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Hwang H, Kim SE, Lee HJ, Lee DA, Park KM. Identification of amnestic mild cognitive impairment by structural and functional MRI using a machine-learning approach. Clin Neurol Neurosurg 2024; 238:108177. [PMID: 38402707 DOI: 10.1016/j.clineuro.2024.108177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The importance of early treatment for mild cognitive impairment (MCI) has been extensively shown. However, classifying patients presenting with memory complaints in clinical practice as having MCI vs normal results is difficult. Herein, we assessed the feasibility of applying a machine learning approach based on structural volumes and functional connectomic profiles to classify the cognitive levels of cognitively unimpaired (CU) and amnestic MCI (aMCI) groups. We further applied the same method to distinguish aMCI patients with a single memory impairment from those with multiple memory impairments. METHODS Fifty patients with aMCI were enrolled and classified as having either verbal or visual-aMCI (verbal or visual memory impairment), or both aMCI (verbal and visual memory impairments) based on memory test results. In addition, 26 CU patients were enrolled in the control group. All patients underwent structural T1-weighted magnetic resonance imaging (MRI) and resting-state functional MRI. We obtained structural volumes and functional connectomic profiles from structural and functional MRI, respectively, using graph theory. A support vector machine (SVM) algorithm was employed, and k-fold cross-validation was performed to discriminate between groups. RESULTS The SVM classifier based on structural volumes revealed an accuracy of 88.9% at classifying the cognitive levels of patients with CU and aMCI. However, when the structural volumes and functional connectomic profiles were combined, the accuracy increased to 92.9%. In the classification of verbal or visual-aMCI (n = 22) versus both aMCI (n = 28), the SVM classifier based on structural volumes revealed a low accuracy of 36.7%. However, when the structural volumes and functional connectomic profiles were combined, the accuracy increased to 53.1%. CONCLUSION Structural volumes and functional connectomic profiles obtained using a machine learning approach can be used to classify cognitive levels to distinguish between aMCI and CU patients. In addition, combining the functional connectomic profiles with structural volumes results in a better classification performance than the use of structural volumes alone for identifying both "aMCI versus CU" and "verbal- or visual-aMCI versus both aMCI" patients.
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Affiliation(s)
- Hyunyoung Hwang
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Si Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
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Rao S, Cai Y, Zhong Z, Gou T, Wang Y, Liao S, Qiu P, Kuang W. Prevalence, cognitive characteristics, and influencing factors of amnestic mild cognitive impairment among older adults residing in an urban community in Chengdu, China. Front Neurol 2024; 15:1336385. [PMID: 38356893 PMCID: PMC10864602 DOI: 10.3389/fneur.2024.1336385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Objective Dementia is a significant public health concern, and mild cognitive impairment (MCI) serves as a transitional stage between normal aging and dementia. Among the various types of MCI, amnestic MCI (aMCI) has been identified as having a higher likelihood of progressing to Alzheimer's dimension. However, limited research has been conducted on the prevalence of aMCI in China. Therefore, the objective of this study is to investigate the prevalence of aMCI, examine its cognitive characteristics, and identify associated risk factors. Methods In this cross-sectional study, we investigated a sample of 368 older adults aged 60 years and above in the urban communities of Chengdu, China. The participants underwent a battery of neuropsychological assessments, including the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR), Auditory Verbal Learning Test (AVLT), Wechsler's Logical Memory Task (LMT), Boston Naming Test (BNT) and Trail Making Test Part A (TMT-A). Social information was collected by standard questionnaire. Multiple logistic regression analysis was utilized to screen for the risk and protective factors of aMCI. Results The data analysis included 309 subjects with normal cognitive function and 59 with aMCI, resulting in a prevalence of 16.0% for aMCI. The average age of participants was 69.06 ± 7.30 years, with 56.0% being females. After controlling for age, gender and education, the Spearman partial correlation coefficient between various cognitive assessments and aMCI ranged from -0.52 for the long-term delayed recall scores in AVLT to 0.19 for the time-usage scores in TMT-A. The results indicated that all cognitive domains, except for naming scores (after semantic cue of BNT) and error quantity (in TMT-A), showed statistically significant associations with aMCI. Furthermore, the multiple logistic regression analysis revealed that older age (OR = 1.044, 95%CI: 1.002~1.087), lower educational level, and diabetes (OR = 2.450, 95%CI: 1.246~4.818) were risk factors of aMCI. Conclusion This study found a high prevalence of aMCI among older adults in Chengdu, China. Individuals with aMCI exhibited lower cognitive function in memory, language, and executive domains, with long-term delayed recall showing the strongest association. Clinicians should prioritize individuals with verbal learning and memory difficulties, especially long-term delayed recall, in clinical practice.
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Affiliation(s)
- Shan Rao
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Chengdu Jinxin Mental Diseases Hospital, Chengdu, Sichuan, China
| | - Yan Cai
- Evidence-Based Nursing Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhujun Zhong
- Department of Epidemiology and Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Tianyuan Gou
- Chengdu Jinxin Mental Diseases Hospital, Chengdu, Sichuan, China
| | - Yangyang Wang
- Department of Epidemiology and Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Shiyi Liao
- Department of Epidemiology and Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Peiyuan Qiu
- Department of Epidemiology and Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Weihong Kuang
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Sampatakakis SN, Mourtzi N, Charisis S, Mamalaki E, Ntanasi E, Hatzimanolis A, Ramirez A, Lambert JC, Yannakoulia M, Kosmidis MH, Dardiotis E, Hadjigeorgiou G, Sakka P, Scarmeas N. Genetic Predisposition for White Matter Hyperintensities and Risk of Mild Cognitive Impairment and Alzheimer's Disease: Results from the HELIAD Study. Curr Issues Mol Biol 2024; 46:934-947. [PMID: 38275674 PMCID: PMC10814944 DOI: 10.3390/cimb46010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/13/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
The present study investigated the association of genetic predisposition for white matter hyperintensities (WMHs) with incident amnestic mild cognitive impairment (aMCI) or Alzheimer's disease (AD), as well as whether such an association was influenced by age, sex, and cognitive reserve. Overall, 537 individuals without aMCI or dementia at baseline were included. Among them, 62 individuals developed aMCI/AD at follow up. Genetic propensity to WMH was estimated using a polygenic risk score for WMHs (PRS WMH). The association of PRS WMH with aMCI/AD incidence was examined using COX models. A higher PRS WMH was associated with a 47.2% higher aMCI/AD incidence (p = 0.015) in the fully adjusted model. Subgroup analyses showed significant results in the older age group, in which individuals with a higher genetic predisposition for WMHs had a 3.4-fold higher risk for developing aMCI/AD at follow up (p < 0.001), as well as in the lower cognitive reserve (CR, proxied by education years) group, in which individuals with a higher genetic predisposition for WMHs had an over 2-fold higher risk (p = 0.013). Genetic predisposition for WMHs was associated with aMCI/AD incidence, particularly in the group of participants with a low CR. Thus, CR might be a modifier in the relationship between genetic predisposition for WMHs and incident aMCI/AD.
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Affiliation(s)
- Stefanos N. Sampatakakis
- 1st Department of Neurology, Aiginition Hospital, Athens Medical School, National and Kapodistrian University, 11528 Athens, Greece; (S.N.S.); (N.M.); (E.M.); (E.N.)
| | - Niki Mourtzi
- 1st Department of Neurology, Aiginition Hospital, Athens Medical School, National and Kapodistrian University, 11528 Athens, Greece; (S.N.S.); (N.M.); (E.M.); (E.N.)
| | - Sokratis Charisis
- Department of Neurology, UT Health San Antonio, San Antonio, TX 78229, USA;
| | - Eirini Mamalaki
- 1st Department of Neurology, Aiginition Hospital, Athens Medical School, National and Kapodistrian University, 11528 Athens, Greece; (S.N.S.); (N.M.); (E.M.); (E.N.)
| | - Eva Ntanasi
- 1st Department of Neurology, Aiginition Hospital, Athens Medical School, National and Kapodistrian University, 11528 Athens, Greece; (S.N.S.); (N.M.); (E.M.); (E.N.)
| | - Alexandros Hatzimanolis
- Department of Psychiatry, Aiginition Hospital, Athens Medical School, National and Kapodistrian University, 11528 Athens, Greece;
| | - Alfredo Ramirez
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, 50923 Cologne, Germany
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE Bonn), 53127 Bonn, Germany
- Department of Psychiatry, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, San Antonio, TX 78229, USA
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50923 Cologne, Germany
| | - Jean-Charles Lambert
- Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE Facteurs de Risque et Déterminants Moléculaires des Maladies Liés au Vieillissement, University of Lille, 59000 Lille, France;
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece;
| | - Mary H. Kosmidis
- Lab of Neuropsychology and Behavioral Neuroscience, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece;
| | | | - Paraskevi Sakka
- Athens Association of Alzheimer’s Disease and Related Disorders, 11636 Marousi, Greece;
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, Athens Medical School, National and Kapodistrian University, 11528 Athens, Greece; (S.N.S.); (N.M.); (E.M.); (E.N.)
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10027, USA
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Jeong SH, Cha J, Jung JH, Yun M, Sohn YH, Chung SJ, Lee PH. Occipital Amyloid Deposition Is Associated with Rapid Cognitive Decline in the Alzheimer's Disease Continuum. J Alzheimers Dis 2023:JAD230187. [PMID: 37355901 DOI: 10.3233/jad-230187] [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: 06/26/2023]
Abstract
BACKGROUND Clinical significance of additional occipital amyloid-β (Aβ) plaques in Alzheimer's disease (AD) remains unclear. OBJECTIVE In this study, we investigated the effect of regional Aβ deposition on cognition in patients on the AD continuum, especially in the occipital region. METHODS We retrospectively reviewed the medical record of 208 patients with AD across the cognitive continuum (non-dementia and dementia). Multivariable linear regression analyses were performed to determine the effect of regional Aβ deposition on cognitive function. A linear mixed model was used to assess the effect of regional deposition on longitudinal changes in Mini-Mental State Examination (MMSE) scores. Additionally, the patients were dichotomized according to the occipital-to-global Aβ deposition ratio (ratio ≤1, Aβ-OCC- group; ratio >1, Aβ-OCC+ group), and the same statistical analyses were applied for between-group comparisons. RESULTS Regional Aβ burden itself was not associated with baseline cognitive function. In terms of Aβ-OCC group effect, the Aβ-OCC+ group exhibited a poorer cognitive performance on language function compared to the Aβ-OCC- group. High Aβ retention in each region was associated with a rapid decline in MMSE scores, only in the dementia subgroup. Additionally, Aβ-OCC+ individuals exhibited a faster annual decline in MMSE scores than Aβ-OCC- individuals in the non-dementia subgroup (β= -0.77, standard error [SE] = 0.31, p = 0.013). CONCLUSION The present study demonstrated that additional occipital Aβ deposition was associated with poor baseline language function and rapid cognitive deterioration in patients on the AD continuum.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Cha
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jin Ho Jung
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- YONSEI BEYOND LAB, Yongin, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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Kim YJ, Kim SE, Hahn A, Jang H, Kim JP, Kim HJ, Na DL, Chin J, Seo SW. Classification and prediction of cognitive trajectories of cognitively unimpaired individuals. Front Aging Neurosci 2023; 15:1122927. [PMID: 36993907 PMCID: PMC10040799 DOI: 10.3389/fnagi.2023.1122927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
Objectives Efforts to prevent Alzheimer's disease (AD) would benefit from identifying cognitively unimpaired (CU) individuals who are liable to progress to cognitive impairment. Therefore, we aimed to develop a model to predict cognitive decline among CU individuals in two independent cohorts. Methods A total of 407 CU individuals from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and 285 CU individuals from the Samsung Medical Center (SMC) were recruited in this study. We assessed cognitive outcomes by using neuropsychological composite scores in the ADNI and SMC cohorts. We performed latent growth mixture modeling and developed the predictive model. Results Growth mixture modeling identified 13.8 and 13.0% of CU individuals in the ADNI and SMC cohorts, respectively, as the "declining group." In the ADNI cohort, multivariable logistic regression modeling showed that increased amyloid-β (Aβ) uptake (β [SE]: 4.852 [0.862], p < 0.001), low baseline cognitive composite scores (β [SE]: -0.274 [0.070], p < 0.001), and reduced hippocampal volume (β [SE]: -0.952 [0.302], p = 0.002) were predictive of cognitive decline. In the SMC cohort, increased Aβ uptake (β [SE]: 2.007 [0.549], p < 0.001) and low baseline cognitive composite scores (β [SE]: -4.464 [0.758], p < 0.001) predicted cognitive decline. Finally, predictive models of cognitive decline showed good to excellent discrimination and calibration capabilities (C-statistic = 0.85 for the ADNI model and 0.94 for the SMC model). Conclusion Our study provides novel insights into the cognitive trajectories of CU individuals. Furthermore, the predictive model can facilitate the classification of CU individuals in future primary prevention trials.
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Affiliation(s)
- Young Ju Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Si Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Alice Hahn
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Center for Neuroimaging, Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Institute of Stem Cell and Regenerative Medicine, Seoul, Republic of Korea
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Juhee Chin
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Institute of Stem Cell and Regenerative Medicine, Seoul, Republic of Korea
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, Seoul, Republic of Korea
- Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
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The Seoul Neuropsychological Screening Battery (SNSB) for Comprehensive Neuropsychological Assessment. Dement Neurocogn Disord 2023; 22:1-15. [PMID: 36814700 PMCID: PMC9939572 DOI: 10.12779/dnd.2023.22.1.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 02/17/2023] Open
Abstract
The Seoul Neuropsychological Screening Battery (SNSB) is known as a representative comprehensive neuropsychological evaluation tool in Korea since its first standardization in 2003. It was the main neuropsychological evaluation tool in the Clinical Research Center for Dementia of South Korea, a large-scale multi-center cohort study in Korea that was started in 2005. Since then, it has been widely used by dementia clinicians, and further solidified its status as a representative dementia evaluation tool in Korea. Many research results related to the SNSB have been used as a basis for the diagnosis and evaluation of patients in various clinical settings, especially, in many areas of cognitive assessment, including dementia evaluation. The SNSB version that was updated in 2012 provides psychometrically improved norms and indicators through a model-based standardization procedure based on a theoretical probability distribution in the norm's development. By providing a score for each cognitive domain, it is easier to compare cognitive abilities between domains and to identify changes in cognitive domain functions over time. Through the development of the SNSB-Core, a short form composed of core tests, which also give a composite score was provided. The SNSB is a useful test battery that provides key information on the evaluation of early cognitive decline, analysis of cognitive decline patterns, judging the severity of dementia, and differential diagnosis of dementia. This review will provide a broad understanding of the SNSB by describing the test composition, contents of individual subtests, characteristics of standardization, analysis of the changed standard score, and related studies.
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Preclinical Alzheimer's dementia: a useful concept or another dead end? Eur J Ageing 2022; 19:997-1004. [PMID: 36692779 PMCID: PMC9729660 DOI: 10.1007/s10433-022-00735-w] [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] [Accepted: 10/10/2022] [Indexed: 02/01/2023] Open
Abstract
The term, preclinical dementia, was introduced in 2011 when new guidelines for the diagnosis of Alzheimer's dementia (AD) were published. In the intervening 11 years, many studies have appeared in the literature focusing on this early stage. A search conducted in English on Google Scholar on 06.23.2022 using the term "preclinical (Alzheimer's) dementia" produced 121, 000 results. However, the label is arguably more relevant for research purposes, and it is possible that the knowledge gained may lead to a cure for AD. The term has not been widely adopted by clinical practitioners. Furthermore, it is still not possible to predict who, after a diagnosis of preclinical dementia, will go on to develop AD, and if so, what the risk factors (modifiable and non-modifiable) might be. This Review/Theoretical article will focus on preclinical Alzheimer's dementia (hereafter called preclinical AD). We outline how preclinical AD is currently defined, explain how it is diagnosed and explore why this is problematic at a number of different levels. We also ask the question: Is the concept 'preclinical AD' useful in clinical practice or is it just another dead end in the Holy Grail to find a treatment for AD? Specific recommendations for research and clinical practice are provided.
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Jeong SH, Cha J, Park M, Jung JH, Ye BS, Sohn YH, Chung SJ, Lee PH. Association of Enlarged Perivascular Spaces With Amyloid Burden and Cognitive Decline in Alzheimer Disease Continuum. Neurology 2022; 99:e1791-e1802. [PMID: 35985826 DOI: 10.1212/wnl.0000000000200989] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 06/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the effects of enlarged perivascular space (EPVS) on amyloid burden and cognitive function in Alzheimer disease (AD) continuum. METHODS We retrospectively reviewed 208 patients with AD across the cognitive continuum (preclinical, prodromal, and AD dementia) who showed amyloid deposition on 18F-florbetaben PET scans and 82 healthy controls. EPVSs were counted for each patient in the basal ganglia (BG), centrum semiovale (CSO), and hippocampus (HP) on axial T2-weighted images. Patients were then classified according to the number of EPVSs into the EPVS+ (>10 EPVSs) and EPVS- (0-10 EPVSs) groups for the BG and CSO, respectively. In terms of HP-EPVS, equal or more than 7 EPVSs on bilateral hemisphere were regarded as the presence of HP-EPVS. After adjusting for markers of small vessel disease (SVD), multiple linear regression analyses were performed to determine the intergroup differences in global and regional amyloid deposition and cognitive function at the time of diagnosis of AD continuum. A linear mixed model was used to assess the effects of EPVSs on the longitudinal changes in the Mini-Mental State Examination (MMSE) scores. RESULTS Amyloid burden at the time of diagnosis of AD continuum was not associated with the degree of BG-, CSO-, or HP-EPVS. BG-EPVS affected language and frontal/executive function via SVD markers, and HP-EPVS was associated with general cognition via SVD markers. However, CSO-EPVS was not associated with baseline cognition. A higher number of CSO-EPVS was significantly associated with a more rapid decline in MMSE scores (β = -0.58, standard error = 0.23, p = 0.011) independent of the amyloid burden. In terms of BG and HP, there was no difference between the EPVS+ and EPVS- groups in the rate of longitudinal decreases in MMSE scores. DISCUSSION Our findings suggest that BG-, CSO-, and HP-EPVS are not associated with baseline β-amyloid burden or cognitive function independently of SVD at the diagnosis of AD continuum. However, CSO-EPVS appears to be associated with the progression of cognitive decline in an amyloid-independent manner. Further studies are needed to investigate whether CSO-EPVS is a potential therapeutic target in patients with AD continuum.
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Affiliation(s)
- Seong Ho Jeong
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Cha
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Mincheol Park
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Seok Ye
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea.
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9
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Yang J, Wang Z, Fu Y, Xu J, Zhang Y, Qin W, Zhang Q. Prediction value of the genetic risk of type 2 diabetes on the amnestic mild cognitive impairment conversion to Alzheimer’s disease. Front Aging Neurosci 2022; 14:964463. [PMID: 36185474 PMCID: PMC9521369 DOI: 10.3389/fnagi.2022.964463] [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: 06/09/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Amnestic mild cognitive impairment (aMCI) and Type 2 diabetes mellitus (T2DM) are both important risk factors for Alzheimer’s disease (AD). We aimed to investigate whether a T2DM-specific polygenic risk score (PRSsT2DM) can predict the conversion of aMCI to AD and further explore the underlying neurological mechanism. All aMCI patients were from the Alzheimer’s disease Neuroimaging Initiative (ADNI) database and were divided into conversion (aMCI-C, n = 164) and stable (aMCI-S, n = 222) groups. PRSsT2DM was calculated by PRSice-2 software to explore the predictive efficacy of the aMCI conversion to AD. We found that PRSsT2DM could independently predict the aMCI conversion to AD after removing the common variants of these two diseases. PRSsT2DM was significantly negatively correlated with gray matter volume (GMV) of the right superior frontal gyrus in the aMCI-C group. In all aMCI patients, PRSsT2DM was significantly negatively correlated with the cortical volume of the right superior occipital gyrus. The cortical volume of the right superior occipital gyrus could significantly mediate the association between PRSsT2DM and aMCI conversion. Gene-based analysis showed that T2DM-specific genes are highly expressed in cortical neurons and involved in ion and protein binding, neural development and generation, cell junction and projection, and PI3K-Akt and MAPK signaling pathway, which might increase the aMCI conversion by affecting the Tau phosphorylation and amyloid-beta (Aβ) accumulation. Therefore, the PRSsT2DM could be used as a measure to predict the conversion of aMCI to AD.
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10
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Chun MY, Park CJ, Kim J, Jeong JH, Jang H, Kim K, Seo SW. Prediction of conversion to dementia using interpretable machine learning in patients with amnestic mild cognitive impairment. Front Aging Neurosci 2022; 14:898940. [PMID: 35992586 PMCID: PMC9389270 DOI: 10.3389/fnagi.2022.898940] [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: 03/18/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Amnestic mild cognitive impairment (aMCI) is a transitional state between normal aging and Alzheimer’s disease (AD). However, not all aMCI patients are observed to convert to AD dementia. Therefore, developing a predictive algorithm for the conversion of aMCI to AD dementia is important. Parametric methods, such as logistic regression, have been developed; however, it is difficult to reflect complex patterns, such as non-linear relationships and interactions between variables. Therefore, this study aimed to improve the predictive power of aMCI patients’ conversion to dementia by using an interpretable machine learning (IML) algorithm and to identify the factors that increase the risk of individual conversion to dementia in each patient. Methods We prospectively recruited 705 patients with aMCI who had been followed-up for at least 3 years after undergoing baseline neuropsychological tests at the Samsung Medical Center between 2007 and 2019. We used neuropsychological tests and apolipoprotein E (APOE) genotype data to develop a predictive algorithm. The model-building and validation datasets were composed of data of 565 and 140 patients, respectively. For global interpretation, four algorithms (logistic regression, random forest, support vector machine, and extreme gradient boosting) were compared. For local interpretation, individual conditional expectations (ICE) and SHapley Additive exPlanations (SHAP) were used to analyze individual patients. Results Among the four algorithms, the extreme gradient boost model showed the best performance, with an area under the receiver operating characteristic curve of 0.852 and an accuracy of 0.807. Variables, such as age, education, the scores of visuospatial and memory domains, the sum of boxes of the Clinical Dementia Rating scale, Mini-Mental State Examination, and APOE genotype were important features for creating the algorithm. Through ICE and SHAP analyses, it was also possible to interpret which variables acted as strong factors for each patient. Conclusion We were able to propose a predictive algorithm for each aMCI individual’s conversion to dementia using the IML technique. This algorithm is expected to be useful in clinical practice and the research field, as it can suggest conversion with high accuracy and identify the degree of influence of risk factors for each patient.
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Affiliation(s)
- Min Young Chun
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chae Jung Park
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, South Korea
| | - Jonghyuk Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, South Korea
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
- *Correspondence: Kyunga Kim,
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, South Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, South Korea
- Sang Won Seo,
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11
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Predictive Scale for Amyloid PET Positivity Based on Clinical and MRI Variables in Patients with Amnestic Mild Cognitive Impairment. J Clin Med 2022; 11:jcm11123433. [PMID: 35743503 PMCID: PMC9224873 DOI: 10.3390/jcm11123433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/11/2022] [Accepted: 06/12/2022] [Indexed: 12/05/2022] Open
Abstract
The presence of amyloid-β (Aβ) deposition is considered important in patients with amnestic mild cognitive impairment (aMCI), since they can progress to Alzheimer’s disease dementia. Amyloid positron emission tomography (PET) has been used for detecting Aβ deposition, but its high cost is a significant barrier for clinical usage. Therefore, we aimed to develop a new predictive scale for amyloid PET positivity using easily accessible tools. Overall, 161 aMCI patients were recruited from six memory clinics and underwent neuropsychological tests, brain magnetic resonance imaging (MRI), apolipoprotein E (APOE) genotype testing, and amyloid PET. Among the potential predictors, verbal and visual memory tests, medial temporal lobe atrophy, APOE genotype, and age showed significant differences between the Aβ-positive and Aβ-negative groups and were combined to make a model for predicting amyloid PET positivity with the area under the curve (AUC) of 0.856. Based on the best model, we developed the new predictive scale comprising integers, which had an optimal cutoff score ≥ 3. The new predictive scale was validated in another cohort of 98 participants and showed a good performance with AUC of 0.835. This new predictive scale with accessible variables may be useful for predicting Aβ positivity in aMCI patients in clinical practice.
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12
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Penfold RB, Carrell DS, Cronkite DJ, Pabiniak C, Dodd T, Glass AM, Johnson E, Thompson E, Arrighi HM, Stang PE. Development of a machine learning model to predict mild cognitive impairment using natural language processing in the absence of screening. BMC Med Inform Decis Mak 2022; 22:129. [PMID: 35549702 PMCID: PMC9097352 DOI: 10.1186/s12911-022-01864-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients and their loved ones often report symptoms or complaints of cognitive decline that clinicians note in free clinical text, but no structured screening or diagnostic data are recorded. These symptoms/complaints may be signals that predict who will go on to be diagnosed with mild cognitive impairment (MCI) and ultimately develop Alzheimer's Disease or related dementias. Our objective was to develop a natural language processing system and prediction model for identification of MCI from clinical text in the absence of screening or other structured diagnostic information. METHODS There were two populations of patients: 1794 participants in the Adult Changes in Thought (ACT) study and 2391 patients in the general population of Kaiser Permanente Washington. All individuals had standardized cognitive assessment scores. We excluded patients with a diagnosis of Alzheimer's Disease, Dementia or use of donepezil. We manually annotated 10,391 clinic notes to train the NLP model. Standard Python code was used to extract phrases from notes and map each phrase to a cognitive functioning concept. Concepts derived from the NLP system were used to predict future MCI. The prediction model was trained on the ACT cohort and 60% of the general population cohort with 40% withheld for validation. We used a least absolute shrinkage and selection operator logistic regression approach (LASSO) to fit a prediction model with MCI as the prediction target. Using the predicted case status from the LASSO model and known MCI from standardized scores, we constructed receiver operating curves to measure model performance. RESULTS Chart abstraction identified 42 MCI concepts. Prediction model performance in the validation data set was modest with an area under the curve of 0.67. Setting the cutoff for correct classification at 0.60, the classifier yielded sensitivity of 1.7%, specificity of 99.7%, PPV of 70% and NPV of 70.5% in the validation cohort. DISCUSSION AND CONCLUSION Although the sensitivity of the machine learning model was poor, negative predictive value was high, an important characteristic of models used for population-based screening. While an AUC of 0.67 is generally considered moderate performance, it is also comparable to several tests that are widely used in clinical practice.
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Affiliation(s)
- Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA.
| | - David S Carrell
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - David J Cronkite
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Chester Pabiniak
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Tammy Dodd
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Ashley Mh Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Ella Thompson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | | | - Paul E Stang
- Janssen Research and Development, LLC, Raritan, USA
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13
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Chen Y, Qian X, Zhang Y, Su W, Huang Y, Wang X, Chen X, Zhao E, Han L, Ma Y. Prediction Models for Conversion From Mild Cognitive Impairment to Alzheimer’s Disease: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2022; 14:840386. [PMID: 35493941 PMCID: PMC9049273 DOI: 10.3389/fnagi.2022.840386] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeAlzheimer’s disease (AD) is a devastating neurodegenerative disorder with no cure, and available treatments are only able to postpone the progression of the disease. Mild cognitive impairment (MCI) is considered to be a transitional stage preceding AD. Therefore, prediction models for conversion from MCI to AD are desperately required. These will allow early treatment of patients with MCI before they develop AD. This study performed a systematic review and meta-analysis to summarize the reported risk prediction models and identify the most prevalent factors for conversion from MCI to AD.MethodsWe systematically reviewed the studies from the databases of PubMed, CINAHL Plus, Web of Science, Embase, and Cochrane Library, which were searched through September 2021. Two reviewers independently identified eligible articles and extracted the data. We used the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS) checklist for the risk of bias assessment.ResultsIn total, 18 articles describing the prediction models for conversion from MCI to AD were identified. The dementia conversion rate of elderly patients with MCI ranged from 14.49 to 87%. Models in 12 studies were developed using the data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). C-index/area under the receiver operating characteristic curve (AUC) of development models were 0.67–0.98, and the validation models were 0.62–0.96. MRI, apolipoprotein E genotype 4 (APOE4), older age, Mini-Mental State Examination (MMSE) score, and Alzheimer’s Disease Assessment Scale cognitive (ADAS-cog) score were the most common and strongest predictors included in the models.ConclusionIn this systematic review, many prediction models have been developed and have good predictive performance, but the lack of external validation of models limited the extensive application in the general population. In clinical practice, it is recommended that medical professionals adopt a comprehensive forecasting method rather than a single predictive factor to screen patients with a high risk of MCI. Future research should pay attention to the improvement, calibration, and validation of existing models while considering new variables, new methods, and differences in risk profiles across populations.
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Affiliation(s)
- Yanru Chen
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, China
| | - Xiaoling Qian
- Department of Neurology, Second Hospital of Lanzhou University, Lanzhou, China
| | - Yuanyuan Zhang
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, China
| | - Wenli Su
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yanan Huang
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, China
| | - Xinyu Wang
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, China
| | - Xiaoli Chen
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, China
| | - Enhan Zhao
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, China
| | - Lin Han
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, China
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, China
- *Correspondence: Yuxia Ma,
| | - Yuxia Ma
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, China
- First School of Clinical Medicine, Lanzhou University, Lanzhou, China
- *Correspondence: Yuxia Ma,
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14
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Jeong SH, Kim HR, Kim J, Kim H, Hong N, Jung JH, Baik K, Cho H, Lyoo CH, Ye BS, Sohn YH, Seong JK, Lee PH. Association of Dipeptidyl Peptidase-4 Inhibitor Use and Amyloid Burden in Diabetic Patients With AD-Related Cognitive Impairment. Neurology 2021; 97:e1110-e1122. [PMID: 34380754 DOI: 10.1212/wnl.0000000000012534] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 07/09/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate whether dipeptidyl peptidase-4 inhibitors (DPP-4i) have beneficial effects on amyloid aggregation and longitudinal cognitive outcome in diabetic Alzheimer's disease-related cognitive impairment (ADCI). METHODS We retrospectively reviewed 282 patients with ADCI who had positive scan of 18F-florbetaben amyloid PET images were classified into three groups according to a prior diagnosis of diabetes and DPP-4i use: diabetic patients being treated with (ADCI-DPP-4i+, n=70) or without DPP-4i (ADCI-DPP-4i-, n=71), and non-diabetic patients (n=141). Multiple linear regression analyses were performed to determine inter-group differences in global and regional amyloid retention using standardized uptake value ratios calculated from cortical areas. We assessed the longitudinal changes in Mini-Mental State Examination (MMSE) score using a linear mixed model. RESULTS The ADCI-DPP-4i+ group had lower global amyloid burden than the ADCI-DPP-4i- group (β = 0.075, SE = 0.024, p = 0.002) and the non-diabetic ADCI group (β = 0.054, SE = 0.021, p = 0.010) after adjusting for age, sex, education, cognitive status, and APOE ε4 carrier status. Additionally, the ADCI-DPP-4i+ group had lower regional amyloid burden in temporo-parietal areas than either the ADCI-DPP-4i- group or the non-diabetic ADCI group. The ADCI-DPP-4i+ group showed a slower longitudinal decrease in MMSE score (β = 0.772, SE = 0.272, p = 0.005) and memory recall sub-score (β = 0.291, SE = 0.116, p = 0.012) than the ADCI-DPP-4i- group. CONCLUSIONS These findings suggest that DPP-4i use is associated with low amyloid burden and favorable long-term cognitive outcome in diabetic patients with ADCI.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Hye Ryun Kim
- Global Health Technology Research Center, College of Health Science, Korea University, Seoul, South Korea
| | - Jeonghun Kim
- Medical & Health Device Division, Korea Testing Laboratory, Seoul, South Korea
| | - Hankyeol Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, Seoul, South Korea.,Department of Artificial Intelligence, Korea University, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea .,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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15
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Park M, Baik K, Lee YG, Kang SW, Jung JH, Jeong SH, Lee PH, Sohn YH, Ye BS. Implication of Small Vessel Disease MRI Markers in Alzheimer's Disease and Lewy Body Disease. J Alzheimers Dis 2021; 83:545-556. [PMID: 34366356 DOI: 10.3233/jad-210669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Small vessel disease (SVD) magnetic resonance imaging (MRI) markers including deep and periventricular white matter hyperintensities (PWMH), lacunes, and microbleeds are frequently observed in Alzheimer's disease (AD) and Lewy body disease (LBD), but their implication has not been clearly elucidated. OBJECTIVE To investigate the implication of SVD MRI markers in cognitively impaired patients with AD and/or LBD. METHODS We consecutively recruited 57 patients with pure AD-related cognitive impairment (ADCI), 49 with pure LBD-related cognitive impairment (LBCI), 45 with mixed ADCI/LBCI, and 34 controls. All participants underwent neuropsychological tests, brain MRI, and amyloid positron emission tomography. SVD MRI markers including the severity of deep and PWMH and the number of lacunes and microbleeds were visually rated. The relationships among vascular risk factors, SVD MRI markers, ADCI, LBCI, and cognitive scores were investigated after controlling for appropriate covariates. RESULTS LBCI was associated with more severe PWMH, which was conversely associated with an increased risk of LBCI independently of vascular risk factors and ADCI. PWMH was associated with attention and visuospatial dysfunction independently of vascular risk factors, ADCI, and LBCI. Both ADCI and LBCI were associated with more lobar microbleeds, but not with deep microbleeds. CONCLUSION Our findings suggest that PWMH could reflect degenerative process related with LBD, and both AD and LBD independently increase lobar microbleeds.
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Affiliation(s)
- Mincheol Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Gun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Woo Kang
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
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16
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Chen W, Li S, Ma Y, Lv S, Wu F, Du J, Wu H, Wang S, Zhao Q. A simple nomogram prediction model to identify relatively young patients with mild cognitive impairment who may progress to Alzheimer's disease. J Clin Neurosci 2021; 91:62-68. [PMID: 34373060 DOI: 10.1016/j.jocn.2021.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/16/2021] [Accepted: 06/14/2021] [Indexed: 12/25/2022]
Abstract
AIM Construct a clinical predictive model based on easily accessible clinical features and imaging data to identify patients 65 years of age and younger with mild cognitive impairment(MCI) who may progress to Alzheimer's disease(AD). METHODS From the ADNI database, patients with MCI who were less than or equal to 65 years of age and who had been followed for 6-60 months were selected.We collected demographic data, neuropsychological test scale scores, and structural magnetic images of these patients. Clinical characteristics were then screened, and VBM and SBM analyses were performed using structural nuclear magnetic images to obtain imaging histology characteristics. Finally, predictive models were constructed combining the clinical and imaging histology characteristics. RESULTS The constructed nomogram has a cross-validated AUC of 0.872 in the training set and 0.867 in the verification set, and the calibration curve fits well.We also provide an online model-based forecasting tool. CONCLUSION The model has good performance and uses convenience,it should be able to provide assistance in clinical work to screen relatively young MCI patients who may progress to AD.
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Affiliation(s)
- Wenhong Chen
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Songtao Li
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yangyang Ma
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shuyue Lv
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Fan Wu
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jianshi Du
- Department of Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Honglin Wu
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shuai Wang
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qing Zhao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China.
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17
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Silva D, Cardoso S, Guerreiro M, Maroco J, Mendes T, Alves L, Nogueira J, Baldeiras I, Santana I, de Mendonça A. Neuropsychological Contribution to Predict Conversion to Dementia in Patients with Mild Cognitive Impairment Due to Alzheimer's Disease. J Alzheimers Dis 2021; 74:785-796. [PMID: 32083585 DOI: 10.3233/jad-191133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diagnosis of Alzheimer's disease (AD) confirmed by biomarkers allows the patient to make important life decisions. However, doubt about the fleetness of symptoms progression and future cognitive decline remains. Neuropsychological measures were extensively studied in prediction of time to conversion to dementia for mild cognitive impairment (MCI) patients in the absence of biomarker information. Similar neuropsychological measures might also be useful to predict the progression to dementia in patients with MCI due to AD. OBJECTIVE To study the contribution of neuropsychological measures to predict time to conversion to dementia in patients with MCI due to AD. METHODS Patients with MCI due to AD were enrolled from a clinical cohort and the effect of neuropsychological performance on time to conversion to dementia was analyzed. RESULTS At baseline, converters scored lower than non-converters at measures of verbal initiative, non-verbal reasoning, and episodic memory. The test of non-verbal reasoning was the only statistically significant predictor in a multivariate Cox regression model. A decrease of one standard deviation was associated with 29% of increase in the risk of conversion to dementia. Approximately 50% of patients with more than one standard deviation below the mean in the z score of that test had converted to dementia after 3 years of follow-up. CONCLUSION In MCI due to AD, lower performance in a test of non-verbal reasoning was associated with time to conversion to dementia. This test, that reveals little decline in the earlier phases of AD, appears to convey important information concerning conversion to dementia.
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Affiliation(s)
- Dina Silva
- Cognitive Neuroscience Research Group, Department of Psychology and Educational Sciences and Centre for Biomedical Research (CBMR), Universidade do Algarve, Faro, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Sandra Cardoso
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | - João Maroco
- Instituto Superior de Psicologia Aplicada, Lisbon, Portugal
| | - Tiago Mendes
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Psychiatry and Mental Health Department, Santa Maria Hospital, Lisbon, Portugal
| | - Luísa Alves
- Chronic Diseases Research Centre, NOVA Medical School, NOVA University of Lisbon, Portugal
| | - Joana Nogueira
- Department of Neurology, Dementia Clinic, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Inês Baldeiras
- Department of Neurology, Laboratory of Neurochemistry, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Isabel Santana
- Department of Neurology, Dementia Clinic, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Department of Neurology, Laboratory of Neurochemistry, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
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18
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Yang SY, Liu HC, Chen WP. Immunomagnetic Reduction Detects Plasma Aβ 1-42 Levels as a Potential Dominant Indicator Predicting Cognitive Decline. Neurol Ther 2020; 9:435-442. [PMID: 33090326 PMCID: PMC7606390 DOI: 10.1007/s40120-020-00215-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/23/2020] [Indexed: 11/03/2022] Open
Abstract
Although the concentrations of Alzheimer’s disease (AD) biomarkers Aβ1–40, Aβ1–42 and tau protein are very low in human plasma, ultrasensitive assays such as immunomagnetic reduction (IMR) are able to precisely quantify them. Review articles have described the detailed working mechanism of IMR and revealed the feasibility of detecting early-stage AD by assaying these plasma biomarkers with IMR. In this review, we aimed to compare the significance of these plasma biomarkers in predicting cognitive decline in patients with Down syndrome, stroke, or amnestic mild cognitive impairment based on findings in the literature. We found that plasma Aβ1–42 might play the predominant role in predicting cognitive decline in these patients.
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Affiliation(s)
- Shieh-Yueh Yang
- MagQu Co., Ltd., New Taipei City, 231, Taiwan. .,MagQu LLC, Surprise, AZ, 85378, USA.
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19
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Boomsma JM, Exalto LG, Barkhof F, Chen CL, Hilal S, Leeuwis AE, Prins ND, Saridin FN, Scheltens P, Teunissen CE, Verwer JH, Weinstein HC, van der Flier WM, Biessels GJ. Prediction of poor clinical outcome in vascular cognitive impairment: TRACE-VCI study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12077. [PMID: 32789162 PMCID: PMC7416669 DOI: 10.1002/dad2.12077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Prognostication in memory clinic patients with vascular brain injury (eg possible vascular cognitive impairment [VCI]) is often uncertain. We created a risk score to predict poor clinical outcome. METHODS Using data from two longitudinal cohorts of memory clinic patients with vascular brain injury without advanced dementia, we created (n = 707) and validated (n = 235) the risk score. Poor clinical outcome was defined as substantial cognitive decline (change of Clinical Dementia Rating ≥1 or institutionalization) or major vascular events or death. Twenty-four candidate predictors were evaluated using Cox proportional hazard models. RESULTS Age, clinical syndrome diagnosis, Disability Assessment for Dementia, Neuropsychiatric Inventory, and medial temporal lobe atrophy most strongly predicted poor outcome and constituted the risk score (C-statistic 0.71; validation cohort 0.78). Of note, none of the vascular predictors were retained in this model. The 2-year risk of poor outcome was 6.5% for the lowest (0-5) and 55.4% for the highest sum scores (10-13). DISCUSSION This is the first, validated, prediction score for 2-year clinical outcome of patients with possible VCI.
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Affiliation(s)
- Jooske M.F. Boomsma
- Department of Neurology and NeurosurgeryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversiteitUtrechtthe Netherlands
- Department of NeurologyOLVG WestAmsterdamthe Netherlands
| | - Lieza G. Exalto
- Department of Neurology and NeurosurgeryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversiteitUtrechtthe Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear MedicineVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Institute of NeurologyUCLLondonUK
- Institute of Healthcare EngineeringUCLLondonUK
| | - Christopher L.H. Chen
- Department of PharmacologyNational University of SingaporeSingapore
- Memory Aging and Cognition CenterNational University Health SystemSingapore
| | - Saima Hilal
- Department of PharmacologyNational University of SingaporeSingapore
- Memory Aging and Cognition CenterNational University Health SystemSingapore
| | - Anna E. Leeuwis
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Niels D. Prins
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Francis N. Saridin
- Department of PharmacologyNational University of SingaporeSingapore
- Memory Aging and Cognition CenterNational University Health SystemSingapore
| | - Philip Scheltens
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry LaboratoryDepartment of Clinical ChemistryAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Jurre H. Verwer
- Department of Neurology and NeurosurgeryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversiteitUtrechtthe Netherlands
| | | | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of EpidemiologyVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Geert Jan Biessels
- Department of Neurology and NeurosurgeryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversiteitUtrechtthe Netherlands
| | - the TRACE‐VCI study group
- Department of Neurology and NeurosurgeryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversiteitUtrechtthe Netherlands
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20
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Canevelli M, Bacigalupo I, Gervasi G, Lacorte E, Massari M, Mayer F, Vanacore N, Cesari M. Methodological Issues in the Clinical Validation of Biomarkers for Alzheimer's Disease: The Paradigmatic Example of CSF. Front Aging Neurosci 2019; 11:282. [PMID: 31680936 PMCID: PMC6812267 DOI: 10.3389/fnagi.2019.00282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/02/2019] [Indexed: 01/06/2023] Open
Abstract
The use of biomarkers is profoundly transforming medical research and practice. Their adoption has triggered major advancements in the field of Alzheimer’s disease (AD) over the past years. For instance, the analysis of the cerebrospinal fluid (CSF) and neuroimaging changes indicative of neuronal loss and amyloid deposition has led to the understanding that AD is characterized by a long preclinical phase. It is also supporting the transition towards a biology-grounded framework and definition of the disease. Nevertheless, though sufficient evidence exists about the analytical validity (i.e., accuracy, reliability, and reproducibility) of the candidate AD biomarkers, their clinical validity (i.e., how well the test measures the clinical features, and the disease or treatment outcomes) and clinical utility (i.e., if and how the test improves the patient’s outcomes, confirms/changes the diagnosis, identifies at-risk individuals, influences therapeutic choices) have not been fully proven. In the present review, some of the methodological issues and challenges that should be addressed in order to better appreciate the potential benefits and limitations of AD biomarkers are discussed. The ultimate goal is to stimulate a constructive discussion aimed at filling the existing gaps and more precisely defining the directions of future research. Specifically, four main aspects of the clinical validation process are addressed and applied to the most relevant CSF biomarkers: (1) the definition of reference values; (2) the identification of reference standards for the disease of interest (i.e., AD); (3) the inclusion within the diagnostic process; and (4) the statistical process supporting the whole framework.
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Affiliation(s)
- Marco Canevelli
- Department of Human Neuroscience, Sapienza University, Rome, Italy.,National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Ilaria Bacigalupo
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Giuseppe Gervasi
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Eleonora Lacorte
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Marco Massari
- National Center for Drug Research and Evaluation, National Institute of Health, Rome, Italy
| | - Flavia Mayer
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Geriatric Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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21
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Prediction of fast decline in amyloid positive mild cognitive impairment patients using multimodal biomarkers. NEUROIMAGE-CLINICAL 2019; 24:101941. [PMID: 31376643 PMCID: PMC6677900 DOI: 10.1016/j.nicl.2019.101941] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 07/14/2019] [Accepted: 07/17/2019] [Indexed: 11/22/2022]
Abstract
It may be possible to classify patients with Aβ positive (+) mild cognitive impairment (MCI) into fast and slow decliners according to their biomarker status. In this study, we aimed to develop a risk prediction model to predict fast decline in the Aβ+ MCI population using multimodal biomarkers. We included 186 Aβ+ MCI patients who underwent florbetapir PET, brain MRI, cerebrospinal fluid (CSF) analyses, and FDG PET at baseline. We defined conversion to dementia within 3 years (= fast decline) as the outcome. The associations of potential covariates (MCI stage, APOE4 genotype, corrected hippocampal volume (HV), FDG PET SUVR, AV45 PET SUVR, CSF Aβ, total tau (t-tau), and phosphorylated tau (p-tau)) with the outcome were tested and nomograms were constructed using logistic regression models in the training dataset (n=124, n of fast decliners=52). The model was internally validated with the testing dataset (n=62, n of fast decliners=22). The multivariable analysis (including CSF t-tau) showed that MCI stage (late MCI vs. early MCI; OR 15.88, 95% CI 4.59, 54.88), APOE4 (OR 5.65, 95% CI 1.52, 20.98), corrected HV*1000 (OR 0.22, 95% CI 0.09, 0.57), FDG SUVR*10 (OR 0.43, 95% CI 0.27, 0.71), and loge CSF t-tau (OR 6.20, 95% CI 1.48, 25.96) were associated with being fast decliners. In the second model including CSF p-tau instead of t-tau, the above associations remained the same, with a significant association between loge CSF p-tau (OR 4.53, 95% CI 1.26, 16.31) and fast decline. The constructed nomograms showed excellent predictive performance (90%) on validation with the testing dataset. Among Aβ+ MCI patients, our findings suggested that multimodal AD biomarkers are significantly associated with being classified as fast decliners. A nomogram incorporating these biomarkers might be useful in early treatment decisions or stratified enrollment of this population into clinical trials. About 40% of Aβ+ MCI patients progressed to dementia within 3 years (fast decliner). Neurodegeneration markers were predictive of fast decline in Aβ+ MCI patients. Presence of APOE4 and late MCI stage were predictive of fast decline in Aβ+ MCI patients. The fast decliner prediction model shows an excellent predictive performance.
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22
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Kim YJ, Cho SK, Kim HJ, Lee JS, Lee J, Jang YK, Vogel JW, Na DL, Kim C, Seo SW. Data-driven prognostic features of cognitive trajectories in patients with amnestic mild cognitive impairments. ALZHEIMERS RESEARCH & THERAPY 2019; 11:10. [PMID: 30670089 PMCID: PMC6343354 DOI: 10.1186/s13195-018-0462-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although amnestic mild cognitive impairment (aMCI) is generally considered to be a prodromal stage of Alzheimer's disease, patients with aMCI show heterogeneous patterns of progression. Moreover, there are few studies investigating data-driven cognitive trajectory in aMCI. We therefore classified patients with aMCI based on their cognitive trajectory, measured by clinical dementia rating sum of boxes (CDR-SOB). Then, we compared the clinical and neuroimaging features among groups classified by cognitive trajectory. METHODS We retrospectively recruited 278 patients with aMCI who underwent three or more timepoints of neuropsychological testing. They also had magnetic resonance imaging (MRI) including structured three-dimensional volume images. Cortical thickness was measured using surface-based methods. We performed trajectory analyses to classify our aMCI patients according to their progression and investigate their cognitive trajectory using CDR-SOB. RESULTS Trajectory analyses showed that patients with aMCI were divided into three groups: stable (61.8%), slow decliner (31.7%), and fast decliner (6.5%). Changes throughout a mean follow-up duration of 3.7 years in the CDR-SOB for the subgroups of stable/slow/fast decliners were 1.3-, 6.4-, and 12-point increases, respectively. Decliners were older and carried apolipoprotein E4 (APOE4) genotypes more frequently than stable patients. Compared with the stable group, decliners showed a higher frequency of aMCI patients with both visual and verbal memory dysfunction, late stage aMCI, and multiple domain dysfunction. In addition, compared with the stable group, the slow decliners showed cortical thinning predominantly in bilateral parietotemporal areas, while the fast decliners showed cortical thinning predominantly in bilateral frontotemporal areas. Both decliner groups showed worse cognitive function in attention, language, visuospatial, memory, and frontal/executive domains than the stable group. CONCLUSIONS Our data-driven trajectory analysis provides new insights into heterogeneous cognitive trajectories of aMCI and further suggests that baseline clinical and neuroimaging profiles might predict aMCI patients with poor prognosis.
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Affiliation(s)
- Yeo Jin Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.,Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Seong-Kyoung Cho
- Institute of Human Complexity and Systems Science, Yonsei University, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jin San Lee
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Juyoun Lee
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Young Kyoung Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jacob W Vogel
- Montreal Neurological Institute, McGill University, Montrèal, Quebec, Canada
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Changsoo Kim
- Institute of Human Complexity and Systems Science, Yonsei University, Seoul, Korea. .,Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Republic of Korea. .,Neuroscience Center, Samsung Medical Center, Seoul, Korea. .,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.
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23
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Kim JP, Jang HM, Kim HJ, Na DL, Seo SW. Neuropsychological test-based risk prediction of conversion to dementia in amnestic mild cognitive impairment patients: a personal view. PRECISION AND FUTURE MEDICINE 2018. [DOI: 10.23838/pfm.2018.00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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