Journal of Alzheimer's Disease - Volume 85, issue 3

Authors: Li, Weihua | Zhao, Zhilian | Liu, Min | Yan, Shaozhen | An, Yanhong | Qiao, Liyan | Wang, Guihong | Qi, Zhigang | Lu, Jie

Article Type: Research Article

Abstract: Background: Alzheimer’s disease (AD) is a progressive neurodegenerative disease characterized by cognitive decline and memory impairment. Amnestic mild cognitive impairment (aMCI) is the intermediate stage between normal cognitive aging and early dementia caused by AD. It can be challenging to differentiate aMCI patients from healthy controls (HC) and mild AD patients. Objective: To validate whether the combination of 18 F-fluorodeoxyglucose positron emission tomography (18 F-FDG PET) and diffusion tensor imaging (DTI) will improve classification performance compared with that based on a single modality. Methods: A total of thirty patients with AD, sixty patients …with aMCI, and fifty healthy controls were included. AD was diagnosed according to the National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable. aMCI diagnosis was based on Petersen’s criteria. The 18 F-FDG PET and DTI measures were each used separately or in combination to evaluate sensitivity, specificity, and accuracy for differentiating HC, aMCI, and AD using receiver operating characteristic analysis together with binary logistic regression. The rate of accuracy was based on the area under the curve (AUC). Results: For classifying AD from HC, we achieve an AUC of 0.96 when combining two modalities of biomarkers and 0.93 when using 18 F-FDG PET individually. For classifying aMCI from HC, we achieve an AUC of 0.79 and 0.76 using the best individual modality of biomarkers. Conclusion: Our results show that the combination of two modalities improves classification performance, compared with that using any individual modality. Show more

Keywords: Alzheimer’s disease, diffusion tensor imaging, 18F-FDG PET, mild cognitive impairment

DOI: 10.3233/JAD-215338

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1063-1075, 2022

Authors: Britz, Jesse | Ojo, Emmanuel | Dhukhwa, Asmita | Saito, Takashi | Saido, Takaomi C. | Hascup, Erin R. | Hascup, Kevin N. | Tischkau, Shelley A.

Article Type: Research Article

Abstract: Background: Circadian disruption has long been recognized as a symptom of Alzheimer’s disease (AD); however, emerging data suggests that circadian dysfunction occurs early on in disease development, potentially preceding any noticeable cognitive deficits. Objective: This study compares the onset of AD in male and female wild type (C57BL6/J), transgenic (AβPP/PS1), and knock-in (APPNL-F/NL-F ) AD mouse models from the period of plaque initiation (6 months) through 12 months. Methods: Rhythmic daily activity patterns, glucose sensitivity, cognitive function (Morris water maze, MWM), and AD pathology (plaques formation) were assessed. A comparison was made across …sexes. Results: Sex-dependent hyperactivity in AβPP/PS1 mice was observed. In comparison to C57BL/6J animals, 6-month-old male AβPP/PS1 demonstrated nighttime hyperactivity, as did 12-month-old females. Female AβPP/PS1 animals performed significantly worse on a MWM task than AβPP/PS1 males at 12 months and trended toward increased plaque pathology. APPNL-F/NL-F 12-month-old males performed significantly worse on the MWM task compared to 12-month-old females. Significantly greater plaque pathology occurred in AβPP/PS1 animals as compared to APPNL-F/NL-F animals. Female AβPP/PS1 animals performed significantly worse than APPNL-F/NL-F animals in spatial learning and memory tasks, though this was reversed in males. Conclusion: Taken together, this study provides novel insights into baseline sex differences, as well as characterizes baseline diurnal activity variations, in the AβPP/PS1 and APPNL-F/NL-F AD mouse models. Show more

Keywords: Alzheimer’s disease, amyloid-β, arginine vasopressin, circadian rhythm, cognition, glial fibrillary acidic protein, metabolism, vasoactive intestinal peptide

DOI: 10.3233/JAD-210629

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1077-1093, 2022

Authors: Smith, Lee | Shin, Jae Il | Oh, Hans | Carmichael, Christina | Jacob, Louis | Stefanac, Sinisa | Lindsay, Rosie K. | Soysal, Pinar | Veronese, Nicola | Tully, Mark A. | Butler, Laurie | Barnett, Yvonne | Koyanagi, Ai

Article Type: Research Article

Abstract: Background: The effect of weight modification on future dementia risk is currently a subject of debate and may be modified by age. Objective: The aim of the present study was to investigate the association between body mass index (BMI) status with mild cognitive impairment (MCI) (a preclinical stage of dementia) in middle-aged and older adults residing in six low- and middle-income countries using nationally representative data. Methods: Cross-sectional data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. MCI was defined using the National Institute on Aging-Alzheimer’s Association criteria. BMI …(kg/m2 ) was based on measured weight and height and categorized as: underweight (<18.5), normal (18.5–24.9), overweight (25.0–29.9), and obese (≥30.0). Multivariable logistic regression analysis and meta-analysis were conducted to assess associations. Results: Data on 32,715 individuals aged ≥50 years with preservation in functional abilities were analyzed [mean (SD) age 62.1 (15.6) years; 51.7% females]. Among those aged 50–64 years, compared to normal weight, underweight (OR = 1.44; 95% CI = 1.14–1.81), overweight (OR = 1.17; 95% CI = 1.002–1.37), and obesity (OR = 1.46; 95% CI = 1.09–1.94) were all significantly associated with higher odds for MCI. In those aged ≥65 years, underweight (OR = 0.71; 95% CI = 0.54–0.95) and overweight (OR = 0.72; 95% CI = 0.55–0.94) were associated with significantly lower odds for MCI, while obesity was not significantly associated with MCI. Conclusion: The results of the study suggest that the association between BMI and MCI is likely moderated by age. Future longitudinal studies are required to confirm or refute the present findings before recommendations for policy and practice can be made. Show more

Keywords: Aged, body mass index, cognitive dysfunction, obesity

DOI: 10.3233/JAD-215345

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1095-1105, 2022

Authors: Mayà, Gerard | Sarto, Jordi | Compta, Yaroslau | Balasa, Mircea | Ximelis, Teresa | Aldecoa, Iban | Gelpi, Ellen | Sánchez-Valle, Raquel | Molina-Porcel, Laura

Article Type: Research Article

Abstract: Background: For neuroscience research, the study of brain tissue of neurologically unimpaired subjects is crucial to interpret findings in neurodegenerative diseases. Sub-optimal neurological follow-up and the presence of neuropathological lesions in supposedly asymptomatic subjects casts doubt as to whether these subjects present an undetected underlying neurodegenerative disease or are resilient to neurodegeneration. Objective: We aimed to assess whether the control donors registered in the Neurological Tissue Bank-Hospital Clínic-IDIBAPS (NTB-HCI) are still free of cognitive symptoms at follow-up and to evaluate the feasibility and utility of a telephone-based screening. Methods: All control subjects older …than 65 years registered at the NTB-HCI database were selected for the study. After a structured telephone interview, those subjects already diagnosed with a neurological disease were excluded. Then, a cognitive screening was performed, including the telephone version of the Mini-Mental State Examination (t-MMSE) and the eight-item interview (AD-8) to the subject and to one informant (AD-8i). Results: In total, 73.8% of the registered donors collaborated in the study. Only 21.4% had at least one of the three cognitive screening tools impaired, and 2.7% had a profile highly suggestive of cognitive impairment. AD-8i correlated moderately with t-MMSE. Conclusion: Telephone-based neurologic screening in control donors is feasible and was within the normal range in most of the subjects in our cohort. Albeit, the involvement of neurologists and periodic neurological screenings are desirable in a control subjects brain donor program, AD8-i could be used to screen the control’s neurological status in the absence of accurate clinical data at the time of the death. Show more

Keywords: AD-8, brain bank, cognitive symptoms, neurological healthy controls, neurological screening, telephone-based screening, telephone MMSE

DOI: 10.3233/JAD-215444

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1107-1113, 2022

Authors: Sakr, Fatemah | Dyrba, Martin | Bräuer, Anja | Teipel, Stefan | for the Alzheimer’s Disease Neuroimaging Initiative

Article Type: Research Article

Abstract: Background: Lipidomics may provide insight into biochemical processes driving Alzheimer’s disease (AD) pathogenesis and ensuing clinical trajectories. Objective: To identify a peripheral lipidomics signature associated with AD pathology and investigate its potential to predict clinical progression. Methods: We used Bayesian elastic net regression to select plasma lipid classes associated with the CSF pTau/Aβ42 ratio as a biomarker of AD pathology in preclinical and prodromal AD cases from the ADNI cohort. Consensus clustering of the selected lipid classes was used to identify lipidomic endophenotypes and study their association with clinical progression. …Results: In the APOE4 -adjusted model, ether-glycerophospholipids, lyso-glycerophospholipids, free-fatty acids, cholesterol esters, and complex sphingolipids were found to be associated with the CSF pTau/Aβ42 ratio. We found an optimal number of five lipidomic endophenotypes in the prodromal and preclinical cases, respectively. In the prodromal cases, these clusters differed with respect to the risk of clinical progression as measured by clinical dementia rating score conversion. Conclusion: Lipid alterations can be captured at the earliest phases of AD. A lipidomic signature in blood may provide a dynamic overview of an individual’s metabolic status and may support identifying different risks of clinical progression. Show more

Keywords: Alzheimer’s disease, heterogeneity, lipidomics, risk assessment

DOI: 10.3233/JAD-201504

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1115-1127, 2022

Authors: Chang, Yu-Ling | Luo, Di-Hua | Huang, Tsung-Ren | Goh, Joshua O.S. | Yeh, Su-Ling | Fu, Li-Chen

Article Type: Research Article

Abstract: Background: Mild cognitive impairment (MCI), which is common in older adults, is a risk factor for dementia. Rapidly growing health care demand associated with global population aging has spurred the development of new digital tools for the assessment of cognitive performance in older adults. Objective: To overcome methodological drawbacks of previous studies (e.g., use of potentially imprecise screening tools that fail to include patients with MCI), this study investigated the feasibility of assessing multiple cognitive functions in older adults with and without MCI by using a social robot. Methods: This study included 33 …older adults with or without MCI and 33 healthy young adults. We examined the utility of five robotic cognitive tests focused on language, episodic memory, prospective memory, and aspects of executive function to classify age-associated cognitive changes versus MCI. Standardized neuropsychological tests were collected to validate robotic test performance. Results: The assessment was well received by all participants. Robotic tests assessing delayed episodic memory, prospective memory, and aspects of executive function were optimal for differentiating between older adults with and without MCI, whereas the global cognitive test (i.e., Mini-Mental State Examination) failed to capture such subtle cognitive differences among older adults. Furthermore, robot-administered tests demonstrated sound ability to predict the results of standardized cognitive tests, even after adjustment for demographic variables and global cognitive status. Conclusion: Overall, our results suggest the human–robot interaction approach is feasible for MCI identification. Incorporating additional cognitive test measures might improve the stability and reliability of such robot-assisted MCI diagnoses. Show more

Keywords: Cognitive assessment, dementia, health care, human–robot interaction, mild cognitive impairment, older adults

DOI: 10.3233/JAD-215015

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1129-1142, 2022

Authors: Wen, Chen | Bi, Yan-Lin | Hu, Hao | Huang, Shu-Yi | Ma, Ya-Hui | Hu, He-Ying | Tan, Lan | Yu, Jin-Tai

Article Type: Research Article

Abstract: Background: Subjective cognitive decline (SCD) might occur at the early stages of dementia. Individuals with SCD have an increased risk of subsequent objective cognitive decline and greater rates of progression to dementia. Objective: We aimed to explore the associations between SCD and cerebrospinal fluid (CSF) biomarkers of Alzheimer’s disease (AD) pathology in cognitively normal individuals. Methods: A total of 1,099 cognitively normal elders with available data on CSF biomarkers of AD pathology (Aβ42 , P-tau, and T-tau) were included in our analysis. Linear regression was used to examine the associations of SCD status …and SCD severity with CSF biomarkers. Additionally, a review was conducted to discuss the associations between SCD and CSF biomarkers of AD pathology. Results: After adjustments for covariates, SCD and SCD severity showed significant associations with CSF Aβ42 (SCD: β= –0.0003, p  = 0.0263; SCD severity: β= –0.0004, p  = 0.0046), CSF T-tau/Aβ42 ratio (SCD: β= 0.1080, p  = 0.0064; SCD severity: β= 0.1129, p  = 0.0009) and CSF P-tau/Aβ42 ratio (SCD: β= 0.0167, p  = 0.0103; SCD severity: β= 0.0193, p  = 0.0006) rather than T-tau and P-tau compared with cognitively normal individuals. In the review, a total of 28 studies were finally included after reviewing 174 articles. CSF Aβ42 was lower in SCD than cognitively normal (CN) individuals, but higher than those with objective cognitive decline. However, CSF tau pathology showed no difference between SCD and CN. Conclusion: The results indicated that pathophysiological changes in CSF Aβ pathology occurred in individuals with SCD, which provide new insights into early intervention of AD. Show more

Keywords: Alzheimer’s disease, cerebrospinal fluid biomarker, subjective cognitive decline

DOI: 10.3233/JAD-215178

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1143-1151, 2022

Authors: Lutski, Miri | Rasooli, Iris | Sternberg, Shelley | Lemberger, John | Mery, Nisim | Shohat, Tamy | Zucker, Inbar

Article Type: Research Article

Abstract: Background: Data on the rate of dementia is essential for planning and developing appropriate services at the national level. Objective: We report the prevalence and incidence of dementia, based on electronic health records available for the whole population. Methods: This national dementia dataset was established as a part of the National Program to Address Alzheimer’s and Other Types of Dementia. Data from medical health records for all persons aged 45+ in Israel, for 2016, were extracted from the databases of the four health maintenance organizations. Dementia cases were identified based on either recorded dementia diagnosis, through …International Classification of Diseases (ICD-9 and ICD-10) or dispensation of anti-dementia drugs. The date of first diagnosis was determined by the earliest recording. Results: A total of 65,951 persons with dementia, aged 45+, were identified from electronic health data. Based on both ICD codes and anti-dementia drugs, the prevalence rates of dementia among individuals aged 45+ and 65+ in 2016 were 2.5%and 6.4%, respectively, and the incidence rates were 0.49%and 1.3%, respectively. Based on ICD codes alone, the prevalence rates of dementia among individuals aged 45+ and 65+ in 2016 were 2.1%and 5.4%respectively, and the incidence rates were 0.36%and 0.96%respectively. The rates were higher among females compared to males and paradoxically lower in lower socioeconomic status compared to higher statuses. Conclusion: This data collection reflects the present access of dementia patients to medical care resources and provides the basis for service planning and future dementia policies. Show more

Keywords: Dementia, early-onset dementia, electronic health data, incidence, national dataset, prevalence

DOI: 10.3233/JAD-215048

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1153-1161, 2022

Authors: Yang, Li | Xuan, Cheng | Yu, Caiyan | Zheng, Pinpin | Yan, Jing

Article Type: Research Article

Abstract: Background: With the accelerating aging process, the number of participants with Alzheimer’s disease (AD) is rising sharply, causing a huge economic burden. Objective: This study aimed to identify blood protein and metabolic biomarkers and explore the diagnostic model for AD among elderly in southeast China. Methods: We established a cohort among population with high risk AD in Zhejiang Province in 2018. Case and control groups each consisting of 45 subjects, matched for gender and age, were randomly selected from the cohort. Based on bioinformatics research, PRM/MRM technology was used to detect candidate biomarkers. Ensemble-based feature selection …and machine learning methods was used to screen important variables as risk indicators for AD. Based on the risk biomarkers, the risk diagnostic model of AD in the elderly was constructed and evaluated. Results: Cystine and CPB2 were evaluated as biomarkers. The diagnostic model is constructed using logistic regression algorithm with the best cutoff value, sensitivity, specificity, and accuracy of 0.554, 0.895, 0.976, and 0.938, respectively, which determined by Youden’s index. The results showed that the model with protein and metabolite had a high efficiency. Conclusion: It showed that the diagnostic model constructed by Cystine and CPB2 had a good performance on sample classification. This study was of great significance for the early screening and diagnosis of AD, timely intervention, control and delay the development of dementia in southeast China. Show more

Keywords: Alzheimer’s disease, biomarker, diagnostic model, elderly

DOI: 10.3233/JAD-215119

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1163-1174, 2022

Authors: Kimmel, Hannah J. | Levine, Deborah A. | Whitney, Rachael T. | Forman, Jane | Plassman, Brenda L. | Fagerlin, Angela | Welsh-Bohmer, Kathleen Anne | Reale, Bailey K. | Galecki, Andrzej T. | Blair, Emilie | Langa, Kenneth M. | Giordani, Bruno | Kollman, Colleen | Wang, Jing | Zahuranec, Darin B.

Article Type: Research Article

Abstract: Background: Older patients (≥65 years) with mild cognitive impairment (MCI) are undertreated for cardiovascular disease (CVD). One reason for this disparity could be that patients with MCI might underestimate the chances of CVD and overestimate dementia. Objective: To compare conceptions of health risk between older patients with MCI and normal cognition (NC) and their care partners. Methods: We conducted a multi-center mixed-methods study of patient-care partner dyads completing written quantitative surveys (73% response rate; 127 dyads: 66 MCI and 61 NC) or semi-structured interviews (20 dyads: 11 MCI, and 9 NC). Surveys assessed two-year patient risks …of dementia, heart attack, stroke, and fall. Interviews assessed similar health risks and reasons for risk perceptions. Results: On surveys, a similarly low proportion of MCI and NC patients felt they were at risk of stroke (5% versus 2%; p  = 0.62) and heart attack (2% versus 0%; p  = 0.99). More MCI than NC patients perceived dementia risk (26% versus 2%; p  < 0.001). Care partners’ survey findings were similar. Interviews generally confirmed these patterns and also identified reasons for future health concerns. For both MCI and NC dyads, personal experience with cognitive decline or CVD (personal or family history) increased concerns about each disease. Additionally, perceptions of irreversibility and lack of treatment for cognitive decline increased concern about dementia. Conclusion: Less use of CVD treatments in MCI seems unlikely to be driven by differential perceptions of CVD risk. Future work to improve awareness of CVD risks in older patients and dementia risk in patients with MCI are warranted. Show more

Keywords: Dementia, family caregivers, heart disease risk factors, mild cognitive impairment, risk assessment

DOI: 10.3233/JAD-215155

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1175-1187, 2022

Authors: Tadokoro, Koh | Yamashita, Toru | Sato, Junko | Omote, Yoshio | Takemoto, Mami | Morihara, Ryuta | Nishiura, Koichiro | Tani, Tomiko | Abe, Koji

Article Type: Research Article

Abstract: Background: Makeup greatly impacts normal social lives but can also be a non-pharmacological form of therapy for dementia. Objective: To evaluate the therapeutic effect of makeup therapy. Methods: We carried out a prospective interventional study on female nursing home residents with dementia, focusing on the chronic therapeutic effect of makeup therapy. Thirty-four patients who received either only skin care (control group, n  = 16) or skin care plus makeup therapy (makeup therapy group, n  = 18) once every 2 weeks for 3 months were assessed. Results: Three months of makeup therapy significantly improved the Mini-Mental State …Examination (MMSE) score compared with control patients (* p  < 0.05). Artificial intelligence (AI) software revealed that the appearance of age decreased significantly in the makeup group compared with the control, especially among patients without depression (* p  < 0.05). Furthermore, a larger AI happiness score was significantly correlated with a greater improvement of ADL in the makeup therapy group (r  = 0.43, * p  < 0.05). Conclusion: Makeup therapy had a chronic beneficial effect on the cognitive function of female dementia patients, while the chronic effect of makeup therapy on facial appearance was successfully detected by the present AI software. Show more

Keywords: Artificial intelligence, dementia, facial appearance, makeup therapy

DOI: 10.3233/JAD-215385

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1189-1194, 2022

Authors: Fan, Fangcheng | Liu, Hua | Shi, Xiaojie | Ai, Yangwen | Liu, Qingshan | Cheng, Yong

Article Type: Research Article

Abstract: Background: Evidence summaries for efficacy and safety of frequently employed treatments of Alzheimer’s disease (AD) are sparse. Objective: We aimed to perform an updated umbrella review to identify an efficacious and safe treatment for AD patients. Methods: We conducted a search for meta-analyses and systematic reviews on the Embase, PubMed, The Cochrane Library, and Web of Science to address this knowledge gap. We examined the cognitive functions, behavioral symptoms, global clinical assessment, and Activities of Daily Living as efficacy endpoints, and the incidence of adverse events as safety profiles. Results: …Sixteen eligible papers including 149 studies were included in the umbrella review. The results showed that AChE inhibitors (donepezil, galantamine, rivastigmine, Huperzine A), Ginkgo biloba, and cerebrolysin appear to be beneficial for cognitive, global performances, and activities of daily living in patients with AD. Furthermore, anti-Aβ agents are unlikely to have an important effect on slowing cognitive or functional impairment in mild to moderate AD. Conclusion: Our study demonstrated that AChE inhibitors, Ginkgo biloba, and cerebrolysin are the optimum cognitive and activities of daily living medication for patients with AD. Show more

Keywords: Acetylcholinesterase inhibitors, Alzheimer’s disease, anti-Aβ agents, systematic review, umbrella review

DOI: 10.3233/JAD-215423

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1195-1204, 2022

Authors: Smith, C. Aaron | Smith, Haddon | Roberts, Lisa | Coward, Lori | Gorman, Gregory | Verma, Amrisha | Li, Qiuhong | Buford, Thomas W. | Carter, Christy S. | Jumbo-Lucioni, Patricia

Article Type: Research Article

Abstract: Background: While extensive research on the brain has failed to identify effective therapies, using probiotics to target the gut microbiome has shown therapeutic potential in Alzheimer’s disease (AD). Genetically modified probiotics (GMP) are a promising strategy to deliver key therapeutic peptides with high efficacy and tissue specificity. Angiotensin (Ang)-(1-7) levels inversely correlate to AD severity, but its administration is challenging. Our group has successfully established a GMP-based method of Ang-(1-7) delivery. Objective: Since Drosophila represents an excellent model to study the effect of probiotics on complex disorders in a high throughput manner, we tested whether oral …supplementation with Lactobacillus paracasei releasing Ang-(1-7) (LP-A) delays memory loss in a Drosophila AD model. Methods: Flies overexpressing the human amyloid-β protein precursor and its β-site cleaving enzyme in neurons were randomized to receive four 24-h doses of Lactobacillus paracasei alone (LP), LP-A or sucrose over 14 days. Memory was assessed via an aversive phototaxic suppression assay. Results: Optimal dilution,1:2, was determined based on palatability. LP-A improved memory in trained AD males but worsened cognition in AD females. LP-supplementation experiments confirmed that Ang-(1-7) conferred additional cognitive benefits in males and was responsible for the deleterious cognitive effects in females. Sex-specific differences in the levels of angiotensin peptides and differential activation of the kynurenine pathway of tryptophan metabolism in response to supplementation may underlie this male-only therapeutic response. Conclusion: In summary, LP-A ameliorated the memory deficits of a Drosophila AD model, but effects were sex-specific. Dosage optimization may be required to address this differential response. Show more

Keywords: Alzheimer’s disease, angiotensin (1-7), probiotic, Lactobacillus, tryptophan

DOI: 10.3233/JAD-210464

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1205-1217, 2022

Authors: Haverkamp, Rinske A. | Melis, René J.F. | Claassen, Jurgen A.H.R. | de Heus, Rianne A.A.

Article Type: Research Article

Abstract: Background: High day-to-day blood pressure variability (BPV) has been associated with an increased risk for cognitive decline and mortality in the general population. Whether BPV is associated with increased all-cause mortality in older people with cognitive impairment is unknown. Objective: To investigate the association between day-to-day home BPV and all-cause mortality in older patients attending a memory clinic. Methods: We included 279 patients attending a memory clinic, who measured home blood pressure (BP) for 7 consecutive days in the morning and evening. Within-subject BPV was defined as the variation independent of the mean (VIM). Time-to-death was …verified through the Dutch population registry. Cox proportional hazard regression was used. Separate analyses were performed for morning-to-morning and evening-to-evening BPV. Results: Mean age was 73±9 years, dementia and mild cognitive impairment were diagnosed in 35% and 34% respectively, and mean home BP was 139/79 mmHg. After a mean follow-up of 3.2 years, 52 patients had died. Neither day-to-day systolic nor diastolic VIM were associated with mortality (adjusted hazard ratio [HR] systolic VIM: 0.99, 95% -CI 0.92–1.06, p  = 0.770, HR diastolic VIM: 1.04, 95% -CI 0.93–1.17, p  = 0.517). When morning and evening measurements were analyzed separately, systolic morning-to-morning VIM was associated with mortality (adjusted HR: 1.09, 95% -CI 1.01–1.18, p  = 0.033). Conclusion: In this study, day-to-day BPV was not associated with all-cause mortality in patients attending a memory clinic. However, morning-to-morning BPV was. Due to the short assessment window, there is still a lack of clarity; hence future research is warranted to clarify the role of all BPV components in aging. Show more

Keywords: Alzheimer, cardiovascular risk management, dementia, geriatrics, home blood pressure monitoring, hypertension

DOI: 10.3233/JAD-215002

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1219-1231, 2022

Authors: Wang, Gang | Zhou, Wenju | Kong, Deping | Qu, Zongshuai | Ba, Maowen | Hao, Jinguang | Yao, Tao | Dong, Qunxi | Su, Yi | Reiman, Eric M. | Caselli, Richard J. | Chen, Kewei | Wang, Yalin | for the Alzheimer’s Disease Neuroimaging Initiative

Article Type: Research Article

Abstract: Background: A univariate neurodegeneration biomarker (UNB) based on MRI with strong statistical discrimination power would be highly desirable for studying hippocampal surface morphological changes associated with APOE ɛ4 genetic risk for AD in the cognitively unimpaired (CU) population. However, existing UNB work either fails to model large group variances or does not capture AD induced changes. Objective: We proposed a subspace decomposition method capable of exploiting a UNB to represent the hippocampal morphological changes related to the APOE ɛ4 dose effects among the longitudinal APOE ɛ4 homozygotes (HM, N  = 30), heterozygotes (HT, N  = 49) and …non-carriers (NC, N  = 61). Methods: Rank minimization mechanism combined with sparse constraint considering the local continuity of the hippocampal atrophy regions is used to extract group common structures. Based on the group common structures of amyloid-β (Aβ) positive AD patients and Aβ negative CU subjects, we identified the regions-of-interest (ROI), which reflect significant morphometry changes caused by the AD development. Then univariate morphometry index (UMI) is constructed from these ROIs. Results: The proposed UMI demonstrates a more substantial statistical discrimination power to distinguish the longitudinal groups with different APOE ɛ4 genotypes than the hippocampal volume measurements. And different APOE ɛ4 allele load affects the shrinkage rate of the hippocampus, i.e., HM genotype will cause the largest atrophy rate, followed by HT, and the smallest is NC. Conclusion: The UMIs may capture the APOE ɛ4 risk allele-induced brain morphometry abnormalities and reveal the dose effects of APOE ɛ4 on the hippocampal morphology in cognitively normal individuals. Show more

Keywords: Effect size, magnetic resonance imaging, permutation t-test, radial distance, regions-of-interest, subspace decomposition

DOI: 10.3233/JAD-215149

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1233-1250, 2022

Authors: Chaudhary, Shefali | Zhornitsky, Simon | Chao, Herta H. | van Dyck, Christopher H. | Li, Chiang-Shan R.

Article Type: Research Article

Abstract: Background: Affecting nearly half of the patients with Alzheimer’s disease (AD), apathy is associated with higher morbidity and reduced quality of life. Basal ganglia and cortical atrophy have been implicated in apathy. However, the findings have varied across studies and left unclear whether subdomains of apathy may involve distinct neuroanatomical correlates. Objective: To identify neuroanatomical correlates of AD-associated apathy. Methods: We performed a meta-analysis and label-based review of the literature. Further, following published routines of voxel-based morphometry, we aimed to confirm the findings in an independent cohort of 19 patients with AD/mild cognitive impairment and 25 …healthy controls assessed with the Apathy Evaluation Scale. Results: Meta-analysis of 167 AD and 56 healthy controls showed convergence toward smaller basal ganglia gray matter volume (GMV) in apathy. Label-based review showed anterior cingulate, putamen, insula, inferior frontal gyrus (IFG) and middle temporal gyrus (MTG) atrophy in AD apathy. In the independent cohort, with small-volume-correction, right putamen and MTG showed GMVs in negative correlation with Apathy Evaluation Scale total, behavioral, and emotional scores, and right IFG with emotional score (p  < 0.05 family-wise error (FWE)-corrected), controlling for age, education, intracranial volume, and depression. With the Mini-Mental State Examination scores included as an additional covariate, the correlation of right putamen GMV with behavioral and emotional score, right MTG GMV with total and emotional score, and right IFG GMV with emotional score were significant. Conclusion: The findings implicate putamen, MTG and IFG atrophy in AD associated apathy, potentially independent of cognitive impairment and depression, and suggest potentially distinct volumetric correlates of apathy. Show more

Keywords: Activation likelihood estimation, Alzheimer-type dementia, Alzheimer’s disease, emotional apathy, gray matter, inferior frontal gyrus, meta-analysis, middle temporal gyrus, striatum

DOI: 10.3233/JAD-215316

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1251-1265, 2022

Authors: Teipel, Stefan J. | Dyrba, Martin | Ballarini, Tommaso | Brosseron, Frederic | Bruno, Davide | Buerger, Katharina | Cosma, Nicoleta-Carmen | Dechent, Peter | Dobisch, Laura | Düzel, Emrah | Ewers, Michael | Fliessbach, Klaus | Haynes, John D. | Janowitz, Daniel | Kilimann, Ingo | Laske, Christoph | Maier, Franziska | Metzger, Coraline D. | Munk, Matthias H. | Peters, Oliver | Pomara, Nunzio | Preis, Lukas | Priller, Josef | Ramírez, Alfredo | Roy, Nina | Scheffler, Klaus | Schneider, Anja | Schott, Björn H. | Spottke, Annika | Spruth, Eike J. | Wagner, Michael | Wiltfang, Jens | Jessen, Frank | Heneka, Michael T.

Article Type: Research Article

Abstract: Background: Inflammation has been described as a key pathogenic event in Alzheimer’s disease (AD), downstream of amyloid and tau pathology. Preclinical and clinical data suggest that the cholinergic basal forebrain may moderate inflammatory response to different pathologies. Objective: To study the association of cholinergic basal forebrain volume and functional connectivity with measures of neuroinflammation in people from the AD spectrum. Methods: We studied 261 cases from the DELCODE cohort, including people with subjective cognitive decline, mild cognitive impairment, AD dementia, first degree relatives, and healthy controls. Using Bayesian ANCOVA, we tested associations of MRI indices of …cholinergic basal forebrain volume and functional connectivity with cerebrospinal fluid (CSF) levels of sTREM2 as a marker of microglia activation, and serum levels of complement C3. Using Bayesian elastic net regression, we determined associations between basal forebrain measures and a large inflammation marker panel from CSF and serum. Results: We found anecdotal to moderate evidence in favor of the absence of an effect of basal forebrain volume and functional connectivity on CSF sTREM2 and serum C3 levels both in Aβ42 /ptau-positive and negative cases. Bayesian elastic net regression identified several CSF and serum markers of inflammation that were associated with basal forebrain volume and functional connectivity. The effect sizes were moderate to small. Conclusion: Our data-driven analyses generate the hypothesis that cholinergic basal forebrain may be involved in the neuroinflammation response to Aβ42 and phospho-tau pathology in people from the AD spectrum. This hypothesis needs to be tested in independent samples. Show more

Keywords: Alzheimer’s disease, cerebrospinal fluid, cholinergic system, neuroinflammation, MRI, plasma, sTREM2

DOI: 10.3233/JAD-215196

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1267-1282, 2022

Authors: von Linstow, Christian Ulrich | Waider, Jonas | Bergh, Marianne Skov-Skov | Anzalone, Marco | Madsen, Cecilie | Nicolau, Aina Battle | Wirenfeldt, Martin | Lesch, Klaus-Peter | Finsen, Bente

Article Type: Research Article

Abstract: Background: A decline of brain serotonin (5-HT) is held responsible for the changes in mood that can be observed in Alzheimer’s disease (AD). However, 5-HT’ergic signaling is also suggested to reduce the production of pathogenic amyloid-β (Aβ). Objective: To investigate the effect of targeted inactivation of tryptophan hydroxylase-2 (Tph2), which is essential for neuronal 5-HT synthesis, on amyloidosis in amyloid precursor protein (APP)swe /presenilin 1 (PS1) ΔE9 transgenic mice. Methods: Triple-transgenic (3xTg) APP/PS1 mice with partial (+/-) or complete Tph2 knockout (–/–) were allowed to survive until 6 months old with APP/PS1, Tph2–/– , …and wildtype mice. Survival and weight were recorded. Levels of Aβ42/40/38 , soluble APPα (sAβPPα) and sAβPPβ, and cytokines were analyzed by mesoscale, neurotransmitters by mass spectrometry, and gene expression by quantitative PCR. Tph2, microglia, and Aβ were visualized histologically. Results: Tph2 inactivation in APP/PS1 mice significantly reduced viability, without impacting soluble and insoluble Aβ42 and Aβ40 in neocortex and hippocampus, and with only mild changes of soluble Aβ42 /Aβ40 . However, sAβPPα and sAβPPβ in hippocampus and Aβ38 and Aβ40 in cerebrospinal fluid were reduced. 3xTg–/–mice were devoid of Tph2 immunopositive fibers and 5-HT. Cytokines were unaffected by genotype, as were neocortical TNF, HTR2a and HTR2b mRNA levels in Tph2–/– mice. Microglia clustered around Aβ plaques regardless of genotype. Conclusion: The results suggest that Tph2 inactivation influences AβPP processing, at least in the hippocampus, although levels of Aβ are unchanged. The reduced viability of 3xTg–/–mice could indicate that 5-HT protects against the seizures that can impact the viability of APP/PS1 mice. Show more

Keywords: Alzheimer’s disease, APP/PS1, AβPP processing, cerebral amyloidosis, cerebrospinal fluid, 5-HT, neuroinflammation, tryptophan hydroxylase 2

DOI: 10.3233/JAD-210581

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1283-1300, 2022

Authors: Malone, Joseph | Jung, Jeah | Tran, Linh | Zhao, Chen

Article Type: Research Article

Abstract: Background: Periodontal disease and hepatitis C virus (HCV) represent chronic infectious states that are common in elderly adults. Both conditions have independently been associated with an increased risk for dementia. Chronic infections are thought to lead to neurodegenerative changes in the central nervous system possibly by promoting a proinflammatory state. This is consistent with growing literature on the etiological role of infections in dementia. Few studies have previously evaluated the association of periodontal disease with dementia in HCV patients. Objective: To examine whether periodontal disease increases the risk of developing Alzheimer’s disease and related dementias (ADRD) among HCV …patients in Medicare claims data. Methods: We used Medicare claims data for HCV patients to assess the incidence rate of ADRD with and without exposure to periodontal disease between 2014 and 2017. Cox multivariate regression was used to estimate the association between periodontal disease and development of ADRD, controlling for age, gender, race, ZIP-level income and education, and medical comorbidities. Results: Of 439,760 HCV patients, the incidence rate of ADRD was higher in patients with periodontal diseases compared to those without (10.84% versus 9.26%, p  < 0.001), and those with periodontal disease developed ADRD earlier compared to those without periodontal disease (13.99 versus 21.60 months, p  < 0.001). The hazard of developing ADRD was 1.35 times higher in those with periodontal disease (95% CI, 1.30 to 1.40, p  < 0.001) after adjusting for all covariates, including age. Conclusion: Periodontal disease increased the risk of developing ADRD among HCV patients in a national Medicare claims dataset. Show more

Keywords: Alzheimer’s disease, Alzheimer’s disease and related dementias, dementia, Hepatitis C virus, infection, periodontal disease

DOI: 10.3233/JAD-210666

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1301-1308, 2022

Authors: Salami, Alireza | Adolfsson, Rolf | Andersson, Micael | Blennow, Kaj | Lundquist, Anders | Adolfsson, Annelie Nordin | Schöll, Michael | Zetterberg, Henrik | Nyberg, Lars

Article Type: Research Article

Abstract: Background: The Apolipoprotein E (APOE ) ɛ4 allele has been linked to increased tau phosphorylation and tangle formation. APOE ɛ4 carriers with elevated tau might be at the higher risk for Alzheimer’s disease (AD) progression. Previous studies showed that tau pathology begins early in areas of the medial temporal lobe. Similarly, APOE ɛ4 carriers showed altered hippocampal functional integrity. However, it remains unknown whether the influence of elevated tau accumulation on hippocampal functional changes would be more pronounced for APOE ɛ4 carriers. Objective: We related ɛ4 carriage to levels of plasma phosphorylated tau (p-tau181) up …to 15 years prior to AD onset. Furthermore, elevated p-tau181 was explored in relation to longitudinal changes in hippocampal function and connectivity. Methods: Plasma p-tau181 was analyzed in 142 clinically defined AD cases and 126 matched controls. The longitudinal analysis involved 87 non-demented individuals (from population-based study) with two waves of plasma samples and three waves of functional magnetic resonance imaging during rest and memory encoding. Results: Increased p-tau181 was observed for both ɛ4 carriers and non-carriers close to AD onset, but exclusively for ɛ4 carriers in the early preclinical groups (7- and 13-years pre-AD). In ɛ4 carriers, longitudinal p-tau181 increase was paralleled by elevated local hippocampal connectivity at rest and subsequent reduction of hippocampus encoding-related activity. Conclusion: Our findings support an association of APOE ɛ4 and p-tau181 with preclinical AD and hippocampus functioning. Show more

Keywords: Alzheimer’s disease, APOE, fMRI, hippocampus, longitudinal, magnetic resonance imaging, p-tau181, phosphorylated tau, population-based

DOI: 10.3233/JAD-210673

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1309-1320, 2022

Authors: Sun, Hao-Lun | Zhou, Fa-Ying | Chen, Dong-Wan | Tan, Cheng-Rong | Zeng, Gui-Hua | Liu, Yu-Hui | Wang, Jun | Bu, Xian-Le | Wang, Yan-Jiang | Li, Hui-Yun | Jin, Wang-Sheng

Article Type: Research Article

Abstract: Background: Recent studies have shown that monocytes can phagocytize the tau protein, which may ameliorate tau-type pathology in Alzheimer’s disease (AD). However, there are few clinical studies on the relationship between monocytes and tau-type pathology in AD patients. Objective: We aimed to explore changes in peripheral monocytes and their association with tau protein in AD patients. Methods: A total of 127 clinically diagnosed AD patients and 100 age- and sex-matched cognitively normal controls were recruited for analysis of the correlation of plasma tau levels with the blood monocyte count. Cerebrospinal fluid (CSF) samples from 46 AD …patients and 88 controls were further collected to analyze the correlation of CSF tau and amyloid-β (Aβ) levels with the blood monocyte count. 105 clinically diagnosed mild cognitive impairment (MCI) patients and 149 age- and sex-matched cognitively normal controls were recruited from another cohort for verification. Results: Compared to normal controls, AD patients showed a significant reduction in the blood monocyte count. In addition, the monocyte count of AD patients was negatively correlated with CSF t-tau and p-tau levels but not with plasma tau levels. In normal people, monocyte count lack correlation with tau levels both in plasma and CSF. Monocyte count were not correlated with CSF Aβ levels in either group but were negatively correlated with CSF tau/Aβ42 levels in the AD group. We had further verified the correlations of monocyte count with CSF tau levels in another cohort. Conclusion: This study suggests that monocytes may play an important role in the clearance of tau protein in the brain. Show more

Keywords: Alzheimer’s disease, monocytes, pathogenesis, tau

DOI: 10.3233/JAD-210692

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1321-1328, 2022

Authors: Chen, Jiu | Chen, Rong | Xue, Chen | Qi, Wenzhang | Hu, Guanjie | Xu, Wenwen | Chen, Shanshan | Rao, Jiang | Zhang, Fuquan | Zhang, Xiangrong

Article Type: Research Article

Abstract: Background: Altered hippocampal subregions (HIPsub) and their network connectivity relate to episodic memory decline in amnestic mild cognitive impairment (aMCI), which is significantly limited by over-dependence on correlational associations. Objective: To identify whether restoration of HIPsub and its network connectivity using repetitive transcranial magnetic stimulation (rTMS) is causally linked to amelioration of episodic memory in aMCI. Methods: In the first cohort, analysis of HIPsub grey matter (GM) and its functional connectivity was performed to identify an episodic memory-related circuit in aMCI by using a pattern classification approach. In the second cohort, this circuit was experimentally modulated …with rTMS. Structural equation modeling was employed to investigate rTMS regulatory mechanism in amelioration of episodic memory. Results: First, in the first cohort, this study identified HIPsub circuit pathology of episodic memory decline in aMCI patients. Second, in the second cohort, restoration of HIPc GM and its connectivity with left middle temporal gyrus (MTG.L) are causally associated with amelioration of episodic memory in aMCI after 4 weeks of rTMS. Especially important, the effects of HIPc GM changes on the improvement of episodic memory were significantly mediated by HIPc connectivity with MTG.L changes in aMCI. Conclusion: This study provides novel experimental evidence about a biological substrate for the treatment of the disabling episodic memory in aMCI patients. Correction of breakdown in HIPc structure and its connectivity with MTG can causally ameliorate episodic memory in aMCI. Show more

Keywords: Amnestic mild cognitive impairment, episodic memory, functional connectivity, grey matter, hippocampalsubregion, pattern classification, repetitive transcranial magnetic stimulation

DOI: 10.3233/JAD-210661

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1329-1342, 2022

Authors: Tropea, Maria Rosaria | Sanfilippo, Giulia | Giannino, Federico | Davì, Valentina | Gulisano, Walter | Puzzo, Daniela

Article Type: Research Article

Abstract: Background: Object recognition task (ORT) is a widely used behavioral paradigm to assess memory in rodent models, due to its easy technical execution, the lack of aversive stressful stimuli, and the possibility to repeat the test on the same animals. However, mouse exploration might be strongly influenced by a variety of variables. Objective: To study whether innate preferences influenced exploration in male and female wild type mice and the Alzheimer’s disease (AD) model 3xTg. Methods: We first evaluated how object characteristics (material, size, and shape) influence exploration levels, latency, and exploration modality. Based …on these findings, we evaluated whether these innate preferences biased the results of ORT performed in wild type mice and AD models. Results: Assessment of Exploration levels, i.e., the time spent in exploring a certain object in respect to the total exploration time, revealed an innate preference for objects made in shiny materials, such as metal and glass. A preference for bigger objects characterized by higher affordance was also evident, especially in male mice. When performing ORT, exploration was highly influenced by these innate preferences. Indeed, both wild type and AD mice spent more time in exploring the metal object, regardless of its novelty. Furthermore, the use of objects with higher affordance such as the cube was a confounding factor leading to “false” results that distorted ORT interpretation. Conclusion: When designing exploration-based behavioral experiments aimed at assessing memory in healthy and AD mice, object characteristics should be carefully evaluated to improve scientific outcomes and minimize possible biases. Show more

Keywords: Alzheimer’s mice, exploration, object preference, object recognition task

DOI: 10.3233/JAD-215209

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1343-1356, 2022

Authors: Kwak, Seyul | Oh, Dae Jong | Jeon, Yeong-Ju | Oh, Da Young | Park, Su Mi | Kim, Hairin | Lee, Jun-Young

Article Type: Research Article

Abstract: Background: In assessing the levels of clinical impairment in dementia, a summary index of neuropsychological batteries has been widely used in describing the overall functional status. Objective: It remains unexamined how complex patterns of the test performances can be utilized to have specific predictive meaning when the machine learning approach is applied. Methods: In this study, the neuropsychological battery (CERAD-K) and assessment of functioning level (Clinical Dementia Rating scale and Instrumental Activities of Daily Living) were administered to 2,642 older adults with no impairment (n  = 285), mild cognitive impairment (n  = 1,057), and Alzheimer’s …disease (n  = 1,300). Predictive accuracy on functional impairment level with the linear models of the single total score or multiple subtest scores (Model 1, 2) and support vector regression with low or high complexity (Model 3, 4) were compared across different sample sizes. Results: The linear models (Model 1, 2) showed superior performance with relatively smaller sample size, while nonlinear models with low and high complexity (Model 3, 4) showed an improved accuracy with a larger dataset. Unlike linear models, the nonlinear models showed a gradual increase in the predictive accuracy with a larger sample size (n  > 500), especially when the model training is allowed to exploit complex patterns of the dataset. Conclusion: Our finding suggests that nonlinear models can predict levels of functional impairment with a sufficient dataset. The summary index of the neuropsychological battery can be augmented for specific purposes, especially in estimating the functional status of dementia. Show more

Keywords: Dementia, functional status, machine learning, neuropsychological tests

DOI: 10.3233/JAD-215244

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1357-1372, 2022

Authors: Yuen, Sze Chung | Lee, Simon Ming-Yuen | Leung, Siu-wai

Article Type: Research Article

Abstract: Background: Neuronal cell cycle re-entry (CCR) is a mechanism, along with amyloid-β (Aβ) oligomers and hyperphosphorylated tau proteins, contributing to toxicity in Alzheimer’s disease (AD). Objective: This study aimed to examine the putative factors in CCR based on evidence corroboration by combining meta-analysis and co-expression analysis of omic data. Methods: The differentially expressed genes (DEGs) and CCR-related modules were obtained through the differential analysis and co-expression of transcriptomic data, respectively. Differentially expressed microRNAs (DEmiRNAs) were extracted from the differential miRNA expression studies. The dysregulations of DEGs and DEmiRNAs as binary outcomes were independently …analyzed by meta-analysis based on a random-effects model. The CCR-related modules were mapped to human protein-protein interaction databases to construct a network. The importance score of each node within the network was determined by the PageRank algorithm, and nodes that fit the pre-defined criteria were treated as putative CCR-related factors. Results: The meta-analysis identified 18,261 DEGs and 36 DEmiRNAs, including genes in the ubiquitination proteasome system, mitochondrial homeostasis, and CCR, and miRNAs associated with AD pathologies. The co-expression analysis identified 156 CCR-related modules to construct a protein-protein interaction network. Five genes, UBC , ESR1 , EGFR , CUL3 , and KRAS , were selected as putative CCR-related factors. Their functions suggested that the combined effects of cellular dyshomeostasis and receptors mediating Aβ toxicity from impaired ubiquitination proteasome system are involved in CCR. Conclusion: This study identified five genes as putative factors and revealed the significance of cellular dyshomeostasis in the CCR of AD. Show more

Keywords: Alzheimer’s disease, cell cycle re-entry, co-expression analysis, meta-analysis, pagerank algorithm

DOI: 10.3233/JAD-215349

Citation: Journal of Alzheimer's Disease, vol. 85, no. 3, pp. 1373-1398, 2022