Journal of Alzheimer's Disease - Volume 63, issue 2

Authors: Radko, Sergey P. | Khmeleva, Svetlana A. | Mantsyzov, Alexey B. | Kiseleva, Yana Y. | Mitkevich, Vladimir A. | Kozin, Sergey A. | Makarov, Alexander A.

Article Type: Research Article

Abstract: Zinc-induced aggregation of amyloid-β peptides (Aβ) is considered to contribute to the pathogenesis of Alzheimer’s disease. While glycosaminoglycans (GAGs) that are commonly present in interneuronal space are known to enhance Aβ self-aggregation in vitro , the impact of GAGs on the formation of zinc-induced amorphous Aβ aggregates has not yet been thoroughly studied. Here, employing dynamic light scattering, bis-ANS fluorimetry, and sedimentation assays, we demonstrate that heparin serving as a representative GAG modulates the kinetics of zinc-induced Aβ42 aggregation in vitro by slowing the rate of aggregate formation and aggregate size growth. By using synthetic Aβ16 peptides …to model the Aβ metal-binding domain (MBD), heparin was found to effectively interact with MBDs in complex with zinc ions. We suggest that heparin adsorbs to the surface of growing zinc-induced Aβ42 aggregates via electrostatic interactions, thus creating a steric hindrance that inhibits further inclusion of monomeric and/or oligomeric zinc-Aβ42 complexes. Furthermore, the adsorbed heparin can interfere with the zinc-bridging mechanism of Aβ42 aggregation, requiring the formation of two zinc-mediated interaction interfaces in the MBD. As revealed by computer simulations of the zinc-Aβ16 homodimer complexed with a heparin chain, heparin can interact with the MBD via polar contacts with residues Arg-5 and Tyr-10, resulting in a conformational rearrangement that hampers the formation of the second zinc-mediated interaction in the MBD interface. The findings of this study suggest that GAGs, which are common in the in vivo macromolecular environment, may have a substantial impact on the time course of zinc-induced Aβ aggregation. Show more

Keywords: Alzheimer’s disease, amyloid-β peptide, aggregation, zinc, heparin

DOI: 10.3233/JAD-171120

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 539-550, 2018

Authors: Zhu, Aiqin | Wu, Zhou | Zhong, Xin | Ni, Junjun | Li, Yinglan | Meng, Jie | Du, Can | Zhao, Xue | Nakanishi, Hiroshi | Wu, Shizheng

Article Type: Research Article

Abstract: Background: Systemic inflammation is known as a risk factor of cognitive decline. Objective: To investigate the effects of propolis on cognitive decline and systemic inflammation in elderly people living at high altitude. Methods: Sixty participants (average 72.8 years) living at altitude (2,260 meters) were randomized to receive propolis (0.83 g, n  = 30) or placebo (n  = 30) for 24 months. Cognitive outcomes were assessed using MMSE and serum cytokine levels were measured for 24 months in a double-blind study. Results: MMSE scores were 26.17 at baseline and 23.87 at 24 months in placebo group. Compared to …placebo group, improvements of MMSE scores were significant in propolis-treated subjects (p  = 0.007) with a response emerging over time (time points×group interaction, p  = 0.016). In addition, the serum IL-1β and IL-6 levels were significantly different across treatments (p  < 0.0001) showing upward and downward trends in placebo- and propolis-treated subjects, respectively (p  < 0.0001). Serum levels of TNF-α were not significantly different across treatment (p  = 0.0528) but with a response emerging over time (time points×group interaction, p  = 0.016). In contrast, serum levels of TGFβ 1 were significantly different across treatments (p  < 0.0001) showing downward and upward trends in placebo- and propolis-treated subjects, respectively. Serum levels of IL-10 were significant for the effect of groups (p  = 0.0411). Furthermore, MMSE scores correlated with the decrease in IL-1β and the increase in TGFβ 1 in serum. Conclusion: Elderly people living at high altitude developed to MCI in 24 months with exacerbation of systemic inflammation. Ingestion of propolis (>12 months) protected against cognitive decline after systemic inflammation was reduced. Show more

Keywords: Alzheimer’s disease, Brazilian green propolis, cognitive function, microglia, mild cognitive impairment, neuroinflammation, neuron, oxidative stress, systemic inflammation

DOI: 10.3233/JAD-170630

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 551-560, 2018

Authors: Makovac, Elena | Serra, Laura | Di Domenico, Carlotta | Marra, Camillo | Caltagirone, Carlo | Cercignani, Mara | Bozzali, Marco

Article Type: Research Article

Abstract: Patients with amnestic mild cognitive impairment (aMCI) have higher probability to develop Alzheimer’s disease (AD) than elderly controls. The detection of subtle changes in brain structure associated with disease progression and the development of tools to identify patients at high risk for dementia in a short time is crucial. Here, we used probabilistic white matter (WM) tractography to explore microstructural alterations within the main association, limbic, and commissural pathways in aMCI patients who converted to AD after 1 year follow-up (MCIconverters ) and those who remained stable (MCIstable ). Both diffusion tensor imaging (DTI) and quantitative magnetization transfer (qMT) parameters …have been considered for a comprehensive pathophysiological characterization of the WM damage. Overall, tract-specific parameters derived from qMT and DTI at baseline were able to differentiate aMCI patients who converted to AD from those who remained stable in time. In particular, the qMT exchange rate, RMB 0 , of the right uncinate fasciculus was significantly decreased in MCIconverters , whereas fractional anisotropy was significantly decreased in the bilateral superior cingulum in MCIconverters compared to MCIstable . These results confirm the involvement of WM and particularly of association fibers in the progression of AD, highlighting disconnection as a potential mechanism. Show more

Keywords: Diffusion tensor imaging, mild cognitive impairment, probabilistic tractography, quantitative magnetization transfer, white matter

DOI: 10.3233/JAD-170995

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 561-575, 2018

Authors: Meyer, Pierre-François | Savard, Melissa | Poirier, Judes | Labonté, Anne | Rosa-Neto, Pedro | Weitz, Tara M. | Town, Terrence | Breitner, John | for the Alzheimer’s Disease Neuroimaging Initiative | the PREVENT-AD Research Group

Article Type: Research Article

Abstract: Immune mechanisms may be important in the pathogenesis of Alzheimer’s disease (AD). Yet, studies comparing cerebrospinal fluid (CSF) and plasma immune marker levels of healthy and demented individuals have yielded conflicting results. We analyzed CSF from 101 members of the parental history-positive PREVENT-AD cohort of healthy aging adults, and 237 participants without dementia from the initial cohort of the Alzheimer’s Disease Neuroimaging Initiative (ADNI-1). Following recent practice, we used the biomarkers total-tau and amyloid-β1-42 to allocate participants from each study into four stages of AD pathogenesis: Stage 0 (no abnormality), Stage 1 (reduced amyloid-β1-42 ), Stage 2 (reduced …amyloid-β1-42 and increased total-tau), or “Suspected Non-Alzheimer Pathology” (elevated total-tau only). Investigating the PREVENT-AD participants’ CSF assay results for 19 immune/inflammatory markers, we found six that showed a distinct bi-directional relationship with pathogenetic stage. Relative to Stage 0, these were diminished at Stage 1 but strongly increased at Stage 2. Among the ADNI participants (90 healthy controls and 147 with mild cognitive impairment), we found that 23 of 83 available CSF markers also showed this distinct pattern. These results support recent observations that immune activation may become apparent only after the onset of both amyloid and tau pathologies. Unexpectedly, they also suggest that immune marker activity may diminish along with earliest appearance of amyloid-β plaque pathology. These findings may explain discordant results from past studies, and suggest the importance of characterizing the extent of AD pathology when comparing clinical groups. Show more

Keywords: Alzheimer’s disease, biomarkers, inflammation, pathology

DOI: 10.3233/JAD-170887

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 577-590, 2018

Authors: Mengel-From, Jonas | Rønne, Mette E. | Carlsen, Anting L. | Skogstrand, Kristin | Larsen, Lisbeth A. | Tan, Qihua | Christiansen, Lene | Christensen, Kaare | Heegaard, Niels H.H.

Article Type: Research Article

Abstract: We aim to examine if circulating micro-RNA and cytokine levels associate with dementia diagnosis and cognitive scores. To test our hypothesis, we use plasma donated from 48 monozygotic twin pairs in 1997 and 46 micro-RNAs and 10 cytokines were quantified using microfluidic RT-qPCR and multiplex solid-phase immunoassays, respectively. Micro-RNA and cytokine profiling were examined for associations with dementia diagnoses in a longitudinal registry study or with cognitive scores at baseline. Thirty-six micro-RNAs and all cytokines were detected consistently. Micro-RNA profiles associate with diagnoses and cognitive scores at statistically significant levels while cytokine only showed trends pointing at chronic inflammation in …twins having or developing dementia. The most notable findings were decreased miR-106a and miR-210, and increased miR-106b expression in twins with a dementia diagnosis. This pioneering evaluation of micro-RNA and cytokine and dementia diagnosis suggests micro-RNA targets in vasculogenesis, lipoprotein transport, and amyloid precursor protein genes. Show more

Keywords: Aging, Alzheimer’s disease, brain, genetics, neurodegenerative

DOI: 10.3233/JAD-171163

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 591-601, 2018

Authors: Stonnington, Cynthia M. | Chen, Yinghua | Savage, Cary R. | Lee, Wendy | Bauer III, Robert J. | Sharieff, Sameen | Thiyyagura, Pradeep | Alexander, Gene E. | Caselli, Richard J. | Locke, Dona E.C. | Reiman, Eric M. | Chen, Kewei

Article Type: Research Article

Abstract: Background: Brain imaging measurements can provide evidence of possible preclinical Alzheimer’s disease (AD). Their ability to predict individual imminent clinical conversion remains unclear. Objective: To investigate the ability of pre-specified volumetric magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (FDG-PET) measurements to predict which cognitively unimpaired older participants would subsequently progress to amnestic mild cognitive impairment (aMCI) within 2 years. Methods: From an apolipoprotein E4 (APOE4) enriched prospective cohort study, 18 participants subsequently progressed to the clinical diagnosis of aMCI or probable AD dementia within 1.8±0.8 years (progressors); 20 participants matched for sex, age, education, …and APOE allele dose remained cognitively unimpaired for at least 4 years (nonprogressors). A complementary control group not matched for APOE allele dose included 35 nonprogressors. Groups were compared on baseline FDG-PET and MRI measures known to be preferentially affected in the preclinical and clinical stages of AD and by voxel-wise differences in regional gray matter volume and glucose metabolism. Receiver Operating Characteristic, binary logistic regression, and leave-one-out procedures were used to predict clinical outcome for the a priori measures. Results: Compared to non-progressors and regardless of APOE -matching, progressors had significantly reduced baseline MRI and PET measurements in brain regions preferentially affected by AD and reduced hippocampal volume was the strongest predictor of an individual’s imminent progression to clinically significant memory decline (79% sensitivity/78% specificity among APOE -matched cohorts). Conclusion: Regional MRI and FDG-PET measurements may be useful in predicting imminent progression to clinically significant memory decline. Show more

Keywords: Alzheimer’s disease, magnetic resonance imaging, mild cognitive impairment, positron-emission tomography, prognosis

DOI: 10.3233/JAD-170852

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 603-615, 2018

Authors: Rouch, Isabelle | Pongan, Elodie | Leveque, Yohana | Tillmann, Barbara | Trombert, Béatrice | Getenet, Jean Claude | Auguste, Nicolas | Krolak-Salmon, Pierre | the LACMé group | Laurent, Bernard | Dorey, Jean-Michel

Article Type: Research Article

Abstract: Background: Alzheimer’s disease (AD) mainly occurs in elderly individuals. Comorbidities and chronic pain are frequent in this population. Previous studies revealed that personality modulates both chronic pain (CP) andADoccurrence and evolution. Moreover, as pain treatments can induce side-effects, non-drugs treatments, such as art interventions, are interesting alternative therapies for decreasing CP in these patients. Objective: Our aim was to assess the potential role of personality traits on art intervention efficacy for reducing CP in a population of patients with mild AD. Methods: Design: multicenter randomized controlled trial. Fifty mild AD patients underwent a 12-week art intervention …including singing and painting groups. Personality was assessed with the Big Five Inventory before the sessions. CP was measured with Numeric Rating Scale (NRS) [Usual pain (NRS-U) and most Intense pain (NRS-I)], Simple Visual Scale [Usual pain (SVS-U) and most Intense pain (SVS-I)] and Brief Pain Inventory (BPI) before and after the sessions. The influence of personality traits on CP evolution before and after art intervention was assessed with multiple linear regression models. Results: A positive association was observed between neuroticism and the evolution of three CP measures including NRS-U (B = 0.34, p = 0.01), SVS-U (B = 0.20, p = 0.04), and BPI-U (B = 0.46, p = 0.02) evolution. No significant relationship was observed between neuroticism and NRS-I, SVS-I and BPI-R evolution. Conclusions: Our findings suggest that neuroticism can decrease the efficacy of group art intervention on pain in patients with mild AD. Individual therapies could be more appropriate for these patients. These results emphasize the interest of taking into account patients’ personality before proposing them to participate to a group therapy. Show more

Keywords: Alzheimer’s disease, music, pain, personality

DOI: 10.3233/JAD-170990

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 617-624, 2018

Authors: Andriuta, Daniela | Roussel, Martine | Barbay, Mélanie | Despretz-Wannepain, Sandrine | Godefroy, Olivier | Godefroy and GRECogVASC study group

Collaborators: Godefroy, Olivier | Roussel, Martine | Barbay, Mélanie | Canaple, Sandrine | Lamy, Chantal | Leclercq, Claire | Arnoux, Audrey | Despretz-Wannepain, Sandrine | Despretz, Pascal | Berrissoul, Hassan | Picard, Carl | Diouf, Momar | Loas, Gwénolé | Deramond, Hervé | Taillia, Hervé | Ardisson, Anne-Emmanuelle | Nédélec-Ciceri, Claudine | Bonnin, Camille | Thomas-Anterion, Catherine | Grangette, Francoise | Varvat, Jérome | Quaglino, Véronique | Beaunieux, Hélène | Moroni, Christine | Martens-Chazelles, Audrey | Batier-Monperrus, Stéphanie | Monteleone, Cécile | Costantino, Véronique | Theunssens, Eric

Article Type: Research Article

Abstract: Background: The contrast between memory versus executive function impairments is commonly used to differentiate between neurocognitive disorders (NCDs) due to Alzheimer’s disease (AD) and vascular cognitive impairment (VCI). We reconsidered this question because of the current use of AD biomarkers and the recent revision of the criteria for AD, VCI, and dysexecutive syndrome. Objective: To establish and compare the neuropsychological profiles in AD (i.e., with positive CSF biomarkers) and in VCI. Methods: We included 62 patients with mild or major NCDs due to pure AD (with positive CSF biomarker assays), and 174 patients (from the GRECogVASC …cohort) with pure VCI. The neuropsychological profiles were compared after stratification for disease severity (mild or major NCD). We defined a memory-executive function index (the mean z score for the third free recall and the delayed free recall in the Free and Cued Selective Reminding Test minus the mean z score for category fluency and the completion time in the Trail Making Test part B) and determined its diagnostic accuracy. Results: Compared with VCI patients, patients with AD had significantly greater memory impairments (p  = 0.001). Executive function was impaired to a similar extent in the two groups (p  = 0.11). Behavioral executive disorders were more prominent in the AD group (p  = 0.001). Although the two groups differed significant with regard to the memory-executive function index (p  < 0.001), the latter’s diagnostic accuracy was only moderate (sensitivity: 63%, specificity: 87%). Conclusion: Although the contrast between memory and executive function impairments was supported at the group level it does not reliably discriminate between AD and VCI at the individual level. Show more

Keywords: Alzheimer’s disease, dysexecutive syndrome, memory, vascular cognitive impairment

DOI: 10.3233/JAD-171097

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 625-633, 2018

Authors: Kim, Mi-Young | Noh, Yoojin | Son, Sang Joon | Shin, Sooyoung | Paik, Hee-Young | Lee, Sukhyang | Jung, Yi-Sook

Article Type: Research Article

Abstract: Background: Ischemic heart disease (IHD) is associated with cognitive decline and may contribute to an increased risk of dementia. Objective: The goal of the present study was to investigate whether cilostazol use is associated with a lower risk of incident dementia in Asian patients with IHD, and whether these effects differed based on sex. Methods: This retrospective cohort study was performed using the Korean National Insurance Claim Data of the Health Insurance Review and Assessment Service; the duration of the study was from January 1, 2007 to December 31, 2015. The study group comprised 66,225 patients …with IHD, aged >65 years, who had received cilostazol. Age- and sex-matched IHD patients without cilostazol exposure were selected as the control group. The risk of dementia was compared between the cilostazol and control groups. Results: Compared to the control group, total cilostazol users had a marginally significant lower risk of incident dementia. After stratification by sex, the reducing effect of cilostazol on incident dementia was significant in female participants, but not in male participants. Female patients who had cilostazol for over 2 years showed a clinically meaningful preventive effect (HR, 0.85; 95% CI, 0.82–0.88). Conclusions: This study suggested that cilostazol treatment may reduce the risk of incident dementia in Korean patients with IHD. Its beneficial effect was remarkably significant in female patients who received cilostazol for over a 2-year period. Show more

Keywords: Cilostazol, dementia, ischemic heart disease, sex difference

DOI: 10.3233/JAD-170895

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 635-644, 2018

Authors: Henley, Brandon C. | Shokouhi, Mahsa | Mahajan, Anushree Y. | Inan, Omer T. | Hajjar, Ihab

Article Type: Research Article

Abstract: Mental stress has been linked to various chronic diseases including Alzheimer’s disease, but the mechanisms underlying cognitive decline with mental stress are unknown. Reduced cardiovascular response to stress is associated with cardiovascular disease, and the latter is associated with cognitive impairment. We measured electrodermal activity, blood pressure, and cardiac hemodynamics in cognitively normal and mild cognitive impairment (MCI) adults (n  = 76, mean age = 58 years, 46% MCI) during rest, a math test, and face-name recall tasks to derive the following cardiovascular indicators: mean arterial pressure, heart rate, stroke volume and cardiac output. These indicators were compared between the two groups. Cerebral …blood perfusion via arterial spin-labeling MRI was measured in a subgroup who underwent an MRI scan (n  = 30). Following exposure to mental stress, a decrease in stroke volume (p  = 0.024) and cardiac output (p  = 0.005) was found in the MCI group, but an increase in both parameters in the cognitively normal group. This difference was largest during face-name recall (standardized difference in stroke volume = –0.50, p  = 0.029, and in cardiac output = –0.52, p  = 0.023). Cardiac output during mental stress, but not at rest, decreased with cerebral perfusion (normal: p  = 0.078, β = 1.97, R2  = 0.090; MCI: p  = 0.007, β = 2.02, R2  = 0.008). No significant difference was found between the two groups at rest. This preliminary study suggests that individuals with MCI have an insufficient cardiac output, and in turn lower cerebral perfusion in response to mental stress. Show more

Keywords: Cardiovascular reactivity, cerebral blood flow, cognitive impairment, functional magnetic resonance imaging, hemodynamics, mental health, stress, vascular disease

DOI: 10.3233/JAD-180036

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 645-654, 2018

Authors: Yasar, Sevil | Varma, Vijay R. | Harris, Gregory C. | Carlson, Michelle C.

Article Type: Research Article

Abstract: Background: Emerging evidence suggests a possible role of the renin angiotensin system in the pathophysiologic process of Alzheimer’s disease, of which angiotensin converting enzyme-1 (ACE-1) and angiotensin II (ANGII) are important proteins. Few studies evaluated associations between blood ACE-1 and none between ANGII levels, and cognition. Objective: Our pilot study was aimed to examine associations between blood ACE-1 and ANG II levels and cognitive function in non-demented participants at baseline and over a 1-year period. Methods: 56 participants were included from the Brain Health Substudy of the Baltimore Experience Corps Study. Linear regression analysis, adjusting for …confounders, was used to determine associations between baseline ACE-1 and ANGII, and baseline and 1-year follow-up measures of psychomotor and processing speed, executive function, verbal learning memory and working memory, and whether these associations were mediated by blood pressure. Results: Participants were predominantly female (75%), African-American (93%), with mean age of 67.8 years and education of 14.3 years. There were no associations between baseline ACE-1 or ANGII levels and cognitive function; however, there were significant association between baseline ACE-1 levels and 1-year follow-up Trail Making Test, Part A (β= 0.003, p  = 0.04) and Digit Span (β= –0.001, p  = 0.02). Conclusions: In this cognitively intact sample, elevated ACE-1 levels were associated with worse processing speed and working memory after 1 year. Findings from this pilot study suggest that changes in the RAS are associated with alterations in cognitive function warranting further assessment of the role of RAS in neurodegenerative disorders. Show more

Keywords: Angiotensin II, angiotensin converting enzyme-1, cognition, cohort study

DOI: 10.3233/JAD-170944

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 655-664, 2018

Authors: Gourmaud, Sarah | Thomas, Priscilla | Thomasseau, Sylvie | Tible, Marion | Abadie, Claire | Paquet, Claire | Hugon, Jacques

Article Type: Research Article

Abstract: Alzheimer’s disease (AD) is characterized by accumulations of amyloid-β (Aβ42 ) and hyperphosphorylated tau proteins, associated with neuroinflammation, synaptic loss, and neuronal death. Several studies indicate that c-Jun N-terminal kinase (JNK) is implicated in the pathological features of AD. We have investigated in 5XFAD mice, the therapeutic effects of Brimapitide, a JNK-specific inhibitory peptide previously tested with higher concentrations in another AD model (TgCRND8). Three-month-old 5XFAD and wild-type littermate mice were treated by intravenous injections of low doses (10 mg/kg) of Brimapitide every 3 weeks, for 3 or 6 months (n  = 6–9 per group). Cognitive deficits and brain lesions were assessed …using Y-maze, fear-conditioning test, and histological and biochemical methods. Chronic treatment of Brimapitide for 3 months resulted in a reduction of Aβ plaque burden in the cortex of 5XFAD treated mice. After 6 months of treatment, cognitive deficits were reduced but also a significant reduction of cell death markers and the pro-inflammatory IL-1β cytokine in treated mice were detected. The Aβ plaque burden was not anymore modified by the 6 months of treatment. In addition to modulating cognition and amyloid plaque accumulation, depending on the treatment duration, Brimapitide seems experimentally to reduce neuronal stress in 5XFAD mice. Show more

Keywords: Alzheimer’s disease, cell death, JNK, memory, mice model peptide inhibitor, therapeutic

DOI: 10.3233/JAD-171099

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 665-674, 2018

Authors: Heymann, Petra | Gienger, Regine | Hett, Andreas | Müller, Stephan | Laske, Christoph | Robens, Sibylle | Ostermann, Thomas | Elbing, Ulrich

Article Type: Research Article

Abstract: Based on the knowledge of art therapy, we developed a new neuropsychological drawing test in order to identify individuals with mild cognitive impairment (MCI) as well as dementia patients and healthy controls (HC). By observing a variety of drawing characteristics of 92 participants with a mean age of 67.7, art therapy and dementia experts discriminate HC from MCI, early dementia of the Alzheimer-type (eDAT), and moderate dementia of the Alzheimer-type (mDAT) by the process analysis of tree drawings on a digitizing tablet. The art therapist’s average categorical rating of healthy and MCI or demented individuals matched the clinical diagnosis by …88%. In a first small study, we analyzed interrater reliability, sensitivity, specificity, negative and positive predicted values of our tree drawing test (TDT) in comparison with the clock drawing test (CDT). Similar values of moderate interrater reliability were found for the TDT (0.56) as well as for the CDT (0.54). A significant high sensitivity of 0.9 within this binary impairment scale (HC versus impaired or demented) can be demonstrated. Substantial values for the specificity (0.67) could be obtained that however remain under a perfect value of the CDT (1.0). Considering 31 individuals that received the clinical diagnosis “impaired or demented” the TDT shows a higher recognition rate for the MCI group than the CDT. Furthermore in 8 of 12 borderline cases of clinical diagnosis, the outcome of the TDT diagnosis was consistent with the final clinical result. Show more

Keywords: Art therapist raters, dichotomous classification, drawing characteristics, early Alzheimer’s disease, mild cognitive impairment, neuropsychological drawing test, screening, tablet-based

DOI: 10.3233/JAD-170946

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 675-687, 2018

Authors: Chao, Fenglei | Jiang, Lin | Zhang, Yi | Zhou, Chunni | Zhang, Lei | Tang, Jing | Liang, Xin | Qi, Yingqiang | Zhu, Yanqing | Ma, Jing | Tang, Yong

Article Type: Research Article

Abstract: The risk of cognitive decline during Alzheimer’s disease (AD) can be reduced if physical activity is maintained; however, the specific neural events underlying this beneficial effect are still uncertain. To quantitatively investigate the neural events underlying the effect of running exercise on middle-aged AD subjects, 12-month-old male APP/PS1 mice were randomly assigned to a control group or running group, and age-matched non-transgenic littermates were used as a wild-type group. AD running group mice were subjected to a treadmill running protocol (regular and moderate intensity) for four months. Spatial learning and memory abilities were assessed using the Morris water maze. Hippocampal …amyloid plaques were observed using Thioflavin S staining and immunohistochemistry. Hippocampal volume, number of neurons, and number of newborn cells (BrdU+ cells) in the hippocampus were estimated using stereological techniques, and newborn neurons were observed using double-labelling immunofluorescence. Marked neuronal loss in both the CA1 field and dentate gyrus (DG) and deficits in both the neurogenesis and survival of new neurons in the DG of middle-aged APP/PS1 mice were observed. Running exercise could improve the spatial learning and memory abilities, reduce amyloid plaques in the hippocampi, delay neuronal loss, induce neurogenesis, and promote the survival of newborn neurons in the DG of middle-aged APP/PS1 mice. Exercise-induced protection of neurons and adult neurogenesis within the DG might be part of the important structural basis of the improved spatial learning and memory abilities observed in AD mice. Show more

Keywords: BrdU+ cell, neuron, newborn neuron, running exercise, transgenic AD mice

DOI: 10.3233/JAD-171017

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 689-703, 2018

Authors: Zolezzi, Juan M. | Lindsay, Carolina B. | Serrano, Felipe G. | Ureta, Roxana C. | Theoduloz, Cristina | Schmeda-Hirschmann, Guillermo | Inestrosa, Nibaldo C.

Article Type: Research Article

Abstract: Soluble amyloid-β (Aβ) oligomers have been recognized as early neurotoxic intermediates with a key role in the synaptic dysfunction observed in Alzheimer’s disease (AD). Aβ oligomers block hippocampal long-term potentiation (LTP) and impair rodent spatial memory. Additionally, the presence of Aβ oligomers is associated with imbalanced intracellular calcium levels and apoptosis in neurons. In this context, we evaluated the effects of three diterpenes (ferruginol, jatrophone, and junicedric acid) that are found in medicinal plants and have several forms of biological activity. The intracellular calcium levels in hippocampal neurons increased in the presence of ferruginol, jatrophone, and junicedric acid, a result …that was consistent with the observed increase in CA1 synaptic transmission in mouse hippocampal slices. Additionally, assays using Aβ peptide demonstrated that diterpenes, particularly ferruginol, restore LTP and reduce apoptosis. Recovery of the Aβ oligomer-induced loss of the synaptic proteins PSD-95, synapsin, VGlut, and NMDA receptor subunit 2A was observed in mouse hippocampal slices treated with junicedric acid. This cascade of events may be associated with the regulation of kinases, e.g., protein kinase C (PKC) and calcium/calmodulin-dependent protein kinase II (CaMKII), in addition to the activation of the canonical Wnt signaling pathway and could thus provide protection against Aβ oligomers, which trigger synaptic dysfunction. Our results suggest a potential neuroprotective role for diterpenes against the Aβ oligomers-induced neurodegenerative alterations, which make them interesting molecules to be further studied in the context of AD. Show more

Keywords: Amyloid-β, diterpenes, ferruginol, jatrophone, junicedric acid, neuroprotection

DOI: 10.3233/JAD-170701

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 705-723, 2018

Authors: Nouriziabari, Bardia | Sarkar, Susmita | Tanninen, Stephanie E. | Dayton, Robert D. | Klein, Ronald L. | Takehara-Nishiuchi, Kaori

Article Type: Research Article

Abstract: Trace eyeblink conditioning is a hippocampus-dependent associative learning paradigm which is impaired in patients with Alzheimer’s disease (AD) and animal AD models. Learning in this paradigm accompanies changes in oscillatory activity in forebrain regions, some of which are loci of pathogenic changes in prodromal AD stages. These observations motivated us to examine how cortical event-related potentials (ERPs) during this paradigm are affected by two features of the asymptomatic, AD-related brain abnormality, entorhinal tau accumulation and mild cholinergic deficit. Adult rats received viral overexpression of P301L mutant human tau in the entorhinal cortex, low-dose scopolamine treatment, or both. Electroencephalograms were recorded …with epidural electrodes on the surface of the frontal, parietal, and temporal cortices during differential and reversal trace eyeblink conditioning. All rats developed conditioned responses to one of two stimuli (auditory or visual) paired with mild eyelid shock (CS+), but not to the other stimulus presented alone (CS-). They were also able to adjust the response when the stimulus contingency was reversed. With learning, the amplitude of several ERP components in the frontal and temporal cortices came to differentiate the CS+ from CS-. Scopolamine affected the learning-related change in temporal P2 and other learning-unrelated components in three regions. Entorhinal tau overexpression primary affected the amplitude of temporal visual ERPs and learning-unrelated frontal and temporal auditory ERP components. The double manipulation only affected two components of temporal auditory ERPs. Thus, cortical ERPs during differential associative learning are sensitive to asymptomatic brain abnormality associated with AD. Show more

Keywords: Acetylcholine, associative learning, EEG, ERPs, rats, scopolamine, tau, viral vector

DOI: 10.3233/JAD-171033

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 725-740, 2018

Authors: van Santen, Joeke | Dröes, Rose-Marie | Holstege, Marije | Henkemans, Olivier Blanson | van Rijn, Annelies | de Vries, Ralph | van Straten, Annemieke | Meiland, Franka

Article Type: Research Article

Abstract: Background: Physical exercise benefits functioning, health, and well-being. However, people living with dementia in particular hardly engage in exercise. Exergaming (exercise and gaming) is an innovative, fun, and relatively safe way of exercising in a virtual reality or gaming environment. It may help people living with dementia overcome barriers they can experience regarding regular exercise activities. Objective: This systematic literature review aims to provide an overview of the cost-effectiveness of exergaming and its effects on physical, cognitive, emotional, and social functioning, as well as the quality of life in people living with dementia. Methods: PubMed, Embase, …Cinahl, PsycINFO, the Cochrane Library, and the Web of Science Core Collection were searched. Selection of studies was carried out by at least two independent researchers. Results: Three studies were found to be eligible and were included in this review. Two of these showed some statistically significant effects of exergaming on physical, cognitive, and emotional functioning in people living with dementia, although based on a very small sample. No articles were found about the cost-effectiveness of exergaming. Conclusions: Only a few controlled studies have been conducted into the effectiveness of exergaming, and these show very little significant benefits. More well-designed studies are necessary to examine the effects of exergaming. Show more

Keywords: Cognition, dementia, exercise, neuropsychiatry, play, quality of life, review

DOI: 10.3233/JAD-170667

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 741-760, 2018

Authors: Li, Mengzhu | Liu, Enjie | Zhou, Qiuzhi | Li, Shihong | Wang, Xin | Liu, Yanchao | Wang, Lin | Sun, Dongsheng | Ye, Jinwang | Gao, Yuan | Yang, Xifei | Liu, Jianjun | Yang, Ying | Wang, Jian-Zhi

Article Type: Research Article

Abstract: The transient receptor potential cation (TRPC) channels are widely expressed in nervous system but their functions remain largely unclear. Here, we found that TRPC1 deletion did not affect learning and memory in physiological conditions, while it aggravated learning and memory deficits induced by amyloid-β (Aβ), the major component of the senile plaques observed in the brains of Alzheimer’s disease (AD). Further studies demonstrated that TRPC1 deletion did not affect cell apoptosis in physiological condition, but it exacerbated the Aβ-induced cell death in mouse hippocampus. Moreover, the level of TRPC1 was decreased in AD cell and mouse models, and upregulation of …TRPC1 decreased Aβ levels with attenuation of apoptosis in the cells stably overexpressing amyloid-β protein precursor (AβPP). Finally, the transmembrane domain of TRPC1 could bind to AβPP and thus decreased Aβ production. These findings indicate that loss of TRPC1 exacerbates Aβ-induced memory deficit and cell apoptosis, though it does not impair cognitive function or induce cell death in physiological conditions. Show more

Keywords: Alzheimer’s disease, amyloid-β, apoptosis, cognitive impairment, transient receptor potential channels

DOI: 10.3233/JAD-180077

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 761-772, 2018

Authors: Wang, Jen-Hung | Wu, Ya-Ju | Tee, Boon Lead | Lo, Raymond Y.

Article Type: Research Article

Abstract: Background: Little is known about the distribution of medical comorbidities in Alzheimer’s disease (AD). Objective: We aimed to describe the comorbidity pattern of AD in a nested case-control study. Methods: Incident AD cases were identified by International Classification of Diseases codes in a random sample of 2 million individuals in Taiwan National Health Insurance program during 2001–2011. We further restricted cases to those treated with AD drugs of approved reimbursement. We sampled a set of age- and sex-matched control subjects (2:1 ratio) and employed conditional logistic regression to estimate the associations between pre-specified 14 comorbidities and …AD. The clusters of multiple chronic diseases were then identified by exploratory factor analysis. Results: A total of 2,618 AD cases were identified during 2001–2011 with a mean age of 76.1 years and female preponderance (59%). The most common 5 comorbidities in AD were hypertension (55.1%), osteoarthritis (38.2%), depression (32.3%), diabetes mellitus (DM) (25.7%), and cerebrovascular disease (CVD) (22.7%). After adjusting for age and sex, DM, osteoporosis, depression, and CVD were significantly associated with AD. The number of comorbidity was 3-fold greater in the AD group. The cluster of hypertension, DM, and hyperlipidemia was the most common combination in old age, whereas the cluster osteoarthritis and osteoporosis was the only multimorbidity pattern significantly associated with AD. Conclusion: Multimorbidity is common in AD. Depression, CVD, osteoporosis, and DM are associated with incident AD, supporting that their co-existence is a typical feature of AD at old age. Comorbidity care should be integrated into current management for patients with AD. Show more

Keywords: Alzheimer’s disease, cholinesterase inhibitors, comorbidity, dementia, nested case-control studies

DOI: 10.3233/JAD-170786

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 773-781, 2018

Authors: Fantoni, Enrico R. | Chalkidou, Anastasia | O’ Brien, John T. | Farrar, Gill | Hammers, Alexander

Article Type: Research Article

Abstract: Background: Amyloid PET (aPET) imaging could improve patient outcomes in clinical practice, but the extent of impact needs quantification. Objective: To provide an aggregated quantitative analysis of the value added by aPET in cognitively impaired subjects. Methods: Systematic literature searches were performed in Embase and Medline until January 2017. 1,531 cases over 12 studies were included (1,142 cases over seven studies in the primary analysis where aPET was the key biomarker; the remaining cases included as defined groups in the secondary analysis). Data was abstracted by consensus among two observers and assessed for bias. Clinical utility …was measured by diagnostic change, diagnostic confidence, and patient management before and after aPET. Three groups were further analyzed: control patients for whom feedback of aPET scan results was delayed; aPET Appropriate Use Criteria (AUC+) cases; and patients undergoing additional FDG/CSF testing. Results: For 1,142 cases with only aPET, 31.3% of diagnoses were revised, whereas 3.2% of diagnoses changed in the delayed aPET control group (p  < 0.0001). Increased diagnostic confidence following aPET was found for 62.1% of 870 patients. Management changes with aPET were found in 72.2% of 740 cases and in 55.5% of 299 cases in the control group (p  < 0.0001). The diagnostic value of aPET in AUC+ patients or when FDG/CSF were additionally available did not substantially differ from the value of aPET alone in the wider population. Conclusions: Amyloid PET contributed to diagnostic revision in almost a third of cases and demonstrated value in increasing diagnostic confidence and refining management plans. Show more

Keywords: Alzheimer’s disease, amyloid PET, dementia, diagnostic confidence, differential diagnosis, impact, patient management, quantitative, systematic review, utility

DOI: 10.3233/JAD-171093

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 783-796, 2018

Authors: Dekker, Alain D. | Sacco, Silvia | Carfi, Angelo | Benejam, Bessy | Vermeiren, Yannick | Beugelsdijk, Gonny | Schippers, Mieke | Hassefras, Lyanne | Eleveld, José | Grefelman, Sharina | Fopma, Roelie | Bomer-Veenboer, Monique | Boti, Mariángeles | Oosterling, G. Danielle E. | Scholten, Esther | Tollenaere, Marleen | Checkley, Laura | Strydom, André | Van Goethem, Gert | Onder, Graziano | Blesa, Rafael | zu Eulenburg, Christine | Coppus, Antonia M.W. | Rebillat, Anne-Sophie | Fortea, Juan | De Deyn, Peter P.

Article Type: Research Article

Abstract: People with Down syndrome (DS) are prone to develop Alzheimer’s disease (AD). Behavioral and psychological symptoms of dementia (BPSD) are core features, but have not been comprehensively evaluated in DS. In a European multidisciplinary study, the novel Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) scale was developed to identify frequency and severity of behavioral changes taking account of life-long characteristic behavior. 83 behavioral items in 12 clinically defined sections were evaluated. The central aim was to identify items that change in relation to the dementia status, and thus may differentiate between diagnostic groups. Structured interviews were conducted …with informants of persons with DS without dementia (DS, n  = 149), with questionable dementia (DS+Q, n  = 65), and with diagnosed dementia (DS+AD, n  = 67). First exploratory data suggest promising interrater, test-retest, and internal consistency reliability measures. Concerning item relevance, group comparisons revealed pronounced increases in frequency and severity in items of anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and eating/drinking behavior. The proportion of individuals presenting an increase was highest in DS+AD, intermediate in DS+Q, and lowest in DS. Interestingly, among DS+Q individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy, and depressive symptoms, suggesting that these changes occur early in the course of AD. Future efforts should optimize the scale based on current results and clinical experiences, and further study applicability, reliability, and validity. Future application of the scale in daily care may aid caregivers to understand changes, and contribute to timely interventions and adaptation of caregiving. Show more

Keywords: Alzheimer’s disease, behavior, BPSD, dementia, Down syndrome, neuropsychiatric symptoms, trisomy 21

DOI: 10.3233/JAD-170920

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 797-819, 2018

Authors: Basurto-Islas, Gustavo | Gu, Jin-hua | Tung, Yunn Chyn | Liu, Fei | Iqbal, Khalid

Article Type: Research Article

Abstract: Dementias including Alzheimer’s disease (AD) are multifactorial disorders that involve several different etiopathogenic mechanisms. Cerebral ischemia has been suspected in the altered regulation of protein kinases and phosphatases that leads to hyperphosphorylation of tau and further neurofibrillary pathology, a key hallmark of AD and related neurodegenerative diseases. However, the deregulation of these enzymes and their relationship with ischemia and AD remain unclear. Previously, we reported a mechanism by which the lysosomal enzyme asparagine endopeptidase (AEP) is associated with brain acidosis and AD. In this study, we subjected mice to middle cerebral artery occlusion and found that compared with wild type …mice, the ischemia-induced brain injury and motor deficit in AEP-knockout mice are reduced, probably because ischemia activates AEP. AEP cleaves inhibitor 2 of protein phosphatase 2A (I2 PP2A), which translocates from the neuronal nucleus to the cytoplasm and produces hyperphosphorylation of tau through inhibition of PP2A. These findings suggest a possible mechanism of tau pathology associated with ischemia. Show more

Keywords: Alzheimer’s disease, asparagine endopeptidase, ischemia, tau

DOI: 10.3233/JAD-170715

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 821-833, 2018

Authors: Wang, Jiaqi | Yuan, Yang | Cai, Rongrong | Huang, Rong | Tian, Sai | Lin, Hongyan | Guo, Dan | Wang, Shaohua

Article Type: Research Article

Abstract: Background: Plasminogen activator inhibitor 1 (PAI-1) and tissue plasminogen activator (tPA) are involved in the complications of type 2 diabetes mellitus (T2DM) and early pathology of Alzheimer’s disease. Objective: This study aimed to investigate the association between plasma PAI-1, tPA/PAI-1 molar ratio, and mild cognitive impairment (MCI) in Chinese T2DM patients. Methods: A total of 162 Chinese T2DM patients were recruited and divided into two groups according to the Montreal Cognitive Assessment score. Demographic data were collected, plasma PAI-1 and tPA levels were measured through enzyme-linked immunosorbent assay, tPA/PAI-1 molar ratio was calculated, and neuropsychological test …results were examined. The association between PAI-1, tPA/PAI-1 molar ratio, and cognition was analyzed. Results: There were 66 diabetic MCI patients and 96 healthy cognition participants (controls). T2DM patients with MCI displayed significantly increased plasma PAI-1 levels (p  = 0.016) and decreased tPA/PAI-1 molar ratio (p  = 0.021) compared with the controls. High PAI-1 levels and low tPA/PAI-1 molar ratio were associated with MCI in T2DM patients, e.g., plasma level of PAI-1 were negatively correlated (r  = –0.343, p  = 0.007) with logic memory in T2DM patients with MCI. Linear regression analysis further revealed that PAI-1 concentration was an independent factor of diabetic MCI (p  = 0.001). Conclusions: High PAI-1 levels and low tPA/PAI-1 molar ratio were significantly correlated with T2DM-associated cognitive impairment, especially memory function, in Chinese patients. Show more

Keywords: Memory, mild cognitive impairment, PAI-1, tPA/PAI-1, type 2 diabetes mellitus

DOI: 10.3233/JAD-171038

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 835-845, 2018

Authors: Vojdani, Aristo | Vojdani, Elroy | Saidara, Evan | Kharrazian, Datis

Article Type: Research Article

Abstract: As early as the 1980s, molecular virologist Ruth Itzhaki began to investigate if there was a causal connection between infections and neurodegenerative disorder. Although the theory has yet to be universally embraced, in 2016 Itzhaki and 33 other scientists from all over the world published a review article in this very journal presenting evidence for the causal role of pathogens in Alzheimer’s disease (AD). Exactly how and in what way pathogens affect the induction of AD has yet to be determined, but one possible answer may involve the cross-reactivity of different pathogens with amyloid-β (Aβ). Aβ autoantibodies have been detected …in the serum and cerebrospinal fluid of AD patients and in some healthy individuals. In the present study our major goal was to investigate whether antibodies made against Aβ would react both with other brain proteins as well as pathogens associated with AD as a result of molecular mimicry or the binding of bacterial toxins to Aβ42 . Our study used a specific monoclonal antibody made against Aβ42 , which not only reacted strongly with Aβ42 , tau protein, and α-synuclein, but also had from weak to strong reactions with 25 different pathogens or their molecules, some of which have been associated with AD. The homology between peptide stretches of microbial origin and proteins involved in AD could be a mechanism by which antibodies to homologous peptides mount attacks against autoantigens in AD. We concluded that bacterial molecules bind to Aβ protein, forming small oligomers, then encasing pathogens and their molecules to form amyloid plaques, the tell-tale markers of AD. Conversely, these same Aβ peptides induce the production of antibodies to both Aβ42 and bacterial molecules, which may inhibit bacterial pathogenesis, but in the process may promote amyloid plaque formation. Show more

Keywords: Alzheimer’s disease, amyloid-β, autoantibody, molecular mimicry, pathogens

DOI: 10.3233/JAD-170961

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 847-860, 2018

Authors: Wada, Masataka | Noda, Yoshihiro | Shinagawa, Shunichiro | Chung, Jun Ku | Sawada, Kyosuke | Ogyu, Kamiyu | Tarumi, Ryosuke | Tsugawa, Sakiko | Miyazaki, Takahiro | Yamagata, Bun | Graff-Guerrero, Ariel | Mimura, Masaru | Nakajima, Shinichiro | for the Alzheimer’s Disease Neuroimaging Initiative

Article Type: Research Article

Abstract: Background: Cognitive reserve is the acquired capacity reflecting a functional brain adaptability/flexibility in the context of aging. Educational attainment is thought to be among the most important factors that contribute to cognitive reserve. Objective: The aim of this study is to investigate the relationships among duration of education and Alzheimer’s disease (AD) related neuroimaging biomarkers such as amyloid-β deposition, glucose metabolism, and brain volumes in each stage of AD. Methods: We reanalyzed a part of the datasets of the Alzheimer’s Disease Neuroimaging Initiative. Participants were between 55 and 90 years of age and diagnosed as one …of the following: healthy controls (HC), mild cognitive impairment (MCI), or AD. Multiple regression analyses were conducted to examine the relationships among duration of education and amyloid-β deposition (n  = 825), brain metabolism (n  = 1,304), and brain volumes (n  = 1,606) among three groups using data for 18 F-Florbetapir (AV-45) imaging, fludeoxyglucose (FDG) positron emission tomography, and T1-weighted magnetic resonance imaging. Results: Duration of education had no correlations with amyloid-β deposition or brain metabolism in any groups. However, duration of education was positively associated with the total brain volume only in participants with MCI. Conclusions: Our findings suggest that education may exert a protective effect on total brain volume in the MCI stage but not in HC or AD. Thus, education may play an important role in preventing the onset of dementia through brain reserve in MCI. Show more

Keywords: Alzheimer’s disease, Alzheimer’s Disease Neuroimaging Initiative (ADNI), brain reserve, brain volume, cognitive reserve, education, mild cognitive impairment

DOI: 10.3233/JAD-171168

Citation: Journal of Alzheimer's Disease, vol. 63, no. 2, pp. 861-869, 2018