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Statsenko Y, Meribout S, Habuza T, Almansoori TM, Gorkom KNV, Gelovani JG, Ljubisavljevic M. Patterns of structure-function association in normal aging and in Alzheimer's disease: Screening for mild cognitive impairment and dementia with ML regression and classification models. Front Aging Neurosci 2023; 14:943566. [PMID: 36910862 PMCID: PMC9995946 DOI: 10.3389/fnagi.2022.943566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/21/2022] [Indexed: 02/25/2023] Open
Abstract
Background The combined analysis of imaging and functional modalities is supposed to improve diagnostics of neurodegenerative diseases with advanced data science techniques. Objective To get an insight into normal and accelerated brain aging by developing the machine learning models that predict individual performance in neuropsychological and cognitive tests from brain MRI. With these models we endeavor to look for patterns of brain structure-function association (SFA) indicative of mild cognitive impairment (MCI) and Alzheimer's dementia. Materials and methods We explored the age-related variability of cognitive and neuropsychological test scores in normal and accelerated aging and constructed regression models predicting functional performance in cognitive tests from brain radiomics data. The models were trained on the three study cohorts from ADNI dataset-cognitively normal individuals, patients with MCI or dementia-separately. We also looked for significant correlations between cortical parcellation volumes and test scores in the cohorts to investigate neuroanatomical differences in relation to cognitive status. Finally, we worked out an approach for the classification of the examinees according to the pattern of structure-function associations into the cohorts of the cognitively normal elderly and patients with MCI or dementia. Results In the healthy population, the global cognitive functioning slightly changes with age. It also remains stable across the disease course in the majority of cases. In healthy adults and patients with MCI or dementia, the trendlines of performance in digit symbol substitution test and trail making test converge at the approximated point of 100 years of age. According to the SFA pattern, we distinguish three cohorts: the cognitively normal elderly, patients with MCI, and dementia. The highest accuracy is achieved with the model trained to predict the mini-mental state examination score from voxel-based morphometry data. The application of the majority voting technique to models predicting results in cognitive tests improved the classification performance up to 91.95% true positive rate for healthy participants, 86.21%-for MCI and 80.18%-for dementia cases. Conclusion The machine learning model, when trained on the cases of this of that group, describes a disease-specific SFA pattern. The pattern serves as a "stamp" of the disease reflected by the model.
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Affiliation(s)
- Yauhen Statsenko
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Big Data Analytics Center (BIDAC), United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sarah Meribout
- Department of Medicine, University of Constantine 3, Constantine, Algeria
| | - Tetiana Habuza
- Big Data Analytics Center (BIDAC), United Arab Emirates University, Al Ain, United Arab Emirates
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Taleb M. Almansoori
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Klaus Neidl-Van Gorkom
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Juri G. Gelovani
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Biomedical Engineering Department, College of Engineering, Wayne State University, Detroit, MI, United States
- Siriraj Hospital, Mahidol University, Salaya, Thailand
| | - Milos Ljubisavljevic
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Abu Dhabi Precision Medicine Virtual Research Institute (ADPMVRI), United Arab Emirates University, Al Ain, United Arab Emirates
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Querry M, Blanc F, Bousiges O, Philippi N, Cretin B, Demuynck C, Muller C, Botzung A. Memory Outcome in Prodromal and Mild Dementia with Lewy Bodies and Alzheimer's Disease: A Longitudinal Study. J Alzheimers Dis 2023; 94:147-162. [PMID: 37212104 PMCID: PMC10357191 DOI: 10.3233/jad-221243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) are likely to induce memory impairments from the prodromal stage but, to our knowledge, no longitudinal study of these patients' memory profile has been conducted to date. OBJECTIVE The aim of our study was to describe the characteristics and the evolution of the long-term memory profile of patients with prodromal and mild DLB and AD. METHODS We collected verbal (RL/RI-16) and visual (DMS48) memory scores from 91 DLB patients, 28 AD patients, 15 patients with both conditions (DLB/AD), and 18 healthy control subjects at their inclusion visit and at 12, 24, and 48 months. RESULTS On the RL/RI-16, DLB patients performed better than AD patients in terms of total recall (p < 0.001), delayed total recall (p < 0.001), recognition (p = 0.031), and loss of information over time (p = 0.023). On the DMS48, differences between these two groups were not significant (p > 0.05). Longitudinally, the memory performance of DLB patients was stable over 48 months, unlike that of AD patients. CONCLUSION Four indicators were relevant to distinguish between DLB and AD patients in terms of memory performance: DLB patients benefitted greatly from semantic cueing, their recognition and consolidation abilities were well-preserved, and both their verbal and visual memory performance remained remarkably stable over four years. However, no performance differences between DLB and AD patients were found regarding visual memory, either qualitatively (memory profile) or quantitatively (severity of impairment), indicating the lesser relevance of this test in distinguishing between these two diseases.
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Affiliation(s)
- Manon Querry
- University Hospitals of Strasbourg, CM2R (Research and Resources Memory Centre), Geriatric Day Hospital, Geriatrics Division, Strasbourg, France
- University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS team, Strasbourg, France
| | - Frédéric Blanc
- University Hospitals of Strasbourg, CM2R (Research and Resources Memory Centre), Geriatric Day Hospital, Geriatrics Division, Strasbourg, France
- University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS team, Strasbourg, France
| | - Olivier Bousiges
- University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS team, Strasbourg, France
- Laboratory of Biochemistry and Molecular Biology, University Hospital of Strasbourg, Strasbourg, France
| | - Nathalie Philippi
- University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS team, Strasbourg, France
- Neurology Department, University Hospitals of Strasbourg, CM2R, Neuropsychology Unit, Head and Neck Division, Strasbourg, France
| | - Benjamin Cretin
- University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS team, Strasbourg, France
- Neurology Department, University Hospitals of Strasbourg, CM2R, Neuropsychology Unit, Head and Neck Division, Strasbourg, France
| | - Catherine Demuynck
- University Hospitals of Strasbourg, CM2R (Research and Resources Memory Centre), Geriatric Day Hospital, Geriatrics Division, Strasbourg, France
| | - Candice Muller
- University Hospitals of Strasbourg, CM2R (Research and Resources Memory Centre), Geriatric Day Hospital, Geriatrics Division, Strasbourg, France
| | - Anne Botzung
- University Hospitals of Strasbourg, CM2R (Research and Resources Memory Centre), Geriatric Day Hospital, Geriatrics Division, Strasbourg, France
- University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS team, Strasbourg, France
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Hausman-Cohen S, Bilich C, Kapoor S, Maristany E, Stefani A, Wilcox A. Genomics as a Clinical Decision Support Tool for Identifying and Addressing Modifiable Causes of Cognitive Decline and Improving Outcomes: Proof of Concept Support for This Personalized Medicine Strategy. Front Aging Neurosci 2022; 14:862362. [PMID: 35517054 PMCID: PMC9062132 DOI: 10.3389/fnagi.2022.862362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
The landscape of therapeutics for mild cognitive impairment and dementia is quite limited. While many single-agent trials of pharmaceuticals have been conducted, these trials have repeatedly been unable to show improvement in cognition. It is hypothesized that because Alzheimer’s, like many other chronic illnesses, is not a monogenic illness, but is instead caused by the downstream effects of an individual’s genetic variants interacting with each other, the environment, and lifestyle, that improving outcomes will require a personalized, precision medicine approach. This approach requires identifying and then addressing contributing genomic and other factors specific to each individual in a simultaneous fashion. Until recently, the utility of genomics as part of clinical decision-making for Alzheimer’s and cognitive decline has been limited by the lack of availability of a genomic platform designed specifically to evaluate factors contributing to cognitive decline and how to respond to these factors The clinical decision support (CDS) platform used in the cases presented focuses on common variants that relate to topics including, but not limited to brain inflammation, amyloid processing, nutrient carriers, brain ischemia, oxidative stress, and detoxification pathways. Potential interventions based on the scientific literature were included in the CDS, but the final decision on what interventions to apply were chosen by each patient’s physician. Interventions included supplements with “generally regarded as safe (GRAS)” rating, along with targeted diet and lifestyle modifications. We hypothesize that a personalized genomically targeted approach can improve outcomes for individuals with mild cognitive impairment who are at high risk of Alzheimer’s. The cases presented in this report represent a subset of cases from three physicians’ offices and are meant to provide initial proof of concept data demonstrating the efficacy of this method and provide support for this hypothesis. These patients were at elevated risk for Alzheimer’s due to their apolipoprotein E ε4 status. While further prospective and controlled trials need to be done, initial case reports are encouraging and lend support to this hypothesis of the benefit of a genomically targeted personalized medicine approach to improve outcomes in individuals with cognitive decline who are at high risk for Alzheimer’s.
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Vogel A, Mellergaard C, Waldemar G, Frederiksen KS. Impaired performances on the category cued memory test in mild Alzheimer's disease and dementia with Lewy bodies: A comparative validity study. APPLIED NEUROPSYCHOLOGY. ADULT 2021:1-6. [PMID: 34958289 DOI: 10.1080/23279095.2021.2021413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cued recall taps amnesia of "the hippocampal type" as typically found in Alzheimer's disease (AD). Studies investigating the validity of cued recall measures in AD have typically been conducted in research settings. The Category Cued Memory Test (CCMT-48) measures learning/memory using the same categories during encoding and acquisition. The aim of this study was to investigate how frequently impairments were found on the CCMT-48 mild AD patients from a memory clinic (N = 77). We used a case-oriented approach where individually observed scores were compared to expected scores derived from regressions-based normative data. We also investigated if CCMT-48 performances differed in patients with mild AD and Dementia with Lewy Bodies (DLB) (N = 90). The results showed a significantly higher frequency of impairment in the AD group as compared to the DLB group for scores below 10th percentile-estimate (impaired: AD 88%; DLB 69%) and 5th percentile-estimate (impaired: AD 82%; DLB 53%). In conclusion, a very high frequency of impairment of a picture-based cued recall test in AD patients (very high sensitivity) in a memory clinic setting. However, specificity is not optimal since impairments also frequently occurred in DLB where memory problems could be assumed to be part of attentional deficits and poor retrieval strategies.
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Affiliation(s)
- Asmus Vogel
- Department of Neurology, Rigshospitalet, Danish Dementia Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Clara Mellergaard
- Department of Neurology, Rigshospitalet, Danish Dementia Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gunhild Waldemar
- Department of Neurology, Rigshospitalet, Danish Dementia Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Steen Frederiksen
- Department of Neurology, Rigshospitalet, Danish Dementia Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
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De Simone MS, Perri R, Rodini M, Fadda L, De Tollis M, Caltagirone C, Carlesimo GA. A Lack of Practice Effects on Memory Tasks Predicts Conversion to Alzheimer Disease in Patients With Amnestic Mild Cognitive Impairment. J Geriatr Psychiatry Neurol 2021; 34:582-593. [PMID: 32734799 DOI: 10.1177/0891988720944244] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The aim of the current study was to test the accuracy of practice effects, that is, improvement in test performance due to repeated neuropsychological evaluations, in identifying patients with amnestic mild cognitive impairment (a-MCI) at greater risk of conversion to Alzheimer disease (AD). For this purpose, we conducted a longitudinal study of 54 patients diagnosed with a-MCI at the first assessment and followed-up for 4 years. During this time, 18 patients converted to AD. Baseline and 6- to 12-month follow-up performances on a large set of neuropsychological tests were analyzed to determine their diagnostic ability to predict later conversion to dementia. Results demonstrate that a lack of practice effects on episodic memory tests is an accurate prognostic indicator of late conversion to AD in a-MCI patients. In fact, even though the performance of both groups was substantially comparable at the baseline evaluation, stable a-MCI patients greatly improved their memory performance at retest after 6 to 12 months; instead, scores of converter a-MCI remained stable or decreased passing from baseline to follow-up. Standardized z-change scores on memory tasks, which were computed as a reliable measure of performance change, classified group membership with very good overall accuracy, which was higher than the classification of converter and stable a-MCIs provided by baseline or follow-up scores. We hypothesize that the lack of practice effects on memory tasks mirrors the early involvement of medial temporal lobe areas in converter a-MCI that are fundamental for the consolidation of new memory traces.
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Affiliation(s)
| | - Roberta Perri
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Marta Rodini
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Lucia Fadda
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Massimo De Tollis
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Carlo Caltagirone
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni Augusto Carlesimo
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, Tor Vergata University, Rome, Italy
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Prentice JL, Schaeffer MJ, Wall AK, Callahan BL. A Systematic Review and Comparison of Neurocognitive Features of Late-Life Attention-Deficit/Hyperactivity Disorder and Dementia With Lewy Bodies. J Geriatr Psychiatry Neurol 2021; 34:466-481. [PMID: 32762393 DOI: 10.1177/0891988720944251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) in adulthood and dementia with Lewy bodies (DLB) share many cognitive and noncognitive similarities. The overlapping features between both disorders complicate differential diagnosis. The aim of the current systematic review was to compare patterns of neuropsychological profiles in older adults with ADHD and DLB. METHOD Of the 1989 ADHD-related articles and 1332 DLB-related articles screened, 3 ADHD and 25 DLB articles were retained for qualitative synthesis and review. RESULTS A synthesis of individual study findings revealed isolated working memory deficits for late-life ADHD, and performance deficits in areas of attention, memory, language, and visuoperceptual abilities for DLB. Results were limited by small samples and absence of data in some cognitive domains. CONCLUSION These initial findings support potentially unique neurocognitive profiles for ADHD in later life and DLB that would enable practitioners to differentially diagnose and appropriately treat older adults presenting with these phenotypically similar disorders.
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Affiliation(s)
| | | | - Alexandra K Wall
- Department of Psychology, 2129University of Calgary, Alberta, Canada
| | - Brandy L Callahan
- Department of Psychology, 2129University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada
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Cremona S, Jobard G, Zago L, Mellet E. Word Meaning Contributes to Free Recall Performance in Supraspan Verbal List-Learning Tests. Front Psychol 2020; 11:2043. [PMID: 32922343 PMCID: PMC7457129 DOI: 10.3389/fpsyg.2020.02043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 11/13/2022] Open
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Schaeffer MJ, Callahan BL. Investigating the Association Between Verbal Forgetting and Pathological Markers of Alzheimer's and Lewy Body Diseases. J Alzheimers Dis 2019; 70:877-887. [PMID: 31282412 DOI: 10.3233/jad-180962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The percentage of verbal forgetting (VF%) measure of the Rey Auditory Verbal Learning Test (RAVLT) has been proposed to differentiate patients diagnosed clinically with Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). OBJECTIVE To determine if VF% aligns with gold-standard biomarker and autopsy evidence of AD and DLB neuropathology. METHODS Clinical, cognitive, sociodemographic, and biomarker data were collected from 315 patients with baseline cognitive impairment and 485 normal controls from the Alzheimer's Disease Neuroimaging Initiative (ADNI). AD markers included reduced cerebrospinal fluid (CSF) amyloid-β, elevated total-tau and phosphorylated-tau, hippocampal atrophy, and the presence of amyloid plaques and neurofibrillary tangles at autopsy. DLB markers included reduced CSF α-synuclein, preserved hippocampus, atrophied putamen, occipital glucose metabolism, and the presence of Lewy bodies at autopsy. Cognitively impaired participants were classified as ADVF% (n = 190) or DLBVF% (n = 125) based on their RAVLT VF% scores using a 75% cut-off (≥75% = ADVF%, <75% = DLBVF%). Postmortem data were available for 13 ADVF% participants, 13 DLBVF% patients, and six healthy controls. RESULTS ADVF% and DLBVF% participants did not differ on CSF or neuroimaging biomarkers, with the exception of total tau levels which were higher in ADVF%. In the subset of participants with autopsy data, comorbid AD and DLB pathology was most frequent in ADVF% participants, and pure DLB pathology was most frequent in DLBVF% participants, however, these differences were not statistically significant. CONCLUSION The RAVLT VF% measure does not reliably align with AD and DLB neuropathology in ADNI participants.
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Affiliation(s)
| | - Brandy L Callahan
- Department of Psychology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada.,Mathison Centre for Mental Health Research & Education, Calgary, AB, Canada
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Yoon G, Song J. Intermittent Fasting: a Promising Approach for Preventing Vascular Dementia. J Lipid Atheroscler 2019; 8:1-7. [PMID: 32821694 PMCID: PMC7379085 DOI: 10.12997/jla.2019.8.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/30/2019] [Accepted: 03/22/2019] [Indexed: 01/04/2023] Open
Abstract
Vascular dementia is the most common neuropsychiatric syndrome and is characterized by synaptic dysfunction, neuroinflammation, and cognitive dysfunction. Vascular dementia is associated with various environmental, genetic, and lifestyle risk factors. Recent research has focused on the association between vascular dementia and dietary patterns, suggesting that dietary regulation leads to better control of energy metabolism, improvements in brain insulin resistance, and the suppression of neuroinflammation. Intermittent fasting is a calorie-restriction method known to be more effective in promoting fat loss and regulating the impairment of glucose metabolism as compared with other dietary restriction regimens. Herein, the authors review the effects of intermittent fasting with regard to vascular dementia based on recent evidence and propose that intermittent fasting could be a therapeutic approach for ameliorating vascular dementia pathology and preventing its onset.
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Affiliation(s)
- Gwangho Yoon
- Department of Anatomy, Chonnam National University Medical School, Gwangju, Korea.,Department of Biochemistry, Chonnam National University, Gwangju, Korea
| | - Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Gwangju, Korea
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Bussè C, Caffarra P, Rossi A, Zorzi G, Fragiacomo F, Camporese G, Pompanin S, Di Bernardo GA, Cagnin A. Testing Hippocampal Memory in Prodromal Dementia with Lewy Bodies. J Alzheimers Dis 2018; 64:349-353. [DOI: 10.3233/jad-180166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Cinzia Bussè
- Department of Neurosciences (DNS), University of Padua, Padua, Italy
- Department of Neurosciences, Psychology, Pharmacology and Child Health, NEUROFARBA, University of Florence, Florence, Italy
| | - Paolo Caffarra
- Section of Neuroscience, DIMEC, University of Parma, Italy
- Alzheimer Center, FERB ONLUS, Gazzaniga, Bergamo, Italy
| | - Alice Rossi
- Department of Neurosciences (DNS), University of Padua, Padua, Italy
| | - Giovanni Zorzi
- Department of Neurosciences (DNS), University of Padua, Padua, Italy
| | | | - Giulia Camporese
- Department of Neurosciences (DNS), University of Padua, Padua, Italy
| | - Sara Pompanin
- Department of Neurosciences (DNS), University of Padua, Padua, Italy
| | - Gian Antonio Di Bernardo
- Department of Education and Humanities, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Annachiara Cagnin
- Department of Neurosciences (DNS), University of Padua, Padua, Italy
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