Urine Formaldehyde Predicts Cognitive Impairment in Post-Stroke Dementia and Alzheimer’s Disease

Article type: Research Article

Authors: Tong, Zhiqian^{a; b; 1; *} | Wang, Weishan^{c; 1} | Luo, Wenhong^{d; 1} | Lv, Jihui^{c; 1} | Li, Hui^d | Luo, Hongjun^d | Jia, Jianping^b | He, Rongqiao^{a; b; e; *}

Affiliations: [a] Center of Alzheimer’s Disease, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China | [b] State Key Laboratory of Brain and Cognitive Sciences, Institute of Biophysics, Beijing, China | [c] Beijing Geriatric Hospital, Beijing, China | [d] Central Laboratory, Shantou University Medical College, Guangdong, China | [e] Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China

Correspondence: [*] Correspondence to: Dr. ZQ Tong and Prof. RQ He, Centerof Alzheimer’s Disease, Beijing Institute for Brain Disorders,Capital Medical University, Beijing 100069, China. Tel.: +86 10 6488 9876; Fax: +86 10 6485 3625; E-mail: tzqbeida@163.com (Zhiqian Tong); herq@sun5.ibp.ac.cn (Rongqiao He).

Note: [1] These authors contributed equally to this work.

Abstract: Although Alzheimer’s disease (AD) was first described over 100 years ago, there is still no suitable biomarker for diagnosing AD in easily collectable samples (e.g., blood plasma, saliva, and urine). Here, we investigated the relationship between morning urine formaldehyde concentration and cognitive impairment in patients with post-stroke dementia (PSD) or AD in this cross-sectional survey for 7 years. Cognitive abilities of the study participants (n = 577, four groups: 231 controls, 61 stroke, 65 PSD, and 220 AD) were assessed by Mini-Mental State Examination (MMSE). Morning urine formaldehyde concentrations were measured by high performance liquid chromatography (HPLC). Gender- and age-matched participants were selected from the four groups (n = 42 in each group). Both semicarbazide-sensitive amine oxidase (SSAO, a formaldehyde-generating enzyme) and formaldehyde levels in the blood and urine were analyzed by using an enzyme-linked immunosorbent assay (ELISA) and HPLC, respectively. We found that morning urine formaldehyde levels were inversely correlated with MMSE scores. The threshold value (the best Cut-Off value) of formaldehyde concentration for predicting cognitive impairment was 0.0418 mM in patients with PSD (Sensitivity: 92.3%; Specificity: 77.1%), and 0.0449 mM in patients with AD (Sensitivity: 94.1%; Specificity: 81.8%), respectively. The results of biochemical analysis revealed that the observed increase in urine formaldehyde resulted from an overexpression of SSAO in the blood. The findings suggest that measuring the concentration of formaldehyde in overnight fasting urine could be used as a potentially noninvasive method for evaluating the likelihood of ensuing cognitive impairment or dementia.

Keywords: Alzheimer’s disease, formaldehyde, Mini-Mental State Examination, norepinephrine, post-stroke dementia, semicarbazide-sensitive amine oxidase

DOI: 10.3233/JAD-160357

Journal: Journal of Alzheimer's Disease, vol. 55, no. 3, pp. 1031-1038, 2017