1
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Ashton NJ, Leuzy A, Karikari TK, Mattsson-Carlgren N, Dodich A, Boccardi M, Corre J, Drzezga A, Nordberg A, Ossenkoppele R, Zetterberg H, Blennow K, Frisoni GB, Garibotto V, Hansson O. The validation status of blood biomarkers of amyloid and phospho-tau assessed with the 5-phase development framework for AD biomarkers. Eur J Nucl Med Mol Imaging 2021; 48:2140-2156. [PMID: 33677733 PMCID: PMC8175325 DOI: 10.1007/s00259-021-05253-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE The development of blood biomarkers that reflect Alzheimer's disease (AD) pathophysiology (phosphorylated tau and amyloid-β) has offered potential as scalable tests for dementia differential diagnosis and early detection. In 2019, the Geneva AD Biomarker Roadmap Initiative included blood biomarkers in the systematic validation of AD biomarkers. METHODS A panel of experts convened in November 2019 at a two-day workshop in Geneva. The level of maturity (fully achieved, partly achieved, preliminary evidence, not achieved, unsuccessful) of blood biomarkers was assessed based on the Biomarker Roadmap methodology and discussed fully during the workshop which also evaluated cerebrospinal fluid (CSF) and positron emission tomography (PET) biomarkers. RESULTS Plasma p-tau has shown analytical validity (phase 2 primary aim 1) and first evidence of clinical validity (phase 3 primary aim 1), whereas the maturity level for Aβ remains to be partially achieved. Full and partial achievement has been assigned to p-tau and Aβ, respectively, in their associations to ante-mortem measures (phase 2 secondary aim 2). However, only preliminary evidence exists for the influence of covariates, assay comparison and cut-off criteria. CONCLUSIONS Despite the relative infancy of blood biomarkers, in comparison to CSF biomarkers, much has already been achieved for phases 1 through 3 - with p-tau having greater success in detecting AD and predicting disease progression. However, sufficient data about the effect of covariates on the biomarker measurement is lacking. No phase 4 (real-world performance) or phase 5 (assessment of impact/cost) aim has been tested, thus not achieved.
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Affiliation(s)
- N J Ashton
- Institute of Neuroscience & Physiology, Department of Psychiatry & Neurochemistry, Sahlgrenska Academy, University of Gothenburg, House V3/SU, SE-431 80, Mölndal, Sweden.
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - A Leuzy
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - T K Karikari
- Institute of Neuroscience & Physiology, Department of Psychiatry & Neurochemistry, Sahlgrenska Academy, University of Gothenburg, House V3/SU, SE-431 80, Mölndal, Sweden
| | - N Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - A Dodich
- NIMTlab - Neuroimaging and Innovative Molecular Tracers Laboratory, University of Geneva, Geneva, Switzerland
- Center for Neurocognitive Rehabilitation (CeRiN), CIMeC, University of Trento, Trento, Italy
| | - M Boccardi
- German Center for Neurodegenerative Diseases (DZNE), Rostock-Greifswald, Rostock, Germany
- LANVIE - Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland
| | - J Corre
- Centre National de la Recherche Scientifique, Montpellier, France
| | - A Drzezga
- Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - A Nordberg
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Aging, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - R Ossenkoppele
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - H Zetterberg
- Institute of Neuroscience & Physiology, Department of Psychiatry & Neurochemistry, Sahlgrenska Academy, University of Gothenburg, House V3/SU, SE-431 80, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - K Blennow
- Institute of Neuroscience & Physiology, Department of Psychiatry & Neurochemistry, Sahlgrenska Academy, University of Gothenburg, House V3/SU, SE-431 80, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - G B Frisoni
- German Center for Neurodegenerative Diseases (DZNE), Rostock-Greifswald, Rostock, Germany
- Memory Clinic, Geneva University Hospitals, Geneva, Switzerland
| | - V Garibotto
- NIMTlab - Neuroimaging and Innovative Molecular Tracers Laboratory, University of Geneva, Geneva, Switzerland
- Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - O Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
- UK Dementia Research Institute at UCL, London, UK.
- Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden.
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2
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Frederiksen KS, Cooper C, Frisoni GB, Frölich L, Georges J, Kramberger MG, Nilsson C, Passmore P, Mantoan Ritter L, Religa D, Schmidt R, Stefanova E, Verdelho A, Vandenbulcke M, Winblad B, Waldemar G. A European Academy of Neurology guideline on medical management issues in dementia. Eur J Neurol 2020; 27:1805-1820. [PMID: 32713125 PMCID: PMC7540303 DOI: 10.1111/ene.14412] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Dementia is one of the most common disorders and is associated with increased morbidity, mortality and decreased quality of life. The present guideline addresses important medical management issues including systematic medical follow-up, vascular risk factors in dementia, pain in dementia, use of antipsychotics in dementia and epilepsy in dementia. METHODS A systematic review of the literature was carried out. Based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework, we developed a guideline. Where recommendations based on GRADE were not possible, a good practice statement was formulated. RESULTS Systematic management of vascular risk factors should be performed in patients with mild to moderate dementia as prevention of cerebrovascular pathology may impact on the progression of dementia (Good Practice statement). Individuals with dementia (without previous stroke) and atrial fibrillation should be treated with anticoagulants (weak recommendation). Discontinuation of opioids should be considered in certain individuals with dementia (e.g. for whom there are no signs or symptoms of pain or no clear indication, or suspicion of side effects; Good Practice statement). Behavioral symptoms in persons with dementia should not be treated with mild analgesics (weak recommendation). In all patients with dementia treated with opioids, assessment of the individual risk-benefit ratio should be performed at regular intervals. Regular, preplanned medical follow-up should be offered to all patients with dementia. The setting will depend on the organization of local health services and should, as a minimum, include general practitioners with easy access to dementia specialists (Good Practice statement). Individuals with dementia and agitation and/or aggression should be treated with atypical antipsychotics only after all non-pharmacological measures have been proven to be without benefit or in the case of severe self-harm or harm to others (weak recommendation). Antipsychotics should be discontinued after cessation of behavioral disturbances and in patients in whom there are side effects (Good Practice statement). For treatment of epilepsy in individuals with dementia, newer anticonvulsants should be considered as first-line therapy (Good Practice statement). CONCLUSION This GRADE-based guideline offers recommendations on several important medical issues in patients with dementia, and thus adds important guidance for clinicians. For some issues, very little or no evidence was identified, highlighting the importance of further studies within these areas.
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Affiliation(s)
- K. S. Frederiksen
- Department of NeurologyDanish Dementia Research CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - C. Cooper
- Department of Clinical Educational and Health PsychologyUniversity College LondonLondonUK
| | - G. B. Frisoni
- Memory ClinicUniversity Hospital of GenevaUniversity of GenevaGenevaSwitzerland
| | - L. Frölich
- Department of Geriatric PsychiatryZentralinstitut für Seelische Gesundheit MannheimMedical Faculty MannheimUniversity of HeidelbergMannheimGermany
| | | | - M. G. Kramberger
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical Center Ljubljana, and Medical facultyUniversity of LjubljanaLjubljanaSlovenia
| | - C. Nilsson
- Department of Neurology and Rehabilitation MedicineSkåne University HospitalLundSweden
- Clinical Memory Research UnitDepartment of Clinical SciencesLund UniversityMalmöSweden
| | | | - L. Mantoan Ritter
- Epilepsy CentreKing's College NHS Foundation TrustKing´s College LondonLondonUK
| | - D. Religa
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetNeo, StockholmSweden
- Karolinska University HospitalTheme AgingHuddingeSweden
| | - R. Schmidt
- University Clinic for NeurologyMedical University of GrazGrazAustria
| | - E. Stefanova
- Medical FacultyNeurology clinic CCSUniversity of BelgradeBelgradeSerbia
| | - A. Verdelho
- Department of Neurosciences and Mental HealthCHLNorte‐Hospital de Santa MariaIMMISAMBFaculty of MedicineUniversity of LisbonLisbonPortugal
| | - M. Vandenbulcke
- Department of NeurosciencesKU LeuvenGeriatric PsychiatryUniversity Hospitals LeuvenLeuvenBelgium
| | - B. Winblad
- Karolinska University HospitalTheme AgingHuddingeSweden
- Division of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetBioClinicumSolnaSweden
| | - G. Waldemar
- Department of NeurologyDanish Dementia Research CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
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3
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Boccardi M, Nicolosi V, Festari C, Bianchetti A, Cappa S, Chiasserini D, Falini A, Guerra UP, Nobili F, Padovani A, Sancesario G, Morbelli S, Parnetti L, Tiraboschi P, Muscio C, Perani D, Pizzini FB, Beltramello A, Salvini Porro G, Ciaccio M, Schillaci O, Trabucchi M, Tagliavini F, Frisoni GB. Italian consensus recommendations for a biomarker-based aetiological diagnosis in mild cognitive impairment patients. Eur J Neurol 2019; 27:475-483. [PMID: 31692118 DOI: 10.1111/ene.14117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 11/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Biomarkers support the aetiological diagnosis of neurocognitive disorders in vivo. Incomplete evidence is available to drive clinical decisions; available diagnostic algorithms are generic and not very helpful in clinical practice. The aim was to develop a biomarker-based diagnostic algorithm for mild cognitive impairment patients, leveraging on knowledge from recognized national experts. METHODS With a Delphi procedure, experienced clinicians making variable use of biomarkers in clinical practice and representing five Italian scientific societies (neurology - Società Italiana di Neurologia per le Demenze; neuroradiology - Associazione Italiana di Neuroradiologia; biochemistry - Società Italiana di Biochimica Clinica; psychogeriatrics - Associazione Italiana di Psicogeriatria; nuclear medicine - Associazione Italiana di Medicina Nucleare) defined the theoretical framework, relevant literature, the diagnostic issues to be addressed and the diagnostic algorithm. An N-1 majority defined consensus achievement. RESULTS The panellists chose the 2011 National Institute on Aging and Alzheimer's Association diagnostic criteria as the reference theoretical framework and defined the algorithm in seven Delphi rounds. The algorithm includes baseline clinical and cognitive assessment, blood examination, and magnetic resonance imaging with exclusionary and inclusionary roles; dopamine transporter single-photon emission computed tomography (if no/unclear parkinsonism) or metaiodobenzylguanidine cardiac scintigraphy for suspected dementia with Lewy bodies with clear parkinsonism (round VII, votes (yes-no-abstained): 3-1-1); 18 F-fluorodeoxyglucose positron emission tomography for suspected frontotemporal lobar degeneration and low diagnostic confidence of Alzheimer's disease (round VII, 4-0-1); cerebrospinal fluid for suspected Alzheimer's disease (round IV, 4-1-0); and amyloid positron emission tomography if cerebrospinal fluid was not possible/accepted (round V, 4-1-0) or inconclusive (round VI, 5-0-0). CONCLUSIONS These consensus recommendations can guide clinicians in the biomarker-based aetiological diagnosis of mild cognitive impairment, whilst guidelines cannot be defined with evidence-to-decision procedures due to incomplete evidence.
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Affiliation(s)
- M Boccardi
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University of Geneva, Geneva, Switzerland
| | - V Nicolosi
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy
| | - C Festari
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University of Brescia, Brescia, Italy
| | - A Bianchetti
- Istituto Clinico S. Anna, Brescia, Italy.,Italian Psychogeriatric Association (AIP), Brescia, Italy
| | - S Cappa
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University Institute of Higher Studies, Pavia, Italy.,Italian Society of Neurology for the Study of the Dementias (SINdem), Milan, Italy
| | - D Chiasserini
- University of Perugia, Perugia, Italy.,Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy
| | - A Falini
- IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Italian Association of Neuroradiology (AINR), Milan, Italy
| | - U P Guerra
- Poliambulanza Foundation, Brescia, Italy.,Italian Association of Nuclear Medicine (AIMN), Bari, Italy
| | - F Nobili
- Italian Association of Nuclear Medicine (AIMN), Bari, Italy.,University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - A Padovani
- Italian Society of Neurology for the Study of the Dementias (SINdem), Milan, Italy.,Brescia University Hospital, Brescia, Italy
| | - G Sancesario
- Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy.,IRCCS Santa Lucia Foundation, Neuroimmunology Unit Via Ardeatina 354, Rome, Italy
| | - S Morbelli
- University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - L Parnetti
- Ospedale S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | | | - C Muscio
- IRCCS 'Carlo Besta', Milan, Italy
| | - D Perani
- IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | - A Beltramello
- Verona University Hospital, Verona, Italy.,IRCCS 'Sacro Cuore-Don Calabria', Negrar, Verona, Italy
| | | | - M Ciaccio
- Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy.,University of Palermo, Palermo, Italy
| | - O Schillaci
- University Tor Vergata, Rome, Italy.,IRCCS-Neuromed, Pozzilli, Italy
| | - M Trabucchi
- Italian Psychogeriatric Association (AIP), Brescia, Italy.,University Tor Vergata, Rome, Italy
| | | | - G B Frisoni
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University of Geneva, Geneva, Switzerland
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4
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Loera-Valencia R, Cedazo-Minguez A, Kenigsberg PA, Page G, Duarte AI, Giusti P, Zusso M, Robert P, Frisoni GB, Cattaneo A, Zille M, Boltze J, Cartier N, Buee L, Johansson G, Winblad B. Current and emerging avenues for Alzheimer's disease drug targets. J Intern Med 2019; 286:398-437. [PMID: 31286586 DOI: 10.1111/joim.12959] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Alzheimer's disease (AD), the most frequent cause of dementia, is escalating as a global epidemic, and so far, there is neither cure nor treatment to alter its progression. The most important feature of the disease is neuronal death and loss of cognitive functions, caused probably from several pathological processes in the brain. The main neuropathological features of AD are widely described as amyloid beta (Aβ) plaques and neurofibrillary tangles of the aggregated protein tau, which contribute to the disease. Nevertheless, AD brains suffer from a variety of alterations in function, such as energy metabolism, inflammation and synaptic activity. The latest decades have seen an explosion of genes and molecules that can be employed as targets aiming to improve brain physiology, which can result in preventive strategies for AD. Moreover, therapeutics using these targets can help AD brains to sustain function during the development of AD pathology. Here, we review broadly recent information for potential targets that can modify AD through diverse pharmacological and nonpharmacological approaches including gene therapy. We propose that AD could be tackled not only using combination therapies including Aβ and tau, but also considering insulin and cholesterol metabolism, vascular function, synaptic plasticity, epigenetics, neurovascular junction and blood-brain barrier targets that have been studied recently. We also make a case for the role of gut microbiota in AD. Our hope is to promote the continuing research of diverse targets affecting AD and promote diverse targeting as a near-future strategy.
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Affiliation(s)
- R Loera-Valencia
- Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - A Cedazo-Minguez
- Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - G Page
- Neurovascular Unit and Cognitive impairments - EA3808, University of Poitiers, Poitiers, France
| | - A I Duarte
- CNC- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.,Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - P Giusti
- Dipartimento di Scienze del Farmaco, Università degli Studi di Padova, Padova, Italy
| | - M Zusso
- Dipartimento di Scienze del Farmaco, Università degli Studi di Padova, Padova, Italy
| | - P Robert
- CoBTeK - lab, CHU Nice University Côte d'Azur, Nice, France
| | - G B Frisoni
- University Hospitals and University of Geneva, Geneva, Switzerland
| | - A Cattaneo
- University Hospitals and University of Geneva, Geneva, Switzerland
| | - M Zille
- Institute of Experimental and Clinical Pharmacology and Toxicology, Lübeck, Germany
| | - J Boltze
- School of Life Sciences, The University of Warwick, Coventry, UK
| | - N Cartier
- Preclinical research platform, INSERM U1169/MIRCen Commissariat à l'énergie atomique, Fontenay aux Roses, France.,Université Paris-Sud, Orsay, France
| | - L Buee
- Alzheimer & Tauopathies, LabEx DISTALZ, CHU-Lille, Inserm, Univ. Lille, Lille, France
| | - G Johansson
- Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - B Winblad
- Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
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5
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Vernooij MW, Pizzini FB, Schmidt R, Smits M, Yousry TA, Bargallo N, Frisoni GB, Haller S, Barkhof F. Dementia imaging in clinical practice: a European-wide survey of 193 centres and conclusions by the ESNR working group. Neuroradiology 2019; 61:633-642. [PMID: 30852630 PMCID: PMC6511357 DOI: 10.1007/s00234-019-02188-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Through a European-wide survey, we assessed the current clinical practice of imaging in the primary evaluation of dementia, with respect to standardised imaging, evaluation and reporting. METHODS An online questionnaire was emailed to all European Society of Neuroradiology (ESNR) members (n = 1662) and non-members who had expressed their interest in ESNR activities in the past (n = 6400). The questionnaire featured 42 individual items, divided into multiple choice, single best choice and free text answers. Information was gathered on the context of the practices, available and preferred imaging modalities, applied imaging protocols and standards for interpretation, reporting and communication. RESULTS A total of 193 unique (non-duplicate) entries from the European academic and non-academic institutions were received from a total of 28 countries. Of these, 75% were neuroradiologists, 12% general radiologists and 11% (neuro) radiologists in training. Of responding centres, 38% performed more than five scans/week for suspected dementia. MRI was primarily used in 72% of centres. Over 90% of centres acquired a combination of T2w, FLAIR, T1w, DWI and T2*w sequences. Visual rating scales were used in 75% of centres, most often the Fazekas and medial temporal atrophy scale; 32% of respondents lacked full confidence in their use. Only 23% of centres performed volumetric analysis. A minority of centres (28%) used structured reports. CONCLUSIONS Current practice in dementia imaging is fairly homogeneous across Europe, in terms of image acquisition and image interpretation. Hurdles identified include training on the use of visual rating scales, implementation of volumetric assessment and structured reporting.
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Affiliation(s)
- M W Vernooij
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - F B Pizzini
- Neuroradiology, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - R Schmidt
- Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria
| | - M Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - T A Yousry
- Lysholm Department of Neuroradiology, UCL Institute of Neurology, London, UK
| | - N Bargallo
- Magnetic Resonance Image Core Facility, IDIBAPS and Center of Diagnostic Image (CDIC), Hospital Clinic, Barcelona, Spain
| | - G B Frisoni
- University Hospitals and University of Geneva, Geneva, Switzerland
| | - S Haller
- CIRD - Centre d'Imagerie Rive Droite|, Geneva, Switzerland
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - F Barkhof
- Lysholm Department of Neuroradiology, UCL Institute of Neurology, London, UK
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam UMC, Amsterdam, The Netherlands
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Abstract
Recent evidence on blood-based biomarkers is pointing the way towards a new era of large-scale, feasible, cost-effective and non-invasive screening for Alzheimer’s disease (AD). This was one of the main focuses of the recent meeting of the European Union-North American Clinical Trials in AD (EU/US CTAD) Task Force, which took place in Barcelona in October 24-27, 2018, and convened drug and diagnostics developers from industry and academia in order to define a roadmap for the development and marketing of blood-based biomarkers (1).
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Affiliation(s)
- F Ribaldi
- Daniele Altomare, University of Geneva, Switzerland,
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7
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Rossi R, Pievani M, Järvenpää T, Testa C, Koskenvuo M, Räihä I, Kaprio J, Frisoni GB, Rinne JO, Laakso MP. Voxel-based morphometry study on monozygotic twins discordant for Alzheimer's disease. Acta Neurol Scand 2016; 133:427-33. [PMID: 26370660 DOI: 10.1111/ane.12480] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We set to investigate the possible role of genes and environment in developing Alzheimer's disease (AD) in monozygotic twin pairs discordant for AD. METHODS Three pairs of twins discordant for AD, who were enrolled in the Finnish Twin Cohort, were used in the study and compared with 13 controls. Gray matter changes were assessed with magnetic resonance images using voxel-based morphometry with statistical parametric mapping. RESULTS In the affected twins, the peaks of volume loss were located bilaterally in the temporal (including the hippocampus), the frontal, and the parietal lobes, while in the unaffected siblings, the peaks were located in the frontal gyri and in the parietal lobule. Thus, in the unaffected twins, the pattern of volume loss overlaps with the neocortical but not with the medial temporal areas. DISCUSSION These findings suggest that genetic factors more largely control neocortical regions, whereas environmental factors more strongly affect medial temporal regions.
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Affiliation(s)
- R. Rossi
- Laboratory of Epidemiology Neuroimaging and Telemedicine; IRCCS - Centro San Giovanni di Dio FBF; Brescia Italy
| | - M. Pievani
- Laboratory of Epidemiology Neuroimaging and Telemedicine; IRCCS - Centro San Giovanni di Dio FBF; Brescia Italy
| | - T. Järvenpää
- Turku PET Centre; University of Turku; Turku Finland
- Department of Neurology; University of Turku; Turku Finland
| | - C. Testa
- Machine Vision Laboratory; Department of Mathematics and Computer Science; University of Udine; Udine Italy
| | - M. Koskenvuo
- Department of Public Health; University of Turku; Turku Finland
| | - I. Räihä
- Department of Geriatrics; University of Turku; Turku Finland
- Turku City Hospital; Turku Finland
| | - J. Kaprio
- Department of Public Health; University of Helsinki; Helsinki Finland
- Department of Mental Health and Alcohol Research; National Public Health Institute; Helsinki Finland
| | - G. B. Frisoni
- Laboratory of Epidemiology Neuroimaging and Telemedicine; IRCCS - Centro San Giovanni di Dio FBF; Brescia Italy
- AFaR Associazione Fatebenefratelli per la Ricerca; Rome Italy
| | - J. O. Rinne
- Turku PET Centre; University of Turku; Turku Finland
| | - M. P. Laakso
- Department of Clinical Radiology; Kuopio University Hospital; Kuopio Finland
- Niuvanniemi Hospital; Kuopio Finland
- Vanha Vaasa Hospital; Vaasa Finland
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8
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Galluzzi S, Marizzoni M, Babiloni C, Albani D, Antelmi L, Bagnoli C, Bartres-Faz D, Cordone S, Didic M, Farotti L, Fiedler U, Forloni G, Girtler N, Hensch T, Jovicich J, Leeuwis A, Marra C, Molinuevo JL, Nobili F, Pariente J, Parnetti L, Payoux P, Del Percio C, Ranjeva JP, Rolandi E, Rossini PM, Schönknecht P, Soricelli A, Tsolaki M, Visser PJ, Wiltfang J, Richardson JC, Bordet R, Blin O, Frisoni GB. Clinical and biomarker profiling of prodromal Alzheimer's disease in workpackage 5 of the Innovative Medicines Initiative PharmaCog project: a 'European ADNI study'. J Intern Med 2016; 279:576-91. [PMID: 26940242 DOI: 10.1111/joim.12482] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the field of Alzheimer's disease (AD), the validation of biomarkers for early AD diagnosis and for use as a surrogate outcome in AD clinical trials is of considerable research interest. OBJECTIVE To characterize the clinical profile and genetic, neuroimaging and neurophysiological biomarkers of prodromal AD in amnestic mild cognitive impairment (aMCI) patients enrolled in the IMI WP5 PharmaCog (also referred to as the European ADNI study). METHODS A total of 147 aMCI patients were enrolled in 13 European memory clinics. Patients underwent clinical and neuropsychological evaluation, magnetic resonance imaging (MRI), electroencephalography (EEG) and lumbar puncture to assess the levels of amyloid β peptide 1-42 (Aβ42), tau and p-tau, and blood samples were collected. Genetic (APOE), neuroimaging (3T morphometry and diffusion MRI) and EEG (with resting-state and auditory oddball event-related potential (AO-ERP) paradigm) biomarkers were evaluated. RESULTS Prodromal AD was found in 55 aMCI patients defined by low Aβ42 in the cerebrospinal fluid (Aβ positive). Compared to the aMCI group with high Aβ42 levels (Aβ negative), Aβ positive patients showed poorer visual (P = 0.001), spatial recognition (P < 0.0005) and working (P = 0.024) memory, as well as a higher frequency of APOE4 (P < 0.0005), lower hippocampal volume (P = 0.04), reduced thickness of the parietal cortex (P < 0.009) and structural connectivity of the corpus callosum (P < 0.05), higher amplitude of delta rhythms at rest (P = 0.03) and lower amplitude of posterior cingulate sources of AO-ERP (P = 0.03). CONCLUSION These results suggest that, in aMCI patients, prodromal AD is characterized by a distinctive cognitive profile and genetic, neuroimaging and neurophysiological biomarkers. Longitudinal assessment will help to identify the role of these biomarkers in AD progression.
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Affiliation(s)
- S Galluzzi
- Laboratory of Alzheimer's Neuroimaging & Epidemiology, Saint John of God Clinical Research Centre, Brescia, Italy
| | - M Marizzoni
- Laboratory of Alzheimer's Neuroimaging & Epidemiology, Saint John of God Clinical Research Centre, Brescia, Italy
| | - C Babiloni
- Department of Physiology and Pharmacology, University of Rome 'La Sapienza', Rome, Italy.,IRCCS San Raffaele Pisana of Rome, Rome, Italy
| | - D Albani
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - L Antelmi
- Laboratory of Alzheimer's Neuroimaging & Epidemiology, Saint John of God Clinical Research Centre, Brescia, Italy
| | - C Bagnoli
- Laboratory of Alzheimer's Neuroimaging & Epidemiology, Saint John of God Clinical Research Centre, Brescia, Italy
| | - D Bartres-Faz
- Department of Psychiatry and Clinical Psychobiology, Faculty of Medicine, University of Barcelona and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - S Cordone
- Department of Physiology and Pharmacology, University of Rome 'La Sapienza', Rome, Italy
| | - M Didic
- Aix-Marseille Université, INSERM, Marseille, France.,Service de Neurologie et Neuropsychologie, APHM Hôpital Timone Adultes, Marseille, France
| | - L Farotti
- Clinica Neurologica, Università di Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - U Fiedler
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - G Forloni
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - N Girtler
- Clinical Neurology, Department of Neurosciences, Rehabilitation, Ophthalmology and Maternal-Fetal Medicine, University of Genoa, Genoa, Italy
| | - T Hensch
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - J Jovicich
- Center for Mind/Brain Sciences, University of Trento, Trento, Italy
| | - A Leeuwis
- Department of Neurology, Alzheimer Centre, VU Medical Centre, Amsterdam, the Netherlands
| | - C Marra
- Department of Gerontology, Neurosciences & Orthopedics, Catholic University, Rome, Italy
| | - J L Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital Clínic de Barcelona, and IDIBAPS, Barcelona, Catalunya, Spain
| | - F Nobili
- Clinical Neurology, Department of Neurosciences, Rehabilitation, Ophthalmology and Maternal-Fetal Medicine, University of Genoa, Genoa, Italy
| | - J Pariente
- INSERM, Imagerie Cérébrale et Handicaps Neurologiques, Toulouse, France
| | - L Parnetti
- Clinica Neurologica, Università di Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - P Payoux
- INSERM, Imagerie Cérébrale et Handicaps Neurologiques, Toulouse, France
| | - C Del Percio
- SDN Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - J-P Ranjeva
- Aix-Marseille Université, INSERM, Marseille, France.,Service de Neurologie et Neuropsychologie, APHM Hôpital Timone Adultes, Marseille, France
| | - E Rolandi
- Laboratory of Alzheimer's Neuroimaging & Epidemiology, Saint John of God Clinical Research Centre, Brescia, Italy
| | - P M Rossini
- Department of Gerontology, Neurosciences & Orthopedics, Catholic University, Rome, Italy
| | - P Schönknecht
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - A Soricelli
- SDN Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - M Tsolaki
- Third Neurologic Clinic, Medical School, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P J Visser
- Department of Neurology, Alzheimer Centre, VU Medical Centre, Amsterdam, the Netherlands
| | - J Wiltfang
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August-University, Goettingen, Germany
| | - J C Richardson
- Neurosciences Therapeutic Area, GlaxoSmithKline R&D, Stevenage, UK
| | - R Bordet
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative and Vascular Cognitive Disorders, Lille, France
| | - O Blin
- Mediterranean Institute of Cognitive Neurosciences, Aix Marseille University, Marseille, France
| | - G B Frisoni
- Laboratory of Alzheimer's Neuroimaging & Epidemiology, Saint John of God Clinical Research Centre, Brescia, Italy.,Memory Clinic and LANVIE - Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
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9
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Frisoni GB, Boccardi M. MRI for Pre-Dementia Trials. J Prev Alzheimers Dis 2016; 3:5-7. [PMID: 29214276 DOI: 10.14283/jpad.2015.69] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Structural magnetic resonance imaging (MRI) provides valid markers of whole brain and regional areas of atrophy in Alzheimer’s disease (AD), which are sensitive to change and correlate with clinical progression. Recent efforts to develop standardized and harmonized protocols for MRI indicate high measurement stability and good reproducibility, supporting the use of these measures in clinical trials. Newer MRI measures of microstructural and connectivity changes are also showing promise as early stage biomarkers of neurodegeneration and potentially as measures of treatment effects. Further work is needed to validate these markers for use in clinical trials.
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Affiliation(s)
- G B Frisoni
- Giovanni B. Frisoni, University Hospitals and University of Geneva, Geneva, Switzerland,
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10
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Inglese P, Amoroso N, Boccardi M, Bocchetta M, Bruno S, Chincarini A, Errico R, Frisoni GB, Maglietta R, Redolfi A, Sensi F, Tangaro S, Tateo A, Bellotti R. Multiple RF classifier for the hippocampus segmentation: Method and validation on EADC-ADNI Harmonized Hippocampal Protocol. Phys Med 2015; 31:1085-1091. [PMID: 26481815 DOI: 10.1016/j.ejmp.2015.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/16/2015] [Accepted: 08/12/2015] [Indexed: 11/24/2022] Open
Abstract
The hippocampus has a key role in a number of neurodegenerative diseases, such as Alzheimer's Disease. Here we present a novel method for the automated segmentation of the hippocampus from structural magnetic resonance images (MRI), based on a combination of multiple classifiers. The method is validated on a cohort of 50 T1 MRI scans, comprehending healthy control, mild cognitive impairment, and Alzheimer's Disease subjects. The preliminary release of the EADC-ADNI Harmonized Protocol training labels is used as gold standard. The fully automated pipeline consists of a registration using an affine transformation, the extraction of a local bounding box, and the classification of each voxel in two classes (background and hippocampus). The classification is performed slice-by-slice along each of the three orthogonal directions of the 3D-MRI using a Random Forest (RF) classifier, followed by a fusion of the three full segmentations. Dice coefficients obtained by multiple RF (0.87 ± 0.03) are larger than those obtained by a single monolithic RF applied to the entire bounding box, and are comparable to state-of-the-art. A test on an external cohort of 50 T1 MRI scans shows that the presented method is robust and reliable. Additionally, a comparison of local changes in the morphology of the hippocampi between the three subject groups is performed. Our work showed that a multiple classification approach can be implemented for the segmentation for the measurement of volume and shape changes of the hippocampus with diagnostic purposes.
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Affiliation(s)
- P Inglese
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Italy; Università degli Studi di Bari, Bari, Italy
| | - N Amoroso
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Italy; Università degli Studi di Bari, Bari, Italy
| | - M Boccardi
- LENITEM Laboratory of Epidemiology, Neuroimaging & Telemedicine, IRCSS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - M Bocchetta
- LENITEM Laboratory of Epidemiology, Neuroimaging & Telemedicine, IRCSS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - S Bruno
- Overdale Hospital, St Helier, Jersey, UK
| | - A Chincarini
- Istituto Nazionale di Fisica Nucleare, Sezione di Genova, Italy
| | - R Errico
- Università degli Studi di Bari, Bari, Italy; Istituto Nazionale di Fisica Nucleare, Sezione di Genova, Italy; Università degli Studi di Genova, Genova, Italy
| | - G B Frisoni
- LENITEM Laboratory of Epidemiology, Neuroimaging & Telemedicine, IRCSS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy; aFaR Associazione FateBeneFratelli per la Ricerca, Rome, Italy; Psychogeriatric Ward, IRCSS S. Giovanni di Dio - FBF, Brescia, Italy
| | - R Maglietta
- Istituto di Studi sui Sistemi Intelligenti per l'Automazione, Consiglio Nazionale delle Ricerche, Bari, Italy
| | - A Redolfi
- LENITEM Laboratory of Epidemiology, Neuroimaging & Telemedicine, IRCSS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - F Sensi
- Istituto Nazionale di Fisica Nucleare, Sezione di Genova, Italy
| | - S Tangaro
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Italy.
| | - A Tateo
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Italy; Università degli Studi di Bari, Bari, Italy
| | - R Bellotti
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Italy; Università degli Studi di Bari, Bari, Italy
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11
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Rossi R, Lanfredi M, Pievani M, Boccardi M, Rasser PE, Thompson PM, Cavedo E, Cotelli M, Rosini S, Beneduce R, Bignotti S, Magni LR, Rillosi L, Magnaldi S, Cobelli M, Rossi G, Frisoni GB. Abnormalities in cortical gray matter density in borderline personality disorder. Eur Psychiatry 2015; 30:221-7. [PMID: 25561291 DOI: 10.1016/j.eurpsy.2014.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is a chronic condition with a strong impact on patients' affective, cognitive and social functioning. Neuroimaging techniques offer invaluable tools to understand the biological substrate of the disease. We aimed to investigate gray matter alterations over the whole cortex in a group of Borderline Personality Disorder (BPD) patients compared to healthy controls (HC). METHODS Magnetic resonance-based cortical pattern matching was used to assess cortical gray matter density (GMD) in 26 BPD patients and in their age- and sex-matched HC (age: 38 ± 11; females: 16, 61%). RESULTS BPD patients showed widespread lower cortical GMD compared to HC (4% difference) with peaks of lower density located in the dorsal frontal cortex, in the orbitofrontal cortex, the anterior and posterior cingulate, the right parietal lobe, the temporal lobe (medial temporal cortex and fusiform gyrus) and in the visual cortex (P<0.005). Our BPD subjects displayed a symmetric distribution of anomalies in the dorsal aspect of the cortical mantle, but a wider involvement of the left hemisphere in the mesial aspect in terms of lower density. A few restricted regions of higher density were detected in the right hemisphere. All regions remained significant after correction for multiple comparisons via permutation testing. CONCLUSIONS BPD patients feature specific morphology of the cerebral structures involved in cognitive and emotional processing and social cognition/mentalization, consistent with clinical and functional data.
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Affiliation(s)
- R Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 25125 Brescia, Italy.
| | - M Lanfredi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 25125 Brescia, Italy
| | - M Pievani
- LENITEM, Laboratory of Epidemiology, Neuroimaging, & Telemedicine, Istituto Centro San Giovanni di Dio-Fatebenefratelli, Brescia, Italy
| | - M Boccardi
- LENITEM, Laboratory of Epidemiology, Neuroimaging, & Telemedicine, Istituto Centro San Giovanni di Dio-Fatebenefratelli, Brescia, Italy
| | - P E Rasser
- Centre for translational Neuroscience and Mental Health, The University of Newcastle, New South Wales, Australia; Schizophrenia Research Institute, Darlinghurst, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - P M Thompson
- Imaging Genetics Center, Laboratory of Neuro Imaging, Department of Neurology, UCLA School of Medicine, Los Angeles, CA, USA
| | - E Cavedo
- LENITEM, Laboratory of Epidemiology, Neuroimaging, & Telemedicine, Istituto Centro San Giovanni di Dio-Fatebenefratelli, Brescia, Italy; Cognition, neuroimaging and brain diseases Laboratory, Centre de Recherche de l'Insitut du Cerveau et de la Moelle (CRICM) UMRS_975, Université Pierre-et-Marie-Curie, Paris, France
| | - M Cotelli
- Unit of Neuropsychology, IRCCS Istituto Centro San Giovanni di Dio-Fatebenefratelli, Brescia, Italy
| | - S Rosini
- Unit of Neuropsychology, IRCCS Istituto Centro San Giovanni di Dio-Fatebenefratelli, Brescia, Italy
| | - R Beneduce
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 25125 Brescia, Italy
| | - S Bignotti
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 25125 Brescia, Italy
| | - L R Magni
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 25125 Brescia, Italy
| | - L Rillosi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 25125 Brescia, Italy
| | - S Magnaldi
- Unit of Neuroradiology, Poliambulanza Hospital, Brescia, Italy
| | - M Cobelli
- Unit of Neuroradiology, Poliambulanza Hospital, Brescia, Italy
| | - G Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 25125 Brescia, Italy
| | - G B Frisoni
- LENITEM, Laboratory of Epidemiology, Neuroimaging, & Telemedicine, Istituto Centro San Giovanni di Dio-Fatebenefratelli, Brescia, Italy; Memory Clinic and LANVIE, Laboratory of Neuroimaging of Aging, University Hospitals, University of Geneva, Geneva, Switzerland
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12
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Borroni B, Turrone R, Galimberti D, Nacmias B, Alberici A, Benussi A, Caffarra P, Caltagirone C, Cappa SF, Frisoni GB, Ghidoni R, Marra C, Padovani A, Rainero I, Scarpini E, Silani V, Sorbi S, Tagliavini F, Tremolizzo L, Bruni AC. Italian Frontotemporal Dementia Network (FTD Group-SINDEM): sharing clinical and diagnostic procedures in Frontotemporal Dementia in Italy. Neurol Sci 2014; 36:751-7. [PMID: 25528460 DOI: 10.1007/s10072-014-2033-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/03/2014] [Indexed: 11/30/2022]
Abstract
In the prospect of improved disease management and future clinical trials in Frontotemporal Dementia, it is desirable to share common diagnostic procedures. To this aim, the Italian FTD Network, under the aegis of the Italian Neurological Society for Dementia, has been established. Currently, 85 Italian Centers involved in dementia care are part of the network. Each Center completed a questionnaire on the local clinical procedures, focused on (1) clinical assessment, (2) use of neuroimaging and genetics; (3) support for patients and caregivers; (4) an opinion about the prevalence of FTD. The analyses of the results documented a comprehensive clinical and instrumental approach to FTD patients and their caregivers in Italy, with about 1,000 newly diagnosed cases per year and 2,500 patients currently followed by the participating Centers. In analogy to other European FTD consortia, future aims will be devoted to collect data on epidemiology of FTD and its subtypes and to provide harmonization of procedures among Centers.
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Affiliation(s)
- B Borroni
- Center of Neurodegenerative Disorders, Neurology Unit, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy,
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13
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Pagani M, De Carli F, Morbelli S, Öberg J, Chincarini A, Frisoni GB, Galluzzi S, Perneczky R, Drzezga A, van Berckel BNM, Ossenkoppele R, Didic M, Guedj E, Brugnolo A, Picco A, Arnaldi D, Ferrara M, Buschiazzo A, Sambuceti G, Nobili F. Volume of interest-based [18F]fluorodeoxyglucose PET discriminates MCI converting to Alzheimer's disease from healthy controls. A European Alzheimer's Disease Consortium (EADC) study. Neuroimage Clin 2014; 7:34-42. [PMID: 25610765 PMCID: PMC4299956 DOI: 10.1016/j.nicl.2014.11.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [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: 09/22/2014] [Revised: 10/14/2014] [Accepted: 11/11/2014] [Indexed: 01/18/2023]
Abstract
An emerging issue in neuroimaging is to assess the diagnostic reliability of PET and its application in clinical practice. We aimed at assessing the accuracy of brain FDG-PET in discriminating patients with MCI due to Alzheimer's disease and healthy controls. Sixty-two patients with amnestic MCI and 109 healthy subjects recruited in five centers of the European AD Consortium were enrolled. Group analysis was performed by SPM8 to confirm metabolic differences. Discriminant analyses were then carried out using the mean FDG uptake values normalized to the cerebellum computed in 45 anatomical volumes of interest (VOIs) in each hemisphere (90 VOIs) as defined in the Automated Anatomical Labeling (AAL) Atlas and on 12 meta-VOIs, bilaterally, obtained merging VOIs with similar anatomo-functional characteristics. Further, asymmetry indexes were calculated for both datasets. Accuracy of discrimination by a Support Vector Machine (SVM) and the AAL VOIs was tested against a validated method (PALZ). At the voxel level SMP8 showed a relative hypometabolism in the bilateral precuneus, and posterior cingulate, temporo-parietal and frontal cortices. Discriminant analysis classified subjects with an accuracy ranging between .91 and .83 as a function of data organization. The best values were obtained from a subset of 6 meta-VOIs plus 6 asymmetry values reaching an area under the ROC curve of .947, significantly larger than the one obtained by the PALZ score. High accuracy in discriminating MCI converters from healthy controls was reached by a non-linear classifier based on SVM applied on predefined anatomo-functional regions and inter-hemispheric asymmetries. Data pre-processing was automated and simplified by an in-house created Matlab-based script encouraging its routine clinical use. Further validation toward nonconverter MCI patients with adequately long follow-up is needed. 18F-FDG-PET/CT analysis of metabolic differences between MCI converting to AD and HC Large and very well controlled cohorts from EADC-Consortium were investigated. Data were analyzed by a friendly-to-use Matlab-based script and Support Vector Machine. Excellent discrimination between MCI and HC (sensitivity 92%; specificity 91%) Highest accuracy reported so far in MCI and promising implementation in clinical routine
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Affiliation(s)
- M Pagani
- Institute of Cognitive Sciences and Technologies, Rome, Italy ; Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden
| | - F De Carli
- Institute of Bioimaging and Molecular Physiology, Consiglio Nazionale delle Ricerche (CNR), Genoa, Italy
| | - S Morbelli
- Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - J Öberg
- Department of Hospital Physics, Karolinska Hospital, Stockholm, Sweden
| | - A Chincarini
- National Institute for Nuclear Physics (INFN), Genoa, Italy
| | - G B Frisoni
- LENITEM Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio-FBF, Brescia, Italy ; University Hospitals and University of Geneva, Geneva, Switzerland
| | - S Galluzzi
- LENITEM Laboratory of Epidemiology and Neuroimaging, IRCCS S. Giovanni di Dio-FBF, Brescia, Italy
| | - R Perneczky
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College London of Science, Technology and Medicine, London, UK ; West London Cognitive Disorders Treatment and Research Unit, London, UK ; Department of Psychiatry and Psychotherapy, Technische Universität, Munich, Germany
| | - A Drzezga
- Department of Nuclear Medicine, Technische Universität, Munich, Germany
| | - B N M van Berckel
- Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands
| | - R Ossenkoppele
- Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands
| | - M Didic
- APHM, CHU Timone, Service de Neurologie et Neuropsychologie, Aix-Marseille University, INSERM U 1106, Marseille, France
| | - E Guedj
- APHM, CHU Timone, Service de Médecine Nucléaire, CERIMED, INT CNRS UMR7289 , Aix-Marseille University, Marseille 13005, France
| | - A Brugnolo
- Clinical Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, IRCCS AOU, San Martino-IST, Genoa, Italy
| | - A Picco
- Clinical Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, IRCCS AOU, San Martino-IST, Genoa, Italy
| | - D Arnaldi
- Clinical Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, IRCCS AOU, San Martino-IST, Genoa, Italy
| | - M Ferrara
- Clinical Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, IRCCS AOU, San Martino-IST, Genoa, Italy
| | - A Buschiazzo
- Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - G Sambuceti
- Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - F Nobili
- Clinical Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, IRCCS AOU, San Martino-IST, Genoa, Italy
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14
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Moretti DV, Binetti G, Zanetti O, Frisoni GB. Non-ergot dopamine agonist rotigotine as a promising therapeutic tool in atypical parkinsonism syndromes: a 24 months pilot observational open-label study. Neuropharmacology 2014; 85:284-9. [PMID: 24915072 DOI: 10.1016/j.neuropharm.2014.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 03/01/2014] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 11/25/2022]
Abstract
Rotigotine (RTG) is a non-ergot dopamine agonist developed as a new transdermal formulation, indicated for use in early and advanced Parkinson's disease (PD). The potential advantages of the RTG patch include immediacy of effect onset, constant drug delivery, better tolerability avoiding drug peaks and easy of use, helping patient's compliance. So, RTG patch appears to be a suitable candidate in the treatment of patients with atypical parkinsonism. The present is an observational study to evaluate the efficacy and tolerability of RTG in patients affected by atypical parkinsonian disorders. 61 subjects with diagnosis of atypical parkinsonian disorders were treated with transdermal RTG. Diagnosis was: Parkinson disease with dementia, multiple system atrophy parkinsonian type, multiple system atrophy cerebellar type, progressive sopranuclear palsy, cortico-basal degeneration, Lewy body dementia and fronto-temporal dementia with parkinsonism. Patients were evaluated by UPDRS-III, NPI, MMSE and adverse events (AEs) were recorded. Patients treated with RTG show an overall decrease of UPDRS III scores without increasing behavioral disturbances. Main adverse events (AE) were hypotension (14 patients), nausea (13), vomiting (5), drowsiness (5), tachycardia (2) dystonia (3 patients, all treated with concomitant l-dopa). On the whole, 16 patients were affected by AE and 7 patients suspended RTG treatment due to AE (vomiting, tachycardia and sleepiness). In our population transdermal RTG seems to be effective and well tolerated. Due to its system of drug delivery, RTG appears to be a suitable therapy in elderly patients as it has a good tolerability profile, improves patient's compliance and helps management of fragile patients.
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Affiliation(s)
- D V Moretti
- IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - G Binetti
- IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - O Zanetti
- IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - G B Frisoni
- IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Moretti DV, Paternicò D, Binetti G, Zanetti O, Frisoni GB. Electroencephalographic upper/low alpha frequency power ratio relates to cortex thinning in mild cognitive impairment. NEURODEGENER DIS 2014; 14:18-30. [PMID: 24434624 DOI: 10.1159/000354863] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/06/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Temporoparietal cortex thinning is associated with mild cognitive impairment (MCI) due to Alzheimer disease (AD). The increase in EEG upper/low α frequency power ratio has been associated with AD converter MCI subjects. We investigated the association of the EEG upper/low α frequency power ratio with patterns of cortical thickness in MCI. METHODS 74 adult subjects with MCI underwent clinical and neuropsychological evaluation, electroencephalography (EEG) recording and high-resolution 3-dimensional magnetic resonance imaging (MRI). The EEG upper/low α frequency power ratio as well as cortical thickness were computed for each subject. Three MCI groups were detected according to increasing tertile values of EEG upper/low α frequency power ratios, and the difference of cortical thickness among the groups was estimated. RESULTS The EEG high upper/low α frequency power ratio group had a total cortical grey matter volume reduction of 471 mm(2), greater than that of the EEG low upper/low α frequency power ratio group (p < 0.001). The EEG high upper/low α frequency power ratio group showed a similar but less marked pattern (160 mm(2)) of cortical thinning when compared to the EEG middle upper/low α frequency power ratio group (p < 0.001). Moreover, the EEG high upper/low α frequency power ratio group had wider cortical thinning than other groups, mapped to the supramarginal gyrus and precuneus bilaterally. No significant regional cortical thickness differences were found between middle and low EEG upper/low α frequency power ratio groups. CONCLUSION A high EEG upper/low α frequency power ratio was associated with temporoparietal cortical thinning in MCI subjects. The combination of upper/low α frequency power ratio and cortical thickness measurement could be useful for identifying individuals at risk for progression to AD dementia and may be of value in the clinical context.
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Affiliation(s)
- D V Moretti
- IRCCS, S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Cavedo E, Frisoni GB. Alzheimer's Disease Prevention: Reality or Utopia? J Prev Alzheimers Dis 2014; 1:141-142. [PMID: 29251741 DOI: 10.14283/jpad.2014.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- E Cavedo
- Enrica Cavado, LENITEM Laboratory of Epidemiology, Neuroimaging and Telemedicine - IRCCS Istituto Centro San Giovanni di Dio - FBF, Brescia, Italy, e-mail:
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Vellas B, Hausner L, Frölich L, Cantet C, Gardette V, Reynish E, Gillette S, Agüera-Morales E, Auriacombe S, Boada M, Bullock R, Byrne J, Camus V, Cherubini A, Eriksdotter-Jönhagen M, Frisoni GB, Hasselbalch S, Jones RW, Martinez-Lage P, Rikkert MO, Tsolaki M, Ousset PJ, Pasquier F, Ribera-Casado JM, Rigaud AS, Robert P, Rodriguez G, Salmon E, Salva A, Scheltens P, Schneider A, Sinclair A, Spiru L, Touchon J, Zekry D, Winblad B, Andrieu S. Progression of Alzheimer disease in Europe: data from the European ICTUS study. Curr Alzheimer Res 2013; 9:902-12. [PMID: 22742853 DOI: 10.2174/156720512803251066] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 12/09/2011] [Accepted: 05/18/2012] [Indexed: 11/22/2022]
Abstract
The clinical progression of Alzheimer disease (AD) was studied in European subjects under treatment with AChE inhibitors (AChE-I) in relation to geographical location over a 2-years period. One thousand three hundred and six subjects from 11 European countries were clustered into 3 regions (North, South, West) and investigated with biannual follow-up over 2 years. Primary outcomes were cognitive, functional and behavioral measures. Caregiver burden, hospital admission and admission to nursing home were also recorded. Participant cognitive function declined non-linearly over time (MMSE: -1.5 pts/first year, -2.5 pts/second year; ADAScog: + 3.5 pts/first year, + 4.8 pts/second year), while the progression of behavioral disturbances (NPI scale) was linear. Neither scale showed regional differences, and progression of the disease was similar across Europe despite different health care systems. Functional decline (ADL, IADL) tended to progress more rapidly in Southern Europe (p=0.09), while progression of caregiver burden (Zarit Burden Interview) was most rapid in Northern Europe (5.6 pts/y, p=0.04). Incidences of hospital admission (10.44, 95%CI: 8.13-12.75, p < 0.001) and admission to nursing home (2.97, 95%CI: 1.83-4.11, p < 0.001) were lowest in Southern Europe. In general cognitive and functional decline was slower than in former cohorts. European geographical location reflecting differences in culture and in health care system does not impact on the progression of AD but does influence the management of AD subjects and caregiver burden.
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Affiliation(s)
- B Vellas
- Gerontopôle, INSERM U 1027, Alzheimer's Disease Research and Clinical Center, Toulouse University Hospital, France
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Filippi M, Agosta F, Barkhof F, Dubois B, Fox NC, Frisoni GB, Jack CR, Johannsen P, Miller BL, Nestor PJ, Scheltens P, Sorbi S, Teipel S, Thompson PM, Wahlund LO. EFNS task force: the use of neuroimaging in the diagnosis of dementia. Eur J Neurol 2012; 19:e131-40, 1487-501. [DOI: 10.1111/j.1468-1331.2012.03859.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 07/18/2012] [Indexed: 01/18/2023]
Affiliation(s)
- M. Filippi
- Neuroimaging Research Unit; Division of Neuroscience; Institute of Experimental Neurology; San Raffaele Scientific Institute; Vita-Salute San Raffaele University; Milan Italy
| | - F. Agosta
- Neuroimaging Research Unit; Division of Neuroscience; Institute of Experimental Neurology; San Raffaele Scientific Institute; Vita-Salute San Raffaele University; Milan Italy
| | - F. Barkhof
- Department of Radiology; VU University Medical Center; Amsterdam The Netherlands
| | - B. Dubois
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière; Université Pierre et Marie Curie; Paris France
| | - N. C. Fox
- Dementia Research Centre; Institute of Neurology; University College London; London UK
| | - G. B. Frisoni
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli di Brescia; Brescia Italy
| | - C. R. Jack
- Department of Radiology; Mayo Clinic and Foundation; Rochester MN USA
| | - P. Johannsen
- Memory Clinic; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - B. L. Miller
- Memory and Aging Center; University of California; San Francisco CA USA
| | - P. J. Nestor
- Department of Clinical Neuroscience; University of Cambridge; Cambridge UK
| | - P. Scheltens
- Department of Neurology and Alzheimer Center; VU University Medical Center; Amsterdam The Netherlands
| | - S. Sorbi
- Department of Neurological and Psychiatric Sciences; Azienda Ospedaliero-Universitaria di Careggi; Florence Italy
| | - S. Teipel
- Department of Psychiatry; University of Rostock, and German Center for Neuro-degenerative Diseases (DZNE); Rostock Germany
| | - P. M. Thompson
- Department of Neurology; David Geffen School of Medicine at the University of California Los Angeles; Los Angeles CA USA
| | - L.-O. Wahlund
- Division of Clinical Geriatrics; Department of Neurobiology; Karolinska Institute; Stockholm Sweden
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Norberg J, Graff C, Almkvist O, Ewers M, Frisoni GB, Frölich L, Hampel H, Jones RW, Kehoe PG, Lenoir H, Minthon L, Nobili F, Olde Rikkert M, Rigaud AS, Scheltens P, Soininen H, Spiru L, Tsolaki M, Wahlund LO, Vellas B, Wilcock G, Elias-Sonnenschein LS, Verhey FRJ, Visser PJ. Regional differences in effects of APOE ε4 on cognitive impairment in non-demented subjects. Dement Geriatr Cogn Disord 2012; 32:135-42. [PMID: 21952537 DOI: 10.1159/000330492] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2011] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The APOE ε4 allele is a risk factor for Alzheimer's disease (AD). APOE ε4 is common in non-demented subjects with cognitive impairment. In both healthy people and people with AD, its prevalence has a north-south gradient across Europe. In the present study, we investigated whether the relation between the APOE ε4 allele and cognitive impairment varied across Northern, Middle and Southern Europe. We also investigated whether a north-south gradient existed in subjects with subjective cognitive impairment (SCI), amnestic mild cognitive impairment (MCI) and non-amnestic MCI. METHODS Data from 16 centers across Europe were analyzed. RESULTS A north-south gradient in APOE ε4 prevalence existed in the total sample (62.7% for APOE ε4 carriers in the northern region, 42.1% in the middle region, and 31.5% in the southern region) and in subjects with SCI and amnestic MCI separately. Only in Middle Europe was the APOE ε4 allele significantly associated with poor performance on tests of delayed recall and learning, as well as with the amnestic subtype of MCI. CONCLUSION The APOE ε4 allele frequencies in subjects with SCI and amnestic MCI have a north-south gradient. The relation between the APOE ε4 allele and cognition is region dependent.
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Affiliation(s)
- J Norberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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20
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Kilimann I, Grothe M, Heinsen H, Frisoni GB, Fellgiebel A, Filippi M, Hampel H, Klöppel S, Teipel SJ. European DTI Study in Dementia - MRT Volumetrie der frontobasalen cholinergen Kerngebiete bei Alzheimer Erkrankung. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Moretti DV, Paternicò D, Binetti G, Zanetti O, Frisoni GB. EEG markers are associated to gray matter changes in thalamus and basal ganglia in subjects with mild cognitive impairment. Neuroimage 2011; 60:489-96. [PMID: 22166796 DOI: 10.1016/j.neuroimage.2011.11.086] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/14/2011] [Accepted: 11/21/2011] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Gray matter (GM) changes of thalamus and basal ganglia have been demonstrated to be involved in Alzheimer's disease (AD). Moreover, the increase of two EEG markers, alpha3/alpha2 and theta/gamma ratio, have been associated with, respectively, AD converter and non-AD converter subjects with mild cognitive impairment (MCI). OBJECTIVE To study the association of prognostic EEG markers with specific GM changes of thalamus and basal ganglia in subjects with MCI to identify different MCI populations. METHODS 74 adult subjects with mild cognitive impairment underwent EEG recording and high resolution 3D magnetic resonance imaging (MRI). The theta/gamma and alpha3/alpha2 ratio was computed for each subject. Three groups were obtained according to increasing tertile values of both alpha3/alpha2 and theta/gamma ratio. Gray matter density differences between groups were investigated using a voxel-based morphometry technique. RESULTS Subjects with higher a3/a2 ratios when compared to subjects with lower and middle a3/a2 ratios showed minor atrophy in the ventral stream of basal ganglia (head of caudate nuclei and accumbens nuclei bilaterally) and of the pulvinar nuclei in the thalamus; subjects with higher t/g ratio showed minor atrophy in putamina nuclei bilaterally than subjects with middle ratio. CONCLUSION The integrated analysis of EEG and morpho-structural markers could be useful in the comprehension of anatomo-physiological underpinning of the MCI entity.
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Affiliation(s)
- D V Moretti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli di Brescia, Italy.
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Abstract
OBJECTIVES The contribution of early microvascular and autonomic derangements to the pathogenesis of mild cognitive impairment (MCI) is unclear. Aim of this study is to evaluate cerebrovascular reactivity (CVR) and cardiac autonomic function in patients with MCI by means of transcranial Doppler (TCD). MATERIAL AND METHODS Fifteen patients with MCI and 28 controls underwent carotid ultrasound and TCD evaluation, including assessment of mean flow velocity (MFV) in the middle cerebral artery at baseline, after CO(2) inhalation and after hyperpnoea. End-tidal CO(2) , mean arterial blood pressure (MAP), heart rate (HR), and respiratory rate were monitored throughout the procedure, and CVR was calculated. RESULTS MAP, end-tidal CO(2) , and MFV variations during hypercapnia and hyperventilation showed no between-group differences. CVR was similar in controls and MCI (2.30 vs 2,39, respectively, P = 0.767). HR significantly increased in hypercapnia (+9.4%, P < 0.0001) and hyperventilation (+18.7%, P < 0.0001) in controls, while in MCI it significantly increased in hyperventilation (+10.4%, P = 0.002), but not in hypercapnia (+1.1%, P = 0.635). CONCLUSIONS This study demonstrates that patients with MCI have a normal CVR, but they exhibit signs of autonomic dysfunction after CO(2) challenge. Should this finding be confirmed in larger studies, HR response to CO(2) challenge could become a marker of MCI.
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Affiliation(s)
- G P Anzola
- Service of Neurology, S. Orsola Hospital, Brescia, Italy.
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Moretti DV, Frisoni GB, Fracassi C, Pievani M, Geroldi C, Binetti G, Rossini PM, Zanetti O. MCI patients' EEGs show group differences between those who progress and those who do not progress to AD. Neurobiol Aging 2011; 32:563-71. [PMID: 20022139 DOI: 10.1016/j.neurobiolaging.2009.04.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 03/20/2009] [Accepted: 04/06/2009] [Indexed: 10/20/2022]
Abstract
The theta/gamma and alpha3/alpha2 ratio were investigated as early markers for prognosticating of progression to dementia. 76 subjects with mild cognitive impairment (MCI) underwent EEG recording, MRI scans and neuropsychological (NPS) tests. After 3 years of follow-up, three subgroups were characterized as converters to Alzheimer's disease (AD, N=18), converters to non-AD dementia (N=14) and non-converters (N=44). The theta/gamma and alpha3/alpha2 ratio, performance on cognitive tests and hippocampal volume, as evaluated at the time of initial MCI diagnosis, were studied in the three groups. As expected, MCI to AD converters had the smallest mean hippocampal volume and poorest performance on verbal learning tests, whereas MCI to non-AD converters had poorest cognitive performance in non-verbal learning tests, abstract thinking, and letter fluency. Increased theta/gamma ratio was associated with conversion to both AD and non-AD dementia; increased alpha3/alpha2 ratio was only associated with conversion to AD. Theta/gamma and alpha3/alpha2 ratio could be promising prognostic markers in MCI patients. In particular, the increase of high alpha frequency seems to be associated with conversion in AD. EEG markers allow a mean correct percentage of correct classification up to 88.3%. Future prospective studies are needed to evaluate the sensitivity and specificity of these measures for predicting an AD outcome.
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Affiliation(s)
- D V Moretti
- IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Moretti DV, Prestia A, Fracassi C, Geroldi C, Binetti G, Rossini PM, Zanetti O, Frisoni GB. Volumetric differences in mapped hippocampal regions correlate with increase of high alpha rhythm in Alzheimer's disease. Int J Alzheimers Dis 2011; 2011:208218. [PMID: 21760984 PMCID: PMC3132513 DOI: 10.4061/2011/208218] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [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: 09/27/2010] [Revised: 04/12/2011] [Accepted: 04/13/2011] [Indexed: 11/26/2022] Open
Abstract
Objective. The increase of high alpha relative to low alpha power has been recently demonstrated as a reliable EEG marker of hippocampal atrophy conversion of patients with mild cognitive impairment (MCI) in Alzheimer's disease (AD). In the present study we test the reliability of this EEG index in subjects with AD. Methods. Correlation between EEG markers and volumetric differences in mapped hippocampal regions was estimated in AD patients. Results. Results show that the increase of alpha3/alpha2 power ratio is correlated with atrophy of mapped hippocampal regions in Alzheimer's disease. Conclusions. The findings confirm the possible diagnostic role of EEG markers.
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Affiliation(s)
- D V Moretti
- IRCCS S. Giovanni di Dio Fatebenefratelli, 4, Pilastroni Road, 25125 Brescia, Italy
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Cavedo E, Frisoni GB. The dynamic marker hypothesis of Alzheimer's disease and its implications for clinical imaging. Q J Nucl Med Mol Imaging 2011; 55:237-249. [PMID: 21532538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In the last ten years the literature on Alzheimer's disease has focused on in vivo neurobiological changes. Extracellular beta-amyloid and intracellular hyperphosphorilated tau deposition are pivotal features and several authors have described their progression over time in pathological specimens. The revised criteria for Alzheimer's disease suggest that in vivo biomarkers reflecting neurobiological changes are useful for early diagnosis in the clinical practice. The most widely used biomarkers for the Alzheimer's disease are: Abeta42 and Tau levels in the cerebrospinal fluid (CSF); brain glucose hypometabolism detected by positron emission tomography (PET) using the 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG); brain structural and functional changes detected by magnetic resonance imaging and amyloid burden by PET using Carbon-11-labelled Pittsburgh compound-B [(11)C]PiB). In order to explain the latest in vivo observations, the dynamic biomarker hypothesis has been recently developed, integrating both pathological and clinical knowledge, and indicating which biomarkers might be more sensitive to disease state and progression at different stages. In this review, we will outline studies that support the dynamic hypothesis by: 1) testing slope differences among biomarkers; 2) describing how biomarkers map all neuropathological and clinical changes starting from the detection of amyloid burden, to neurodegeneration, and symptoms; and finally 3) identifying the best combination of biomarkers sensitive to prodromal AD in clinical practice.
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Affiliation(s)
- E Cavedo
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine) - IRCCS San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Cavedo E, Boccardi M, Ganzola R, Canu E, Beltramello A, Caltagirone C, Thompson PM, Frisoni GB. Local amygdala structural differences with 3T MRI in patients with Alzheimer disease. Neurology 2011; 76:727-33. [PMID: 21339500 DOI: 10.1212/wnl.0b013e31820d62d9] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Histologic studies show that the amygdala is affected by Alzheimer disease (AD) pathology, and its medial aspect is the most involved. We aimed to assess in vivo local structural differences in the amygdala of patients with AD using high-field MRI. METHODS A total of 19 patients with AD (mean age 76, SD 6 years, mean Mini-Mental State Examination score [MMSE] 13, SD 4) and 19 healthy elderly controls (age 74, SD 5, MMSE 29, SD 1) were enrolled. The radial atrophy mapping technique was used to reconstruct the 3-dimensional surface of the amygdala. Maps of surface tissue loss in patients with AD vs controls were computed and statistically tested with permutation tests thresholded at p < 0.05, to correct for multiple comparisons. A digital atlas of the amygdalar nuclei was used to infer which nuclei were involved. RESULTS Both amygdalar volumes were significantly smaller in patients with AD (right 1,508 mm³, SD 418; left 1,646, SD 419) than controls (right 2,129 mm³, SD 316; left 2,077, SD 376; p < 0.002). In the dorsomedial part, significant local tissue loss (20%-30%) was mapped in the medial and central nuclei. Ventrally, the lateral nucleus (La) and the basolateral ventral medial nucleus (BLVM) were also involved (20%-30% loss). CONCLUSIONS We found in vivo local structural differences in the amygdala of patients with AD. The nuclei involved have known connections to the hippocampus (BLVM, La) and olfactory system (medial nucleus) and with cholinergic pathways (central nucleus). This pattern is consistent with the known pathophysiology of neural systems affected by AD.
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Affiliation(s)
- E Cavedo
- LENITEM (Laboratory of Epidemiology Neuroimaging & Telemedicine), IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Filippini N, Ebmeier KP, MacIntosh BJ, Trachtenberg AJ, Frisoni GB, Wilcock GK, Beckmann CF, Smith SM, Matthews PM, Mackay CE. Differential effects of the APOE genotype on brain function across the lifespan. Neuroimage 2010; 54:602-10. [PMID: 20705142 DOI: 10.1016/j.neuroimage.2010.08.009] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 08/04/2010] [Indexed: 01/21/2023] Open
Abstract
Increasing age and carrying an APOE ε4 allele are well established risk factors for Alzheimer's disease (AD). The earlier age of onset of AD observed in ε4-carriers may reflect an accelerated aging process. We recently reported that APOE genotype modulates brain function decades before the appearance of any cognitive or clinical symptoms. Here we test the hypothesis that APOE influences brain aging by comparing healthy ε4-carriers and non-carriers, using the same imaging protocol in distinct groups of younger and older healthy volunteers. A cross-sectional factorial design was used to examine the effects of age and APOE genotype, and their interaction, on fMRI activation during an encoding memory task. The younger (N=36; age range 20-35; 18 ε4-carriers) and older (35 middle-age/elderly; age range 50-78 years; 15 ε4-carriers) healthy volunteers taking part in the study were cognitively normal. We found a significant interaction between age and ε4-status in the hippocampi, frontal pole, subcortical nuclei, middle temporal gyri and cerebellum, such that aging was associated with decreased activity in e4-carriers and increased activity in non-carriers. Reduced cerebral blood flow was found in the older ε4-carriers relative to older non-carriers despite preserved grey matter volume. Overactivity of brain function in young ε4-carriers is disproportionately reduced with advancing age even before the onset of measurable memory impairment. The APOE genotype determines age-related changes in brain function that may reflect the increased vulnerability of ε4-carriers to late-life pathology or cognitive decline.
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Affiliation(s)
- N Filippini
- University Department of Psychiatry, University of Oxford, Oxford, UK
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Galluzzi S, Geroldi C, Ghidoni R, Paghera B, Amicucci G, Bonetti M, Zanetti O, Cotelli M, Gennarelli M, Frisoni GB. The new Alzheimer’s criteria in a naturalistic series of patients with mild cognitive impairment. J Neurol 2010; 257:2004-14. [DOI: 10.1007/s00415-010-5650-0] [Citation(s) in RCA: 31] [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: 03/20/2010] [Revised: 06/27/2010] [Accepted: 06/29/2010] [Indexed: 10/19/2022]
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Lorenzi M, Donohue M, Paternicò D, Scarpazza C, Ostrowitzki S, Blin O, Irving E, Frisoni GB. Enrichment through biomarkers in clinical trials of Alzheimer's drugs in patients with mild cognitive impairment. Neurobiol Aging 2010; 31:1443-51, 1451.e1. [PMID: 20541287 DOI: 10.1016/j.neurobiolaging.2010.04.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/29/2010] [Accepted: 04/29/2010] [Indexed: 11/25/2022]
Abstract
Clinical trials of disease modifying drugs for Alzheimer's disease (AD) in patients with mild cognitive impairment (MCI) might benefit from enrichment with true AD cases. Four hundred five MCI patients (143 converters and 262 nonconverters to AD within 2 years) of the Alzheimer's disease Neuroimaging Initiative (ADNI) were used. Markers for enrichment were hippocampal atrophy on magnetic resonance (MRI), temporoparietal hypometabolism on FDG PET, cerebrospinal fluid (CSF) biomarkers (Abeta42, tau, and phospho-tau), and cortical amyloid deposition (11C-PIB positron emission tomography (PET)). Two separate enrichment strategies were tested to A) maximize the proportion of MCI converters screened in, and B) minimize the proportion of MCI converters screened out. Based on strategy A, when compared with no enrichment and ADAS-Cog as an outcome measure (sample size of 834), enrichment with 18F-FDG PET and hippocampal volume lowered samples size to 260 and 277 cases per arm, but at the cost of screening out 1,597 and 434 cases per arm. When compared with no enrichment and clinical dementia rating (CDR-SOB) as an outcome measure (sample size of 674), enrichment with hippocampal volume and Abeta42 lowered sample sizes to 191 and 291 cases per arm, with 639 and 157 screened out cases. Strategy B reduced the number of screened out cases (740 for [11C]-PIB PET, 101 hippocampal volume, 82 ADAS-COG and 330 for [18F]-FDG PET) but at the expense of decreased power and a relative increase size (740 for [11C]-PIB PET, 676 for hippocampal volume, 744 for ADAS-Cog, and 517 for [18F]-FDG PET). Enrichment comes at the price of an often relevant proportion of screened out cases, and in clinical trial settings, the balance between enrichment of screened in and loss of screened out patients should be critically discussed.
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Affiliation(s)
- M Lorenzi
- LENITEM Laboratory of Epidemiology, Neuroimaging and Telemedicine, IRCCS San Giovanni di Dio-FBF, Brescia, Italy
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Caroli A, Lorenzi M, Geroldi C, Nobili F, Paghera B, Bonetti M, Cotelli M, Frisoni GB. Metabolic compensation and depression in Alzheimer's disease. Dement Geriatr Cogn Disord 2010; 29:37-45. [PMID: 20110699 DOI: 10.1159/000257761] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to map metabolic compensation and depression in Alzheimer's disease (AD) on a voxel-by-voxel basis. METHODS Twenty-one healthy elderly subjects and 25 AD patients underwent cerebral MR and FDG-PET imaging. All images were processed with SPM2, and whole-brain gray matter (GM) atrophy and hypometabolism maps were computed. Metabolic compensation and depression were assessed using Biological Parametric Mapping software. RESULTS GM atrophy and hypometabolism mapped to similar regions, with varying degrees of severity. Significant metabolic compensation was found in the amygdala, while exceeding hypometabolism was mainly located in the posterior cingulate cortex. CONCLUSION Metabolic depression can be due to both distant effects of atrophy and to additional hypometabolism-inducing factors, such as amyloid deposition. Conversely, metabolic compensation could reflect spared synaptic plasticity of the surviving neurons. The investigation of the metabolic compensation mechanism could help in the comprehension of the AD underlying pathology.
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Affiliation(s)
- A Caroli
- LENITEM Laboratory of Epidemiology, Neuroimaging and Telemedicine, IRCCS S. Giovanni di Dio-Fatebenefratelli, Brescia, Italy
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Moretti DV, Pievani M, Geroldi C, Binetti G, Zanetti O, Rossini PM, Frisoni GB. EEG markers discriminate among different subgroup of patients with mild cognitive impairment. Am J Alzheimers Dis Other Demen 2010; 25:58-73. [PMID: 19204371 PMCID: PMC10845572 DOI: 10.1177/1533317508329814] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [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: 11/16/2022]
Abstract
Aim of the study is to discriminate among participants with mild cognitive impairment through electroencephalography brain rhythms. A total of 79 participants with MCI were classified into 4 subgroups based on the beginning of memory complaints up to the time of first visit. All participants underwent electroencephalography recording, magnetic resonance imaging, apolipoprotein E characterization, and volumetric morphometry estimation of hippocampal region. Electroencephalography markers show 2 distinct patterns: (1) increase of theta/ delta power ratio and highest value of alpha2 band power in the group with shorter duration of disease, the greater right-left hippocampal volume difference and worst memory performance; (2) the highest value of alpha3 band power and the highest alpha3/alpha2 power ratio in the group with the lesser total hippocampal volume but preserved memory performance. Apolipoprotein E4 is linked to a major risk of early beginning of disease. Electroencephalography markers allow a mean correct percentage of correct classification up to 89%.
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Affiliation(s)
- D V Moretti
- Neurophysiology, IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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32
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Nourhashémi F, Olde Rikkert MG, Burns A, Winblad B, Frisoni GB, Fitten J, Vellas B. Follow-up for Alzheimer patients: European Alzheimer Disease Consortium position paper. J Nutr Health Aging 2010; 14:121-30. [PMID: 20126960 DOI: 10.1007/s12603-010-0023-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Alzheimer disease (AD) is one of the leading causes of dependence in the elderly. Providing care for patients with AD is complex and the type of care required depends on the stage of the disease and varies over time. The aim of this article is to discuss available care strategies once the AD diagnosis has been made and to propose a follow-up plan as standard of care at a European level. METHODS The proposals developed in this article stem from the collaborative work of a panel of multidisciplinary experts involved in the care of AD patients (European Alzheimer Disease Consortium) based on the results of published scientific studies and on their experience from clinical practice. CONCLUSION Suggestions for follow-up frequency and easily administered and scored assessment tools are provided, thereby increasing efficiency and quality of care for patients with Alzheimer disease.
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van de Pol LA, Verhey F, Frisoni GB, Tsolaki M, Papapostolou P, Nobili F, Wahlund LO, Minthon L, Frölich L, Hampel H, Soininen H, Knol DL, Barkhof F, Scheltens P, Visser PJ. White matter hyperintensities and medial temporal lobe atrophy in clinical subtypes of mild cognitive impairment: the DESCRIPA study. J Neurol Neurosurg Psychiatry 2009; 80:1069-74. [PMID: 19541689 DOI: 10.1136/jnnp.2008.158881] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Clinical subtypes of mild cognitive impairment (MCI) may represent different underlying aetiologies. METHODS This European, multicentre, memory clinic based study (DESCRIPA) of non-demented subjects investigated whether MCI subtypes have different brain correlates on MRI and whether the relation between subtypes and brain pathology is modified by age. Using visual rating scales, medial temporal lobe atrophy (MTA) (0-4) and white matter hyperintensities (WMH) (0-30) were assessed. RESULTS Severity of MTA differed between MCI subtypes (p<0.001), increasing from a mean of 0.8 (SD 0.7) in subjective complaints (n = 77) to 1.3 (0.8) in non-amnestic MCI (n = 93), and from 1.4 (0.9) in single domain amnestic MCI (n = 70) to 1.7 (0.9) in multiple domain amnestic MCI (n = 89). The association between MCI subtype and MTA was modified by age and mainly present in subjects >70 years of age. Severity of WMH did not differ between MCI subtypes (p = 0.21). However, the combination of MTA and WMH differed between MCI subtypes (p = 0.02) CONCLUSION We conclude that MCI subtypes may have different brain substrates, especially in older subjects. Isolated MTA was mainly associated with amnestic MCI subtypes, suggesting AD as the underlying cause. In non-amnestic MCI, the relatively higher prevalence of MTA in combination with WMH may suggest a different pathophysiological origin.
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Affiliation(s)
- L A van de Pol
- VUMC, Department of Neurology, Amsterdam, The Netherlands.
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Benussi L, Ghidoni R, Galimberti D, Boccardi M, Fenoglio C, Scarpini E, Frisoni GB, Binetti G. TheCST3B haplotype is associated with frontotemporal lobar degeneration. Eur J Neurol 2009; 17:143-6. [DOI: 10.1111/j.1468-1331.2009.02767.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Galluzzi S, Nicosia F, Geroldi C, Alicandri A, Bonetti M, Romanelli G, Zulli R, Frisoni GB. Cardiac Autonomic Dysfunction Is Associated With White Matter Lesions in Patients With Mild Cognitive Impairment. J Gerontol A Biol Sci Med Sci 2009; 64:1312-5. [DOI: 10.1093/gerona/glp105] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Filippini N, MacIntosh BJ, Hough MG, Goodwin GM, Frisoni GB, Ebmeier K, Smith S, Matthews PM, Beckmann CF, Mackay CE. Distinct patterns of brain activity in young carriers of the APOE e4 allele. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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37
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Boccardi M, Frisoni GB, Najt P, Pievani M, Ganzola R, Rossi R, Laakso MP, Aronen HJ, Vaurio O, Perez J, Repo-Tiihonen E, Thompson PM, Tiihonen J. Abnormal Cortical Morphology in Offenders with Psychopathy. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)72027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
OBJECTIVE To study the relationship between gray matter atrophy and amyloid deposition in Alzheimer disease (AD). METHODS Volumetric magnetic resonance (MR) and [11C]-PIB PET were acquired from 23 patients with AD and 17 healthy older persons. Standardized [11C]-PIB uptake values were coregistered to MR scans in a standard space. Decreased density of and increased [11C]-PIB uptake in the gray matter of patients with AD vs controls were assessed with both voxel-based (p < 0.05 corrected) and region-of-interest (ROI) analyses. The relationship between decreased density of and increased [11C]-PIB uptake in the gray matter was investigated with voxel-based Pearson r maps (thresholded at p < 0.05) and ROI linear regression plots. RESULTS Atrophy mapped to the hippocampus and increased [11C]-PIB uptake to large frontal, parietal, and posterior cingulate cortical areas. ROI analysis showed the largest effect size for atrophy in the hippocampus (2.01) and amygdala (1.27) and the highest effect size for [11C]-PIB uptake in frontal (2.66), posterior cingulate/retrosplenial (2.43), insular (2.41), and temporal (2.23) regions. In the hippocampus, [11C]-PIB uptake was significantly increased, but effect size was milder (1.72). Significant correlations between atrophy and increased [11C]-PIB uptake were found in the hippocampal (r = -0.54) and amygdalar ROIs (r = -0.40) but not in the frontal, temporal, posterior cingulate/retrosplenial, insular, and caudate ROIs (r between 0.04 and 0.25). CONCLUSION The medial temporal lobe might be highly susceptible to amyloid toxicity, whereas neocortical areas might be more resilient.
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Affiliation(s)
- G B Frisoni
- Laboratory of Epidemiology and Neuroimaging, IRCCS San Giovanni di Dio-FBF, via Pilastroni 4, I-25123 Brescia, Italy.
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Pievani M, Rasser PE, Galluzzi S, Benussi L, Ghidoni R, Sabattoli F, Bonetti M, Binetti G, Thompson PM, Frisoni GB. Mapping the effect of APOE epsilon4 on gray matter loss in Alzheimer's disease in vivo. Neuroimage 2009; 45:1090-8. [PMID: 19349226 PMCID: PMC2739903 DOI: 10.1016/j.neuroimage.2009.01.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [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: 10/08/2008] [Revised: 12/12/2008] [Accepted: 01/07/2009] [Indexed: 11/17/2022] Open
Abstract
Previous studies suggest that in Alzheimer's disease (AD) the Apolipoprotein E (APOE) epsilon4 allele is associated with greater vulnerability of medial temporal lobe structures. However, less is known about its effect on the whole cortical mantle. Here we aimed to identify APOE-related patterns of cortical atrophy in AD using an advanced computational anatomy technique. We studied 15 AD patients carriers (epsilon4+, age: 72+/-10 SD years, MMSE: 20+/-3 SD) and 14 non-carriers (epsilon4-, age: 69+/-9, MMSE: 20+/-5) of the epsilon4 allele and compared them to 29 age-and-sex matched controls (age: 70+/-9, MMSE: 28+/-1). Each subject underwent a clinical evaluation, a neuropsychological battery, and high-resolution MRI. UCLA's cortical pattern matching technique was used to identify regions of local cortical atrophy. epsilon4+ and epsilon4- patients showed similar performance on neuropsychological tests (p>.05, t-test). Diffuse cortical atrophy was detected for both epsilon4+ (p=.0001, permutation test) and epsilon4- patients (p=.0001, permutation test) relative to controls, and overall gray matter loss was about 15% in each patients group. Differences in gray matter loss between carriers and non-carriers mapped to the temporal cortex and right occipital pole (20% greater loss in carriers) and to the posterior cingulate, left orbitofrontal and dorsal fronto-parietal cortex (5-15% greater loss in non-carriers). APOE effect in AD was not significant (p>.74, ANOVA), but a significant APOE by region (temporal vs fronto-parietal cortex) interaction was detected (p=.002, ANOVA), in both early and late-onset patients (p<.05, ANOVA). We conclude that the epsilon4 allele modulates disease phenotype in AD, being associated with a pattern of differential temporal and fronto-parietal vulnerability.
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Affiliation(s)
- M Pievani
- LENITEM Laboratory of Epidemiology, Neuroimaging and Telemedicine, IRCCS Centro San Giovanni di Dio - FBF, Brescia, Italy
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40
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Affiliation(s)
- G B Frisoni
- IRCCS Fatebenefratelli, via Pilastroni 1, Brescia, Italy.
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41
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Abstract
The first disease modifying drugs targeting beta amyloid that were tested in phase II and III clinical trials have been disappointing. We believe that failures descended from a leaky drug development pipeline where insufficient attention has been devoted to valid animal models and valid imaging markers of disease progression. In the future, valid animal models will need to take into greater consideration the natural and molecular history of AD, where both beta amyloid and tau play a key role. Valid imaging markers of disease progression will need to be identified in humans and translated into animal versions. Future testing of putative disease modifying drugs in valid animal models with valid imaging markers of disease progression will allow to maximize the predictability of their effect in phase II and III clinical trials.
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Moretti DV, Fracassi C, Pievani M, Geroldi C, Binetti G, Zanetti O, Sosta K, Rossini PM, Frisoni GB. Increase of theta/gamma ratio is associated with memory impairment. Clin Neurophysiol 2009; 120:295-303. [PMID: 19121602 DOI: 10.1016/j.clinph.2008.11.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 11/07/2008] [Accepted: 11/14/2008] [Indexed: 11/28/2022]
Affiliation(s)
- D V Moretti
- IRCCS San Giovanni di Dio Fatebenefratelli, Department of Neurophysiology, 4, Pilastroni Road, 25125 Brescia, Italy.
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43
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Winblad B, Frisoni GB, Frolich L, Johannsen P, Johansson G, Kehoe P, Lovestone S, Olde-Rikkert M, Reynish E, Visser PJ, Vellas B. Editorial: EADC (European Alzheimer Disease Consortium) recommendations for future Alzheimer disease research in Europe. J Nutr Health Aging 2008; 12:683-4. [PMID: 19043641 DOI: 10.1007/bf03028614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Caroli A, Geroldi C, Nobili F, Barnden LR, Guerra UP, Bonetti M, Frisoni GB. Functional compensation in incipient Alzheimer's disease. Neurobiol Aging 2008; 31:387-97. [PMID: 18554752 DOI: 10.1016/j.neurobiolaging.2008.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 03/27/2008] [Accepted: 05/01/2008] [Indexed: 10/21/2022]
Abstract
Aim of this study was to investigate the functional compensation mechanism in incipient Alzheimer's disease (AD). Seventeen elderly healthy subjects and nine amnestic MCI patients with incipient AD underwent brain MR scan and 99mTc ECD SPECT. We processed all images with SPM2, we created t maps, showing the wholebrain GM atrophy and functional changes, and we properly masked them with each other in order to assess relatively preserved perfusion or depression. Incipient AD showed GM atrophy in the medial temporal and temporoparietal lobes, in the insula and in the retrosplenial cortex, and GM hypoperfusion in the medial temporal and temporoparietal lobes. Relatively preserved perfusion, we could hypothesize to be compensatory in the setting of neuronal loss, was found in the posterior cingulate, in the head of the hippocampus, in the amigdala, and in the insula bilaterally, while functional depression occurred in bilateral parahippocampal gyri. In AD, a perfusional compensatory mechanism takes place in the neocortex, while perfusional depression occurs in the medial temporal lobe. These results help understand the reactive phenomena induced by the brain to try and counteract the pathological changes of AD.
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Affiliation(s)
- A Caroli
- LENITEM Laboratory of Epidemiology, Neuroimaging, and Telemedicine, IRCCS San Giovanni di Dio-FBF, 25125 Brescia, Italy
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45
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Visser PJ, Verhey FRJ, Boada M, Bullock R, De Deyn PP, Frisoni GB, Frolich L, Hampel H, Jolles J, Jones R, Minthon L, Nobili F, Olde Rikkert M, Ousset PJ, Rigaud AS, Scheltens P, Soininen H, Spiru L, Touchon J, Tsolaki M, Vellas B, Wahlund LO, Wilcock G, Winblad B. Development of screening guidelines and clinical criteria for predementia Alzheimer's disease. The DESCRIPA Study. Neuroepidemiology 2008; 30:254-65. [PMID: 18515975 DOI: 10.1159/000135644] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 03/02/2008] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND There is an urgent need to identify subjects with Alzheimer's disease (AD) in the predementia phase, but validated diagnostic approaches are currently lacking. In this paper, we present the background, design and methods of a study, which aims to develop clinical criteria for predementia AD. We also present baseline characteristics of the subjects included. The study was part of the multicentre DESCRIPA project, which is being conducted within the network of the European Alzheimer's Disease Consortium. METHODS Clinical criteria will be based on a prospective cohort study of non-demented subjects older than 55 years and referred to a memory clinic. At baseline, a number of markers and risk factors for AD were collected, including demographic variables, measures of performance in activities of daily living, cognitive, neuroimaging and genetic markers, and serum and cerebrospinal fluid markers. Subjects will be reassessed annually for 2-3 years, and we will evaluate which combination of variables best predicts AD-type dementia at follow-up. RESULTS Between 2003 and 2005, 881 subjects were included from 20 memory clinics. Subjects were on average 70.3 years old, and had 10.4 years of education. The average score on the Mini-Mental State Examination was 27.4.
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Affiliation(s)
- P J Visser
- Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, The Netherlands.
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Galluzzi S, Geroldi C, Benussi L, Ghidoni R, Testa C, Borsci G, Bonetti M, Manfellotto D, Romanelli G, Zulli R, Binetti G, Frisoni GB. Association of Blood Pressure and Genetic Background With White Matter Lesions in Patients With Mild Cognitive Impairment. J Gerontol A Biol Sci Med Sci 2008; 63:510-7. [DOI: 10.1093/gerona/63.5.510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Duchesne S, Caroli A, Geroldi C, Barillot C, Frisoni GB, Collins DL. MRI-based automated computer classification of probable AD versus normal controls. IEEE Trans Med Imaging 2008; 27:509-520. [PMID: 18390347 DOI: 10.1109/tmi.2007.908685] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Automated computer classification (ACC) techniques are needed to facilitate physician's diagnosis of complex diseases in individual patients. We provide an example of ACC using computational techniques within the context of cross-sectional analysis of magnetic resonance images (MRI) in neurodegenerative diseases, namely Alzheimer's dementia (AD). In this paper, the accuracy of our ACC methodology is assessed when presented with real life, imperfect data, i.e., cohorts of MRI with varying acquisition parameters and imaging quality. The comparative methodology uses the Jacobian determinants derived from dense deformation fields and scaled grey-level intensity from a selected volume of interest centered on the medial temporal lobe. The ACC performance is assessed in a series of leave-one-out experiments aimed at separating 75 probable AD and 75 age-matched normal controls. The resulting accuracy is 92% using a support vector machine classifier based on least squares optimization. Finally, it is shown in the Appendix that determinants and scaled grey-level intensity are appreciably more robust to varying parameters in validation studies using simulated data, when compared to raw intensities or grey/white matter volumes. The ability of cross-sectional MRI at detecting probable AD with high accuracy could have profound implications in the management of suspected AD candidates.
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Affiliation(s)
- S Duchesne
- Centre de Recherche de l'Université Laval Robert Giffard, Québec, QC, G1J 2G3 Canada.
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Sabattoli F, Boccardi M, Galluzzi S, Treves A, Thompson PM, Frisoni GB. Hippocampal shape differences in dementia with Lewy bodies. Neuroimage 2008; 41:699-705. [PMID: 18467130 DOI: 10.1016/j.neuroimage.2008.02.060] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 02/11/2008] [Accepted: 02/27/2008] [Indexed: 01/02/2023] Open
Abstract
To assess the morphological changes of the hippocampus in Lewy body dementia (LBD) patients we used radial atrophy mapping, a mathematical modeling method sensitive to subtle differences in hippocampal shape. T1-weighted high resolution magnetic resonance (MR) scans were acquired from 14 LBD and 28 controls of similar age and gender, and were compared to those of 28 patients with Alzheimer's disease (AD) described previously. MR images were normalized by linear (12 parameter) transformation to a customized template. The hippocampal formation was isolated by manual tracing. Group differences were assessed with algorithms that average hippocampal shapes across subjects, using three-dimensional parametric surface mesh models. In LBD patients, significant tissue loss amounting to 10-20% was found in the hippocampal subregions corresponding to the anterior portion of the CA1 field on both sides, along the longitudinal midline in the dorsal aspect within the CA2-3 field, and in the subiculum and presubiculum. The direct comparisons between LBD and AD patients showed that this pattern of local atrophy is different from that characteristic of AD. LBD pattern of hippocampal atrophy might be related to the peculiar neuropathology of the disease.
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Affiliation(s)
- F Sabattoli
- LENITEM Laboratory of Epidemiology, Neuroimaging, and Telemedicine - IRCCS Centro S. Giovanni di Dio - FBF, via Pilastroni 4, 25125 Brescia, Italy
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Abstract
The neuropathological and cognitive changes preceding Alzheimer's disease (AD) appear to begin decades before disease symptoms make the clinical diagnosis obvious. Clinical trials have begun to focus on preventive treatments aimed to slow cognitive decline in people with only subjective memory complaints. However, it is not clear how many years before clinical diagnosis of Alzheimer's disease is possible to recognize early signs of neurodegeneration. We report evidence from the literature showing feasibility to diagnose AD at the stage of mild cognitive impairment (MCI) and also a few years before the MCI stage with imaging markers. However, we showed that neuroimaging brain changes evidenced decades before MCI are not early signs of neurodegeneration but expression of genetic risk states for AD or markers of inter-individual variability of cognitive performance due to genetic or environmental factors.
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Affiliation(s)
- S Galluzzi
- Laboratory of Epidemiology, Neuroimaging and Telemedicine IRCCS San Giovanni di Dio - FBF, via Pilastroni 4, 25125 Brescia, Italy
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50
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Caroli A, Testa C, Geroldi C, Nobili F, Barnden LR, Guerra UP, Bonetti M, Frisoni GB. Cerebral perfusion correlates of conversion to Alzheimer's disease in amnestic mild cognitive impairment. J Neurol 2007; 254:1698-707. [DOI: 10.1007/s00415-007-0631-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 03/23/2007] [Accepted: 04/23/2007] [Indexed: 10/22/2022]
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