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Vassilaki M, Pittock RR, Aakre JA, Castillo AM, Ramanan VK, Kremers WK, Jack CR, Vemuri P, Lowe VJ, Knopman DS, Petersen RC, Graff-Radford J. Author Response: Eligibility for Anti-Amyloid Treatment in a Population-Based Study of Cognitive Aging. Neurology 2024; 102:e209377. [PMID: 38648608 DOI: 10.1212/wnl.0000000000209377] [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: 04/25/2024] Open
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Karstens AJ, Christianson TJ, Lundt ES, Machulda MM, Mielke MM, Fields JA, Kremers WK, Graff-Radford J, Vemuri P, Jack CR, Knopman DS, Petersen RC, Stricker NH. Mayo normative studies: regression-based normative data for ages 30-91 years with a focus on the Boston Naming Test, Trail Making Test and Category Fluency. J Int Neuropsychol Soc 2024; 30:389-401. [PMID: 38014536 PMCID: PMC11014770 DOI: 10.1017/s1355617723000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Normative neuropsychological data are essential for interpretation of test performance in the context of demographic factors. The Mayo Normative Studies (MNS) aim to provide updated normative data for neuropsychological measures administered in the Mayo Clinic Study of Aging (MCSA), a population-based study of aging that randomly samples residents of Olmsted County, Minnesota, from age- and sex-stratified groups. We examined demographic effects on neuropsychological measures and validated the regression-based norms in comparison to existing normative data developed in a similar sample. METHOD The MNS includes cognitively unimpaired adults ≥30 years of age (n = 4,428) participating in the MCSA. Multivariable linear regressions were used to determine demographic effects on test performance. Regression-based normative formulas were developed by first converting raw scores to normalized scaled scores and then regressing on age, age2, sex, and education. Total and sex-stratified base rates of low scores (T < 40) were examined in an older adult validation sample and compared with Mayo's Older Americans Normative Studies (MOANS) norms. RESULTS Independent linear regressions revealed variable patterns of linear and/or quadratic effects of age (r2 = 6-27% variance explained), sex (0-13%), and education (2-10%) across measures. MNS norms improved base rates of low performance in the older adult validation sample overall and in sex-specific patterns relative to MOANS. CONCLUSIONS Our results demonstrate the need for updated norms that consider complex demographic associations on test performance and that specifically exclude participants with mild cognitive impairment from the normative sample.
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Affiliation(s)
- Aimee J. Karstens
- Division of Neurocognitive Disorders, Department of
Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Teresa J. Christianson
- Division of Biomedical Statistics and Informatics,
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily S. Lundt
- Division of Biomedical Statistics and Informatics,
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary M. Machulda
- Division of Neurocognitive Disorders, Department of
Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle M. Mielke
- Department of Epidemiology and Prevention, Wake Forest
University School of Medicine, Winston-Salem, NC, USA
- Department of Gerontology and Geriatric Medicine, Wake
Forest University School of Medicine, Winston-Salem, NC, USA
| | - Julie A. Fields
- Division of Neurocognitive Disorders, Department of
Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter K. Kremers
- Division of Biomedical Statistics and Informatics,
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | | - Nikki H. Stricker
- Division of Neurocognitive Disorders, Department of
Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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3
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Udine E, DeJesus-Hernandez M, Tian S, das Neves SP, Crook R, Finch NA, Baker MC, Pottier C, Graff-Radford NR, Boeve BF, Petersen RC, Knopman DS, Josephs KA, Oskarsson B, Da Mesquita S, Petrucelli L, Gendron TF, Dickson DW, Rademakers R, van Blitterswijk M. Abundant transcriptomic alterations in the human cerebellum of patients with a C9orf72 repeat expansion. Acta Neuropathol 2024; 147:73. [PMID: 38641715 PMCID: PMC11031479 DOI: 10.1007/s00401-024-02720-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/21/2024]
Abstract
The most prominent genetic cause of both amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD) is a repeat expansion in the gene C9orf72. Importantly, the transcriptomic consequences of the C9orf72 repeat expansion remain largely unclear. Here, we used short-read RNA sequencing (RNAseq) to profile the cerebellar transcriptome, detecting alterations in patients with a C9orf72 repeat expansion. We focused on the cerebellum, since key C9orf72-related pathologies are abundant in this neuroanatomical region, yet TDP-43 pathology and neuronal loss are minimal. Consistent with previous work, we showed a reduction in the expression of the C9orf72 gene and an elevation in homeobox genes, when comparing patients with the expansion to both patients without the C9orf72 repeat expansion and control subjects. Interestingly, we identified more than 1000 alternative splicing events, including 4 in genes previously associated with ALS and/or FTLD. We also found an increase of cryptic splicing in C9orf72 patients compared to patients without the expansion and controls. Furthermore, we demonstrated that the expression level of select RNA-binding proteins is associated with cryptic splice junction inclusion. Overall, this study explores the presence of widespread transcriptomic changes in the cerebellum, a region not confounded by severe neurodegeneration, in post-mortem tissue from C9orf72 patients.
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Affiliation(s)
- Evan Udine
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
- Neuroscience Ph.D. Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | | | - Shulan Tian
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Richard Crook
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - NiCole A Finch
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Matthew C Baker
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Cyril Pottier
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | | | | | | | | | | | - Björn Oskarsson
- Department of Neurology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Sandro Da Mesquita
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
- Neuroscience Ph.D. Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
- Neuroscience Ph.D. Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Tania F Gendron
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
- Neuroscience Ph.D. Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
- Neuroscience Ph.D. Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
- VIB Center for Molecular Neurology, VIB, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Marka van Blitterswijk
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
- Neuroscience Ph.D. Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA.
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4
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Singh NA, Goodrich AW, Graff-Radford J, Machulda MM, Sintini I, Carlos AF, Robinson CG, Reid RI, Lowe VJ, Jack CR, Petersen RC, Boeve BF, Josephs KA, Kantarci K, Whitwell JL. Altered structural and functional connectivity in Posterior Cortical Atrophy and Dementia with Lewy bodies. Neuroimage 2024; 290:120564. [PMID: 38442778 PMCID: PMC11019668 DOI: 10.1016/j.neuroimage.2024.120564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/03/2024] [Indexed: 03/07/2024] Open
Abstract
Posterior cortical atrophy (PCA) and dementia with Lewy bodies (DLB) show distinct atrophy and overlapping hypometabolism profiles, but it is unknown how disruptions in structural and functional connectivity compare between these disorders and whether breakdowns in connectivity relate to either atrophy or hypometabolism. Thirty amyloid-positive PCA patients, 24 amyloid-negative DLB patients and 30 amyloid-negative cognitively unimpaired (CU) healthy individuals were recruited at Mayo Clinic, Rochester, MN, and underwent a 3T head MRI, including structural MRI, resting state functional MRI (rsfMRI) and diffusion tensor imaging (DTI) sequences, as well as [18F] fluorodeoxyglucose (FDG) PET. We assessed functional connectivity within and between 12 brain networks using rsfMRI and the CONN functional connectivity toolbox and calculated regional DTI metrics using the Johns Hopkins atlas. Multivariate linear-regression models corrected for multiple comparisons and adjusted for age and sex compared DTI metrics and within-network and between-network functional connectivity across groups. Regional gray-matter volumes and FDG-PET standard uptake value ratios (SUVRs) were calculated and analyzed at the voxel-level using SPM12. We used univariate linear-regression models to investigate the relationship between connectivity measures, gray-matter volume, and FDG-PET SUVR. On DTI, PCA showed degeneration in occipito-parietal white matter, posterior thalamic radiations, splenium of the corpus collosum and sagittal stratum compared to DLB and CU, with greater degeneration in the temporal white matter and the fornix compared to CU. We observed no white-matter degeneration in DLB compared to CU. On rsfMRI, reduced within-network connectivity was present in dorsal and ventral default mode networks (DMN) and the dorsal-attention network in PCA compared to DLB and CU, with reduced within-network connectivity in the visual and sensorimotor networks compared to CU. DLB showed reduced connectivity in the cerebellar network compared to CU. Between-network analysis showed increased connectivity in both cerebellar-to-sensorimotor and cerebellar-to-dorsal attention network connectivity in PCA and DLB. PCA showed reduced anterior DMN-to-cerebellar and dorsal attention-to-sensorimotor connectivity, while DLB showed reduced posterior DMN-to-sensorimotor connectivity compared to CU. PCA showed reduced dorsal DMN-to-visual connectivity compared to DLB. The multimodal analysis revealed weak associations between functional connectivity and volume in PCA, and between functional connectivity and metabolism in DLB. These findings suggest that PCA and DLB have unique connectivity alterations, with PCA showing more widespread disruptions in both structural and functional connectivity; yet some overlap was observed with both disorders showing increased connectivity from the cerebellum.
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Affiliation(s)
| | - Austin W Goodrich
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | | | - Mary M Machulda
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States
| | - Irene Sintini
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Arenn F Carlos
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - Robert I Reid
- Department of Radiology, Mayo Clinic, Rochester, MN, United States; Department of Information Technology, Mayo Clinic, Rochester, MN, United States
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | | | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
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Kouri N, Frankenhauser I, Peng Z, Labuzan SA, Boon BDC, Moloney CM, Pottier C, Wickland DP, Caetano-Anolles K, Corriveau-Lecavalier N, Tranovich JF, Wood AC, Hinkle KM, Lincoln SJ, Spychalla AJ, Senjem ML, Przybelski SA, Engelberg-Cook E, Schwarz CG, Kwan RS, Lesser ER, Crook JE, Carter RE, Ross OA, Lachner C, Ertekin-Taner N, Ferman TJ, Fields JA, Machulda MM, Ramanan VK, Nguyen AT, Reichard RR, Jones DT, Graff-Radford J, Boeve BF, Knopman DS, Petersen RC, Jack CR, Kantarci K, Day GS, Duara R, Graff-Radford NR, Dickson DW, Lowe VJ, Vemuri P, Murray ME. Clinicopathologic Heterogeneity and Glial Activation Patterns in Alzheimer Disease. JAMA Neurol 2024:2817289. [PMID: 38619853 PMCID: PMC11019448 DOI: 10.1001/jamaneurol.2024.0784] [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] [Received: 10/17/2023] [Accepted: 01/05/2024] [Indexed: 04/16/2024]
Abstract
Importance Factors associated with clinical heterogeneity in Alzheimer disease (AD) lay along a continuum hypothesized to associate with tangle distribution and are relevant for understanding glial activation considerations in therapeutic advancement. Objectives To examine clinicopathologic and neuroimaging characteristics of disease heterogeneity in AD along a quantitative continuum using the corticolimbic index (CLix) to account for individuality of spatially distributed tangles found at autopsy. Design, Setting, and Participants This cross-sectional study was a retrospective medical record review performed on the Florida Autopsied Multiethnic (FLAME) cohort accessioned from 1991 to 2020. Data were analyzed from December 2022 to December 2023. Structural magnetic resonance imaging (MRI) and tau positron emission tomography (PET) were evaluated in an independent neuroimaging group. The FLAME cohort includes 2809 autopsied individuals; included in this study were neuropathologically diagnosed AD cases (FLAME-AD). A digital pathology subgroup of FLAME-AD cases was derived for glial activation analyses. Main Outcomes and Measures Clinicopathologic factors of heterogeneity that inform patient history and neuropathologic evaluation of AD; CLix score (lower, relative cortical predominance/hippocampal sparing vs higher, relative cortical sparing/limbic predominant cases); neuroimaging measures (ie, structural MRI and tau-PET). Results Of the 2809 autopsied individuals in the FLAME cohort, 1361 neuropathologically diagnosed AD cases were evaluated. A digital pathology subgroup included 60 FLAME-AD cases. The independent neuroimaging group included 93 cases. Among the 1361 FLAME-AD cases, 633 were male (47%; median [range] age at death, 81 [54-96] years) and 728 were female (53%; median [range] age at death, 81 [53-102] years). A younger symptomatic onset (Spearman ρ = 0.39, P < .001) and faster decline on the Mini-Mental State Examination (Spearman ρ = 0.27; P < .001) correlated with a lower CLix score in FLAME-AD series. Cases with a nonamnestic syndrome had lower CLix scores (median [IQR], 13 [9-18]) vs not (median [IQR], 21 [15-27]; P < .001). Hippocampal MRI volume (Spearman ρ = -0.45; P < .001) and flortaucipir tau-PET uptake in posterior cingulate and precuneus cortex (Spearman ρ = -0.74; P < .001) inversely correlated with CLix score. Although AD cases with a CLix score less than 10 had higher cortical tangle count, we found lower percentage of CD68-activated microglia/macrophage burden (median [IQR], 0.46% [0.32%-0.75%]) compared with cases with a CLix score of 10 to 30 (median [IQR], 0.75% [0.51%-0.98%]) and on par with a CLix score of 30 or greater (median [IQR], 0.40% [0.32%-0.57%]; P = .02). Conclusions and Relevance Findings show that AD heterogeneity exists along a continuum of corticolimbic tangle distribution. Reduced CD68 burden may signify an underappreciated association between tau accumulation and microglia/macrophages activation that should be considered in personalized therapy for immune dysregulation.
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Affiliation(s)
- Naomi Kouri
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Isabelle Frankenhauser
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
- Paracelsus Medical Private University, Salzburg, Austria
| | - Zhongwei Peng
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | | | | | | | - Cyril Pottier
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Daniel P. Wickland
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | | | - Nick Corriveau-Lecavalier
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Ashley C. Wood
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Kelly M. Hinkle
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | | | | | | | - Scott A. Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | | | | | - Rain S. Kwan
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Elizabeth R. Lesser
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Julia E. Crook
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Owen A. Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Christian Lachner
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida
| | - Nilüfer Ertekin-Taner
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | - Tanis J. Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida
| | - Julie A. Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | | | - Aivi T. Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - David T. Jones
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Gregory S. Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | - Ranjan Duara
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Florida
| | | | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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6
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Lavrova A, Pham NTT, Vernon CJ, Carlos AF, Petersen RC, Dickson DW, Lowe VJ, Jack CR, Whitwell JL, Josephs KA. A multimodal clinical diagnostic approach using MRI and 18F-FDG-PET for antemortem diagnosis of TDP-43 in cases with low-intermediate Alzheimer's disease neuropathologic changes and primary age-related tauopathy. J Neurol 2024:10.1007/s00415-024-12312-5. [PMID: 38578498 DOI: 10.1007/s00415-024-12312-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To evaluate the utility of clinical assessment scales for MRI and 18F-FDG-PET as potential in vivo predictive diagnostic tools for TAR DNA-binding protein of 43 kDa (TDP-43) proteinopathy in cases with low-intermediate Alzheimer's disease neuropathologic changes (ADNC) and primary age-related tauopathy (PART). METHODS We conducted a cross-sectional analysis on patients with antemortem MRI and 18F-FDG-PET scans and postmortem diagnosis of low-intermediate ADNC or PART (Braak stage ≤ III; Thal β-amyloid phase 0-5). We employed visual imaging scales to grade structural changes on MRI and metabolic changes on 18F-FDG-PET and statistically compared demographic and clinicopathological characteristics between TDP-43 positive and negative cases. Independent regression analyses were performed to assess further influences of pathological characteristics on imaging outcomes. Within-reader repeatability and inter-reader reliability were calculated (CI = 0.95). Additional quantitative region-of-interest analyses of MRI gray matter volumes and PET ligand uptake were performed. RESULTS Of the 64 cases in the study, 20 (31%) were TDP-43 ( +), of which 12 (60%) were female. TDP-43 ( +) cases were more likely to have hippocampal sclerosis (HS) (p = 0.014) and moderate-severe medial temporal lobe atrophy on MRI (p = 0.048). TDP-43( +) cases also showed a trend for less parietal atrophy on MRI (p = 0.086) and more medial temporal lobe hypometabolism on 18F-FDG-PET (p = 0.087) than TDP-43( - ) cases. Regression analysis showed an association between medial temporal hypometabolism and HS (p = 0.0113). ICC values for MRI and PET within one reader were 0.75 and 0.91; across two readers were 0.79 and 0.82. The region-of-interest-based analysis confirmed a significant difference between TDP-43( +) and TDP-43( - ) cases for medial temporal lobe gray matter volume on MRI (p = 0.014) and medial temporal metabolism on PET (p = 0.011). CONCLUSION Visual inspection of the medial temporal lobe on MRI and FDG-PET may help to predict TDP-43 status in the context of low-intermediate ADNC and PART.
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Affiliation(s)
- Anna Lavrova
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Arenn F Carlos
- Department of Neurology, College of Medicine and Science, 200 First Street S.W., Rochester, MN, 55905, USA
| | - Ronald C Petersen
- Department of Neurology, College of Medicine and Science, 200 First Street S.W., Rochester, MN, 55905, USA
| | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Keith A Josephs
- Department of Neurology, College of Medicine and Science, 200 First Street S.W., Rochester, MN, 55905, USA.
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7
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Shue F, White LJ, Hendrix R, Ulrich J, Henson RL, Knight W, Martens YA, Wang N, Roy B, Starling SC, Ren Y, Xiong C, Asmann YW, Syrjanen JA, Vassilaki M, Mielke MM, Timsina J, Sung YJ, Cruchaga C, Holtzman DM, Bu G, Petersen RC, Heckman MG, Kanekiyo T. CSF biomarkers of immune activation and Alzheimer's disease for predicting cognitive impairment risk in the elderly. Sci Adv 2024; 10:eadk3674. [PMID: 38569027 PMCID: PMC10990276 DOI: 10.1126/sciadv.adk3674] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/23/2024] [Indexed: 04/05/2024]
Abstract
The immune system substantially influences age-related cognitive decline and Alzheimer's disease (AD) progression, affected by genetic and environmental factors. In a Mayo Clinic Study of Aging cohort, we examined how risk factors like APOE genotype, age, and sex affect inflammatory molecules and AD biomarkers in cerebrospinal fluid (CSF). Among cognitively unimpaired individuals over 65 (N = 298), we measured 365 CSF inflammatory molecules, finding age, sex, and diabetes status predominantly influencing their levels. We observed age-related correlations with AD biomarkers such as total tau, phosphorylated tau-181, neurofilament light chain (NfL), and YKL40. APOE4 was associated with lower Aβ42 and higher SNAP25 in CSF. We explored baseline variables predicting cognitive decline risk, finding age, CSF Aβ42, NfL, and REG4 to be independently correlated. Subjects with older age, lower Aβ42, higher NfL, and higher REG4 at baseline had increased cognitive impairment risk during follow-up. This suggests that assessing CSF inflammatory molecules and AD biomarkers could predict cognitive impairment risk in the elderly.
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Affiliation(s)
- Francis Shue
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Launia J. White
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Rachel Hendrix
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jason Ulrich
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rachel L. Henson
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - William Knight
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Yuka A. Martens
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ni Wang
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Bhaskar Roy
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Yingxue Ren
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Chengjie Xiong
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO 93110, USA
| | - Yan W. Asmann
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Jeremy A. Syrjanen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN 55905, USA
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN 55905, USA
| | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN 55905, USA
| | - Jigyasha Timsina
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 93110, USA
| | - Yun Ju Sung
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 93110, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 93110, USA
| | - David M. Holtzman
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Guojun Bu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Michael G. Heckman
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Takahisa Kanekiyo
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
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8
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Corriveau-Lecavalier N, Barnard LR, Botha H, Graff-Radford J, Ramanan VK, Lee J, Dicks E, Rademakers R, Boeve BF, Machulda MM, Fields JA, Dickson DW, Graff-Radford N, Knopman DS, Lowe VJ, Petersen RC, Jack CR, Jones DT. Uncovering the distinct macro-scale anatomy of dysexecutive and behavioural degenerative diseases. Brain 2024; 147:1483-1496. [PMID: 37831661 PMCID: PMC10994526 DOI: 10.1093/brain/awad356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/28/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
There is a longstanding ambiguity regarding the clinical diagnosis of dementia syndromes predominantly targeting executive functions versus behaviour and personality. This is due to an incomplete understanding of the macro-scale anatomy underlying these symptomatologies, a partial overlap in clinical features and the fact that both phenotypes can emerge from the same pathology and vice versa. We collected data from a patient cohort of which 52 had dysexecutive Alzheimer's disease, 30 had behavioural variant frontotemporal dementia (bvFTD), seven met clinical criteria for bvFTD but had Alzheimer's disease pathology (behavioural Alzheimer's disease) and 28 had amnestic Alzheimer's disease. We first assessed group-wise differences in clinical and cognitive features and patterns of fluorodeoxyglucose (FDG) PET hypometabolism. We then performed a spectral decomposition of covariance between FDG-PET images to yield latent patterns of relative hypometabolism unbiased by diagnostic classification, which are referred to as 'eigenbrains'. These eigenbrains were subsequently linked to clinical and cognitive data and meta-analytic topics from a large external database of neuroimaging studies reflecting a wide range of mental functions. Finally, we performed a data-driven exploratory linear discriminant analysis to perform eigenbrain-based multiclass diagnostic predictions. Dysexecutive Alzheimer's disease and bvFTD patients were the youngest at symptom onset, followed by behavioural Alzheimer's disease, then amnestic Alzheimer's disease. Dysexecutive Alzheimer's disease patients had worse cognitive performance on nearly all cognitive domains compared with other groups, except verbal fluency which was equally impaired in dysexecutive Alzheimer's disease and bvFTD. Hypometabolism was observed in heteromodal cortices in dysexecutive Alzheimer's disease, temporo-parietal areas in amnestic Alzheimer's disease and frontotemporal areas in bvFTD and behavioural Alzheimer's disease. The unbiased spectral decomposition analysis revealed that relative hypometabolism in heteromodal cortices was associated with worse dysexecutive symptomatology and a lower likelihood of presenting with behaviour/personality problems, whereas relative hypometabolism in frontotemporal areas was associated with a higher likelihood of presenting with behaviour/personality problems but did not correlate with most cognitive measures. The linear discriminant analysis yielded an accuracy of 82.1% in predicting diagnostic category and did not misclassify any dysexecutive Alzheimer's disease patient for behavioural Alzheimer's disease and vice versa. Our results strongly suggest a double dissociation in that distinct macro-scale underpinnings underlie predominant dysexecutive versus personality/behavioural symptomatology in dementia syndromes. This has important implications for the implementation of criteria to diagnose and distinguish these diseases and supports the use of data-driven techniques to inform the classification of neurodegenerative diseases.
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Affiliation(s)
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Vijay K Ramanan
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Jeyeon Lee
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ellen Dicks
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Center for Molecular Neurology, Antwerp University, Antwerp, Belgium
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
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9
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Mak E, Reid RI, Przybelski SA, Lesnick TG, Schwarz CG, Senjem ML, Raghavan S, Vemuri P, Jack CR, Min HK, Jain MK, Miyagawa T, Forsberg LK, Fields JA, Savica R, Graff-Radford J, Jones DT, Botha H, St Louis EK, Knopman DS, Ramanan VK, Dickson DW, Graff-Radford NR, Ferman TJ, Petersen RC, Lowe VJ, Boeve BF, O'Brien JT, Kantarci K. Influences of amyloid-β and tau on white matter neurite alterations in dementia with Lewy bodies. NPJ Parkinsons Dis 2024; 10:76. [PMID: 38570511 PMCID: PMC10991290 DOI: 10.1038/s41531-024-00684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Abstract
Dementia with Lewy bodies (DLB) is a neurodegenerative condition often co-occurring with Alzheimer's disease (AD) pathology. Characterizing white matter tissue microstructure using Neurite Orientation Dispersion and Density Imaging (NODDI) may help elucidate the biological underpinnings of white matter injury in individuals with DLB. In this study, diffusion tensor imaging (DTI) and NODDI metrics were compared in 45 patients within the dementia with Lewy bodies spectrum (mild cognitive impairment with Lewy bodies (n = 13) and probable dementia with Lewy bodies (n = 32)) against 45 matched controls using conditional logistic models. We evaluated the associations of tau and amyloid-β with DTI and NODDI parameters and examined the correlations of AD-related white matter injury with Clinical Dementia Rating (CDR). Structural equation models (SEM) explored relationships among age, APOE ε4, amyloid-β, tau, and white matter injury. The DLB spectrum group exhibited widespread white matter abnormalities, including reduced fractional anisotropy, increased mean diffusivity, and decreased neurite density index. Tau was significantly associated with limbic and temporal white matter injury, which was, in turn, associated with worse CDR. SEM revealed that amyloid-β exerted indirect effects on white matter injury through tau. We observed widespread disruptions in white matter tracts in DLB that were not attributed to AD pathologies, likely due to α-synuclein-related injury. However, a fraction of the white matter injury could be attributed to AD pathology. Our findings underscore the impact of AD pathology on white matter integrity in DLB and highlight the utility of NODDI in elucidating the biological basis of white matter injury in DLB.
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Affiliation(s)
- Elijah Mak
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Robert I Reid
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Scott A Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Timothy G Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Hoon Ki Min
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Manoj K Jain
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Toji Miyagawa
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Erik K St Louis
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Dennis W Dickson
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Tanis J Ferman
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Ronald C Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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10
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Fu S, Jia H, Vassilaki M, Keloth VK, Dang Y, Zhou Y, Garg M, Petersen RC, St Sauver J, Moon S, Wang L, Wen A, Li F, Xu H, Tao C, Fan J, Liu H, Sohn S. FedFSA: Hybrid and federated framework for functional status ascertainment across institutions. J Biomed Inform 2024; 152:104623. [PMID: 38458578 PMCID: PMC11005095 DOI: 10.1016/j.jbi.2024.104623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/12/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Patients' functional status assesses their independence in performing activities of daily living, including basic ADLs (bADL), and more complex instrumental activities (iADL). Existing studies have discovered that patients' functional status is a strong predictor of health outcomes, particularly in older adults. Depite their usefulness, much of the functional status information is stored in electronic health records (EHRs) in either semi-structured or free text formats. This indicates the pressing need to leverage computational approaches such as natural language processing (NLP) to accelerate the curation of functional status information. In this study, we introduced FedFSA, a hybrid and federated NLP framework designed to extract functional status information from EHRs across multiple healthcare institutions. METHODS FedFSA consists of four major components: 1) individual sites (clients) with their private local data, 2) a rule-based information extraction (IE) framework for ADL extraction, 3) a BERT model for functional status impairment classification, and 4) a concept normalizer. The framework was implemented using the OHNLP Backbone for rule-based IE and open-source Flower and PyTorch library for federated BERT components. For gold standard data generation, we carried out corpus annotation to identify functional status-related expressions based on ICF definitions. Four healthcare institutions were included in the study. To assess FedFSA, we evaluated the performance of category- and institution-specific ADL extraction across different experimental designs. RESULTS ADL extraction performance ranges from an F1-score of 0.907 to 0.986 for bADL and 0.825 to 0.951 for iADL across the four healthcare sites. The performance for ADL extraction with impairment ranges from an F1-score of 0.722 to 0.954 for bADL and 0.674 to 0.813 for iADL across four healthcare sites. For category-specific ADL extraction, laundry and transferring yielded relatively high performance, while dressing, medication, bathing, and continence achieved moderate-high performance. Conversely, food preparation and toileting showed low performance. CONCLUSION NLP performance varied across ADL categories and healthcare sites. Federated learning using a FedFSA framework performed higher than non-federated learning for impaired ADL extraction at all healthcare sites. Our study demonstrated the potential of the federated learning framework in functional status extraction and impairment classification in EHRs, exemplifying the importance of a large-scale, multi-institutional collaborative development effort.
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Affiliation(s)
- Sunyang Fu
- Mayo Clinic, Rochester, MN, United States; University of Texas Health Science Center, Houston, TX, United States.
| | - Heling Jia
- Mayo Clinic, Rochester, MN, United States.
| | | | | | - Yifang Dang
- University of Texas Health Science Center, Houston, TX, United States.
| | - Yujia Zhou
- University of Texas Health Science Center, Houston, TX, United States.
| | | | | | | | | | - Liwei Wang
- Mayo Clinic, Rochester, MN, United States.
| | - Andrew Wen
- University of Texas Health Science Center, Houston, TX, United States.
| | - Fang Li
- University of Texas Health Science Center, Houston, TX, United States.
| | - Hua Xu
- Yale University, New Haven, CT, United States.
| | - Cui Tao
- University of Texas Health Science Center, Houston, TX, United States.
| | | | - Hongfang Liu
- Mayo Clinic, Rochester, MN, United States; University of Texas Health Science Center, Houston, TX, United States.
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11
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Diaz‐Galvan P, Przybelski SA, Algeciras‐Schimnich A, Figdore DJ, Lesnick TG, Schwarz CG, Senjem ML, Gunter JL, Jack CR, Min PH, Jain MK, Miyagawa T, Forsberg LK, Fields JA, Savica R, Graff‐Radford J, Ramanan VK, Jones DT, Botha H, St Louis EK, Knopman DS, Graff‐Radford NR, Ferman TJ, Petersen RC, Lowe VJ, Boeve BF, Kantarci K. Plasma biomarkers of Alzheimer's disease in the continuum of dementia with Lewy bodies. Alzheimers Dement 2024; 20:2485-2496. [PMID: 38329197 PMCID: PMC11032523 DOI: 10.1002/alz.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Patients with dementia with Lewy bodies (DLB) may have Alzheimers disease (AD) pathology that can be detected by plasma biomarkers. Our objective was to evaluate plasma biomarkers of AD and their association with positron emission tomography (PET) biomarkers of amyloid and tau deposition in the continuum of DLB, starting from prodromal stages of the disease. METHODS The cohort included patients with isolated rapid eye movement (REM) sleep behavior disorder (iRBD), mild cognitive impairment with Lewy bodies (MCI-LB), or DLB, with a concurrent blood draw and PET scans. RESULTS Abnormal levels of plasma glial fibrillary acidic protein (GFAP) were found at the prodromal stage of MCI-LB in association with increased amyloid PET. Abnormal levels of plasma phosphorylated tau (p-tau)-181 and neurofilament light (NfL) were found at the DLB stage. Plasma p-tau-181 showed the highest accuracy in detecting abnormal amyloid and tau PET in patients with DLB. DISCUSSION The range of AD co-pathology can be detected with plasma biomarkers in the DLB continuum, particularly with plasma p-tau-181 and GFAP.
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Affiliation(s)
| | | | | | - Dan J. Figdore
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | - Timothy G. Lesnick
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | | | | | | | - Paul H Min
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
| | - Manoj K. Jain
- Department of RadiologyMayo ClinicJacksonvilleFloridaUSA
| | - Toji Miyagawa
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | | | - Julie A. Fields
- Department of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | | | | | | | | | - Hugo Botha
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Erik K. St Louis
- Mayo Center for Sleep MedicineMayo ClinicRochesterMinnesotaUSA
- Departments of Neurology and Clinical and Translational ResearchMayo Clinic Southwest WisconsinLa CrosseWisconsinUSA
| | | | | | - Tanis J. Ferman
- Department of Psychiatry & PsychologyMayo ClinicJacksonvilleFloridaUSA
| | - Ronald C. Petersen
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Val J. Lowe
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
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12
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Calliari A, Daughrity LM, Albagli EA, Castellanos Otero P, Yue M, Jansen-West K, Islam NN, Caulfield T, Rawlinson B, DeTure M, Cook C, Graff-Radford NR, Day GS, Boeve BF, Knopman DS, Petersen RC, Josephs KA, Oskarsson B, Gitler AD, Dickson DW, Gendron TF, Prudencio M, Ward ME, Zhang YJ, Petrucelli L. HDGFL2 cryptic proteins report presence of TDP-43 pathology in neurodegenerative diseases. Mol Neurodegener 2024; 19:29. [PMID: 38539264 PMCID: PMC10967196 DOI: 10.1186/s13024-024-00718-8] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
This letter demonstrates the potential of novel cryptic proteins resulting from TAR DNA-binding protein 43 (TDP-43) dysfunction as markers of TDP-43 pathology in neurodegenerative diseases.
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Affiliation(s)
- Anna Calliari
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Ellen A Albagli
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Mei Yue
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Naeyma N Islam
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Michael DeTure
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neurobiology of Disease Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Casey Cook
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neurobiology of Disease Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | | | | | - Aaron D Gitler
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neurobiology of Disease Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Tania F Gendron
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neurobiology of Disease Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Mercedes Prudencio
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neurobiology of Disease Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michael E Ward
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
- Center for Alzheimer's and Related Dementias, National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
| | - Yong-Jie Zhang
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA.
- Neurobiology of Disease Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA.
- Neurobiology of Disease Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Rochester, MN, USA.
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13
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Robinson CG, Goodrich AW, Weigand SD, Pham NTT, Carlos AF, Buciuc M, Murray ME, Nguyen AT, Reichard RR, Knopman DS, Petersen RC, Dickson DW, Utianski RL, Whitwell JL, Josephs KA, Machulda MM. Determinants of confrontation naming deficits on the Boston Naming Test associated with transactive response DNA-binding protein 43 pathology. J Int Neuropsychol Soc 2024:1-9. [PMID: 38525671 DOI: 10.1017/s1355617724000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To determine whether poorer performance on the Boston Naming Test (BNT) in individuals with transactive response DNA-binding protein 43 pathology (TDP-43+) is due to greater loss of word knowledge compared to retrieval-based deficits. METHODS Retrospective clinical-pathologic study of 282 participants with Alzheimer's disease neuropathologic changes (ADNC) and known TDP-43 status. We evaluated item-level performance on the 60-item BNT for first and last available assessment. We fit cross-sectional negative binomial count models that assessed total number of incorrect items, number correct of responses with phonemic cue (reflecting retrieval difficulties), and number of "I don't know" (IDK) responses (suggestive of loss of word knowledge) at both assessments. Models included TDP-43 status and adjusted for sex, age, education, years from test to death, and ADNC severity. Models that evaluated the last assessment adjusted for number of prior BNT exposures. RESULTS 43% were TDP-43+. The TDP-43+ group had worse performance on BNT total score at first (p = .01) and last assessments (p = .01). At first assessment, TDP-43+ individuals had an estimated 29% (CI: 7%-56%) higher mean number of incorrect items after adjusting for covariates, and a 51% (CI: 15%-98%) higher number of IDK responses compared to TDP-43-. At last assessment, compared to TDP-43-, the TDP-43+ group on average missed 31% (CI: 6%-62%; p = .01) more items and had 33% more IDK responses (CI: 1% fewer to 78% more; p = .06). CONCLUSIONS An important component of poorer performance on the BNT in participants who are TDP-43+ is having loss of word knowledge versus retrieval difficulties.
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Affiliation(s)
| | - Austin W Goodrich
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Stephen D Weigand
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Arenn F Carlos
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Marina Buciuc
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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14
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Shir D, Corriveau-Lecavalier N, Bermudez Noguera C, Barnard L, Pham NTT, Botha H, Duffy JR, Clark HM, Utianski RL, Knopman DS, Petersen RC, Boeve BF, Murray ME, Nguyen AT, Reichard RR, Dickson DW, Day GS, Kremers WK, Graff-Radford NR, Jones DT, Machulda MM, Fields JA, Whitwell JL, Josephs KA, Graff-Radford J. Clinicoradiological and neuropathological evaluation of primary progressive aphasia. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332862. [PMID: 38514176 DOI: 10.1136/jnnp-2023-332862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Primary progressive aphasia (PPA) defines a group of neurodegenerative disorders characterised by language decline. Three PPA variants correlate with distinct underlying pathologies: semantic variant PPA (svPPA) with transactive response DNA-binding protein of 43 kD (TDP-43) proteinopathy, agrammatic variant PPA (agPPA) with tau deposition and logopenic variant PPA (lvPPA) with Alzheimer's disease (AD). Our objectives were to differentiate PPA variants using clinical and neuroimaging features, assess progression and evaluate structural MRI and a novel 18-F fluorodeoxyglucose positron emission tomography (FDG-PET) image decomposition machine learning algorithm for neuropathology prediction. METHODS We analysed 82 autopsied patients diagnosed with PPA from 1998 to 2022. Clinical histories, language characteristics, neuropsychological results and brain imaging were reviewed. A machine learning framework using a k-nearest neighbours classifier assessed FDG-PET scans from 45 patients compared with a large reference database. RESULTS PPA variant distribution: 35 lvPPA (80% AD), 28 agPPA (89% tauopathy) and 18 svPPA (72% frontotemporal lobar degeneration-TAR DNA-binding protein (FTLD-TDP)). Apraxia of speech was associated with 4R-tauopathy in agPPA, while pure agrammatic PPA without apraxia was linked to 3R-tauopathy. Longitudinal data revealed language dysfunction remained the predominant deficit for patients with lvPPA, agPPA evolved to corticobasal or progressive supranuclear palsy syndrome (64%) and svPPA progressed to behavioural variant frontotemporal dementia (44%). agPPA-4R-tauopathy exhibited limited pre-supplementary motor area atrophy, lvPPA-AD displayed temporal atrophy extending to the superior temporal sulcus and svPPA-FTLD-TDP had severe temporal pole atrophy. The FDG-PET-based machine learning algorithm accurately predicted clinical diagnoses and underlying pathologies. CONCLUSIONS Distinguishing 3R-taupathy and 4R-tauopathy in agPPA may rely on apraxia of speech presence. Additional linguistic and clinical features can aid neuropathology prediction. Our data-driven brain metabolism decomposition approach effectively predicts underlying neuropathology.
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Affiliation(s)
- Dror Shir
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Leland Barnard
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary M Machulda
- Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julie A Fields
- Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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15
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Walton RL, Koga S, Beasley AI, White LJ, Griesacker T, Murray ME, Kasanuki K, Hou X, Fiesel FC, Springer W, Uitti RJ, Fields JA, Botha H, Ramanan VK, Kantarci K, Lowe VJ, Jack CR, Ertekin-Taner N, Savica R, Graff-Radford J, Petersen RC, Parisi JE, Reichard RR, Graff-Radford NR, Ferman TJ, Boeve BF, Wszolek ZK, Dickson DW, Ross OA, Heckman MG. Role of GBA variants in Lewy body disease neuropathology. Acta Neuropathol 2024; 147:54. [PMID: 38472443 PMCID: PMC11049671 DOI: 10.1007/s00401-024-02699-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 03/14/2024]
Abstract
Rare and common GBA variants are risk factors for both Parkinson's disease (PD) and dementia with Lewy bodies (DLB). However, the degree to which GBA variants are associated with neuropathological features in Lewy body disease (LBD) is unknown. Herein, we assessed 943 LBD cases and examined associations of 15 different neuropathological outcomes with common and rare GBA variants. Neuropathological outcomes included LBD subtype, presence of a high likelihood of clinical DLB (per consensus guidelines), LB counts in five cortical regions, tyrosine hydroxylase immunoreactivity in the dorsolateral and ventromedial putamen, ventrolateral substantia nigra neuronal loss, Braak neurofibrillary tangle (NFT) stage, Thal amyloid phase, phospho-ubiquitin (pS65-Ub) level, TDP-43 pathology, and vascular disease. Sequencing of GBA exons revealed a total of 42 different variants (4 common [MAF > 0.5%], 38 rare [MAF < 0.5%]) in our series, and 165 cases (17.5%) had a copy of the minor allele for ≥ 1 variant. In analysis of common variants, p.L483P was associated with a lower Braak NFT stage (OR = 0.10, P < 0.001). In gene-burden analysis, presence of the minor allele for any GBA variant was associated with increased odds of a high likelihood of DLB (OR = 2.00, P < 0.001), a lower Braak NFT stage (OR = 0.48, P < 0.001), a lower Thal amyloid phase (OR = 0.55, P < 0.001), and a lower pS65-Ub level (β: -0.37, P < 0.001). Subgroup analysis revealed that GBA variants were most common in LBD cases with a combination of transitional/diffuse LBD and Braak NFT stage 0-II or Thal amyloid phase 0-1, and correspondingly that the aforementioned associations of GBA gene-burden with a decreased Braak NFT stage and Thal amyloid phase were observed only in transitional or diffuse LBD cases. Our results indicate that in LBD, GBA variants occur most frequently in cases with greater LB pathology and low AD pathology, further informing disease-risk associations of GBA in PD, PD dementia, and DLB.
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Affiliation(s)
- Ronald L Walton
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Launia J White
- Division of Clinical Trials and Biostatistics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA
| | | | | | - Koji Kasanuki
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Xu Hou
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Julie A Fields
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Kejal Kantarci
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Department of Nuclear Medicine, Mayo Clinic, Rochester, MN, USA
| | - Clifford R Jack
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
| | - Nilufer Ertekin-Taner
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Joseph E Parisi
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R Ross Reichard
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, USA
| | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA.
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Pradeep A, Raghavan S, Przybelski SA, Preboske G, Schwarz CG, Lowe VJ, Knopman DS, Petersen RC, Jack CR, Graff-Radford J, Cogswell PM, Vemuri P. Can white matter hyperintensities based Fazekas visual assessment scales inform about Alzheimer's disease pathology in the population? Res Sq 2024:rs.3.rs-4017874. [PMID: 38558965 PMCID: PMC10980106 DOI: 10.21203/rs.3.rs-4017874/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background White matter hyperintensities (WMH) are considered hallmark features of cerebral small vessel disease and have recently been linked to Alzheimer's disease pathology. Their distinct spatial distributions, namely periventricular versus deep WMH, may differ by underlying age-related and pathobiological processes contributing to cognitive decline. We aimed to identify the spatial patterns of WMH using the 4-scale Fazekas visual assessment and explore their differential association with age, vascular health, Alzheimer's imaging markers, namely amyloid and tau burden, and cognition. Because our study consisted of scans from GE and Siemens scanners with different resolutions, we also investigated inter-scanner reproducibility and combinability of WMH measurements on imaging. Methods We identified 1144 participants from the Mayo Clinic Study of Aging consisting of older adults from Olmsted County, Minnesota with available structural magnetic resonance imaging (MRI), amyloid, and tau positron emission tomography (PET). WMH distribution patterns were assessed on FLAIR-MRI, both 2D axial and 3D, using Fazekas ratings of periventricular and deep WMH severity. We compared the association of periventricular and deep WMH scales with vascular risk factors, amyloid-PET and tau-PET standardized uptake value ratio, WMH volume, and cognition using Pearson partial correlation after adjusting for age. We also evaluated vendor compatibility and reproducibility of the Fazekas scales using intraclass correlations (ICC). Results Periventricular and deep WMH measurements showed similar correlations with age, cardiometabolic conditions score (vascular risk), and cognition, (p < 0.001). Both periventricular WMH and deep WMH showed weak associations with amyloidosis (R = 0.07, p = < 0.001), and none with tau burden. We found substantial agreement between data from the two scanners for Fazekas measurements (ICC = 0.78). The automated WMH volume had high discriminating power for identifying participants with Fazekas ≥ 2 (area under curve = 0.97). Conclusion Our study investigates risk factors underlying WMH spatial patterns and their impact on global cognition, with no discernible differences between periventricular and deep WMH. We observed minimal impact of amyloidosis on WMH severity. These findings, coupled with enhanced inter-scanner reproducibility of WMH data, suggest the combinability of inter-scanner data assessed by harmonized protocols in the context of vascular contributions to cognitive impairment and dementia biomarker research.
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Garbarino VR, Palavicini JP, Melendez J, Barthelemy N, He Y, Kautz TF, Lopez-Cruzan M, Mathews JJ, Xu P, Zhan B, Saliba A, Ragi N, Sharma K, Craft S, Petersen RC, Espindola-Netto JM, Xue A, Tchkonia T, Kirkland JL, Seshadri S, Salardini A, Musi N, Bateman RJ, Gonzales MM, Orr ME. Evaluation of Exploratory Fluid Biomarker Results from a Phase 1 Senolytic Trial in Mild Alzheimer's Disease. Res Sq 2024:rs.3.rs-3994894. [PMID: 38496619 PMCID: PMC10942554 DOI: 10.21203/rs.3.rs-3994894/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Senescent cell accumulation contributes to the progression of age-related disorders including Alzheimer's disease (AD). Clinical trials evaluating senolytics, drugs that clear senescent cells, are underway, but lack standardized outcome measures. Our team recently published data from the first open-label trial to evaluate senolytics (dasatinib plus quercetin) in AD. After 12-weeks of intermittent treatment, we reported brain exposure to dasatinib, favorable safety and tolerability, and modest post-treatment changes in cerebrospinal fluid (CSF) inflammatory and AD biomarkers using commercially available assays. Herein, we present more comprehensive exploratory analyses of senolytic associated changes in AD relevant proteins, metabolites, lipids, and transcripts measured across blood, CSF, and urine. These analyses included mass spectrometry for precise quantification of amyloid beta (Aß) and tau in CSF; immunoassays to assess senescence associated secretory factors in plasma, CSF, and urine; mass spectrometry analysis of urinary metabolites and lipids in blood and CSF; and transcriptomic analyses relevant to chronic stress measured in peripheral blood cells. Levels of Aß and tau species remained stable. Targeted cytokine and chemokine analyses revealed treatment-associated increases in inflammatory plasma fractalkine and MMP-7 and CSF IL-6. Urinary metabolites remained unchanged. Modest treatment-associated lipid profile changes suggestive of decreased inflammation were observed both peripherally and centrally. Blood transcriptomic analysis indicated downregulation of inflammatory genes including FOS, FOSB, IL1β, IL8, JUN, JUNB, PTGS2. These data provide a foundation for developing standardized outcome measures across senolytic studies and indicate distinct biofluid-specific signatures that will require validation in future studies. ClinicalTrials.gov: NCT04063124.
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Affiliation(s)
- Valentina R. Garbarino
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Cell Systems and Anatomy, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Juan Pablo Palavicini
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Justin Melendez
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Tracy Family SILQ Center for Neurodegenerative Biology, St. Louis, MO, USA
| | - Nicolas Barthelemy
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Tracy Family SILQ Center for Neurodegenerative Biology, St. Louis, MO, USA
| | - Yingxin He
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Tracy Family SILQ Center for Neurodegenerative Biology, St. Louis, MO, USA
| | - Tiffany F. Kautz
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Marisa Lopez-Cruzan
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio, San Antonio, TX, USA
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Julia J. Mathews
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Peng Xu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bin Zhan
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Afaf Saliba
- Center for Precision Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Nagarjunachary Ragi
- Center for Precision Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kumar Sharma
- Center for Precision Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Suzanne Craft
- Department of Internal Medicine Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | - Ailing Xue
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Tamara Tchkonia
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | | | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Arash Salardini
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Nicolas Musi
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Randall J. Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Tracy Family SILQ Center for Neurodegenerative Biology, St. Louis, MO, USA
| | - Mitzi M. Gonzales
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Miranda E. Orr
- Department of Internal Medicine Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Salisbury VA Medical Center, Salisbury, NC, 28144, USA
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18
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Jack CR, Wiste HJ, Algeciras‐Schimnich A, Weigand SD, Figdore DJ, Lowe VJ, Vemuri P, Graff‐Radford J, Ramanan VK, Knopman DS, Mielke MM, Machulda MM, Fields J, Schwarz CG, Cogswell PM, Senjem ML, Therneau TM, Petersen RC. Comparison of plasma biomarkers and amyloid PET for predicting memory decline in cognitively unimpaired individuals. Alzheimers Dement 2024; 20:2143-2154. [PMID: 38265198 PMCID: PMC10984437 DOI: 10.1002/alz.13651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND We compared the ability of several plasma biomarkers versus amyloid positron emission tomography (PET) to predict rates of memory decline among cognitively unimpaired individuals. METHODS We studied 645 Mayo Clinic Study of Aging participants. Predictor variables were age, sex, education, apolipoprotein E (APOE) ε4 genotype, amyloid PET, and plasma amyloid beta (Aβ)42/40, phosphorylated tau (p-tau)181, neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and p-tau217. The outcome was a change in a memory composite measure. RESULTS All plasma biomarkers, except NfL, were associated with mean memory decline in models with individual biomarkers. However, amyloid PET and plasma p-tau217, along with age, were key variables independently associated with mean memory decline in models combining all predictors. Confidence intervals were narrow for estimates of population mean prediction, but person-level prediction intervals were wide. DISCUSSION Plasma p-tau217 and amyloid PET provide useful information about predicting rates of future cognitive decline in cognitively unimpaired individuals at the population mean level, but not at the individual person level.
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Affiliation(s)
| | - Heather J. Wiste
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | - Stephen D. Weigand
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Dan J. Figdore
- Department of Laboratory MedicineMayo ClinicRochesterMinnesotaUSA
| | - Val J. Lowe
- Department of Nuclear MedicineMayo ClinicRochesterMinnesotaUSA
| | | | | | | | | | - Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Mary M. Machulda
- Department of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Julie Fields
- Department of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | | | | | | | - Terry M. Therneau
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
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Robinson CG, Lee J, Min PH, Przybelski SA, Josephs KA, Jones DT, Graff‐Radford J, Boeve BF, Knopman DS, Jack CR, Petersen RC, Machulda MM, Fields JA, Lowe VJ. Significance of a positive tau PET scan with a negative amyloid PET scan. Alzheimers Dement 2024; 20:1923-1932. [PMID: 38159060 PMCID: PMC10947949 DOI: 10.1002/alz.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/24/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The implications of positive tau positron emission tomography (T) with negative beta amyloid positron emission tomography (A) are not well understood. We investigated cognitive performance in participants who were T+ but A-. METHODS We evaluated 98 participants from the Mayo Clinic who were T+ and A-. Participants were matched 2:1 to A- and T- cognitively unimpaired (CU) controls. Cognitive test scores were compared between different groups. RESULTS The A-T+ group demonstrated lower performance than the A-T- group on the Mini-Mental Status Exam (MMSE) (p < 0.001), Wechsler Memory Scale-Revised Logical Memory I (p < 0.001) and Logical Memory II (p < 0.001), Auditory Verbal Learning Test (AVLT) delayed recall (p = 0.004), category fluency (animals p = 0.005; vegetables p = 0.021), Trail Making Test A and B (p < 0.001), and others. There were no significant differences in demographic features or apolipoprotein E (APOE) e4 genotype between CU A-T+ and CI A-T+. DISCUSSION A-T+ participants show an association with lower cognitive performance.
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Affiliation(s)
| | - Jeyeon Lee
- College of MedicineHanyang UniversitySeoulSouth Korea
| | - Paul H. Min
- Departments of RadiologyMayo ClinicRochesterMinnesotaUSA
| | | | | | - David T. Jones
- Departments of NeurologyMayo ClinicRochesterMinnesotaUSA
| | | | | | | | | | | | - Mary M. Machulda
- Departments of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Julie A. Fields
- Departments of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Val J. Lowe
- Departments of RadiologyMayo ClinicRochesterMinnesotaUSA
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20
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Lee J, Burkett BJ, Min HK, Senjem ML, Dicks E, Corriveau-Lecavalier N, Mester CT, Wiste HJ, Lundt ES, Murray ME, Nguyen AT, Reichard RR, Botha H, Graff-Radford J, Barnard LR, Gunter JL, Schwarz CG, Kantarci K, Knopman DS, Boeve BF, Lowe VJ, Petersen RC, Jack CR, Jones DT. Synthesizing images of tau pathology from cross-modal neuroimaging using deep learning. Brain 2024; 147:980-995. [PMID: 37804318 PMCID: PMC10907092 DOI: 10.1093/brain/awad346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/30/2023] [Accepted: 09/24/2023] [Indexed: 10/09/2023] Open
Abstract
Given the prevalence of dementia and the development of pathology-specific disease-modifying therapies, high-value biomarker strategies to inform medical decision-making are critical. In vivo tau-PET is an ideal target as a biomarker for Alzheimer's disease diagnosis and treatment outcome measure. However, tau-PET is not currently widely accessible to patients compared to other neuroimaging methods. In this study, we present a convolutional neural network (CNN) model that imputes tau-PET images from more widely available cross-modality imaging inputs. Participants (n = 1192) with brain T1-weighted MRI (T1w), fluorodeoxyglucose (FDG)-PET, amyloid-PET and tau-PET were included. We found that a CNN model can impute tau-PET images with high accuracy, the highest being for the FDG-based model followed by amyloid-PET and T1w. In testing implications of artificial intelligence-imputed tau-PET, only the FDG-based model showed a significant improvement of performance in classifying tau positivity and diagnostic groups compared to the original input data, suggesting that application of the model could enhance the utility of the metabolic images. The interpretability experiment revealed that the FDG- and T1w-based models utilized the non-local input from physically remote regions of interest to estimate the tau-PET, but this was not the case for the Pittsburgh compound B-based model. This implies that the model can learn the distinct biological relationship between FDG-PET, T1w and tau-PET from the relationship between amyloid-PET and tau-PET. Our study suggests that extending neuroimaging's use with artificial intelligence to predict protein specific pathologies has great potential to inform emerging care models.
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Affiliation(s)
- Jeyeon Lee
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Korea
| | - Brian J Burkett
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Hoon-Ki Min
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ellen Dicks
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Carly T Mester
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Heather J Wiste
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Emily S Lundt
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ross R Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - David T Jones
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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21
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Khandalavala KR, Marinelli JP, Lohse CM, Przybelski SA, Petersen RC, Vassilaki M, Vemuri P, Carlson ML. Neuroimaging Characteristics of Hearing Loss in the Mayo Clinic Study of Aging. Otolaryngol Head Neck Surg 2024; 170:886-895. [PMID: 38018509 PMCID: PMC10922536 DOI: 10.1002/ohn.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To investigate the association between standard pure tone and speech audiometry with neuroimaging characteristics reflective of aging and dementia in older adults. STUDY DESIGN Prospective population-based study. SETTING Single tertiary care referral center. METHODS Participants from the Mayo Clinic Study of aging 60 years old or older with normal cognition or mild cognitive impairment, baseline neuroimaging, and a behavioral audiogram associated with neuroimaging were eligible for study. Imaging modalities included structural MRI (sMRI) and fluid-attenuated inversion recovery MRI (FLAIR-MRI; N = 605), diffusion tensor imaging MRI (DTI-MRI; N = 444), and fluorodeoxyglucose-positron emission tomography (FDG-PET; N = 413). Multivariable logistic and linear regression models were used to evaluate associations with neuroimaging outcomes. RESULTS Mean (SD) pure tone average (PTA) was 33 (15) dB HL and mean (SD) word recognition score (WRS) was 91% (14). There were no significant associations between audiometric performance and cortical thinning assessed by sMRI. Each 10-dB increase in PTA was associated with increased likelihood of abnormal white-matter hyperintensity (WMH) from FLAIR-MRI (odds ratio 1.26, P = .02). From DTI-MRI, participants with <100% WRSs had significantly lower fractional anisotropy in the genu of the corpus callosum (parameter estimate [PE] -0.012, P = .008) compared to those with perfect WRSs. From FDG-PET, each 10% decrease in WRSs was associated with decreased uptake in the anterior cingulate cortex (PE -0.013, P = .001). CONCLUSION Poorer audiometric performance was not significantly associated with cortical thinning but was associated with white matter damage relevant to cerebrovascular disease (increased abnormal WMH, decreased corpus callosum diffusion). These neuroimaging results suggest a pathophysiologic link between hearing loss and cerebrovascular disease.
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Affiliation(s)
| | - John P. Marinelli
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Ronald C. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Matthew L. Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
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Raulin AC, Doss SV, Heckman MG, Craver EC, Li Z, Ikezu TC, Sekiya H, Liu CC, Martens YA, Rosenberg CL, Kuchenbecker LA, DeTure M, Reichard RR, Nguyen AT, Constantopoulos E, Larsen RA, Kounaves EK, Murray ME, Dickson DW, Petersen RC, Bu G, Kanekiyo T. Impact of APOE on amyloid and tau accumulation in argyrophilic grain disease and Alzheimer's disease. Acta Neuropathol Commun 2024; 12:25. [PMID: 38336940 PMCID: PMC10854035 DOI: 10.1186/s40478-024-01731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024] Open
Abstract
Alzheimer's disease (AD), characterized by the deposition of amyloid-β (Aβ) in senile plaques and neurofibrillary tangles of phosphorylated tau (pTau), is increasingly recognized as a complex disease with multiple pathologies. AD sometimes pathologically overlaps with age-related tauopathies such as four repeat (4R)-tau predominant argyrophilic grain disease (AGD). While AGD is often detected with AD pathology, the contribution of APOE4 to AGD risk is not clear despite its robust effects on AD pathogenesis. Specifically, how APOE genotype influences Aβ and tau pathology in co-occurring AGD and AD has not been fully understood. Using postmortem brain samples (N = 353) from a neuropathologically defined cohort comprising of cases with AD and/or AGD pathology built to best represent different APOE genotypes, we measured the amounts of major AD-related molecules, including Aβ40, Aβ42, apolipoprotein E (apoE), total tau (tTau), and pTau181, in the temporal cortex. The presence of tau lesions characteristic of AD (AD-tau) was correlated with cognitive decline based on Mini-Mental State Examination (MMSE) scores, while the presence of AGD tau lesions (AGD-tau) was not. Interestingly, while APOE4 increased the risk of AD-tau pathology, it did not increase the risk of AGD-tau pathology. Although APOE4 was significantly associated with higher levels of insoluble Aβ40, Aβ42, apoE, and pTau181, the APOE4 effect was no longer detected in the presence of AGD-tau. We also found that co-occurrence of AGD with AD was associated with lower insoluble Aβ42 and pTau181 levels. Overall, our findings suggest that different patterns of Aβ, tau, and apoE accumulation mediate the development of AD-tau and AGD-tau pathology, which is affected by APOE genotype.
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Affiliation(s)
| | - Sydney V Doss
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Zonghua Li
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Tadafumi C Ikezu
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Hiroaki Sekiya
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Chia-Chen Liu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- Biogen, Cambridge, MA, 02142, USA
| | - Yuka A Martens
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- SciNeuro Pharmaceuticals, Rockville, MD, 20850, USA
| | | | | | - Michael DeTure
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Eleni Constantopoulos
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Rachel A Larsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Emmaline K Kounaves
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | | | - Guojun Bu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- Division of Life Science, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong, China
| | - Takahisa Kanekiyo
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA.
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23
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Pagali SR, Kumar R, LeMahieu AM, Basso MR, Boeve BF, Croarkin PE, Geske JR, Hassett LC, Huston J, Kung S, Lundstrom BN, Petersen RC, St Louis EK, Welker KM, Worrell GA, Pascual-Leone A, Lapid MI. Efficacy and safety of transcranial magnetic stimulation on cognition in mild cognitive impairment, Alzheimer's disease, Alzheimer's disease-related dementias, and other cognitive disorders: a systematic review and meta-analysis. Int Psychogeriatr 2024:1-49. [PMID: 38329083 DOI: 10.1017/s1041610224000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE We aim to analyze the efficacy and safety of TMS on cognition in mild cognitive impairment (MCI), Alzheimer's disease (AD), AD-related dementias, and nondementia conditions with comorbid cognitive impairment. DESIGN Systematic review, Meta-Analysis. SETTING We searched MEDLINE, Embase, Cochrane database, APA PsycINFO, Web of Science, and Scopus from January 1, 2000, to February 9, 2023. PARTICIPANTS AND INTERVENTIONS RCTs, open-label, and case series studies reporting cognitive outcomes following TMS intervention were included. MEASUREMENT Cognitive and safety outcomes were measured. Cochrane Risk of Bias for RCTs and MINORS (Methodological Index for Non-Randomized Studies) criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42022326423). RESULTS The systematic review included 143 studies (n = 5,800 participants) worldwide, encompassing 94 RCTs, 43 open-label prospective, 3 open-label retrospective, and 3 case series. The meta-analysis included 25 RCTs in MCI and AD. Collectively, these studies provide evidence of improved global and specific cognitive measures with TMS across diagnostic groups. Only 2 studies (among 143) reported 4 adverse events of seizures: 3 were deemed TMS unrelated and another resolved with coil repositioning. Meta-analysis showed large effect sizes on global cognition (Mini-Mental State Examination (SMD = 0.80 [0.26, 1.33], p = 0.003), Montreal Cognitive Assessment (SMD = 0.85 [0.26, 1.44], p = 0.005), Alzheimer's Disease Assessment Scale-Cognitive Subscale (SMD = -0.96 [-1.32, -0.60], p < 0.001)) in MCI and AD, although with significant heterogeneity. CONCLUSION The reviewed studies provide favorable evidence of improved cognition with TMS across all groups with cognitive impairment. TMS was safe and well tolerated with infrequent serious adverse events.
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Affiliation(s)
- Sandeep R Pagali
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MI, USA
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MI, USA
| | - Rakesh Kumar
- Department of Psychiatry and Psychology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MI, USA
| | - Allison M LeMahieu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MI, USA
| | - Michael R Basso
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
| | | | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
| | - Jennifer R Geske
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MI, USA
| | | | - John Huston
- Department of Radiology (Huston and Welker), Mayo Clinic, Rochester, MI, USA
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
| | | | | | | | - Kirk M Welker
- Department of Radiology (Huston and Welker), Mayo Clinic, Rochester, MI, USA
| | | | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna, Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Roslindale, MA, USA
- Department of Neurology, Harvard Medical School, Cambridge, MA, USA
| | - Maria I Lapid
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MI, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
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24
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Raghavan S, Przybelski SA, Lesnick TG, Fought AJ, Reid RI, Gebre RK, Windham BG, Algeciras‐Schimnich A, Machulda MM, Vassilaki M, Knopman DS, Jack CR, Petersen RC, Graff‐Radford J, Vemuri P. Vascular risk, gait, behavioral, and plasma indicators of VCID. Alzheimers Dement 2024; 20:1201-1213. [PMID: 37932910 PMCID: PMC10916988 DOI: 10.1002/alz.13540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Cost-effective screening tools for vascular contributions to cognitive impairment and dementia (VCID) has significant implications. We evaluated non-imaging indicators of VCID using magnetic resonance imaging (MRI)-measured white matter (WM) damage and hypothesized that these indicators differ based on age. METHODS In 745 participants from the Mayo Clinic Study of Aging (≥50 years of age) with serial WM assessments from diffusion MRI and fluid-attenuated inversion recovery (FLAIR)-MRI, we examined associations between baseline non-imaging indicators (demographics, vascular risk factors [VRFs], gait, behavioral, plasma glial fibrillary acidic protein [GFAP], and plasma neurofilament light chain [NfL]) and WM damage across three age tertiles. RESULTS VRFs and gait were associated with diffusion changes even in low age strata. All measures (VRFs, gait, behavioral, plasma GFAP, plasma NfL) were associated with white matter hyperintensities (WMHs) but mainly in intermediate and high age strata. DISCUSSION Non-imaging indicators of VCID were related to WM damage and may aid in screening participants and assessing outcomes for VCID. HIGHLIGHTS Non-imaging indicators of VCID can aid in prediction of MRI-measured WM damage but their importance differed by age. Vascular risk and gait measures were associated with early VCID changes measured using diffusion MRI. Plasma markers explained variability in WMH across age strata. Most non-imaging measures explained variability in WMH and vascular WM scores in intermediate and older age groups. The framework developed here can be used to evaluate new non-imaging VCID indicators proposed in the future.
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Affiliation(s)
| | | | - Timothy G. Lesnick
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Angela J. Fought
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Robert I. Reid
- Department of Information TechnologyMayo ClinicRochesterMinnesotaUSA
| | | | - B. Gwen Windham
- Department of MedicineUniversity of Mississippi Medical CenterJacksonUSA
| | | | | | - Maria Vassilaki
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
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25
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Corriveau-Lecavalier N, Tosakulwong N, Lesnick TG, Fought AJ, Reid RI, Schwarz CG, Senjem ML, Jack CR, Jones DT, Vemuri P, Rademakers R, Ramos EM, Geschwind DH, Knopman DS, Botha H, Savica R, Graff-Radford J, Ramanan VK, Fields JA, Graff-Radford N, Wszolek Z, Forsberg LK, Petersen RC, Heuer HW, Boxer AL, Rosen HJ, Boeve BF, Kantarci K. Neurite-based white matter alterations in MAPT mutation carriers: A multi-shell diffusion MRI study in the ALLFTD consortium. Neurobiol Aging 2024; 134:135-145. [PMID: 38091751 PMCID: PMC10872472 DOI: 10.1016/j.neurobiolaging.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
We assessed white matter (WM) integrity in MAPT mutation carriers (16 asymptomatic, 5 symptomatic) compared to 31 non-carrier family controls using diffusion tensor imaging (DTI) (fractional anisotropy; FA, mean diffusivity; MD) and neurite orientation dispersion and density imaging (NODDI) (neurite density index; NDI, orientation and dispersion index; ODI). Linear mixed-effects models accounting for age and family relatedness revealed alterations across DTI and NODDI metrics in all mutation carriers and in symptomatic carriers, with the most significant differences involving fronto-temporal WM tracts. Asymptomatic carriers showed higher entorhinal MD and lower cingulum FA and patterns of higher ODI mostly involving temporal areas and long association and projections fibers. Regression models between estimated time to or time from disease and DTI and NODDI metrics in key regions (amygdala, cingulum, entorhinal, inferior temporal, uncinate fasciculus) in all carriers showed increasing abnormalities with estimated time to or time from disease onset, with FA and NDI showing the strongest relationships. Neurite-based metrics, particularly ODI, appear to be particularly sensitive to early WM involvement in asymptomatic carriers.
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Affiliation(s)
- Nick Corriveau-Lecavalier
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Timothy G Lesnick
- Departmenf of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Angela J Fought
- Departmenf of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Robert I Reid
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic Jacksonville, FL, USA; Center for Molecular Neurology, Antwerp University, Belgium
| | | | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Hilary W Heuer
- Department of Neurology, University of California San Francisco, CA, USA
| | - Adam L Boxer
- Department of Neurology, University of California San Francisco, CA, USA
| | - Howard J Rosen
- Department of Neurology, University of California San Francisco, CA, USA
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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26
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Stricker NH, Stricker JL, Frank RD, Fan WZ, Christianson TJ, Patel JS, Karstens AJ, Kremers WK, Machulda MM, Fields JA, Graff-Radford J, Jack CR, Knopman DS, Mielke MM, Petersen RC. Stricker Learning Span criterion validity: a remote self-administered multi-device compatible digital word list memory measure shows similar ability to differentiate amyloid and tau PET-defined biomarker groups as in-person Auditory Verbal Learning Test. J Int Neuropsychol Soc 2024; 30:138-151. [PMID: 37385974 PMCID: PMC10756923 DOI: 10.1017/s1355617723000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The Stricker Learning Span (SLS) is a computer-adaptive digital word list memory test specifically designed for remote assessment and self-administration on a web-based multi-device platform (Mayo Test Drive). We aimed to establish criterion validity of the SLS by comparing its ability to differentiate biomarker-defined groups to the person-administered Rey's Auditory Verbal Learning Test (AVLT). METHOD Participants (N = 353; mean age = 71, SD = 11; 93% cognitively unimpaired [CU]) completed the AVLT during an in-person visit, the SLS remotely (within 3 months) and had brain amyloid and tau PET scans available (within 3 years). Overlapping groups were formed for 1) those on the Alzheimer's disease (AD) continuum (amyloid PET positive, A+, n = 125) or not (A-, n = 228), and those with biological AD (amyloid and tau PET positive, A+T+, n = 55) vs no evidence of AD pathology (A-T-, n = 195). Analyses were repeated among CU participants only. RESULTS The SLS and AVLT showed similar ability to differentiate biomarker-defined groups when comparing AUROCs (p's > .05). In logistic regression models, SLS contributed significantly to predicting biomarker group beyond age, education, and sex, including when limited to CU participants. Medium (A- vs A+) to large (A-T- vs A+T+) unadjusted effect sizes were observed for both SLS and AVLT. Learning and delay variables were similar in terms of ability to separate biomarker groups. CONCLUSIONS Remotely administered SLS performed similarly to in-person-administered AVLT in its ability to separate biomarker-defined groups, providing evidence of criterion validity. Results suggest the SLS may be sensitive to detecting subtle objective cognitive decline in preclinical AD.
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Affiliation(s)
- Nikki H Stricker
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - John L Stricker
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Ryan D Frank
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Winnie Z Fan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Jay S Patel
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Aimee J Karstens
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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27
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Gunter NB, Gebre RK, Graff-Radford J, Heckman MG, Jack CR, Lowe VJ, Knopman DS, Petersen RC, Ross OA, Vemuri P, Ramanan VK. Machine Learning Models of Polygenic Risk for Enhanced Prediction of Alzheimer Disease Endophenotypes. Neurol Genet 2024; 10:e200120. [PMID: 38250184 PMCID: PMC10798228 DOI: 10.1212/nxg.0000000000200120] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/01/2023] [Indexed: 01/23/2024]
Abstract
Background and Objectives Alzheimer disease (AD) has a polygenic architecture, for which genome-wide association studies (GWAS) have helped elucidate sequence variants (SVs) influencing susceptibility. Polygenic risk score (PRS) approaches show promise for generating summary measures of inherited risk for clinical AD based on the effects of APOE and other GWAS hits. However, existing PRS approaches, based on traditional regression models, explain only modest variation in AD dementia risk and AD-related endophenotypes. We hypothesized that machine learning (ML) models of polygenic risk (ML-PRS) could outperform standard regression-based PRS methods and therefore have the potential for greater clinical utility. Methods We analyzed combined data from the Mayo Clinic Study of Aging (n = 1,791) and the Alzheimer's Disease Neuroimaging Initiative (n = 864). An AD PRS was computed for each participant using the top common SVs obtained from a large AD dementia GWAS. In parallel, ML models were trained using those SV genotypes, with amyloid PET burden as the primary outcome. Secondary outcomes included amyloid PET positivity and clinical diagnosis (cognitively unimpaired vs impaired). We compared performance between ML-PRS and standard PRS across 100 training sessions with different data splits. In each session, data were split into 80% training and 20% testing, and then five-fold cross-validation was used within the training set to ensure the best model was produced for testing. We also applied permutation importance techniques to assess which genetic factors contributed most to outcome prediction. Results ML-PRS models outperformed the AD PRS (r2 = 0.28 vs r2 = 0.24 in test set) in explaining variation in amyloid PET burden. Among ML approaches, methods accounting for nonlinear genetic influences were superior to linear methods. ML-PRS models were also more accurate when predicting amyloid PET positivity (area under the curve [AUC] = 0.80 vs AUC = 0.63) and the presence of cognitive impairment (AUC = 0.75 vs AUC = 0.54) compared with the standard PRS. Discussion We found that ML-PRS approaches improved upon standard PRS for prediction of AD endophenotypes, partly related to improved accounting for nonlinear effects of genetic susceptibility alleles. Further adaptations of the ML-PRS framework could help to close the gap of remaining unexplained heritability for AD and therefore facilitate more accurate presymptomatic and early-stage risk stratification for clinical decision-making.
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Affiliation(s)
- Nathaniel B Gunter
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Robel K Gebre
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Jonathan Graff-Radford
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Michael G Heckman
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Clifford R Jack
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Val J Lowe
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - David S Knopman
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Ronald C Petersen
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Owen A Ross
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Prashanthi Vemuri
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
| | - Vijay K Ramanan
- From the Departments of Radiology (N.B.G., R.K.G., C.R.J., V.J.L., P.V.), Neurology (J.G.-R., D.S.K., R.C.P., V.K.R.), and Quantitative Health Sciences (R.C.P.), Mayo Clinic Rochester, MN; and Departments of Quantitative Health Sciences (M.G.H.), Neuroscience (O.A.R.), and Clinical Genomics (O.A.R.), Mayo Clinic Florida, Jacksonville
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28
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Cogswell PM, Lundt ES, Therneau TM, Wiste HJ, Graff‐Radford J, Algeciras‐Schimnich A, Lowe VJ, Mielke MM, Schwarz CG, Senjem ML, Gunter JL, Knopman DS, Vemuri P, Petersen RC, Jack Jr CR. Modeling the temporal evolution of plasma p-tau in relation to amyloid beta and tau PET. Alzheimers Dement 2024; 20:1225-1238. [PMID: 37963289 PMCID: PMC10916944 DOI: 10.1002/alz.13539] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION The timing of plasma biomarker changes is not well understood. The goal of this study was to evaluate the temporal co-evolution of plasma and positron emission tomography (PET) Alzheimer's disease (AD) biomarkers. METHODS We included 1408 Mayo Clinic Study of Aging and Alzheimer's Disease Research Center participants. An accelerated failure time (AFT) model was fit with amyloid beta (Aβ) PET, tau PET, plasma p-tau217, p-tau181, and glial fibrillary acidic protein (GFAP) as endpoints. RESULTS Individual timing of plasma p-tau progression was strongly associated with Aβ PET and GFAP progression. In the population, GFAP became abnormal first, then Aβ PET, plasma p-tau, and tau PET temporal meta-regions of interest when applying cut points based on young, cognitively unimpaired participants. DISCUSSION Plasma p-tau is a stronger indicator of a temporally linked response to elevated brain Aβ than of tau pathology. While Aβ deposition and a rise in GFAP are upstream events associated with tau phosphorylation, the temporal link between p-tau and Aβ PET was the strongest. HIGHLIGHTS Plasma p-tau progression was more strongly associated with Aβ than tau PET. Progression on plasma p-tau was associated with Aβ PET and GFAP progression. P-tau181 and p-tau217 become abnormal after Aβ PET and before tau PET. GFAP became abnormal first, before plasma p-tau and Aβ PET.
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Affiliation(s)
| | - Emily S. Lundt
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Terry M. Therneau
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Heather J. Wiste
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | | | - Val J. Lowe
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
| | - Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | | | - Matthew L. Senjem
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
- Department of Information TechnologyMayo ClinicRochesterMinnesotaUSA
| | | | | | | | - Ronald C. Petersen
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
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Marks JD, Ayuso VE, Carlomagno Y, Yue M, Todd TW, Hao Y, Li Z, McEachin ZT, Shantaraman A, Duong DM, Daughrity LM, Jansen-West K, Shao W, Calliari A, Bejarano JG, DeTure M, Rawlinson B, Casey MC, Lilley MT, Donahue MH, Jawahar VM, Boeve BF, Petersen RC, Knopman DS, Oskarsson B, Graff-Radford NR, Wszolek ZK, Dickson DW, Josephs KA, Qi YA, Seyfried NT, Ward ME, Zhang YJ, Prudencio M, Petrucelli L, Cook CN. TMEM106B core deposition associates with TDP-43 pathology and is increased in risk SNP carriers for frontotemporal dementia. Sci Transl Med 2024; 16:eadf9735. [PMID: 38232138 PMCID: PMC10841341 DOI: 10.1126/scitranslmed.adf9735] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
Genetic variation at the transmembrane protein 106B gene (TMEM106B) has been linked to risk of frontotemporal lobar degeneration with TDP-43 inclusions (FTLD-TDP) through an unknown mechanism. We found that presence of the TMEM106B rs3173615 protective genotype was associated with longer survival after symptom onset in a postmortem FTLD-TDP cohort, suggesting a slower disease course. The seminal discovery that filaments derived from TMEM106B is a common feature in aging and, across a range of neurodegenerative disorders, suggests that genetic variants in TMEM106B could modulate disease risk and progression through modulating TMEM106B aggregation. To explore this possibility and assess the pathological relevance of TMEM106B accumulation, we generated a new antibody targeting the TMEM106B filament core sequence. Analysis of postmortem samples revealed that the TMEM106B rs3173615 risk allele was associated with higher TMEM106B core accumulation in patients with FTLD-TDP. In contrast, minimal TMEM106B core deposition was detected in carriers of the protective allele. Although the abundance of monomeric full-length TMEM106B was unchanged, carriers of the protective genotype exhibited an increase in dimeric full-length TMEM106B. Increased TMEM106B core deposition was also associated with enhanced TDP-43 dysfunction, and interactome data suggested a role for TMEM106B core filaments in impaired RNA transport, local translation, and endolysosomal function in FTLD-TDP. Overall, these findings suggest that prevention of TMEM106B core accumulation is central to the mechanism by which the TMEM106B protective haplotype reduces disease risk and slows progression.
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Affiliation(s)
- Jordan D. Marks
- Medical Scientist Training Program, Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA
- Neuroscience Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA
| | - Virginia Estades Ayuso
- Neuroscience Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Yari Carlomagno
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Mei Yue
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Tiffany W. Todd
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ying Hao
- Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ziyi Li
- Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Zachary T. McEachin
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA 30307, USA
- Department for Human Genetics, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Anantharaman Shantaraman
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Duc M. Duong
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA 30307, USA
| | | | - Karen Jansen-West
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Wei Shao
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Anna Calliari
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Michael DeTure
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Bailey Rawlinson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Meredith T. Lilley
- Neuroscience Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA
| | - Megan H. Donahue
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | | | | | | | - Björn Oskarsson
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | | | - Dennis W. Dickson
- Neuroscience Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Yue A. Qi
- Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nicholas T. Seyfried
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Michael E. Ward
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Yong-Jie Zhang
- Neuroscience Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Mercedes Prudencio
- Neuroscience Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Leonard Petrucelli
- Neuroscience Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Casey N. Cook
- Neuroscience Graduate Program, Mayo Graduate School, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
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30
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Sintini I, Corriveau-Lecavalier N, Jones DT, Machulda MM, Gunter JL, Schwarz CG, Botha H, Carlos AF, Kamykowski MG, Singh NA, Petersen RC, Jack CR, Lowe VJ, Graff-Radford J, Josephs KA, Whitwell JL. Longitudinal default mode sub-networks in the language and visual variants of Alzheimer's disease. Brain Commun 2024; 6:fcae005. [PMID: 38444909 PMCID: PMC10914456 DOI: 10.1093/braincomms/fcae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/13/2023] [Accepted: 01/05/2024] [Indexed: 03/07/2024] Open
Abstract
Disruption of the default mode network is a hallmark of Alzheimer's disease, which has not been extensively examined in atypical phenotypes. We investigated cross-sectional and 1-year longitudinal changes in default mode network sub-systems in the visual and language variants of Alzheimer's disease, in relation to age and tau. Sixty-one amyloid-positive Alzheimer's disease participants diagnosed with posterior cortical atrophy (n = 33) or logopenic progressive aphasia (n = 28) underwent structural MRI, resting-state functional MRI and [18F]flortaucipir PET. One-hundred and twenty-two amyloid-negative cognitively unimpaired individuals and 60 amyloid-positive individuals diagnosed with amnestic Alzheimer's disease were included as controls and as a comparison group, respectively, and had structural and resting-state functional MRI. Forty-one atypical Alzheimer's disease participants, 26 amnestic Alzheimer's disease participants and 40 cognitively unimpaired individuals had one follow-up functional MRI ∼1-2 years after the baseline scan. Default mode network connectivity was calculated using the dual regression method for posterior, ventral, anterior ventral and anterior dorsal sub-systems derived from independent component analysis. A global measure of default mode network connectivity, the network failure quotient, was also calculated. Linear mixed-effects models and voxel-based analyses were computed for each connectivity measure. Both atypical and amnestic Alzheimer's disease participants had lower cross-sectional posterior and ventral and higher anterior dorsal connectivity and network failure quotient relative to cognitively unimpaired individuals. Age had opposite effects on connectivity in Alzheimer's disease participants and cognitively unimpaired individuals. While connectivity declined with age in cognitively unimpaired individuals, younger Alzheimer's disease participants had lower connectivity than the older ones, particularly in the ventral default mode network. Greater baseline tau-PET uptake was associated with lower ventral and anterior ventral default mode network connectivity in atypical Alzheimer's disease. Connectivity in the ventral default mode network declined over time in atypical Alzheimer's disease, particularly in older participants, with lower tau burden. Voxel-based analyses validated the findings of higher anterior dorsal default mode network connectivity, lower posterior and ventral default mode network connectivity and decline in ventral default mode network connectivity over time in atypical Alzheimer's disease. Visuospatial symptoms were associated with default mode network connectivity disruption. In summary, default mode connectivity disruption was similar between atypical and amnestic Alzheimer's disease variants, and discriminated Alzheimer's disease from cognitively unimpaired individuals, with decreased posterior and increased anterior connectivity and with disruption more pronounced in younger participants. The ventral default mode network declined over time in atypical Alzheimer's disease, suggesting a shift in default mode network connectivity likely related to tau pathology.
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Affiliation(s)
- Irene Sintini
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - David T Jones
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Arenn F Carlos
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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31
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Veitch DP, Weiner MW, Miller M, Aisen PS, Ashford MA, Beckett LA, Green RC, Harvey D, Jack CR, Jagust W, Landau SM, Morris JC, Nho KT, Nosheny R, Okonkwo O, Perrin RJ, Petersen RC, Rivera Mindt M, Saykin A, Shaw LM, Toga AW, Tosun D. The Alzheimer's Disease Neuroimaging Initiative in the era of Alzheimer's disease treatment: A review of ADNI studies from 2021 to 2022. Alzheimers Dement 2024; 20:652-694. [PMID: 37698424 PMCID: PMC10841343 DOI: 10.1002/alz.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 09/13/2023]
Abstract
The Alzheimer's Disease Neuroimaging Initiative (ADNI) aims to improve Alzheimer's disease (AD) clinical trials. Since 2006, ADNI has shared clinical, neuroimaging, and cognitive data, and biofluid samples. We used conventional search methods to identify 1459 publications from 2021 to 2022 using ADNI data/samples and reviewed 291 impactful studies. This review details how ADNI studies improved disease progression understanding and clinical trial efficiency. Advances in subject selection, detection of treatment effects, harmonization, and modeling improved clinical trials and plasma biomarkers like phosphorylated tau showed promise for clinical use. Biomarkers of amyloid beta, tau, neurodegeneration, inflammation, and others were prognostic with individualized prediction algorithms available online. Studies supported the amyloid cascade, emphasized the importance of neuroinflammation, and detailed widespread heterogeneity in disease, linked to genetic and vascular risk, co-pathologies, sex, and resilience. Biological subtypes were consistently observed. Generalizability of ADNI results is limited by lack of cohort diversity, an issue ADNI-4 aims to address by enrolling a diverse cohort.
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Affiliation(s)
- Dallas P. Veitch
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterCenter for Imaging of Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
| | - Michael W. Weiner
- Department of Veterans Affairs Medical CenterCenter for Imaging of Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Melanie Miller
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterCenter for Imaging of Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
| | - Paul S. Aisen
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Miriam A. Ashford
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
| | - Laurel A. Beckett
- Division of BiostatisticsDepartment of Public Health SciencesUniversity of CaliforniaDavisCaliforniaUSA
| | - Robert C. Green
- Division of GeneticsDepartment of MedicineBrigham and Women's HospitalBroad Institute Ariadne Labs and Harvard Medical SchoolBostonMassachusettsUSA
| | - Danielle Harvey
- Division of BiostatisticsDepartment of Public Health SciencesUniversity of CaliforniaDavisCaliforniaUSA
| | | | - William Jagust
- Helen Wills Neuroscience InstituteUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - Susan M. Landau
- Helen Wills Neuroscience InstituteUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - John C. Morris
- Knight Alzheimer's Disease Research CenterWashington University School of MedicineSaint LouisMissouriUSA
- Department of NeurologyWashington University School of MedicineSaint LouisMissouriUSA
- Department of Pathology and ImmunologyWashington University School of MedicineSaint LouisMissouriUSA
| | - Kwangsik T. Nho
- Department of Radiology and Imaging Sciences and the Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Center for Computational Biology and BioinformaticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Rachel Nosheny
- Department of Veterans Affairs Medical CenterCenter for Imaging of Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Ozioma Okonkwo
- Wisconsin Alzheimer's Disease Research Center and Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Richard J. Perrin
- Knight Alzheimer's Disease Research CenterWashington University School of MedicineSaint LouisMissouriUSA
- Department of NeurologyWashington University School of MedicineSaint LouisMissouriUSA
- Department of Pathology and ImmunologyWashington University School of MedicineSaint LouisMissouriUSA
| | | | - Monica Rivera Mindt
- Department of PsychologyLatin American and Latino Studies InstituteAfrican and African American StudiesFordham UniversityNew YorkNew YorkUSA
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrew Saykin
- Department of Radiology and Imaging Sciences and the Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Leslie M. Shaw
- Department of Pathology and Laboratory Medicine and the PENN Alzheimer's Disease Research CenterCenter for Neurodegenerative ResearchPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Arthur W. Toga
- Laboratory of Neuro ImagingInstitute of Neuroimaging and InformaticsKeck School of Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Duygu Tosun
- Department of Veterans Affairs Medical CenterCenter for Imaging of Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
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32
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Figdore DJ, Wiste HJ, Bornhorst JA, Bateman RJ, Li Y, Graff‐Radford J, Knopman DS, Vemuri P, Lowe VJ, Jr CRJ, Petersen RC, Algeciras‐Schimnich A. Performance of the Lumipulse plasma Aβ42/40 and pTau181 immunoassays in the detection of amyloid pathology. Alzheimers Dement (Amst) 2024; 16:e12545. [PMID: 38304322 PMCID: PMC10831129 DOI: 10.1002/dad2.12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION This study evaluated the performance of the Lumipulse plasma beta-amyloid (Aβ) 42/40 and pTau181 compared to other assays to detect an abnormal amyloid-positron emission tomography (PET). METHODS Plasma samples from cognitively unimpaired (N = 179) and MCI/AD dementia (N = 36) individuals were retrospectively evaluated. Plasma Aβ42/40 and pTau181 were measured using the Lumipulse and Simoa immunoassays. An immunoprecipitation mass spectrometry (IP-MS) assay for plasma Aβ42/40 was also evaluated. Amyloid-PET status was the outcome measure. RESULTS Lumipulse and IP-MS Aβ42/40 exhibited the highest diagnostic accuracy for detecting an abnormal amyloid-PET (areas under the curve [AUCs] of 0.81 and 0.84, respectively). The Lumipulse and Simoa pTau181 assays exhibited lower performance (AUCs of 0.74 and 0.72, respectively). The Simoa Aβ42/40 assay demonstrated the lowest diagnostic accuracy (AUC 0.57). Combining Aβ42/40 and pTau181 did not significantly improve performance over Aβ42/40 alone for Lumipulse (AUC 0.83) or over pTau181 alone for Simoa (AUC 0.71). DISCUSSION The Lumipulse Aβ42/40 assay showed similar performance to the IP-MS Aβ42/40 assay for detection of an abnormal amyloid-PET; and both assays performed better than the two p-tau181 immunoassays. The Simoa Aβ42/Aβ40 assay was the least accurate at predicting an abnormal amyloid-PET status. Highlights Lumipulse plasma Aβ42/Aβ40 AUC for abnormal amyloid-PET detection was 0.81.This performance was comparable to previously reported IP-MS and higher than Simoa.Performance of Alzheimer's disease blood biomarkers varies between assays.
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Affiliation(s)
- Daniel J. Figdore
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | - Heather J. Wiste
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Joshua A. Bornhorst
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | - Randall J. Bateman
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Yan Li
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | | | | | | | - Val J. Lowe
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
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Erickson CM, Karlawish J, Grill JD, Harkins K, Landau SM, Rivera-Mindt MG, Okonkwo O, Petersen RC, Aisen PS, Weiner MW, Largent EA. A Pragmatic, Investigator-Driven Process for Disclosure of Amyloid PET Scan Results to ADNI-4 Research Participants. J Prev Alzheimers Dis 2024; 11:294-302. [PMID: 38374735 PMCID: PMC10883638 DOI: 10.14283/jpad.2024.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Prior studies of Alzheimer's disease (AD) biomarker disclosure have answered important questions about individuals' safety after learning and comprehending their amyloid PET results; however, these studies have typically employed highly structured disclosure protocols and focused on the psychological impact of disclosure (e.g., anxiety, depression, and suicidality) in homogeneous populations. More work is needed to develop flexible disclosure protocols and study outcomes in ethnoculturally representative samples. METHODS The Alzheimer's Disease Neuroimaging Initiative (ADNI) is formally incorporating amyloid PET disclosure into the newest protocol (ADNI-4). Participants across the cognitive spectrum who wish to know their amyloid PET results may learn them. The pragmatic disclosure process spans four timepoints: (1) a pre-disclosure visit, (2) the PET scan and its read, (3) a disclosure visit, and (4) a post-disclosure check-in. This process applies to all participants, with slight modifications to account for their cognitive status. In designing this process, special emphasis was placed on utilizing investigator discretion. Participant measures include perceived risk of dementia, purpose in life, and disclosure satisfaction. Investigator assessment of the disclosure visit (e.g., challenges encountered, topics discussed, etc.) is also included. RESULTS Data collection is ongoing. Results will allow for more robust characterization of the impact of learning amyloid PET results on individuals and describe the perspectives of investigators. CONCLUSION The pragmatic design of the disclosure process in ADNI-4 coupled with the novel participant and investigator data will inform future disclosure practices. This is especially important as disclosure of biomarker results expands in research and care.
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Affiliation(s)
- C M Erickson
- Emily Largent JD, PhD, RN, 423 Guardian Drive Philadelphia, PA 19104, USA,
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Corriveau-Lecavalier N, Barnard LR, Przybelski SA, Gogineni V, Botha H, Graff-Radford J, Ramanan VK, Forsberg LK, Fields JA, Machulda MM, Rademakers R, Gavrilova RH, Lapid MI, Boeve BF, Knopman DS, Lowe VJ, Petersen RC, Jack CR, Kantarci K, Jones DT. Assessing network degeneration and phenotypic heterogeneity in genetic frontotemporal lobar degeneration by decoding FDG-PET. Neuroimage Clin 2023; 41:103559. [PMID: 38147792 PMCID: PMC10944211 DOI: 10.1016/j.nicl.2023.103559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023]
Abstract
Genetic mutations causative of frontotemporal lobar degeneration (FTLD) are highly predictive of a specific proteinopathy, but there exists substantial inter-individual variability in their patterns of network degeneration and clinical manifestations. We collected clinical and 18Fluorodeoxyglucose-positron emission tomography (FDG-PET) data from 39 patients with genetic FTLD, including 11 carrying the C9orf72 hexanucleotide expansion, 16 carrying a MAPT mutation and 12 carrying a GRN mutation. We performed a spectral covariance decomposition analysis between FDG-PET images to yield unbiased latent patterns reflective of whole brain patterns of metabolism ("eigenbrains" or EBs). We then conducted linear discriminant analyses (LDAs) to perform EB-based predictions of genetic mutation and predominant clinical phenotype (i.e., behavior/personality, language, asymptomatic). Five EBs were significant and explained 58.52 % of the covariance between FDG-PET images. EBs indicative of hypometabolism in left frontotemporal and temporo-parietal areas distinguished GRN mutation carriers from other genetic mutations and were associated with predominant language phenotypes. EBs indicative of hypometabolism in prefrontal and temporopolar areas with a right hemispheric predominance were mostly associated with predominant behavioral phenotypes and distinguished MAPT mutation carriers from other genetic mutations. The LDAs yielded accuracies of 79.5 % and 76.9 % in predicting genetic status and predominant clinical phenotype, respectively. A small number of EBs explained a high proportion of covariance in patterns of network degeneration across FTLD-related genetic mutations. These EBs contained biological information relevant to the variability in the pathophysiological and clinical aspects of genetic FTLD, and for offering valuable guidance in complex clinical decision-making, such as decisions related to genetic testing.
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Affiliation(s)
- Nick Corriveau-Lecavalier
- Department of Neurology, Mayo Clinic Rochester, USA; Department of Psychiatry and Psychology, Mayo Clinic Rochester, USA
| | | | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic Rochester, USA
| | | | | | | | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, USA
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic Jacksonville, USA; VIB-UA Center for Molecular Neurology, VIB, University of Antwerp, Belgium
| | | | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, USA
| | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic Rochester, USA
| | | | | | | | - David T Jones
- Department of Neurology, Mayo Clinic Rochester, USA; Department of Radiology, Mayo Clinic Rochester, USA.
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35
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Carlos AF, Sekiya H, Koga S, Gatto RG, Casey MC, Pham NTT, Sintini I, Machulda MM, Jack CR, Lowe VJ, Whitwell JL, Petrucelli L, Reichard RR, Petersen RC, Dickson DW, Josephs KA. Clinicopathologic features of a novel star-shaped transactive response DNA-binding protein 43 (TDP-43) pathology in the oldest old. J Neuropathol Exp Neurol 2023; 83:36-52. [PMID: 38086178 PMCID: PMC10746697 DOI: 10.1093/jnen/nlad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
Transactive response DNA-binding protein 43 (TDP-43) pathology is categorized as type A-E in frontotemporal lobar degeneration and as type α-β in Alzheimer disease (AD) based on inclusion type. We screened amygdala slides of 131 cases with varying ages at death, clinical/neuroimaging findings, and AD neuropathologic changes for TDP-43 pathology using anti-phospho-TDP-43 antibodies. Seven cases (5%) only showed atypical TDP-43 inclusions that could not be typed. Immunohistochemistry and immunofluorescence assessed the atypical star-shaped TDP-43 pathology including its distribution, species, cellular localization, and colocalization with tau. All 7 had died at an extremely old age (median: 100 years [IQR: 94-101]) from nonneurological causes and none had dementia (4 cognitively unimpaired, 3 with amnestic mild cognitive impairment). Neuroimaging showed mild medial temporal involvement. Pathologically, the star-shaped TDP-43-positive inclusions were found in medial (subpial) amygdala and, occasionally, in basolateral regions. Hippocampus only showed TDP-43-positive neurites in the fimbria and subiculum while the frontal lobe was free of TDP-43 inclusions. The star-shaped inclusions were better detected with antibodies against N-terminal than C-terminal TDP-43. Double-labeling studies confirmed deposition of TDP-43 within astrocytes and colocalization with tau. We have identified a novel TDP-43 pathology with star-shaped morphology associated with superaging, with a homogeneous clinicopathologic picture, possibly representing a novel, true aging-related TDP-43 pathology.
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Affiliation(s)
- Arenn F Carlos
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hiroaki Sekiya
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Rodolfo G Gatto
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Irene Sintini
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary M Machulda
- Department of Psychiatry (Psychology), Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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36
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Liu Z, Garg M, Fu S, Sarkar S, Vassilaki M, Petersen RC, St Sauver J, Sohn S. Harnessing Transfer Learning for Dementia Prediction: Leveraging Sex-Different Mild Cognitive Impairment Prognosis. Proceedings (IEEE Int Conf Bioinformatics Biomed) 2023; 2023:2097-2100. [PMID: 38404694 PMCID: PMC10883588 DOI: 10.1109/bibm58861.2023.10385516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
This paper presents a machine learning-based prediction for dementia, leveraging transfer learning to reuse the knowledge learned from prediction of mild cognitive impairment, a precursor of dementia. We also examine the impacts of temporal aspects of longitudinal data and sex differences. The methodology encompasses key components such as setting the duration window, comparing different modeling strategies, conducting comprehensive evaluations, and examining the sex-specific impacts of simulated scenarios. The findings reveal that cognitive deficits in females, once detected at the mild cognitive impairment stage, tend to deteriorate over time, while males exhibit more diverse decline across various characteristics without highlighting specific ones. However, the underlying reasons for these sex differences remain unknown and warrant further investigation.
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Affiliation(s)
- Ziming Liu
- Mechanical, Aerospace and Biomedical Engineering, University of Tennessee, Knoxville, USA
| | - Muskan Garg
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, USA
| | - Sunyang Fu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, USA
| | - Surjodeep Sarkar
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, USA
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, USA
| | | | | | - Sunghwan Sohn
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, USA
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Garg M, Liu X, Vassilaki M, Petersen RC, St Sauver J, Sohn S. Navigating Sex-Specific Disease Dynamics in Incident Dementia. Proceedings (IEEE Int Conf Bioinformatics Biomed) 2023; 2023:4065-4072. [PMID: 38404695 PMCID: PMC10883293 DOI: 10.1109/bibm58861.2023.10385324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Dementia is among the leading causes of cognitive and functional loss and disability in older adults. Past studies suggested sex differences in health conditions and progression of cognitive decline. Existing studies on the temporal trajectory of health conditions for patient characterization after dementia diagnosis are scarce and ambiguous. Thus, there's limited and unclear research on how health conditions change over time after a dementia diagnosis. To this end, we aim to analyze the shift in medical conditions and examine sex-specific changes in patterns of chronic health conditions after dementia diagnosis. We centered our analysis on a 15-year window around the point of dementia diagnosis, encompassing the 5 years leading up to the diagnosis and the 10 years following it. We introduce (i) MedMet, a network metric to quantify the contribution of each medical condition, and (ii) growth and decay function for temporal trajectory analysis of medical conditions. Our experiments demonstrate that certain health conditions are more prevalent among females than males. Thus, our findings underscore the pressing need to examine differences between men and women, which could be important for healthcare utilization after a dementia diagnosis.
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Affiliation(s)
- Muskan Garg
- Artificial Intelligence & Informatics, Mayo Clinic, Rochester, MN, USA
| | - Xingyi Liu
- Artificial Intelligence & Informatics, Mayo Clinic, Rochester, MN, USA
| | - Maria Vassilaki
- Quantitative Health Science Research, Mayo Clinic, Rochester, MN, USA
| | | | | | - Sunghwan Sohn
- Artificial Intelligence & Informatics, Mayo Clinic, Rochester, MN, USA
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Petersen RC, Weintraub S, Sabbagh M, Karlawish J, Adler CH, Dilworth-Anderson P, Frank L, Huling Hummel C, Taylor A. A New Framework for Dementia Nomenclature. JAMA Neurol 2023; 80:1364-1370. [PMID: 37843871 DOI: 10.1001/jamaneurol.2023.3664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Importance Nomenclature in the field of neurodegenerative diseases presents a challenging problem. Inconsistent use of terms such as Alzheimer disease and dementia has compromised progress in clinical care, research, and development of therapeutics. Dementia-associated stigma further contributes to inconsistent and imprecise language. The result is a lack of clarity that produces confusion with patients and the general public and presents communication challenges among researchers. Therefore, the Advisory Council on Research, Care, and Services of the National Plan to Address Alzheimer's Disease authorized a committee to make recommendations for improvement. Objective To establish a systematic neurodegenerative disease framework for information collection and communication to standardize language usage for research, clinical, and public health purposes. Evidence Review The Dementia Nomenclature Initiative organized into 3 major stakeholder working groups: clinicians, researchers, and the public (including individuals living with dementia and family caregivers). To inform the work, the initiative completed a narrative literature review of dementia nomenclature evolution over the last century across the PubMed, CINAHL, PsycInfo, and Scopus databases (January 1, 2000, through July 31, 2020). Initiative working groups used the results as a foundation for understanding current challenges with dementia nomenclature and implications for research, clinical practice, and public understanding. The initiative obtained additional input via focus groups with individuals living with dementia and caregivers, with separate groups for race and ethnicity (American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, Hispanic or Latino, and White) as an initial assessment of the meaning of dementia-related terms to these groups. Findings From working group deliberations, the literature review, and focus group input, the initiative developed a framework clearly separating the clinical syndromic presentation experienced by affected individuals from possible underlying pathophysiologies. In the framework, domains of clinical impairment, such as cognitive, behavioral, motor, and other neurologic features, are graded by level of impairment between none and severe. Next, biomarker information describes underlying disease processes, explains the syndrome, and identifies possible disease labels: Alzheimer disease, frontotemporal degeneration, dementia with Lewy bodies, or vascular cognitive impairment dementia. Conclusions and Relevance The Dementia Nomenclature Initiative established a framework to guide communication about cognitive impairment among older adults. Wider testing and refinement of the framework will subsequently improve the information used in communicating about cognitive impairment and the way in which the information is used in clinical, research, and public settings.
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Affiliation(s)
- Ronald C Petersen
- Department of Neurology, Alzheimer's Disease Research Center, Mayo Clinic, Rochester, Minnesota
| | - Sandra Weintraub
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Marwan Sabbagh
- Alzheimer's and Memory Disorders Program, Barrow Neurological Institute, Phoenix, Arizona
| | - Jason Karlawish
- Penn Memory Center, Departments of Medicine, Medical Ethics, and Health Policy, and Neurology, University of Pennsylvania, Philadelphia
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Phoenix
| | | | - Lori Frank
- New York Academy of Medicine, New York, New York
| | | | - Angela Taylor
- Strategic Partnerships, Lewy Body Dementia Association, Lilburn, Georgia
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Corriveau-Lecavalier N, Botha H, Graff-Radford J, Switzer AR, Przybelski SA, Wiste HJ, Murray ME, Reichard RR, Dickson DW, Nguyen AT, Ramanan VK, McCarter SJ, Boeve BF, Machulda MM, Fields JA, Stricker NH, Nelson PT, Grothe MJ, Knopman DS, Lowe VJ, Petersen RC, Jack CR, Jones DT. A limbic-predominant amnestic neurodegenerative syndrome associated with TDP-43 pathology. medRxiv 2023:2023.11.19.23298314. [PMID: 38045300 PMCID: PMC10690340 DOI: 10.1101/2023.11.19.23298314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Limbic-predominant age-related TDP-43 encephalopathy (LATE) is a neuropathologically-defined disease that affects 40% of persons in advanced age, but its associated neurological syndrome is not defined. LATE neuropathological changes (LATE-NC) are frequently comorbid with Alzheimer's disease neuropathologic changes (ADNC). When seen in isolation, LATE-NC have been associated with a predominantly amnestic profile and slow clinical progression. We propose a set of clinical criteria for a limbic-predominant amnestic neurodegenerative syndrome (LANS) that is highly associated with LATE-NC but also other pathologic entities. The LANS criteria incorporate core, standard and advanced features that are measurable in vivo, including older age at evaluation, mild clinical syndrome, disproportionate hippocampal atrophy, impaired semantic memory, limbic hypometabolism, absence of neocortical degenerative patterns and low likelihood of neocortical tau, with degrees of certainty (highest, high, moderate, low). We operationalized this set of criteria using clinical, imaging and biomarker data to validate its associations with clinical and pathologic outcomes. We screened autopsied patients from Mayo Clinic (n = 922) and ADNI (n = 93) cohorts and applied the LANS criteria to those with an antemortem predominant amnestic syndrome (Mayo, n = 165; ADNI, n = 53). ADNC, ADNC/LATE-NC and LATE-NC accounted for 35%, 37% and 4% of cases in the Mayo cohort, respectively, and 30%, 22%, and 9% of cases in the ADNI cohort, respectively. The LANS criteria effectively categorized these cases, with ADNC having the lowest LANS likelihoods, LATE-NC patients having the highest likelihoods, and ADNC/LATE-NC patients having intermediate likelihoods. A logistic regression model using the LANS features as predictors of LATE-NC achieved a balanced accuracy of 74.6% in the Mayo cohort, and out-of-sample predictions in the ADNI cohort achieved a balanced accuracy of 73.3%. Patients with high LANS likelihoods had a milder and slower clinical course and more severe temporo-limbic degeneration compared to those with low likelihoods. Stratifying ADNC/LATE-NC patients from the Mayo cohort according to their LANS likelihood revealed that those with higher likelihoods had more temporo-limbic degeneration and a slower rate of cognitive decline, and those with lower likelihoods had more lateral temporo-parietal degeneration and a faster rate of cognitive decline. The implementation of LANS criteria has implications to disambiguate the different driving etiologies of progressive amnestic presentations in older age and guide prognosis, treatment, and clinical trials. The development of in vivo biomarkers specific to TDP-43 pathology are needed to refine molecular associations between LANS and LATE-NC and precise antemortem diagnoses of LATE.
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Affiliation(s)
- Nick Corriveau-Lecavalier
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Heather J. Wiste
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, MN, USA
| | | | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA
| | | | - Aivi T. Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA
| | | | | | | | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Julie A. Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Nikki H. Stricker
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Peter T. Nelson
- Department of Pathology, University of Kentucky, Lexington, KY, USA
| | - Michel J. Grothe
- CIEN Foundation/Queen Sofia Foundation Alzheimer Center, Madrid, Spain
- Wallenberg Center for Molecular and Translational Medicine and Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Clifford R. Jack
- Department of Neuroscience, Mayo Clinic Jacksonville, FL, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Switzer A, Charidimou A, McCarter SJ, Vemuri P, Nguyen A, Przybelski SA, Lesnick TG, Rabinstein AA, Brown RD, Knopman DS, Petersen RC, Jack CR, Reichard RR, Graff-Radford J. Boston criteria v2.0 for cerebral amyloid angiopathy without hemorrhage: An MRI-neuropathological validation study. medRxiv 2023:2023.11.09.23298325. [PMID: 37986913 PMCID: PMC10659504 DOI: 10.1101/2023.11.09.23298325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Updated criteria for the clinical-MRI diagnosis of cerebral amyloid angiopathy (CAA) have recently been proposed. However, their performance in individuals without intracerebral hemorrhage (ICH) or transient focal neurological episodes (TFNE) is unknown. We assessed the diagnostic performance of the Boston criteria version 2.0 for CAA diagnosis in a cohort of individuals presenting without symptomatic ICH. METHODS Fifty-four participants from the Mayo Clinic Study of Aging or Alzheimer's Disease Research Center were included if they had an antemortem MRI with gradient-recall echo sequences and a brain autopsy with CAA evaluation. Performance of the Boston criteria v2.0 was compared to v1.5 using histopathologically verified CAA as the reference standard. RESULTS Median age at MRI was 75 years (IQR 65-80) with 28/54 participants having histopathologically verified CAA (i.e., moderate-to-severe CAA in at least 1 lobar region). The sensitivity and specificity of the Boston criteria v2.0 were 28.6% (95%CI: 13.2-48.7%) and 65.3% (95%CI: 44.3-82.8%) for probable CAA diagnosis (AUC 0.47) and 75.0% (55.1-89.3) and 38.5% (20.2-59.4) for any CAA diagnosis (possible + probable; AUC: 0.57), respectively. The v2.0 Boston criteria was not superior in performance compared to the prior v1.5 criteria for either CAA diagnostic category. CONCLUSIONS The Boston criteria v2.0 have low accuracy in patients who are asymptomatic or only have cognitive symptoms.. Additional biomarkers need to be explored to optimize CAA diagnosis in this population.
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Pittock RR, Aakre JA, Castillo AM, Ramanan VK, Kremers WK, Jack CR, Vemuri P, Lowe VJ, Knopman DS, Petersen RC, Graff-Radford J, Vassilaki M. Eligibility for Anti-Amyloid Treatment in a Population-Based Study of Cognitive Aging. Neurology 2023; 101:e1837-e1849. [PMID: 37586881 PMCID: PMC10663008 DOI: 10.1212/wnl.0000000000207770] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Treatment options for Alzheimer disease (AD) are limited and have focused mainly on symptomatic therapy and improving quality of life. Recently, lecanemab, an anti-β-amyloid monoclonal antibody (mAb), received accelerated approval by the US Food and Drug Administration for treatment in the early stages of biomarker-confirmed symptomatic AD. An additional anti-β-amyloid mAb, aducanumab, was approved in 2021, and more will potentially become available in the near future. Research on the applicability and generalizability of the anti-β-amyloid mAb eligibility criteria on adults with biomarkers available in the general population has been lacking. The study's primary aim was to apply the clinical trial eligibility criteria for lecanemab treatment to participants with early AD of the population-based Mayo Clinic Study of Aging (MCSA) and assess the generalizability of anti-amyloid treatment. The secondary aim of this study was to apply the clinical trial eligibility criteria for aducanumab treatment in MCSA participants. METHODS This cross-sectional study aimed to apply the clinical trial eligibility criteria for lecanemab and aducanumab treatment to participants with early AD of the population-based MCSA and assess the generalizability of anti-amyloid treatment. RESULTS Two hundred thirty-seven MCSA participants (mean age [SD] 80.9 [6.3] years, 54.9% male, and 97.5% White) with mild cognitive impairment (MCI) or mild dementia and increased brain amyloid burden by PiB PET comprised the study sample. Lecanemab trial's inclusion criteria reduced the study sample to 112 (47.3% of 237) participants. The trial's exclusion criteria further narrowed the number of potentially eligible participants to 19 (overall 8% of 237). Modifying the eligibility criteria to include all participants with MCI (instead of applying additional cognitive criteria) resulted in 17.4% of participants with MCI being eligible for lecanemab treatment. One hundred four participants (43.9% of 237) fulfilled the aducanumab clinical trial's inclusion criteria. The aducanumab trial's exclusion criteria further reduced the number of available participants, narrowing those eligible to 12 (5.1% of 237). Common exclusions were related to other chronic conditions and neuroimaging findings. DISCUSSION Findings estimate the limited eligibility in typical older adults with cognitive impairment for anti-β-amyloid mAbs.
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Affiliation(s)
- Rioghna R Pittock
- From the Department of Neurology (R.R.P., V.K.R., D.S.K., R.C.P., J.G.-R.), Mayo Clinic, Rochester, MN; The College (R.R.P.), University of Chicago, IL; Departments of Quantitative Health Sciences (J.A.A., A.M.C., W.K.K., R.C.P., M.V.) and Radiology (C.R.J., P.V., V.J.L.), Mayo Clinic, Rochester, MN
| | - Jeremiah A Aakre
- From the Department of Neurology (R.R.P., V.K.R., D.S.K., R.C.P., J.G.-R.), Mayo Clinic, Rochester, MN; The College (R.R.P.), University of Chicago, IL; Departments of Quantitative Health Sciences (J.A.A., A.M.C., W.K.K., R.C.P., M.V.) and Radiology (C.R.J., P.V., V.J.L.), Mayo Clinic, Rochester, MN
| | - Anna M Castillo
- From the Department of Neurology (R.R.P., V.K.R., D.S.K., R.C.P., J.G.-R.), Mayo Clinic, Rochester, MN; The College (R.R.P.), University of Chicago, IL; Departments of Quantitative Health Sciences (J.A.A., A.M.C., W.K.K., R.C.P., M.V.) and Radiology (C.R.J., P.V., V.J.L.), Mayo Clinic, Rochester, MN
| | - Vijay K Ramanan
- From the Department of Neurology (R.R.P., V.K.R., D.S.K., R.C.P., J.G.-R.), Mayo Clinic, Rochester, MN; The College (R.R.P.), University of Chicago, IL; Departments of Quantitative Health Sciences (J.A.A., A.M.C., W.K.K., R.C.P., M.V.) and Radiology (C.R.J., P.V., V.J.L.), Mayo Clinic, Rochester, MN
| | - Walter K Kremers
- From the Department of Neurology (R.R.P., V.K.R., D.S.K., R.C.P., J.G.-R.), Mayo Clinic, Rochester, MN; The College (R.R.P.), University of Chicago, IL; Departments of Quantitative Health Sciences (J.A.A., A.M.C., W.K.K., R.C.P., M.V.) and Radiology (C.R.J., P.V., V.J.L.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Department of Neurology (R.R.P., V.K.R., D.S.K., R.C.P., J.G.-R.), Mayo Clinic, Rochester, MN; The College (R.R.P.), University of Chicago, IL; Departments of Quantitative Health Sciences (J.A.A., A.M.C., W.K.K., R.C.P., M.V.) and Radiology (C.R.J., P.V., V.J.L.), Mayo Clinic, Rochester, MN
| | - Prashanthi Vemuri
- From the Department of Neurology (R.R.P., V.K.R., D.S.K., R.C.P., J.G.-R.), Mayo Clinic, Rochester, MN; The College (R.R.P.), University of Chicago, IL; Departments of Quantitative Health Sciences (J.A.A., A.M.C., W.K.K., R.C.P., M.V.) and Radiology (C.R.J., P.V., V.J.L.), Mayo Clinic, Rochester, MN
| | - Val J Lowe
- From the Department of Neurology (R.R.P., V.K.R., D.S.K., R.C.P., J.G.-R.), Mayo Clinic, Rochester, MN; The College (R.R.P.), University of Chicago, IL; Departments of Quantitative Health Sciences (J.A.A., A.M.C., W.K.K., R.C.P., M.V.) and Radiology (C.R.J., P.V., V.J.L.), Mayo Clinic, Rochester, MN
| | - David S Knopman
- From the Department of Neurology (R.R.P., V.K.R., D.S.K., R.C.P., J.G.-R.), Mayo Clinic, Rochester, MN; The College (R.R.P.), University of Chicago, IL; Departments of Quantitative Health Sciences (J.A.A., A.M.C., W.K.K., R.C.P., M.V.) and Radiology (C.R.J., P.V., V.J.L.), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- From the Department of Neurology (R.R.P., V.K.R., D.S.K., R.C.P., J.G.-R.), Mayo Clinic, Rochester, MN; The College (R.R.P.), University of Chicago, IL; Departments of Quantitative Health Sciences (J.A.A., A.M.C., W.K.K., R.C.P., M.V.) and Radiology (C.R.J., P.V., V.J.L.), Mayo Clinic, Rochester, MN
| | - Jonathan Graff-Radford
- From the Department of Neurology (R.R.P., V.K.R., D.S.K., R.C.P., J.G.-R.), Mayo Clinic, Rochester, MN; The College (R.R.P.), University of Chicago, IL; Departments of Quantitative Health Sciences (J.A.A., A.M.C., W.K.K., R.C.P., M.V.) and Radiology (C.R.J., P.V., V.J.L.), Mayo Clinic, Rochester, MN
| | - Maria Vassilaki
- From the Department of Neurology (R.R.P., V.K.R., D.S.K., R.C.P., J.G.-R.), Mayo Clinic, Rochester, MN; The College (R.R.P.), University of Chicago, IL; Departments of Quantitative Health Sciences (J.A.A., A.M.C., W.K.K., R.C.P., M.V.) and Radiology (C.R.J., P.V., V.J.L.), Mayo Clinic, Rochester, MN.
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Vassilaki M, Syrjanen JA, Krell-Roesch J, Graff-Radford J, Vemuri P, Scharf EL, Machulda MM, Fields JA, Kremers WK, Lowe VJ, Jack CR, Knopman DS, Petersen RC, Geda YE. Association of Cerebrovascular Imaging Biomarkers, Depression, and Anxiety, with Mild Cognitive Impairment. J Alzheimers Dis Rep 2023; 7:1237-1246. [PMID: 38025797 PMCID: PMC10657723 DOI: 10.3233/adr-230073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
The study included 1,738 Mayo Clinic Study of Aging participants (≥50 years old; 1,460 cognitively unimpaired and 278 with mild cognitive impairment (MCI)) and examined the cross-sectional association between cerebrovascular (CVD) imaging biomarkers (e.g., white matter hyperintensities (WMH), infarctions) and Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) scores, as well as their association with MCI. High (abnormal) WMH burden was significantly associated with having BDI-II>13 and BAI > 7 scores, and both (CVD imaging biomarkers and depression/anxiety) were significantly associated with MCI when included simultaneously in the model, suggesting that both were independently associated with the odds of MCI.
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Affiliation(s)
- Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jeremy A. Syrjanen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Janina Krell-Roesch
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | | | | | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Julie A. Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Walter K. Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ronald C. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Yonas E. Geda
- Department of Neurology, and the Franke Barrow Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix, AZ, USA
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Ramanan VK, Gebre RK, Graff-Radford J, Hofrenning E, Algeciras-Schimnich A, Figdore DJ, Lowe VJ, Mielke MM, Knopman DS, Ross OA, Jack CR, Petersen RC, Vemuri P. Genetic risk scores enhance the diagnostic value of plasma biomarkers of brain amyloidosis. Brain 2023; 146:4508-4519. [PMID: 37279785 PMCID: PMC10629762 DOI: 10.1093/brain/awad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 06/08/2023] Open
Abstract
Blood-based biomarkers offer strong potential to revolutionize diagnosis, trial enrolment and treatment monitoring in Alzheimer's disease (AD). However, further advances are needed before these biomarkers can achieve wider deployment beyond selective research studies and specialty memory clinics, including the development of frameworks for optimal interpretation of biomarker profiles. We hypothesized that integrating Alzheimer's disease genetic risk score (AD-GRS) data would enhance the diagnostic value of plasma AD biomarkers by better capturing extant disease heterogeneity. Analysing 962 individuals from a population-based sample, we observed that an AD-GRS was independently associated with amyloid PET levels (an early marker of AD pathophysiology) over and above APOE ε4 or plasma p-tau181, amyloid-β42/40, glial fibrillary acidic protein or neurofilament light chain. Among individuals with a high or moderately high plasma p-tau181, integrating AD-GRS data significantly improved classification accuracy of amyloid PET positivity, including the finding that the combination of a high AD-GRS and high plasma p-tau181 outperformed p-tau181 alone in classifying amyloid PET positivity (88% versus 68%; P = 0.001). A machine learning approach incorporating plasma biomarkers, demographics and the AD-GRS was highly accurate in predicting amyloid PET levels (90% training set; 89% test set) and Shapley value analyses (an explainer method based in cooperative game theory) indicated that the AD-GRS and plasma biomarkers had differential importance in explaining amyloid deposition across individuals. Polygenic risk for AD dementia appears to account for a unique portion of disease heterogeneity, which could non-invasively enhance the interpretation of blood-based AD biomarker profiles in the population.
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Affiliation(s)
- Vijay K Ramanan
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Robel K Gebre
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Ekaterina Hofrenning
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Daniel J Figdore
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
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Mielke MM, Dage JL, Frank RD, Algeciras-Schimnich A, Knopman DS, Lowe VJ, Bu G, Vemuri P, Graff-Radford J, Jack CR, Petersen RC. Author Correction: Performance of plasma phosphorylated tau 181 and 217 in the community. Nat Med 2023; 29:2954. [PMID: 36216947 DOI: 10.1038/s41591-022-02066-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Michelle M Mielke
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
- Department of Epidemiology and Prevention, School of Medicine, Wake Forest University, Winston-Salem, NC, USA.
| | - Jeffrey L Dage
- Stark Neurosciences Research Institute, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Ryan D Frank
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Guojun Bu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - Ronald C Petersen
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Gebre RK, Rial AM, Raghavan S, Wiste HJ, Johnson Sparrman KL, Heeman F, Costoya-Sánchez A, Schwarz CG, Spychalla AJ, Lowe VJ, Graff-Radford J, Knopman DS, Petersen RC, Schöll M, Jack CR, Vemuri P. Advancing Tau-PET quantification in Alzheimer's disease with machine learning: introducing THETA, a novel tau summary measure. Res Sq 2023:rs.3.rs-3290598. [PMID: 37886506 PMCID: PMC10602128 DOI: 10.21203/rs.3.rs-3290598/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Alzheimer's disease (AD) exhibits spatially heterogeneous 3R/4R tau pathology distributions across participants, making it a challenge to quantify extent of tau deposition. Utilizing Tau-PET from three independent cohorts, we trained and validated a machine learning model to identify visually positive Tau-PET scans from regional SUVR values and developed a novel summary measure, THETA, that accounts for heterogeneity in tau deposition. The model for identification of tau positivity achieved a balanced test accuracy of 95% and accuracy of ≥87% on the validation datasets. THETA captured heterogeneity of tau deposition, had better association with clinical measures, and corresponded better with visual assessments in comparison with the temporal meta-region-of-interest Tau-PET quantification methods. Our novel approach aids in identification of positive Tau-PET scans and provides a quantitative summary measure, THETA, that effectively captures the heterogeneous tau deposition seen in AD. The application of THETA for quantifying Tau-PET in AD exhibits great potential.
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Affiliation(s)
- Robel K. Gebre
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Alexis Moscoso Rial
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Heather J. Wiste
- Department of Qualitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Fiona Heeman
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Alejandro Costoya-Sánchez
- Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Nuclear Medicine Department and Molecular Imaging Group, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Travesía da Choupana s/n, Santiago de Compostela, 15706, Spain
| | | | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Ronald C. Petersen
- Department of Qualitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael Schöll
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Nuclear Medicine Department and Molecular Imaging Group, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Travesía da Choupana s/n, Santiago de Compostela, 15706, Spain
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Ramanan VK, Graff-Radford J, Syrjanen J, Shir D, Algeciras-Schimnich A, Lucas J, Martens YA, Carrasquillo MM, Day GS, Ertekin-Taner N, Lachner C, Willis FB, Knopman DS, Jack CR, Petersen RC, Vemuri P, Graff-Radford N, Mielke MM. Association of Plasma Biomarkers of Alzheimer Disease With Cognition and Medical Comorbidities in a Biracial Cohort. Neurology 2023; 101:e1402-e1411. [PMID: 37580163 PMCID: PMC10573134 DOI: 10.1212/wnl.0000000000207675] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/06/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recent advances in blood-based biomarkers offer the potential to revolutionize the diagnosis and management of Alzheimer disease (AD), but additional research in diverse populations is critical. We assessed the profiles of blood-based AD biomarkers and their relationships to cognition and common medical comorbidities in a biracial cohort. METHODS Participants were evaluated through the Mayo Clinic Jacksonville Alzheimer Disease Research Center and matched on age, sex, and cognitive status. Plasma AD biomarkers (β-amyloid peptide 1-42 [Aβ42/40], plasma tau phosphorylated at position 181 [p-tau181], glial fibrillary acidic protein [GFAP], and neurofilament light) were measured using the Quanterix SiMoA HD-X analyzer. Cognition was assessed with the Mini-Mental State Examination. Wilcoxon rank sum tests were used to assess for differences in plasma biomarker levels by sex. Linear models tested for associations of self-reported race, chronic kidney disease (CKD), and vascular risk factors with plasma AD biomarker levels. Additional models assessed for interactions between race and plasma biomarkers in predicting cognition. RESULTS The sample comprised African American (AA; N = 267) and non-Hispanic White (NHW; N = 268) participants, including 69% female participants and age range 43-100 (median 80.2) years. Education was higher in NHW participants (median 16 vs 12 years, p < 0.001) while APOE ε4 positivity was higher in AA participants (43% vs 34%; p = 0.04). We observed no differences in plasma AD biomarker levels between AA and NHW participants. These results were unchanged after stratifying by cognitive status (unimpaired vs impaired). Although the p-tau181-cognition association seemed stronger in NHW participants while the Aβ42/40-cognition association seemed stronger in AA participants, these findings did not survive after excluding individuals with CKD. Female participants displayed higher GFAP (177.5 pg/mL vs 157.73 pg/mL; p = 0.002) and lower p-tau181 (2.62 pg/mL vs 3.28 pg/mL; p = 0.001) levels than male participants. Diabetes was inversely associated with GFAP levels (β = -0.01; p < 0.001). DISCUSSION In a biracial community-based sample of adults, we observed that sex differences, CKD, and vascular risk factors, but not self-reported race, contributed to variation in plasma AD biomarkers. Although some prior studies have reported primary effects of race/ethnicity, our results reinforce the need to account for broad-based medical and social determinants of health (including sex, systemic comorbidities, and other factors) in effectively and equitably deploying plasma AD biomarkers in the general population.
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Affiliation(s)
- Vijay K Ramanan
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Jonathan Graff-Radford
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Jeremy Syrjanen
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Dror Shir
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Alicia Algeciras-Schimnich
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - John Lucas
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Yuka A Martens
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Minerva M Carrasquillo
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Gregory S Day
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Nilüfer Ertekin-Taner
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christian Lachner
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Floyd B Willis
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - David S Knopman
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Clifford R Jack
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ronald C Petersen
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Prashanthi Vemuri
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Neill Graff-Radford
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michelle M Mielke
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
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Marinelli JP, Reed NS, Lohse CM, Fussell WL, Petersen RC, Machulda MM, Vassilaki M, Carlson ML. Cognitive Performance, Sociodemographic Factors, Pure-Tone Audiometry, and their Association with Speech Discrimination: A Prospective Population-Based Study of 1,061 Older Adults. Otol Neurotol 2023; 44:860-865. [PMID: 37621101 PMCID: PMC10529826 DOI: 10.1097/mao.0000000000004003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Hearing loss is increasingly recognized as a chronic disease state with important health sequelae. Although considered a central component of routine audiometric testing, the degree to which various patient factors influence speech discrimination is poorly characterized to date. The primary objective of the current work was to describe associations of cognitive performance, sociodemographic factors, and pure-tone audiometry with speech discrimination in older adults. STUDY DESIGN Prospective study. SETTING Olmsted County, Minnesota. PATIENTS There were 1,061 study participants 50 years or older at enrollment in the population-based Mayo Clinic Study of Aging between November 2004 and December 2019 who underwent formal audiometric and cognitive testing included in the current investigation. MAIN OUTCOME MEASURES The primary outcome measure was word recognition scores (WRSs; measured as <100% vs 100% as well as continuous), with pure-tone averages (PTAs; 0.5, 1, 2, and 3 kHz), age, sex, years of education, state area deprivation index (ADI) quintiles, and global cognition z scores as explanatory features. RESULTS The mean (SD) age among the 1,061 participants was 76 (9) years with 528 (50%) males. Participant age [OR (95% CI) for a 10-year increase of 1.8 (1.4-2.3), p < 0.001], male sex [OR = 2.6 (1.9-3.7), p < 0.001], and PTA [OR for a 10-dB hearing loss increase of 2.4 (2.1-2.8), p < 0.001] were all significantly associated with <100% WRSs, with the greatest explanatory ability attributable to the PTA. Years of education ( p = 0.9), state ADI quintile ( p = 0.6), and global cognitive performance ( p = 0.2) were not associated with WRS. The multivariable model demonstrated strong predictive ability for less than perfect WRSs, with a c index of 0.854. Similar results were seen for WRSs analyzed as continuous, with the multivariable model resulting in an R2 value of 0.433. CONCLUSIONS Although PTA exhibited the greatest influence on speech discrimination, advancing age and male sex both independently increased the likelihood of having worse speech discrimination among older adults, even after accounting for years of education, neighborhood-level socioeconomic disadvantage, and cognitive function. These findings help identify patient factors that can be instrumental when designing screening programs for adult-onset hearing loss.
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Affiliation(s)
| | | | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Wanda L Fussell
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
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Krell-Roesch J, Rakusa M, Syrjanen JA, van Harten AC, Lowe VJ, Jack CR, Kremers WK, Knopman DS, Stokin GB, Petersen RC, Vassilaki M, Geda YE. Association between CSF biomarkers of Alzheimer's disease and neuropsychiatric symptoms: Mayo Clinic Study of Aging. Alzheimers Dement 2023; 19:4498-4506. [PMID: 35142047 PMCID: PMC10433790 DOI: 10.1002/alz.12557] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/17/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We examined the association between cerebrospinal fluid (CSF)-derived biomarkers of Alzheimer's disease and neuropsychiatric symptoms (NPS) in older non-demented adults. METHODS We included 784 persons (699 cognitively unimpaired, 85 with mild cognitive impairment) aged ≥ 50 years who underwent CSF amyloid beta (Aβ42), hyperphosphorylated tau 181 (p-tau), and total tau (t-tau) as well as NPS assessment using Beck Depression and Anxiety Inventories (BDI-II, BAI), and Neuropsychiatric Inventory Questionnaire (NPI-Q). RESULTS Lower CSF Aβ42, and higher t-tau/Aβ42 and p-tau/Aβ42 ratios were associated with BDI-II and BAI total scores, clinical depression (BDI-II ≥ 13), and clinical anxiety (BAI ≥ 10), as well as NPI-Q-assessed anxiety, apathy, and nighttime behavior. DISCUSSION CSF Aβ42, t-tau/Aβ42, and p-tau/Aβ42 ratios were associated with NPS in community-dwelling individuals free of dementia. If confirmed by a longitudinal cohort study, the findings have clinical relevance of taking into account the NPS status of individuals with abnormal CSF biomarkers.
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Affiliation(s)
- Janina Krell-Roesch
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Martin Rakusa
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Jeremy A. Syrjanen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Argonde C. van Harten
- Alzheimer Center, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Walter K. Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Gorazd B. Stokin
- International Clinical Research Center, St. Anne’s Hospital, Brno, Czech Republic
| | - Ronald C. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Yonas E. Geda
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
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Petersen RC, Graf A, Brady C, De Santi S, Florian H, Landen J, Pontecorvo M, Randolph C, Sink KM, Carrillo MC, Weber CJ. Operationalizing selection criteria for clinical trials in Alzheimer's disease: Biomarker and clinical considerations. Alzheimers Dement (N Y) 2023; 9:e12434. [PMID: 38023620 PMCID: PMC10655199 DOI: 10.1002/trc2.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
Alzheimer's disease (AD) staging criteria lack standardized, empirical description. Well-defined AD staging criteria are an important consideration in protocol design, influencing a more standardized inclusion/exclusion criteria and defining what constitutes meaningful differentiation among the stages. However, many trials are being designed on the basis of biomarker features and the two need to be coordinated. The Alzheimer's Association Research Roundtable (AARR) Spring 2021 meeting discussed the implementation of preclinical AD staging criteria, and provided recommendations for how they may best be incorporated into clinical trials research. Discussion also included what currently available tools for global clinical trials may best define populations in preclinical AD trials, and if are we able to differentiate preclinical from clinical stages of the disease. Well-defined AD staging criteria are key to improving early detection, diagnostics, clinical trial enrollment, and identifying statistically significant clinical changes, and researchers discussed how emerging blood biomarkers may help with more efficient screening in preclinical stages.
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Affiliation(s)
| | - Ana Graf
- Novartis Pharma AGBaselSwitzerland
| | - Chris Brady
- WCG Clinical Endpoint Solutions, PrincetonNew JerseyUSA
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Gonzales MM, Garbarino VR, Kautz TF, Palavicini JP, Lopez-Cruzan M, Dehkordi SK, Mathews JJ, Zare H, Xu P, Zhang B, Franklin C, Habes M, Craft S, Petersen RC, Tchkonia T, Kirkland JL, Salardini A, Seshadri S, Musi N, Orr ME. Senolytic therapy in mild Alzheimer's disease: a phase 1 feasibility trial. Nat Med 2023; 29:2481-2488. [PMID: 37679434 PMCID: PMC10875739 DOI: 10.1038/s41591-023-02543-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
Cellular senescence contributes to Alzheimer's disease (AD) pathogenesis. An open-label, proof-of-concept, phase I clinical trial of orally delivered senolytic therapy, dasatinib (D) and quercetin (Q), was conducted in early-stage symptomatic patients with AD to assess central nervous system (CNS) penetrance, safety, feasibility and efficacy. Five participants (mean age = 76 + 5 years; 40% female) completed the 12-week pilot study. D and Q levels in blood increased in all participants (12.7-73.5 ng ml-1 for D and 3.29-26.3 ng ml-1 for Q). In cerebrospinal fluid (CSF), D levels were detected in four participants (80%) ranging from 0.281 to 0.536 ml-1 with a CSF to plasma ratio of 0.422-0.919%; Q was not detected. The treatment was well-tolerated, with no early discontinuation. Secondary cognitive and neuroimaging endpoints did not significantly differ from baseline to post-treatment further supporting a favorable safety profile. CSF levels of interleukin-6 (IL-6) and glial fibrillary acidic protein (GFAP) increased (t(4) = 3.913, P = 0.008 and t(4) = 3.354, P = 0.028, respectively) with trending decreases in senescence-related cytokines and chemokines, and a trend toward higher Aβ42 levels (t(4) = -2.338, P = 0.079). In summary, CNS penetrance of D was observed with outcomes supporting safety, tolerability and feasibility in patients with AD. Biomarker data provided mechanistic insights of senolytic effects that need to be confirmed in fully powered, placebo-controlled studies. ClinicalTrials.gov identifier: NCT04063124 .
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Affiliation(s)
- Mitzi M Gonzales
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Valentina R Garbarino
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Tiffany F Kautz
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Juan Pablo Palavicini
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Marisa Lopez-Cruzan
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Shiva Kazempour Dehkordi
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Cell Systems and Anatomy, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Julia J Mathews
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Habil Zare
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Cell Systems and Anatomy, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Peng Xu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Bin Zhang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Crystal Franklin
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mohamad Habes
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Neuroimage Analytics Laboratory and Biggs Institute Neuroimaging Core, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Suzanne Craft
- Department of Internal Medicine Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Tamara Tchkonia
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - James L Kirkland
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arash Salardini
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Nicolas Musi
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Miranda E Orr
- Department of Internal Medicine Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Salisbury VA Medical Center, Salisbury, NC, USA.
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