig Group, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Axel Sandvig
- Sandvig Group, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Institute of Neuromedicine and Movement Science, Department of Neurology, St. Olavs Hospital, Trondheim, Norway.,Department of Pharmacology and Clinical Neurosciences, Division of Neuro, Head, and Neck, University Hospital of Umeå, Umeå, Sweden
| | - Ioanna Sandvig
- Sandvig Group, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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23
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Bennett RE, Hu M, Fernandes A, Perez-Rando M, Robbins A, Kamath T, Dujardin S, Hyman BT. Tau reduction in aged mice does not impact Microangiopathy. Acta Neuropathol Commun 2020; 8:137. [PMID: 32811565 PMCID: PMC7436970 DOI: 10.1186/s40478-020-01014-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022] Open
Abstract
Microangiopathy, including proliferation of small diameter capillaries, increasing vessel tortuosity, and increased capillary blockage by leukocytes, was previously observed in the aged rTg4510 mouse model. Similar gene expression changes related to angiogenesis were observed in both rTg4510 and Alzheimer's disease (AD). It is uncertain if tau is directly responsible for these vascular changes by interacting directly with microvessels, and/or if it contributes indirectly via neurodegeneration and concurrent neuronal loss and inflammation. To better understand the nature of tau-related microangiopathy in human AD and in tau mice, we isolated capillaries and observed that bioactive soluble tau protein could be readily detected in association with vasculature. To examine whether this soluble tau is directly responsible for the microangiopathic changes, we made use of the tetracycline-repressible gene expression cassette in the rTg4510 mouse model and measured vascular pathology following tau reduction. These data suggest that reduction of tau is insufficient to alter established microvascular complications including morphological alterations, enhanced expression of inflammatory genes involved in leukocyte adherence, and blood brain barrier compromise. These data imply that 1) soluble bioactive tau surprisingly accumulates at the blood brain barrier in human brain and in mouse models, and 2) the morphological and molecular phenotype of microvascular disturbance does not resolve with reduction of whole brain soluble tau. Additional consideration of vascular-directed therapies and strategies that target tau in the vascular space may be required to restore normal function in neurodegenerative disease.
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Affiliation(s)
- Rachel E Bennett
- Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA.
| | - Miwei Hu
- Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Analiese Fernandes
- Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Marta Perez-Rando
- Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Ashley Robbins
- Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Tarun Kamath
- Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Simon Dujardin
- Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Bradley T Hyman
- Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
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24
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Ducharme S, Dols A, Laforce R, Devenney E, Kumfor F, van den Stock J, Dallaire-Théroux C, Seelaar H, Gossink F, Vijverberg E, Huey E, Vandenbulcke M, Masellis M, Trieu C, Onyike C, Caramelli P, de Souza LC, Santillo A, Waldö ML, Landin-Romero R, Piguet O, Kelso W, Eratne D, Velakoulis D, Ikeda M, Perry D, Pressman P, Boeve B, Vandenberghe R, Mendez M, Azuar C, Levy R, Le Ber I, Baez S, Lerner A, Ellajosyula R, Pasquier F, Galimberti D, Scarpini E, van Swieten J, Hornberger M, Rosen H, Hodges J, Diehl-Schmid J, Pijnenburg Y. Recommendations to distinguish behavioural variant frontotemporal dementia from psychiatric disorders. Brain 2020; 143:1632-1650. [PMID: 32129844 PMCID: PMC7849953 DOI: 10.1093/brain/awaa018] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/27/2019] [Accepted: 12/08/2019] [Indexed: 12/12/2022] Open
Abstract
The behavioural variant of frontotemporal dementia (bvFTD) is a frequent cause of early-onset dementia. The diagnosis of bvFTD remains challenging because of the limited accuracy of neuroimaging in the early disease stages and the absence of molecular biomarkers, and therefore relies predominantly on clinical assessment. BvFTD shows significant symptomatic overlap with non-degenerative primary psychiatric disorders including major depressive disorder, bipolar disorder, schizophrenia, obsessive-compulsive disorder, autism spectrum disorders and even personality disorders. To date, ∼50% of patients with bvFTD receive a prior psychiatric diagnosis, and average diagnostic delay is up to 5-6 years from symptom onset. It is also not uncommon for patients with primary psychiatric disorders to be wrongly diagnosed with bvFTD. The Neuropsychiatric International Consortium for Frontotemporal Dementia was recently established to determine the current best clinical practice and set up an international collaboration to share a common dataset for future research. The goal of the present paper was to review the existing literature on the diagnosis of bvFTD and its differential diagnosis with primary psychiatric disorders to provide consensus recommendations on the clinical assessment. A systematic literature search with a narrative review was performed to determine all bvFTD-related diagnostic evidence for the following topics: bvFTD history taking, psychiatric assessment, clinical scales, physical and neurological examination, bedside cognitive tests, neuropsychological assessment, social cognition, structural neuroimaging, functional neuroimaging, CSF and genetic testing. For each topic, responsible team members proposed a set of minimal requirements, optimal clinical recommendations, and tools requiring further research or those that should be developed. Recommendations were listed if they reached a ≥ 85% expert consensus based on an online survey among all consortium participants. New recommendations include performing at least one formal social cognition test in the standard neuropsychological battery for bvFTD. We emphasize the importance of 3D-T1 brain MRI with a standardized review protocol including validated visual atrophy rating scales, and to consider volumetric analyses if available. We clarify the role of 18F-fluorodeoxyglucose PET for the exclusion of bvFTD when normal, whereas non-specific regional metabolism abnormalities should not be over-interpreted in the case of a psychiatric differential diagnosis. We highlight the potential role of serum or CSF neurofilament light chain to differentiate bvFTD from primary psychiatric disorders. Finally, based on the increasing literature and clinical experience, the consortium determined that screening for C9orf72 mutation should be performed in all possible/probable bvFTD cases or suspected cases with strong psychiatric features.
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Affiliation(s)
- Simon Ducharme
- Department of Psychiatry, McGill University Health Centre, McGill University, Montreal, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University Str., Montreal, Quebec, H3A 2B4, Canada
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZ InGeest, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire (CIME), Laval University, Quebec, Canada
| | - Emma Devenney
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Fiona Kumfor
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Jan van den Stock
- Laboratory for Translational Neuropsychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - Harro Seelaar
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Flora Gossink
- Department of Old Age Psychiatry, GGZ InGeest, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Everard Vijverberg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Edward Huey
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Psychiatry, Colombia University, New York, USA
| | - Mathieu Vandenbulcke
- Department of Geriatric Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Mario Masellis
- Department of Neurology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Calvin Trieu
- Department of Old Age Psychiatry, GGZ InGeest, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Chiadi Onyike
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leonardo Cruz de Souza
- Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Maria Landqvist Waldö
- Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Olivier Piguet
- Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Wendy Kelso
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - David Perry
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
| | - Peter Pressman
- Department of Neurology, University of Colorado Denver, Aurora, USA
| | - Bradley Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rik Vandenberghe
- Department of Neurology, University Hospital Leuven, Leuven, Belgium
| | - Mario Mendez
- Department of Neurology, UCLA Medical Centre, University of California Los Angeles, Los Angeles, USA
| | - Carole Azuar
- Department of Neurology, Hôpital La Pitié Salpêtrière, Paris, France
| | - Richard Levy
- Department of Neurology, Hôpital La Pitié Salpêtrière, Paris, France
| | - Isabelle Le Ber
- Department of Neurology, Hôpital La Pitié Salpêtrière, Paris, France
| | - Sandra Baez
- Department of Psychology, Andes University, Bogota, Colombia
| | - Alan Lerner
- Department of Neurology, University Hospital Cleveland Medical Center, Cleveland, USA
| | - Ratnavalli Ellajosyula
- Department of Neurology, Manipal Hospital and Annasawmy Mudaliar Hospital, Bangalore, India
| | - Florence Pasquier
- Univ Lille, Inserm U1171, Memory Center, CHU Lille, DISTAlz, Lille, France
| | - Daniela Galimberti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Policlinico, Neurodegenerative Diseases Unit Milan, Italy
| | - Elio Scarpini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Policlinico, Neurodegenerative Diseases Unit Milan, Italy
| | - John van Swieten
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Howard Rosen
- Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | - John Hodges
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Fink HA, Linskens EJ, Silverman PC, McCarten JR, Hemmy LS, Ouellette JM, Greer NL, Wilt TJ, Butler M. Accuracy of Biomarker Testing for Neuropathologically Defined Alzheimer Disease in Older Adults With Dementia. Ann Intern Med 2020; 172:669-677. [PMID: 32340038 DOI: 10.7326/m19-3888] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Biomarker accuracy for Alzheimer disease (AD) is uncertain. PURPOSE To summarize evidence on biomarker accuracy for classifying AD in older adults with dementia. DATA SOURCES Electronic bibliographic databases (searched from January 2012 to November 2019 for brain imaging and cerebrospinal fluid [CSF] tests and from inception to November 2019 for blood tests), ClinicalTrials.gov (to November 2019), and systematic review bibliographies. STUDY SELECTION English-language studies evaluating the accuracy of brain imaging, CSF testing, or blood tests for distinguishing neuropathologically defined AD from non-AD among older adults with dementia. Studies with low or medium risk of bias were analyzed. DATA EXTRACTION Two reviewers rated risk of bias. One extracted data; the other verified accuracy. DATA SYNTHESIS Fifteen brain imaging studies and 9 CSF studies met analysis criteria. Median sensitivity and specificity, respectively, were 0.91 and 0.92 for amyloid positron emission tomography (PET), 0.89 and 0.74 for 18F-labeled fluorodeoxyglucose (18F-FDG) PET, 0.64 and 0.83 for single-photon emission computed tomography, and 0.91 and 0.89 for medial temporal lobe atrophy on magnetic resonance imaging (MRI). Individual CSF biomarkers and ratios had moderate sensitivity (range, 0.62 to 0.83) and specificity (range, 0.53 to 0.69); in the few direct comparisons, β-amyloid 42 (Aβ42)/phosphorylated tau (p-tau) ratio, total tau (t-tau)/Aβ42 ratio, and p-tau appeared more accurate than Aβ42 and t-tau alone. Single studies suggested that amyloid PET, 18F-FDG PET, and CSF test combinations may add accuracy to clinical evaluation. LIMITATIONS Studies were small, biomarker cut points and neuropathologic AD were inconsistently defined, and methods with uncertain applicability to typical clinical settings were used. Few studies directly compared biomarkers, assessed test combinations, evaluated whether biomarkers improved classification accuracy when added to clinical evaluation, or reported harms. CONCLUSION In methodologically heterogeneous studies of uncertain applicability to typical clinical settings, amyloid PET, 18F-FDG PET, and MRI were highly sensitive for neuropathologic AD. Amyloid PET, 18F-FDG PET, and CSF test combinations may add accuracy to clinical evaluation. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality. (PROSPERO: CRD42018117897).
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Affiliation(s)
- Howard A Fink
- Minneapolis VA Health Care System and University of Minnesota, Minneapolis, Minnesota (H.A.F., J.R.M., L.S.H., T.J.W.)
| | - Eric J Linskens
- Minneapolis VA Health Care System, Minneapolis, Minnesota (E.J.L., N.L.G.)
| | | | - J Riley McCarten
- Minneapolis VA Health Care System and University of Minnesota, Minneapolis, Minnesota (H.A.F., J.R.M., L.S.H., T.J.W.)
| | - Laura S Hemmy
- Minneapolis VA Health Care System and University of Minnesota, Minneapolis, Minnesota (H.A.F., J.R.M., L.S.H., T.J.W.)
| | | | - Nancy L Greer
- Minneapolis VA Health Care System, Minneapolis, Minnesota (E.J.L., N.L.G.)
| | - Timothy J Wilt
- Minneapolis VA Health Care System and University of Minnesota, Minneapolis, Minnesota (H.A.F., J.R.M., L.S.H., T.J.W.)
| | - Mary Butler
- University of Minnesota, Minneapolis, Minnesota (J.M.O., M.B.)
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26
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Baldacci F, Mazzucchi S, Della Vecchia A, Giampietri L, Giannini N, Koronyo-Hamaoui M, Ceravolo R, Siciliano G, Bonuccelli U, Elahi FM, Vergallo A, Lista S, Giorgi FS. The path to biomarker-based diagnostic criteria for the spectrum of neurodegenerative diseases. Expert Rev Mol Diagn 2020; 20:421-441. [PMID: 32066283 PMCID: PMC7445079 DOI: 10.1080/14737159.2020.1731306] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
Abstract
Introduction: The postmortem examination still represents the reference standard for detecting the pathological nature of chronic neurodegenerative diseases (NDD). This approach displays intrinsic conceptual limitations since NDD represent a dynamic spectrum of partially overlapping phenotypes, shared pathomechanistic alterations that often give rise to mixed pathologies.Areas covered: We scrutinized the international clinical diagnostic criteria of NDD and the literature to provide a roadmap toward a biomarker-based classification of the NDD spectrum. A few pathophysiological biomarkers have been established for NDD. These are time-consuming, invasive, and not suitable for preclinical detection. Candidate screening biomarkers are gaining momentum. Blood neurofilament light-chain represents a robust first-line tool to detect neurodegeneration tout court and serum progranulin helps detect genetic frontotemporal dementia. Ultrasensitive assays and retinal scans may identify Aβ pathology early, in blood and the eye, respectively. Ultrasound also represents a minimally invasive option to investigate the substantia nigra. Protein misfolding amplification assays may accurately detect α-synuclein in biofluids.Expert opinion: Data-driven strategies using quantitative rather than categorical variables may be more reliable for quantification of contributions from pathophysiological mechanisms and their spatial-temporal evolution. A systems biology approach is suitable to untangle the dynamics triggering loss of proteostasis, driving neurodegeneration and clinical evolution.
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Affiliation(s)
- Filippo Baldacci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l’hôpital, Paris, France
| | - Sonia Mazzucchi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Linda Giampietri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ubaldo Bonuccelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fanny M. Elahi
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Andrea Vergallo
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l’hôpital, Paris, France
- Brain & Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, Paris, France
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France
| | - Simone Lista
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l’hôpital, Paris, France
- Brain & Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, Paris, France
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France
| | - Filippo Sean Giorgi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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27
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Ye LQ, Li XY, Zhang YB, Cheng HR, Ma Y, Chen DF, Tao QQ, Li HL, Wu ZY. The discriminative capacity of CSF β-amyloid 42 and Tau in neurodegenerative diseases in the Chinese population. J Neurol Sci 2020; 412:116756. [PMID: 32142967 DOI: 10.1016/j.jns.2020.116756] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/09/2020] [Accepted: 02/21/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In the past few years, the β-amyloid 42 peptide and tau protein in cerebrospinal fluid (CSF) have become primary diagnostic biomarkers in differentiating Alzheimer's disease (AD) and cognitive normal controls. As we know, several neurodegenerative diseases have been reported to overlap with AD in neuropathology and clinical symptoms. To examine the discriminative utility of these biomarkers in AD and other neurodegenerative diseases, we measured them in a cohort of Chinese population. METHODS We measured CSF Aβ42, t-tau and p-tau181 by ELISA tests and calculated the ratios of t-tau/Aβ42 and p-tau181/Aβ42 in 240 Chinese Han patients with AD (n = 82), frontotemporal dementia (FTD, n = 20), Huntington's disease (HD, n = 27), multiple system atrophy (MSA, n = 24), spinocerebellar ataxia type-3 (SCA3, n = 27), amyotrophic lateral sclerosis (ALS, n = 36) and controls (n = 24). RESULTS As expected, all biomarkers showed high discriminative capacity between AD and non-AD groups (p < .05) except for the elevated CSF t-tau in FTD (p > .05). Comparing with the controls, tau related biomarkers significantly elevated in the FTD (p < .001) and MSA (p < .05) groups. Surprisingly, comparing with controls, we found that CSF Aβ42 increased remarkably in the SCA3 (p < .05), HD and ALS groups (p < .001), achieving a high specificity, respectively. CONCLUSION To our best knowledge, this is the first comprehensive study in the Han Chinese population that confirmed the discriminative utility of CSF Aβ42 and tau biomarkers between AD and other neurodegenerative diseases.
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Affiliation(s)
- Ling-Qi Ye
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Yan Li
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan-Bin Zhang
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hong-Rong Cheng
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yin Ma
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Dian-Fu Chen
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing-Qing Tao
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong-Lei Li
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China.
| | - Zhi-Ying Wu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China.
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Lleó A, Irwin DJ, Illán-Gala I, McMillan CT, Wolk DA, Lee EB, Van Deerlin VM, Shaw LM, Trojanowski JQ, Grossman M. A 2-Step Cerebrospinal Algorithm for the Selection of Frontotemporal Lobar Degeneration Subtypes. JAMA Neurol 2019; 75:738-745. [PMID: 29554190 DOI: 10.1001/jamaneurol.2018.0118] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Cerebrospinal fluid (CSF) core Alzheimer disease (AD) biomarkers have shown an excellent capacity for the in vivo detection of AD. Previous studies have shown that CSF levels of phosphorylated tau (p-tau) also correlate with tau pathology in frontotemporal lobar degeneration (FTLD) after accounting for AD copathology. Objective To develop an algorithm based on core AD CSF measures to exclude cases with AD pathology and then differentiate between FTLD-tau and FTLD transactive response DNA-binding protein of approximately 43kDa (FTLD-TDP). Design, Setting, and Participants A case-control study at the University of Pennsylvania. Participants were selected from a database of 1796 patients included between 1992 and 2016 with different neurodegenerative diseases with available CSF. Three patient cohorts were included: a cohort of patients with sporadic, autopsy-confirmed FTLD and AD (n = 143); a cohort of patients with frontotemporal degeneration (FTD) with TDP-associated or tau-associated mutations (n = 60); and a living cohort of patients with syndromes highly predictive of FTLD (progressive supranuclear palsy and FTD-amyotrophic lateral sclerosis; n = 62). Main Outcomes and Measures Cerebrospinal fluid values of amyloid β1-42 (Aβ1-42), total tau (t-tau), and p-tau obtained using the INNO-BIA AlzBio3 (xMAP; Luminex) assay or INNOTEST enzyme-linked immunosorbent assay transformed using a previously validated algorithm. Sensitivities and specificities for differentiating AD from FTLD groups were calculated. Results This autopsy cohort included FTLD-tau (n = 27; mean [SD] age at onset, 60.8 [9.7] years), FTLD-TDP (n = 13; mean [SD] age at onset, 62.4 [8.5] years), AD (n = 89, mean [SD] age at onset, 66.5 [9.7] years); and mixed FTLD-AD (n = 14, mean [SD] age at onset, 70.6 [8.5] years).The p-tau/Aβ1-42 ratio showed an excellent diagnostic accuracy to exclude AD cases in the autopsy cohort with single neurodegenerative pathologies (area under the curve [AUC], 0.98; 95% CI, 0.96-1.00). Cerebrospinal fluid p-tau levels showed a good AUC (0.87; 95% CI, 0.73-1.00) for discriminating pure FTLD-TDP from pure FTLD-tau. The application of an algorithm using cutpoints of CSF p-tau to Aβ1-42 ratio and p-tau allowed a good discrimination of pure FTLD-TDP cases from the remaining FTLD-tau and mixed FTLD cases. The diagnostic value of this algorithm was confirmed in an independent cohort of living patients with progressive supranuclear palsy and FTD-amyotrophic lateral sclerosis (AUC, 0.9; 95% CI, 0.81-0.99). However, the algorithm was less useful in FTD cases carrying a pathogenic mutation (AUC, 0.58; 95% CI, 0.38-0.77) owing to elevated p-tau levels in TDP-associated mutation carriers. Conclusions and Relevance Alzheimer disease CSF core biomarkers can be used with high specificity for the in vivo identification of patients with pure FTLD-TDP and FTLD-tau when accounting for comorbid AD and genetic status.
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Affiliation(s)
- Alberto Lleó
- Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau, Hospital de Sant Pau, Universitat Autònoma de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, Barcelona, Spain
| | - David J Irwin
- Penn Frontotemporal Degeneration Center, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ignacio Illán-Gala
- Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau, Hospital de Sant Pau, Universitat Autònoma de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, Barcelona, Spain
| | - Corey T McMillan
- Penn Frontotemporal Degeneration Center, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David A Wolk
- Alzheimer's Disease Core Center, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Edward B Lee
- Alzheimer's Disease Core Center, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Translational Neuropathology Research Laboratory, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Vivianna M Van Deerlin
- Alzheimer's Disease Core Center, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Leslie M Shaw
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - John Q Trojanowski
- Alzheimer's Disease Core Center, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Alzheimer's Disease Core Center, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Bera G, Migliaccio R, Michelin T, Lamari F, Ferrieux S, Nogues M, Bertin H, Habert MO, Dubois B, Teichmann M, Kas A. Parietal Involvement in the Semantic Variant of Primary Progressive Aphasia with Alzheimer's Disease Cerebrospinal Fluid Profile. J Alzheimers Dis 2019; 66:271-280. [PMID: 30282352 DOI: 10.3233/jad-180087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Semantic variant of primary progressive aphasia (svPPA) is typically associated with non-Alzheimer's disease (AD) pathology. However, some anatomopathological studies have found AD lesions in those patients. We compared brain perfusion SPECT of 18 svPPA patients with cerebrospinal fluid (CSF) biomarkers indicative of non-AD pathology (svPPA-nonAD) and three svPPA patients with CSF biomarkers indicative of underlying AD (svPPA-AD). All svPPA patients had severe left temporopolar hypoperfusion. SvPPA-nonAD had additional anterior cingulate and mediofrontal hypoperfusion, whereas svPPA-AD had greater left parietal and posterior cingulate involvement. Parietal damage in svPPA constitutes a biomarker for underlying Alzheimer pathology thus refining the classification of this PPA variant.
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Affiliation(s)
- Géraldine Bera
- Service de Médecine Nucléaire, Groupe Hospitalier Pitié Salpêtrière-Charles Foix, AP-HP, Paris CEDEX 13, France.,INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), FrontLab, Paris CEDEX 13, France
| | - Raffaella Migliaccio
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), FrontLab, Paris CEDEX 13, France.,Département de Neurologie, Institut de la mémoire et de la maladie d'Alzheimer, Groupe Hospitalier Pitié Salpêtrière-Charles Foix, AP-HP, Paris CEDEX 13, France
| | - Thibaut Michelin
- Service de Médecine Nucléaire, Groupe Hospitalier Pitié Salpêtrière-Charles Foix, AP-HP, Paris CEDEX 13, France
| | - Foudil Lamari
- Laboratoire de Biochimie, AP-HP, Groupe Hospitalier Pitié Salpêtrière-Charles Foix, Paris CEDEX 13, France
| | - Sophie Ferrieux
- Département de Neurologie, Institut de la mémoire et de la maladie d'Alzheimer, Groupe Hospitalier Pitié Salpêtrière-Charles Foix, AP-HP, Paris CEDEX 13, France
| | - Marie Nogues
- Département de Neurologie, Institut de la mémoire et de la maladie d'Alzheimer, Groupe Hospitalier Pitié Salpêtrière-Charles Foix, AP-HP, Paris CEDEX 13, France
| | | | - Marie Odile Habert
- Service de Médecine Nucléaire, Groupe Hospitalier Pitié Salpêtrière-Charles Foix, AP-HP, Paris CEDEX 13, France.,CATI, http://www.cati-neuroimaging.com.,Laboratoire d'Imagerie Biomédicale, INSERM U1146, Sorbonne Universités et Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Bruno Dubois
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), FrontLab, Paris CEDEX 13, France.,Département de Neurologie, Institut de la mémoire et de la maladie d'Alzheimer, Groupe Hospitalier Pitié Salpêtrière-Charles Foix, AP-HP, Paris CEDEX 13, France
| | - Marc Teichmann
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), FrontLab, Paris CEDEX 13, France.,Département de Neurologie, Institut de la mémoire et de la maladie d'Alzheimer, Groupe Hospitalier Pitié Salpêtrière-Charles Foix, AP-HP, Paris CEDEX 13, France
| | - Aurélie Kas
- Service de Médecine Nucléaire, Groupe Hospitalier Pitié Salpêtrière-Charles Foix, AP-HP, Paris CEDEX 13, France.,CATI, http://www.cati-neuroimaging.com.,Laboratoire d'Imagerie Biomédicale, INSERM U1146, Sorbonne Universités et Université Pierre et Marie Curie-Paris 6, Paris, France
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Casoli T, Paolini S, Fabbietti P, Fattoretti P, Paciaroni L, Fabi K, Gobbi B, Galeazzi R, Rossi R, Lattanzio F, Pelliccioni G. Cerebrospinal fluid biomarkers and cognitive status in differential diagnosis of frontotemporal dementia and Alzheimer's disease. J Int Med Res 2019; 47:4968-4980. [PMID: 31524025 PMCID: PMC6833432 DOI: 10.1177/0300060519860951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective This study aimed to determine the most appropriate cognitive and cerebrospinal fluid (CSF) biomarker setting to distinguish frontotemporal dementia (FTD) from Alzheimer’s disease (AD). Method Patients with FTD, those with AD, and those without dementia were enrolled in this study. CSF amyloid-ß 42 (Aß42), total (t)-tau, and phosphorylated (p)-tau concentrations were determined by enzyme-linked immunosorbent assays. Cognition was evaluated by the Mini-Mental State Examination (MMSE) and its domain scores. The associations of CSF biomarkers with cognitive measures were examined using regression models and the diagnostic value of CSF biomarkers was determined by receiver operating characteristics curves. Results CSF Aß42 levels were lower, whereas t-tau/Aß42 and p-tau/Aß42 ratios were higher in patients with AD compared with those with FTD. Some MMSE domain scores were different in FTD and AD, but they did not improve the ability to distinguish between the two pathologies. Poor temporal orientation scores were associated with low Aß42 levels only in patients with FTD. The p-tau/Aß42 ratio reached sufficient levels of sensitivity and specificity to discriminate FTD with primary progressive aphasia from AD. Conclusions The ratio of CSF p-tau/Aß42 is a sensitive and specific biomarker for discriminating patients with primary progressive aphasia from those with AD.
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Affiliation(s)
- Tiziana Casoli
- Center for Neurobiology of Aging, IRCCS INRCA, Ancona, Italy
| | - Susy Paolini
- Neurology Unit, Geriatric Hospital, IRCCS INRCA, Ancona, Italy
| | - Paolo Fabbietti
- Diagnostic Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA, Cosenza, Italy
| | | | - Lucia Paciaroni
- Neurology Unit, Geriatric Hospital, IRCCS INRCA, Ancona, Italy
| | - Katia Fabi
- Neurology Unit, Geriatric Hospital, IRCCS INRCA, Ancona, Italy
| | - Beatrice Gobbi
- Neurology Unit, Geriatric Hospital, IRCCS INRCA, Ancona, Italy
| | - Roberta Galeazzi
- Clinical Laboratory & Molecular Diagnostics, IRCCS INRCA, Ancona, Italy
| | - Roberto Rossi
- Diagnostic and Interventional Radiology Unit, IRCCS INRCA, Ancona, Italy
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Hansson O, Santillo AF, Meeter LH, Nilsson K, Landqvist Waldö M, Nilsson C, Blennow K, van Swieten JC, Janelidze S. CSF placental growth factor - a novel candidate biomarker of frontotemporal dementia. Ann Clin Transl Neurol 2019; 6:863-872. [PMID: 31139684 PMCID: PMC6529985 DOI: 10.1002/acn3.763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/30/2019] [Accepted: 02/15/2019] [Indexed: 12/12/2022] Open
Abstract
Objective Diagnosis of frontotemporal dementia (FTD) is complicated by the overlap of clinical symptoms with other dementia disorders. Development of robust fluid biomarkers is critical to improve the diagnostic work‐up of FTD. Methods CSF concentrations of placental growth factor (PlGF) were measured in the discovery cohort including patients with FTD (n = 27), Alzheimer disease (AD) dementia (n = 75), DLB or PDD (n = 47), subcortical vascular dementia (VaD, n = 33), mild cognitive impairment that later converted to AD (MCI‐AD, n = 34), stable MCI (sMCI, n = 62), and 50 cognitively healthy controls from the Swedish BioFINDER study. For validation, CSF PlGF was measured in additional independent cohort of FTD patients (n = 22) and controls (n = 18) from the Netherlands. Results In the discovery cohort, MCI, MCI‐AD, AD dementia, DLB‐PDD, VaD, and FTD patients all showed increased CSF levels of PlGF compared with controls (sMCI P = 0.019; MCI‐AD P = 0.005; AD dementia, DLB‐PDD, VaD, and FTD all P < 0.001). PlGF levels were 1.8–2.1‐fold higher in FTD than in AD, DLB‐PDD and VaD (all P < 0.001). PlGF distinguished with high accuracy FTD from controls and sMCI performing better than tau/Aβ42 (AUC 0.954–0.996 versus 0.564–0.754, P < 0.001). A combination of PlGF, tau, and Aβ42 (tau/Aβ42/PlGF) was more accurate than tau/Aβ42 when differentiating FTD from a group of other dementias (AUC 0.972 vs. 0.932, P < 0.01). Increased CSF levels of PlGF in FTD compared with controls were corroborated in the validation cohort. Interpretation CSF PlGF is increased in FTD compared with other dementia disorders, MCI, and healthy controls and might be useful as a diagnostic biomarker of FTD.
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Affiliation(s)
- Oskar Hansson
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden.,Memory Clinic Skåne University Hospital Malmö Sweden
| | - Alexander F Santillo
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden.,Memory Clinic Skåne University Hospital Malmö Sweden
| | - Lieke H Meeter
- Department of Neurology Erasmus Medical Center Rotterdam The Netherlands
| | - Karin Nilsson
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden
| | - Maria Landqvist Waldö
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden.,Clinical Sciences Helsingborg Department of Clinical Sciences Lund University Lund Sweden
| | - Christer Nilsson
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden.,Department of Neurology Skåne University Hospital Lund Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry The Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden.,Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
| | - John C van Swieten
- Department of Neurology Erasmus Medical Center Rotterdam The Netherlands.,Department of Clinical Genetics VU University Medical Center Amsterdam The Netherlands
| | - Shorena Janelidze
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden
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Gibbons GS, Kim SJ, Robinson JL, Changolkar L, Irwin DJ, Shaw LM, Lee VMY, Trojanowski JQ. Detection of Alzheimer's disease (AD) specific tau pathology with conformation-selective anti-tau monoclonal antibody in co-morbid frontotemporal lobar degeneration-tau (FTLD-tau). Acta Neuropathol Commun 2019; 7:34. [PMID: 30832741 PMCID: PMC6399892 DOI: 10.1186/s40478-019-0687-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 12/12/2022] Open
Abstract
Pathological tau aggregates in Alzheimer’s disease (AD) and frontotemporal lobar degeneration-tau (FTLD-tau) adopt distinct conformations differentiated by the AD-tau specific monoclonal antibody (mAb) GT-38 that are not readily visualized using phosphorylation-specific anti-tau mAbs. To determine the extent of co-morbid AD-tau pathology in FTLD-tau, we performed immunohistochemical (IHC) staining with GT-38 and assigned Braak stages of AD-tau in a cohort 180 FTLD-tau cases consisting of corticobasal degeneration (CBD; n = 49), progressive supranuclear palsy (PSP; n = 109), and Pick’s disease (PiD; n = 22). Nearly two-thirds of patients (n = 115 of 180, 63.8%) with FTLD-tau had some degree of comorbid AD-tau pathology and 20.5% of the FTLD-tau cohort had Braak stage ≥B2, consistent with medium-to-high-level AD neuropathological change (ADNPC). The PSP group had the highest frequency of medium-high AD-tau pathology compared to other tauopathies (PSP = 31/109, 28.4%; Picks = 2/22, 9.1%, CBD = 4/49, 8.2%) but neuropathological diagnosis was not found to be a significant independent predictor of medium-high AD Braak stage in a multivariate model after accounting for age at death (OR = 1.09; 95% CI = 1.03–1.15; p = 0.002) and CERAD plaque scores (OR = 3.75, 95% CI = 1.58–8.89; p = 0.003), suggesting there is no predilection for a specific FTLD tauopathy to develop AD-tau co-pathology after accounting for age. Patients with FTLD-tau who had, clinically significant, medium-high AD-tau pathology had significantly higher antemortem CSF levels of both total-tau (t-tau; mean = 89.98 pg/ml, SD = 36.70 pg/ml) and phosphorylated-tau (p-tau; mean = 20.45 pg/ml, SD = 9.31 pg/ml) compared to patients with negligible-low AD-tau, t-tau (mean = 43.04 pg/ml, SD = 25.40 pg/ml) and p-tau (mean = 11.90 pg/ml, SD = 4.48 pg/ml) (p ≤ 0.001 both). Finally, in an exploratory analysis in our largest pathology group (PSP) we find an association of GT-38 AD-tau Braak stage with lower baseline MMSE (p = 0.03). Together, these finding validate the use of GT-38 to selectively detect AD-tau pathology in the context of FTLD-tau and provides a novel tool to investigate associations of clinical phenotypes amongst co-morbid tauopathies.
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Alcolea D, Irwin DJ, Illán-Gala I, Muñoz L, Clarimón J, McMillan CT, Fortea J, Blesa R, Lee EB, Trojanowski JQ, Grossman M, Lleó A. Elevated YKL-40 and low sAPPβ:YKL-40 ratio in antemortem cerebrospinal fluid of patients with pathologically confirmed FTLD. J Neurol Neurosurg Psychiatry 2019; 90:180-186. [PMID: 30297518 PMCID: PMC6351153 DOI: 10.1136/jnnp-2018-318993] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The combination of high YKL-40 (a glial inflammatory marker) and low sAPPβ (a soluble β fragment of amyloid precursor protein) in cerebrospinal fluid (CSF) has been associated with frontotemporal lobar degeneration (FTLD) in clinical series. We investigate these biomarkers in a neuropathologically confirmed cohort of patients with FTLD. METHODS CSF samples were selected from the Penn FTD Center (University of Pennsylvania). Participants were followed to autopsy and had a neuropathological diagnosis of FTLD-Tau (n=24), transactive response DNA-binding protein with 43 kDa (FTLD-TDP) (n=25) or Alzheimer's disease (AD, n=97). We compared levels of YKL-40 and sAPPβ between groups and with cognitively normal controls (n=77), and assessed their diagnostic utility using receiver operating characteristic curves. We also investigated the effect of AD copathology and the correlation between these CSF markers and tau burden at autopsy. RESULTS Both FTLD groups had lower levels of sAPPβ, higher levels of YKL-40 and lower sAPPβ:YKL-40 ratio in CSF compared with controls. The group of pure FTLD-Tau (without AD copathology) showed higher levels of YKL-40 than AD and than pure FTLD-TDP. YKL-40 levels correlated with pathological tau burden. The sAPPβ:YKL-40 ratio had an area under the curve (AUC) of 0.91 (95% CI 0.86 to 0.96) to distinguish subjects with FTLD from controls, but lower values to distinguish FTLD from AD (AUC 0.70; 95% CI 0.61 to 0.79) and to discriminate FTLD-Tau from FTLD-TDP (AUC 0.67; 95% CI 0.51 to 0.82). CONCLUSIONS Our study provides pathological confirmation that the combination of low sAPPβ and high YKL-40 in CSF is associated with FTLD. These biomarkers could be useful in particular clinical settings when FTLD is suspected.
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Affiliation(s)
- Daniel Alcolea
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau - Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - David J Irwin
- Penn FTD Center, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ignacio Illán-Gala
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau - Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Laia Muñoz
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau - Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Jordi Clarimón
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau - Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Corey T McMillan
- Penn FTD Center, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau - Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Rafael Blesa
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau - Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Edward B Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Murray Grossman
- Penn FTD Center, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau - Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain .,Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
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Saraceno C, Catania M, Paterlini A, Fostinelli S, Ciani M, Zanardini R, Binetti G, Di Fede G, Caroppo P, Benussi L, Ghidoni R, Bolognin S. Altered Expression of Circulating Cdc42 in Frontotemporal Lobar Degeneration. J Alzheimers Dis 2019; 61:1477-1483. [PMID: 29376863 DOI: 10.3233/jad-170722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The term frontotemporal lobar degeneration (FTLD) defines a group of heterogeneous conditions histologically characterized by neuronal degeneration, inclusions of various proteins, and synaptic loss. However, the molecular mechanisms contributing to these alterations are still unknown. As the Rho-GTPase family member Cell division cycle 42 (Cdc42) plays a key role in the regulation of actin cytoskeleton dynamics and spine formation, we investigated whether Cdc42 protein levels were altered in the disease. Cdc42 was increased in the frontal cortex of FTLD patients compared to age-matched controls, but also in Alzheimer's disease (AD) patients included in the data-set. On the other hand, the pool of circulating Cdc42 in the plasma was altered in FTLD but not in AD patients. Interestingly, the stratification of the FTLD patients according to the different clinical variants showed a specific decrease of Cdc42 expression in the behavioral subgroup. This data support a role of Cdc42 in FTLD and specifically in the behavioral variant.
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Affiliation(s)
- Claudia Saraceno
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Marcella Catania
- Division of Neurology and Neuropathology, IRCCS Foundation - Carlo Besta Neurological Institute, Milan, Italy
| | - Anna Paterlini
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Silvia Fostinelli
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Miriam Ciani
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Roberta Zanardini
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuliano Binetti
- MAC Memory Center, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuseppe Di Fede
- Division of Neurology and Neuropathology, IRCCS Foundation - Carlo Besta Neurological Institute, Milan, Italy
| | - Paola Caroppo
- Division of Neurology and Neuropathology, IRCCS Foundation - Carlo Besta Neurological Institute, Milan, Italy
| | - Luisa Benussi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Silvia Bolognin
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Developmental and Cellular Biology, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Belvaux, Luxembourg
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Steinacker P, Barschke P, Otto M. Biomarkers for diseases with TDP-43 pathology. Mol Cell Neurosci 2018; 97:43-59. [PMID: 30399416 DOI: 10.1016/j.mcn.2018.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 01/01/2023] Open
Abstract
The discovery that aggregated transactive response DNA-binding protein 43 kDa (TDP-43) is the major component of pathological ubiquitinated inclusions in amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD) caused seminal progress in the unveiling of the genetic bases and molecular characteristics of these now so-called TDP-43 proteinopathies. Substantial increase in the knowledge of clinic-pathological coherencies, especially for FTLD variants, could be made in the last decade, but also revealed a considerable complexity of TDP-43 pathology and often a poor correlation of clinical and molecular disease characteristics. To date, an underlying TDP-43 pathology can be predicted only for patients with mutations in the genes C9orf72 and GRN, but is dependent on neuropathological verification in patients without family history, which represent the majority of cases. As etiology-specific therapies for neurodegenerative proteinopathies are emerging, methods to forecast TDP-43 pathology at patients' lifetime are highly required. Here, we review the current status of research pursued to identify specific indicators to predict or exclude TDP-43 pathology in the ALS-FTLD spectrum disorders and findings on candidates for prognosis and monitoring of disease progression in TDP-43 proteinopathies with a focus on TDP-43 with its pathological forms, neurochemical and imaging biomarkers.
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Affiliation(s)
| | - Peggy Barschke
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany.
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Ljubenkov PA, Staffaroni AM, Rojas JC, Allen IE, Wang P, Heuer H, Karydas A, Kornak J, Cobigo Y, Seeley WW, Grinberg LT, Spina S, Fagan AM, Jerome G, Knopman D, Boeve BF, Dickerson BC, Kramer J, Miller B, Boxer AL, Rosen HJ. Cerebrospinal fluid biomarkers predict frontotemporal dementia trajectory. Ann Clin Transl Neurol 2018; 5:1250-1263. [PMID: 30349860 PMCID: PMC6186942 DOI: 10.1002/acn3.643] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/10/2018] [Indexed: 12/12/2022] Open
Abstract
Objective The prognostic value of cerebrospinal fluid neurofilament light chain, total tau, phosphorylated tau181, and amyloid beta1-42 was examined in frontotemporal dementia subtypes. Methods We compared baseline biomarkers between 49 controls, 40 patients with behavioral variant frontotemporal dementia, 24 with semantic variant primary progressive aphasia, and 26 with nonfluent variant primary progressive aphasia. Linear mixed effect models were used to assess the value of baseline biomarkers in predicting clinical and radiographic change in patient cohorts over multiple yearly follow up visits. Results Neurofilament light chain concentrations were lowest in controls. Elevated baseline neurofilament light chain predicted faster worsening in clinical severity, frontotemporal volume and frontotemporal fractional anisotropy in patients with behavioral variant frontotemporal dementia and nonfluent variant primary progressive aphasia. High total tau similarly predicted faster progression in nonfluent variant primary progressive aphasia. In behavioral variant frontotemporal dementia, higher phosphorylated tau181 predicted faster clinical progression whereas lower amyloid beta1-42 predicted faster volumetric and fractional anisotropy reduction. Neurofilament light chain and phosphorylated tau181 were of greater predictive value in patients with tau pathology as compared to TDP-43 pathology. Baseline neurofilament light chain correlated with baseline clinical severity and frontotemporal volume in behavioral variant frontotemporal dementia. Baseline total tau correlated with baseline clinical severity in semantic variant primary progressive aphasia. Interpretation High cerebrospinal fluid neurofilament light chain predicts more aggressive disease in behavioral variant frontotemporal dementia and nonfluent variant primary progressive aphasia. Total tau, phosphorylated tau181, and amyloid beta1-42 also predict some measures of disease aggressiveness in frontotemporal dementia.
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Affiliation(s)
- Peter A Ljubenkov
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - Adam M Staffaroni
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - Julio C Rojas
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics University of California San Francisco San Francisco California
| | - Ping Wang
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - Hilary Heuer
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - Anna Karydas
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - John Kornak
- Department of Epidemiology and Biostatistics University of California San Francisco San Francisco California
| | - Yann Cobigo
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - William W Seeley
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - Lea T Grinberg
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - Salvatore Spina
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - Anne M Fagan
- Department of Neurology Washington University St. Louis Missouri
| | - Gina Jerome
- Department of Neurology Washington University St. Louis Missouri
| | - David Knopman
- Department of Neurology Mayo Clinic Rochester Minnesota
| | - Brad F Boeve
- Department of Neurology Mayo Clinic Rochester Minnesota
| | - Bradford C Dickerson
- Frontotemporal Dementia Unit Department of Neurology Massachusetts Alzheimer's Disease Research Center Harvard Medical School, Boston Boston Massachusetts
| | - Joel Kramer
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - Bruce Miller
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - Adam L Boxer
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
| | - Howard J Rosen
- Department of Neurology Memory and Aging Center University of California, San Francisco San Francisco California
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Takeda S. Progression of Alzheimer's disease, tau propagation, and its modifiable risk factors. Neurosci Res 2018; 141:36-42. [PMID: 30120962 DOI: 10.1016/j.neures.2018.08.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/15/2018] [Accepted: 08/13/2018] [Indexed: 12/21/2022]
Abstract
The number of patients with Alzheimer's disease (AD) has been increasing exponentially side by side with aging societies worldwide. Symptoms of AD worsen over time due to progressive neurodegeneration, requiring institutional care at the later stage and resulting in a heavy burden on patients, caregivers, and the public-health system. AD neuropathology is characterized by cerebral accumulation and aggregation of amyloid-β (Aβ) and tau proteins. For decades, Aβ has been a leading target in the therapeutic development for AD, and many drug candidates have been tested in clinical trials; however, most medications have failed to slow the progression of the disease. Tau pathology currently is attracting more attention as an alternate target for developing disease-modifying therapy. Tau is known to spread in a hierarchical pattern in AD brain, likely by trans-synaptic tau transfer between neurons. Extracellular tau may mediate tau spreading and serve as biomarker for AD. AD pathogenesis is multifactorial, and many genetic- and non-genetic factors are known to contribute to Aβ- and tau-related pathology. Recent studies indicate an association between vascular risk factors and AD. Identifying modifiable risk factors for AD and understanding their contributory mechanisms could be key in tackling this devastating disease.
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Affiliation(s)
- Shuko Takeda
- Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
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Lewczuk P, Riederer P, O’Bryant SE, Verbeek MM, Dubois B, Visser PJ, Jellinger KA, Engelborghs S, Ramirez A, Parnetti L, Jack CR, Teunissen CE, Hampel H, Lleó A, Jessen F, Glodzik L, de Leon MJ, Fagan AM, Molinuevo JL, Jansen WJ, Winblad B, Shaw LM, Andreasson U, Otto M, Mollenhauer B, Wiltfang J, Turner MR, Zerr I, Handels R, Thompson AG, Johansson G, Ermann N, Trojanowski JQ, Karaca I, Wagner H, Oeckl P, van Waalwijk van Doorn L, Bjerke M, Kapogiannis D, Kuiperij HB, Farotti L, Li Y, Gordon BA, Epelbaum S, Vos SJB, Klijn CJM, Van Nostrand WE, Minguillon C, Schmitz M, Gallo C, Mato AL, Thibaut F, Lista S, Alcolea D, Zetterberg H, Blennow K, Kornhuber J, Riederer P, Gallo C, Kapogiannis D, Mato AL, Thibaut F. Cerebrospinal fluid and blood biomarkers for neurodegenerative dementias: An update of the Consensus of the Task Force on Biological Markers in Psychiatry of the World Federation of Societies of Biological Psychiatry. World J Biol Psychiatry 2018; 19:244-328. [PMID: 29076399 PMCID: PMC5916324 DOI: 10.1080/15622975.2017.1375556] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the 12 years since the publication of the first Consensus Paper of the WFSBP on biomarkers of neurodegenerative dementias, enormous advancement has taken place in the field, and the Task Force takes now the opportunity to extend and update the original paper. New concepts of Alzheimer's disease (AD) and the conceptual interactions between AD and dementia due to AD were developed, resulting in two sets for diagnostic/research criteria. Procedures for pre-analytical sample handling, biobanking, analyses and post-analytical interpretation of the results were intensively studied and optimised. A global quality control project was introduced to evaluate and monitor the inter-centre variability in measurements with the goal of harmonisation of results. Contexts of use and how to approach candidate biomarkers in biological specimens other than cerebrospinal fluid (CSF), e.g. blood, were precisely defined. Important development was achieved in neuroimaging techniques, including studies comparing amyloid-β positron emission tomography results to fluid-based modalities. Similarly, development in research laboratory technologies, such as ultra-sensitive methods, raises our hopes to further improve analytical and diagnostic accuracy of classic and novel candidate biomarkers. Synergistically, advancement in clinical trials of anti-dementia therapies energises and motivates the efforts to find and optimise the most reliable early diagnostic modalities. Finally, the first studies were published addressing the potential of cost-effectiveness of the biomarkers-based diagnosis of neurodegenerative disorders.
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Affiliation(s)
- Piotr Lewczuk
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Neurodegeneration Diagnostics, Medical University of Białystok, and Department of Biochemical Diagnostics, University Hospital of Białystok, Białystok, Poland
| | - Peter Riederer
- Center of Mental Health, Clinic and Policlinic of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Sid E. O’Bryant
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Marcel M. Verbeek
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer center, Nijmegen, The Netherlands
| | - Bruno Dubois
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Salpêtrièrie Hospital, INSERM UMR-S 975 (ICM), Paris 6 University, Paris, France
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Alzheimer Centre, Amsterdam Neuroscience VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), University of Antwerp, Antwerp, Belgium
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Alfredo Ramirez
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Lucilla Parnetti
- Section of Neurology, Center for Memory Disturbances, Lab of Clinical Neurochemistry, University of Perugia, Perugia, Italy
| | | | - Charlotte E. Teunissen
- Neurochemistry Lab and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Harald Hampel
- AXA Research Fund & UPMC Chair, Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Paris 06, Inserm, CNRS, Institut du Cerveau et de la Moelle Épinière (ICM), Département de Neurologie, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Hôpital Pitié-Salpêtrière, Boulevard de l’hôpital, Paris, France
| | - Alberto Lleó
- Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau - Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
- German Center for Neurodegenerative Disorders (DZNE), Bonn, Germany
| | - Lidia Glodzik
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Mony J. de Leon
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Anne M. Fagan
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - José Luis Molinuevo
- Barcelonabeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
- Alzheimer’s Disease and Other Cognitive Disorders Unit, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Willemijn J. Jansen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Bengt Winblad
- Karolinska Institutet, Department NVS, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden
| | - Leslie M. Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ulf Andreasson
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel and University Medical Center Göttingen, Department of Neurology, Göttingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry & Psychotherapy, University of Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- iBiMED, Medical Sciences Department, University of Aveiro, Aveiro, Portugal
| | - Martin R. Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Inga Zerr
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Clinical Dementia Centre, Department of Neurology, University Medical School, Göttingen, Germany
| | - Ron Handels
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
- Karolinska Institutet, Department NVS, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden
| | | | - Gunilla Johansson
- Karolinska Institutet, Department NVS, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden
| | - Natalia Ermann
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ilker Karaca
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Holger Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Patrick Oeckl
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Linda van Waalwijk van Doorn
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer center, Nijmegen, The Netherlands
| | - Maria Bjerke
- Reference Center for Biological Markers of Dementia (BIODEM), University of Antwerp, Antwerp, Belgium
| | - Dimitrios Kapogiannis
- Laboratory of Neurosciences, National Institute on Aging/National Institutes of Health (NIA/NIH), Baltimore, MD, USA
| | - H. Bea Kuiperij
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer center, Nijmegen, The Netherlands
| | - Lucia Farotti
- Section of Neurology, Center for Memory Disturbances, Lab of Clinical Neurochemistry, University of Perugia, Perugia, Italy
| | - Yi Li
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Brian A. Gordon
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Stéphane Epelbaum
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Salpêtrièrie Hospital, INSERM UMR-S 975 (ICM), Paris 6 University, Paris, France
| | - Stephanie J. B. Vos
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Catharina J. M. Klijn
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | | | - Carolina Minguillon
- Barcelonabeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Matthias Schmitz
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Clinical Dementia Centre, Department of Neurology, University Medical School, Göttingen, Germany
| | - Carla Gallo
- Departamento de Ciencias Celulares y Moleculares/Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andrea Lopez Mato
- Chair of Psychoneuroimmunoendocrinology, Maimonides University, Buenos Aires, Argentina
| | - Florence Thibaut
- Department of Psychiatry, University Hospital Cochin-Site Tarnier 89 rue d’Assas, INSERM 894, Faculty of Medicine Paris Descartes, Paris, France
| | - Simone Lista
- AXA Research Fund & UPMC Chair, Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Paris 06, Inserm, CNRS, Institut du Cerveau et de la Moelle Épinière (ICM), Département de Neurologie, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Hôpital Pitié-Salpêtrière, Boulevard de l’hôpital, Paris, France
| | - Daniel Alcolea
- Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau - Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
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Paraskevaidi M, Martin-Hirsch PL, Martin FL. Progress and Challenges in the Diagnosis of Dementia: A Critical Review. ACS Chem Neurosci 2018; 9:446-461. [PMID: 29390184 DOI: 10.1021/acschemneuro.8b00007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Longer life expectancies have led to an increased number of neurodegenerative disease cases globally. Accurate diagnosis of this devastating disorder is of crucial importance but is still feasible only by a brain biopsy after death. An enormous amount of attention and research has been in place over the years toward the better understanding of the mechanisms, as well as the early diagnosis, of neurodegeneration. However, numerous studies have been contradictory from time to time, while new diagnostic methods are constantly developed in a tireless effort to tackle the disease. Nonetheless, there is not yet a conclusive report covering a broader range of techniques for the diagnosis of different types of dementia. In this paper, we critically review current knowledge on the different hypotheses about the pathogenesis of distinct types of dementia, as well as risk factors and current diagnostic approaches in a clinical setting, including neuroimaging, cerebrospinal (CSF), and blood tests. Encouraging research results for the diagnosis and investigation of neurodegenerative disorders are also reported. Particular attention is given to the field of spectroscopy as an emerging tool to detect dementias, follow-up patients, and potentially monitor the patients' response to a therapeutic approach. Spectroscopic techniques, such as infrared and Raman spectroscopy, have facilitated numerous disease-related studies, including neurodegenerative disorders, and are currently undergoing trials for clinical implementation. This review constitutes a comprehensive report with an in-depth focus on promising imaging, molecular biomarker and spectroscopic tests in the field of dementive diseases.
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Affiliation(s)
- Maria Paraskevaidi
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, United Kingdon
| | - Pierre L. Martin-Hirsch
- Department of Obstetrics and Gynaecology, Central Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, United Kingdom
| | - Francis L. Martin
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, United Kingdon
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40
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Rivero-Santana A, Ferreira D, Perestelo-Pérez L, Westman E, Wahlund LO, Sarría A, Serrano-Aguilar P. Cerebrospinal Fluid Biomarkers for the Differential Diagnosis between Alzheimer's Disease and Frontotemporal Lobar Degeneration: Systematic Review, HSROC Analysis, and Confounding Factors. J Alzheimers Dis 2018; 55:625-644. [PMID: 27716663 DOI: 10.3233/jad-160366] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Differential diagnosis in dementia is at present one of the main challenges both in clinical practice and research. Cerebrospinal fluid (CSF) biomarkers are included in the current diagnostic criteria of Alzheimer's disease (AD) but their clinical utility is still unclear. OBJECTIVE We performed a systematic review of studies analyzing the diagnostic performance of CSF Aβ42, total tau (t-tau), and phosphorylated tau (p-tau) in the discrimination between AD and frontotemporal lobar degeneration (FTLD) dementias. METHODS The following electronic databases were consulted until May 2016: Medline and PreMedline, EMBASE, PsycInfo, CINAHL, Cochrane Library, and CRD. For the first-time in the field, a Hierarchical Summary Receiver Operating Characteristic (HRSOC) model was applied, which avoids methodological problems of meta-analyses based on summary points of sensitivity and specificity values. We also investigated relevant confounders of CSF biomarkers' diagnostic performance such as age, disease duration, and global cognitive impairment. RESULTS The p-tau/Aβ42 ratio showed the best diagnostic performance. No statistically significant effects of the confounders were observed. Nonetheless, the p-tau/Aβ42 ratio may be especially indicated for younger patients. P-tau may be preferable for less cognitively impaired patients (high MMSE scores) and the t-tau/Aβ42 ratio for more cognitively impaired patients (low MMSE scores). CONCLUSION The p-tau/Aβ42 ratio has potential for being implemented in the clinical routine for the differential diagnosis between AD and FTLD. It is of utmost importance that future studies report information on confounders such as age, disease duration, and cognitive impairment, which should also stimulate understanding of the role of these factors in disease mechanisms and pathophysiology.
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Affiliation(s)
- Amado Rivero-Santana
- Canarian Foundation for Health Research (FUNCANIS), Tenerife, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lilisbeth Perestelo-Pérez
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.,Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Antonio Sarría
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain.,Agency for Health Technology Assessment (AETS), Institute of Health Carlos III, Madrid, Spain
| | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.,Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain
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41
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Kuiperij HB, Versleijen AAM, Beenes M, Verwey NA, Benussi L, Paterlini A, Binetti G, Teunissen CE, Raaphorst J, Schelhaas HJ, Küsters B, Pijnenburg YAL, Ghidoni R, Verbeek MM. Tau Rather than TDP-43 Proteins are Potential Cerebrospinal Fluid Biomarkers for Frontotemporal Lobar Degeneration Subtypes: A Pilot Study. J Alzheimers Dis 2018; 55:585-595. [PMID: 27662293 DOI: 10.3233/jad-160386] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Frontotemporal dementia (FTD) is a heterogeneous disease both at the clinical, genetic, and pathobiological level. The underlying pathological spectrum (termed FTLD, frontotemporal lobar degeneration) is in most cases defined by accumulation of either tau (FTLD-tau) or TDP-43 proteins (FTLD-TDP). Biomarkers to differentiate these subtypes are not yet available, whereas these are essential requirements to study the natural course of disease and for homogeneous inclusion of patients in clinical studies. OBJECTIVE To study if a combination of total (t-) and phosphorylated (p-)tau, and t-TDP-43 and p-TDP-43 proteins in cerebrospinal fluid (CSF) is suitable to discriminate FTLD-tau and FTLD-TDP subtypes. METHODS We developed immunoassays for the quantification of t-TDP-43 and p-TDP-43 proteins and used commercially available assays for the quantification of t-tau and p-tau proteins. We quantified these proteins in ventricular CSF samples from neuropathologically defined FTLD-tau and FTLD-TDP cases to study the reflection of underlying brain pathology in CSF composition, and in lumbar CSF samples from FTLD-tau and FTLD-TDP patients to study the diagnostic potential of CSF biomarkers. RESULTS In ventricular CSF, t-TDP-43 and t-tau levels, when combined into one model, were significantly different between neuropathologically-defined FTLD-tau and FTLD-TDP cases. In a pilot study using lumbar CSF, the p-tau/t-tau ratio, but not t-TDP-43 levels, were significantly different between FTLD-TDP and FTLD-tau patients. CONCLUSION We conclude that with current available methods, CSF tau, rather than TDP-43 proteins, may have diagnostic value in the differentiation of FTLD patients with either tau or TDP-43 pathology.
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Affiliation(s)
- H Bea Kuiperij
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Marijke Beenes
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicolaas A Verwey
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Present affiliation: Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Luisa Benussi
- Molecular Markers Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Anna Paterlini
- Molecular Markers Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuliano Binetti
- Molecular Markers Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Charlotte E Teunissen
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helenius J Schelhaas
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benno Küsters
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberta Ghidoni
- Molecular Markers Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Marcel M Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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42
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Takano Y, Kunitoki K, Tatewaki Y, Mutoh T, Totsune T, Shimomura H, Nakagawa M, Arai H, Taki Y. Posterior Associative and Cingulate Cortex Involvement of Brain Single-Photon Emission Computed Tomography (SPECT) Imaging in Semantic Dementia with Probable Alzheimer Disease Pathology: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:153-157. [PMID: 29429985 PMCID: PMC5817968 DOI: 10.12659/ajcr.907799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Male, 61 Final Diagnosis: Semantic dementia Symptoms: Primary progressive aphasia Medication: — Clinical Procedure: Neuroimaging Specialty: Nuclear Medicine
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Affiliation(s)
- Yumi Takano
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Keiko Kunitoki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yasuko Tatewaki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Tatsushi Mutoh
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Tomoko Totsune
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hideo Shimomura
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku Univerisity, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Manabu Nakagawa
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hiroyuki Arai
- Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yasuyuki Taki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
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43
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Fumagalli GG. Diagnosis of Frontotemporal Dementia. NEURODEGENER DIS 2018. [DOI: 10.1007/978-3-319-72938-1_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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44
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Vergallo A, Carlesi C, Pagni C, Giorgi FS, Baldacci F, Petrozzi L, Ceravolo R, Tognoni G, Siciliano G, Bonuccelli U. A single center study: Aβ42/p-Tau181 CSF ratio to discriminate AD from FTD in clinical setting. Neurol Sci 2017; 38:1791-1797. [DOI: 10.1007/s10072-017-3053-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 06/30/2017] [Indexed: 12/20/2022]
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45
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Meeter LH, Kaat LD, Rohrer JD, van Swieten JC. Imaging and fluid biomarkers in frontotemporal dementia. Nat Rev Neurol 2017. [PMID: 28621768 DOI: 10.1038/nrneurol.2017.75] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Frontotemporal dementia (FTD), the second most common type of presenile dementia, is a heterogeneous neurodegenerative disease characterized by progressive behavioural and/or language problems, and includes a range of clinical, genetic and pathological subtypes. The diagnostic process is hampered by this heterogeneity, and correct diagnosis is becoming increasingly important to enable future clinical trials of disease-modifying treatments. Reliable biomarkers will enable us to better discriminate between FTD and other forms of dementia and to predict disease progression in the clinical setting. Given that different underlying pathologies probably require specific pharmacological interventions, robust biomarkers are essential for the selection of patients with specific FTD subtypes. This Review emphasizes the increasing availability and potential applications of structural and functional imaging biomarkers, and cerebrospinal fluid and blood fluid biomarkers in sporadic and genetic FTD. The relevance of new MRI modalities - such as voxel-based morphometry, diffusion tensor imaging and arterial spin labelling - in the early stages of FTD is discussed, together with the ability of these modalities to classify FTD subtypes. We highlight promising new fluid biomarkers for staging and monitoring of FTD, and underline the importance of large, multicentre studies of individuals with presymptomatic FTD. Harmonization in the collection and analysis of data across different centres is crucial for the implementation of new biomarkers in clinical practice, and will become a great challenge in the next few years.
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Affiliation(s)
- Lieke H Meeter
- Department of Neurology, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Laura Donker Kaat
- Department of Neurology, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.,Department of Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative diseases, Institute of Neurology, Queen Square, University College London, London WC1N 3BG, UK
| | - John C van Swieten
- Department of Neurology, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.,Department of Clinical Genetics, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, Netherlands
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46
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Mattsson N, Lönneborg A, Boccardi M, Blennow K, Hansson O. Clinical validity of cerebrospinal fluid Aβ42, tau, and phospho-tau as biomarkers for Alzheimer's disease in the context of a structured 5-phase development framework. Neurobiol Aging 2017; 52:196-213. [DOI: 10.1016/j.neurobiolaging.2016.02.034] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 01/01/2023]
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47
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Sawyer RP, Rodriguez-Porcel F, Hagen M, Shatz R, Espay AJ. Diagnosing the frontal variant of Alzheimer's disease: a clinician's yellow brick road. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2017; 4:2. [PMID: 28265458 PMCID: PMC5333400 DOI: 10.1186/s40734-017-0052-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/07/2017] [Indexed: 12/12/2022]
Abstract
Background Disruption of the frontal lobes and its associated networks are a common consequence of neurodegenerative disorders. Given the wide range of cognitive, behavioral and motor processes in which the frontal lobes are involved, there can be a great variety of manifestations depending on the pathology distribution. The most common are the behavioral variant of frontotemporal dementia (bvFTD) and the frontal variant of Alzheimer’s disease (fvAD), which are particularly challenging to disentangle. Recognizing fvAD from bvFTD-related pathologies is a diagnostic challenge and a critical need in the management and counseling of these patients. Case presentation Here we present three pathology-proven cases of Alzheimer’s disease initially misdiagnosed as bvFTD and discuss the distinctive or less overlapping historical, examination, and laboratory findings of fvAD and bvFTD, deriving analogies for mnemonic endurance from the Wizard of Oz worldview. Conclusion The Yellow Brick Road to diagnosing these disorders may be served by the metaphor of fvAD as the irritable, paranoid, and tremulous Scarecrow and bvFTD the heartless, ritualistic, and rigid Tin Man. An Oz-inspired creative license may help the clinician recognize the differential disease progression, caregiver burden, and treatment response of fvAD compared with bvFTD. Electronic supplementary material The online version of this article (doi:10.1186/s40734-017-0052-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Russell P Sawyer
- Department of Neurology, University of Cincinnati, 260 Stetson Street Suite 2300, Cincinnati, OH 45219 USA
| | - Federico Rodriguez-Porcel
- Department of Neurology, University of Cincinnati, 260 Stetson Street Suite 2300, Cincinnati, OH 45219 USA.,UC Memory Disorders Center, University of Cincinnati, 234 Goodman Street, Cincinnati, OH 45219 USA.,Gardner Family Center for Parkinson's disease and Movement Disorders, University of Cincinnati, 234 Goodman Street, Cincinnati, OH 45219 USA
| | - Matthew Hagen
- Department of Pathology and Laboratory Medicine, University of Cincinnati, 234 Goodman Street, Cincinnati, OH 45219-0533 USA
| | - Rhonna Shatz
- Department of Neurology, University of Cincinnati, 260 Stetson Street Suite 2300, Cincinnati, OH 45219 USA.,UC Memory Disorders Center, University of Cincinnati, 234 Goodman Street, Cincinnati, OH 45219 USA
| | - Alberto J Espay
- Department of Neurology, University of Cincinnati, 260 Stetson Street Suite 2300, Cincinnati, OH 45219 USA.,Gardner Family Center for Parkinson's disease and Movement Disorders, University of Cincinnati, 234 Goodman Street, Cincinnati, OH 45219 USA
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48
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Blanco-Cantó ME, Monge-Argilés JA, Pérez-Cejuela C, Badía C, Gabaldón L, Muñoz-Ruíz C, Sánchez-Payá J, Gasparini-Berenguer R, Leiva-Santana C. Diagnostic Validity Comparison Between Criteria Based on CSF Alzheimer's Disease Biomarkers. Am J Alzheimers Dis Other Demen 2017; 32:101-107. [PMID: 28191798 PMCID: PMC10852644 DOI: 10.1177/1533317516688298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To compare the diagnostic validity of NIA-AA criteria, for AD CSF biomarkers, with our own new criteria. MATERIALS AND METHODS Between 2008 and 2011, 170 patients with Mild Cognitive Impairment (MCI) were included. CSF levels of Aβ1-42, T-tau, P-tau181, and ratios of T-tau/Aβ1-42 and P-tau181/Aβ1-42 were analyzed. In our criteria, we considered 3 or more abnormal variables indicative of a high likelihood of MCI due to AD. RESULTS After a clinical follow-up of 4.5 ± 1.2 years, 44 patients remained stable, 95 developed AD, 15 other forms of dementia, 7 died and 9 received other diagnoses. Using the NIA-AA criteria and our own criteria, the diagnostic validity of the CSF biomarkers was 58% versus 85%, specificity 84% versus 72%, PPV 82% versus 79% and NPV 61% versus 79%. CONCLUSION The inclusion of the ratios in diagnostic criteria increases sensitivity and NPV for the diagnosis of MCI due to AD.
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Affiliation(s)
| | - J. A. Monge-Argilés
- Department of Neurology, General University Hospital of Alicante, Alicante, Spain
| | - C. Pérez-Cejuela
- Neurology Section, Baix Vinalopó hospital, Elche, Alicante, Spain
| | - C. Badía
- Denia Marina-Salud Regional Hospital, Alicante, Spain
| | - L. Gabaldón
- Denia Marina-Salud Regional Hospital, Alicante, Spain
| | - C. Muñoz-Ruíz
- Immunology Laboratory, General University Hospital of Alicante, Alicante, Spain
| | - J. Sánchez-Payá
- Department of Preventive Medicine, General University Hospital of Alicante, Alicante, Spain
| | | | - C. Leiva-Santana
- Department of Neurology, General University Hospital of Alicante, Alicante, Spain
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49
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Krudop WA, Dols A, Kerssens CJ, Prins ND, Möller C, Schouws S, Barkhof F, van Berckel BNM, Teunissen CE, van der Flier WM, Scheltens P, Sikkes SAM, Stek ML, Pijnenburg YAL. Impact of Imaging and Cerebrospinal Fluid Biomarkers on Behavioral Variant Frontotemporal Dementia Diagnosis within a Late-Onset Frontal Lobe Syndrome Cohort. Dement Geriatr Cogn Disord 2016; 41:16-26. [PMID: 26473985 DOI: 10.1159/000441023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The criteria for behavioral variant frontotemporal dementia (bvFTD) incorporate MRI and [18F]-FDG-PET. Cerebrospinal fluid (CSF) analysis is merely advised for excluding Alzheimer's disease. AIMS We aimed to assess the impact of biomarkers on diagnostic certainty and contingent changes of bvFTD diagnosis within the clinically relevant neuropsychiatric differential diagnosis of subjects with a late-onset frontal lobe syndrome (LOF). METHODS We included 137 patients with LOF, aged 45-75 years, 72% males. Biomarker disclosure was considered contributing after any substantial difference in diagnostic certainty or a diagnostic change. Percentages of contributing biomarkers were compared between three major diagnostic groups (bvFTD, psychiatry, other neurological disorders). Certainty levels in stable diagnostic groups were compared to those with a diagnostic change. RESULTS Biomarkers contributed in 53, 60 and 41% of the LOF patients for MRI, [18F]-FDG-PET and CSF, respectively. Biomarkers changed the diagnosis in 14% of cases towards bvFTD and in 13% from bvFTD into an alternative. Those that changed had a lower level of a priori diagnostic certainty compared to stable diagnoses. CONCLUSION Our study not only supports the widely accepted use of MRI and [18F]-FDG-PET in diagnosing or excluding bvFTD, but also shows that CSF biomarkers aid clinicians in the diagnostic process.
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Affiliation(s)
- Welmoed A Krudop
- Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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50
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Schönecker S, Brendel M, Huber M, Vollmar C, Huppertz HJ, Teipel S, Okamura N, Levin J, Rominger A, Danek A. Applied multimodal diagnostics in a case of presenile dementia. BMC Neurol 2016; 16:131. [PMID: 27506761 PMCID: PMC4977691 DOI: 10.1186/s12883-016-0647-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/26/2016] [Indexed: 12/14/2022] Open
Abstract
Background Alzheimer’s disease (AD) is the most common cause of dementia in the elderly. The possibility of disease-modifying strategies has evoked a need for early and accurate diagnosis. To improve the accuracy of the clinical diagnosis of AD, biomarkers like cerebrospinal fluid (CSF) and neuroimaging techniques like magnetic resonance imaging (MRI) and positron emission tomography (PET) have been incorporated into the diagnostic guidelines of AD. Case presentation In this case report we outline in reference to one of our patients with presenile dementia the current approaches to the diagnosis of AD. The patient was a 59-year old woman presenting with progressive memory decline. CSF-Aβ42 was normal while P-tau was slightly increased. FDG-PET indicated a pattern typical for AD, amyloid-PET showed an extensive global amyloid load, and tau-PET depicted a pronounced hippocampal tracer accumulation. The MRI scan was rated as normal at routine diagnostics, however quantitative volumetric analysis revealed significant atrophy especially of the parietal lobe. The combination of biomarkers and neuroimaging techniques was therefore suggestive of an underlying AD pathology. Conclusions To enable early and accurate diagnosis of AD and thereby also patient recruitment for anti-tau or anti-β-amyloid therapeutic trials, a combination of biomarkers and neuroimaging techniques seems useful.
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Affiliation(s)
- Sonja Schönecker
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany.
| | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Marion Huber
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
| | | | - Stefan Teipel
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases, Rostock, Germany
| | - Nobuyuki Okamura
- Department of Pharmacology, Tohoku University School of Medicine, Sendai, Japan
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany.,German Center for Neurodegenerative Diseases, Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
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