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Dominke C, Fischer AM, Grimmer T, Diehl-Schmid J, Jahn T. CERAD-NAB and flexible battery based neuropsychological differentiation of Alzheimer's dementia and depression using machine learning approaches. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2024; 31:221-248. [PMID: 36320158 DOI: 10.1080/13825585.2022.2138255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Depression (DEP) and dementia of the Alzheimer's type (DAT) represent the most common neuropsychiatric disorders in elderly patients. Accurate differential diagnosis is indispensable to ensure appropriate treatment. However, DEP can yet mimic cognitive symptoms of DAT and patients with DAT often also present with depressive symptoms, impeding correct diagnosis. Machine learning (ML) approaches could eventually improve this discrimination using neuropsychological test data, but evidence is still missing. We therefore employed Support Vector Machine (SVM), Naïve Bayes (NB), Random Forest (RF) and conventional Logistic Regression (LR) to retrospectively predict the diagnoses of 189 elderly patients (68 DEP and 121 DAT) based on either the well-established Consortium to Establish a Registry for Alzheimer's Disease neuropsychological assessment battery (CERAD-NAB) or a flexible battery approach (FLEXBAT). The best performing combination consisted of FLEXBAT and NB, correctly classifying 87.0% of patients as either DAT or DEP. However, all accuracies were similar across algorithms and test batteries (83.0% - 87.0%). Accordingly, our study is the first to show that common ML algorithms with their default parameters can accurately differentiate between patients clinically diagnosed with DAT or DEP using neuropsychological test data, but do not necessarily outperform conventional LR.
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Affiliation(s)
- Clara Dominke
- Division Clinical Neuropsychology, Department of Psychology, Ludwig-Maximilians-University, Munich, Germany
| | - Alina Maria Fischer
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Timo Grimmer
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Janine Diehl-Schmid
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
- Centre for Geriatric Medicine, Kbo-Inn-Salzach-Klinikum, Wasserburg am Inn, Germany
| | - Thomas Jahn
- Division Clinical Neuropsychology, Department of Psychology, Ludwig-Maximilians-University, Munich, Germany
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
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Wang Z, Lewis V, Stehmann C, Varghese S, Senesi M, McGlade A, Ellett LJ, Doecke JD, Eratne D, Velakoulis D, Masters CL, Collins SJ, Li Q. Alzheimer's disease biomarker utilization at first referral enhances differential diagnostic precision with simultaneous exclusion of Creutzfeldt-Jakob disease. Alzheimers Dement (Amst) 2024; 16:e12548. [PMID: 38352040 PMCID: PMC10862167 DOI: 10.1002/dad2.12548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
Abstract
Most suspected Creutzfeldt-Jakob disease (CJD) cases are eventually diagnosed with other disorders. We assessed the utility of investigating Alzheimer's disease (AD) biomarkers and neurofilament light (NfL) in patients when CJD is suspected. The study cohort consisted of cerebrospinal fluid (CSF) samples referred for CJD biomarker screening wherein amyloid beta 1-42 (Aβ1-42), phosphorylated tau 181 (p-tau181), and total tau (t-tau) could be assessed via Elecsys immunoassays (n = 419) and NfL via enzyme-linked immunosorbent assay (ELISA; n = 161). In the non-CJD sub cohort (n = 371), 59% (219/371) had A+T- (abnormal Aβ1-42 only) and 21% (79/371) returned A+T+ (abnormal Aβ1-42 and p-tau181). In the 48 CJD subjects, a similar AD biomarker profile distribution was observed. To partially address the prevalence of likely pre-symptomatic AD, NfL was utilized to assess for neuronal damage. NfL was abnormal in 76% (25/33) of A+T- subjects 40 to 69 years of age, 80% (20/25) of whom had normal t-tau. This study reinforces AD as an important differential diagnosis of suspected CJD, highlighting that incorporating AD biomarkers and NfL at initial testing is worthwhile.
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Affiliation(s)
- Zitianyu Wang
- National Dementia Diagnostics Laboratory (NDDL), The Florey InstituteThe University of MelbourneParkvilleAustralia
- Australian National Creutzfeldt‐Jakob Disease Registry (ANCJDR), The Florey InstituteThe University of MelbourneParkvilleAustralia
| | - Victoria Lewis
- Australian National Creutzfeldt‐Jakob Disease Registry (ANCJDR), The Florey InstituteThe University of MelbourneParkvilleAustralia
- Department of Medicine, Clinical Sciences Building, Royal Melbourne Hospital (RMH)The University of MelbourneParkvilleAustralia
| | - Christiane Stehmann
- Australian National Creutzfeldt‐Jakob Disease Registry (ANCJDR), The Florey InstituteThe University of MelbourneParkvilleAustralia
| | - Shiji Varghese
- National Dementia Diagnostics Laboratory (NDDL), The Florey InstituteThe University of MelbourneParkvilleAustralia
| | - Matteo Senesi
- Australian National Creutzfeldt‐Jakob Disease Registry (ANCJDR), The Florey InstituteThe University of MelbourneParkvilleAustralia
- Department of Medicine, Clinical Sciences Building, Royal Melbourne Hospital (RMH)The University of MelbourneParkvilleAustralia
| | - Amelia McGlade
- Australian National Creutzfeldt‐Jakob Disease Registry (ANCJDR), The Florey InstituteThe University of MelbourneParkvilleAustralia
| | - Laura J. Ellett
- Australian National Creutzfeldt‐Jakob Disease Registry (ANCJDR), The Florey InstituteThe University of MelbourneParkvilleAustralia
| | | | - Dhamidhu Eratne
- National Dementia Diagnostics Laboratory (NDDL), The Florey InstituteThe University of MelbourneParkvilleAustralia
- Neuropsychiatry, John Cade BuildingRoyal Melbourne HospitalParkvilleAustralia
| | - Dennis Velakoulis
- Neuropsychiatry, John Cade BuildingRoyal Melbourne HospitalParkvilleAustralia
| | - Colin L. Masters
- National Dementia Diagnostics Laboratory (NDDL), The Florey InstituteThe University of MelbourneParkvilleAustralia
- Australian National Creutzfeldt‐Jakob Disease Registry (ANCJDR), The Florey InstituteThe University of MelbourneParkvilleAustralia
| | - Steven J. Collins
- National Dementia Diagnostics Laboratory (NDDL), The Florey InstituteThe University of MelbourneParkvilleAustralia
- Australian National Creutzfeldt‐Jakob Disease Registry (ANCJDR), The Florey InstituteThe University of MelbourneParkvilleAustralia
- Department of Medicine, Clinical Sciences Building, Royal Melbourne Hospital (RMH)The University of MelbourneParkvilleAustralia
| | - Qiao‐Xin Li
- National Dementia Diagnostics Laboratory (NDDL), The Florey InstituteThe University of MelbourneParkvilleAustralia
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Panzavolta A, Cerami C, Marcone A, Zamboni M, Iannaccone S, Dodich A. Diagnostic Performance of Socio-Emotional Informant-Based Questionnaires for the Clinical Detection of the Behavioral Variant of Frontotemporal Dementia. J Alzheimers Dis 2024; 97:1249-1260. [PMID: 38277289 DOI: 10.3233/jad-230591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Although social cognitive dysfunction is a major feature of the behavioral variant of frontotemporal dementia (bvFTD), quantitative measurement of social behavior changes is poorly available in clinical settings. OBJECTIVE The aim of the study is to evaluate diagnostic accuracy of social-emotional questionnaires in distinguishing bvFTD from healthy control (HC) subjects and Alzheimer's disease (AD) patients. METHODS We enrolled 29 bvFTD, 24 AD, and 18 HC subjects matched for age, sex, and education. Two informant-based measures of socio-emotional sensitivity and empathy (i.e., revised Self-Monitoring Scale (rSMS) and Interpersonal Reactivity Index (IRI)) were administered. One-way ANOVA was performed to compare groups, whereas Receiver Operating Characteristics (ROC) curve analysis tested questionnaire ability in distinguishing groups. A short version of IRI (sIRI) was obtained by excluding the non-contributing subscale (i.e., personal distress). RESULTS Compared to HC and AD, bvFTD showed significantly lower scores in rSMS and IRI scores, except for IRI personal distress subscale. The sIRI showed an excellent performance in early diagnosis (bvFTD versus HC = AUC 0.95). Both sIRI and rSMS showed good performance in distinguishing bvFTD from AD (AUC 0.83). CONCLUSIONS ROC analyses support the usefulness of informant social questionnaires in memory clinics and their potential value in screening procedures for research eligibility in forthcoming trials. In the timely diagnosis of bvFTD patients, IRI and rSMS may supply crucial information for the early detection of signs and symptoms affecting social-emotional skills, which might otherwise be underrecognized.
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Affiliation(s)
- Andrea Panzavolta
- IUSS Cognitive Neuroscience ICoN Center, Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
| | - Chiara Cerami
- IUSS Cognitive Neuroscience ICoN Center, Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Alessandra Marcone
- Department of Rehabilitation and Functional Recovery, San Raffaele Hospital, Milan, Italy
| | - Michele Zamboni
- Department of Rehabilitation and Functional Recovery, San Raffaele Hospital, Milan, Italy
| | - Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, San Raffaele Hospital, Milan, Italy
| | - Alessandra Dodich
- Center for Neurocognitive Rehabilitation - CIMeC, University of Trento, Rovereto (TN), Italy
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Borchert RJ, Azevedo T, Badhwar A, Bernal J, Betts M, Bruffaerts R, Burkhart MC, Dewachter I, Gellersen HM, Low A, Lourida I, Machado L, Madan CR, Malpetti M, Mejia J, Michopoulou S, Muñoz-Neira C, Pepys J, Peres M, Phillips V, Ramanan S, Tamburin S, Tantiangco HM, Thakur L, Tomassini A, Vipin A, Tang E, Newby D, Ranson JM, Llewellyn DJ, Veldsman M, Rittman T. Artificial intelligence for diagnostic and prognostic neuroimaging in dementia: A systematic review. Alzheimers Dement 2023; 19:5885-5904. [PMID: 37563912 DOI: 10.1002/alz.13412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Artificial intelligence (AI) and neuroimaging offer new opportunities for diagnosis and prognosis of dementia. METHODS We systematically reviewed studies reporting AI for neuroimaging in diagnosis and/or prognosis of cognitive neurodegenerative diseases. RESULTS A total of 255 studies were identified. Most studies relied on the Alzheimer's Disease Neuroimaging Initiative dataset. Algorithmic classifiers were the most commonly used AI method (48%) and discriminative models performed best for differentiating Alzheimer's disease from controls. The accuracy of algorithms varied with the patient cohort, imaging modalities, and stratifiers used. Few studies performed validation in an independent cohort. DISCUSSION The literature has several methodological limitations including lack of sufficient algorithm development descriptions and standard definitions. We make recommendations to improve model validation including addressing key clinical questions, providing sufficient description of AI methods and validating findings in independent datasets. Collaborative approaches between experts in AI and medicine will help achieve the promising potential of AI tools in practice. HIGHLIGHTS There has been a rapid expansion in the use of machine learning for diagnosis and prognosis in neurodegenerative disease Most studies (71%) relied on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset with no other individual dataset used more than five times There has been a recent rise in the use of more complex discriminative models (e.g., neural networks) that performed better than other classifiers for classification of AD vs healthy controls We make recommendations to address methodological considerations, addressing key clinical questions, and validation We also make recommendations for the field more broadly to standardize outcome measures, address gaps in the literature, and monitor sources of bias.
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Affiliation(s)
- Robin J Borchert
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Tiago Azevedo
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - AmanPreet Badhwar
- Department of Pharmacology and Physiology, University of Montreal, Montreal, Canada
- Centre de recherche de l'Institut Universitaire de Gériatrie (CRIUGM), Montreal, Canada
| | - Jose Bernal
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Matthew Betts
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences, University of Magdeburg, Magdeburg, Germany
| | - Rose Bruffaerts
- Computational Neurology, Experimental Neurobiology Unit, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Ilse Dewachter
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Helena M Gellersen
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Audrey Low
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Luiza Machado
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Jhony Mejia
- Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Sofia Michopoulou
- Imaging Physics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carlos Muñoz-Neira
- Research into Memory, Brain sciences and dementia Group (ReMemBr Group), Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Artificial Intelligence & Computational Neuroscience Group (AICN Group), Sheffield Institute for Translational Neuroscience (SITraN), Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Jack Pepys
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Marion Peres
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Siddharth Ramanan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Lokendra Thakur
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, UK
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Tomassini
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | | | - Eugene Tang
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Danielle Newby
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - David J Llewellyn
- University of Exeter Medical School, Exeter, UK
- Alan Turing Institute, London, UK
| | - Michele Veldsman
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Sokolovič L, Hofmann MJ, Mohammad N, Kukolja J. Neuropsychological differential diagnosis of Alzheimer's disease and vascular dementia: a systematic review with meta-regressions. Front Aging Neurosci 2023; 15:1267434. [PMID: 38020767 PMCID: PMC10657839 DOI: 10.3389/fnagi.2023.1267434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Diagnostic classification systems and guidelines posit distinguishing patterns of impairment in Alzheimer's (AD) and vascular dementia (VaD). In our study, we aim to identify which diagnostic instruments distinguish them. Methods We searched PubMed and PsychInfo for empirical studies published until December 2020, which investigated differences in cognitive, behavioral, psychiatric, and functional measures in patients older than 64 years and reported information on VaD subtype, age, education, dementia severity, and proportion of women. We systematically reviewed these studies and conducted Bayesian hierarchical meta-regressions to quantify the evidence for differences using the Bayes factor (BF). The risk of bias was assessed using the Newcastle-Ottawa-Scale and funnel plots. Results We identified 122 studies with 17,850 AD and 5,247 VaD patients. Methodological limitations of the included studies are low comparability of patient groups and an untransparent patient selection process. In the digit span backward task, AD patients were nine times more probable (BF = 9.38) to outperform VaD patients (β g = 0.33, 95% ETI = 0.12, 0.52). In the phonemic fluency task, AD patients outperformed subcortical VaD (sVaD) patients (β g = 0.51, 95% ETI = 0.22, 0.77, BF = 42.36). VaD patients, in contrast, outperformed AD patients in verbal (β g = -0.61, 95% ETI = -0.97, -0.26, BF = 22.71) and visual (β g = -0.85, 95% ETI = -1.29, -0.32, BF = 13.67) delayed recall. We found the greatest difference in verbal memory, showing that sVaD patients outperform AD patients (β g = -0.64, 95% ETI = -0.88, -0.36, BF = 72.97). Finally, AD patients performed worse than sVaD patients in recognition memory tasks (β g = -0.76, 95% ETI = -1.26, -0.26, BF = 11.50). Conclusion Our findings show inferior performance of AD in episodic memory and superior performance in working memory. We found little support for other differences proposed by diagnostic systems and diagnostic guidelines. The utility of cognitive, behavioral, psychiatric, and functional measures in differential diagnosis is limited and should be complemented by other information. Finally, we identify research areas and avenues, which could significantly improve the diagnostic value of cognitive measures.
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Affiliation(s)
- Leo Sokolovič
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
- Department of General and Biological Psychology, University of Wuppertal, Wuppertal, Germany
| | - Markus J. Hofmann
- Department of General and Biological Psychology, University of Wuppertal, Wuppertal, Germany
| | - Nadia Mohammad
- Department of General and Biological Psychology, University of Wuppertal, Wuppertal, Germany
| | - Juraj Kukolja
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
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van Gils AM, van de Beek M, van Unnik AAJM, Tolonen A, Handgraaf D, van Leeuwenstijn M, Lötjönen J, van der Flier WM, Lemstra A, Rhodius‐Meester HFM. Optimizing cCOG, a Web-based tool, to detect dementia with Lewy Bodies. Alzheimers Dement (Amst) 2022; 14:e12379. [PMID: 36569383 PMCID: PMC9773307 DOI: 10.1002/dad2.12379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 12/24/2022]
Abstract
Introduction Distinguishing dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) is challenging due to overlapping presentations. We adapted a Web-based test tool, cCOG, by adding a visuospatial task and a brief clinical survey and assessed its ability to differentiate between DLB and AD. Methods We included 110 patients (n = 30 DLB, n = 32 AD dementia, and n = 48 controls with subjective cognitive decline (SCD)). Full cCOG comprises six cognitive subtasks and a survey addressing self-reported DLB core and autonomic features. First, we compared cCOG cognitive tasks to traditional neuropsychological tasks for all diagnostic groups and clinical questions to validated assessments of clinical features in DLB only. Then, we studied the performance of cCOG cognitive tasks and clinical questions, separately and combined, in differentiating diagnostic groups. Results cCOG cognitive tasks and clinical survey had moderate to strong correlations to standard neuropsychological testing (.61≤ r s ≤ .77) and to validated assessments of clinical features (.41≤ r s ≤ .65), except for fluctuations and REM-sleep behavior disorder (RBD) (r s = .32 and r s = .10). Full cCOG, including both cognitive tasks and brief survey had a diagnostic accuracy (acc) of 0.82 [95% CI 0.73-0.89], with good discrimination of DLB versus AD (acc 0.87 [0.76-0.95]) and DLB versus controls (acc 0.94 [0.86-0.98]). Conclusion We illustrated that cCOG aids in distinguishing DLB and AD patients by using remote assessment of cognition and clinical features. Our findings pave the way to a funneled, harmonized diagnostic process among memory clinics and, eventually, a more timely and accurate diagnosis of DLB and AD.
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Affiliation(s)
- Aniek M. van Gils
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Marleen van de Beek
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Annemartijn A. J. M. van Unnik
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | | | - Dédé Handgraaf
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Mardou van Leeuwenstijn
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | | | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands,Department of Epidemiology and Data SciencesVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Afina Lemstra
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Hanneke F. M. Rhodius‐Meester
- Alzheimer Center AmsterdamNeurologyVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands,Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands,Department of Internal MedicineGeriatric Medicine SectionVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
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Wang H, Sheng L, Xu S, Jin Y, Jin X, Qiao S, Chen Q, Xing W, Zhao Z, Yan J, Mao G, Xu X. Develop a diagnostic tool for dementia using machine learning and non-imaging features. Front Aging Neurosci 2022; 14:945274. [PMID: 36092811 PMCID: PMC9461143 DOI: 10.3389/fnagi.2022.945274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEarly identification of Alzheimer’s disease or mild cognitive impairment can help guide direct prevention and supportive treatments, improve outcomes, and reduce medical costs. Existing advanced diagnostic tools are mostly based on neuroimaging and suffer from certain problems in cost, reliability, repeatability, accessibility, ease of use, and clinical integration. To address these problems, we developed, evaluated, and implemented an early diagnostic tool using machine learning and non-imaging factors.Methods and resultsA total of 654 participants aged 65 or older from the Nursing Home in Hangzhou, China were identified. Information collected from these patients includes dementia status and 70 demographic, cognitive, socioeconomic, and clinical features. Logistic regression, support vector machine (SVM), neural network, random forest, extreme gradient boosting (XGBoost), least absolute shrinkage and selection operator (LASSO), and best subset models were trained, tuned, and internally validated using a novel double cross validation algorithm and multiple evaluation metrics. The trained models were also compared and externally validated using a separate dataset with 1,100 participants from four communities in Zhejiang Province, China. The model with the best performance was then identified and implemented online with a friendly user interface. For the nursing dataset, the top three models are the neural network (AUROC = 0.9435), XGBoost (AUROC = 0.9398), and SVM with the polynomial kernel (AUROC = 0.9213). With the community dataset, the best three models are the random forest (AUROC = 0.9259), SVM with linear kernel (AUROC = 0.9282), and SVM with polynomial kernel (AUROC = 0.9213). The F1 scores and area under the precision-recall curve showed that the SVMs, neural network, and random forest were robust on the unbalanced community dataset. Overall the SVM with the polynomial kernel was found to be the best model. The LASSO and best subset models identified 17 features most relevant to dementia prediction, mostly from cognitive test results and socioeconomic characteristics.ConclusionOur non-imaging-based diagnostic tool can effectively predict dementia outcomes. The tool can be conveniently incorporated into clinical practice. Its online implementation allows zero barriers to its use, which enhances the disease’s diagnosis, improves the quality of care, and reduces costs.
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Affiliation(s)
- Huan Wang
- Department of Biostatistics, The George Washington University, Washington, DC, United States
| | - Li Sheng
- Department of Mathematics, Drexel University, Philadelphia, PA, United States
| | - Shanhu Xu
- Department of Neurology, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Yu Jin
- Department of Neurology, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoqing Jin
- Department of Neurology, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Song Qiao
- Department of Neurology, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Qingqing Chen
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenmin Xing
- Zhejiang Provincial Key Lab of Geriatrics & Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhenlei Zhao
- Zhejiang Provincial Key Lab of Geriatrics & Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Jing Yan
- Zhejiang Provincial Key Lab of Geriatrics & Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Jing Yan,
| | - Genxiang Mao
- Zhejiang Provincial Key Lab of Geriatrics & Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Genxiang Mao,
| | - Xiaogang Xu
- Zhejiang Provincial Key Lab of Geriatrics & Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Xiaogang Xu,
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González DA, Gonzales MM, Jennette KJ, Soble JR, Fongang B. Cognitive screening with functional assessment improves diagnostic accuracy and attenuates bias. Alzheimers Dement (Amst) 2021; 13:e12250. [PMID: 34934799 PMCID: PMC8652409 DOI: 10.1002/dad2.12250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Cognitive screening measures often lack sensitivity and are hampered by inequities across ethnoracial groups. A multitrait multimethod (MTMM) classification may attenuate these shortcomings. METHODS A sample of 7227 participants across the diagnostic spectrum were selected from the National Alzheimer's Coordinating Center cohort. Random forest ensemble methods were used to predict diagnosis across the sample and within Black American (n = 1025) and non-Hispanic White groups (n = 5263) based on: (1) a demographically corrected Montreal Cognitive Assessment (MoCA), (2) MoCA and Functional Assessment Questionnaire (FAQ), (3) MoCA and FAQ with demographic correction. RESULTS The MTMM approach with demographic correction had the highest diagnostic accuracy for the cognitively unimpaired (area under curve [AUC] [95% confidence interval (CI)]): 0.906 [0.892, 0.920]) and mild cognitive impairment (AUC: 0.835 [0.810, 0.860]) groups and reduced racial disparities. DISCUSSION With further validation, the MTMM approach combining cognitive screening and functional status assessment may serve to improve diagnostic accuracy and extend opportunities for early intervention with greater equity.
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Affiliation(s)
- David Andrés González
- Department of NeurologyUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative DiseasesUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Mitzi M. Gonzales
- Department of NeurologyUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative DiseasesUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Kyle J. Jennette
- Department of PsychiatryUniversity of Illinois College of MedicineChicagoIllinoisUSA
| | - Jason R. Soble
- Department of PsychiatryUniversity of Illinois College of MedicineChicagoIllinoisUSA
- Department of NeurologyUniversity of Illinois College of MedicineChicagoIllinoisUSA
| | - Bernard Fongang
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative DiseasesUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
- Department of Biochemistry and Structural BiologyUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
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9
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Muurling M, Rhodius-Meester HFM, Pärkkä J, van Gils M, Frederiksen KS, Bruun M, Hasselbalch SG, Soininen H, Herukka SK, Hallikainen M, Teunissen CE, Visser PJ, Scheltens P, van der Flier WM, Mattila J, Lötjönen J, de Boer C. Gait Disturbances are Associated with Increased Cognitive Impairment and Cerebrospinal Fluid Tau Levels in a Memory Clinic Cohort. J Alzheimers Dis 2021; 76:1061-1070. [PMID: 32597806 PMCID: PMC7505008 DOI: 10.3233/jad-200225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Gait analysis with accelerometers is a relatively inexpensive and easy to use method to potentially support clinical diagnoses of Alzheimer’s disease and other dementias. It is not clear, however, which gait features are most informative and how these measures relate to Alzheimer’s disease pathology. Objective: In this study, we tested if calculated features of gait 1) differ between cognitively normal subjects (CN), mild cognitive impairment (MCI) patients, and dementia patients, 2) are correlated with cerebrospinal fluid (CSF) biomarkers related to Alzheimer’s disease, and 3) predict cognitive decline. Methods: Gait was measured using tri-axial accelerometers attached to the fifth lumbar vertebra (L5) in 58 CN, 58 MCI, and 26 dementia participants, while performing a walk and dual task. Ten gait features were calculated from the vertical L5 accelerations, following principal component analysis clustered in four domains, namely pace, rhythm, time variability, and length variability. Cognitive decline over time was measured using MMSE, and CSF biomarkers were available in a sub-group. Results: Linear mixed models showed that dementia patients had lower pace scores than MCI patients and CN subjects (p < 0.05). In addition, we found associations between the rhythm domain and CSF-tau, especially in the dual task. Gait was not associated with CSF Aβ42 levels and cognitive decline over time as measured with the MMSE. Conclusion: These findings suggest that gait — particularly measures related to pace and rhythm — are altered in dementia and have a direct link with measures of neurodegeneration.
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Affiliation(s)
- Marijn Muurling
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Hanneke F M Rhodius-Meester
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Internal Medicine, Geriatric Medicine section, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Juha Pärkkä
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Kristian S Frederiksen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Marie Bruun
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Steen G Hasselbalch
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Merja Hallikainen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Charlotte E Teunissen
- Neurochemistry Lab and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | - Casper de Boer
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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10
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Eckerström C, Eckerström M, Göthlin M, Molinder A, Jonsson M, Kettunen P, Svensson J, Rolstad S, Wallin A. Characteristic Biomarker and Cognitive Profile in Incipient Mixed Dementia. J Alzheimers Dis 2020; 73:597-607. [PMID: 31815692 PMCID: PMC7029359 DOI: 10.3233/jad-190651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Research has shown that mixed dementia is more common than previously believed but little is known of its early stages. Objective: To examine if incipient mixed dementia can be differentiated from incipient Alzheimer’s disease (AD) and subcortical ischemic vascular dementia (SVD) using neuropsychological tests, cerebrospinal fluid (CSF) markers, and magnetic resonance imaging markers. Methods: We included 493 patients and controls from the Gothenburg MCI study and used the dementia groups for marker selection (CSF total-tau (T-tau), phospho-tau (P-tau), and amyloid-β42 (Aβ42), 11 neuropsychological tests, and 92 regional brain volumes) and to obtain cut-off values which were then applied to the MCI groups. Results: Incipient mixed dementia was best differentiated from incipient AD by the Word fluency F-A-S test and the Trail making test A. CSF T-tau, P-tau, and Aβ42 differentiated incipient mixed dementia from incipient SVD. Conclusion: Incipient mixed dementia is characterized by an AD-like biomarker profile and an SVD-like cognitive profile. Incipient mixed dementia can be separated from incipient AD and incipient SVD using CSF markers and cognitive testing.
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Affiliation(s)
- Carl Eckerström
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Immunology and Transfusion Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Eckerström
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Göthlin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Molinder
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Jonsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Petronella Kettunen
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Svensson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sindre Rolstad
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Wallin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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11
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Jeong JH, Lee SE, Lee JH, Kim HD, Seo KH, Kim DH, Han SY. Aster ageratoides Turcz. extract attenuates Alzheimer's disease-associated cognitive deficits and vascular dementia-associated neuronal death. Anat Cell Biol 2020; 53:216-227. [PMID: 32647089 PMCID: PMC7343560 DOI: 10.5115/acb.20.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022] Open
Abstract
Dementia is the common neurodegenerative disorder affecting the elderly, with a progressive cognitive decline and memory loss. Since Alzheimer’s disease (AD) and vascular dementia (VD) share key pathologies including oxidative damage, oral supplement of phytochemical medicines, which are well-known for their antioxidant properties, can be a viable therapy for both types of dementia. In this study, the therapeutic potential of the Aster ageratoides extract (AAE), an oriental drug with multiple medicinal properties, was tested on experimental rat models of AD and VD. After confirming the in vitro attenuation of neuronal excitotoxicity by AAE, rats were orally administered with AAE for 7 days and subsequently tested under 2 different experimental paradigms: efficacy screening against #1 AD and #2 VD. For paradigm #1, the rats received intraperitoneal scopolamine and subsequently underwent 3 different behavior tests i.e., the Y-maze, novel object recognition, and passive avoidance tests. For paradigm #2, the rats were operated with the 2-vessel occlusion and hypovolemia (2VO/H) technique, and at postoperative day 7, their hippocampal neuronal viability and the neuroinflammatory changes were quantified. The results showed that the scopolamine-induced impairment of memory performance was significantly improved by AAE intake. Furthermore, while the 2VO/H operation induced marked hippocampal neuronal death and microglial activation, both these effects were significantly attenuated by AAE supplements. Some of the aforementioned effects of AAE intake were dose-dependent. These results provided evidence that AAE supplements can exert anti-AD and -VD efficacies and suggested that AAE might be used as an edible phytotherapeutic for the 2 major types of dementia.
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Affiliation(s)
- Ji Heun Jeong
- Department of Anatomy, College of Medicine, Konyang University, Daejeon, Korea
| | - Seung Eun Lee
- Department of Herbal Crop Research, National Institute of Horticultural and Herbal Science, Rural Development Administration, Eumseong, Korea
| | - Jeong Hoon Lee
- Department of Herbal Crop Research, National Institute of Horticultural and Herbal Science, Rural Development Administration, Eumseong, Korea
| | - Hyung Don Kim
- Department of Herbal Crop Research, National Institute of Horticultural and Herbal Science, Rural Development Administration, Eumseong, Korea
| | - Kyung-Hae Seo
- Department of Herbal Crop Research, National Institute of Horticultural and Herbal Science, Rural Development Administration, Eumseong, Korea
| | - Dong Hwi Kim
- Department of Herbal Crop Research, National Institute of Horticultural and Herbal Science, Rural Development Administration, Eumseong, Korea
| | - Seung Yun Han
- Department of Anatomy, College of Medicine, Konyang University, Daejeon, Korea
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12
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Ebenau JL, Timmers T, Wesselman LMP, Verberk IMW, Verfaillie SCJ, Slot RER, van Harten AC, Teunissen CE, Barkhof F, van den Bosch KA, van Leeuwenstijn M, Tomassen J, Braber AD, Visser PJ, Prins ND, Sikkes SAM, Scheltens P, van Berckel BNM, van der Flier WM. ATN classification and clinical progression in subjective cognitive decline: The SCIENCe project. Neurology 2020; 95:e46-e58. [PMID: 32522798 PMCID: PMC7371376 DOI: 10.1212/wnl.0000000000009724] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/12/2019] [Indexed: 02/06/2023] Open
Abstract
Objective To investigate the relationship between the ATN classification system (amyloid, tau, neurodegeneration) and risk of dementia and cognitive decline in individuals with subjective cognitive decline (SCD). Methods We classified 693 participants with SCD (60 ± 9 years, 41% women, Mini-Mental State Examination score 28 ± 2) from the Amsterdam Dementia Cohort and Subjective Cognitive Impairment Cohort (SCIENCe) project according to the ATN model, as determined by amyloid PET or CSF β-amyloid (A), CSF p-tau (T), and MRI-based medial temporal lobe atrophy (N). All underwent extensive neuropsychological assessment. For 342 participants, follow-up was available (3 ± 2 years). As a control population, we included 124 participants without SCD. Results Fifty-six (n = 385) participants had normal Alzheimer disease (AD) biomarkers (A–T–N–), 27% (n = 186) had non-AD pathologic change (A–T–N+, A–T+N–, A–T+N+), 18% (n = 122) fell within the Alzheimer continuum (A+T–N–, A+T–N+, A+T+N–, A+T+N+). ATN profiles were unevenly distributed, with A–T+N+, A+T–N+, and A+T+N+ containing very few participants. Cox regression showed that compared to A–T–N–, participants in A+ profiles had a higher risk of dementia with a dose–response pattern for number of biomarkers affected. Linear mixed models showed participants in A+ profiles showed a steeper decline on tests addressing memory, attention, language, and executive functions. In the control group, there was no association between ATN and cognition. Conclusions Among individuals presenting with SCD at a memory clinic, those with a biomarker profile A–T+N+, A+T–N–, A+T+N–, and A+T+N+ were at increased risk of dementia, and showed steeper cognitive decline compared to A–T–N– individuals. These results suggest a future where biomarker results could be used for individualized risk profiling in cognitively normal individuals presenting at a memory clinic.
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Affiliation(s)
- Jarith L Ebenau
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden.
| | - Tessa Timmers
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Linda M P Wesselman
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Inge M W Verberk
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Sander C J Verfaillie
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Rosalinde E R Slot
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Argonde C van Harten
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Charlotte E Teunissen
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Frederik Barkhof
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Karlijn A van den Bosch
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Mardou van Leeuwenstijn
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Jori Tomassen
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Anouk den Braber
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Pieter Jelle Visser
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Niels D Prins
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Sietske A M Sikkes
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Philip Scheltens
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Bart N M van Berckel
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
| | - Wiesje M van der Flier
- From the Alzheimer Center, Department of Neurology (J.L.E., T.T., L.M.P.W., I.M.W.V., R.E.R.S., A.C.v.H., K.A.v.d.B., M.v.L., J.T., A.d.B., P.J.V., N.D.P., S.A.M.S., P.S., B.N.M.v.B., W.M.v.d.F.), and Department of Radiology & Nuclear Medicine (S.C.J.V., F.B., B.N.v.B.), Amsterdam Neuroscience, Neurochemistry Laboratory, Department of Clinical Chemistry (I.M.W.V., C.E.T.), and Department of Epidemiology & Biostatistics (W.M.v.d.F.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; Department of Biological Psychology (A.d.B.), Neuroscience Amsterdam, VU University Amsterdam; Alzheimer Center Limburg (P.J.V.), School for Mental Health and Neuroscience, Maastricht University, the Netherlands; and Department of Neurobiology, Care Sciences and Society (P.J.V.), Division of Neurogeriatrics, Karolinska Institutet, Stockholm Sweden
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Gjerum L, Frederiksen KS, Henriksen OM, Law I, Bruun M, Simonsen AH, Mecocci P, Baroni M, Dottorini ME, Koikkalainen J, Lötjönen J, Hasselbalch SG. Evaluating 2-[ 18F]FDG-PET in differential diagnosis of dementia using a data-driven decision model. Neuroimage Clin 2020; 27:102267. [PMID: 32417727 DOI: 10.1016/j.nicl.2020.102267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/14/2022]
Abstract
Addition of 2-[18F]FDG-PET to common diagnostic tests improved the accuracy for DLB and FTD. Two new 2-[18F]FDG-PET biomarkers demonstrated specific disease patterns for DLB and FTD. Different combinations of diagnostic tests were valuable for each subtype of dementia.
2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography (2-[18F]FDG-PET) has an emerging supportive role in dementia diagnostic as distinctive metabolic patterns are specific for Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and frontotemporal dementia (FTD). Previous studies have demonstrated that a data-driven decision model based on the disease state index (DSI) classifier supports clinicians in the differential diagnosis of dementia by using different combinations of diagnostic tests and biomarkers. Until now, this model has not included 2-[18F]FDG-PET data. The objective of the study was to evaluate 2-[18F]FDG-PET biomarkers combined with commonly used diagnostic tests in the differential diagnosis of dementia using the DSI classifier. We included data from 259 subjects diagnosed with AD, DLB, FTD, vascular dementia (VaD), and subjective cognitive decline from two independent study cohorts. We also evaluated three 2-[18F]FDG-PET biomarkers (anterior vs. posterior index (API-PET), occipital vs. temporal index, and cingulate island sign) to improve the classification accuracy for both FTD and DLB. We found that the addition of 2-[18F]FDG-PET biomarkers to cognitive tests, CSF and MRI biomarkers considerably improved the classification accuracy for all pairwise comparisons of DLB (balanced accuracies: DLB vs. AD from 64% to 77%; DLB vs. FTD from 71% to 92%; and DLB vs. VaD from 71% to 84%). The two 2-[18F]FDG-PET biomarkers, API-PET and occipital vs. temporal index, improved the accuracy for FTD and DLB, especially as compared to AD. Moreover, different combinations of diagnostic tests were valuable to differentiate specific subtypes of dementia. In conclusion, this study demonstrated that the addition of 2-[18F]FDG-PET to commonly used diagnostic tests provided complementary information that may help clinicians in diagnosing patients, particularly for differentiating between patients with FTD, DLB, and AD.
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Rhodius-Meester HFM, van Maurik IS, Koikkalainen J, Tolonen A, Frederiksen KS, Hasselbalch SG, Soininen H, Herukka SK, Remes AM, Teunissen CE, Barkhof F, Pijnenburg YAL, Scheltens P, Lötjönen J, van der Flier WM. Selection of memory clinic patients for CSF biomarker assessment can be restricted to a quarter of cases by using computerized decision support, without compromising diagnostic accuracy. PLoS One 2020; 15:e0226784. [PMID: 31940390 PMCID: PMC6961870 DOI: 10.1371/journal.pone.0226784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/03/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION An accurate and timely diagnosis for Alzheimer's disease (AD) is important, both for care and research. The current diagnostic criteria allow the use of CSF biomarkers to provide pathophysiological support for the diagnosis of AD. How these criteria should be operationalized by clinicians is unclear. Tools that guide in selecting patients in which CSF biomarkers have clinical utility are needed. We evaluated computerized decision support to select patients for CSF biomarker determination. METHODS We included 535 subjects (139 controls, 286 Alzheimer's disease dementia, 82 frontotemporal dementia and 28 vascular dementia) from three clinical cohorts. Positive (AD like) and negative (normal) CSF biomarker profiles were simulated to estimate whether knowledge of CSF biomarkers would impact (confidence in) diagnosis. We applied these simulated CSF values and combined them with demographic, neuropsychology and MRI data to initiate CSF testing (computerized decision support approach). We compared proportion of CSF measurements and patients diagnosed with sufficient confidence (probability of correct class ≥0.80) based on an algorithm with scenarios without CSF (only neuropsychology, MRI and APOE), CSF according to the appropriate use criteria (AUC) and CSF for all patients. RESULTS The computerized decision support approach recommended CSF testing in 140 (26%) patients, which yielded a diagnosis with sufficient confidence in 379 (71%) of all patients. This approach was more efficient than CSF in none (0% CSF, 308 (58%) diagnosed), CSF selected based on AUC (295 (55%) CSF, 350 (65%) diagnosed) or CSF in all (100% CSF, 348 (65%) diagnosed). CONCLUSIONS We used a computerized decision support with simulated CSF results in controls and patients with different types of dementia. This approach can support clinicians in making a balanced decision in ordering additional biomarker testing. Computer-supported prediction restricts CSF testing to only 26% of cases, without compromising diagnostic accuracy.
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Affiliation(s)
- Hanneke F M Rhodius-Meester
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Internal Medicine, Geriatric Medicine section, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ingrid S van Maurik
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Antti Tolonen
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Kristian S Frederiksen
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steen G Hasselbalch
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Research Neurology, Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
- MRC Oulu, Oulu University Hospital, Oulu, Finland
| | - Charlotte E Teunissen
- Neurochemistry Lab and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
- Institutes of Neurology and Healthcare Engineering, UCL, London, England, United Kingdom
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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von Arnim CAF, Bartsch T, Jacobs AH, Holbrook J, Bergmann P, Zieschang T, Polidori MC, Dodel R. Diagnosis and treatment of cognitive impairment. Z Gerontol Geriatr 2019; 52:309-315. [PMID: 31161337 DOI: 10.1007/s00391-019-01560-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/07/2019] [Indexed: 01/14/2023]
Abstract
As a result of the aging population dementia is a growing challenge, especially in healthcare. Nevertheless, cognitive disorders are often not systematically evaluated, especially during hospital stays for other reasons; however, cognitive impairment is associated with a number of geriatric syndromes, including falls, delirium, dysphagia and lack of adherence to treatment plans. This article considers the current state of diagnosis and treatment of dementia. Non-pharmacological therapeutic approaches as well as current and future pharmacological treatment options are discussed. The drugs of choice for the symptomatic treatment of cognitive deficits in Alzheimer's disease and Parkinson-associated dementia are cholinesterase inhibitors and memantine; there is no specific pharmacological treatment for other types of dementia. Prevention and treatment of cardiovascular risk factors can potentially retard the progression of possibly all forms of dementia.
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Affiliation(s)
- Christine A F von Arnim
- Clinic for Neurogeriatrics and Neurological Rehabilitation, RKU, University and Rehabilitation Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | | | | | - Jill Holbrook
- Clinic for Neurogeriatrics and Neurological Rehabilitation, RKU, University and Rehabilitation Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | | | - Tania Zieschang
- University Clinic of Geriatric Medicine, Oldenburg University, Oldenburg, Germany
| | - M Cristina Polidori
- Ageing Clinical Research, Dpt. II Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Richard Dodel
- Geriatric Medicine, University Duisburg-Essen, Essen, Germany
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Koikkalainen JR, Rhodius-Meester HFM, Frederiksen KS, Bruun M, Hasselbalch SG, Baroni M, Mecocci P, Vanninen R, Remes A, Soininen H, van Gils M, van der Flier WM, Scheltens P, Barkhof F, Erkinjuntti T, Lötjönen JMP. Automatically computed rating scales from MRI for patients with cognitive disorders. Eur Radiol 2019; 29:4937-4947. [DOI: 10.1007/s00330-019-06067-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/09/2019] [Accepted: 02/04/2019] [Indexed: 01/09/2023]
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Bruun M, Koikkalainen J, Rhodius-Meester HFM, Baroni M, Gjerum L, van Gils M, Soininen H, Remes AM, Hartikainen P, Waldemar G, Mecocci P, Barkhof F, Pijnenburg Y, van der Flier WM, Hasselbalch SG, Lötjönen J, Frederiksen KS. Detecting frontotemporal dementia syndromes using MRI biomarkers. Neuroimage Clin 2019; 22:101711. [PMID: 30743135 PMCID: PMC6369219 DOI: 10.1016/j.nicl.2019.101711] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 12/20/2022]
Abstract
Background Diagnosing frontotemporal dementia may be challenging. New methods for analysis of regional brain atrophy patterns on magnetic resonance imaging (MRI) could add to the diagnostic assessment. Therefore, we aimed to develop automated imaging biomarkers for differentiating frontotemporal dementia subtypes from other diagnostic groups, and from one another. Methods In this retrospective multicenter cohort study, we included 1213 patients (age 67 ± 9, 48% females) from two memory clinic cohorts: 116 frontotemporal dementia, 341 Alzheimer's disease, 66 Dementia with Lewy bodies, 40 vascular dementia, 104 other dementias, 229 mild cognitive impairment, and 317 subjective cognitive decline. Three MRI atrophy biomarkers were derived from the normalized volumes of automatically segmented cortical regions: 1) the anterior vs. posterior index, 2) the asymmetry index, and 3) the temporal pole left index. We used the following performance metrics: area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. To account for the low prevalence of frontotemporal dementia we pursued a high specificity of 95%. Cross-validation was used in assessing the performance. The generalizability was assessed in an independent cohort (n = 200). Results The anterior vs. posterior index performed with an AUC of 83% for differentiation of frontotemporal dementia from all other diagnostic groups (Sensitivity = 59%, Specificity = 95%, positive likelihood ratio = 11.8, negative likelihood ratio = 0.4). The asymmetry index showed highest performance for separation of primary progressive aphasia and behavioral variant frontotemporal dementia (AUC = 85%, Sensitivity = 79%, Specificity = 92%, positive likelihood ratio = 9.9, negative likelihood ratio = 0.2), whereas the temporal pole left index was specific for detection of semantic variant primary progressive aphasia (AUC = 85%, Sensitivity = 82%, Specificity = 80%, positive likelihood ratio = 4.1, negative likelihood ratio = 0.2). The validation cohort provided corresponding results for the anterior vs. posterior index and temporal pole left index. Conclusion This study presents three quantitative MRI biomarkers, which could provide additional information to the diagnostic assessment and assist clinicians in diagnosing frontotemporal dementia. Quantitative MRI biomarkers (API, ASI, and TPL) for detection of FTD and its subtypes. API differentiated FTD from other diagnostic groups with AUC of 83%. ASI and TPL showed highest performance for PPA subtypes. A subcortical bvFTD subtype resembling AD atrophy pattern seems undetectable for MRI.
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Affiliation(s)
- Marie Bruun
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark.
| | | | - Hanneke F M Rhodius-Meester
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Marta Baroni
- Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Le Gjerum
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Mark van Gils
- VTT Technical Research Center of Finland Ltd, Tampere, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland; Neurocenter, neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland; Medical Research Center, Oulu University Hospital, Oulu, Finland
| | | | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; UCL institutes of Neurology and Healthcare Engineering, London, UK
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Steen G Hasselbalch
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | | | - Kristian S Frederiksen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
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