Erlangen Score Predicts Cognitive and Neuroimaging Progression in Mild Cognitive Impairment Stage of Alzheimer’s Disease

Article type: Research Article

Authors: Skillbäck, Tobias^{a; *} | Kornhuber, Johannes^b | Blennow, Kaj^{a; c} | Zetterberg, Henrik^{a; c; d; e} | Lewczuk, Piotr^{b; f} | for the Alzheimer’s Disease Neuroimaging Initiative¹

Affiliations: [a] Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden | [b] Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany | [c] Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden | [d] Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1, N 3BG, UK | [e] UK Dementia Research Institute at UCL, London WC1, N 3BG, UK | [f] Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Poland

Correspondence: [*] Correspondence to: Tobias Skillbäck, Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital/Mölndal, S-431 80 Mölndal, Sweden. Tel.: +46 31 3430025; E-mail: tobias.skillback@gu.se.

Note: [1] Data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (http://adni.loni.usc.edu). As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report. A complete listing of ADNI investigators can be found at: http://adni.loni.usc.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf (also available as Supplemental Material).

Abstract: Background:To alleviate the interpretation of the core Alzheimer’s disease (AD) cerebrospinal fluid (CSF) biomarkers, amyloid β1–42 (Aβ42), total tau (T-tau), and phosphorylated tau (P-tau), the Erlangen Score (ES) interpretation algorithm has been proposed. Objective:In this study, we aim to assess the predictive properties of the ES algorithm on cognitive and neuroimaging outcomes in mild cognitive impairment (MCI). Methods:All MCI subjects with an available baseline CSF sample from ADNI-1 were included (n = 193), and assigned an ES between 0 and 4 based on their baseline CSF biomarker profile. Structural magnetic resonance imaging brain scans and MMSE and ADAS-Cog scores were collected at up to 7 times in follow-up examinations. Results:We observed strong and significant correlations between the ES at baseline and neuroimaging and cognitive results with patients with neurochemically probable AD (ES = 4) progressing significantly (p≤0.01) faster than those with a neurochemically improbable AD (ES = 0 or 1), and the subjects with neurochemically possible AD (ES = 2 or 3) in-between these two groups. Conclusion:This study further demonstrates the utility of the ES algorithm as a as a tool in predicting cognitive and imaging progression in MCI patients.

Keywords: Aβ_1–42, Alzheimer’s disease, biomarkers, cerebrospinal fluid, Erlangen score, P-tau, T-tau

DOI: 10.3233/JAD-190067

Journal: Journal of Alzheimer's Disease, vol. 69, no. 2, pp. 551-559, 2019