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Asken BM, Tanner JA, Vandevrede L, Apple A, Chapleau M, Gaynor LS, Lane-Donovan C, Lenio S, Yadollahikhales G, Lee S, Gontrum E, Knudtson M, Iaccarino L, La Joie R, Cobigo Y, Staffaroni AM, Casaletto KB, Gardner RC, Grinberg LT, Gorno-Tempini ML, Rosen HJ, Seeley WW, Miller BL, Kramer J, Rabinovici GD. Linking Type and Extent of Head Trauma to Cavum Septum Pellucidum in Older Adults With and Without Alzheimer Disease and Related Dementias. Neurology 2024; 102:e209183. [PMID: 38489566 PMCID: PMC11033989 DOI: 10.1212/wnl.0000000000209183] [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] [Received: 10/17/2023] [Accepted: 12/18/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cavum septum pellucidum (CSP) is a common but nonspecific MRI finding in individuals with prior head trauma. The type and extent of head trauma related to CSP, CSP features specific to head trauma, and the impact of brain atrophy on CSP are unknown. We evaluated CSP cross-sectionally and longitudinally in healthy and clinically impaired older adults who underwent detailed lifetime head trauma characterization. METHODS This is an observational cohort study of University of California, San Francisco Memory and Aging Center participants (healthy controls [HCs], those with Alzheimer disease or related dementias [ADRDs], subset with traumatic encephalopathy syndrome [TES]). We characterized traumatic brain injury (TBI) and repetitive head impacts (RHI) through contact/collision sports. Study groups were no RHI/TBI, prior TBI only, prior RHI only, and prior RHI + TBI. We additionally looked within TBI (1, 2, or 3+) and RHI (1-4, 5-10, and 11+ years). All underwent baseline MRI, and 67% completed a second MRI (median follow-up = 5.4 years). CSP measures included grade (0-4) and length (millimeters). Groups were compared on likelihood of CSP (logistic regression, odds ratios [ORs]) and whether CSP length discriminated groups (area under the curve [AUC]). RESULTS Our sample included 266 participants (N = 160 HCs, N = 106 with ADRD or TES; age 66.8 ± 8.2 years, 45.3% female). Overall, 123 (49.8%) participants had no RHI/TBI, 52 (21.1%) had TBI only, 41 (16.6%) had RHI only, 31 (12.6%) had RHI + TBI, and 20 were classified as those with TES (7.5%). Compared with no RHI/TBI, RHI + TBI (OR 3.11 [1.23-7.88]) and TES (OR 11.6 [2.46-54.8]) had greater odds of CSP. Approximately 5-10 years (OR 2.96 [1.13-7.77]) and 11+ years of RHI (OR 3.14 [1.06-9.31]) had higher odds of CSP. CSP length modestly discriminated participants with 5-10 years (AUC 0.63 [0.51-0.75]) and 11+ years of prior RHI (AUC 0.69 [0.55-0.84]) from no RHI/TBI (cut point = 6 mm). Strongest effects were noted in analyses of American football participation. Longitudinally, CSP grade was unchanged in 165 (91.7%), and length was unchanged in 171 (95.5%) participants. DISCUSSION Among older adults with and without neurodegenerative disease, risk of CSP is driven more by duration (years) of RHI, especially American football, than number of TBI. CSP length (≥6 mm) is relatively specific to individuals who have had substantial prior RHI. Neurodegenerative disease and progressive atrophy do not clearly influence development or worsening of CSP.
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Affiliation(s)
- Breton M Asken
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Jeremy A Tanner
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Lawren Vandevrede
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Alexandra Apple
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Marianne Chapleau
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Leslie S Gaynor
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Courtney Lane-Donovan
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Steven Lenio
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Golnaz Yadollahikhales
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Shannon Lee
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Eva Gontrum
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Marguerite Knudtson
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Leonardo Iaccarino
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Renaud La Joie
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Yann Cobigo
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Adam M Staffaroni
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Kaitlin B Casaletto
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Raquel C Gardner
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Lea T Grinberg
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Maria Luisa Gorno-Tempini
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Howard J Rosen
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - William W Seeley
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Bruce L Miller
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Joel Kramer
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Gil D Rabinovici
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
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Asken BM, Tanner JA, Gaynor LS, VandeVrede L, Mantyh WG, Casaletto KB, Staffaroni AM, Fonseca C, Shankar R, Grant H, Smith K, Lago AL, Xu H, La Joie R, Cobigo Y, Rosen H, Perry DC, Rojas JC, Miller BL, Gardner RC, Wang KKW, Kramer JH, Rabinovici GD. Alzheimer's pathology is associated with altered cognition, brain volume, and plasma biomarker patterns in traumatic encephalopathy syndrome. Alzheimers Res Ther 2023; 15:126. [PMID: 37480088 PMCID: PMC10360257 DOI: 10.1186/s13195-023-01275-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: 05/06/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Traumatic encephalopathy syndrome (TES) is a clinical phenotype sensitive but non-specific to underlying chronic traumatic encephalopathy (CTE) neuropathology. However, cognitive symptoms of TES overlap with Alzheimer's disease (AD), and features of AD pathology like beta-amyloid (Aβ) plaques often co-occur with CTE, making clinical-to-pathological conclusions of TES diagnoses challenging. We investigated how Alzheimer's neuropathological changes associated with cognition, brain volume, and plasma biomarkers in patients with repetitive head impacts (RHI)/TES, clinical AD, or typically aging controls. METHODS We studied 154 participants including 33 with RHI/TES (age 61.5 ± 11.5, 100% male, 11/33 Aβ[ +]), 62 with AD and no known prior RHI (age 67.1 ± 10.2, 48% male, 62/62 Aβ[ +]), and 59 healthy controls without RHI (HC; age 73.0 ± 6.2, 40% male, 0/59 Aβ[ +]). Patients completed neuropsychological testing (memory, executive functioning, language, visuospatial) and structural MRI (voxel-based morphometry analysis), and provided plasma samples analyzed for GFAP, NfL, IL-6, IFN-γ, and YKL-40. For cognition and plasma biomarkers, patients with RHI/TES were stratified as Aβ[ +] or Aβ[ -] and compared to each other plus the AD and HC groups (ANCOVA adjusting for age and sex). Differences with at least a medium effect size (Cohen's d > 0.50) were interpreted as potentially meaningful. RESULTS Cognitively, within the TES group, Aβ[ +] RHI/TES performed worse than Aβ[-] RHI/TES on visuospatial (p = .04, d = 0.86) and memory testing (p = .07, d = 0.74). Comparing voxel-wise brain volume, both Aβ[ +] and Aβ[ -] RHI/TES had lower medial and anterior temporal lobe volume than HC and did not significantly differ from AD. Comparing plasma biomarkers, Aβ[ +] RHI/TES had higher plasma GFAP than HC (p = .01, d = 0.88) and did not significantly differ from AD. Conversely, Aβ[ -] RHI/TES had higher NfL than HC (p = .004, d = 0.93) and higher IL-6 than all other groups (p's ≤ .004, d's > 1.0). CONCLUSIONS Presence of Alzheimer's pathology in patients with RHI/TES is associated with altered cognitive and biomarker profiles. Patients with RHI/TES and positive Aβ-PET have cognitive and plasma biomarker changes that are more like patients with AD than patients with Aβ[ -] RHI/TES. Measuring well-validated Alzheimer's biomarkers in patients with RHI/TES could improve interpretation of research findings and heighten precision in clinical management.
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Affiliation(s)
- Breton M Asken
- Department of Clinical & Health Psychology, 1Florida Alzheimer's Disease Research Center, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA.
| | - Jeremy A Tanner
- Department of Neurology, Biggs Institute for Alzheimer's and Neurodegenerative Diseases, South Texas Alzheimer's Disease Research Center, University of Texas Health - San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Leslie S Gaynor
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Lawren VandeVrede
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - William G Mantyh
- Department of Neurology, University of Minnesota, PWB 12-100, 516 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Kaitlin B Casaletto
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Adam M Staffaroni
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Corrina Fonseca
- Department of Neuroscience, Helen Wills Neuroscience Institute, University of California, 132 Barker Hall MC#3190, Berkeley, CA, 94720, USA
| | - Ranjani Shankar
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Harli Grant
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Karen Smith
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Argentina Lario Lago
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Haiyan Xu
- Department of Surgery, University of Florida, PO Box 100128, Gainesville, FL, 32610, USA
| | - Renaud La Joie
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Yann Cobigo
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Howie Rosen
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - David C Perry
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Julio C Rojas
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Bruce L Miller
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Raquel C Gardner
- Sheba Medical Center, Tel Hashomer City of Health, Tel Aviv District, Derech Sheba 2, Ramat Gan, Israel
| | - Kevin K W Wang
- Department of Neurobiology, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Joel H Kramer
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Gil D Rabinovici
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
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