Journal of Alzheimer's Disease Reports - Volume 5, issue 1

Authors: Innes, Kim E. | Montgomery, Caitlin | Selfe, Terry Kit | Wen, Sijin | Khalsa, Dharma Singh | Flick, Madison

Article Type: Research Article

Abstract: Background: Recent studies suggest meditation and music listening (ML) may improve cognitive and psychosocial outcomes in adults with subjective cognitive decline (SCD). However, lack of a usual care group has limited conclusions. Objective: To assess the: 1) feasibility of incorporating an enhanced usual care (EUC) comparator in a trial of Kirtan Kriya meditation (KK) and ML for adults experiencing SCD; and 2) preliminary effects of active treatment (KK/ML) versus an EUC program. Methods: Forty participants with SCD were randomized 1:1:2 to a 12-week KK, ML, or EUC program. KK and ML participants were asked to practice …12 minutes/day; EUC participants were given a comprehensive educational packet regarding healthy aging and strategies for improving/maintaining brain health and asked to record any activities or strategies used. Feasibility was assessed using measures of retention, adherence, treatment expectancies, and participant satisfaction, as well as information from exit questionnaires and daily practice/activity logs. Cognitive functioning, stress, mood, sleep-quality, and health-related quality of life (QOL) were measured pre- and post-intervention using well-validated instruments. Results: Thirty-two participants (80%) completed the 3-month study, with retention highest in the EUC group (p  < 0.05). Active treatment participants averaged 6.0±0.4 practice sessions/week, and EUC participants, 7.5±0.6 brain health activities/week. Treatment expectancies were similar across groups. EUC participants indicated high satisfaction with the program and study. Despite limited study power, the active treatment group showed significantly greater gains in subjective memory functioning (ps≤0.025) and nonsignificant improvements in cognitive performance (TMT-B), perceived stress, QOL, and mood (ps≤0.08) compared to the EUC group. Conclusion: Findings of this pilot feasibility trial suggest incorporation of an EUC program is feasible, and that participation in a simple 12-week relaxation program may be helpful for adults with SCD versus engagement in an EUC program. Show more

Keywords: Acceptability, Alzheimer’s disease, cognition, memory complaints, mind-body therapy, mood, quality of life, stress, subjective cognitive impairment

DOI: 10.3233/ADR-200249

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 187-206, 2021

Authors: Sabbagh, Marwan | Miller, Justin | Jones, Stephen | Ritter, Aaron | Shi, Jiong | DeCourt, Boris | Wint, Dylan

Article Type: Research Article

Abstract: Background: Informant-based measures are effective screening tools for cognitive impairment. The Alzheimer’s Questionnaire (AQ) is a subjective, informant-based measure that detects amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD) with high sensitivity and specificity and has been shown to predict amyloid burden. Objective: To determine whether informant-based report of cognitive decline correlates with hippocampal volume changes in MCI and AD. Methods: Retrospective chart review of 139 clinically referred patients with clinical diagnoses of aMCI or mild dementia due to AD was conducted. Diagnostic status (clinical diagnosis made by a neurologist), NeuroQuant measured MRI brain with …percentile rank hippocampal volume, Montreal Cognitive Assessment (MoCA) total, AQ-Total score, and demographic variables were extracted from medical records. Spearman correlation was used to assess the relationship between hippocampal volume and AQ-Total. The AQ was used to assign diagnostic status. Thus, the relationship between the AQ and diagnostic status was excluded. Results: The sample include 88 female and 51 male participants. The mean age was 74.37±9.45, mean MOCA was 22.65±4.18, mean education was 14.80±3.35, and mean AQ score was 10.54±5.22. Hippocampal volume and the AQ correlation was r  = –0.33 [95%CI –0.47 to –0.17], p  < 0.0001. Conclusion: In a mixed-clinical sample of patients presenting to an outpatient memory disorders center, higher endorseme-nts of functional impairments by caregivers were significantly associated with smaller hippocampal volumes. When used in conjunction with other available measures, these findings further support the role of the AQ in clinical decision-making and demonstrate an additional relationship between clinical measures and volumetric MRI. Show more

Keywords: Alzheimer’s disease, Alzheimer’s Questionnaire, hippocampal volume, informant-based measures, screening tools

DOI: 10.3233/ADR-200260

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 207-211, 2021

Authors: Khan, Hafiz | Rafiq, Aamrin | Palle, Komaraiah | Faysel, Mohammad | Gabbidon, Kemesha | Chowdhury, Mohammed | Reddy, P. Hemachandra

Article Type: Research Article

Abstract: Background: The prevalence of cognitive dysfunction increases in elderly due to cardiovascular disease related risk factors in rural communities like West Texas. Objective: The purpose of this study was to find risk factors of cardiovascular disease (CVD) related to cognitive dysfunction and their impact on elderly adults in rural West Texans. Methods: Statistical methods such as Pearson’s chi-squared and a multinomial logistic regression were utilized to analyze data. We used SPSS software to detect and understand the nature of the risk factors. Results: A summary of statistics was obtained by using Pearson’s chi-squared test …for categorical variables. CVD, diabetes mellitus, and depression were significantly associated with cognitive dysfunction for both males and females (p  = 0.0001), whereas anxiety was found to be significantly associated with cognitive dysfunction for females (p  = 0.0001). Age group and race/ethnicity were significantly associated with cognitive dysfunction for both males and females (p  = 0.0001). By performing a multinomial logistic regression method and controlling for confounders, the significant risk factors (p  <  0.05)— age (65– 84 years), diabetes, and memory loss for age-associated cognitive impairment; diabetes for cognitive impairment no dementia; age (65– 84, ≥85 years), CVD, diabetes, depression, memory loss, non-Hispanic Whites, and Black/African-Americans for mild cognitive impairment; and age, memory loss, non-Hispanic Whites, Black/African-Americans, and male gender were found for dementia. Conclusion: CVD related risk factors in developing cognitive dysfunction exist and integrating such risk variables may guide relevant policy interventions to reduce Alzheimer’s incidence or dementia in rural communities in West Texans. Show more

Keywords: Alzheimer’s disease, cardiovascular disease, cognitive dysfunction FRONTIER database

DOI: 10.3233/ADR-200278

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 213-226, 2021

Authors: Gorantla, Nalini V. | Das, Rashmi | Mulani, Fayaj A. | Thulasiram, Hirekodathakallu V. | Chinnathambi, Subashchandrabose

Article Type: Correction

DOI: 10.3233/ADR-219001

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 227-227, 2021

Authors: Lopatko Lindman, Karin | Weidung, Bodil | Olsson, Jan | Josefsson, Maria | Johansson, Anders | Eriksson, Sture | Hallmans, Göran | Elgh, Fredrik | Lövheim, Hugo

Article Type: Research Article

Abstract: Background: Amyloid-β (Aβ), the key constituent of Alzheimer’s disease (AD) plaques, has antimicrobial properties. Objective: To investigate the association between plasma Aβ and antibodies against the AD-related pathogens herpes simplex virus (HSV), cytomegalovirus (CMV), and C. pneumoniae . Methods: Plasma from 339 AD cases, obtained on average 9.4 years (±4.00) before diagnosis, and their matched controls were analyzed for Aβ40 and Aβ42 concentrations with Luminex xMAP technology and INNOBIA plasma Aβ-form assays. Enzyme-linked immunosorbent assays were utilized for analyses of anti-HSV immunoglobulin (Ig) G, anti-HSV1 IgG, anti-HSV2 IgG, anti-CMV IgG, and anti-C. pneumoniae …IgG. Follow-up samples were available for 150 of the cases. Results: Presence and levels of anti-HSV1 IgG, anti-HSV2 IgG, anti-CMV IgG, and anti-C. pneumoniae IgG did not correlate with concentrations of Aβ42 or Aβ40 in cases or controls. Conclusion: Levels of plasma Aβ were not associated with antibodies against different AD-related pathogens. Show more

Keywords: Alzheimer’s disease, amyloid-β peptides, Chlamydophila pneumoniae, cytomegalovirus, dementia, Herpes simplex, nested case-control study

DOI: 10.3233/ADR-210008

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 229-235, 2021

Authors: Olsen, Ingar

Article Type: Research Article

Abstract: Alzheimer’s disease (AD) has been associated with periodontitis, which starts as gingivitis. Similar to periodontitis, gingivitis bacteria, bacterial products, and inflammatory mediators can travel to the brain via the blood stream and promote brain inflammation. Periodontal pathogens such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, both associated with AD, have been found in dental plaque of children already at the age of 3. It is suggested that these bacteria during long-term exposure may drive microglia (brain resident macrophage cells) into a pro-inflammatory M1 phase where they contribute to AD rather than protect against it. This notion comes from studies …in mice showing that microglia actually can “remember” previous inflammatory challenge and become “trained” or “tolerant” to toxins like lipopolysaccharide. If gingivitis has an impact on AD, which should be verified, AD prophylaxis should start already at this pre-periodontitis stage with removal of supragingival plaque. Show more

Keywords: Bacteria, bacteremia, inflammation, microglia, periodontitis, systemic

DOI: 10.3233/ADR-210006

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 237-241, 2021

Authors: Tombini, Mario | Assenza, Giovanni | Ricci, Lorenzo | Lanzone, Jacopo | Boscarino, Marilisa | Vico, Carlo | Magliozzi, Alessandro | Di Lazzaro, Vincenzo

Article Type: Review Article

Abstract: Increasing evidence coming from both experimental and humans’ studies strongly suggest the existence of a link between epilepsy, in particular temporal lobe epilepsy (TLE), and Alzheimer’s disease (AD). Patients with mild cognitive impairment and AD are more prone to have seizures, and seizures seem to facilitate amyloid-β and tau deposits, thus promoting neurodegenerative processes. Consistent with this view, long-lasting drug-resistant TLE and AD have been shown to share several pathological and neuroimaging features. Even if studies addressing prevalence of interictal and subclinical epileptiform activity in these patients are not yet conclusive, their findings raise the possibility that epileptiform activity might …negatively impact memory and hasten cognitive decline, either directly or by association with unrecognized silent seizures. In addition, data about detrimental effect of network hyperexcitability in temporal regions in the premorbid and early stages ofADopen up newtherapeutic opportunities for antiseizure medications and/or antiepileptic strategies that might complement or enhance existing therapies, and potentially modify disease progression. Here we provide a review of evidence linking epileptiform activity, network hyperexcitability, and AD, and their role promoting and accelerating neurodegenerative process. Finally, the effects of antiseizure medications on cognition and their optimal administration in patients with AD are summarized. Show more

Keywords: Alzheimer’s disease, antiseizure medications, cognition, epilepsy, epileptiform activity, network hyperexcitability

DOI: 10.3233/ADR-200286

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 243-261, 2021

Authors: Pahrudin Arrozi, Aslina | Yanagisawa, Daijiro | Kato, Tomoko | Akatsu, Hiroyasu | Hashizume, Yoshio | Kaneda, Daita | Tooyama, Ikuo

Article Type: Research Article

Abstract: Background: Emerging evidence indicates that the misfolded tau protein can propagate aggregates between cells in a prion-like manner. This prion activity has been typically studied in brain extracts of patients with Alzheimer’s disease (AD), but not in the olfactory region that can be a potential biomarker in AD. Objective: To investigate the prion seeding activity of tau in nasal mucosa tissues using a cell culture model of tau propagation. Methods: Brain and nasal mucosa homogenates were added to HEK293T cells expressing three repeat or four-repeat domains of tau with the L266V, V337M (3RD* VM) and P301L …and V377M mutations (4RD* LM) fused to the enhanced green fluorescence protein (EGFP) respectively. We also measured the level of phosphorylated tau (p-tau), total tau (t-tau), and p-tau/t-tau ratio and performed correlation analysis between tau prion activity and the level of tau. Results: We found that brain and nasal tissue homogenates from patients with AD significantly induced tau aggregation in HEK293T cells either expressing tau 3RD* VM-EGFP or 4RD* LM-EGFP compared with control brain and nasal tissue homogenates. The levels of p-tau and p-tau/t-tau ratio were significantly increased in the brain of patients with AD; however, no significant difference was found in nasal tissue compared with their respective control tissue homogenates. Conclusion: These results suggest that the nasal tissues contain tau seeds, similar to the brain, albeit without changes in the levels of p-tau and t-tau. Therefore, a cellular bioassay using nasal tissues would have great potential as an AD biomarker because of the usefulness of nasal tissue biopsy. Show more

Keywords: Alzheimer’s disease, nasal extracts, tau aggregation, tau propagation

DOI: 10.3233/ADR-210298

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 263-274, 2021

Authors: Bezuch, Natalia | Bradburn, Steven | Robinson, Andrew C. | Pendleton, Neil | Payton, Antony | Murgatroyd, Chris

Article Type: Research Article

Abstract: Background: The APOE ɛ4 allele is the strongest known genetic risk factor for sporadic Alzheimer’s disease (AD). The neighboring TOMM40 gene has also been implicated in AD due to its close proximity to APOE . Objective: Here we tested whether methylation of the TOMM40-APOE locus may influence ApoE protein levels and AD pathology. Methods: DNA methylation levels across the TOMM40-APOE locus and ApoE levels were measured in superior frontal gyrus tissues of 62 human brains genotyped for APOE and scored for AD neuropathology. Results: Methylation levels within the TOMM40 …CpG island in the promoter or APOE CpG island in Exon 4 did not differ between APOE ɛ4 carriers versus non-carriers. However, APOE ɛ4 carriers had significantly higher methylation the APOE promoter compared with non-carriers. Although DNA methylation at TOMM40 , APOE promoter region, or APOE did not differ between AD pathological groups, there was a negative association between TOMM40 methylation and CERAD scores. ApoE protein concentrations did not significantly different between APOE ɛ4 carriers and non-carriers, or between AD pathological groups. Finally, there was no correlation between ApoE protein concentrations and DNA methylation levels. Conclusion: APOE gene methylation may not be affected by genotype, relate to AD pathology or ApoE protein levels in the superior frontal gyrus, though, DNA methylation at the ApoE promoter differed between genotype. DNA methylation at TOMM40 associated with amyloid-β plaques and longitudinal fluid intelligence. In sum, these results suggest a complicated regulation of the TOMM40-APOE locus in the brain in controlling ApoE protein levels and AD neuropathology. Show more

Keywords: Alzheimer’s disease, APOE, DNA methylation, frontal gyrus, neuropathology, TOMM40

DOI: 10.3233/ADR-201000

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 275-282, 2021

Authors: Mold, Matthew John | O’Farrell, Adam | Morris, Benjamin | Exley, Christopher

Article Type: Research Article

Abstract: Background: Familial Alzheimer’s disease (fAD) is driven by genetic predispositions affecting the expression and metabolism of the amyloid-β protein precursor. Aluminum is a non-essential yet biologically-reactive metal implicated in the etiology of AD. Recent research has identified aluminum intricately and unequivocally associated with amyloid-β in senile plaques and, more tentatively, co-deposited with neuropil-like threads in the brains of a Colombian cohort of donors with fAD. Objective: Herein, we have assessed the co-localization of aluminum to immunolabelled phosphorylated tau to probe the potential preferential binding of aluminum to senile plaques or neurofibrillary tangles in the same Colombian kindred. …Methods: Herein, we have performed phosphorylated tau-specific immunolabelling followed by aluminum-specific fluorescence microscopy of the identical brain tissue sections via a sequential labelling method. Results: Aluminum was co-localized with immunoreactive phosphorylated tau in the brains of donors with fAD. While aluminum was predominantly co-located to neurofibrillary tangles in the temporal cortex, aluminum was more frequently co-deposited with cortical senile plaques. Conclusion: These data suggest that the co-deposition of aluminum with amyloid-β precedes that with neurofibrillary tangles. Extracellularly deposited amyloid-β may also be more immediately available to bind aluminum versus intracellular aggregates of tau. Therapeutic approaches to reduce tau have demonstrated the amelioration of its synergistic interactions with amyloid-β, ultimately reducing tau pathology and reducing neuronal loss. These data support the intricate associations of aluminum in the neuropathology of fAD, of which its subsequent reduction may further therapeutic benefits observed in ongoing clinical trials in vivo . Show more

Keywords: Aluminum in human brain tissue, amyloid-β , familial Alzheimer’s disease, neurofibrillary tangles, senile plaques, tau

DOI: 10.3233/ADR-210011

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 283-294, 2021

Authors: Rangasamy, Suresh B. | Dasarathi, Sridevi | Nutakki, Aparna | Mukherjee, Shreya | Nellivalasa, Rohith | Pahan, Kalipada

Article Type: Research Article

Abstract: Background: Parkinson’s disease (PD) is one of the most important neurodegenerative disorders in human in which recovery of functions could be achieved by improving the survival and function of residual dopaminergic neurons in the substantia nigra pars compacta. Tyrosine hydroxylase (TH) is the rate-limiting enzyme in the dopamine (DA) biosynthesis pathway. Objective: Earlier our laboratory has shown that sodium benzoate (NaB), a metabolite of cinnamon and an FDA-approved drug against urea cycle disorders and glycine encephalopathy, increases neuroprotective molecules and protects dopaminergic neurons in a mouse model of PD. Here, we examined whether NaB could stimulate the production …of DA in dopaminergic neurons. Methods: We employed PCR, real-time PCR, western blot, immunostaining, and HPLC to study the signature function of dopaminergic neurons. Locomotor functions were monitored in mice by open-field. Results: NaB increased the mRNA and protein expression of TH to produce DA in mouse MN9D dopaminergic neuronal cells. Accordingly, oral feeding of NaB increased the expression of TH in the nigra, upregulated striatal DA, and improved locomotor activities in striatum of normal C57/BL6 and aged A53T-α -syn transgenic mice. Rapid induction of cAMP response element binding (CREB) activation by NaB in dopaminergic neuronal cells and the abrogation of NaB-induced expression of TH by siRNA knockdown of CREB suggest that NaB stimulates the transcription of TH in dopaminergic neurons via CREB. Conclusion: These results indicate a new function of NaB in which it may be beneficial in PD via stimulation of DA production from residual dopaminergic neurons. Show more

Keywords: A53T, CREB, dopamine, sodium benzoate, striatum, substantia nigra pars compacta, tyrosine hydroxylase

DOI: 10.3233/ADR-210001

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 295-310, 2021

Authors: Pezzoli, Stefania | De Marco, Matteo | Zorzi, Giovanni | Cagnin, Annachiara | Venneri, Annalena

Article Type: Research Article

Abstract: Background: The presence of recurrent, complex visual hallucinations (VH) is among the core clinical features of dementia with Lewy bodies (DLB). It has been proposed that VH arise from a disrupted organization of functional brain networks. However, studies are still limited, especially investigating the resting-state functional brain features underpinning VH in patients with dementia. Objective: The aim of the present pilot study was to investigate whether there were any alterations in functional connectivity associated with VH in DLB. Methods: Seed-based analyses and independent component analysis (ICA) of resting-state fMRI scans were carried out to explore differences …in functional connectivity between DLB patients with and without VH. Results: Seed-based analyses reported decreased connectivity of the lateral geniculate nucleus, the superior parietal lobule and the putamen with the medial frontal gyrus in DLB patients with VH. Visual areas showed a pattern of both decreased and increased functional connectivity. ICA revealed between-group differences in the default mode network (DMN). Conclusion: Functional connectivity analyses suggest dysfunctional top-down and bottom-up processes and DMN-related alterations in DLB patients with VH. This impairment might foster the generation of false visual images that are misinterpreted, ultimately resulting in VH. Show more

Keywords: Dementia with Lewy bodies, functional connectivity, resting-state fMRI, resting-state networks, visual hallucinations

DOI: 10.3233/ADR-200288

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 311-320, 2021

Authors: Lo, Albert C. | Evans, Cynthia Duggan | Mancini, Michele | Wang, Hong | Shcherbinin, Sergey | Lu, Ming | Natanegara, Fanni | Willis, Brian A.

Article Type: Research Article

Abstract: Background: LY3202626 is a small molecule inhibitor of β-site amyloid precursor protein cleaving enzyme (BACE)1 shown to reduce amyloid-β (Aβ)1–40 and Aβ1–42 concentrations in plasma and cerebrospinal fluid developed for the treatment of Alzheimer’s disease (AD). Objective: To assess the change from baseline in flortaucipir positron emission tomography (PET) after treatment with LY3202626 compared with placebo in patients with mild AD dementia. Methods: Patients received daily 3 mg or 12 mg doses of LY3202626 or placebo for 52 weeks. The primary outcome was assessment of cerebral neurofibrillary tangle load by flortaucipir PET. The study was terminated …early following an interim analysis due to a low probability of identifying a statistically significant slowing of cognitive and/or functional decline. Results: A total of 316 patients were randomized and 47 completed the study. There was no statistically significant difference between placebo and either dose of LY3202626 from baseline to 52 weeks, or in annualized change for flortaucipir PET. There was no clinically meaningful difference between placebo and LY3202626 doses on efficacy measures of cognition and function. No deaths or serious adverse events considered related to LY3202626 were reported. A statistically significant increase in treatment-emergent adverse events in the psychiatric disorders system organ class was reported for both LY3202626 doses compared to placebo. Conclusion: LY3202626 tested at doses generating 70–90% BACE inhibition was generally well tolerated in this study. LY3202626 treatment did not result in a clinically significant change in cerebral tau burden as measured by flortaucipir nor in change of functional or cognitive decline compared to placebo. Show more

Keywords: Alzheimer’s disease, amyloid, neurofibrillary tangles, positron-emission tomography, tau

DOI: 10.3233/ADR-210296

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 321-336, 2021

Authors: Chung, Hojune E. | Chen, Jessica | Ghosalkar, Dhairyasheel | Christensen, Jared L. | Chu, Alice J. | Mantsounga, Chris S. | Neverson, Jade | Soares, Cullen | Shah, Nishant R. | Wu, Wen-Chih | Choudhary, Gaurav | Morrison, Alan R.

Article Type: Research Article

Abstract: Background: While an association between atherosclerosis and dementia has been identified, few studies have assessed the longitudinal relationship between aortic valve calcification (AVC) and cognitive impairment (CI). Objective: We sought to determine whether AVC derived from lung cancer screening CT (LCSCT) was associated with CI in a moderate-to-high atherosclerotic risk cohort. Methods: This was a single site, retrospective analysis of 1401 U.S. veterans (65 years [IQI: 61, 68] years; 97%male) who underwent quantification of AVC from LCSCT indicated for smoking history. The primary outcome was new diagnosis of CI identified by objective testing (Mini-Mental Status Exam …or Montreal Cognitive Assessment) or by ICD coding. Time-to-event analysis was carried out using AVC as a continuous variable. Results: Over 5 years, 110 patients (8%) were diagnosed with CI. AVC was associated with new diagnosis of CI using 3 Models for adjustment: 1) age (HR: 1.104; CI: 1.023–1.191; p  = 0.011); 2) Model 1 plus hypertension, hyperlipidemia, diabetes, CKD stage 3 or higher (glomerular filtration rate < 60 mL/min) and CAD (HR: 1.097; CI: 1.014–1.186; p  = 0.020); and 3) Model 2 plus CVA (HR: 1.094; CI: 1.011–1.182; p  = 0.024). Sensitivity analysis demonstrated that the association between AVC and new diagnosis of CI remained significant upon exclusion of severe AVC (HR: 1.100 [1.013–1.194 ]; p  = 0.023). Subgroup analysis demonstrated that this association remained significant when including education in the multivariate analysis (HR: 1.127 [1.030–1.233 ]; p  = 0.009). Conclusion: This is the first study demonstrating that among mostly male individuals who underwent LCSCT, quantified aortic valve calcification is associated with new diagnosis of CI. Show more

Keywords: Atherosclerosis, calcific aortic valve disease, computed tomography, dementia

DOI: 10.3233/ADR-200253

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 337-343, 2021

Authors: Ávila-Villanueva, Marina | Gómez-Ramírez, Jaime | Ávila, Jesús | Fernández-Blázquez, Miguel A.

Article Type: Review Article

Abstract: In recent years there has been increasing interest in examining the role of empathic abilities in Alzheimer’s disease (AD). Empathy, the ability to understand and share another person’s feelings, implies the existence of emotional and cognitive processes and is a pivotal aspect for success in social interactions. In turn, self-empathy is oriented to one’s thoughts and feelings. Decline of empathy and self-empathy can occur during the AD continuum and can be linked to different neuroanatomical pathways in which the cingulate cortex may play a crucial role. Here, we will summarize the involvement of empathic abilities through the AD continuum and …further discuss the potential neurocognitive mechanisms that contribute to decline of empathy and self-empathy in AD. Show more

Keywords: Aging, Alzheimer’s disease, anosognosia, cingulate cortex, empathy

DOI: 10.3233/ADR-200282

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 345-352, 2021

Authors: Emblad, Shayla Y.M. | Mukaetova-Ladinska, Elizabeta B.

Article Type: Research Article

Abstract: Background: Non-pharmacological therapies have been shown to be effective in managing challenging behavior in people with dementia. However, the efficacy of art therapy has yet to be determined. Objective: In the present systematic review, we evaluate the efficacy of art therapy as a non-pharmacological intervention for dementia and examine whether art therapy improves wellbeing and quality of life while decreasing biological and psychological symptoms of dementia (BPSD). Methods: Research undertaken between 2015 and 2020 was examined and a total of seventeen studies met the specified search criteria, with 853 participants (657 people with dementia, 180 formal …and informal carers, and 16 volunteers) involved. Results: We identified four outcome domains: wellbeing, quality of life, BPSD, and cognitive function. One or more significant outcomes as having an impact on the efficacy of the intervention were reported in 88% (15/17) of the studies, whereas 17% (3/17) demonstrated significant outcomes across quality of life, wellbeing, and BPSD. Conclusion: People with dementia benefit from art therapy. These interventions when incorporating elements of being ‘in the moment’ increase opportunities for communication between people with dementia and their caregiver(s) and facilitate person-centered therapeutic activities. Show more

Keywords: Art therapy, behavioral and psychological symptoms of dementia, cognition, dementia, non-pharmacological therapy, systematic review

DOI: 10.3233/ADR-201002

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 353-364, 2021

Authors: Gallucci, Maurizio | Mazzarolo, Anna Paola | Focella, Lucia | Berlin, Elisa | Fiore, Vittorio | Di Paola, Francesco | Bendini, Matteo | Zanusso, Gianluigi | Fenoglio, Chiara | Galimberti, Daniela | Bonanni, Laura

Article Type: Research Article

Abstract: Background: A 57-year-old right-handed man was admitted to the Treviso Memory Clinic due to the presence of memory forgetfulness, repetition of the same questions, episodes of confusion, initial difficulties in performing complex tasks and easy distraction over the past two years, as well as recurrent and never-happened-before car accidents. Objective: We report a peculiar case of an early onset Alzheimer’s disease (AD) with an unusual symptomatology, apparently not fitting in any of the categorized atypical forms of AD nor being representative of a typical amnestic AD. Methods: The patient underwent a neuropsychological, structural, and metabolic cerebral …evaluation by MRI and 18 F-FDG PET, together with the search for cerebral amyloid (amyloid PET), a genetic testing for dementia related genes and the dosage of CSF protein biomarkers of neurodegenerative conditions. Results: We observed a convergence of predominant frontal (dysexecutive, verbal disinhibition) and posterior (visuospatial) features of cognitive impairment. Structural MRI sequences showed subarachnoid spaces of the vault enlarged in the fronto-parietal region with anterior and posterior cortical atrophy. The hippocampus appeared preserved. The 18 F-FDG PET scans showed hypometabolism in the prefrontal, lateral temporal, posterior parietal, and occipital regions bilaterally. The 18 F-Flutemetamol scan showed a diffused uptake of the amyloid tracer at the cerebral cortex. CSF biomarkers were compatible with Alzheimer’s disease (AD). Conclusion: This case report presented with clinical phenotypic aspects atypical of AD, both frontal and posterior, never described as concomitant in the most accredited criteria for atypical AD, and appeared therefore more atypical than each of the atypical AD phenotypes already reported. Show more

Keywords: Alzheimer’s disease, frontal variant, magnetic resonance, neurodegenerative diseases, PET scan, posterior cortical atrophy, TREDEM

DOI: 10.3233/ADR-210009

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 365-374, 2021

Authors: Fereshetian, Shaunt | Agranat, Joshua S. | Siegel, Nicole | Ness, Steven | Stein, Thor D. | Subramanian, Manju L.

Article Type: Review Article

Abstract: Alzheimer’s disease (AD) is one of the most common causes of dementia worldwide. Although no formal curative therapy exists for the treatment of AD, considerable research has been performed to identify biomarkers for early detection of this disease, and thus improved subsequent management. Given that the eye can be examined and imaged non-invasively with relative ease, it has emerged as an exciting area of research for evidence of biomarkers and to aid in the early diagnosis of AD. This review explores the current understanding of both protein and retinal imaging biomarkers in the eye. Herein, primary findings in the literature …regarding AD biomarkers associated with the lens, retina, and other ocular structures are reviewed. Show more

Keywords: Alzheimer’s disease, amyloid, cataract, crystalline, eye, lens, retina, vitreous

DOI: 10.3233/ADR-210283

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 375-387, 2021

Authors: Deutsch, Curtis K. | Patnaik, Pooja P. | Greco, Frank A.

Article Type: Short Communication

Abstract: We sought to determine whether skin conductance level could warn of outbursts of combative behavior in dementia patients by using a wristband device. Two outbursts were captured and are reported here. Although no physiologic parameter measured by the wristband gave advance warning, there is a common pattern of parasympathetic withdrawal (increased heart rate) followed approximately 30 seconds later by sympathetic activation (increased skin conductance). In the literature, a similar pattern occurs in psychogenic non-epileptic seizures. We hypothesize that similar autonomic responses reflect similarities in pathophysiology and that physical activity may partially account for the time course of skin conductance.

Keywords: Autonomic nervous system, dementia, galvanic skin response, heart rate, non-epileptic seizures

DOI: 10.3233/ADR-210007

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 389-394, 2021

Authors: Barthelson, Karissa | Pederson, Stephen Martin | Newman, Morgan | Jiang, Haowei | Lardelli, Michael

Article Type: Research Article

Abstract: Background: Mutations in PRESENILIN 2 (PSEN2 ) cause early onset familial Alzheimer’s disease (EOfAD) but their mode of action remains elusive. One consistent observation for all PRESENILIN gene mutations causing EOfAD is that a transcript is produced with a reading frame terminated by the normal stop codon—the “reading frame preservation rule”. Mutations that do not obey this rule do not cause the disease. The reasons for this are debated. Objective: To predict cellular functions affected by heterozygosity for a frameshift, or a reading frame-preserving mutation in zebrafish psen2 using bioinformatic techniques. Methods: A …frameshift mutation (psen2N 140fs ) and a reading frame-preserving (in-frame) mutation (psen2T 141 _ L 142delinsMISLISV ) were previously isolated during genome editing directed at the N140 codon of zebrafish psen2 (equivalent to N141 of human PSEN2 ). We mated a pair of fish heterozygous for each mutation to generate a family of siblings including wild type and heterozygous mutant genotypes. Transcriptomes from young adult (6 months) brains of these genotypes were analyzed. Results: The in-frame mutation uniquely caused subtle, but statistically significant, changes to expression of genes involved in oxidative phosphorylation, long-term potentiation and the cell cycle. The frameshift mutation uniquely affected genes involved in Notch and MAPK signaling, extracellular matrix receptor interactions and focal adhesion. Both mutations affected ribosomal protein gene expression but in opposite directions. Conclusion: A frameshift and an in-frame mutation at the same position in zebrafish psen2 cause discrete effects. Changes in oxidative phosphorylation, long-term potentiation and the cell cycle may promote EOfAD pathogenesis in humans. Show more

Keywords: Alzheimer’s disease, mitochondria, PSEN2, RNA-seq, zebrafish

DOI: 10.3233/ADR-200279

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 395-404, 2021

Authors: Priya, Khadgawat | Siddesha, J.M. | Dharini, Shashank | Shashanka, K. Prasad

Article Type: Review Article

Abstract: Alzheimer’s disease (AD) is the primary cause of dementia affecting millions each year across the world, though still remains incurable. This might be attributed to the lack of knowledge about the associated proteins, their cellular and molecular mechanisms, and the genesis of the disease. The discovery of drugs that earlier revolved around targeting the amyloid-β cascade has now been reformed with the upgraded knowledge of the cross-seeding ability of tau protein which opens new gateways for therapeutic targets. This article provides a comprehensive review of various direct and indirect connecting pathways between the two main proteins involved in development and …progression of AD, enabling us to further expand our repertoire of information regarding the etiology of AD. The current review indicates the need for extensive research in this niche, thus considerable advances can be made in understanding AD which eventually helps to improve the current therapeutics against AD. Show more

Keywords: AGE, Alzheimer’s disease, CDK5, GSK3, oxidative stress, RAGE

DOI: 10.3233/ADR-210018

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 405-411, 2021

Authors: Lindblom, Nina | Lindquist, Lars | Westman, Jacob | Åström, Mikael | Bullock, Roger | Hendrix, Suzanne | Wahlund, Lars-Olof

Article Type: Research Article

Abstract: Background: Accumulating data suggest infectious agents are involved in Alzheimer’s disease (AD). The two primary aims of this trial were to assess safety and efficacy of an antiviral drug combination on AD progression. Objective: The trial evaluated whether Apovir, a combination of two antiviral agents, pleconaril (active on enteroviruses) and ribavirin (active on several viruses), could slow AD progression. Methods: Sixty-nine patients 60–85 years were treated with Apovir or placebo for 9 months and followed until 12 months after end of treatment. Cognitive tests, safety, biomarkers, drug plasma, and cerebrospinal fluid concentrations were assessed. …Results: The tolerability of Apovir was compromised as demonstrated by the large drop-out rate and increased frequency and severity of adverse events. The primary endpoint, demonstrating a difference in change from baseline to 9 months between groups in ADAS-cog total score, was not met (p  = 0.1809). However, there were observations indicating potential effects on both ADAS-cog and CDR-SB but these effects need to be verified. Also, there was a decrease in cerebrospinal fluid amyloid-β in Apovir at 9 months (p  = 0.0330) but no change in placebo. Conclusion: This was the first randomized, placebo controlled clinical trial exploring antiviral treatment on AD progression. The trial is considered inconclusive due to the large drop-out rate. New trials are needed to verify if the indications of effect observed can be confirmed and which component(s) in Apovir contributed to such effects. Pleconaril alone may be studied to improve the tolerability and to verify if enterovirus is involved in the disease process. Show more

Keywords: Alzheimer’s disease, amyloid-β , antiviral agents, clinical trial, infection, pleconaril, ribavirin

DOI: 10.3233/ADR-210301

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 413-431, 2021

Authors: Rodriguez, Katie | Fugard, Madison | Amini, Shawna | Smith, Glenn | Marasco, Deann | Shatzer, Julie | Guerrero, Michelle | Garvan, Cynthia | Davis, Jonathan | Price, Catherine

Article Type: Research Article

Abstract: Background: Web-based educational interventions are emerging as a potential solution to improve caregiver dementia knowledge and overall well-being. Objective: To assess the feasibility of delivering a web-based intervention for dementia caregivers by examining: 1) engagement with the online platform, 2) skill implementation, and 3) changes on outcome metrics over the 30-day study period. Methods: Enrolled participants were onboarded by a trained research coordinator and provided 24/7 access to the platform over 30 days. At study onset and completion, caregivers completed assessments of care recipient dementia severity and neuropsychiatric symptoms along with instruments which measured dementia knowledge, …caregiver burden, and carer experience. Results: Of 84 referrals, 60 caregivers met study inclusion criteria and 55 completed pre and post study measures. Caregivers completed an average of 8 hours of learning over the 30-day web-based intervention, with 84.4%of participants reporting using at least one skill they learned from the online platform. Eighty-nine percent of participants reported high satisfaction with the web-based educational intervention. There were small effect sizes for decreases in NPIQ neuropsychiatric symptom severity and caregiver distress scores from pre- to post-intervention. Small effect sizes were observed for changes in caregiver burden from pre- to post-intervention among caregivers who perceived their care recipient as having high global deterioration. Conclusion: Findings show online educational programs are feasible for informal family caregivers of dementia and have perceived value. Future studies should address caregiver response to online education in less severe versus more severe care recipients, and explore the value of caregiver online platforms in diverse caregiver samples. Show more

Keywords: Alzheimer’s disease, caregiver burden, dementia knowledge, feasibility studies, internet-based intervention, personal satisfaction

DOI: 10.3233/ADR-200292

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 433-442, 2021

Authors: Fowler, Christopher | Rainey-Smith, Stephanie R. | Bird, Sabine | Bomke, Julia | Bourgeat, Pierrick | Brown, Belinda M. | Burnham, Samantha C. | Bush, Ashley I. | Chadunow, Carolyn | Collins, Steven | Doecke, James | Doré, Vincent | Ellis, Kathryn A. | Evered, Lis | Fazlollahi, Amir | Fripp, Jurgen | Gardener, Samantha L. | Gibson, Simon | Grenfell, Robert | Harrison, Elise | Head, Richard | Jin, Liang | Kamer, Adrian | Lamb, Fiona | Lautenschlager, Nicola T. | Laws, Simon M. | Li, Qiao-Xin | Lim, Lucy | Lim, Yen Ying | Louey, Andrea | Macaulay, S. Lance | Mackintosh, Lucy | Martins, Ralph N. | Maruff, Paul | Masters, Colin L. | McBride, Simon | Milicic, Lidija | Peretti, Madeline | Pertile, Kelly | Porter, Tenielle | Radler, Morgan | Rembach, Alan | Robertson, Joanne | Rodrigues, Mark | Rowe, Christopher C. | Rumble, Rebecca | Salvado, Olivier | Savage, Greg | Silbert, Brendan | Soh, Magdalene | Sohrabi, Hamid R. | Taddei, Kevin | Taddei, Tania | Thai, Christine | Trounson, Brett | Tyrrell, Regan | Vacher, Michael | Varghese, Shiji | Villemagne, Victor L. | Weinborn, Michael | Woodward, Michael | Xia, Ying | Ames, David | the AIBL investigators

Article Type: Research Article

Abstract: Background: The Australian Imaging, Biomarkers and Lifestyle (AIBL) Study commenced in 2006 as a prospective study of 1,112 individuals (768 cognitively normal (CN), 133 with mild cognitive impairment (MCI), and 211 with Alzheimer’s disease dementia (AD)) as an ‘Inception cohort’ who underwent detailed ssessments every 18 months. Over the past decade, an additional 1247 subjects have been added as an ‘Enrichment cohort’ (as of 10 April 2019). Objective: Here we provide an overview of these Inception and Enrichment cohorts of more than 8,500 person-years of investigation. Methods: Participants underwent reassessment every 18 months including comprehensive …cognitive testing, neuroimaging (magnetic resonance imaging, MRI; positron emission tomography, PET), biofluid biomarkers and lifestyle evaluations. Results: AIBL has made major contributions to the understanding of the natural history of AD, with cognitive and biological definitions of its three major stages: preclinical, prodromal and clinical. Early deployment of Aβ-amyloid and tau molecular PET imaging and the development of more sensitive and specific blood tests have facilitated the assessment of genetic and environmental factors which affect age at onset and rates of progression. Conclusion: This fifteen-year study provides a large database of highly characterized individuals with longitudinal cognitive, imaging and lifestyle data and biofluid collections, to aid in the development of interventions to delay onset, prevent or treat AD. Harmonization with similar large longitudinal cohort studies is underway to further these aims. Show more

Keywords: Aβ-amyloid imaging, Alzheimer’s disease, biomarkers, cognition, cohort study, lifestyle, mild cognitive impairment, observational longitudinal, preclinical Alzheimer’s disease, prodromal Alzheimer’s disease

DOI: 10.3233/ADR-210005

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 443-468, 2021

Authors: Gan, Li | Wan, Xiaonan | Ma, Delin | Yang, Fu-Chen | Zhu, Jingpeng | Rogers, Robert S. | Wheatley, Joshua L. | Koch, Lauren G. | Britton, Steven L. | Thyfault, John P. | Geiger, Paige C. | Stanford, John A.

Article Type: Research Article

Abstract: Background: Aerobic capacity is associated with metabolic, cardiovascular, and neurological health. Low-capacity runner (LCR) rats display low aerobic capacity, metabolic dysfuction, and spatial memory deficits. A heat treatment (HT) can improve metabolic dysfunction in LCR peripheral organs after high fat diet (HFD). Little is known about metabolic changes in the brains of these rats following HT. Objective: Our objective was to examine the extent to which high or low aerobic capacity impacts Akt (a protein marker of metabolism) and heat shock protein 72 (HSP72, a marker of heat shock response) after HFD and HT in hippocampus. …Methods: We measured phosphorylated Akt (pAkt) in the striatum and hippocampus, and HSP72 in the hippocampus, of HFD-fed and chow-fed LCR and high-capacity runner (HCR) rats with and without HT. Results: pAkt was lower in the hippocampus of chow-fed LCR than HCR rats. HFD resulted in greater pAkt in LCR but not HCR rats, but HT resulted in lower pAkt in the LCR HFD group. HSP72 was greater in both HCR and LCR rat hippocampus after HT. The HFD blunted this effect in LCR compared to HCR hippocampus. Conclusion: The abnormal phosphorylation of Akt and diminished HSP response in the hippocampus of young adult LCR rats might indicate early vulnerability to metabolic challenges in this key brain region associated with learning and memory. Show more

Keywords: Acute high fat diet, Akt, heat treatment, intrinsic aerobic running capacity

DOI: 10.3233/ADR-200289

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 469-475, 2021

Article Type: Correction

DOI: 10.3233/ADR-219002

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 477-477, 2021

Authors: Sun, Xicui | Duan, Songwei | Cao, Anna | Villagomez, Bryan | Lin, Runxuan | Chen, Hongxia | Pi, Liya | Ren, Bin | Chen, Rong | Chen, Minjie | Ying, Zhekang | Fang, Shenyun | Cao, Qi

Article Type: Research Article

Abstract: Background: Current understanding of amyloid-β protein (Aβ) aggregation and toxicity provides an extensive list of drugs for treating Alzheimer’s disease (AD); however, one of the most promising strategies for its treatment has been tri-peptides. Objective: The aim of this study is to examine those tri-peptides, such as Arg-Arg-Try (RRY), which have the potential of Aβ1–42 aggregating inhibition and Aβ clearance. Methods: In the present study, in silico , in vitro , and in vivo studies were integrated for screening tri-peptides binding to Aβ, then evaluating its inhibition of aggregation of Aβ, and finally its …rescuing cognitive deficit. Results: In the in silico simulations, molecular docking and molecular dynamics determined that seven top-ranking tri-peptides could bind to Aβ1–42 and form stable complexes. Circular dichroism, ThT assay, and transmission electron microscope indicated the seven tri-peptides might inhibit the aggregation of Aβ1–42 in vitro . In the in vivo studies, Morris water maze, ELISA, and Diolistic staining were used, and data showed that RRY was capable of rescuing the Aβ1–42 -induced cognitive deficit, reducing the Aβ1–42 load and increasing the dendritic spines in the transgenic mouse model. Conclusion: Such converging outcomes from three consecutive studies lead us to conclude that RRY is a preferred inhibitor of Aβ1–42 aggregation and treatment for Aβ-induced cognitive deficit. Show more

Keywords: Alzheimer’s disease, amyloid-β , APP/PS1 transgenic mice, high throughput screening, small peptide

DOI: 10.3233/ADR-210012

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 479-495, 2021

Authors: Lazarou, Ioulietta | Stavropoulos, Thanos G. | Mpaltadoros, Lampros | Nikolopoulos, Spiros | Koumanakos, George | Tsolaki, Magda | Kompatsiaris, Ioannis (Yiannis)

Article Type: Research Article

Abstract: Background: Mobile Health (mHealth) apps can delay the cognitive decline of people with dementia (PwD), by providing both objective assessment and cognitive enhancement. Objective: This patient involvement survey aims to explore human factors, needs and requirements of PwD, their caregivers, and Healthcare Professionals (HCPs) with respect to supportive and interactive mHealth apps, such as brain games, medication reminders, and geolocation trackers through a constructive questionnaire. Methods: Following the principles of user-centered design to involve end-users in design we constructed a questionnaire, containing both open-ended and closed-ended questions as well as multiple choice and Likert scale, in …order to investigate the specific requirements and preferences for mHealth apps. We recruited 48 participants including people with cognitive impairment (n  = 15), caregivers (n  = 16), and HCPs (n  = 17) and administered the questionnaire. Results: All participants are likely to use mHealth apps, with the primary desired features being the improvement of memory and cognition, assistance on medication treatment, and perceived ease to use. HCPs, caregivers, and PwD consider brain games as an important technology-based, non-pharmaceutical intervention. Both caregivers and patients are willing to use a medication reminder app frequently. Finally, caregivers are worried about the patient wandering. Therefore, global positioning system tracking would be particularly important to them. On the other hand, patients are concerned about their privacy, but are still willing to use a geolocation app for cases of emergency. Conclusion: This research contributes to mHealth app design and potential adoption. All three groups agree that mHealth services could facilitate care and ameliorate behavioral and cognitive disturbances of patients. Show more

Keywords: Alzheimer’s disease, apps, eHealth, information technologies, mHealth, mild cognitive impairment, remote monitoring, serious games, telemedicine

DOI: 10.3233/ADR-201001

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 497-513, 2021

Authors: Fernandes, Mariana | Placidi, Fabio | Mercuri, Nicola Biagio | Liguori, Claudio

Article Type: Review Article

Abstract: Obstructive sleep apnea (OSA) is a highly frequent sleep disorder in the middle-aged and older population, and it has been associated with an increased risk of developing cognitive decline and dementia, including mild cognitive impairment (MCI) and Alzheimer’s disease (AD). In more recent years, a growing number of studies have focused on: 1) the presence of OSA in patients with MCI or AD, 2) the link between OSA and markers of AD pathology, and 3) the role of OSA in accelerating cognitive deterioration in patients with MCI or AD. Moreover, some studies have also assessed the effects of continuous positive …airway pressure (CPAP) treatment on the cognitive trajectory in MCI and AD patients with comorbid OSA. This narrative review summarizes the findings of studies that analyzed OSA as a risk factor for developing MCI and/or AD in the middle-aged and older populations with a special focus on cognition. In addition, it describes the results regarding the effects of CPAP treatment in hampering the progressive cognitive decline in AD and delaying the conversion to AD in MCI patients. Considering the importance of identifying and treating OSA in patients with MCI or AD in order to prevent or reduce the progression of cognitive decline, further larger and adequately powered studies are needed both to support these findings and to set programs for the early recognition of OSA in patients with cognitive impairment. Show more

Keywords: Alzheimer’s disease, cognitive impairment, continuous positive airway pressure, neuropsychological function, sleep-disordered breathing

DOI: 10.3233/ADR-210004

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 515-533, 2021

Authors: Zhong, Wenjun | Liu, Xinyue | Voss, Tiffini | Khalilieh, Sauzanne | Khandker, Rezaul Karim | Bortnichak, Edward | Liaw, Kai-Li

Article Type: Research Article

Abstract: Background: Behavioral disturbance (BD) is common in dementia patients, with no FDA approved medications for this condition. Little data exists on the real-world medication use in this population. Objective: To describe real-world medications use in this population. Methods: A cross-sectional study was conducted using the MarketScan database for outpatient medications and the Cerner database for inpatient medications. The study period was Oct 2015–Jun 2018. Patients with dementia and BD were identified through ICD-10-CM. We examined outpatient medications prescribed during 6-month before or after BD event date, and inpatient medications during inpatient visits, especially on central nervous …systems (CNS) drugs including antidementia drugs, antidepressants, antipsychotics, anxiolytics, and anticonvulsants. Results: A total of 56,544 outpatients and 34,245 patient hospitalizations were assessed separately. Among outpatients, patients filled more medications after a BD event. The use of the five CNS drug classes generally increased after a BD event, and the largest increase was seen in antipsychotics (23%to 33%). Among inpatients, the median number of medications used in each hospitalization was 14. The use of antipsychotics was particularly high (64%), followed by anxiolytics (51%). A list of 60 unique medications were suggested to be the commonly used drugs in dementia patients with BD. Conclusion: In dementia patients with BD, anti-dementia medications, antidepressants, anticonvulsants, hypnotics and antipsychotics were the most used drug classes. Antidepressants and antipsychotics use were more frequent after a BD event, which suggests a need for safe drugs targeting BD in dementia patients. Show more

Keywords: Behavioral disturbance, Cerner Health Facts, dementia, IBM Marketscan, prescriptions

DOI: 10.3233/ADR-210023

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 535-540, 2021

Authors: Levy, Sigal | Guttmann-Beck, Nili | Shweiki, Dorit

Article Type: Research Article

Abstract: Background: The multiple appearance phenotypes in Alzheimer’s disease (AD) are manifested in epidemiologic sexual dimorphism, variation in age of onset, progress, and severity of the disease. Objective: In this study, we focused on sexual dimorphism, aiming to untie some of the complex interconnections in AD between sex, disease status, and gene expression profiles. Two strategic decisions guided our study: 1) to value transcriptomic multi-layered profiles over alterations in single genes expression; and 2) to embrace a sexual dimorphism centered approach, as we suspect that transcriptomic profiles may dramatically differ not only between healthy and sick individuals but between …men and women as well. Methods: Microarray dataset GSE15222, fulfilling our strict criteria, was retrieved from the GEO repository. We performed cluster analysis for each sex separately, comparing the proportion of healthy and AD individuals in each cluster. Results: We were able to identify a biased, female, AD-typified cluster. Furthermore, we showed that this female AD-typified cluster is highly similar to one of the male clusters. While the female cluster constitutes mostly sick individuals, the male cluster constitutes healthy and sick individuals in almost identical proportion. Conclusion: Our results clearly indicate that similar transcriptomic profiles in the two sexes are “physiologically translated” in to a very different, dramatic outcome. Thus, our results suggest the need for a sex-based and transcriptomic profile-based study, for a better understanding of the onset and progression of AD. Show more

Keywords: Alzheimer’s disease, early onset Alzheimer’s disease, functional genomics, gene expression profiling, P-center cluster analysis, sexual dimorphism

DOI: 10.3233/ADR-210014

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 541-547, 2021

Authors: Huang, Jie | Beach, Paul | Bozoki, Andrea | Zhu, David C.

Article Type: Research Article

Abstract: Background: Postmortem studies of brains with Alzheimer’s disease (AD) not only find amyloid-beta (Aβ) and neurofibrillary tangles (NFT) in the visual cortex, but also reveal temporally sequential changes in AD pathology from higher-order association areas to lower-order areas and then primary visual area (V1) with disease progression. Objective: This study investigated the effect of AD severity on visual functional network. Methods: Eight severe AD (SAD) patients, 11 mild/moderate AD (MAD), and 26 healthy senior (HS) controls undertook a resting-state fMRI (rs-fMRI) and a task fMRI of viewing face photos. A resting-state visual functional connectivity (FC) network …and a face-evoked visual-processing network were identified for each group. Results: For the HS, the identified group-mean face-evoked visual-processing network in the ventral pathway started from V1 and ended within the fusiform gyrus. In contrast, the resting-state visual FC network was mainly confined within the visual cortex. AD disrupted these two functional networks in a similar severity dependent manner: the more severe the cognitive impairment, the greater reduction in network connectivity. For the face-evoked visual-processing network, MAD disrupted and reduced activation mainly in the higher-order visual association areas, with SAD further disrupting and reducing activation in the lower-order areas. Conclusion: These findings provide a functional corollary to the canonical view of the temporally sequential advancement of AD pathology through visual cortical areas. The association of the disruption of functional networks, especially the face-evoked visual-processing network, with AD severity suggests a potential predictor or biomarker of AD progression. Show more

Keywords: Alzheimer’s disease, face-evoked visual-processing network, FAUPA, functional areas of unitary pooled activity, resting-state visual functional connectivity network

DOI: 10.3233/ADR-210017

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 549-562, 2021

Authors: Mendez, Mario F.

Article Type: Correction

DOI: 10.3233/ADR-219003

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 563-563, 2021

Authors: Barclay, Sarah F. | Potocki, Kendra | Burles, Ford | Bech-Hansen, N. Torben | Iaria, Giuseppe

Article Type: Short Communication

Abstract: The three common alleles of the APOE gene, ɛ2/ɛ3/ɛ4, have been linked to human spatial orientation. We investigated the genetic role of APOE in developmental topographical disorientation (DTD), a lifelong condition that results in topographical disorientation. We genotyped the APOE ɛ2/ɛ3/ɛ4 alleles in a cohort of 20 unrelated DTD probands, and found allele frequencies not statistically different from the those seen in the population as a whole. Therefore, we found no evidence that DTD occurs preferentially on a genetic background containing any particular APOE allele, making it unlikely that these APOE alleles are contributing to …the development of DTD. Show more

Keywords: Cognition disorders, genotype, memory, navigation, spatial learning

DOI: 10.3233/ADR-210304

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 565-570, 2021

Authors: Paley, Elena L.

Article Type: Research Article

Abstract: Background: COVID-19 can be related to any diseases caused by microbial infection(s) because 1) co-infection with COVID-19-related virus and other microorganism(s) and 2) because metabolites produced by microorganisms such as bacteria, fungi, and protozoan can be involved in necrotizing pneumonia and other necrotizing medical conditions observed in COVID-19. Objective: By way of illustration, the microbial metabolite of aromatic amino acid tryptophan, a biogenic amine tryptamine inducing neurodegeneration in cell and animal models, also induces necrosis. Methods: This report includes analysis of COVID-19 positivity by zip codes in Florida and relation of the positivity to population density, …possible effect of ecological and social factors on spread of COVID-19, autopsy analysis of COVID-19 cases from around the world, serum metabolomics analysis, and evaluation of autoantigenome related to COVID-19. Results: In the present estimations, COVID-19 positivity percent per zip code population varied in Florida from 4.65% to 44.3% (February 2021 data). COVID-19 analysis is partially included in my book Microbial Metabolism and Disease (2021). The autoantigenome related to COVID-19 is characterized by alterations in protein biosynthesis proteins including aminoacyl-tRNA synthetases. Protein biosynthesis alteration is a feature of Alzheimer’s disease. Serum metabolomics of COVID-19 positive patients show alteration in shikimate pathway metabolism, which is associated with the presence of Alzheimer’s disease-associated human gut bacteria. Conclusion: Such alterations in microbial metabolism and protein biosynthesis can lead to toxicity and neurodegeneration as described earlier in my book Protein Biosynthesis Interference in Disease (2020). Show more

Keywords: Aminoacyl-tRNA synthetases, biogenic amines, co-infections, COVID-19, microbial metabolism, necrotizing factor, protein biosynthesis, shikimate pathway, tryptamine, tryptophan metabolism

DOI: 10.3233/ADR-210010

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 571-600, 2021

Authors: Li, Danni | Zhang, Lin | Nelson, Nathaniel W. | Mielke, Michelle M. | Yu, Fang

Article Type: Research Article

Abstract: Background: Utilities of blood-based biomarkers in Alzheimer’s disease (AD) clinical trials remain unknown. Objective: To evaluate the ability of plasma neurofilament light chain (NfL) to predict future declines in cognition and activities of daily living (ADL) outcomes in 26 older adults with mild-to-moderate AD dementia from the FIT-AD Trial. Methods: Plasma NfL was measured at baseline and 3 and 6 months. Cognition and ADL were assessed using the AD Assessment Scale-Cognition (ADAS-Cog) and AD Uniform Dataset Instruments and Disability Assessment for Dementia (DAD), respectively, at baseline, 3, 6, 9, and 12 months. Linear mixed effects models …were used to examine the associations between baseline or change in plasma NfL and changes in outcomes. Results: Higher baseline plasma NfL was associated with greater rate of decline in ADAS-Cog from baseline to 6 months (standardized estimate of 0.00462, p  = 0.02853) and in ADL from baseline to 12 months (standardized estimate of –0.00284, p  = 0.03338). Greater increase in plasma NfL in short term from baseline to 3 months was associated with greater rate of decline in memory and ADL from 3 to 6 months (standardized estimate of –0.04638 [0.003], p  = 0.01635; standardized estimate of –0.03818, p  = 0.0435) and greater rate of decline in ADL from 3 to 12 month (standardized estimate of –0.01492, p  = 0.01082). Conclusion: This study demonstrated that plasma NfL might have the potential to predict cognitive and function decline up to 12 months. However, future studies with bigger sample sizes need to confirm the findings. Show more

Keywords: Activities of daily living, ADAS-Cog, Alzheimer’s disease, blood-based biomarkers, cognition, longitudinal, neurofilament light

DOI: 10.3233/ADR-210302

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 601-611, 2021

Authors: Muñiz, Ruben | López-Álvarez, Jorge | Perea, Luis | Rivera, Sofía | González, Liliana | Olazarán, Javier

Article Type: Research Article

Abstract: Background: Over- and potentially inappropriate prescribing of psychotropic medications is a major public health concern among people with dementia. Objective: Describe the CH emical R estraints avO idance ME thodology (CHROME) criteria and evaluate its effects on psychotropic prescribing and quality of life (QoL). Methods: Observational, prospective, two-wave study conducted in two nursing homes. A multicomponent program to eliminate chemical restraints and attain quality prescription of psychotropic medications was implemented. CHROME’s diagnostic criteria comprise constellations of behavioral and psychological symptoms of dementia under six primary syndromic diagnoses. Since pharmacologic treatment is aimed at only one syndrome, …polypharmacy is avoided. Psychotropic prescription, QoL, neuropsychiatric symptoms (NPS), and other clinical measurements were collected before and one year after the intervention. Results are presented for all residents (n  = 171) and for completer subjects (n  = 115). Results: Mean age (SD) of the residents was 87.8 (5.7), 78.9% were women, and 68.5% suffered advanced dementia. Psychotropic prescriptions decreased from 1.9 (1.1) to 0.9 (1.0) (p  < 0.0005). Substantive reduction in prescribing frequency was observed for antidepressants (76.9% pre-intervention, 33.8% post-intervention) and for atypical neuroleptics (38.8% pre-intervention, 15.1% post-intervention). There was improvement in patient’s response to surroundings (p  < 0.0005) and total NPS (p  < 0.01), but small worsening occurred in social interaction (p  < 0.02, completer subjects). Safety measurements remained stable. Conclusion: CHROME criteria appear to optimize psychotropic prescriptions, avoid chemical restraints, and allow external verification of quality prescriptions. Extensive use seems feasible, related to substantial reduction of prescriptions, and of benefit for people with dementia as de-prescriptions are not associated to increased NPS or QoL loss. Show more

Keywords: Chemical restraint, dementia, neuropsychiatric symptoms, nursing home, psychotropic medications, quality of life

DOI: 10.3233/ADR-210015

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 613-624, 2021

Authors: Richards, Emma | Tales, Andrea | Bayer, Antony | Norris, Jade E. | Hanley, Claire J. | Thornton, Ian M.

Article Type: Research Article

Abstract: Background: The study of reaction time (RT) and its intraindividual variability (IIV) in aging, cognitive impairment, and dementia typically fails to investigate the processing stages that contribute to an overall response. Applying “mental chronometry” techniques makes it possible to separately assess the role of processing components during environmental interaction. Objective: To determine whether RT and IIV-decomposition techniques can shed light on the nature of underlying deficits in subcortical ischemic vascular cognitive impairment (VCI). Using a novel iPad task, we examined whether VCI deficits occur during both initiation and movement phases of a response, and whether they are equally …reflected in both RT and IIV. Methods: Touch cancellation RT and its IIV were measured in a group of younger adults (n  = 22), cognitively healthy older adults (n  = 21), and patients with VCI (n  = 21) using an iPad task. Results: Whereas cognitively healthy aging affected the speed (RT) of response initiation and movement but not its variability (IIV), VCI resulted in both slowed RT and increased IIV for both response phases. Furthermore, there were group differences with respect to response phase. Conclusion: These results indicate that IIV can be more sensitive than absolute RT in separating VCI from normal aging. Furthermore, compared to cognitively healthy aging, VCI was characterized by significant deficits in planning/initiating action as well as performing movements. Such deficits have important implications for real life actions such as driving safety, employment, and falls risk. Show more

Keywords: Aging, attention, cerebral small vessel disease, dementia, intra-individual variability, mental chronometry, reaction time, stimulus response/movement initiation & control, vascular cognitive impairment

DOI: 10.3233/ADR-210029

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 625-636, 2021

Authors: Daly, Timothy | Houot, Marion | Barberousse, Anouk | Petit, Amélie | Epelbaum, Stéphane

Article Type: Research Article

Abstract: Background: Therapeutic research into Alzheimer’s disease (AD) has been dominated by the amyloid cascade hypothesis (ACH) since the 1990s. However, targeting amyloid in AD patients has not yet resulted in highly significant disease-modifying effects. Furthermore, other promising theories of AD etiology exist. Objective: We sought to directly investigate whether the ACH still dominates the opinions of researchers working on AD and explore the implications of this question for future directions of research. Methods: During 2019, we undertook an international survey promoted with the help of the Alzheimer’s Association with questions on theories and treatments of AD. …Further efforts to promote a similar study in 2021 did not recruit a significant number of participants. Results: 173 researchers took part in the 2019 survey, 22% of which held “pro-ACH” opinions, tended to have more publications, were more likely to be male, and over 60. Thus, pro-ACH may now be a minority opinion in the field but is nevertheless the hypothesis on which the most clinical trials are based, suggestive of a representation bias. Popular vote of all 173 participants suggested that lifestyle treatments and anti-tau drugs were a source of more therapeutic optimism than anti-amyloid treatments. Conclusion: We propose a more democratic research structure which increases the likelihood that promising theories are published and funded fairly, promotes a broader scientific view of AD, and reduces the larger community’s dependence on a fragile economic model. Show more

Keywords: Alzheimer’s disease, amyloid-β , dementia prevention, diversity in science, gender, lifestyle factors, lifestyle interventions, pharmaceutical industry, tau protein, women in science

DOI: 10.3233/ADR-210030

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 637-645, 2021

Authors: Chakrabarti, Sudipta | Prorok, Tim | Roy, Avik | Patel, Dhruv | Dasarathi, Sridevi | Pahan, Kalipada

Article Type: Research Article

Abstract: Background: Neuroinflammation is a recognized aspect of Alzheimer’s disease (AD) and other neurological illnesses. Interleukin 1 receptor antagonist (IL-1Ra) is an anti-inflammatory molecule, which inhibits inflammatory molecules in different cells including brain cells. However, mechanisms for upregulating IL-1Ra in brain cells are poorly understood. Objective: Since aspirin is a widely available pain reliever that shows promise beyond its known pain-relieving capacity, we examined whether aspirin could upregulate the IL-1Ra in the brain. Methods: We employed PCR, real-time PCR, western blot, immunostaining, chromatin immunoprecipitation (ChIP), and lentiviral transduction in glial cells. 5xFAD mice, an animal model of …AD, were treated with aspirin orally via gavage. Results: Aspirin increased the expression of IL-1Ra mRNA and protein in primary mouse astrocytes and mouse BV-2 microglial cells. While investigating the mechanism, we found that the IL-1Ra gene promoter harbors peroxisome proliferator response element (PPRE) and that aspirin upregulated IL-1Ra in astrocytes isolated from peroxisome proliferator-activated receptor-beta knockout (PPARβ–/– ), but not PPARα–/– , mice. Moreover, we observed that aspirin bound to tyrosine 314 residue of PPARα to stimulate IL-1Ra and that aspirin treatment also increased the recruitment of PPARα to the IL-1Ra promoter. Accordingly, aspirin increased IL-1Ra in vivo in the brain of wild type and PPARβ–/– , but not in PPARα–/– mice. Similarly, aspirin treatment also increased astroglial and microglial IL-1Ra in the cortex of 5xFAD, but not 5xFAD/PPARα–/– mice. Conclusion: Aspirin may reduce the severity of different neurological conditions by upregulating IL-1Ra and reducing the inflammation. Show more

Keywords: 5xFAD model, aspirin, astrocytes, IL-1Ra, microglia, PPARα

DOI: 10.3233/ADR-210026

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 647-661, 2021

Authors: Panegyres, Peter K.

Article Type: Research Article

Abstract: Background: Dementia is a major global health problem and the search for improved therapies is ongoing. The study of young onset dementia (YOD)—with onset prior to 65 years—represents a challenge owing to the variety of clinical presentations, pathology, and gene mutations. The advantage of the investigation of YOD is the lack of comorbidities that complicate the clinical picture in older adults. Here we explore the origins of YOD. Objective: To define the clinical diversity of YOD in terms of its demography, range of presentations, neurological examination findings, comorbidities, medical history, cognitive findings, imaging abnormalities both structural and functional, …electroencephagraphic (EEG) data, neuropathology, and genetics. Methods: A prospective 20-year study of 240 community-based patients referred to specialty neurology clinics established to elucidate the nature of YOD. Results: Alzheimer’s disease (AD; n  = 139) and behavioral variant frontotemporal (bvFTD; n  = 58) were the most common causes with a mean age of onset of 56.5 years for AD (±1 SD 5.45) and 57.1 years for bvFTD (±1 SD 5.66). Neuropathology showed a variety of diagnoses from multiple sclerosis, Lewy body disease, FTD-MND, TDP-43 proteinopathy, adult-onset leukoencephalopathy with axonal steroids and pigmented glia, corticobasal degeneration, unexplained small vessel disease, and autoimmune T-cell encephalitis. Non-amnestic forms of AD and alternative forms of FTD were discovered. Mutations were only found in 11 subjects (11/240 = 4.6%). APOE genotyping was not divergent between the two populations. Conclusion: There are multiple kinds of YOD, and most are sporadic. These observations point to their stochastic origins. Show more

Keywords: Neurodegeneration, sporadic onset, stochasticity, young onset dementia

DOI: 10.3233/ADR-210309

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 663-679, 2021

Authors: Ambegaonkar, Anjay | Ritchie, Craig | de la Fuente Garcia, Sofia

Article Type: Review Article

Abstract: Background: Communication difficulties are one of the primary symptoms associated with dementia, and mobile applications have shown promise as tools for facilitating communication in patients with dementia (PwD). The literature regarding mobile health (mHealth) applications, especially communications-based mHealth applications, is limited. Objective: This review aims to compile the existing literature on communications-based mobile applications regarding dementia and assess their opportunities and limitations. A PICO framework was applied with a Population consisting of PwD, Interventions consisting of communication technology, focusing primarily on mobile applications, Comparisons between patient well-being with and without technological intervention, and Outcomes that vary but can …include usability of technology, quality of communication, and user acceptance. Methods: Searches of PubMed, IEEE XPLORE, and ACM Digital Library databases were conducted to establish a comprehensive understanding of the current literature on dementia care as related to 1) mobile applications, 2) communication technology, and 3) communications-based mobile applications. Applying certain inclusion and exclusion criteria, yielded a set of articles (n  = 11). Results: The literature suggests that mobile applications as tools for facilitating communication in PwD are promising. Mobile applications are not only feasible socially, logistically, and financially, but also produce meaningful communication improvements in PwD and their caregivers. However, the number of satisfactory communications-based mobile applications in the mHealth marketplace and their usability is still insufficient. Conclusion: Despite favorable outcomes, more research involving PwD using these applications are imperative to shed further light on their communication needs and on the role of mHealth. Show more

Keywords: Caregiver, communication, dementia, mobile applications

DOI: 10.3233/ADR-200259

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 681-692, 2021

Authors: Hakim, Md A. | Behringer, Erik J.

Article Type: Research Article

Abstract: Background: As the sixth-leading cause of death in the United States, Alzheimer’s disease (AD) entails deteriorating endothelial control of blood flow throughout the brain. In particular, reduced inward-rectifying K+ (KIR ) channel function in animal models of aging and AD compromises endothelial function and optimal perfusion of brain parenchyma. Deficient endothelial KIR channels may result from aberrant interaction with plasma membrane cholesterol as a primary regulator of membrane fluidity and ion channels. Objective: We tested the hypothesis that mild methyl-β-cyclodextrin (MβCD) treatment to reduce membrane cholesterol may restore endothelial KIR channel function in brain endothelium …of old AD mice. Methods: Membrane potential was continuously measured in isolated endothelial tubes from posterior cerebral arteries of young (1 to 3 months) and old (16 to 19 months) female 3xTg-AD mice before and after mild treatment with the cholesterol-removing agent MβCD (1 mmol/L). Elevated extracellular potassium ([K+ ]E ; 15 mmol/L) and NS309 (1μmol/L) activated KIR and Ca2+ -activated K+ (SKCa /IKCa ) channels respectively before and after MβCD treatment. Results: SKCa /IKCa channel function for producing hyperpolarization remained stable regardless of age group and MβCD treatment (Δ Vm : ∼–33 mV). However, as deficient during AD, KIR channel function was restored (Δ Vm : –9±1 mV) versus pre-MβCD conditions (–5±1 mV); a progressive effect that reached –14±1 mV hyperpolarization at 60 min following MβCD washout. Conclusion: In female animals, MβCD treatment of brain endothelium selectively restores KIR versus SKCa /IKCa channel function during AD. Thus, the endothelial cholesterol-KIR channel interface is a novel target for ameliorating perfusion of the AD brain. Show more

Keywords: Alzheimer’s disease, brain endothelium, cholesterol, K+ ion channels

DOI: 10.3233/ADR-210016

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 693-703, 2021

Authors: Yunusa, Ismaeel | Alsahali, Saud | Rane, Amey | Eguale, Tewodros

Article Type: Research Article

Abstract: Background: Pharmacological treatment of Alzheimer’s disease (AD) involves symptomatic improvement of cognition using cholinesterase inhibitors (ChEIs) and memantine. The cost-effectiveness of these medications will guide decision-makers in making judicious use of scarce healthcare resources, particularly during the advanced disease stages. Objective: To evaluate the cost-effectiveness of ChEIs, memantine, and ChEI-memantine combinations in persons with moderate-to-severe AD from the US healthcare perspective. Methods: This pharmacoeconomic evaluation study used a state-transition Markov cohort model to simulate the costs and effectiveness of ChEI-memantine combinations compared with monotherapies of ChEI (donepezil, galantamine and rivastigmine) and memantine in persons with moderate-to-severe …AD over a lifetime horizon with a 1-year cycle length. We estimated expected quality-adjusted life-years (QALYs), costs (in 2020 $US), net monetary benefits, and incremental cost-effectiveness ratios (ICERs). We discounted future costs and QALYs at the rate of 3%. Results: In this study, donepezil monotherapy, galantamine-memantine combination, and rivastigmine transdermal patch formed the cost-effectiveness frontier. Findings suggests that rivastigmine transdermal patch is the optimal treatment strategy at a willingness-to-pay (WTP) threshold of $150,000/QALY (ICER = $93,307/QALY [versus donepezil monotherapy]). Results across subgroups by age and sex also suggest that the rivastigmine transdermal patch is the optimal treatment strategy with the highest net benefit. Conclusion: From the US healthcare perspective, we found that, for persons with moderate-to-severe AD at a WTP threshold of $150,000/QALY, the rivastigmine transdermal patch is the most cost-effective pharmacological treatment option. Given that the transdermal patch is a preferred route of administration for persons with AD and their caregivers due to its convenience, our findings provide additional incentives for its use. Show more

Keywords: Alzheimer’s disease, cholinesterase inhibitors, cost-effectiveness analysis, donepezil, memantine, quality-adjusted life years, rivastigmine

DOI: 10.3233/ADR-210307

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 705-713, 2021

Authors: Giannouli, Vaitsa | Tsolaki, Magda

Article Type: Short Communication

Abstract: Neuropsychological assessment in amnestic mild cognitive impairment (aMCI) becomes complicated when education-literacy is taken into consideration. This study sought to explore the potential influence of literacy/illiteracy and education on financial capacity in patients with multiple-domain aMCI. Six groups consisting of aMCI (illiterate-no formal education, literate with low education, and literate with high education) and non-demented controls were examined. Literacy has an effect on financial capacity, as the illiterate aMCI group alone had the lowest scores in a financial capacity test resembling the performance of patients with mild Alzheimer’s disease. In controls there was a similar pattern, but all three healthy …groups regardless of education scored above the cut-off score for incapacity. Show more

Keywords: Amnestic mild cognitive impairment, financial capacity, literacy/illiteracy

DOI: 10.3233/ADR-210033

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 715-719, 2021

Authors: Elwishahy, Abdelrahman | Antia, Khatia | Bhusari, Sneha | Ilechukwu, Nkorika Chiamaka | Horstick, Olaf | Winkler, Volker

Article Type: Research Article

Abstract: Background: Alzheimer’s disease (AD) is a chronic neurodegenerative disease that accounts for more than 50% of all dementia cases worldwide. There is wide consensus on the risk factors of AD; however, a clear etiology remains unknown. Evidence suggests that the inflammatory-mediated disease model, such as that found with periodontal disease due to Porphyromonas gingivalis (P. gingivalis ), plays a role in AD progression. Objective: This study aims to systematically review the literature on the association between P. gingivalis to AD, and to identify the homogeneity of the methods used across studies to measure P. gingivalis …involvement in AD. Methods: We systematically searched studies on Cochrane library, Ovid Medline, PubMed, Web of Science, WHOLIS, Google Scholar databases, and reference lists of identified studies. Results: 6 studies out of 636 identified records fulfilled all eligibility criteria. Results showed no clear pathophysiology of AD due to P. gingivalis and its various virulence factors. No consensus was found in the literature pertaining to the method of measurement of AD or P. gingivalis and its virulence factors. Conclusion: The included studies suggest that P. gingivalis bacteria play a role in the process of systemic inflammation which leads to cerebrospinal fluid inflammation and indirectly cause hastening of AD onset and progression. Our included studies revealed heterogeneity in the methodologies of measurement of AD and/or P. gingivalis and its virulence factors, which opens discussion about the benefits and weakness of possible standardization. Show more

Keywords: Alzheimer’s disease, dementia, geriatrics, P. gingivalis , periodontitis, systematic review

DOI: 10.3233/ADR-200237

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 721-732, 2021

Authors: Paley, Elena L.

Article Type: Research Article

Abstract: The author discussed recently the possible molecular mechanisms that cause the COVID-19 disease symptoms. Here the analysis of the recent experimental data supports the hypothesis that production of the gut microbial tryptamine can be induced by the SARS-CoV-2 fecal viral activity due to the selective pressure or positive selection of tryptamine-producing microorganisms. In this report, the author suggests that the mechanism of microbial selection bases on the abilities of tryptamine to affect the viral nucleic acid. In other words, the gut microorganisms producing tryptamine are more resistant to SARS-CoV-2 fecal viral activity than microorganisms producing no tryptamine. Earlier we demonstrated …the induction of neurodegeneration by tryptamine in human cells and mouse brain. Furthermore, we were able to uncover the human gut bacteria associated with Alzheimer’s disease (AD) using PCR testing of human fecal samples with the new-designed primers targeting the tryptophan-tryptamine pathway. Likely, SARS-CoV-2 is one of the selective pressure factors in the cascade accelerating the neurodegenerative process in AD. This suggestion is consistent with a higher proportion of AD patients among COVID-19 related victims. Gut microbial tryptamine increase due to the viral infection-induced dysbiosis can synergize and potentiate the tryptamine cytotoxicity, necrotizing ability and other properties as a virulence factor. Show more

Keywords: Alzheimer’s disease, COVID-19, dysbiosis, human gut microbiome biogenic amines, necrotizing ability, PCR testing, SARS-CoV-2, tryptamine-induced model of neurodegeneration, tryptophanyl-tRNA synthetase

DOI: 10.3233/ADR-210032

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 733-738, 2021

Authors: O’Caoimh, Rónán | Calnan, Mareeta | Dhar, Arup | Molloy, D. William

Article Type: Research Article

Abstract: Background: Although caregiver burden is common among carers of people with dementia, little is known about its prevalence and predictors among caregivers of patients attending memory clinics. Objective: To examine carer and patient-specific characteristics associated with caregiver burden across the cognitive spectrum in a memory clinic population. Methods: Consecutive patients referred to a university hospital geriatric memory clinic were included. Caregiver burden was scored using the Caregiver Burden Score (CBS), (modified Zarit), with scores≥15/30 suggesting burden. BPSD were measured with the dysfunctional behaviour rating instrument (DBRI). Cognition was screened using the Montreal Cognitive Assessment (MoCA) and …Quick Mild Cognitive Impairment (Qmci ) screen. Results: In all, 351 patients were included, median age 77 (±11) years; 65.5% were female. The prevalence of caregiver burden was 33.6% overall, increasing from 10.8% in subjective cognitive decline (SCD), to 15% in mild cognitive impairment (MCI) and 43% in dementia; CBS scores were significantly higher in dementia (p  < 0.001). Caregivers with burden were significantly younger (p  = 0.045) and were more likely to be adult children (p  = 0.007). The CBS weakly correlated with the stage of cognitive impairment (r  = 0.16) but had moderate correlation with MoCA (r  = –0.54) and Qmci scores (r  = –0.60). After adjustment for co-variates, DBRI scores alone independently predicted burden (odds ratio 1.23;1.11–1.35, p  < 0.001). Conclusion: Caregiver burden is associated with the stage of cognitive impairment, with higher prevalence proportions in those with dementia compared with MCI and SCD. Only the severity of neuropsychiatric symptoms independently predicted caregiver burden in this population and its presence should prompt assessment for burden. Show more

Keywords: Caregiver burden, carers, dementia, memory clinic, mild cognitive impairment, predictors, prevalence

DOI: 10.3233/ADR-201003

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 739-747, 2021

Authors: Habiba, Umma | Ozawa, Makiko | Chambers, James K. | Uchida, Kazuyuki | Descallar, Joseph | Nakayama, Hiroyuki | Summers, Brian A. | Morley, John W. | Tayebi, Mourad

Article Type: Research Article

Abstract: Background: Canine cognitive dysfunction (CCD) is a progressive syndrome recognized in mature to aged dogs with a variety of neuropathological changes similar to human Alzheimer’s disease (AD), for which it is thought to be a good natural model. However, the presence of hyperphosphorylated tau protein (p-Tau) in dogs with CCD has only been demonstrated infrequently. Objective: The aim of the present study was to investigate the presence of p-Tau and amyloid-β oligomer (Aβo) in cerebral cortex and hippocampus of dogs with CCD, with focus on an epitope retrieval protocol to unmask p-Tau. Methods: Immunohistochemical and immunofluorescence …analysis of the cortical and hippocampal regions of five CCD-affected and two nondemented aged dogs using 4G8 anti-Aβp, anti-Aβ1 - 42 nanobody (PrioAD13) and AT8 anti-p-Tau (Ser202, Thr205) antibody were used to demonstrate the presence of Aβ plaques (Aβp) and Aβ1 - 42 oligomers and p-Tau deposits, respectively. Results: The extracellular Aβ senile plaques were of the diffuse type which lack the dense core normally seen in human AD. While p-Tau deposits displayed a widespread pattern and closely resembled the typical human neuropathology, they did not co-localize with the Aβp. Of considerable interest, however, widespread intraneuronal deposition of Aβ1 - 42 oligomers were exhibited in the frontal cortex and hippocampal region that co-localized with p-Tau. Conclusion: Taken together, these findings reveal further shared neuropathologic features of AD and CCD, supporting the case that aged dogs afflicted with CCD offer a relevant model for investigating human AD. Show more

Keywords: Alzheimer’s disease, Aβ1 - 42 oligomers, amyloid-β plaques, canine cognitive dysfunction, hyperphosphorylated tau

DOI: 10.3233/ADR-210035

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 749-760, 2021

Authors: Hu, Chaur-Jong | Chiu, Ming-Jang | Pai, Ming-Chyi | Yan, Sui-Hing | Wang, Pei-Ning | Chiu, Pai-Yi | Lin, Chin-Hsien | Chen, Ta-Fu | Yang, Fu-Chi | Huang, Kuo-Lun | Hsu, Yi-Ting | Hou, Yi-Chou | Lin, Wei-Che | Lu, Cheng-Hsien | Huang, Li-Kai | Yang, Shieh-Yueh

Article Type: Research Article

Abstract: Background: In Alzheimer’s disease (AD), cognitive impairment begins 10–15 years later than neurodegeneration in the brain. Plasma biomarkers are promising candidates for assessing neurodegeneration in people with normal cognition. It has been reported that subjects with the concentration of plasma amyloid-β 1-42×total tau protein higher than 455 pg2 /ml2 are assessed as having a high risk of amnesic mild impairment or AD, denoted as high risk of AD (HRAD). Objective: The prevalence of high-risk for dementia in cognitively normal controls is explored by assaying plasma biomarkers. Methods: 422 subjects with normal cognition were enrolled around Taiwan. …Plasma Aβ1-40 , Aβ1-42 , and T-Tau levels were assayed using immunomagnetic reduction to assess the risk of dementia. Results: The results showed that 4.6% of young adults (age: 20–44 years), 8.5% of middle-aged adults (age: 45–64 years), and 7.3% of elderly adults (age: 65–90 years) had HRAD. The percentage of individuals with HRAD dramatically increased in middle-aged and elderly adults compared to young adults. Conclusion: The percentage of HRAD in cognitively normal subjects are approximately 10%, which reveals that the potentially public-health problem of AD in normal population. Although the subject having abnormal levels of Aβ or tau is not definitely going on to develop cognitive declines or AD, the risk of suffering cognitive impairment in future is relatively high. Suitable managements are suggested for these high-risk cognitively normal population. Worth noting, attention should be paid to preventing cognitive impairment due to AD, not only in elderly adults but also middle-aged adults. Show more

Keywords: Alzheimer’s disease, immunomagnetic reduction, normal cognition, plasma biomarkers

DOI: 10.3233/ADR-210310

Citation: Journal of Alzheimer's Disease Reports, vol. 5, no. 1, pp. 761-770, 2021