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Holland N, Savulich G, Jones PS, Whiteside DJ, Street D, Swann P, Naessens M, Malpetti M, Hong YT, Fryer TD, Rittman T, Mulroy E, Aigbirhio FI, Bhatia KP, O'Brien JT, Rowe JB. Differential Synaptic Loss in β-Amyloid Positive Versus β-Amyloid Negative Corticobasal Syndrome. Mov Disord 2024. [PMID: 38671545 DOI: 10.1002/mds.29814] [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: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND/OBJECTIVE The corticobasal syndrome (CBS) is a complex asymmetric movement disorder, with cognitive impairment. Although commonly associated with the primary 4-repeat-tauopathy of corticobasal degeneration, clinicopathological correlation is poor, and a significant proportion is due to Alzheimer's disease (AD). Synaptic loss is a pathological feature of many clinical and preclinical tauopathies. We therefore measured the degree of synaptic loss in patients with CBS and tested whether synaptic loss differed according to β-amyloid status. METHODS Twenty-five people with CBS, and 32 age-/sex-/education-matched healthy controls participated. Regional synaptic density was estimated by [11C]UCB-J non-displaceable binding potential (BPND), AD-tau pathology by [18F]AV-1451 BPND, and gray matter volume by T1-weighted magnetic resonance imaging. Participants with CBS had β-amyloid imaging with 11C-labeled Pittsburgh Compound-B ([11C]PiB) positron emission tomography. Symptom severity was assessed with the progressive supranuclear palsy-rating-scale, the cortical basal ganglia functional scale, and the revised Addenbrooke's Cognitive Examination. Regional differences in BPND and gray matter volume between groups were assessed by ANOVA. RESULTS Compared to controls, patients with CBS had higher [18F]AV-1451 uptake, gray matter volume loss, and reduced synaptic density. Synaptic loss was more severe and widespread in the β-amyloid negative group. Asymmetry of synaptic loss was in line with the clinically most affected side. DISCUSSION Distinct patterns of [11C]UCB-J and [18F]AV-1451 binding and gray matter volume loss, indicate differences in the pathogenic mechanisms of CBS according to whether it is associated with the presence of Alzheimer's disease or not. This highlights the potential for different therapeutic strategies in CBSs. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Negin Holland
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - George Savulich
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - David J Whiteside
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Duncan Street
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Peter Swann
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Michelle Naessens
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Young T Hong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Franklin I Aigbirhio
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - John T O'Brien
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
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Whiteside DJ, Holland N, Tsvetanov KA, Mak E, Malpetti M, Savulich G, Jones PS, Naessens M, Rouse MA, Fryer TD, Hong YT, Aigbirhio FI, Mulroy E, Bhatia KP, Rittman T, O'Brien JT, Rowe JB. Synaptic density affects clinical severity via network dysfunction in syndromes associated with frontotemporal lobar degeneration. Nat Commun 2023; 14:8458. [PMID: 38114493 PMCID: PMC10730886 DOI: 10.1038/s41467-023-44307-7] [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: 04/04/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
There is extensive synaptic loss from frontotemporal lobar degeneration, in preclinical models and human in vivo and post mortem studies. Understanding the consequences of synaptic loss for network function is important to support translational models and guide future therapeutic strategies. To examine this relationship, we recruited 55 participants with syndromes associated with frontotemporal lobar degeneration and 24 healthy controls. We measured synaptic density with positron emission tomography using the radioligand [11C]UCB-J, which binds to the presynaptic vesicle glycoprotein SV2A, neurite dispersion with diffusion magnetic resonance imaging, and network function with task-free magnetic resonance imaging functional connectivity. Synaptic density and neurite dispersion in patients was associated with reduced connectivity beyond atrophy. Functional connectivity moderated the relationship between synaptic density and clinical severity. Our findings confirm the importance of synaptic loss in frontotemporal lobar degeneration syndromes, and the resulting effect on behaviour as a function of abnormal connectivity.
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Affiliation(s)
- David J Whiteside
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Negin Holland
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kamen A Tsvetanov
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - George Savulich
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Michelle Naessens
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Matthew A Rouse
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Young T Hong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Franklin I Aigbirhio
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Eoin Mulroy
- UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Kailash P Bhatia
- UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John T O'Brien
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Street D, Bevan-Jones WR, Malpetti M, Jones PS, Passamonti L, Ghosh BC, Rittman T, Coyle-Gilchrist IT, Allinson K, Dawson CE, Rowe JB. Structural correlates of survival in progressive supranuclear palsy. Parkinsonism Relat Disord 2023; 116:105866. [PMID: 37804622 PMCID: PMC7615224 DOI: 10.1016/j.parkreldis.2023.105866] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/12/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Many studies of the Richardson's syndrome phenotype of progressive supranuclear palsy (PSP) have elucidated regions of progressive atrophy and neural correlates of clinical severity. However, the neural correlates of survival and how these differ according to variant phenotypes are poorly understood. We set out to identify structural changes that predict severity and survival from scanning date to death. METHODS Structural magnetic resonance imaging data from 112 deceased people with clinically defined 'probable' or 'possible' PSP were analysed. Neuroanatomical regions of interest volumes, thickness and area were correlated with 'temporal stage', defined as the ratio of time from symptom onset to death, time from scan to death ('survival from scan'), and in a subset of patients, clinical severity, adjusting for age and total intracranial volume. Forty-nine participants had post mortem confirmation of the diagnosis. RESULTS Using T1-weighted magnetic resonance imaging, we confirmed the midbrain, and bilateral cortical structural correlates of contemporary disease severity. Atrophy of the striatum, cerebellum and frontotemporal cortex correlate with temporal stage and survival from scan, even after adjusting for severity. Subcortical structure-survival relationships were stronger in Richardson's syndrome than variant phenotypes. CONCLUSIONS Although the duration of PSP varies widely between people, an individual's progress from disease onset to death (their temporal stage) reflects atrophy in striatal, cerebellar and frontotemporal cortical regions. Our findings suggest magnetic resonance imaging may contribute to prognostication and stratification of patients with heterogenous clinical trajectories and clarify the processes that confer mortality risk in PSP.
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Affiliation(s)
- Duncan Street
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | | | - Maura Malpetti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Consiglio Nazionale Delle Ricerche (CNR), Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Milano, Italy
| | - Boyd Cp Ghosh
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - Ian Ts Coyle-Gilchrist
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Norfolk and Norwich NHS Foundation Trust, Norwich, UK
| | - Kieren Allinson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Department of Pathology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Catherine E Dawson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
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Ye R, Hezemans FH, O'Callaghan C, Tsvetanov KA, Rua C, Jones PS, Holland N, Malpetti M, Murley AG, Barker RA, Williams-Gray CH, Robbins TW, Passamonti L, Rowe JB. Locus Coeruleus Integrity Is Linked to Response Inhibition Deficits in Parkinson's Disease and Progressive Supranuclear Palsy. J Neurosci 2023; 43:7028-7040. [PMID: 37669861 PMCID: PMC10586538 DOI: 10.1523/jneurosci.0289-22.2023] [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: 01/19/2022] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 09/07/2023] Open
Abstract
Parkinson's disease (PD) and progressive supranuclear palsy (PSP) both impair response inhibition, exacerbating impulsivity. Inhibitory control deficits vary across individuals and are linked with worse prognosis, and lack improvement on dopaminergic therapy. Motor and cognitive control are associated with noradrenergic innervation of the cortex, arising from the locus coeruleus (LC) noradrenergic system. Here we test the hypothesis that structural variation of the LC explains response inhibition deficits in PSP and PD. Twenty-four people with idiopathic PD, 14 with PSP-Richardson's syndrome, and 24 age- and sex-matched controls undertook a stop-signal task and ultrahigh field 7T magnetization-transfer-weighted imaging of the LC. Parameters of "race models" of go- versus stop-decisions were estimated using hierarchical Bayesian methods to quantify the cognitive processes of response inhibition. We tested the multivariate relationship between LC integrity and model parameters using partial least squares. Both disorders impaired response inhibition at the group level. PSP caused a distinct pattern of abnormalities in inhibitory control with a paradoxically reduced threshold for go responses, but longer nondecision times, and more lapses of attention. The variation in response inhibition correlated with the variability of LC integrity across participants in both clinical groups. Structural imaging of the LC, coupled with behavioral modeling in parkinsonian disorders, confirms that LC integrity is associated with response inhibition and LC degeneration contributes to neurobehavioral changes. The noradrenergic system is therefore a promising target to treat impulsivity in these conditions. The optimization of noradrenergic treatment is likely to benefit from stratification according to LC integrity.SIGNIFICANCE STATEMENT Response inhibition deficits contribute to clinical symptoms and poor outcomes in people with Parkinson's disease and progressive supranuclear palsy. We used cognitive modeling of performance of a response inhibition task to identify disease-specific mechanisms of abnormal inhibitory control. Response inhibition in both patient groups was associated with the integrity of the noradrenergic locus coeruleus, which we measured in vivo using ultra-high field MRI. We propose that the imaging biomarker of locus coeruleus integrity provides a trans-diagnostic tool to explain individual differences in response inhibition ability beyond the classic nosological borders and diagnostic criteria. Our data suggest a potential new stratified treatment approach for Parkinson's disease and progressive supranuclear palsy.
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Affiliation(s)
- Rong Ye
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, 230032, China
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Frank H Hezemans
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 GD Nijmegen, The Netherlands
| | - Claire O'Callaghan
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2050, New South Wales, Australia
| | - Kamen A Tsvetanov
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, CB2 3EA, United Kingdom
| | - Catarina Rua
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - P Simon Jones
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Negin Holland
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Maura Malpetti
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Alexander G Murley
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Roger A Barker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- Wellcome-MRC Stem Cell Institute, University of Cambridge, Cambridge, CB2 0AW, United Kingdom
| | - Caroline H Williams-Gray
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge, CB2 3EA, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EA, United Kingdom
| | - Luca Passamonti
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - James B Rowe
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EA, United Kingdom
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Street D, Jabbari E, Costantini A, Jones PS, Holland N, Rittman T, Jensen MT, Chelban V, Goh YY, Guo T, Heslegrave AJ, Roncaroli F, Klein JC, Ansorge O, Allinson KSJ, Jaunmuktane Z, Revesz T, Warner TT, Lees AJ, Zetterberg H, Russell LL, Bocchetta M, Rohrer JD, Burn DJ, Pavese N, Gerhard A, Kobylecki C, Leigh PN, Church A, Hu MTM, Houlden H, Morris H, Rowe JB. Progression of atypical parkinsonian syndromes: PROSPECT-M-UK study implications for clinical trials. Brain 2023; 146:3232-3242. [PMID: 36975168 PMCID: PMC10393398 DOI: 10.1093/brain/awad105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/24/2022] [Revised: 02/11/2023] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
The advent of clinical trials of disease-modifying agents for neurodegenerative disease highlights the need for evidence-based end point selection. Here we report the longitudinal PROSPECT-M-UK study of progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), multiple system atrophy (MSA) and related disorders, to compare candidate clinical trial end points. In this multicentre UK study, participants were assessed with serial questionnaires, motor examination, neuropsychiatric and MRI assessments at baseline, 6 and 12 months. Participants were classified by diagnosis at baseline and study end, into Richardson syndrome, PSP-subcortical (PSP-parkinsonism and progressive gait freezing subtypes), PSP-cortical (PSP-frontal, PSP-speech and language and PSP-CBS subtypes), MSA-parkinsonism, MSA-cerebellar, CBS with and without evidence of Alzheimer's disease pathology and indeterminate syndromes. We calculated annual rate of change, with linear mixed modelling and sample sizes for clinical trials of disease-modifying agents, according to group and assessment type. Two hundred forty-three people were recruited [117 PSP, 68 CBS, 42 MSA and 16 indeterminate; 138 (56.8%) male; age at recruitment 68.7 ± 8.61 years]. One hundred and fifty-nine completed the 6-month assessment (82 PSP, 27 CBS, 40 MSA and 10 indeterminate) and 153 completed the 12-month assessment (80 PSP, 29 CBS, 35 MSA and nine indeterminate). Questionnaire, motor examination, neuropsychiatric and neuroimaging measures declined in all groups, with differences in longitudinal change between groups. Neuroimaging metrics would enable lower sample sizes to achieve equivalent power for clinical trials than cognitive and functional measures, often achieving N < 100 required for 1-year two-arm trials (with 80% power to detect 50% slowing). However, optimal outcome measures were disease-specific. In conclusion, phenotypic variance within PSP, CBS and MSA is a major challenge to clinical trial design. Our findings provide an evidence base for selection of clinical trial end points, from potential functional, cognitive, clinical or neuroimaging measures of disease progression.
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Affiliation(s)
- Duncan Street
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Edwin Jabbari
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Alyssa Costantini
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - P Simon Jones
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Negin Holland
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Timothy Rittman
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Marte T Jensen
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Viorica Chelban
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Neurobiology and Medical Genetics Laboratory, ‘Nicolae Testemitanu’ State University of Medicine and Pharmacy, Chisinau 2004, Republic of Moldova
| | - Yen Y Goh
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Tong Guo
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Amanda J Heslegrave
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute, University College London, London, W1T 7NF, UK
| | - Federico Roncaroli
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M6 8HD, UK
| | - Johannes C Klein
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Kieren S J Allinson
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Thomas T Warner
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Andrew J Lees
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute, University College London, London, W1T 7NF, UK
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 30 Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Salhgrenska Academy at the University of Gothenburg, 413 45 Goteborg, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong Science Park, Shatin, N.T., Hong Kong, China
| | - Lucy L Russell
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Martina Bocchetta
- Centre for Cognitive and Clinical Neuroscience, Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, UB8 3PH, UK
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle, NE2 4HH, UK
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle, NE4 5PL, UK
| | - Alexander Gerhard
- Division of Neuroscience, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, N20 3LJ, UK
- Departments of Geriatric Medicine and Nuclear Medicine, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, 45356 Essen, Germany
| | - Christopher Kobylecki
- Division of Neuroscience, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, N20 3LJ, UK
- Department of Neurology, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Salford, M13 9NQ, UK
| | - P Nigel Leigh
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Alistair Church
- Department of Neurology, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - Michele T M Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Physiology, Anatomy and Genetics, Oxford Parkinson’s Disease Centre, University of Oxford, Oxford, OX1 3QU, UK
| | - Henry Houlden
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Huw Morris
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - James B Rowe
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, UK
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6
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Holland N, Jones PS, Savulich G, Naessens M, Malpetti M, Whiteside DJ, Street D, Swann P, Hong YT, Fryer TD, Rittman T, Mulroy E, Aigbirhio FI, Bhatia KP, O'Brien JT, Rowe JB. Longitudinal Synaptic Loss in Primary Tauopathies: An In Vivo [ 11 C]UCB-J Positron Emission Tomography Study. Mov Disord 2023; 38:1316-1326. [PMID: 37171832 PMCID: PMC10947001 DOI: 10.1002/mds.29421] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 02/04/2023] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Synaptic loss is characteristic of many neurodegenerative diseases; it occurs early and is strongly related to functional deficits. OBJECTIVE In this longitudinal observational study, we determine the rate at which synaptic density is reduced in the primary tauopathies of progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD), and we test the relationship with disease progression. METHODS Our cross-sectional cohort included 32 participants with probable PSP and 16 with probable CBD (all amyloid-negative corticobasal syndrome), recruited from tertiary care centers in the United Kingdom, and 33 sex- and age-matched healthy control subjects. Synaptic density was estimated by positron emission tomography imaging with the radioligand [11 C]UCB-J that binds synaptic vesicle 2A. Clinical severity and cognition were assessed by the PSP Rating Scale and the Addenbrooke's cognitive examination. Regional [11 C]UCB-J nondisplaceable binding potential was estimated in Hammersmith Atlas regions of interest. Twenty-two participants with PSP/CBD had a follow-up [11 C]UCB-J positron emission tomography scan after 1 year. We calculated the annualized change in [11 C]UCB-J nondisplaceable binding potential and correlated this with the change in clinical severity. RESULTS We found significant annual synaptic loss within the frontal lobe (-3.5%, P = 0.03) and the right caudate (-3.9%, P = 0.046). The degree of longitudinal synaptic loss within the frontal lobe correlated with the rate of change in the PSP Rating Scale (R = 0.47, P = 0.03) and cognition (Addenbrooke's Cognitive Examination-Revised, R = -0.62, P = 0.003). CONCLUSIONS We provide in vivo evidence for rapid progressive synaptic loss, correlating with clinical progression in primary tauopathies. Synaptic loss may be an important therapeutic target and outcome variable for early-phase clinical trials of disease-modifying treatments. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Negin Holland
- Department of Clinical NeurosciencesUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUnited Kingdom
- Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - P. Simon Jones
- Department of Clinical NeurosciencesUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - George Savulich
- Department of PsychiatryUniversity of Cambridge, School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - Michelle Naessens
- Department of Clinical NeurosciencesUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - Maura Malpetti
- Department of Clinical NeurosciencesUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - David J. Whiteside
- Department of Clinical NeurosciencesUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - Duncan Street
- Department of Clinical NeurosciencesUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - Peter Swann
- Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
- Department of PsychiatryUniversity of Cambridge, School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - Young T. Hong
- Department of Clinical NeurosciencesUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUnited Kingdom
- Wolfson Brain Imaging CentreUniversity of CambridgeCambridgeUnited Kingdom
| | - Tim D. Fryer
- Department of Clinical NeurosciencesUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUnited Kingdom
- Wolfson Brain Imaging CentreUniversity of CambridgeCambridgeUnited Kingdom
| | - Timothy Rittman
- Department of Clinical NeurosciencesUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - Eoin Mulroy
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Franklin I. Aigbirhio
- Department of Clinical NeurosciencesUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - Kailash P. Bhatia
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - John T. O'Brien
- Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
- Department of PsychiatryUniversity of Cambridge, School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - James B. Rowe
- Department of Clinical NeurosciencesUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUnited Kingdom
- Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
- Medical Research Council Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUnited Kingdom
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7
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Whiteside DJ, Street D, Murley AG, Jones PS, Malpetti M, Ghosh BCP, Coyle-Gilchrist I, Gerhard A, Hu MT, Klein JC, Leigh PN, Church A, Burn DJ, Morris HR, Rowe JB, Rittman T. Network connectivity and structural correlates of survival in progressive supranuclear palsy and corticobasal syndrome. Hum Brain Mapp 2023. [PMID: 37269181 DOI: 10.1002/hbm.26342] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 06/04/2023] Open
Abstract
There is a pressing need to understand the factors that predict prognosis in progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS), with high heterogeneity over the poor average survival. We test the hypothesis that the magnitude and distribution of connectivity changes in PSP and CBS predict the rate of progression and survival time, using datasets from the Cambridge Centre for Parkinson-plus and the UK National PSP Research Network (PROSPECT-MR). Resting-state functional MRI images were available from 146 participants with PSP, 82 participants with CBS, and 90 healthy controls. Large-scale networks were identified through independent component analyses, with correlations taken between component time series. Independent component analysis was also used to select between-network connectivity components to compare with baseline clinical severity, longitudinal rate of change in severity, and survival. Transdiagnostic survival predictors were identified using partial least squares regression for Cox models, with connectivity compared to patients' demographics, structural imaging, and clinical scores using five-fold cross-validation. In PSP and CBS, between-network connectivity components were identified that differed from controls, were associated with disease severity, and were related to survival and rate of change in clinical severity. A transdiagnostic component predicted survival beyond demographic and motion metrics but with lower accuracy than an optimal model that included the clinical and structural imaging measures. Cortical atrophy enhanced the connectivity changes that were most predictive of survival. Between-network connectivity is associated with variability in prognosis in PSP and CBS but does not improve predictive accuracy beyond clinical and structural imaging metrics.
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Affiliation(s)
- David J Whiteside
- Department of Clinical Neurosciences and Cambridge Centre for Parkinson-plus, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Duncan Street
- Department of Clinical Neurosciences and Cambridge Centre for Parkinson-plus, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alexander G Murley
- Department of Clinical Neurosciences and Cambridge Centre for Parkinson-plus, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences and Cambridge Centre for Parkinson-plus, University of Cambridge, Cambridge, UK
| | - Maura Malpetti
- Department of Clinical Neurosciences and Cambridge Centre for Parkinson-plus, University of Cambridge, Cambridge, UK
| | - Boyd C P Ghosh
- Wessex Neurological Centre, University Hospital Southampton, Southampton, UK
| | | | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
- Departments of Geriatric Medicine and Nuclear Medicine, University of Duisburg-Essen, Duisburg, Germany
| | - Michele T Hu
- Oxford Parkinson's Disease Centre and Division of Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Johannes C Klein
- Oxford Parkinson's Disease Centre and Division of Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - P Nigel Leigh
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK
| | | | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Huw R Morris
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge Centre for Parkinson-plus, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences and Cambridge Centre for Parkinson-plus, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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8
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Cope TE, Sohoglu E, Peterson KA, Jones PS, Rua C, Passamonti L, Sedley W, Post B, Coebergh J, Butler CR, Garrard P, Abdel-Aziz K, Husain M, Griffiths TD, Patterson K, Davis MH, Rowe JB. Temporal lobe perceptual predictions for speech are instantiated in motor cortex and reconciled by inferior frontal cortex. Cell Rep 2023; 42:112422. [PMID: 37099422 DOI: 10.1016/j.celrep.2023.112422] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/04/2022] [Revised: 12/23/2022] [Accepted: 04/05/2023] [Indexed: 04/27/2023] Open
Abstract
Humans use predictions to improve speech perception, especially in noisy environments. Here we use 7-T functional MRI (fMRI) to decode brain representations of written phonological predictions and degraded speech signals in healthy humans and people with selective frontal neurodegeneration (non-fluent variant primary progressive aphasia [nfvPPA]). Multivariate analyses of item-specific patterns of neural activation indicate dissimilar representations of verified and violated predictions in left inferior frontal gyrus, suggestive of processing by distinct neural populations. In contrast, precentral gyrus represents a combination of phonological information and weighted prediction error. In the presence of intact temporal cortex, frontal neurodegeneration results in inflexible predictions. This manifests neurally as a failure to suppress incorrect predictions in anterior superior temporal gyrus and reduced stability of phonological representations in precentral gyrus. We propose a tripartite speech perception network in which inferior frontal gyrus supports prediction reconciliation in echoic memory, and precentral gyrus invokes a motor model to instantiate and refine perceptual predictions for speech.
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Affiliation(s)
- Thomas E Cope
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK; Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK.
| | - Ediz Sohoglu
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK; School of Psychology, University of Sussex, Brighton BN1 9RH, UK
| | - Katie A Peterson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK; Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Catarina Rua
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - William Sedley
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Brechtje Post
- Theoretical and Applied Linguistics, Faculty of Modern & Medieval Languages & Linguistics, University of Cambridge, Cambridge CB3 9DA, UK
| | - Jan Coebergh
- Ashford and St Peter's Hospital, Ashford TW15 3AA, UK; St George's Hospital, London SW17 0QT, UK
| | - Christopher R Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK; Faculty of Medicine, Department of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Peter Garrard
- St George's Hospital, London SW17 0QT, UK; Molecular and Clinical Sciences Research Institute, St. George's, University of London, London SW17 0RE, UK
| | - Khaled Abdel-Aziz
- Ashford and St Peter's Hospital, Ashford TW15 3AA, UK; St George's Hospital, London SW17 0QT, UK
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Timothy D Griffiths
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Karalyn Patterson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Matthew H Davis
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK; Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK
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9
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Whiteside DJ, Malpetti M, Jones PS, Ghosh BCP, Coyle‐Gilchrist I, van Swieten JC, Seelaar H, Jiskoot L, Borroni B, Sanchez‐Valle R, Moreno F, Laforce R, Graff C, Synofzik M, Galimberti D, Masellis M, Tartaglia MC, Finger E, Vandenberghe R, de Mendonça A, Tagliavini F, Butler CR, Santana I, Ber IL, Gerhard A, Ducharme S, Levin J, Danek A, Otto M, Sorbi S, Pasquier F, Bouzigues A, Russell LL, Rohrer JD, Rowe JB, Rittman T. Temporal dynamics predict symptom onset and cognitive decline in familial frontotemporal dementia. Alzheimers Dement 2023; 19:1947-1962. [PMID: 36377606 PMCID: PMC7614527 DOI: 10.1002/alz.12824] [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: 07/05/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We tested whether changes in functional networks predict cognitive decline and conversion from the presymptomatic prodrome to symptomatic disease in familial frontotemporal dementia (FTD). METHODS For hypothesis generation, 36 participants with behavioral variant FTD (bvFTD) and 34 controls were recruited from one site. For hypothesis testing, we studied 198 symptomatic FTD mutation carriers, 341 presymptomatic mutation carriers, and 329 family members without mutations. We compared functional network dynamics between groups, with clinical severity and with longitudinal clinical progression. RESULTS We identified a characteristic pattern of dynamic network changes in FTD, which correlated with neuropsychological impairment. Among presymptomatic mutation carriers, this pattern of network dynamics was found to a greater extent in those who subsequently converted to the symptomatic phase. Baseline network dynamic changes predicted future cognitive decline in symptomatic participants and older presymptomatic participants. DISCUSSION Dynamic network abnormalities in FTD predict cognitive decline and symptomatic conversion. HIGHLIGHTS We investigated brain network predictors of dementia symptom onset Frontotemporal dementia results in characteristic dynamic network patterns Alterations in network dynamics are associated with neuropsychological impairment Network dynamic changes predict symptomatic conversion in presymptomatic carriers Network dynamic changes are associated with longitudinal cognitive decline.
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Affiliation(s)
- David J. Whiteside
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeCambridgeshireUK
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Maura Malpetti
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeCambridgeshireUK
| | - P. Simon Jones
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeCambridgeshireUK
| | - Boyd C. P. Ghosh
- Wessex Neurological CentreUniversity Hospital SouthamptonSouthamptonUK
| | | | | | - Harro Seelaar
- Department of NeurologyErasmus Medical CentreRotterdamNetherlands
| | - Lize Jiskoot
- Department of NeurologyErasmus Medical CentreRotterdamNetherlands
| | - Barbara Borroni
- Centre for Neurodegenerative DisordersDepartment of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Raquel Sanchez‐Valle
- Alzheimer's Disease and Other Cognitive Disorders UnitNeurology Service, Hospital ClínicInstitut d'Investigacións Biomèdiques August Pi I SunyerUniversity of BarcelonaBarcelonaSpain
| | - Fermin Moreno
- Cognitive Disorders UnitDepartment of NeurologyDonostia University HospitalSan SebastianGipuzkoaSpain
- Neuroscience AreaBiodonostia Health Research InstituteSan SebastianGipuzkoaSpain
| | - Robert Laforce
- CHU de Québec, and Faculté de MédecineDépartement des Sciences NeurologiquesClinique Interdisciplinaire de Mémoire, Université LavalQCCanada
| | - Caroline Graff
- Center for Alzheimer ResearchDivision of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyBioclinicum, Karolinska InstitutetSolnaSweden
- Unit for Hereditary Dementias, Theme AgingKarolinska University HospitalSolnaSweden
| | - Matthis Synofzik
- Department of Neurodegenerative DiseasesHertie‐Institute for Clinical Brain ResearchTübingenGermany
- Center of NeurologyUniversity of TübingenTübingenGermany
| | - Daniela Galimberti
- Fondazione IRCCS Ospedale PoliclinicoMilanItaly
- Department of Biomedical, Surgical and Dental SciencesUniversity of MilanMilanItaly
| | - Mario Masellis
- Sunnybrook Health Sciences CentreSunnybrook Research InstituteUniversity of TorontoTorontoCanada
| | | | - Elizabeth Finger
- Department of Clinical Neurological SciencesUniversity of Western OntarioLondonOntarioCanada
| | - Rik Vandenberghe
- Laboratory for Cognitive NeurologyDepartment of NeurosciencesKU LeuvenLeuvenBelgium
- Neurology ServiceUniversity Hospitals LeuvenBelgium
- Leuven Brain InstituteKU LeuvenLeuvenBelgium
| | | | | | - Chris R. Butler
- Nuffield Department of Clinical NeurosciencesMedical Sciences DivisionUniversity of OxfordOxfordUK
- Department of Brain SciencesImperial College LondonLondonUK
| | - Isabel Santana
- University Hospital of Coimbra (HUC)Neurology Service, Faculty of MedicineUniversity of CoimbraCoimbraPortugal
- Center for Neuroscience and Cell BiologyFaculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Isabelle Le Ber
- Paris Brain Institute – Institut du Cerveau – ICMInserm U1127, CNRS UMR 7225, AP‐HP ‐ Hôpital Pitié‐SalpêtrièreSorbonne UniversitéParisFrance
- Centre de référence des démences rares ou précoces, IM2ADépartement de NeurologieAP‐HP ‐ Hôpital Pitié‐SalpêtrièreParisFrance
- Département de NeurologieAP‐HP ‐ Hôpital Pitié‐SalpêtrièreParisFrance
| | - Alexander Gerhard
- Division of Neuroscience and Experimental PsychologyWolfson Molecular Imaging CentreUniversity of ManchesterManchesterUK
- Departments of Geriatric Medicine and Nuclear MedicineUniversity of Duisburg‐ EssenDuisburgGermany
| | - Simon Ducharme
- Department of PsychiatryMcGill University Health CentreMcGill UniversityMontrealQuébecCanada
- Department of Neurology & NeurosurgeryMcConnell Brain Imaging CentreMontreal Neurological InstituteMcGill UniversityMontrealCanada
| | - Johannes Levin
- Neurologische KlinikLudwig‐Maximilians‐Universität MünchenMunichGermany
- German Center for Neurodegenerative Diseases (DZNE)MunichGermany
- Munich Cluster of Systems NeurologyMunichGermany
| | - Adrian Danek
- Neurologische KlinikLudwig‐Maximilians‐Universität MünchenMunichGermany
| | - Markus Otto
- Department of NeurologyUniversity of UlmUlmGermany
| | - Sandro Sorbi
- Department of NeurofarbaUniversity of FlorenceFlorenceItaly
- IRCCS Fondazione Don Carlo GnocchiFlorenceItaly
| | - Florence Pasquier
- Univ LilleLilleFrance
- Inserm 1172LilleFrance
- CHU, CNR‐MAJ, Labex DistalzLiCEND LilleLilleFrance
| | - Arabella Bouzigues
- Department of Neurodegenerative DiseaseDementia Research Centre UCL Institute of NeurologyQueen SquareLondonUK
| | - Lucy L. Russell
- Department of Neurodegenerative DiseaseDementia Research Centre UCL Institute of NeurologyQueen SquareLondonUK
| | - Jonathan D. Rohrer
- Department of Neurodegenerative DiseaseDementia Research Centre UCL Institute of NeurologyQueen SquareLondonUK
| | - James B. Rowe
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeCambridgeshireUK
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK
| | - Timothy Rittman
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeCambridgeshireUK
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
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10
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Malpetti M, Cope TE, Street D, Jones PS, Hezemans FH, Mak E, Tsvetanov KA, Rittman T, Bevan-Jones WR, Patterson K, Passamonti L, Fryer TD, Hong YT, Aigbirhio FI, O'Brien JT, Rowe JB. Microglial activation in the frontal cortex predicts cognitive decline in frontotemporal dementia. Brain 2023:7072407. [PMID: 36883644 PMCID: PMC10393407 DOI: 10.1093/brain/awad078] [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: 10/01/2022] [Revised: 01/22/2023] [Accepted: 02/19/2023] [Indexed: 03/09/2023] Open
Abstract
Frontotemporal dementia is clinically and neuropathologically heterogeneous, but neuroinflammation, atrophy, and cognitive impairment occur in all of its principal syndromes. Across the clinical spectrum of frontotemporal dementia, we assess the predictive value of in vivo neuroimaging measures of microglial activation and grey-matter volume on the rate of future cognitive decline. We hypothesised that inflammation is detrimental to cognitive performance, in addition to the effect of atrophy. Thirty patients with a clinical diagnosis of frontotemporal dementia underwent a baseline multi-modal imaging assessment, including [11C]PK11195 positron emission tomography (PET) to index microglial activation, and structural magnetic resonance imaging (MRI) to quantify grey-matter volume. Ten people had behavioural variant frontotemporal dementia, ten the semantic variant of primary progressive aphasia and ten had the non-fluent agrammatic variant of primary progressive aphasia. Cognition was assessed at baseline and longitudinally with the revised Addenbrooke's Cognitive Examination (ACE-R), at an average of 7-month intervals (for an average of ∼2 years, up to ∼5 years). Regional [11C]PK11195 binding potential and grey-matter volume were determined, and these were averaged within four hypothesis-driven regions of interest: bilateral frontal and temporal lobes. Linear mixed-effect models were applied to the longitudinal cognitive test scores, with [11C]PK11195 binding potentials and grey-matter volumes as predictors of cognitive performance, with age, education and baseline cognitive performance as covariates. Faster cognitive decline was associated with reduced baseline grey-matter volume and increased microglial activation in frontal regions, bilaterally. In frontal regions, microglial activation and grey-matter volume were negatively correlated, but provided independent information, with inflammation the stronger predictor of the rate of cognitive decline. When clinical diagnosis was included as a factor in the models, a significant predictive effect was found for [11C]PK11195 BPND in the left frontal lobe (-0.70, p=0.01), but not for grey-matter volumes (p>0.05), suggesting that inflammation severity in this region relates to cognitive decline regardless of clinical variant. The main results were validated by two-step prediction frequentist and Bayesian estimation of correlations, showing significant associations between the estimated rate of cognitive change (slope) and baseline microglial activation in the frontal lobe. These findings support preclinical models in which neuroinflammation (by microglial activation) accelerates the neurodegenerative disease trajectory. We highlight the potential for immunomodulatory treatment strategies in frontotemporal dementia, in which measures of microglial activation may also improve stratification for clinical trials.
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Affiliation(s)
- Maura Malpetti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Thomas E Cope
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Duncan Street
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Frank H Hezemans
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | | | - Karalyn Patterson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Tim D Fryer
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Young T Hong
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Franklin I Aigbirhio
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
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11
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Malpetti M, Jones PS, Cope TE, Holland N, Naessens M, Rouse MA, Rittman T, Savulich G, Whiteside DJ, Street D, Fryer TD, Hong YT, Milicevic Sephton S, Aigbirhio FI, O′Brien JT, Rowe JB. Synaptic Loss in Frontotemporal Dementia Revealed by [ 11 C]UCB-J Positron Emission Tomography. Ann Neurol 2023; 93:142-154. [PMID: 36321699 PMCID: PMC10099663 DOI: 10.1002/ana.26543] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 03/17/2022] [Revised: 09/28/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Synaptic loss is an early feature of neurodegenerative disease models, and is severe in post mortem clinical studies, including frontotemporal dementia. Positron emission tomography (PET) with radiotracers that bind to synaptic vesicle glycoprotein 2A enables quantification of synaptic density in vivo. This study used [11 C]UCB-J PET in participants with behavioral variant frontotemporal dementia (bvFTD), testing the hypothesis that synaptic loss is severe and related to clinical severity. METHODS Eleven participants with clinically probable bvFTD and 25 age- and sex-matched healthy controls were included. Participants underwent dynamic [11 C]UCB-J PET, structural magnetic resonance imaging, and a neuropsychological battery, including the revised Addenbrooke Cognitive Examination, and INECO frontal screening. General linear models compared [11 C]UCB-J binding potential maps and gray matter volume between groups, and assessed associations between synaptic density and clinical severity in patients. Analyses were also performed using partial volume corrected [11 C]UCB-J binding potential from regions of interest (ROIs). RESULTS Patients with bvFTD showed severe synaptic loss compared to controls. [11 C]UCB-J binding was reduced bilaterally in medial and dorsolateral frontal regions, inferior frontal gyri, anterior and posterior cingulate gyrus, insular cortex, and medial temporal lobe. Synaptic loss in the frontal and cingulate regions correlated significantly with cognitive impairments. Synaptic loss was more severe than atrophy. Results from ROI-based analyses mirrored the voxelwise results. INTERPRETATION In accordance with preclinical models, and human postmortem evidence, there is widespread frontotemporal loss of synapses in symptomatic bvFTD, in proportion to severity. [11 C]UCB-J PET could support translational studies and experimental medicine strategies for new disease-modifying treatments for neurodegeneration. ANN NEUROL 2023;93:142-154.
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Affiliation(s)
- Maura Malpetti
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Cambridge University Hospitals National Health Service Foundation TrustCambridgeUK
| | - P. Simon Jones
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - Thomas E. Cope
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Cambridge University Hospitals National Health Service Foundation TrustCambridgeUK
- Medical Research Council Cognition and Brain Sciences UnitUniversity of CambridgeUK
| | - Negin Holland
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Cambridge University Hospitals National Health Service Foundation TrustCambridgeUK
| | - Michelle Naessens
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - Matthew A. Rouse
- Medical Research Council Cognition and Brain Sciences UnitUniversity of CambridgeUK
| | - Timothy Rittman
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Cambridge University Hospitals National Health Service Foundation TrustCambridgeUK
| | | | - David J. Whiteside
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Cambridge University Hospitals National Health Service Foundation TrustCambridgeUK
| | - Duncan Street
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Cambridge University Hospitals National Health Service Foundation TrustCambridgeUK
| | - Tim D. Fryer
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Wolfson Brain Imaging CentreUniversity of CambridgeCambridgeUK
| | - Young T. Hong
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Wolfson Brain Imaging CentreUniversity of CambridgeCambridgeUK
| | - Selena Milicevic Sephton
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Wolfson Brain Imaging CentreUniversity of CambridgeCambridgeUK
| | - Franklin I. Aigbirhio
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Wolfson Brain Imaging CentreUniversity of CambridgeCambridgeUK
| | - John T. O′Brien
- Cambridge University Hospitals National Health Service Foundation TrustCambridgeUK
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - James B. Rowe
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Cambridge University Hospitals National Health Service Foundation TrustCambridgeUK
- Medical Research Council Cognition and Brain Sciences UnitUniversity of CambridgeUK
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12
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Malpetti M, Jones PS, Cope TE, Holland N, Naessens M, Rouse MA, Savulich G, Fryer TD, Hong YT, Milicevic‐Sephton S, Aigbirhio FI, O'Brien JT, Rowe JB. Synaptic loss in behavioural variant of frontotemporal dementia:an
in vivo
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11
C]UCB‐J PET study. Alzheimers Dement 2022. [DOI: 10.1002/alz.061706] [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: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Tim D Fryer
- University of Cambridge Cambridge United Kingdom
| | - Young T Hong
- University of Cambridge Cambridge United Kingdom
| | | | | | | | - James B Rowe
- University of Cambridge Cambridge United Kingdom
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13
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Perry A, Hughes LE, Adams N, Naessens M, Murley AG, Rouse MA, Street D, Jones PS, Cope TE, Kocagoncu E, Rowe JB. The neurophysiological effect of NMDA-R antagonism of frontotemporal lobar degeneration is conditional on individual GABA concentration. Transl Psychiatry 2022; 12:348. [PMID: 36030249 PMCID: PMC9420128 DOI: 10.1038/s41398-022-02114-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023] Open
Abstract
There is a pressing need to accelerate therapeutic strategies against the syndromes caused by frontotemporal lobar degeneration, including symptomatic treatments. One approach is for experimental medicine, coupling neurophysiological studies of the mechanisms of disease with pharmacological interventions aimed at restoring neurochemical deficits. Here we consider the role of glutamatergic deficits and their potential as targets for treatment. We performed a double-blind placebo-controlled crossover pharmaco-magnetoencephalography study in 20 people with symptomatic frontotemporal lobar degeneration (10 behavioural variant frontotemporal dementia, 10 progressive supranuclear palsy) and 19 healthy age- and gender-matched controls. Both magnetoencephalography sessions recorded a roving auditory oddball paradigm: on placebo or following 10 mg memantine, an uncompetitive NMDA-receptor antagonist. Ultra-high-field magnetic resonance spectroscopy confirmed lower concentrations of GABA in the right inferior frontal gyrus of people with frontotemporal lobar degeneration. While memantine showed a subtle effect on early-auditory processing in patients, there was no significant main effect of memantine on the magnitude of the mismatch negativity (MMN) response in the right frontotemporal cortex in patients or controls. However, the change in the right auditory cortex MMN response to memantine (vs. placebo) in patients correlated with individuals' prefrontal GABA concentration. There was no moderating effect of glutamate concentration or cortical atrophy. This proof-of-concept study demonstrates the potential for baseline dependency in the pharmacological restoration of neurotransmitter deficits to influence cognitive neurophysiology in neurodegenerative disease. With changes to multiple neurotransmitters in frontotemporal lobar degeneration, we suggest that individuals' balance of excitation and inhibition may determine drug efficacy, with implications for drug selection and patient stratification in future clinical trials.
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Affiliation(s)
- Alistair Perry
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, UK. .,Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ, UK.
| | - Laura E. Hughes
- grid.5335.00000000121885934MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF UK ,grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Natalie Adams
- grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Michelle Naessens
- grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Alexander G. Murley
- grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Matthew A. Rouse
- grid.5335.00000000121885934MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF UK
| | - Duncan Street
- grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - P. Simon Jones
- grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Thomas E. Cope
- grid.5335.00000000121885934MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF UK ,grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Ece Kocagoncu
- grid.5335.00000000121885934MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF UK ,grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - James B. Rowe
- grid.5335.00000000121885934MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF UK ,grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
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14
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Ye R, O'Callaghan C, Rua C, Hezemans FH, Holland N, Malpetti M, Jones PS, Barker RA, Williams‐Gray CH, Robbins TW, Passamonti L, Rowe J. Locus Coeruleus Integrity from 7 T MRI Relates to Apathy and Cognition in Parkinsonian Disorders. Mov Disord 2022; 37:1663-1672. [PMID: 35576973 PMCID: PMC9541468 DOI: 10.1002/mds.29072] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/15/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Neurodegeneration in the locus coeruleus (LC) contributes to neuropsychiatric symptoms in both Parkinson's disease (PD) and progressive supranuclear palsy (PSP). Spatial precision of LC imaging is improved with ultrahigh field 7 T magnetic resonance imaging. OBJECTIVES This study aimed to characterize the spatial patterns of LC pathological change in PD and PSP and the transdiagnostic relationship between LC signals and neuropsychiatric symptoms. METHODS Twenty-five people with idiopathic PD, 14 people with probable PSP-Richardson's syndrome, and 24 age-matched healthy controls were recruited. Participants underwent clinical assessments and high-resolution (0.08 mm3 ) 7 T-magnetization-transfer imaging to measure LC integrity in vivo. Spatial patterns of LC change were obtained using subregional mean contrast ratios and significant LC clusters; we further correlated the LC contrast with measures of apathy and cognition, using both mixed-effect models and voxelwise analyses. RESULTS PSP and PD groups showed significant LC degeneration in the caudal subregion relative to controls. Mixed-effect models revealed a significant interaction between disease-group and apathy-related correlations with LC degeneration (β = 0.46, SE [standard error] = 0.17, F(1, 35) = 7.46, P = 0.01), driven by a strong correlation in PSP (β = -0.58, SE = 0.21, t(35) = -2.76, P = 0.009). Across both disease groups, voxelwise analyses indicated that lower LC integrity was associated with worse cognition and higher apathy scores. CONCLUSIONS The relationship between LC and nonmotor symptoms highlights a role for noradrenergic dysfunction across both PD and PSP, confirming the potential for noradrenergic therapeutic strategies to address transdiagnostic cognitive and behavioral features in neurodegenerative disease. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rong Ye
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - Claire O'Callaghan
- Brain and Mind Centre and School of Medical SciencesFaculty of Medicine and Health, University of SydneySydneyAustralia
- Department of PsychiatryUniversity of CambridgeCambridgeUnited Kingdom
| | - Catarina Rua
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - Frank H. Hezemans
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUnited Kingdom
| | - Negin Holland
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - Maura Malpetti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - P. Simon Jones
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - Roger A. Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain RepairUniversity of CambridgeCambridgeUnited Kingdom
- Wellcome Trust—Medical Research Council Stem Cell InstituteUniversity of CambridgeCambridgeUnited Kingdom
| | - Caroline H. Williams‐Gray
- Department of Clinical Neurosciences, John van Geest Centre for Brain RepairUniversity of CambridgeCambridgeUnited Kingdom
| | - Trevor W. Robbins
- Department of PsychologyUniversity of CambridgeCambridgeUnited Kingdom
- Behavioural and Clinical Neuroscience InstituteUniversity of CambridgeCambridgeUnited Kingdom
| | - Luca Passamonti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
- Istituto di Bioimmagini e Fisiologia MolecolareConsiglio Nazionale delle RicercheCefalùItaly
| | - James Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUnited Kingdom
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15
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Malpetti M, Kaalund SS, Tsvetanov KA, Rittman T, Briggs M, Allinson KSJ, Passamonti L, Holland N, Jones PS, Fryer TD, Hong YT, Kouli A, Bevan-Jones WR, Mak E, Savulich G, Spillantini MG, Aigbirhio FI, Williams-Gray CH, O'Brien JT, Rowe JB. In Vivo 18F-Flortaucipir PET Does Not Accurately Support the Staging of Progressive Supranuclear Palsy. J Nucl Med 2022; 63:1052-1057. [PMID: 34795013 PMCID: PMC7612961 DOI: 10.2967/jnumed.121.262985] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/08/2021] [Indexed: 02/02/2023] Open
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterized by neuroglial tau pathology. A new staging system for PSP pathology postmortem has been described and validated. We used a data-driven approach to test whether postmortem pathologic staging in PSP can be reproduced in vivo with 18F-flortaucipir PET. Methods: Forty-two patients with probable PSP and 39 controls underwent 18F-flortaucipir PET. Conditional inference tree analyses on regional binding potential values identified absent/present pathology thresholds to define in vivo staging. Following the postmortem staging approach for PSP pathology, we evaluated the combinations of absent/present pathology (or abnormal/normal PET signal) across all regions to assign each participant to in vivo stages. ANOVA was applied to analyze differences among means of disease severity between stages. In vivo staging was compared with postmortem staging in 9 patients who also had postmortem confirmation of the diagnosis and stage. Results: Stage assignment was estimable in 41 patients: 10, 26, and 5 patients were classified in stage I/II, stage III/IV, and stage V/VI, respectively, whereas 1 patient was not classifiable. Explorative substaging identified 2 patients in stage I, 8 in stage II, 9 in stage III, 17 in stage IV, and 5 in stage V. However, the nominal 18F-flortaucipir--derived stage was not associated with clinical severity and was not indicative of pathology staging postmortem. Conclusion:18F-flortaucipir PET in vivo does not correspond to neuropathologic staging in PSP. This analytic approach, seeking to mirror in vivo neuropathology staging with PET-to-autopsy correlational analyses, might enable in vivo staging with next-generation tau PET tracers; however, further evidence and comparisons with postmortem data are needed.
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Affiliation(s)
- Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom;
| | - Sanne S Kaalund
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Mayen Briggs
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Cambridge University Brain Bank, Cambridge, United Kingdom
| | - Kieren S J Allinson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Cambridge University Brain Bank, Cambridge, United Kingdom
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Consiglio Nazionale delle Ricerche (CNR), Milano, Italy
| | - Negin Holland
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Young T Hong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Antonina Kouli
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - W Richard Bevan-Jones
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; and
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; and
| | - George Savulich
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; and
| | | | - Franklin I Aigbirhio
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Caroline H Williams-Gray
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - John T O'Brien
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; and
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
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16
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Holland N, Simon Jones P, Savulich G, Hong YT, Fryer T, Manavaki R, Milicevic-Sephton S, Aigbirhio FI, O’Brien J, Rowe JB. 226 Reduced synaptic density in progressive supranuclear palsy and corticobasal syndrome, revealed by [11C]UCB-J PET. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.255] [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: 11/04/2022]
Abstract
Synaptic loss is prominent in several human neurodegenerative diseases. We tested the hypothesis that synaptic density is reduced by the primary tauopathies of progressive supranuclear palsy (PSP) and cor- ticobasal syndrome (CBS). Thirty-three participants (10 CBS, 10 PSP, and thirteen age-/sex-/education- matched controls) underwent clinical and neuropsychological assessment, 3T-magnetic resonance imaging, and positron emission tomography with the radioligand [11C]UCB-J which targets the Synaptic Vesicle Glycoprotein 2A (SV2A). Eight CBS patients had negative β-amyloid biomarker. As expected, PSP and CBS groups were impaired in executive, memory and visuospatial tasks. [11C]UCB-J binding was reduced across frontal, temporal, parietal, and occipital lobes, cingulate, hippocampus, insula, amygdala and subcortical structures in both PSP and CBS patients compared to controls (p<0.001), with reductions up to 50%, consistent with post mortem data. The revised Addenbrooke’s Cognitive Examination score correlated positively with cortical [11C]UCB-J binding (frontal, temporal, parietal, and occipital lobes, hippocampus, insula and amygdala, all p<0.05); putamen and precentral [11C]UCB-J binding correlated inversely with the PSP rating scale (both p<0.05). In conclusion, we confirm severe synaptic loss in PSP and CBS, which correlates with disease severity, providing critical insights into the underlying pathophysiology of primary degenerative tauopathies and supporting potential treatment strategies based on synaptic maintenance or restoration.nda26@cam.ac.uk
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17
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Kang KM, Muralidharan K, Knowlton H, Hassan KIA, Yekula A, Misra M, Swearingen B, Jones PS. Utility of bilateral inferior petrosal sinus sampling for diagnosis and lateralization of Cushing's disease in the pediatric population: case series and review of the literature. J Endocrinol Invest 2022; 45:617-627. [PMID: 34655038 DOI: 10.1007/s40618-021-01680-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022]
Abstract
OBJECTS Cushing's disease (CD) is the most common cause of ACTH-dependent hypercortisolism in children age ≥ 7. The utility of bilateral inferior petrosal sinus sampling (BIPSS), an important test in adults, is less defined in children. We present a case series of children with ACTH-dependent hypercortisolemia and review the literature to assess the utility of BIPSS in the diagnosis and localization of CD. METHODS We performed an IRB-approved chart review of patients aged ≤ 18 with ACTH-dependent hypercortisolism at MGH between 2000 and 2019 and collected clinical, laboratory, radiographic, BIPSS, surgical, and outcomes data. RESULTS In our cohort (n = 21), BIPSS had a sensitivity of 93% and specificity of 100% for diagnosis of CD. Compared to surgery, successful BIPSS correctly predicted adenoma laterality in 69% of cases vs. 70% by MRI. Among patients with lesions ≥ 4 mm (n = 9), BIPSS correctly lateralized in 50% vs. 100% by MRI. In patients with subtle lesions (< 4 mm, n = 7), BIPSS correctly lateralized in 80% vs. 71% by MRI. In patients (n = 4) with CD and negative MRIs, BIPSS correctly lateralized in 75% cases. Surgical cure was achieved in 90% of patients and 95% of patients had long-term disease control. CONCLUSIONS In our cohort (n = 21; n = 20 CD, n = 1 ectopic ACTH secretion), BIPSS was sensitive and specific for the diagnosis of CD. Compared to MRI, BIPSS was not additionally helpful for lateralization in patients with lesions ≥ 4 mm on MRI. BIPSS was helpful in guiding surgical exploration and achieving immediate postoperative remission among patients with subtle and negative MRI findings.
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Affiliation(s)
- K M Kang
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
- University of California San Diego, San Diego, CA, USA.
| | - K Muralidharan
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - H Knowlton
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - K I A Hassan
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - A Yekula
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - M Misra
- Division of Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - B Swearingen
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - P S Jones
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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18
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Naessens M, Cope TE, Murley AG, Malpetti M, Rua C, Hughes LE, Perry A, Ye R, Rodgers CT, Jones PS, Rowe JB. 7T imaging in progressive supranuclear palsy and behavioural variant frontotemporal dementia. Alzheimers Dement 2021. [DOI: 10.1002/alz.058516] [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: 11/05/2022]
Affiliation(s)
| | | | - Alexander G Murley
- University of Cambridge Cambridge United Kingdom
- Cambridge University Hospitals NHS Foundation Trust Cambridge United Kingdom
| | | | - Catarina Rua
- University of Cambridge Cambridge United Kingdom
| | | | | | - Rong Ye
- University of Cambridge Cambridge United Kingdom
| | | | | | - James B Rowe
- University of Cambridge Cambridge United Kingdom
- Cambridge University Centre for Frontotemporal Dementia University of Cambridge Cambridge United Kingdom
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19
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Malpetti M, Jones PS, Hezemans FH, Mak E, Street D, Passamonti L, Rittman T, Cope TE, Bevan‐Jones WR, Patterson K, Fryer TD, Hong YT, Aigbirho FI, O'Brien JT, Rowe JB. Microglial activation and atrophy in frontal cortex predict executive dysfunction in frontotemporal dementia. Alzheimers Dement 2021. [DOI: 10.1002/alz.055456] [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: 11/11/2022]
Affiliation(s)
| | | | | | - Elijah Mak
- University of Cambridge Cambridge United Kingdom
| | | | - Luca Passamonti
- University of Cambridge Cambridge United Kingdom
- Consiglio Nazionale delle Ricerche (CNR) Milan Italy
| | | | | | | | | | - Tim D. Fryer
- University of Cambridge Cambridge United Kingdom
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20
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Ye R, O'Callaghan C, Rua C, Hezemans FH, Holland N, Malpetti M, Jones PS, Passamonti L, Rowe JB. 7T locus coeruleus imaging correlates of apathy and cognition in patients with Parkinson’s disease and progressive supranuclear palsy. Alzheimers Dement 2021. [DOI: 10.1002/alz.053045] [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: 11/06/2022]
Affiliation(s)
- Rong Ye
- University of Cambridge Cambridge United Kingdom
| | - Claire O'Callaghan
- University of Cambridge Cambridge United Kingdom
- University of Sydney Sydney NSW Australia
| | - Catarina Rua
- University of Cambridge Cambridge United Kingdom
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21
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Malpetti M, Savulich G, Mak E, Nicastro N, Jones PS, Surendranathan A, Su L, Passamonti L, Chouliaras L, Fryer TD, Hong YT, Aigbirho FI, Rowe JB, O'Brien JT. Neuroinflammation in medial temporal regions predicts cognitive decline in dementia with Lewy bodies. Alzheimers Dement 2021. [DOI: 10.1002/alz.053674] [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: 11/12/2022]
Affiliation(s)
| | | | - Elijah Mak
- University of Cambridge Cambridge United Kingdom
| | - Nicolas Nicastro
- University of Cambridge Cambridge United Kingdom
- Geneva University Hospitals Geneva Switzerland
| | | | | | - Li Su
- University of Cambridge Cambridge United Kingdom
- University of Sheffield Sheffield United Kingdom
| | - Luca Passamonti
- University of Cambridge Cambridge United Kingdom
- Consiglio Nazionale delle Ricerche (CNR) Milan Italy
| | | | - Tim D. Fryer
- University of Cambridge Cambridge United Kingdom
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22
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Murley AG, Tsvetanov KA, Rouse MA, Jones PS, Sværke K, Li W, Carpenter A, Rowe JB. Proton magnetic resonance spectroscopy in frontotemporal lobar degeneration-related syndromes. Neurobiol Aging 2021; 111:64-70. [PMID: 34971846 PMCID: PMC8776136 DOI: 10.1016/j.neurobiolaging.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/11/2021] [Accepted: 10/23/2021] [Indexed: 12/13/2022]
Abstract
There is an urgent need for a better understanding of the pathophysiology of cognitive impairment in syndromes associated with frontotemporal lobar degeneration. Here, we used magnetic resonance spectroscopy to quantify metabolite deficits in sixty patients with a clinical syndrome associated with frontotemporal lobar degeneration (behavioral variant frontotemporal dementia n = 11, progressive supranuclear palsy n = 26, corticobasal syndrome n = 11, primary progressive aphasias n = 12), and 38 age- and sex-matched healthy controls. We measured nine metabolites in the right inferior frontal gyrus, superior temporal gyrus and right primary visual cortex. Metabolite concentrations were corrected for age, sex, and partial volume then compared with cognitive and behavioral measures using canonical correlation analysis. Metabolite concentrations varied significantly by brain region and diagnosis (region x metabolite x diagnosis interaction F(64) = 1.73, p < 0.001, corrected for age, sex, and atrophy within the voxel). N-acetyl aspartate and glutamate concentrations were reduced in the right prefrontal cortex in behavioral variant frontotemporal dementia and progressive supranuclear palsy, even after partial volume correction. The reduction of these metabolites was associated with executive dysfunction and behavioral impairment (canonical correlation analysis R = 0.85, p < 0.001).
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Affiliation(s)
- Alexander G Murley
- Department of Clinical Neurosciences, University of Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, UK.
| | | | - Matthew A Rouse
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Katrine Sværke
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Win Li
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Adrian Carpenter
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, UK; MRC Cognition and Brain, Sciences Unit, University of Cambridge, UK
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23
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O’Callaghan C, Hezemans FH, Ye R, Rua C, Jones PS, Murley AG, Holland N, Regenthal R, Tsvetanov KA, Wolpe N, Barker RA, Williams-Gray CH, Robbins TW, Passamonti L, Rowe JB. Locus coeruleus integrity and the effect of atomoxetine on response inhibition in Parkinson's disease. Brain 2021; 144:2513-2526. [PMID: 33783470 PMCID: PMC7611672 DOI: 10.1093/brain/awab142] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 11/23/2022] Open
Abstract
Cognitive decline is a common feature of Parkinson's disease, and many of these cognitive deficits fail to respond to dopaminergic therapy. Therefore, targeting other neuromodulatory systems represents an important therapeutic strategy. Among these, the locus coeruleus-noradrenaline system has been extensively implicated in response inhibition deficits. Restoring noradrenaline levels using the noradrenergic reuptake inhibitor atomoxetine can improve response inhibition in some patients with Parkinson's disease, but there is considerable heterogeneity in treatment response. Accurately predicting the patients who would benefit from therapies targeting this neurotransmitter system remains a critical goal, in order to design the necessary clinical trials with stratified patient selection to establish the therapeutic potential of atomoxetine. Here, we test the hypothesis that integrity of the noradrenergic locus coeruleus explains the variation in improvement of response inhibition following atomoxetine. In a double-blind placebo-controlled randomized crossover design, 19 patients with Parkinson's disease completed an acute psychopharmacological challenge with 40 mg of oral atomoxetine or placebo. A stop-signal task was used to measure response inhibition, with stop-signal reaction times obtained through hierarchical Bayesian estimation of an ex-Gaussian race model. Twenty-six control subjects completed the same task without undergoing the drug manipulation. In a separate session, patients and controls underwent ultra-high field 7 T imaging of the locus coeruleus using a neuromelanin-sensitive magnetization transfer sequence. The principal result was that atomoxetine improved stop-signal reaction times in those patients with lower locus coeruleus integrity. This was in the context of a general impairment in response inhibition, as patients on placebo had longer stop-signal reaction times compared to controls. We also found that the caudal portion of the locus coeruleus showed the largest neuromelanin signal decrease in the patients compared to controls. Our results highlight a link between the integrity of the noradrenergic locus coeruleus and response inhibition in patients with Parkinson's disease. Furthermore, they demonstrate the importance of baseline noradrenergic state in determining the response to atomoxetine. We suggest that locus coeruleus neuromelanin imaging offers a marker of noradrenergic capacity that could be used to stratify patients in trials of noradrenergic therapy and to ultimately inform personalized treatment approaches.
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Affiliation(s)
- Claire O’Callaghan
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Frank H Hezemans
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Rong Ye
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Catarina Rua
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge 04107, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Alexander G Murley
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Negin Holland
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Ralf Regenthal
- Division of Clinical Pharmacology, Rudolf-Boehm-Institute for Pharmacology and Toxicology, University of Leipzig, Leipzig 69978, Germany
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Noham Wolpe
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK
- Department of Physical Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roger A Barker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
- Wellcome Trust—Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge CB2 0AW, UK
| | - Caroline H Williams-Gray
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge CB2 3EA, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EA, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - James B Rowe
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
- Cambridge University Hospitals NHS Trust, Cambridge, CB2 0QQ, UK
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24
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Whiteside DJ, Jones PS, Ghosh BCP, Coyle-Gilchrist I, Gerhard A, Hu MT, Klein JC, Leigh PN, Church A, Burn DJ, Morris HR, Rowe JB, Rittman T. Altered network stability in progressive supranuclear palsy. Neurobiol Aging 2021; 107:109-117. [PMID: 34419788 PMCID: PMC8599965 DOI: 10.1016/j.neurobiolaging.2021.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 06/15/2021] [Accepted: 07/08/2021] [Indexed: 01/18/2023]
Abstract
We investigated network dynamics in the tauopathy progressive supranuclear palsy Abnormal temporal properties of large-scale networks are related to phenotype Progressive supranuclear palsy paradoxically increases frontoparietal state time Reductions in neural signal complexity relate to altered network dynamics Dynamic network and topological changes occur distally to primary sites of atrophy
The clinical syndromes of Progressive Supranuclear Palsy (PSP) may be mediated by abnormal temporal dynamics of brain networks, due to the impact of atrophy, synapse loss and neurotransmitter deficits. We tested the hypothesis that alterations in signal complexity in neural networks influence short-latency state transitions. Ninety-four participants with PSP and 64 healthy controls were recruited from two independent cohorts. All participants underwent clinical and neuropsychological testing and resting-state functional MRI. Network dynamics were assessed using hidden Markov models and neural signal complexity measured in terms of multiscale entropy. In both cohorts, PSP increased the proportion of time in networks associated with higher cognitive functions. This effect correlated with clinical severity as measured by the PSP-rating-scale, and with reduced neural signal complexity. Regional atrophy influenced abnormal brain-state occupancy, but abnormal network topology and dynamics were not restricted to areas of atrophy. Our findings show that the pathology of PSP causes clinically relevant changes in neural temporal dynamics, leading to a greater proportion of time in inefficient brain-states.
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Affiliation(s)
- David J Whiteside
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK.
| | - P Simon Jones
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - Boyd C P Ghosh
- Wessex Neurological Centre, University Hospital Southampton, Southampton, UK
| | | | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Michele T Hu
- Oxford Parkinson's Disease Centre and Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Johannes C Klein
- Oxford Parkinson's Disease Centre and Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - P Nigel Leigh
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK
| | | | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Huw R Morris
- Department of Clinical and Movement Neurosciences, University College London. Queen Square Institute of Neurology, London, UK
| | - James B Rowe
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - Timothy Rittman
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
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25
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Holland N, Malpetti M, Rittman T, Mak EE, Passamonti L, Kaalund SS, Hezemans FH, Jones PS, Savulich G, Hong YT, Fryer TD, Aigbirhio FI, O'Brien JT, Rowe JB. Molecular pathology and synaptic loss in primary tauopathies: an 18F-AV-1451 and 11C-UCB-J PET study. Brain 2021; 145:340-348. [PMID: 34398211 PMCID: PMC8967099 DOI: 10.1093/brain/awab282] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/02/2021] [Accepted: 07/10/2021] [Indexed: 12/02/2022] Open
Abstract
The relationship between in vivo synaptic density and molecular pathology in primary tauopathies is key to understanding the impact of tauopathy on functional decline and in informing new early therapeutic strategies. In this cross-sectional observational study, we determine the in vivo relationship between synaptic density and molecular pathology in the primary tauopathies of progressive supranuclear palsy and corticobasal degeneration as a function of disease severity. Twenty-three patients with progressive supranuclear palsy and 12 patients with corticobasal syndrome were recruited from a tertiary referral centre. Nineteen education-, sex- and gender-matched control participants were recruited from the National Institute for Health Research ‘Join Dementia Research’ platform. Cerebral synaptic density and molecular pathology, in all participants, were estimated using PET imaging with the radioligands 11C-UCB-J and 18F-AV-1451, respectively. Patients with corticobasal syndrome also underwent amyloid PET imaging with 11C-PiB to exclude those with likely Alzheimer’s pathology—we refer to the amyloid-negative cohort as having corticobasal degeneration, although we acknowledge other underlying pathologies exist. Disease severity was assessed with the progressive supranuclear palsy rating scale; regional non-displaceable binding potentials of 11C-UCB-J and 18F-AV-1451 were estimated in regions of interest from the Hammersmith Atlas, excluding those with known off-target binding for 18F-AV-1451. As an exploratory analysis, we also investigated the relationship between molecular pathology in cortical brain regions and synaptic density in subcortical areas. Across brain regions, there was a positive correlation between 11C-UCB-J and 18F-AV-1451 non-displaceable binding potentials (β = 0.4, t = 3.6, P = 0.001), independent of age or time between PET scans. However, this correlation became less positive as a function of disease severity in patients (β = −0.02, t = −2.9, P = 0.007, R = −0.41). Between regions, cortical 18F-AV-1451 binding was negatively correlated with synaptic density in subcortical areas (caudate nucleus, putamen). Brain regions with higher synaptic density are associated with a higher 18F-AV-1451 binding in progressive supranuclear palsy/corticobasal degeneration, but this association diminishes with disease severity. Moreover, higher cortical 18F-AV-1451 binding correlates with lower subcortical synaptic density. Longitudinal imaging is required to confirm the mediation of synaptic loss by molecular pathology. However, the effect of disease severity suggests a biphasic relationship between synaptic density and molecular pathology with synapse-rich regions vulnerable to accrual of pathological aggregates, followed by a loss of synapses in response to the molecular pathology. Given the importance of synaptic function for cognition and action, our study elucidates the pathophysiology of primary tauopathies and may inform the design of future clinical trials.
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Affiliation(s)
- Negin Holland
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Elijah E Mak
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, CB2 0QQ, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK.,Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Consiglio Nazionale delle Ricerche (CNR), 20090, Milano, Italy
| | - Sanne S Kaalund
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - Frank H Hezemans
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK.,Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, CB2 7EF, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - George Savulich
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, CB2 0QQ, UK
| | - Young T Hong
- Wolfson Brain Imaging Centre, University of Cambridge, CB2 0QQ, UK
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK.,Wolfson Brain Imaging Centre, University of Cambridge, CB2 0QQ, UK
| | - Franklin I Aigbirhio
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - John T O'Brien
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.,Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, CB2 0QQ, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.,Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, CB2 7EF, UK
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26
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Tsvetanov KA, Henson RNA, Jones PS, Mutsaerts H, Fuhrmann D, Tyler LK, Rowe JB. The effects of age on resting-state BOLD signal variability is explained by cardiovascular and cerebrovascular factors. Psychophysiology 2021; 58:e13714. [PMID: 33210312 PMCID: PMC8244027 DOI: 10.1111/psyp.13714] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 07/27/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022]
Abstract
Accurate identification of brain function is necessary to understand neurocognitive aging, and thereby promote health and well-being. Many studies of neurocognitive aging have investigated brain function with the blood-oxygen level-dependent (BOLD) signal measured by functional magnetic resonance imaging. However, the BOLD signal is a composite of neural and vascular signals, which are differentially affected by aging. It is, therefore, essential to distinguish the age effects on vascular versus neural function. The BOLD signal variability at rest (known as resting state fluctuation amplitude, RSFA), is a safe, scalable, and robust means to calibrate vascular responsivity, as an alternative to breath-holding and hypercapnia. However, the use of RSFA for normalization of BOLD imaging assumes that age differences in RSFA reflecting only vascular factors, rather than age-related differences in neural function (activity) or neuronal loss (atrophy). Previous studies indicate that two vascular factors, cardiovascular health (CVH) and cerebrovascular function, are insufficient when used alone to fully explain age-related differences in RSFA. It remains possible that their joint consideration is required to fully capture age differences in RSFA. We tested the hypothesis that RSFA no longer varies with age after adjusting for a combination of cardiovascular and cerebrovascular measures. We also tested the hypothesis that RSFA variation with age is not associated with atrophy. We used data from the population-based, lifespan Cam-CAN cohort. After controlling for cardiovascular and cerebrovascular estimates alone, the residual variance in RSFA across individuals was significantly associated with age. However, when controlling for both cardiovascular and cerebrovascular estimates, the variance in RSFA was no longer associated with age. Grey matter volumes did not explain age differences in RSFA, after controlling for CVH. The results were consistent between voxel-level analysis and independent component analysis. Our findings indicate that cardiovascular and cerebrovascular signals are together sufficient predictors of age differences in RSFA. We suggest that RSFA can be used to separate vascular from neuronal factors, to characterize neurocognitive aging. We discuss the implications and make recommendations for the use of RSFA in the research of aging.
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Affiliation(s)
- Kamen A. Tsvetanov
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Department of PsychologyCentre for Speech, Language and the BrainUniversity of CambridgeCambridgeUK
| | - Richard N. A. Henson
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - P. Simon Jones
- Department of PsychologyCentre for Speech, Language and the BrainUniversity of CambridgeCambridgeUK
| | - Henk Mutsaerts
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Delia Fuhrmann
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
| | - Lorraine K. Tyler
- Department of PsychologyCentre for Speech, Language and the BrainUniversity of CambridgeCambridgeUK
| | - Cam‐CAN
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Department of PsychologyCentre for Speech, Language and the BrainUniversity of CambridgeCambridgeUK
| | - James B. Rowe
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
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27
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Murley AG, Rouse MA, Coyle-Gilchrist ITS, Jones PS, Li W, Wiggins J, Lansdall C, Vázquez Rodríguez P, Wilcox A, Patterson K, Rowe JB. Predicting loss of independence and mortality in frontotemporal lobar degeneration syndromes. J Neurol Neurosurg Psychiatry 2021; 92:737-744. [PMID: 33563798 PMCID: PMC8223632 DOI: 10.1136/jnnp-2020-324903] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To test the hypothesis that in syndromes associated with frontotemporal lobar degeneration, behavioural impairment predicts loss of functional independence and motor clinical features predict mortality, irrespective of diagnostic group. METHODS We used a transdiagnostic approach to survival in an epidemiological cohort in the UK, testing the association between clinical features, independence and survival in patients with clinical diagnoses of behavioural variant frontotemporal dementia (bvFTD n=64), non-fluent variant primary progressive aphasia (nfvPPA n=36), semantic variant primary progressive aphasia (svPPA n=25), progressive supranuclear palsy (PSP n=101) and corticobasal syndrome (CBS n=68). A principal components analysis identified six dimensions of clinical features. Using Cox proportional hazards and logistic regression, we identified the association between each of these dimensions and both functionally independent survival (time from clinical assessment to care home admission) and absolute survival (time to death). Analyses adjusted for the covariates of age, gender and diagnostic group. Secondary analysis excluded specific diagnostic groups. RESULTS Behavioural disturbance, including impulsivity and apathy, was associated with reduced functionally independent survival (OR 2.46, p<0.001), even if patients with bvFTD were removed from the analysis. Motor impairments were associated with reduced absolute survival, even if patients with PSP and CBS were removed from the analysis. CONCLUSION Our results can assist individualised prognostication and planning of disease-modifying trials, and they support a transdiagnostic approach to symptomatic treatment trials in patients with clinical syndromes associated with frontotemporal lobar degeneration.
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Affiliation(s)
- Alexander G Murley
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Matthew A Rouse
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ian T S Coyle-Gilchrist
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Neurology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - P Simon Jones
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Win Li
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Julie Wiggins
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Claire Lansdall
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Alicia Wilcox
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Karalyn Patterson
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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28
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Malpetti M, Holland N, Jones PS, Ye R, Cope TE, Fryer TD, Hong YT, Savulich G, Rittman T, Passamonti L, Mak E, Aigbirhio FI, O'Brien JT, Rowe JB. Synaptic density in carriers of C9orf72 mutations: a [ 11 C]UCB-J PET study. Ann Clin Transl Neurol 2021; 8:1515-1523. [PMID: 34133849 PMCID: PMC8283163 DOI: 10.1002/acn3.51407] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/05/2021] [Accepted: 05/28/2021] [Indexed: 12/12/2022] Open
Abstract
Synaptic loss is an early and clinically relevant feature of many neurodegenerative diseases. Here we assess three adults at risk of frontotemporal dementia from C9orf72 mutation, using [11 C]UCB-J PET to quantify synaptic density in comparison with 19 healthy controls and one symptomatic patient with behavioural variant frontotemporal dementia. The three pre-symptomatic C9orf72 carriers showed reduced synaptic density in the thalamus compared to controls, and there was an additional extensive synaptic loss in frontotemporal regions of the symptomatic patient. [11 C]UCB-J PET may facilitate early, pre-symptomatic assessment, monitoring of disease progression and evaluation of new preventive treatment strategies for frontotemporal dementia.
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Affiliation(s)
- Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Negin Holland
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Rong Ye
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Thomas E Cope
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Young T Hong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - George Savulich
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Consiglio Nazionale delle Ricerche (CNR), Milano, Italy
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Franklin I Aigbirhio
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - John T O'Brien
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK
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29
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Tsvetanov KA, Gazzina S, Simon Jones P, van Swieten J, Borroni B, Sanchez-Valle R, Moreno F, LaforceJr R, Graff C, Synofzik M, Galimberti D, Masellis M, Tartaglia MC, Finger E, Vandenberghe R, de Mendonça A, Tagliavini F, Santana I, Ducharme S, Butler C, Gerhard A, Danek A, Levin J, Otto M, Frisoni G, Ghidoni R, Sorbi S, Rohrer JD, Rowe JB. Brain functional network integrity sustains cognitive function despite atrophy in presymptomatic genetic frontotemporal dementia. Alzheimers Dement 2021; 17:500-514. [PMID: 33215845 PMCID: PMC7611220 DOI: 10.1002/alz.12209] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 09/07/2020] [Accepted: 09/12/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The presymptomatic phase of neurodegenerative disease can last many years, with sustained cognitive function despite progressive atrophy. We investigate this phenomenon in familial frontotemporal dementia (FTD). METHODS We studied 121 presymptomatic FTD mutation carriers and 134 family members without mutations, using multivariate data-driven approach to link cognitive performance with both structural and functional magnetic resonance imaging. Atrophy and brain network connectivity were compared between groups, in relation to the time from expected symptom onset. RESULTS There were group differences in brain structure and function, in the absence of differences in cognitive performance. Specifically, we identified behaviorally relevant structural and functional network differences. Structure-function relationships were similar in both groups, but coupling between functional connectivity and cognition was stronger for carriers than for non-carriers, and increased with proximity to the expected onset of disease. DISCUSSION Our findings suggest that the maintenance of functional network connectivity enables carriers to maintain cognitive performance.
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Affiliation(s)
- Kamen A. Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Centre for Ageing and Neuroscience (Cam-CAN), University of Cambridge and MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - Stefano Gazzina
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P. Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - John van Swieten
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Raquel Sanchez-Valle
- Alzheimer’s disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Institut d’Investigacións iomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Fermin Moreno
- Cognitive Disorders Unit, Department of Neurology, Hospital Universitario Donostia, San Sebastian, Gipuzkoa, Spain
- Neuroscience Area, Biodonostia Health Research Insitute, San Sebastian, Gipuzkoa, Spain
| | - Robert LaforceJr
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, and Faculté de Médecine, Université Laval, Québec, Canada
| | - Caroline Graff
- Karolinska Institutet, Department NVS, Center for Alzheimer Research, Division of Neurogenetics, Stockholm, Sweden
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research & Center of Neurology, University of Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Daniela Galimberti
- University of Milan, Centro Dino Ferrari, Milan, Italy
- Fondazione IRCSS Ca’ Granda, Ospedale Maggiore Policlinico, Neurodegenerative Diseases Unit, Milan, Italy
| | - Mario Masellis
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, Toronto, Ontario, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Neurology Service, University Hospitals Leuven, Belgium, Laboratory for Neurobiology, VIB-KU
| | - Alexandre de Mendonça
- Laboratory of Neurosciences, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Fabrizio Tagliavini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Ital
| | - Isabel Santana
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Centre of Neurosciences and Cell biology, Universidade de Coimbra, Coimbra, Portugal
| | - Simon Ducharme
- Department of Psychiatry, McGill University Health Centre, McGill University, Montreal, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Chris Butler
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
- Departments of Geriatric Medicine and Nuclear Medicine, University of Duisburg-Essen, Germany
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Munich, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Johannes Levin
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Munich, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Markus Otto
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | - Giovanni Frisoni
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Memory Clinic and LANVIE-Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) “Don Gnocchi”, Florence, Italy
| | - Jonathan D. Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Centre for Ageing and Neuroscience (Cam-CAN), University of Cambridge and MRC Cognition and Brain Sciences Unit, Cambridge, UK
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30
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Mak E, Holland N, Jones PS, Savulich G, Low A, Malpetti M, Kaalund SS, Passamonti L, Rittman T, Romero-Garcia R, Manavaki R, Williams GB, Hong YT, Fryer TD, Aigbirhio FI, O'Brien JT, Rowe JB. In vivo coupling of dendritic complexity with presynaptic density in primary tauopathies. Neurobiol Aging 2021; 101:187-198. [PMID: 33631470 PMCID: PMC8209289 DOI: 10.1016/j.neurobiolaging.2021.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 01/03/2023]
Abstract
Understanding the cellular underpinnings of neurodegeneration remains a challenge; loss of synapses and dendritic arborization are characteristic and can be quantified in vivo, with [11C]UCB-J PET and MRI-based Orientation Dispersion Imaging (ODI), respectively. We aimed to assess how both measures are correlated, in 4R-tauopathies of progressive supranuclear palsy - Richardson's Syndrome (PSP-RS; n = 22) and amyloid-negative (determined by [11C]PiB PET) Corticobasal Syndrome (Cortiobasal degeneration, CBD; n =14), as neurodegenerative disease models, in this proof-of-concept study. Compared to controls (n = 27), PSP-RS and CBD patients had widespread reductions in cortical ODI, and [11C]UCB-J non-displaceable binding potential (BPND) in excess of atrophy. In PSP-RS and CBD separately, regional cortical ODI was significantly associated with [11C]UCB-J BPND in disease-associated regions (p < 0.05, FDR corrected). Our findings indicate that reductions in synaptic density and dendritic complexity in PSP-RS and CBD are more severe and extensive than atrophy. Furthermore, both measures are tightly coupled in vivo, furthering our understanding of the pathophysiology of neurodegeneration, and applicable to studies of early neurodegeneration with a safe and widely available MRI platform.
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Affiliation(s)
- Elijah Mak
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Negin Holland
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - George Savulich
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Audrey Low
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Sanne S Kaalund
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Rafael Romero-Garcia
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Roido Manavaki
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Guy B Williams
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Young T Hong
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Franklin I Aigbirhio
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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31
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Mak E, Dounavi ME, Low A, Carter SF, McKiernan E, Williams GB, Jones PS, Carriere I, Muniz GT, Ritchie K, Ritchie C, Su L, O'Brien JT. Proximity to dementia onset and multi-modal neuroimaging changes: The prevent-dementia study. Neuroimage 2021; 229:117749. [PMID: 33454416 DOI: 10.1016/j.neuroimage.2021.117749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND First-degree relatives of people with dementia (FH+) are at increased risk of developing Alzheimer's disease (AD). Here, we investigate "estimated years to onset of dementia" (EYO) as a surrogate marker of preclinical disease progression and assess its associations with multi-modal neuroimaging biomarkers. METHODS 89 FH+ participants in the PREVENT-Dementia study underwent longitudinal MR imaging over 2 years. EYO was calculated as the difference between the parental age of dementia diagnosis and the current age of the participant (mean EYO = 23.9 years). MPRAGE, ASL and DWI data were processed using Freesurfer, FSL-BASIL and DTI-TK. White matter lesion maps were segmented from FLAIR scans. The SPM Sandwich Estimator Toolbox was used to test for the main effects of EYO and interactions between EYO, Time, and APOE-ε4+. Threshold free cluster enhancement and family wise error rate correction (TFCE FWER) was performed on voxelwise statistical maps. RESULTS There were no significant effects of EYO on regional grey matter atrophy or white matter hyperintensities. However, a shorter EYO was associated with lower white matter Fractional Anisotropy and elevated Mean/Radial Diffusivity, particularly in the corpus callosum (TFCEFWERp < 0.05). The influence of EYO on white matter deficits were significantly stronger compared to that of normal ageing. APOE-ε4 carriers exhibited hyperperfusion with nearer proximity to estimated onset in temporo-parietal regions. There were no interactions between EYO and time, suggesting that EYO was not associated with accelerated imaging changes in this sample. CONCLUSIONS Amongst cognitively normal midlife adults with a family history of dementia, a shorter hypothetical proximity to dementia onset may be associated with incipient brain abnormalities, characterised by white matter disruptions and perfusion abnormalities, particularly amongst APOE-ε4 carriers. Our findings also confer biological validity to the construct of EYO as a potential stage marker of preclinical progression in the context of sporadic dementia. Further clinical follow-up of our longitudinal sample would provide critical validation of these findings.
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Affiliation(s)
- Elijah Mak
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK.
| | - Maria-Eleni Dounavi
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - Audrey Low
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - Stephen F Carter
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - Elizabeth McKiernan
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - Guy B Williams
- Department of Clinical Neurosciences and Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences and Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Isabelle Carriere
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | | | - Karen Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK; INSERM and University of Montpellier, Montpellier, France
| | - Craig Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
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32
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Peterson KA, Jones PS, Patel N, Tsvetanov KA, Ingram R, Cappa SF, Lambon Ralph MA, Patterson K, Garrard P, Rowe JB. Language Disorder in Progressive Supranuclear Palsy and Corticobasal Syndrome: Neural Correlates and Detection by the MLSE Screening Tool. Front Aging Neurosci 2021; 13:675739. [PMID: 34381350 PMCID: PMC8351757 DOI: 10.3389/fnagi.2021.675739] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) affect speech and language as well as motor functions. Clinical and neuropathological data indicate a close relationship between these two disorders and the non-fluent variant of primary progressive aphasia (nfvPPA). We use the recently developed Mini Linguistic State Examination tool (MLSE) to study speech and language disorders in patients with PSP, CBS, and nfvPPA, in combination with structural magnetic resonance imaging (MRI). Methods: Fifty-one patients (PSP N = 13, CBS N = 19, nfvPPA N = 19) and 30 age-matched controls completed the MLSE, the short form of the Boston Diagnostic Aphasia Examination (BDAE), and the Addenbrooke's Cognitive Examination III. Thirty-eight patients and all controls underwent structural MRI at 3 Tesla, with T1 and T2-weighted images processed by surface-based and subcortical segmentation within FreeSurfer 6.0.0 to extract cortical thickness and subcortical volumes. Morphometric differences were compared between groups and correlated with the severity of speech and language impairment. Results: CBS and PSP patients showed impaired MLSE performance, compared to controls, with a similar language profile to nfvPPA, albeit less severe. All patient groups showed reduced cortical thickness in bilateral frontal regions and striatal volume. PSP and nfvPPA patients also showed reduced superior temporal cortical thickness, with additional thalamic and amygdalo-hippocampal volume reductions in nfvPPA. Multivariate analysis of brain-wide cortical thickness and subcortical volumes with MLSE domain scores revealed associations between performance on multiple speech and language domains with atrophy of left-lateralised fronto-temporal cortex, amygdala, hippocampus, putamen, and caudate. Conclusions: The effect of PSP and CBS on speech and language overlaps with nfvPPA. These three disorders cause a common anatomical pattern of atrophy in the left frontotemporal language network and striatum. The MLSE is a short clinical screening tool that can identify the language disorder of PSP and CBS, facilitating clinical management and patient access to future clinical trials.
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Affiliation(s)
- Katie A. Peterson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, United Kingdom
| | - P. Simon Jones
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, United Kingdom
| | - Nikil Patel
- Department of Neurosciences, St. George’s, University of London, London, United Kingdom
| | - Kamen A. Tsvetanov
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Ruth Ingram
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Stefano F. Cappa
- IUSS Cognitive Neuroscience Center (ICoN), University Institute for Advanced Studies IUSS, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Karalyn Patterson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, United Kingdom
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Peter Garrard
- Department of Neurosciences, St. George’s, University of London, London, United Kingdom
| | - James B. Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, United Kingdom
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: James B. Rowe
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33
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Malpetti M, Jones PS, Tsvetanov KA, Rittman T, van Swieten JC, Borroni B, Sanchez-Valle R, Moreno F, Laforce R, Graff C, Synofzik M, Galimberti D, Masellis M, Tartaglia MC, Finger E, Vandenberghe R, de Mendonça A, Tagliavini F, Santana I, Ducharme S, Butler CR, Gerhard A, Levin J, Danek A, Otto M, Frisoni GB, Ghidoni R, Sorbi S, Heller C, Todd EG, Bocchetta M, Cash DM, Convery RS, Peakman G, Moore KM, Rohrer JD, Kievit RA, Rowe JB, Genfi GFI. Apathy in presymptomatic genetic frontotemporal dementia predicts cognitive decline and is driven by structural brain changes. Alzheimers Dement 2020; 17:969-983. [PMID: 33316852 PMCID: PMC8247340 DOI: 10.1002/alz.12252] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 12/31/2022]
Abstract
Introduction Apathy adversely affects prognosis and survival of patients with frontotemporal dementia (FTD). We test whether apathy develops in presymptomatic genetic FTD, and is associated with cognitive decline and brain atrophy. Methods Presymptomatic carriers of MAPT, GRN or C9orf72 mutations (N = 304), and relatives without mutations (N = 296) underwent clinical assessments and MRI at baseline, and annually for 2 years. Longitudinal changes in apathy, cognition, gray matter volumes, and their relationships were analyzed with latent growth curve modeling. Results Apathy severity increased over time in presymptomatic carriers, but not in non‐carriers. In presymptomatic carriers, baseline apathy predicted cognitive decline over two years, but not vice versa. Apathy progression was associated with baseline low gray matter volume in frontal and cingulate regions. Discussion Apathy is an early marker of FTD‐related changes and predicts a subsequent subclinical deterioration of cognition before dementia onset. Apathy may be a modifiable factor in those at risk of FTD.
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Affiliation(s)
- Maura Malpetti
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | | | - Barbara Borroni
- Department of Clinical and Experimental Sciences, Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Raquel Sanchez-Valle
- Alzheimer's disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Institut d'Investigacións Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Fermin Moreno
- Department of Neurology, Cognitive Disorders Unit, Donostia Universitary Hospital, San Sebastian, Spain.,Neuroscience Area, Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, Faculté de Médecine, Université Laval, Québec, Canada
| | - Caroline Graff
- Department of Neurobiology Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Bioclinicum, Karolinska Institutet, Solna, Sweden.,Unit for Hereditary Dementias, Theme Aging, Karolinska University Hospital, Solna, Sweden
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Daniela Galimberti
- Fondazione Ca' Granda, IRCCS Ospedale Policlinico, Milan, Italy.,Centro Dino Ferrari, University of Milan, Milan, Italy
| | - Mario Masellis
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Rik Vandenberghe
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium.,Neurology Service, University Hospitals Leuven, Leuven, Belgium.,KU Leuven, Leuven Brain Institute, Leuven, Belgium
| | | | | | - Isabel Santana
- University Hospital of Coimbra (HUC), Neurology Service, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Simon Ducharme
- Department of Psychiatry, McGill University Health Centre, McGill University, Montreal, Québec, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Québec, Canada
| | - Chris R Butler
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.,Departments of Geriatric Medicine and Nuclear Medicine, University of Duisburg- Essen, Duisburg, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians Universität München, Munich, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sandro Sorbi
- Department of Neuroscience Psychology Drug Research and Child Health, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Carolin Heller
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Emily G Todd
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Martina Bocchetta
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - David M Cash
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rhian S Convery
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Georgia Peakman
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Katrina M Moore
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rogier A Kievit
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.,Cognitive Neuroscience Department, Donders Institute for Brain Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - James B Rowe
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK.,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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34
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Murley AG, Rouse MA, Jones PS, Ye R, Hezemans FH, O’Callaghan C, Frangou P, Kourtzi Z, Rua C, Carpenter TA, Rodgers CT, Rowe JB. GABA and glutamate deficits from frontotemporal lobar degeneration are associated with disinhibition. Brain 2020; 143:3449-3462. [PMID: 33141154 PMCID: PMC7719029 DOI: 10.1093/brain/awaa305] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/11/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022] Open
Abstract
Behavioural disinhibition is a common feature of the syndromes associated with frontotemporal lobar degeneration (FTLD). It is associated with high morbidity and lacks proven symptomatic treatments. A potential therapeutic strategy is to correct the neurotransmitter deficits associated with FTLD, thereby improving behaviour. Reductions in the neurotransmitters glutamate and GABA correlate with impulsive behaviour in several neuropsychiatric diseases and there is post-mortem evidence of their deficit in FTLD. Here, we tested the hypothesis that prefrontal glutamate and GABA levels are reduced by FTLD in vivo, and that their deficit is associated with impaired response inhibition. Thirty-three participants with a syndrome associated with FTLD (15 patients with behavioural variant frontotemporal dementia and 18 with progressive supranuclear palsy, including both Richardson's syndrome and progressive supranuclear palsy-frontal subtypes) and 20 healthy control subjects were included. Participants undertook ultra-high field (7 T) magnetic resonance spectroscopy and a stop-signal task of response inhibition. We measured glutamate and GABA levels using semi-LASER magnetic resonance spectroscopy in the right inferior frontal gyrus, because of its strong association with response inhibition, and in the primary visual cortex, as a control region. The stop-signal reaction time was calculated using an ex-Gaussian Bayesian model. Participants with frontotemporal dementia and progressive supranuclear palsy had impaired response inhibition, with longer stop-signal reaction times compared with controls. GABA concentration was reduced in patients versus controls in the right inferior frontal gyrus, but not the occipital lobe. There was no group-wise difference in partial volume corrected glutamate concentration between patients and controls. Both GABA and glutamate concentrations in the inferior frontal gyrus correlated inversely with stop-signal reaction time, indicating greater impulsivity in proportion to the loss of each neurotransmitter. We conclude that the glutamatergic and GABAergic deficits in the frontal lobe are potential targets for symptomatic drug treatment of frontotemporal dementia and progressive supranuclear palsy.
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Affiliation(s)
- Alexander G Murley
- Department of Clinical Neurosciences, University of Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - Matthew A Rouse
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Rong Ye
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Frank H Hezemans
- Department of Clinical Neurosciences, University of Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
| | | | | | - Zoe Kourtzi
- Department of Psychology, University of Cambridge, UK
| | - Catarina Rua
- Wolfson Brain Imaging Centre, University of Cambridge, UK
| | | | | | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
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35
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Malpetti M, Kievit RA, Passamonti L, Jones PS, Tsvetanov KA, Rittman T, Mak E, Nicastro N, Bevan‐Jones WR, Su L, Hong YT, Fryer TD, Aigbirho FI, O'Brien JT, Rowe JB. The prognostic role of microglia and tau PET in Alzheimer’s disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.039817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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)
| | | | | | | | | | | | - Elijah Mak
- University of Cambridge Cambridge United Kingdom
| | | | | | - Li Su
- University of Cambridge Cambridge United Kingdom
| | - Young T Hong
- University of Cambridge Cambridge United Kingdom
| | - Tim D Fryer
- University of Cambridge Cambridge United Kingdom
| | | | - John T O'Brien
- Department of Psychiatry University of Cambridge Cambridge United Kingdom
| | - James B Rowe
- University of Cambridge Cambridge United Kingdom
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36
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Peterson KA, Jones PS, Patel N, Ingram R, Patterson K, Rowe JB, Garrard P. Language impairment in progressive supranuclear palsy and corticobasal syndrome: MLSE screening and its neural correlates. Alzheimers Dement 2020. [DOI: 10.1002/alz.045809] [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: 11/06/2022]
Affiliation(s)
| | | | - Nikil Patel
- St Georges University of London London United Kingdom
| | - Ruth Ingram
- University of Manchester Manchester United Kingdom
| | | | | | - Peter Garrard
- St Georges University of London London United Kingdom
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37
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Malpetti M, Kievit RA, Jones PS, Rittman T, Tsvetanov KA, van Swieten JC, Borroni B, Galimberti D, Sanchez‐Valle R, Laforce R, Moreno F, Synofzik M, Graff C, Masellis M, Tartaglia C, Vandenberghe R, Finger E, Tagliavini F, de Mendonca A, Santana I, Butler C, Ducharme S, Gerhard A, Danek A, Levin J, Otto M, Frisoni GB, Ghidoni R, Heller C, Todd E, Bocchetta M, Convery RS, Peakman G, Moore KM, Rohrer JD, Rowe JB. Trajectory of apathy, cognition and neural correlates in the decades before symptoms in frontotemporal dementia. Alzheimers Dement 2020. [DOI: 10.1002/alz.041821] [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: 11/08/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Daniela Galimberti
- University of Milan Fondazione Cà Granda, IRCCS Ospedale Policlinico Milan Italy
| | | | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire CHU de Québec‐Université Laval Quebec QC Canada
| | - Fermin Moreno
- Department of Neurology Hospital Universitario Donostia San Sebastian Spain
| | - Matthis Synofzik
- Centre for Neurology and Hertie‐Institute for Clinical Brain Research Hoppe‐Seyler‐Str Tuebingen Germany
| | - Caroline Graff
- Center for Alzheimer Research, Division of Neurogeriatrics Karolinska Institutet Huddinge Sweden
| | - Mario Masellis
- Cognitive and Movement Disorders Clinic Sunnybrook Health Sciences Center Toronto ON Canada
| | | | | | | | - Fabrizio Tagliavini
- Division of Neurology V/Neuropathology Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | | | | | | | - Simon Ducharme
- Montreal Neurological Institute McGill University Montreal QC Canada
| | | | - Adrian Danek
- German Center for Neurodegenerative Diseases (DZNE) Munich Munich Germany
| | | | | | - Giovanni B Frisoni
- Memory Clinic and LANVIE‐Laboratory of Neuroimaging of Aging University Hospitals and University of Geneva Geneva Switzerland
| | - Roberta Ghidoni
- IRCCS Centro San Giovanni di Dio Fatebenefratelli Brescia Italy
| | | | - Emily Todd
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Martina Bocchetta
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Rhian S Convery
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Georgia Peakman
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Katrina M Moore
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, Queen Square Institute of Neurology University College London London United Kingdom
| | - James B Rowe
- University of Cambridge Cambridge United Kingdom
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38
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Malpetti M, Passamonti L, Rittman T, Jones PS, Rodríguez PV, Bevan-Jones WR, Hong YT, Fryer TD, Aigbirhio FI, O’Brien JT, Rowe JB. Neuroinflammation and Tau Colocalize in vivo in Progressive Supranuclear Palsy. Ann Neurol 2020; 88:1194-1204. [PMID: 32951237 PMCID: PMC7116392 DOI: 10.1002/ana.25911] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 04/22/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We examined the relationship between tau pathology and neuroinflammation using [11 C]PK11195 and [18 F]AV-1451 PET in 17 patients with progressive supranuclear palsy (PSP) Richardson's syndrome. We tested the hypothesis that neuroinflammation and tau protein aggregation colocalize macroscopically, and correlate with clinical severity. METHODS Nondisplaceable binding potential (BPND ) for each ligand was quantified in 83 regions of interest (ROIs). The [11 C]PK11195 and [18 F]AV-1451 BPND values were correlated across all regions. The spatial distributions of [11 C]PK11195 and [18 F]AV-1451 binding were determined by principal component analyses (PCAs), and the loading of each spatial component compared against the patients' clinical severity (using the PSP rating scale). RESULTS Regional [11 C]PK11195 and [18 F]AV-1451 binding were positively correlated (R = 0.577, p < 0.0001). The PCA identified 4 components for each ligand, reflecting the relative expression of tau pathology or neuroinflammation in distinct groups of brain regions. Positive associations between [11 C]PK11195 and [18 F]AV-1451 components' loadings were found in both subcortical (R = 0.769, p < 0.0001) and cortical regions (R = 0.836, p < 0.0001). There were positive correlations between clinical severity and both subcortical tau pathology (R = 0.667, p = 0.003) and neuroinflammation (R = 0.788, p < 0.001). INTERPRETATION We show that tau pathology and neuroinflammation colocalize in PSP, and that individual differences in subcortical tau pathology and neuroinflammation are linked to clinical severity. Although longitudinal studies are needed to determine causal associations between these molecular pathologies, we suggest that the combination of tau- and immune-oriented strategies may be useful for effective disease-modifying treatments in PSP. ANN NEUROL 2020;88:1194-1204.
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Affiliation(s)
- Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Institute of Molecular Bioimaging and Physiology, National Research Council, Milano, Italy
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - P. Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | | | - Young T. Hong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Tim D. Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | | | - John T. O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Cambridge, UK
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39
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Mak E, Nicastro N, Malpetti M, Savulich G, Surendranathan A, Holland N, Passamonti L, Jones PS, Carter SF, Su L, Hong YT, Fryer TD, Williams GB, Aigbirhio F, Rowe JB, O'Brien JT. Imaging tau burden in dementia with Lewy bodies using [ 18F]-AV1451 positron emission tomography. Neurobiol Aging 2020; 101:172-180. [PMID: 33631469 PMCID: PMC8209140 DOI: 10.1016/j.neurobiolaging.2020.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/27/2020] [Accepted: 11/07/2020] [Indexed: 12/16/2022]
Abstract
Alzheimer's disease (AD) pathology is frequently observed as a comorbidity in people with dementia with Lewy bodies (DLB). Here, we evaluated the in vivo distribution of tau burden and its influence on the clinical phenotype of DLB. Tau deposition was quantified using [18F]-AV1451 positron emission tomography in people with DLB (n = 10), AD (n = 27), and healthy controls (n = 14). A subset of patients with Lewy body diseases (n = 4) also underwent [11C]-PK11195 positron emission tomography to estimate microglial activation. [18F]-AV1451 BPND was lower in DLB than AD across widespread regions. The medial temporal lobe [18F]-AV1451 BPND distinguished people with DLB from AD (AUC = 0.87), and negatively correlated with Addenbrooke's Cognitive Examination-Revised and Mini-Mental State Examination. There was a high degree of colocalization between [18F]-AV1451 and [11C]-PK11195 binding (p < 0.001). Our findings of minimal tau burden in DLB confirm previous studies. Nevertheless, the associations of [18F]-AV1451 binding with cognitive impairment suggest that tau may interact synergistically with other pathologic processes to aggravate disease severity in DLB. We evaluated [18F]-AV1451 uptake in dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). There is minimal tau deposition in DLB compared to healthy controls. Tau imaging may be useful for differential diagnosis of DLB and AD. Tau deposition was correlated with cognitive impairment in DLB.
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Affiliation(s)
- Elijah Mak
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nicolas Nicastro
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Maura Malpetti
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - George Savulich
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ajenthan Surendranathan
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Negin Holland
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Stephen F Carter
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Young T Hong
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Wolfson Brain Imaging Centre, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Tim D Fryer
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Wolfson Brain Imaging Centre, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Guy B Williams
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Wolfson Brain Imaging Centre, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Franklin Aigbirhio
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
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40
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Ye R, Rua C, O'Callaghan C, Jones PS, Hezemans FH, Kaalund SS, Tsvetanov KA, Rodgers CT, Williams G, Passamonti L, Rowe JB. An in vivo probabilistic atlas of the human locus coeruleus at ultra-high field. Neuroimage 2020; 225:117487. [PMID: 33164875 PMCID: PMC7779564 DOI: 10.1016/j.neuroimage.2020.117487] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/22/2020] [Accepted: 10/17/2020] [Indexed: 12/16/2022] Open
Abstract
Early and profound pathological changes are evident in the locus coeruleus (LC) in dementia and Parkinson's disease, with effects on arousal, attention, cognitive and motor control. The LC can be identified in vivo using non-invasive magnetic resonance imaging techniques which have potential as biomarkers for detecting and monitoring disease progression. Technical limitations of existing imaging protocols have impaired the sensitivity to regional contrast variance or the spatial variability on the rostrocaudal extent of the LC, with spatial mapping consistent with post mortem findings. The current study employs a sensitive magnetisation transfer sequence using ultrahigh field 7T MRI to investigate the LC structure in vivo at high-resolution (0.4 × 0.4 × 0.5 mm). Magnetisation transfer images from 53 healthy older volunteers (52 - 84 years) clearly revealed the spatial features of the LC and were used to create a probabilistic LC atlas for older adults. This atlas may be especially relevant for studying disorders associated with older age. To use the atlas does not require use of the same MT sequence of 7T MRI, provided good co-registration and normalisation is achieved. Consistent rostrocaudal gradients of slice-wise volume, contrast and variance along the LC were observed, mirroring distinctive ex vivo spatial distributions of LC cells in its subregions. The contrast-to-noise ratios were calculated for the peak voxels, and for the averaged signals within the atlas, to accommodate the volumetric differences in estimated contrast. The probabilistic atlas is freely available, and the MRI dataset will be made available for non-commercial research, for replication or to facilitate accurate LC localisation and unbiased contrast extraction in future studies.
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Affiliation(s)
- Rong Ye
- Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK.
| | - Catarina Rua
- Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Claire O'Callaghan
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine, University of Sydney, Sydney, Australia; Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK
| | - Frank H Hezemans
- Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Sanne S Kaalund
- Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK; Department of Psychology, University of Cambridge, Cambridge, UK
| | | | - Guy Williams
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK; Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Consiglio Nazionale delle Ricerche (CNR), Milano, Italy
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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41
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Hughes JL, Beech JS, Jones PS, Wang D, Menon DK, Aigbirhio FI, Fryer TD, Baron JC. Early-stage 11C-Flumazenil PET predicts day-14 selective neuronal loss in a rodent model of transient focal cerebral ischemia. J Cereb Blood Flow Metab 2020; 40:1997-2009. [PMID: 31637947 PMCID: PMC7786851 DOI: 10.1177/0271678x19883040] [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: 11/16/2022]
Abstract
Predicting tissue outcome early after stroke is an important goal. MRI >3 h accurately predicts infarction but is insensitive to selective neuronal loss (SNL). Previous studies suggest that chronic-stage 11C-flumazenil PET (FMZ-PET) is a validated marker of SNL in rats, while early-stage FMZ-PET may predict infarction. Whether early FMZ-PET also predicts SNL is unknown. Following 45-min distal MCA occlusion, adult rats underwent FMZ-PET at 1 h and 48 h post-reperfusion to map distribution volume (VT), which reflects GABA-A receptor binding. NeuN immunohistochemistry was performed at Day 14. In each rat, VT and %NeuN loss were determined in 44 ROIs spanning the hemisphere. NeuN revealed isolated SNL and cortical infarction in five and one rats, respectively. In the SNL subgroup, VT-1 h was mildly reduced and only weakly predicted SNL, while VT-48 h was significantly increased and predicted SNL both individually (p < 0.01, Kendall) and across the group (p < 0.001), i.e. the higher the VT, the stronger the SNL. Similar correlations were found in the rat with infarction. Our findings suggest GABA-A receptors are still present on injured neurons at the 48 h timepoint, and the increased 48 h VT observed here is consistent with earlier rat studies showing early GABA-A receptor upregulation. That FMZ binding at 48 h was predictive of SNL may have clinical implications.
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Affiliation(s)
- Jessica L Hughes
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - John S Beech
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - P Simon Jones
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Dechao Wang
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Franklin I Aigbirhio
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Tim D Fryer
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Jean-Claude Baron
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Inserm U1266, Paris Descartes University, Sainte-Anne Hospital, Paris, France
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42
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Holland N, Jones PS, Savulich G, Wiggins JK, Hong YT, Fryer TD, Manavaki R, Sephton SM, Boros I, Malpetti M, Hezemans FH, Aigbirhio FI, Coles JP, O’Brien J, Rowe JB. Synaptic Loss in Primary Tauopathies Revealed by [ 11 C]UCB-J Positron Emission Tomography. Mov Disord 2020; 35:1834-1842. [PMID: 32652635 PMCID: PMC7611123 DOI: 10.1002/mds.28188] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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: 04/13/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Synaptic loss is a prominent and early feature of many neurodegenerative diseases. OBJECTIVES We tested the hypothesis that synaptic density is reduced in the primary tauopathies of progressive supranuclear palsy (PSP) (Richardson's syndrome) and amyloid-negative corticobasal syndrome (CBS). METHODS Forty-four participants (15 CBS, 14 PSP, and 15 age-/sex-/education-matched controls) underwent PET with the radioligand [11 C]UCB-J, which binds to synaptic vesicle glycoprotein 2A, a marker of synaptic density; participants also had 3 Tesla MRI and clinical and neuropsychological assessment. RESULTS Nine CBS patients had negative amyloid biomarkers determined by [11 C]PiB PET and hence were deemed likely to have corticobasal degeneration (CBD). Patients with PSP-Richardson's syndrome and amyloid-negative CBS were impaired in executive, memory, and visuospatial tasks. [11 C]UCB-J binding was reduced across frontal, temporal, parietal, and occipital lobes, cingulate, hippocampus, insula, amygdala, and subcortical structures in both PSP and CBD patients compared to controls (P < 0.01), with median reductions up to 50%, consistent with postmortem data. Reductions of 20% to 30% were widespread even in areas of the brain with minimal atrophy. There was a negative correlation between global [11 C]UCB-J binding and the PSP and CBD rating scales (R = -0.61, P < 0.002; R = -0.72, P < 0.001, respectively) and a positive correlation with the revised Addenbrooke's Cognitive Examination (R = 0.52; P = 0.01). CONCLUSIONS We confirm severe synaptic loss in PSP and CBD in proportion to disease severity, providing critical insight into the pathophysiology of primary degenerative tauopathies. [11 C]UCB-J may facilitate treatment strategies for disease-modification, synaptic maintenance, or restoration. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Negin Holland
- Department of Clinical Neurosciences, University of Cambridge
| | - P. Simon Jones
- Department of Clinical Neurosciences, University of Cambridge
| | | | | | - Young T. Hong
- Department of Clinical Neurosciences, University of Cambridge
- Wolfson Brain Imaging Centre, University of Cambridge
| | - Tim D. Fryer
- Department of Clinical Neurosciences, University of Cambridge
- Wolfson Brain Imaging Centre, University of Cambridge
| | | | - Selena Milicevic Sephton
- Department of Clinical Neurosciences, University of Cambridge
- Wolfson Brain Imaging Centre, University of Cambridge
| | - Istvan Boros
- Department of Clinical Neurosciences, University of Cambridge
- Wolfson Brain Imaging Centre, University of Cambridge
| | - Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge
| | - Frank H. Hezemans
- Department of Clinical Neurosciences, University of Cambridge
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge
| | | | - Jonathan P. Coles
- Division of Anaesthesia, Department of Medicine, University of Cambridge
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John O’Brien
- Department of Psychiatry, University of Cambridge
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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43
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Bevan-Jones WR, Cope TE, Jones PS, Kaalund SS, Passamonti L, Allinson K, Green O, Hong YT, Fryer TD, Arnold R, Coles JP, Aigbirhio FI, Larner AJ, Patterson K, O'Brien JT, Rowe JB. Neuroinflammation and protein aggregation co-localize across the frontotemporal dementia spectrum. Brain 2020; 143:1010-1026. [PMID: 32179883 PMCID: PMC7089669 DOI: 10.1093/brain/awaa033] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 12/04/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022] Open
Abstract
The clinical syndromes of frontotemporal dementia are clinically and neuropathologically heterogeneous, but processes such as neuroinflammation may be common across the disease spectrum. We investigated how neuroinflammation relates to the localization of tau and TDP-43 pathology, and to the heterogeneity of clinical disease. We used PET in vivo with (i) 11C-PK-11195, a marker of activated microglia and a proxy index of neuroinflammation; and (ii) 18F-AV-1451, a radioligand with increased binding to pathologically affected regions in tauopathies and TDP-43-related disease, and which is used as a surrogate marker of non-amyloid-β protein aggregation. We assessed 31 patients with frontotemporal dementia (10 with behavioural variant, 11 with the semantic variant and 10 with the non-fluent variant), 28 of whom underwent both 18F-AV-1451 and 11C-PK-11195 PET, and matched control subjects (14 for 18F-AV-1451 and 15 for 11C-PK-11195). We used a univariate region of interest analysis, a paired correlation analysis of the regional relationship between binding distributions of the two ligands, a principal component analysis of the spatial distributions of binding, and a multivariate analysis of the distribution of binding that explicitly controls for individual differences in ligand affinity for TDP-43 and different tau isoforms. We found significant group-wise differences in 11C-PK-11195 binding between each patient group and controls in frontotemporal regions, in both a regions-of-interest analysis and in the comparison of principal spatial components of binding. 18F-AV-1451 binding was increased in semantic variant primary progressive aphasia compared to controls in the temporal regions, and both semantic variant primary progressive aphasia and behavioural variant frontotemporal dementia differed from controls in the expression of principal spatial components of binding, across temporal and frontotemporal cortex, respectively. There was a strong positive correlation between 11C-PK-11195 and 18F-AV-1451 uptake in all disease groups, across widespread cortical regions. We confirmed this association with post-mortem quantification in 12 brains, demonstrating strong associations between the regional densities of microglia and neuropathology in FTLD-TDP (A), FTLD-TDP (C), and FTLD-Pick's. This was driven by amoeboid (activated) microglia, with no change in the density of ramified (sessile) microglia. The multivariate distribution of 11C-PK-11195 binding related better to clinical heterogeneity than did 18F-AV-1451: distinct spatial modes of neuroinflammation were associated with different frontotemporal dementia syndromes and supported accurate classification of participants. These in vivo findings indicate a close association between neuroinflammation and protein aggregation in frontotemporal dementia. The inflammatory component may be important in shaping the clinical and neuropathological patterns of the diverse clinical syndromes of frontotemporal dementia.
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Affiliation(s)
| | - Thomas E Cope
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - P Simon Jones
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sanne S Kaalund
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Luca Passamonti
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Consiglio Nazionale delle Ricerche (CNR), via Fratelli Cervi, Milano, Italy
| | - Kieren Allinson
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridge, UK
| | - Oliver Green
- Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Consiglio Nazionale delle Ricerche (CNR), via Fratelli Cervi, Milano, Italy
| | - Young T Hong
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Tim D Fryer
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Robert Arnold
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | | | - Karalyn Patterson
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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44
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Malpetti M, Kievit RA, Passamonti L, Jones PS, Tsvetanov KA, Rittman T, Mak E, Nicastro N, Bevan-Jones WR, Su L, Hong YT, Fryer TD, Aigbirhio FI, O’Brien JT, Rowe JB. Microglial activation and tau burden predict cognitive decline in Alzheimer's disease. Brain 2020; 143:1588-1602. [PMID: 32380523 PMCID: PMC7241955 DOI: 10.1093/brain/awaa088] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/09/2020] [Accepted: 02/07/2020] [Indexed: 11/12/2022] Open
Abstract
Tau pathology, neuroinflammation, and neurodegeneration are key aspects of Alzheimer's disease. Understanding whether these features predict cognitive decline, alone or in combination, is crucial to develop new prognostic measures and enhanced stratification for clinical trials. Here, we studied how baseline assessments of in vivo tau pathology (measured by 18F-AV-1451 PET), neuroinflammation (measured by 11C-PK11195 PET) and brain atrophy (derived from structural MRI) predicted longitudinal cognitive changes in patients with Alzheimer's disease pathology. Twenty-six patients (n = 12 with clinically probable Alzheimer's dementia and n = 14 with amyloid-positive mild cognitive impairment) and 29 healthy control subjects underwent baseline assessment with 18F-AV-1451 PET, 11C-PK11195 PET, and structural MRI. Cognition was examined annually over the subsequent 3 years using the revised Addenbrooke's Cognitive Examination. Regional grey matter volumes, and regional binding of 18F-AV-1451 and 11C-PK11195 were derived from 15 temporo-parietal regions characteristically affected by Alzheimer's disease pathology. A principal component analysis was used on each imaging modality separately, to identify the main spatial distributions of pathology. A latent growth curve model was applied across the whole sample on longitudinal cognitive scores to estimate the rate of annual decline in each participant. We regressed the individuals' estimated rate of cognitive decline on the neuroimaging components and examined univariable predictive models with single-modality predictors, and a multi-modality predictive model, to identify the independent and combined prognostic value of the different neuroimaging markers. Principal component analysis identified a single component for the grey matter atrophy, while two components were found for each PET ligand: one weighted to the anterior temporal lobe, and another weighted to posterior temporo-parietal regions. Across the whole-sample, the single-modality models indicated significant correlations between the rate of cognitive decline and the first component of each imaging modality. In patients, both stepwise backward elimination and Bayesian model selection revealed an optimal predictive model that included both components of 18F-AV-1451 and the first (i.e. anterior temporal) component for 11C-PK11195. However, the MRI-derived atrophy component and demographic variables were excluded from the optimal predictive model of cognitive decline. We conclude that temporo-parietal tau pathology and anterior temporal neuroinflammation predict cognitive decline in patients with symptomatic Alzheimer's disease pathology. This indicates the added value of PET biomarkers in predicting cognitive decline in Alzheimer's disease, over and above MRI measures of brain atrophy and demographic data. Our findings also support the strategy for targeting tau and neuroinflammation in disease-modifying therapy against Alzheimer's disease.
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Affiliation(s)
- Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Rogier A Kievit
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Institute of Molecular Bioimaging and Physiology, National Research Council, Milano, Italy
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Nicolas Nicastro
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, Geneva University Hospitals, Switzerland
| | | | - Li Su
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Young T Hong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - John T O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Cambridge, UK
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Murley AG, Coyle-Gilchrist I, Rouse MA, Jones PS, Li W, Wiggins J, Lansdall C, Rodríguez PV, Wilcox A, Tsvetanov KA, Patterson K, Lambon Ralph MA, Rowe JB. Redefining the multidimensional clinical phenotypes of frontotemporal lobar degeneration syndromes. Brain 2020; 143:1555-1571. [PMID: 32438414 PMCID: PMC7241953 DOI: 10.1093/brain/awaa097] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/14/2020] [Accepted: 02/07/2020] [Indexed: 12/14/2022] Open
Abstract
The syndromes caused by frontotemporal lobar degeneration have highly heterogeneous and overlapping clinical features. There has been great progress in the refinement of clinical diagnostic criteria in the past decade, but we propose that a better understanding of aetiology, pathophysiology and symptomatic treatments can arise from a transdiagnostic approach to clinical phenotype and brain morphometry. In a cross-sectional epidemiological study, we examined 310 patients with a syndrome likely to be caused by frontotemporal lobar degeneration, including behavioural variant frontotemporal dementia, non-fluent, and semantic variants of primary progressive aphasia (PPA), progressive supranuclear palsy and corticobasal syndrome. We included patients with logopenic PPA and those who met criteria for PPA but not a specific subtype. To date, 49 patients have a neuropathological diagnosis. A principal component analysis identified symptom dimensions that broadly recapitulated the core features of the main clinical syndromes. However, the subject-specific scores on these dimensions showed considerable overlap across the diagnostic groups. Sixty-two per cent of participants had phenotypic features that met the diagnostic criteria for more than one syndrome. Behavioural disturbance was prevalent in all groups. Forty-four per cent of patients with corticobasal syndrome had progressive supranuclear palsy-like features and 30% of patients with progressive supranuclear palsy had corticobasal syndrome-like features. Many patients with progressive supranuclear palsy and corticobasal syndrome had language impairments consistent with non-fluent variant PPA while patients with behavioural variant frontotemporal dementia often had semantic impairments. Using multivariate source-based morphometry on a subset of patients (n = 133), we identified patterns of covarying brain atrophy that were represented across the diagnostic groups. Canonical correlation analysis of clinical and imaging components found three key brain-behaviour relationships, with a continuous spectrum across the cohort rather than discrete diagnostic entities. In the 46 patients with follow-up (mean 3.6 years) syndromic overlap increased with time. Together, these results show that syndromes associated with frontotemporal lobar degeneration do not form discrete mutually exclusive categories from their clinical features or structural brain changes, but instead exist in a multidimensional spectrum. Patients often manifest diagnostic features of multiple disorders while deficits in behaviour, movement and language domains are not confined to specific diagnostic groups. It is important to recognize individual differences in clinical phenotype, both for clinical management and to understand pathogenic mechanisms. We suggest that a transdiagnostic approach to the spectrum of frontotemporal lobar degeneration syndromes provides a useful framework with which to understand disease aetiology, progression, and heterogeneity and to target future treatments to a higher proportion of patients.
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Affiliation(s)
- Alexander G Murley
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian Coyle-Gilchrist
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Norfolk and Norwich NHS Foundation Trust, Norwich, UK
| | - Matthew A Rouse
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Win Li
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Julie Wiggins
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Claire Lansdall
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Alicia Wilcox
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Karalyn Patterson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Matthew A Lambon Ralph
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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46
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Jabbari E, Holland N, Chelban V, Jones PS, Lamb R, Rawlinson C, Guo T, Costantini AA, Tan MMX, Heslegrave AJ, Roncaroli F, Klein JC, Ansorge O, Allinson KSJ, Jaunmuktane Z, Holton JL, Revesz T, Warner TT, Lees AJ, Zetterberg H, Russell LL, Bocchetta M, Rohrer JD, Williams NM, Grosset DG, Burn DJ, Pavese N, Gerhard A, Kobylecki C, Leigh PN, Church A, Hu MTM, Woodside J, Houlden H, Rowe JB, Morris HR. Diagnosis Across the Spectrum of Progressive Supranuclear Palsy and Corticobasal Syndrome. JAMA Neurol 2020; 77:377-387. [PMID: 31860007 PMCID: PMC6990759 DOI: 10.1001/jamaneurol.2019.4347] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [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: 07/31/2019] [Accepted: 10/27/2019] [Indexed: 12/29/2022]
Abstract
Importance Atypical parkinsonian syndromes (APS), including progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), and multiple system atrophy (MSA), may be difficult to distinguish in early stages and are often misdiagnosed as Parkinson disease (PD). The diagnostic criteria for PSP have been updated to encompass a range of clinical subtypes but have not been prospectively studied. Objective To define the distinguishing features of PSP and CBS subtypes and to assess their usefulness in facilitating early diagnosis and separation from PD. Design, Setting, Participants This cohort study recruited patients with APS and PD from movement disorder clinics across the United Kingdom from September 1, 2015, through December 1, 2018. Patients with APS were stratified into the following groups: those with Richardson syndrome (PSP-RS), PSP-subcortical (including PSP-parkinsonism and progressive gait freezing subtypes), PSP-cortical (including PSP-frontal and PSP-CBS overlap subtypes), MSA-parkinsonism, MSA-cerebellar, CBS-Alzheimer disease (CBS-AD), and CBS-non-AD. Data were analyzed from February 1, through May 1, 2019. Main Outcomes and Measures Baseline group comparisons used (1) clinical trajectory; (2) cognitive screening scales; (3) serum neurofilament light chain (NF-L) levels; (4) TRIM11, ApoE, and MAPT genotypes; and (5) volumetric magnetic resonance imaging measures. Results A total of 222 patients with APS (101 with PSP, 55 with MSA, 40 with CBS, and 26 indeterminate) were recruited (129 [58.1%] male; mean [SD] age at recruitment, 68.3 [8.7] years). Age-matched control participants (n = 76) and patients with PD (n = 1967) were included for comparison. Concordance between the antemortem clinical and pathologic diagnoses was achieved in 12 of 13 patients with PSP and CBS (92.3%) undergoing postmortem evaluation. Applying the Movement Disorder Society PSP diagnostic criteria almost doubled the number of patients diagnosed with PSP from 58 to 101. Forty-nine of 101 patients with reclassified PSP (48.5%) did not have the classic PSP-RS subtype. Patients in the PSP-subcortical group had a longer diagnostic latency and a more benign clinical trajectory than those in PSP-RS and PSP-cortical groups. The PSP-subcortical group was distinguished from PSP-cortical and PSP-RS groups by cortical volumetric magnetic resonance imaging measures (area under the curve [AUC], 0.84-0.89), cognitive profile (AUC, 0.80-0.83), serum NF-L level (AUC, 0.75-0.83), and TRIM11 rs564309 genotype. Midbrain atrophy was a common feature of all PSP groups. Eight of 17 patients with CBS (47.1%) undergoing cerebrospinal fluid analysis were identified as having the CBS-AD subtype. Patients in the CBS-AD group had a longer diagnostic latency, relatively benign clinical trajectory, greater cognitive impairment, and higher APOE-ε4 allele frequency than those in the CBS-non-AD group (AUC, 0.80-0.87; P < .05). Serum NF-L levels distinguished PD from all PSP and CBS cases combined (AUC, 0.80; P < .05). Conclusions and Relevance These findings suggest that studies focusing on the PSP-RS subtype are likely to miss a large number of patients with underlying PSP tau pathology. Analysis of cerebrospinal fluid defined a distinct CBS-AD subtype. The PSP and CBS subtypes have distinct characteristics that may enhance their early diagnosis.
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Affiliation(s)
- Edwin Jabbari
- Department of Clinical and Movement Neurosciences, UCL (University College London) Queen Square Institute of Neurology, London, United Kingdom
- Movement Disorders Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Negin Holland
- Department of Clinical Neurosciences and MRC (Medical Research Council) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Viorica Chelban
- Department of Clinical and Movement Neurosciences, UCL (University College London) Queen Square Institute of Neurology, London, United Kingdom
- Movement Disorders Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - P. Simon Jones
- Department of Clinical Neurosciences and MRC (Medical Research Council) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ruth Lamb
- Department of Clinical and Movement Neurosciences, UCL (University College London) Queen Square Institute of Neurology, London, United Kingdom
- Movement Disorders Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Charlotte Rawlinson
- Department of Clinical and Movement Neurosciences, UCL (University College London) Queen Square Institute of Neurology, London, United Kingdom
- Movement Disorders Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Tong Guo
- Department of Clinical and Movement Neurosciences, UCL (University College London) Queen Square Institute of Neurology, London, United Kingdom
- Movement Disorders Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Alyssa A. Costantini
- Department of Clinical and Movement Neurosciences, UCL (University College London) Queen Square Institute of Neurology, London, United Kingdom
- Movement Disorders Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Manuela M. X. Tan
- Department of Clinical and Movement Neurosciences, UCL (University College London) Queen Square Institute of Neurology, London, United Kingdom
- Movement Disorders Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Amanda J. Heslegrave
- UK Dementia Research Institute, UCL Queen Square Institute of Neurology, London, United Kingdom
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Federico Roncaroli
- Department of Neurology, Manchester Academic Health Science Centre, Salford Royal NHS (National Health Service) Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Johannes C. Klein
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Kieren S. J. Allinson
- Department of Clinical Neurosciences and MRC (Medical Research Council) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Zane Jaunmuktane
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, United Kingdom
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Janice L. Holton
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, United Kingdom
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Tamas Revesz
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, United Kingdom
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Thomas T. Warner
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, United Kingdom
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Andrew J. Lees
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, United Kingdom
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Henrik Zetterberg
- UK Dementia Research Institute, UCL Queen Square Institute of Neurology, London, United Kingdom
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Lucy L. Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jonathan D. Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Nigel M. Williams
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom
| | - Donald G. Grosset
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - David J. Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Nicola Pavese
- Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Alexander Gerhard
- Departments of Geriatrics and Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Christopher Kobylecki
- Department of Neurology, Manchester Academic Health Science Centre, Salford Royal NHS (National Health Service) Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - P. Nigel Leigh
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Alistair Church
- Department of Neurology, Royal Gwent Hospital, Newport, United Kingdom
| | - Michele T. M. Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - John Woodside
- Department of Clinical and Movement Neurosciences, UCL (University College London) Queen Square Institute of Neurology, London, United Kingdom
- Movement Disorders Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Henry Houlden
- Department of Clinical and Movement Neurosciences, UCL (University College London) Queen Square Institute of Neurology, London, United Kingdom
- Movement Disorders Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - James B. Rowe
- Department of Clinical Neurosciences and MRC (Medical Research Council) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Huw R. Morris
- Department of Clinical and Movement Neurosciences, UCL (University College London) Queen Square Institute of Neurology, London, United Kingdom
- Movement Disorders Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
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Murley AG, Jones PS, Coyle Gilchrist I, Bowns L, Wiggins J, Tsvetanov KA, Rowe JB. Metabolomic changes associated with frontotemporal lobar degeneration syndromes. J Neurol 2020; 267:2228-2238. [PMID: 32277260 PMCID: PMC7359154 DOI: 10.1007/s00415-020-09824-1] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Widespread metabolic changes are seen in neurodegenerative disease and could be used as biomarkers for diagnosis and disease monitoring. They may also reveal disease mechanisms that could be a target for therapy. In this study we looked for blood-based biomarkers in syndromes associated with frontotemporal lobar degeneration. METHODS Plasma metabolomic profiles were measured from 134 patients with a syndrome associated with frontotemporal lobar degeneration (behavioural variant frontotemporal dementia n = 30, non fluent variant primary progressive aphasia n = 26, progressive supranuclear palsy n = 45, corticobasal syndrome n = 33) and 32 healthy controls. RESULTS Forty-nine of 842 metabolites were significantly altered in frontotemporal lobar degeneration syndromes (after false-discovery rate correction for multiple comparisons). These were distributed across a wide range of metabolic pathways including amino acids, energy and carbohydrate, cofactor and vitamin, lipid and nucleotide pathways. The metabolomic profile supported classification between frontotemporal lobar degeneration syndromes and controls with high accuracy (88.1-96.6%) while classification accuracy was lower between the frontotemporal lobar degeneration syndromes (72.1-83.3%). One metabolic profile, comprising a range of different pathways, was consistently identified as a feature of each disease versus controls: the degree to which a patient expressed this metabolomic profile was associated with their subsequent survival (hazard ratio 0.74 [0.59-0.93], p = 0.0018). CONCLUSIONS The metabolic changes in FTLD are promising diagnostic and prognostic biomarkers. Further work is required to replicate these findings, examine longitudinal change, and test their utility in differentiating between FTLD syndromes that are pathologically distinct but phenotypically similar.
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Affiliation(s)
- Alexander G Murley
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Lucy Bowns
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Julie Wiggins
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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48
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Nicastro N, Rodriguez PV, Malpetti M, Bevan-Jones WR, Simon Jones P, Passamonti L, Aigbirhio FI, O'Brien JT, Rowe JB. 18F-AV1451 PET imaging and multimodal MRI changes in progressive supranuclear palsy. J Neurol 2019; 267:341-349. [PMID: 31641878 PMCID: PMC6989441 DOI: 10.1007/s00415-019-09566-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 12/11/2022]
Abstract
Objectives Progressive supranuclear palsy (PSP) is characterized by deposition of straight filament tau aggregates in the grey matter (GM) of deep nuclei and cerebellum. We examined the relationship between tau pathology (assessed via 18F-AV1451 PET) and multimodal MRI imaging using GM volume, cortical thickness (CTh), and diffusion tensor imaging (DTI). Methods Twenty-three people with clinically probable PSP-Richardson’s syndrome (age 68.8 ± 5.8 years, 39% female) and 23 controls underwent structural 3 T brain MRI including DTI. Twenty-one patients also had 18F-AV1451 PET imaging. Voxelwise volume-based morphometry, surface-based morphometry, and DTI correlations were performed with 18F-AV1451 binding in typical PSP regions of interest (putamen, thalamus and dentate cerebellum). Clinical impairment was also assessed in relation to the different imaging modalities. Results PSP subjects showed GM volume loss in frontotemporal regions, basal ganglia, midbrain, and cerebellum (FDR-corrected p < 0.05), reduced CTh in the left entorhinal and fusiform gyrus (p < 0.001) as well as DTI changes in the corpus callosum, internal capsule, and superior longitudinal fasciculus (FWE-corrected p < 0.05). In PSP, higher 18F-AV1451 binding correlated with GM volume loss in frontal regions, DTI changes in motor tracts, and cortical thinning in parietooccipital areas. Cognitive impairment was related to decreased GM volume in frontotemporal regions, thalamus and pallidum, as well as DTI alteration in corpus callosum and cingulum. Conclusion This cross-sectional study demonstrates an association between in vivo proxy measures of tau pathology and grey and white matter degeneration in PSP. This adds to the present literature about the complex interplay between structural changes and protein deposition.
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Affiliation(s)
- Nicolas Nicastro
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Patricia Vazquez Rodriguez
- Department of Clinical Neurosciences, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - William Richard Bevan-Jones
- Department of Clinical Neurosciences, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK.,Consiglio Nazionale Delle Ricerche (CNR), Istituto Di Bioimmagini E Fisiologia Molecolare (IBFM), Milano, Italy
| | | | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK. .,Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
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49
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Passamonti L, Tsvetanov KA, Jones PS, Bevan-Jones WR, Arnold R, Borchert RJ, Mak E, Su L, O'Brien JT, Rowe JB. Neuroinflammation and Functional Connectivity in Alzheimer's Disease: Interactive Influences on Cognitive Performance. J Neurosci 2019; 39:7218-7226. [PMID: 31320450 PMCID: PMC6733539 DOI: 10.1523/jneurosci.2574-18.2019] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/25/2019] [Accepted: 04/11/2019] [Indexed: 12/30/2022] Open
Abstract
Neuroinflammation is a key part of the etio-pathogenesis of Alzheimer's disease (AD). We tested the relationship between neuroinflammation and the disruption of functional connectivity in large-scale networks, and their joint influence on cognitive impairment. We combined [11C]PK11195 positron emission tomography (PET) and resting-state functional magnetic resonance imaging (rs-fMRI) in 28 patients (12 females/16 males) with clinical diagnosis of probable AD or mild cognitive impairment with positive PET biomarker for amyloid, and 14 age-, sex-, and education-matched healthy controls (8 females/6 males). Source-based "inflammetry" was used to extract principal components of [11C]PK11195 PET signal variance across all participants. rs-fMRI data were preprocessed via independent component analyses to classify neuronal and non-neuronal signals. Multiple linear regression models identified sources of signal covariance between neuroinflammation and brain connectivity profiles, in relation to the diagnostic group (patients, controls) and cognitive status.Patients showed significantly higher [11C]PK11195 binding relative to controls, in a distributed spatial pattern including the hippocampus, frontal, and inferior temporal cortex. Patients with enhanced loading on this [11C]PK11195 binding distribution displayed diffuse abnormal functional connectivity. The expression of a stronger association between such abnormal connectivity and higher levels of neuroinflammation correlated with worse cognitive deficits.Our study suggests that neuroinflammation relates to the pathophysiological changes in network function that underlie cognitive deficits in Alzheimer's disease. Neuroinflammation, and its association with functionally-relevant reorganization of brain networks, is proposed as a target for emerging immunotherapeutic strategies aimed at preventing or slowing the emergence of dementia.SIGNIFICANCE STATEMENT Neuroinflammation is an important aspect of Alzheimer's disease (AD), but it was not known whether the influence of neuroinflammation on brain network function in humans was important for cognitive deficit. Our study provides clear evidence that in vivo neuroinflammation in AD impairs large-scale network connectivity; and that the link between neuro inflammation and functional network connectivity is relevant to cognitive impairment. We suggest that future studies should address how neuroinflammation relates to network function as AD progresses, and whether the neuroinflammation in AD is reversible, as the basis of immunotherapeutic strategies to slow the progression of AD.
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Affiliation(s)
- L Passamonti
- Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Consiglio Nazionale delle Ricerche (CNR), 20090, Milano, Italy,
- Departments of Clinical Neurosciences
| | | | - P S Jones
- Departments of Clinical Neurosciences
| | - W R Bevan-Jones
- Psychiatry, University of Cambridge, Cambridge CB2 0SZ, United Kingdom, and
| | - R Arnold
- Departments of Clinical Neurosciences
| | | | - E Mak
- Psychiatry, University of Cambridge, Cambridge CB2 0SZ, United Kingdom, and
| | - L Su
- Psychiatry, University of Cambridge, Cambridge CB2 0SZ, United Kingdom, and
| | - J T O'Brien
- Psychiatry, University of Cambridge, Cambridge CB2 0SZ, United Kingdom, and
| | - J B Rowe
- Departments of Clinical Neurosciences
- Cognition and Brain Sciences Unit, Medical Research Council, Cambridge CB2 7EF, United Kingdom
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50
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Calautti C, Jones PS, Naccarato M, Sharma N, Carpenter TA, Warburton EA, Baron JC. Further evidence for a non-cortical origin of mirror movements after stroke. Brain 2019; 142:e1. [PMID: 30596902 DOI: 10.1093/brain/awy308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cinzia Calautti
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - P Simon Jones
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Marcello Naccarato
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Nikhil Sharma
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - T Adrian Carpenter
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Elisabeth A Warburton
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Jean-Claude Baron
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK.,Department of Neurology, Sainte-Anne Hospital, Université Paris Descartes, INSERM U894, Paris, France
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