Journal of Alzheimer's Disease - Volume 68, issue 2

Authors: Mandal, Pravat K. | Shukla, Deepika | Tripathi, Manjari | Ersland, Lars

Article Type: Editorial

Abstract: Alzheimer’s disease (AD) is a devastating neurodegenerative disorder affecting millions of people worldwide. The actual cause of AD is still unknown. Oxidative stress is believed to be important player in AD pathology. Glutathione (GSH) is a major antioxidant, and it is already known that GSH is depleted significantly in the hippocampal regions in mild cognitive impairment (MCI) and AD patients compared to healthy old subjects. Hence there is a serious discussion to improve the brain GSH level by supplementation. This editorial highlights the need for GSH supplementation for the cognitive enhancement in MCI and AD.

DOI: 10.3233/JAD-181054

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 531-535, 2019

Authors: Devanarayan, Priya | Devanarayan, Viswanath | Llano, Daniel A. | and for the Alzheimer’s Disease Neuroimaging Initiative

Article Type: Research Article

Abstract: The 2018 NIA-AA research framework proposes a classification system with Amyloid-β deposition, pathologic Tau, and Neurodegeneration (ATN) for diagnosis and staging of Alzheimer’s disease (AD). Data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database can be utilized to identify diagnostic signatures for predicting AD progression, and to determine the utility of this NIA-AA research framework. Profiles of 320 peptides from baseline cerebrospinal fluid (CSF) samples of 287 normal, mild cognitive impairment (MCI), and AD subjects followed over a 3–10-year period were measured via multiple reaction monitoring mass spectrometry. CSF Aβ42 , total-Tau (tTau), phosphorylated-Tau (pTau-181), and hippocampal volume were also …measured. From these candidate markers, optimal signatures with decision thresholds to separate AD and normal subjects were first identified via unbiased regression and tree-based algorithms. The best performing signature determined via cross-validation was then tested in an independent group of MCI subjects to predict future progression. This multivariate analysis yielded a simple diagnostic signature comprising CSF pTau-181 to Aβ42 ratio, MRI hippocampal volume, and low CSF levels of a novel PTPRN peptide, with a decision threshold on each marker. When applied to a separate MCI group at baseline, subjects meeting these signature criteria experience 4.3-fold faster progression to AD compared to a 2.2-fold faster progression using only conventional markers. This novel 4-marker signature represents an advance over the current diagnostics based on widely used markers, and is easier to use in practice than recently published complex signatures. This signature also reinforces the ATN construct from the 2018 NIA-AA research framework. Show more

Keywords: Biomarker, mild cognitive impairment, PTPRN, receptor-type tyrosine-phosphatase-like N

DOI: 10.3233/JAD-180905

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 537-550, 2019

Authors: Liu, Jia | Wang, Qianqian | Jing, Donglai | Gao, Ran | Zhang, Jing | Cui, Chunlei | Qiao, Hongwen | Liang, Zhigang | Wang, Chaodong | Rosa-Neto, Pedro | Wu, Liyong | Jia, Jianping | Gauthier, Serge

Article Type: Research Article

Abstract: For early-onset Alzheimer’s disease (EOAD) cases with unclear family history, most cases are sporadic. Some cases are positive in genetic findings, that is, either incomplete penetrance or de novo mutation. We aimed to focus on EOAD cases with de novo mutations. Case reports and literature review were performed. The implication for diagnostic approach of early-onset dementia with negative family history was developed. We reported two Chinese EOAD cases with de novo mutations. The genotype PSEN1 G206S appeared to correlate with the phenotype of EOAD with pure cognitive problems. The second case had a PSEN1 M233V mutation with …an earlier age of onset of 25 with cognitive decline, parkinsonism, and epilepsy. Although EOAD due to de novo mutations is not common, it should be considered in patients with a phenotype of progressive cognitive decline and amyloid positivity on PET or CSF analysis. Show more

Keywords: De novo PSEN1 mutation, diagnostic approach, early-onset Alzheimer’s disease, early-onset dementia with negative family history

DOI: 10.3233/JAD-181108

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 551-558, 2019

Authors: Marjańska, Małgorzata | McCarten, J. Riley | Hodges, James S. | Hemmy, Laura S. | Terpstra, Melissa

Article Type: Research Article

Abstract: This study’s objective was to increase understanding of biological mechanisms underlying clinical Alzheimer’s disease (AD) by noninvasively measuring an expanded neurochemical profile and exploring how well this advanced technology distinguishes AD from cognitively normal controls. We measured concentrations of 14 neurochemicals using ultra-high field (7 T) ultra-short echo time (8 ms) magnetic resonance spectroscopy (MRS) in 16 participants with mild to moderate clinical AD and 33 age- and gender-matched control participants. MRS was localized to the posterior cingulate cortex (PCC), a region known to be impacted by AD, and the occipital cortex (OCC), a control region. Participants with AD were recruited …from dementia specialty clinics. Concentration of the antioxidant ascorbate was higher (p  < 0.0007) in both brain regions. Concentrations of the glial marker myo -inositol and the choline-containing compounds involved in membrane turnover were higher (p ≤0.0004) in PCC of participants with AD. Ascorbate and myo -inositol concentrations were strongly associated, especially in the PCC. Random forests, using the 14 neurochemicals in the two regions, distinguished participants with AD from controls: same-sample sensitivity and specificity were 88% and 97%, respectively, though out-of-sample-values would be lower. Ultra-high field ultra-short echo time MRS identified the co-occurrence of elevated ascorbate and myo -inositol in the PCC as markers that distinguish participants with mild to moderate AD from controls. While elevated myo -inositol may be a surrogate marker of neuroinflammation, the unexpected elevation of the antioxidant ascorbate may reflect infiltration of ascorbate-rich leukocytes. Show more

Keywords: Ascorbate, myo-inositol, neurochemical profile, neuroinflammation, posterior cingulate cortex, ultra-high field, ultra-short echo time

DOI: 10.3233/JAD-180861

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 559-569, 2019

Authors: Tiiman, Ann | Jelić, Vesna | Jarvet, Jüri | Järemo, Petter | Bogdanović, Nenad | Rigler, Rudolf | Terenius, Lars | Gräslund, Astrid | Vukojević, Vladana

Article Type: Research Article

Abstract: Background: Biomarkers are central to current research on molecular mechanisms underlying Alzheimer’s disease (AD). Their further development is of paramount importance for understanding pathophysiological processes that eventually lead to disease onset. Biomarkers are also crucial for early disease detection, before clinical manifestation, and for development of new disease modifying therapies. Objective: The overall aim of this work is to develop a minimally invasive method for fast, ultra-sensitive and cost-effective detection of structurally modified peptide/protein self-assemblies in the peripheral blood and in other biological fluids. Specifically, we focus here on using this method to detect structured amyloidogenic oligomeric aggregates …in the blood serum of apparently healthy individuals and patients in early AD stage, and measure their concentration and size. Methods: Time-resolved detection of Thioflavin T (ThT) fluorescence intensity fluctuations in a sub-femtoliter observation volume element was used to identify in blood serum ThT-active structured amyloidogenic oligomeric aggregates, hereafter called nanoplaques, and measure with single-particle sensitivity their concentration and size. Results: The concentration and size of structured amyloidogenic nanoplaques are significantly higher in the blood serum of individuals diagnosed with AD than in control subjects. Conclusion: A new method with the ultimate, single-particle sensitivity was successfully developed. The proposed approach neither relies on the use of immune-based probes, nor on the use of radiotracers, signal-amplification or protein separation techniques, and provides a minimally invasive test for fast and cost-effective early determination of structurally modified peptides/proteins in the peripheral blood, as shown here, but also in other biological fluids. Show more

Keywords: Alzheimer’s disease, amyloidogenic aggregates, β-pleated sheet, blood serum, early diagnosis, florescence intensity fluctuation analysis, fluorescence correlation spectroscopy, single-molecule sensitivity, Thioflavin T

DOI: 10.3233/JAD-181144

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 571-582, 2019

Authors: Marksteiner, Josef | Oberacher, Herbert | Humpel, Christian

Article Type: Research Article

Abstract: Diagnosis of Alzheimer’s disease (AD) is still a challenge. Salivary analysis could produce an easily accessible and inexpensive possibility to study metabolic changes in AD. In the present pilot study, we show for the first time using targeted metabolomics that acyl-alkyl phosphatidylcholines (PCae C34:1-2; PCae C36:1-2-3; PCaeC38:1c3; PCae C40:2-3) are significantly reduced in saliva of AD patients (n  = 25) compared to healthy controls (n  = 25). Saliva levels of PCae C36Λ 1-2-3) were also decreased in patients with mild cognitive impairment (n  = 25). No changes were seen for saliva diacyl-phosphatidylcholines, lyso-acyl-phosphatidylcholines, and sphinogomyelins. These data suggest specific lipid changes in the …saliva of AD patients, thus salivary measures could establish new biomarkers. However, these preliminary results have to be established in larger scale studies. Show more

Keywords: Alzheimer’s disease, biomarkers, diagnosis, metabolomics, phosphatidylcholines, saliva

DOI: 10.3233/JAD-181278

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 583-589, 2019

Authors: Brett, Benjamin L. | Wilmoth, Kristin | Cummings, Peter | Solomon, Gary S. | McCrea, Michael A. | Zuckerman, Scott L.

Article Type: Research Article

Abstract: This work critically reviews chronic traumatic encephalopathy (CTE), with a specific focus on the single criterion necessary and sufficient for diagnosis. Herein, CTE is compared to other well-established neurodegenerative entities including Alzheimer’s disease and dementia with Lewy bodies. Each neurodegenerative disorder is reviewed in five pertinent areas: 1) historical perspective, 2) guideline formation process, 3) clinical diagnostic criteria, 4) pathological diagnostic criteria, and 5) validation of previously described diagnostic criteria (e.g., sensitivity and specificity). These comparisons indicate that CTE is a disease in the earliest stages of formation and has yet to undergo rigorous development and refinement similar to other …neurodegenerative diseases. Suggested future revisions to the diagnostic criterion of CTE include establishing a lower threshold for accumulation of pathology, as well as accounting for the presence of concomitant neuropathology and comorbid neurodegenerative disorders. Currently, while initial efforts have been attempted, agreed upon antemortem clinical criteria do not exist. As has been the scientific standard with similar neurodegenerative disorders, antemortem diagnostic guidelines should first be refined through subcommittees of neuroscientists from diverse institutional backgrounds with a subclassification of levels of diagnostic certainty (possible, probably, and definite). Validation studies should then assess the predictive value and accuracy of proposed antemortem diagnostic criteria in relation to potential pathological criteria. Show more

Keywords: Chronic traumatic encephalopathy, concussion, football, neurodegenerative diseases, sports, traumatic brain injury

DOI: 10.3233/JAD-181058

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 591-608, 2019

Authors: Ameen-Ali, Kamar E. | Simpson, Julie E. | Wharton, Stephen B. | Heath, Paul R. | Sharp, Paul S. | Brezzo, Gaia | Berwick, Jason

Article Type: Research Article

Abstract: The role of cellular changes in the neurovascular unit is increasingly being investigated to understand the pathogenesis of Alzheimer’s disease (AD). The aim of the current study was to determine the time course of recognition memory impairment in the J20 mouse model of AD, in relation to neuroinflammatory responses and the pathology of amyloid-β (Aβ). Male hAPP-J20 and wild-type mice were assessed at 3, 6, 9, and 12 months of age. The spontaneous object recognition (SOR) task provided a measure of memory, with assessment of both a short delay (1 min) and a long delay (4 h). Immunohistochemistry was used to characterize …Aβ deposition, and quantify astrocyte and microglial responses. At all ages tested, J20 mice had impaired long-term, but preserved short-term, recognition memory. Wild-types demonstrated preserved long-term memory up to 9 months of age, and preserved short-term memory at all ages tested. Plaque pathology in the J20 mice was present from 6 months onwards, with co-localization of reactive microglia and activated astrocytes. Reactive microglia and astrocyte activation in the hippocampus were significantly greater in the J20 mice at 9 months, compared to wild-types. This study contributes to our understanding of the pathological and cognitive mechanisms at play in AD. J20 mice showed impairment in retaining information over longer periods from an early age, preceding the deposition of Aβ and glial activation. Defining early physiological changes in relation to cognitive decline could provide insight into new therapeutic targets early in the disease process, when intervention is most likely to effectively slow disease progression. Show more

Keywords: Alzheimer’s disease, amyloid, astrocytes, hAPP-J20, microglia, recognition memory

DOI: 10.3233/JAD-181238

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 609-624, 2019

Authors: Abner, Erin L. | Nelson, Peter T. | Jicha, Gregory A. | Cooper, Gregory E. | Fardo, David W. | Schmitt, Frederick A. | Kryscio, Richard J.

Article Type: Research Article

Abstract: Tobacco smoking was examined as a risk for dementia and neuropathological burden in 531 initially cognitively normal older adults followed longitudinally at the University of Kentucky’s Alzheimer’s Disease Center. The cohort was followed for an average of 11.5 years; 111 (20.9%) participants were diagnosed with dementia, while 242 (45.6%) died without dementia. At baseline, 49 (9.2%) participants reported current smoking (median pack-years = 47.3) and 231 (43.5%) former smoking (median pack-years = 24.5). The hazard ratio (HR) for dementia for former smokers versus never smokers based on the Cox model was 1.64 (95% CI: 1.09, 2.46), while the HR for current smokers versus never …smokers was 1.20 (0.50, 2.87). However, the Fine-Gray model, which accounts for the competing risk of death without dementia, yielded a subdistribution hazard ratio (sHR) = 1.21 (0.81, 1.80) for former and 0.70 (0.30, 1.64) for current smokers. In contrast, current smoking increased incidence of death without dementia (sHR = 2.38; 1.52, 3.72). All analyses were adjusted for baseline age, education, sex, diabetes, head injury, hypertension, overweight, APOE ɛ 4, family history of dementia, and use of hormone replacement therapy. Once adjusted for the competing risk of death without dementia, smoking was not associated with incident dementia. This finding was supported by neuropathology on 302 of the participants. Show more

Keywords: Competing risks, dementia, dementia free death, lifetime smoking

DOI: 10.3233/JAD-181119

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 625-633, 2019

Authors: Kaczynski, Anika | Michalowsky, Bernhard | Eichler, Tilly | Thyrian, Jochen René | Wucherer, Diana | Zwingmann, Ina | Hoffmann, Wolfgang

Article Type: Research Article

Abstract: Background: People with dementia (PwD) suffer from coexisting medical conditions, creating complex clinical challenges and increasing the risk of poor outcomes, which could be associated with high healthcare cost. Objective: To describe the prevalence of comorbidity in PwD and to analyze the association between comorbidity in dementia diseases and healthcare costs from a payer’s perspective. Methods: This cross-sectional analysis was based on n  = 362 PwD of the DelpHi-MV trial (Dementia: Life-and person-centered help in Mecklenburg-Western Pomerania). Comorbidity was assessed using the Charlson comorbidity index (CCI) and was categorized into low, high, and very high comorbidity. Healthcare …resource utilization and unit costs were used to calculate costs. Multivariable regression models were applied to analyze the association between comorbidity and costs. Results: Comorbidity was highly prevalent in the sample. 47% of PwD had a very high, 37% a high, and 16% a low comorbidity in addition to dementia. The most prevalent co-existing comorbidity were diabetes mellitus (42%), peripheral vascular disease (28%) and cerebrovascular disease (25%). Total costs significantly increased by 528€ (SE  = 214, CI95  = 109–947, p  = 0.014) with each further comorbidity, especially due to higher cost for medication and medical aids. Compared with a low comorbidity, a very high comorbidity was significantly associated with 818€ (SE  = 168, CI95  = 489–1147, p  < 0.001) higher medication costs and 336€ (SE  = 161, CI95  = 20–652, p  = 0.037) higher cost for medical aids. There were no significant association between a higher comorbidity and cost for formal care services. Conclusions: Comorbidity in PwD represents a substantial financial burden on healthcare payers and is a challenge for patients, healthcare providers, and the health systems. Innovative approaches are needed to achieve a patient-oriented management of treatment and care in comorbid PwD to reduce long-term costs. Show more

Keywords: Alzheimer’s disease, comorbidity, dementia, economics, health care costs, health care resources

DOI: 10.3233/JAD-180896

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 635-646, 2019

Authors: Lee, Cecilia S. | Larson, Eric B. | Gibbons, Laura E. | Latimer, Caitlin S. | Rose, Shannon E. | Hellstern, Leanne L. | Keene, C. Dirk | Crane, Paul K. | for the Adult Changes in Thought (ACT) Study

Article Type: Research Article

Abstract: Background: The aging eye offers unique opportunities to study and understand the aging brain, in particular related to Alzheimer’s disease (AD) and dementia. However, little is known about relationships between eye diseases and dementia-related neurodegeneration. Objective: To determine the potential association between three age-related eye diseases and AD and dementia-related neuropathology. Methods: We reviewed autopsy data from the prospective longitudinal Adult Changes in Thought (ACT) cohort. ICD-9 codes were used to identify diagnoses of diabetic retinopathy, glaucoma, and age-related macular degeneration. Multivariate regression models were used to determine odds ratios (OR) of neuropathology features associated with …dementia, including Braak stage, Consortium to Establish a Registry for AD (CERAD score), Lewy bodies, hippocampal sclerosis, and microvascular brain injury, in addition to quantitative paired helical filament (PHF)-tau levels for people with and without each eye condition. We also evaluated interactions between eye conditions and dementia related neuropathologic findings were evaluated. Results: 676 autopsies were included. Diabetic retinopathy was significantly associated with increased risk of deep cerebral microinfarcts (OR = 1.91 [95% confidence interval (CI) 1.11, 3.27], p  = 0.02). No other significant association or interaction between eye diseases and neuropathology was found. When PHF-tau quantity was evaluated in 124 decedents, the OR for the association between PHF-tau in the occipital cortex and glaucoma was 1.36 (95% CI 0.91, 2.03, p  = 0.13). No statistical correction was made for multiple comparisons. Conclusion: Increased risk of deep cerebral microinfarcts was found in participants diagnosed with diabetic retinopathy. Eye diseases such as glaucoma may increase susceptibility to neurofibrillary tangles in the occipital cortex. Show more

Keywords: Alzheimer’s disease, diabetic retinopathy, glaucoma, macular degeneration, neuropathology

DOI: 10.3233/JAD-181087

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 647-655, 2019

Authors: de la Monte, Suzanne M. | Tong, Ming | Daiello, Lori A. | Ott, Brian R.

Article Type: Research Article

Abstract: Background: Brain insulin resistance is a well-recognized abnormality in Alzheimer’s disease (AD) and the likely mediator of impaired glucose utilization that emerges early and progresses with disease severity. Moreover, the rates of mild cognitive impairment (MCI) or AD are significantly greater in people with diabetes mellitus or obesity. Objective: This study was designed to determine whether systemic and central nervous system (CNS) insulin resistant disease states emerge together and thus may be integrally related. Methods: Insulin-related molecules were measured in paired human serum and cerebrospinal fluid (CSF) samples from 19 with MCI or early AD, and …21 controls using a multiplex ELISA platform. Results: In MCI/AD, both the CSF and serum samples had significantly elevated mean levels of C-peptide and an incretin, and reduced expression of Visfatin, whereas only CSF showed significant reductions in insulin and leptin and only serum had increased glucagon, PAI-1, and ghrelin. Although the overall CSF and serum responses reflected insulin resistance together with insulin deficiency, the specific alterations measured in CSF and serum were different. Conclusion: In MCI and early-stage AD, CNS and systemic insulin-related metabolic dysfunctions, including insulin resistance, occur simultaneously, suggesting that they are integrally related and possibly mediated similar pathogenic factors. Show more

Keywords: Alzheimer’s disease, cerebrospinal fluid, insulin resistance, mild cognitive impairment, neurodegeneration, serum

DOI: 10.3233/JAD-180906

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 657-668, 2019

Authors: Nunes, Paula Villela | Schwarzer, Monise Caroline | Leite, Renata Elaine Paraizo | Ferretti-Rebustini, Renata Eloah de Lucena | Pasqualucci, Carlos Augusto | Nitrini, Ricardo | Rodriguez, Roberta Diehl | Nascimento, Camila Fernandes | Oliveira, Katia Cristina de | Grinberg, Lea Tenenholz | Jacob-Filho, Wilson | Lafer, Beny | Suemoto, Claudia Kimie

Article Type: Research Article

Abstract: Background: Behavioral and psychological symptoms (BPSD) can be a prodrome of dementia, and the Neuropsychiatric Inventory (NPI) is widely used for BPSD evaluation. Objective: To compare the prevalence of BPSD according to cognitive status, and to determine NPI cutoffs that best discern individuals with mild cognitive impairment (MCI) and dementia from those without dementia. Methods: We included 1,565 participants (mean age = 72.7±12.2 years, 48% male). BPSD and cognitive status were assessed with the NPI and the Clinical Dementia Rating (CDR). We used multivariable logistic regression models to investigate the association of BPSD with cognitive status. The area …under the curve (AUC) was used to assess model discrimination, and to determine the best NPI cutoff for MCI and dementia. Results: Participants were cognitively normal (CDR = 0; n  = 1,062), MCI (CDR = 0.5; n  = 145), or dementia (CDR≥1.0, n  = 358). NPI symptoms were more frequent in dementia and MCI when compared to cognitively normal. Higher odds for delusions, hallucinations, disinhibition, and psychomotor alterations were found among participants with dementia and MCI than in those who were cognitively normal. The best NPI cutoff to discern participants with dementia from those cognitively normal was 11 (AUC = 0.755). Poor discrimination (AUC = 0.563) was found for the comparison of MCI and those cognitively normal. Conclusions: We found an increase in BPSD frequencies across the continuum of cognitive impairment. BPSD severity and frequency in MCI was more similar to individuals cognitively normal than with dementia. NPI scores≥to 11 in individuals with no diagnosis of dementia can support the decision for further investigation of dementia. Show more

Keywords: Behavioral and psychological symptoms, dementia, mild cognitive impairment, Neuropsychiatric Inventory

DOI: 10.3233/JAD-180641

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 669-678, 2019

Authors: Boccia, Maddalena | Di Vita, Antonella | Diana, Sofia | Margiotta, Roberta | Imbriano, Letizia | Rendace, Lidia | Campanelli, Alessandra | D’Antonio, Fabrizia | Trebbastoni, Alessandro | de Lena, Carlo | Piccardi, Laura | Guariglia, Cecilia

Article Type: Research Article

Abstract: Spatial navigation tasks reveal small differences between normal and pathological aging and may thus disclose potential neuropsychological predictors of neurodegenerative diseases. The aim of our study was to investigate which navigational skills are compromised in the early phase of pathological aging as well as the extent to which they are compromised. We performed an extensive neuropsychological evaluation based on working memory and learning tasks (i.e., Corsi Block-Tapping Test and Walking Corsi Test) involving both reaching and navigational vista spaces. We also assessed spatial navigation skills in the real world by asking participants to perform route-learning and landmark-recognition tasks. We conducted …a cross-sectional study on nineteen patients with a diagnosis of mild cognitive impairment (MCI) who displayed either an isolated memory deficit (single-domain amnestic MCI, MCIsd; N = 3) or a memory deficit associated with deficits in other cognitive functions (multi-domain MCI, MCImd; N = 16) as well as on nineteen healthy control participants. The groups’ performances were compared by means of mixed factorial ANOVA and two-sample t -tests. We found that patients with MCI performed worse than controls, especially when they were required to learn spatial positions within the navigational vista space. Route-learning within the real environment was also impaired whereas landmark-recognition was spared. The same pattern of results emerged in the MCImd subgroup. Moreover, single case analyses on MCIsd patients revealed a dissociation between learning of spatial positions within navigational vista space and within reaching space. These results suggest that topographical learning is compromised in the early phase of MCIsd and MCImd and that spatial navigation tasks may be used to better characterize topographical disorientation in MCI patients as well as for the early diagnosis of pathological aging. Show more

Keywords: Alzheimer’s disease, environmental navigation, mild cognitive impairment, topographical memory

DOI: 10.3233/JAD-180890

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 679-693, 2019

Authors: Strunz, Maximilian | Jarrell, Juliet T. | Cohen, David S. | Rosin, Eric R. | Vanderburg, Charles R. | Huang, Xudong

Article Type: Research Article

Abstract: Alzheimer’s disease (AD) is an age-related progressive form of dementia that features neuronal loss, intracellular tau, and extracellular amyloid-β (Aβ) protein deposition. Neurodegeneration is accompanied by neuroinflammation mainly involving microglia, the resident innate immune cell population of the brain. During AD progression, microglia shift their phenotype, and it has been suggested that they express matricellular proteins such as secreted protein acidic and rich in cysteine (SPARC) and Hevin protein, which facilitate the migration of other immune cells, such as blood-derived dendritic cells. We have detected both SPARC and Hevin in postmortem AD brain tissues and confirmed significant alterations in transcript …expression using real-time qPCR. We suggest that an infiltration of myeloid-derived immune cells occurs in the areas of diseased tissue. SPARC is highly expressed in AD brain and collocates to Aβ protein deposits, thus contributing actively to cerebral inflammation and subsequent tissue repair, and Hevin may be downregulated in the diseased state. However, further research is needed to reveal the exact roles of SPARC and Hevin proteins and associated signaling pathways in AD-related neuroinflammation. Nevertheless, normalizing SPARC/Hevin protein expression such as interdicting heightened SPARC protein expression may confer a novel therapeutic opportunity for modulating AD progression. Show more

Keywords: Alzheimer’s disease, amyloid-β , dendritic cells, Hevin/SPARCL1 protein, macrophages, microglia, SPARC protein

DOI: 10.3233/JAD-181032

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 695-710, 2019

Authors: Ngabirano, Laure | Samieri, Cecilia | Feart, Catherine | Gabelle, Audrey | Artero, Sylvaine | Duflos, Claire | Berr, Claudine | Mura, Thibault

Article Type: Research Article

Abstract: Background: The links between diet and the risk of dementia have never been studied considering the possibility of protopathic bias (i.e., reverse causation). Objective: We aimed to examine the relationship between consumption frequency of meat, fish, fruits, and vegetables and long-term risk of dementia and Alzheimer’s disease (AD), by taking into account this possibility. Methods: We analyzed data of 5,934 volunteers aged 65 and over from the Three-city study who were followed every 2 to 4 years for 12 years. Dietary habits were assessed at inclusion using a brief food frequency questionnaire. The presence of symptoms …of dementia was investigated at each follow-up visit. To limit the risk of protopathic bias, a 4-year lag window between exposure and disease assessment was implemented by excluding from the analyses all dementia cases that occurred during the first four years after inclusion. Analyses were performed using a Cox proportional hazard model and were adjusted for socio-demographic, lifestyle, and health factors. Results: The average follow-up time was 9.8 years. During this period, 662 cases of dementia, including 466 of AD, were identified. After adjustment, only low meat consumption (≤1 time/week) was associated with an increased risk of dementia and AD compared with regular consumption (≥4 times/week) (HR = 1.58 95% CI = [1.17–2.14], HR = 1.67 95% CI = [1.18–2.37], respectively). No association was found between the consumption of fish, raw fruits, or cooked fruits and vegetables and the risk of dementia or AD. Conclusion: These findings suggest very low meat consumption increases the long-term risk of dementia and AD, and that a protopathic bias could have impacted finding from previous studies. Show more

Keywords: Cohort, dementia, fish, meat, protopathic bias, reverse causation

DOI: 10.3233/JAD-180919

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 711-722, 2019

Authors: Abu-Rumeileh, Samir | Giannini, Giulia | Polischi, Barbara | Albini-Riccioli, Luca | Milletti, David | Oppi, Federico | Stanzani-Maserati, Michelangelo | Capellari, Sabina | Mantovani, Paolo | Palandri, Giorgio | Cortelli, Pietro | Cevoli, Sabina | Parchi, Piero

Article Type: Research Article

Abstract: Cerebrospinal fluid (CSF) biomarkers have been extensively investigated in idiopathic normal pressure hydrocephalus (iNPH) with the aim of a better differential diagnosis, but the pathophysiological mechanisms underlying CSF biomarker changes and the relationship between biomarker levels and clinical variables are still a matter of debate. We evaluated CSF amyloid-β (Aβ)42 and Aβ40 , total (t)-tau, phosphorylated (p)-tau, total prion protein (t-PrP), and neurofilament light chain protein (NfL) in healthy controls (n  = 50) and subjects with iNPH (n  = 71), Alzheimer’s disease (AD) (n  = 60), and several other subtypes of dementia (n  = 145). Patients with iNPH showed significantly lower levels of …Aβ42 , Aβ40 , t-tau, and p-tau compared to controls. Similarly, t-PrP values showed a trend toward lower levels in iNPH patients than in controls. At variance, NfL levels were increased in iNPH as in all other neurodegenerative dementias, with no significant difference between “pure” iNPH cases and those with vascular or AD comorbidities. The Aβ42 /Aβ40 ratio showed higher diagnostic value than Aβ42 alone in the differential diagnosis between iNPH and AD. There were no clinically relevant associations between neuroimaging markers, scores at clinical and cognitive scales/tests, or rates of response at tap test and CSF biomarker results. In summary, the CSF biomarker signature in patients with iNPH is mainly characterized by reduced CSF concentrations of Aβ- and tau-related proteins. The assessment of CSF neurodegenerative biomarker profile in iNPH, including the Aβ42 /Aβ40 ratio, contributes to the differential diagnosis with AD and other dementias but shows poor associations with clinical variables. Show more

Keywords: Aβ42/Aβ40 ratio, Alzheimer’s disease, amyloid, dementia with Lewy bodies, frontotemporal dementia, neurofilament light chain protein, prion protein, tau, vascular dementia

DOI: 10.3233/JAD-181012

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 723-733, 2019

Authors: Nakajima, Madoka | Kuriyama, Nagato | Miyajima, Masakazu | Ogino, Ikuko | Akiba, Chihiro | Kawamura, Kaito | Kurosawa, Michiko | Watanabe, Yoshiyuki | Fukushima, Wakaba | Mori, Etsuro | Kato, Takeo | Sugano, Hidenori | Tange, Yuichi | Karagiozov, Kostadin | Arai, Hajime

Article Type: Research Article

Abstract: Background: Patients with idiopathic normal-pressure hydrocephalus (iNPH) are typically older adults with multiple comorbidities that are associated with a reduction in the efficacy of iNPH treatment via cerebrospinal fluid (CSF) shunt placement. Objective: The present study aimed to investigate the effectiveness of CSF shunt for iNPH using data from a nationwide epidemiological survey in Japan. Methods: We examined 1,423 patients (581 women) aged ≥60 years (median age [25%–75%]: 77 [73–80] years) who were diagnosed with iNPH following a hospital visit in 2012. Patients who experienced an improvement of at least one modified Rankin Scale (mRS) grade …after the CSF shunt were classified as “improvement” while the remaining patients were classified as “non-improvement.” The efficacy of the shunt intervention (n  = 842) was analyzed using a binomial logistic regression analysis. Results: An analysis of risk factors associated with shunt placement in patients with mRS grade 2 revealed an association between comorbid chronic ischemic lesions (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11–4.67; p  = 0.025) and cervical spondylosis (OR, 3.62; 95% CI, 1.15–11.34; p  = 0.027). Patients with mRS grade 3 at study entry had an association with comorbid Alzheimer’s disease (OR, 3.02; 95% CI, 1.44–6.31; p  = 0.003). Conclusions: The results presented here showed that any age-related risk is minimal and should not be cause for rejection of surgical treatment options. Clinical decisions regarding CSF shunt should be individualized to each patient, with adequate consideration of the relative risks and benefits, including maximizing a healthy life expectancy. Show more

Keywords: Alzheimer’s disease, cerebrospinal fluid shunt, geriatric care, healthy life expectancy, normal pressure hydrocephalus

DOI: 10.3233/JAD-180955

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 735-744, 2019

Authors: Nordheim, Johanna | Häusler, Andreas | Yasar, Sevil | Suhr, Ralf | Kuhlmey, Adelheid | Rapp, Michael | Gellert, Paul

Article Type: Research Article

Abstract: Background: Psychosocial interventions may improve the quality of life of both people with dementia (PWD) and their family caregivers. However, research is inconclusive and focused primarily on the quality of life of either the PWD or the caregiver, rather than on both. Objective: Our aim was to evaluate the effect of couple-based interdisciplinary psychosocial intervention in patients with mild-to-moderate dementia on quality of life of both partners. Methods: 108 community-dwelling PWD and their caregiving partners were enrolled in this pragmatic randomized controlled trial. The intervention consisted of 7 sessions at participants’ homes led by a psychotherapist …and a social worker. Quality of life was evaluated at baseline, one, and six-month follow-up for patients and their partners. Mixed effects models have been applied. Results: Intervention allocation was not associated with an improvement in quality of life in either the patients or their partners. In subgroup analyses, intervention was negatively associated with caregiver performance. However, this was only present in those reporting poor relationship quality. Patients in the intervention group who reported good relationship quality were found to have decreased cognitive decline. Conclusion: A couple-based interdisciplinary intervention did not yield improvements in quality of life. This may be the result of a bias caused by an increased awareness due to the intervention. Relationship quality and support in the long-term should be considered when designing and implementing interventions for PWD and their partners. Show more

Keywords: Caregiving, coping with illness/disability, dementia, family, psychosocial intervention, quality of life

DOI: 10.3233/JAD-180812

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 745-755, 2019

Authors: Wang, Ya-Juan | Wan, Yu | Wang, Hui-Fu | Tan, Chen-Chen | Li, Jie-Qiong | Yu, Jin-Tai | Tan, Lan | Alzheimer’s Disease Neuroimaging Initiative

Article Type: Research Article

Abstract: Two CD33 common variants, rs3826656 and rs3865444, have been identified to be correlated with Alzheimer’s disease (AD). Our study examined the effects of the two AD-related CD33 common variants (rs3826656 and rs3865444) on the chosen AD-related brain regions (including hippocampus, amygdala, parahippocampus, middle temporal, entorhinal cortex, and total brain volume) in non-demented elders recruited from the Alzheimer’s Disease Neuroimaging Initiative database at baseline and during four-year follow-up. We further tested the effects in an Aβ-positive group (including preclinical and prodromal stage of AD) and an Aβ-negative group. In the total non-demented elderly population, no associations reached significant levels …after FDR correction. In the Aβ-positive group, we found that rs3826656 was associated with hippocampal and amygdala volumes (Hippocampus-R: pc  = 0.0022; Amygdala-L: pc  = 0.0044; Amygdala-R: pc  = 0.0066), and rs3865444 was associated with right entorhinal volume (pc  = 0.0286). The associations of rs3826656 with hippocampal and amygdala volumes in the Aβ-positive group were successfully replicated in the prodromal AD group (Hippocampus-R: pc  = 0.0022; Amygdala-L: pc  = 0.0022; Amygdala-R: pc  = 0.0088). These changes became more obvious over time during four-year follow-up. No associations were found between the two CD33 variants and neuroimaging biomarkers in the Aβ-negative and preclinical AD groups after FDR correction. These results suggested that the two CD33 common variants (rs3826656 and rs3865444) influenced volumes and atrophy rates of AD-related brain regions in non-demented elders. Subgroup analyses showed the effects mainly existed in the Aβ-positive group instead of the Aβ-negative group, and the effects began in the prodromal AD stage. Show more

Keywords: Alzheimer’s disease, brain structure, CD33, neuroimaging, non-demented elders, polymorphism

DOI: 10.3233/JAD-181062

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 757-766, 2019

Authors: Hackney, Madeleine E. | McCullough, Lauren E. | Bay, Allison A. | Silverstein, Hayley A. | Hart, Ariel R. | Shin, Ryan J. | Wharton, Whitney

Article Type: Research Article

Abstract: Alzheimer’s disease (AD) is a devastating progressive neurodegenerative disease resulting in memory loss and a severe reduction in ability to perform activities of daily living. The role of caring for someone with AD frequently falls to female family members, often daughters. The burden of caregiving can increase stress and anxiety and cause health decline in the caregiver. The combination of ethnicity-related genetic factors promoting the development of dementias among African-Americans (AA) and the increased risk among women for developing AD means that AA women who are caregivers of a parent with AD are at great risk for developing dementias including …AD. The proposed study would compare the cognitive, motor, and psychosocial benefits of a well-established 12 week, 20-lesson adapted Argentine Tango intervention (N = 30) to a no-contact control group (N = 10) in middle-aged (45–65 years) AA women who are caregivers of a parent with AD in the metro Atlanta area. Show more

Keywords: African American, Alzheimer’s disease, caregiver, clinical trial, dance, inflammation

DOI: 10.3233/JAD-181130

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 767-775, 2019

Authors: Sato, Kenichiro | Mano, Tatsuo | Ihara, Ryoko | Suzuki, Kazushi | Tomita, Naoki | Arai, Hiroyuki | Ishii, Kenji | Senda, Michio | Ito, Kengo | Ikeuchi, Takeshi | Kuwano, Ryozo | Matsuda, Hiroshi | Iwatsubo, Takeshi | Toda, Tatsushi | Iwata, Atsushi | Alzheimer’s Disease Neuroimaging Initiative, and Japanese Alzheimer’s Disease Neuroimaging Initiative

Article Type: Research Article

Abstract: Background: Effect of serum calcium level to the incidence of mild cognitive impairment (MCI) conversion to early Alzheimer’s disease (AD) remains uncertain. Objective: To investigate association between baseline serum calcium and the MCI conversion in the Japanese Alzheimer’s Disease Neuroimaging Initiative (J-ADNI) study cohort. Methods: In this sub-analysis of J-ADNI study, we reviewed data from MCI participants at baseline regarding their conversion to early AD during the 3 years of observation period and assessed the associated factors including serum calcium level. In addition, we compared our results from the J-ADNI study with the corresponding results from …the North American (NA)-ADNI. Results: Of 234 eligible MCI participants from the J-ADNI cohort, 121 (51.7%) converted to AD during the first 36 months of observation. Using univariate analysis, being female, having shorter years of education, and lower serum calcium level were correlated with increased risk of MCI-to-AD conversion exclusively in J-ADNI cohort. The lower corrected serum calcium level remained as one of conversion-associated factors in the J-ADNI cohort even after adjustment for multiple confounding variables, although this was not observed in the NA-ADNI cohort. Conclusion: Our findings suggest that lower serum calcium may be associated with an increased risk of MCI conversion to AD in Japanese cohorts. The reason for this correlation remains unclear and further external validation using other Asian cohorts is needed. It would be interesting for future AD studies to obtain serum calcium levels and other related factors, such as vitamin D levels, culture-specific dietary or medication information. Show more

Keywords: Alzheimer’s disease, calcium, conversion, Japanese Alzheimer’s Disease Neuroimaging Initiative, mild cognitive impairment

DOI: 10.3233/JAD-181115

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 777-788, 2019

Authors: Damulina, Anna | Pirpamer, Lukas | Seiler, Stephan | Benke, Thomas | Dal-Bianco, Peter | Ransmayr, Gerhard | Struhal, Walter | Hofer, Edith | Langkammer, Christian | Duering, Marco | Fazekas, Franz | Schmidt, Reinhold

Article Type: Research Article

Abstract: Background/Objective: Higher white matter hyperintensity (WMH) load has been reported in Alzheimer’s disease (AD) patients in different brain regions when compared to controls. We aimed to assess possible differences of WMH spatial distribution between AD patients and age-matched controls by means of lesion probability maps. Methods: The present study included MRI scans of 130 probable AD patients with a mean age of 73.4±8.2 years from the Prospective Dementia Registry Austria Study and 130 age-matched healthy controls (HC) from the Austrian Stroke Prevention Family Study. Risk factors such as hypertension, diabetes mellitus, hypercholesterolemia, coronary artery disease, and smoking were …assessed. Manually segmented FLAIR WMH masks were non-linearly registered to a template and voxel-based probability mapping was performed. Results: There were no significant between-group differences in cardiovascular risk factors and WMH volume. AD patients showed a significantly higher likelihood of having WMH in a bilateral periventricular distribution than controls before and after correcting for age, sex, cardiovascular risk factors, and ventricular volume (p ≤0.05; threshold-free cluster enhancement corrected). There was no significant association between the periventricular WMH volume and cognitive decline of AD patients. Conclusion: In AD, WMH were preferentially found in a periventricular location but the volume of lesions was unrelated to cognitive decline in our study irrespective of lesion location. Show more

Keywords: Alzheimer’s disease, magnetic resonance imaging, periventricular white matter, white matter hyperintensities

DOI: 10.3233/JAD-180982

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 789-796, 2019

Authors: Kasahara, Hiroo | Ikeda, Masaki | Nagashima, Kazuaki | Fujita, Yukio | Makioka, Kouki | Tsukagoshi, Setsuki | Yamazaki, Tsuneo | Takai, Eriko | Sanada, Etsuko | Kobayashi, Ayumi | Kishi, Kazuhiro | Suto, Takayuki | Higuchi, Tetsuya | Tsushima, Yoshito | Ikeda, Yoshio

Article Type: Research Article

Abstract: Neuroimages of cerebral amyloid-β (Aβ) accumulation and small vessel disease (SVD) were examined in patients with various types of cognitive disorders using 11 C-labeled Pittsburgh Compound B-positron emission tomography (PiB-PET) and magnetic resonance imaging (MRI). The mean cortical standardized uptake value ratio (mcSUVR) was applied for a quantitative analysis of PiB-PET data. The severity of white matter lesions (WML) and enlarged perivascular spaces (EPVS) on MRI were assessed to evaluate complicating cerebral SVD using semiquantitative scales. In homozygous apolipoprotein E ɛ 3/ɛ 3 carriers, the incidence of more severe WML and EPVS was higher in PiB-positive than PiB-negative patients, indicating …that WML and EPVS might be associated with enhanced Aβ accumulation. An association study between PiB-PET and MRI findings revealed that higher WML grades significantly correlate with lower mcSUVRs, especially in the frontal area, indicating that more severe ischemic MRI findings are associated with milder Aβ accumulation among patients with Alzheimer’s disease. In these patients SVD may accelerate the occurrence of cognitive decline and facilitate early recognition of dementia. Show more

Keywords: Alzheimer’s disease, amyloid-β, dementia, Pittsburgh Compound B, positron emission tomography, white matter lesion

DOI: 10.3233/JAD-180939

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 797-808, 2019

Authors: Griffith, Chelsea M. | Macklin, Lauren N. | Cai, Yan | Sharp, Andrew A. | Yan, Xiao-Xin | Reagan, Lawrence P. | Strader, April D. | Rose, Gregory M. | Patrylo, Peter R.

Article Type: Research Article

Abstract: Several studies have demonstrated that mouse models of Alzheimer’s disease (AD) can exhibit impaired peripheral glucose tolerance. Further, in the APP/PS1 mouse model, this is observed prior to the appearance of AD-related neuropathology (e.g., amyloid-β plaques; Aβ) or cognitive impairment. In the current study, we examined whether impaired glucose tolerance also preceded AD-like changes in the triple transgenic model of AD (3xTg-AD). Glucose tolerance testing (GTT), insulin ELISAs, and insulin tolerance testing (ITT) were performed at ages prior to (1–3 months and 6–8 months old) and post-pathology (16–18 months old). Additionally, we examined for altered insulin signaling in the hippocampus. …Western blots were used to evaluate the two-primary insulin signaling pathways: PI3K/AKT and MAPK/ERK. Since the PI3K/AKT pathway affects several downstream targets associated with metabolism (e.g., GSK3, glucose transporters), western blots were used to examine possible alterations in the expression, translocation, or activation of these targets. We found that 3xTg-AD mice display impaired glucose tolerance as early as 1 month of age, concomitant with a decrease in plasma insulin levels well prior to the detection of plaques (∼14 months old), aggregates of hyperphosphorylated tau (∼18 months old), and cognitive decline (≥18 months old). These alterations in peripheral metabolism were seen at all time points examined. In comparison, PI3K/AKT, but not MAPK/ERK, signaling was altered in the hippocampus only in 18-20-month-old 3xTg-AD mice, a time point at which there was a reduction in GLUT3 translocation to the plasma membrane. Taken together, our results provide further evidence that disruptions in energy metabolism may represent a foundational step in the development of AD. Show more

Keywords: 3xTg-AD, AKT, Alzheimer’s disease, diabetes, glucose, GLUT, hippocampus, insulin, metabolism

DOI: 10.3233/JAD-180707

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 809-837, 2019

Article Type: Correction

DOI: 10.3233/JAD-189016

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 839-839, 2019

Article Type: Correction

DOI: 10.3233/JAD-189017

Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 841-841, 2019