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Duong MT, Chen YJ, Doot RK, Young AJ, Lee H, Cai J, Pilania A, Wolk DA, Nasrallah IM. Astrocyte activation imaging with 11C-acetate and amyloid PET in mild cognitive impairment due to Alzheimer pathology. Nucl Med Commun 2021; 42:1261-1269. [PMID: 34231519 PMCID: PMC8800345 DOI: 10.1097/mnm.0000000000001460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuroinflammation is a well-known feature of early Alzheimer disease (AD) yet astrocyte activation has not been extensively evaluated with in vivo imaging in mild cognitive impairment (MCI) due to amyloid plaque pathology. Unlike neurons, astrocytes metabolize acetate, which has potential as a glial biomarker in neurodegeneration in response to AD pathologic features. Since the medial temporal lobe (MTL) is a hotspot for AD neurodegeneration and inflammation, we assessed astrocyte activity in the MTL and compared it to amyloid and cognition. METHODS We evaluate spatial patterns of in vivo astrocyte activation and their relationships to amyloid deposition and cognition in a cross-sectional pilot study of six participants with MCI and five cognitively normal participants. We measure 11C-acetate and 18F-florbetaben amyloid standardized uptake values ratios (SUVRs) and kinetic flux compared to the cerebellum on PET, with MRI and neurocognitive testing. RESULTS MTL 11C-acetate SUVR was significantly elevated in MCI compared to cognitively normal participants (P = 0.03; Cohen d = 1.76). Moreover, MTL 11C-acetate SUVR displayed significant associations with global and regional amyloid burden in MCI. Greater MTL 11C-acetate retention was significantly related with worse neurocognitive measures including the Montreal Cognitive Assessment (P = 0.001), word list recall memory (P = 0.03), Boston naming test (P = 0.04) and trails B test (P = 0.04). CONCLUSIONS While further validation is required, this exploratory pilot study suggests a potential role for 11C-acetate PET as a neuroinflammatory biomarker in MCI and early AD to provide clinical and translational insights into astrocyte activation as a pathological response to amyloid.
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Affiliation(s)
- Michael Tran Duong
- Division of Nuclear Medicine, Department of Radiology
- Penn Memory Center, Department of Neurology, Perelman School of Medicine
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yin Jie Chen
- Division of Nuclear Medicine, Department of Radiology
| | - Robert K Doot
- Division of Nuclear Medicine, Department of Radiology
| | | | - Hsiaoju Lee
- Division of Nuclear Medicine, Department of Radiology
| | - Jenny Cai
- Division of Nuclear Medicine, Department of Radiology
| | - Arun Pilania
- Penn Memory Center, Department of Neurology, Perelman School of Medicine
| | - David A Wolk
- Penn Memory Center, Department of Neurology, Perelman School of Medicine
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ilya M Nasrallah
- Division of Nuclear Medicine, Department of Radiology
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Klooster N, Humphries S, Cardillo E, Hartung F, Xie L, Das S, Yushkevich P, Pilania A, Wang J, Wolk DA, Chatterjee A. Sensitive Measures of Cognition in Mild Cognitive Impairment. J Alzheimers Dis 2021; 82:1123-1136. [PMID: 34151789 DOI: 10.3233/jad-201280] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sensitive measures of cognition are needed in preclinical and prodromal Alzheimer's disease (AD) to track cognitive change and evaluate potential interventions. Neurofibrillary tangle pathology in AD is first observed in Brodmann Area 35 (BA35), the medial portion of the perirhinal cortex. The importance of the perirhinal cortex for semantic memory may explain early impairments of semantics in preclinical AD. Additionally, our research has tied figurative language impairment to neurodegenerative disease. OBJECTIVE We aim to identify tasks that are sensitive to cognitive impairment in individuals with mild cognitive impairment (MCI), and that are sensitive to atrophy in BA35. METHODS Individuals with MCI and cognitively normal participants (CN) were tested on productive and receptive experimental measures of semantic memory and experimental tests of figurative language comprehension (including metaphor and verbal analogy). Performance was related to structural imaging and standard neuropsychological assessment. RESULTS On the experimental tests of semantics and figurative language, people with MCI performed worse than CN participants. The experimental semantic memory tasks are sensitive and specific; performance on the experimental semantic memory tasks related to medial temporal lobe structural integrity, including BA35, while standard neuropsychological assessments of semantic memory did not, demonstrating the sensitivity of these experimental measures. A visuo-spatial analogy task did not differentiate groups, confirming the specificity of semantic and figurative language tasks. CONCLUSION These experimental measures appear sensitive to cognitive change and neurodegeneration early in the AD trajectory and may prove useful in tracking cognitive change in clinical trials aimed at early intervention.
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Affiliation(s)
- Nathaniel Klooster
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.,Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - Stacey Humphries
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.,Penn Center for Neuroaesthetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Eileen Cardillo
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.,Penn Center for Neuroaesthetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Franziska Hartung
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.,Penn Center for Neuroaesthetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Long Xie
- Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandhitsu Das
- Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Yushkevich
- Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA, USA
| | - Arun Pilania
- Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA, USA.,Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jieqiong Wang
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.,Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Anjan Chatterjee
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.,Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Penn Center for Neuroaesthetics, University of Pennsylvania, Philadelphia, PA, USA.,Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA
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Xie L, Das SR, Pilania A, Daffner M, Stockbower GE, Dolui S, Yushkevich PA, Detre JA, Wolk DA. Task-enhanced arterial spin labeled perfusion MRI predicts longitudinal neurodegeneration in mild cognitive impairment. Hippocampus 2018; 29:26-36. [PMID: 30207006 DOI: 10.1002/hipo.23026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/12/2017] [Revised: 07/09/2018] [Accepted: 09/02/2018] [Indexed: 12/11/2022]
Abstract
Mild cognitive impairment (MCI) is considered a prodromal stage of Alzheimer's disease (AD), but is also recognized to be a heterogeneous condition. Biomarkers that predict AD progression in MCI are of clinical significance because they can be used to better identify appropriate candidates for therapeutic intervention studies. It has been hypothesized that comparing to structural measurements, functional ones may be more sensitive to early disease abnormalities and the sensitivity could be further enhanced when combined with cognitive task, a "brain stress test." In this study, we investigated the value of regional cerebral blood flow (CBF), measured by arterial spin labeled perfusion MRI (ASL MRI) during a memory-encoding task, in predicting the estimated rate of hippocampal atrophy, an established marker of AD progression. Thirty-one amnestic MCI patients (20 male and 11 female; age: 70.9 ± 6.5 years, range from 56 to 83 years; mini mental status examination: 27.8 ± 1.8) and 42 normal control subjects (13 male and 29 female; age: 70.6 ± 8.8 years, range from 55 to 88 years; mini mental status examination: 29.1 ± 1.2) were included in this study. We compared the predictive value of CBF during task to CBF during rest and structural volumetry. Both region-of-interest and voxelwise analyses showed that baseline CBF measurements during task (strongest effect in fusiform gyrus, region-of-interest analysis statistics: r = 0.56, p = .003), but not resting ASL MRI or structural volumetry, were correlated with the estimated rate of hippocampal atrophy in amnestic MCI patients. Further, stepwise linear regression demonstrated that resting ASL MRI and volumetry did not provide complementary information in prediction. These results support the notion that physiologic measures during a cognitive challenge may increase the ability to detect subtle functional changes that predict progression. As such, ASL MRI could have important utility in stratifying candidates for AD treatment trials.
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Affiliation(s)
- Long Xie
- Penn Image Computing and Science Laboratory (PICSL), Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sandhitsu R Das
- Penn Image Computing and Science Laboratory (PICSL), Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arun Pilania
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Molly Daffner
- Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Functional Neuroimaging, Department of Neurology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Grace E Stockbower
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sudipto Dolui
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Functional Neuroimaging, Department of Neurology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul A Yushkevich
- Penn Image Computing and Science Laboratory (PICSL), Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Functional Neuroimaging, Department of Neurology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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