Journal of Alzheimer's Disease - Volume 83, issue 2

Authors: Thorlacius-Ussing, Gorm | Bruun, Marie | Gjerum, Le | Frederiksen, Kristian S. | Rhodius-Meester, Hanneke F.M. | van der Flier, Wiesje M. | Waldemar, Gunhild | Hasselbalch, Steen G.

Article Type: Research Article

Abstract: Background: Evidence-based recommendations on the optimal evaluation approach for dementia diagnostics are limited. This impedes a harmonized workup across clinics and nations. Objective: To evaluate the diagnostic performance of a multidisciplinary consensus conference compared to a single clinician approach. Methods: In this prospective study, we enrolled 457 patients with suspected cognitive decline, from two European memory clinics. A diagnostic evaluation was performed at baseline independently in two ways: 1) by a single clinician and 2) at a multidisciplinary consensus conference. A syndrome diagnosis and an etiological diagnosis was made. The confidence in the diagnosis was recorded …using a visual analogue scale. An expert panel re-evaluation diagnosis served as reference for the baseline syndrome diagnosis and a 12-24-month follow-up diagnosis for the etiological diagnosis. Results: 439 patients completed the study. We observed 12.5%discrepancy (k  = 0.81) comparing the baseline syndrome diagnoses of the single clinician to the consensus conference, and 22.3%discrepancy (k  = 0.68) for the baseline etiological diagnosis. The accuracy of the baseline etiological diagnosis was significantly higher at the consensus conference and was driven mainly by increased accuracy in the MCI group. Confidence in the etiological diagnosis at baseline was significantly higher at the consensus conference (p  < 0.005), especially for the frontotemporal dementia diagnosis. Conclusion: The multidisciplinary consensus conference performed better on diagnostic accuracy of disease etiology and increased clinicians’ confidence. This highlights the importance of a multidisciplinary diagnostic evaluation approach for dementia diagnostics, especially when evaluating patients in the MCI stage. Show more

Keywords: Alzheimer disease, clinical decision-making, dementia, differential diagnosis, frontotemporal dementia, Lewy body disease, vascular dementia

DOI: 10.3233/JAD-210278

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 741-751, 2021

Authors: Rasmussen, Ingrid Daae | Boayue, Nya Mehnwolo | Mittner, Matthias | Bystad, Martin | Grønli, Ole K. | Vangberg, Torgil Riise | Csifcsák, Gábor | Aslaksen, Per M.

Article Type: Research Article

Abstract: Background: The optimal stimulation parameters when using transcranial direct current stimulation (tDCS) to improve memory performance in patients with Alzheimer’s disease (AD) are lacking. In healthy individuals, inter-individual differences in brain anatomy significantly influence current distribution during tDCS, an effect that might be aggravated by variations in cortical atrophy in AD patients. Objective: To measure the effect of individualized HD-tDCS in AD patients. Methods: Nineteen AD patients were randomly assigned to receive active or sham high-definition tDCS (HD-tDCS). Computational modeling of the HD-tDCS-induced electric field in each patient’s brain was analyzed based on magnetic resonance imaging …(MRI) scans. The chosen montage provided the highest net anodal electric field in the left dorsolateral prefrontal cortex (DLPFC). An accelerated HD-tDCS design was conducted (2 mA for 3×20 min) on two separate days. Pre- and post-intervention cognitive tests and T1 and T2-weighted MRI and diffusion tensor imaging data at baseline were analyzed. Results: Different montages were optimal for individual patients. The active HD-tDCS group improved significantly in delayed memory and MMSE performance compared to the sham group. Five participants in the active group had higher scores on delayed memory post HD-tDCS, four remained stable and one declined. The active HD-tDCS group had a significant positive correlation between fractional anisotropy in the anterior thalamic radiation and delayed memory score. Conclusion: HD-tDCS significantly improved delayed memory in AD. Our study can be regarded as a proof-of-concept attempt to increase tDCS efficacy. The present findings should be confirmed in larger samples. Show more

Keywords: Alzheimer’s disease, computational modeling, NIBS, noninvasive brain stimulation, tDCS, transcranial direct current stimulation

DOI: 10.3233/JAD-210378

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 753-769, 2021

Authors: Matias-Guiu, Jordi A. | Pytel, Vanesa | Hernández-Lorenzo, Laura | Patel, Nikil | Peterson, Katie A. | Matías-Guiu, Jorge | Garrard, Peter | Cuetos, Fernando

Article Type: Research Article

Abstract: Background: Primary progressive aphasia (PPA) is a neurodegenerative syndrome with three main clinical variants: non-fluent, semantic, and logopenic. Clinical diagnosis and accurate classification are challenging and often time-consuming. The Mini-Linguistic State Examination (MLSE) has been recently developed as a short language test to specifically assess language in neurodegenerative disorders. Objective: Our aim was to adapt and validate the Spanish version of MLSE for PPA diagnosis. Methods: Cross-sectional study involving 70 patients with PPA and 42 healthy controls evaluated with the MLSE. Patients were independently diagnosed and classified according to comprehensive cognitive evaluation and advanced neuroimaging. …Results: Internal consistency was 0.758. The influence of age and education was very low. The area under the curve for discriminating PPA patients and healthy controls was 0.99. Effect sizes were moderate-large for the discrimination between PPA and healthy controls. Motor speech, phonology, and semantic subscores discriminated between the three clinical variants. A random forest classification model obtained an F1-score of 81%for the three PPA variants. Conclusion: Our study provides a brief and useful language test for PPA diagnosis, with excellent properties for both clinical routine assessment and research purposes. Show more

Keywords: Alzheimer’s disease, frontotemporal dementia, neuropsychological, primary progressive aphasia

DOI: 10.3233/JAD-210668

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 771-778, 2021

Authors: He, Haining | Liu, An | Zhang, Wei | Yang, Huanqing | Zhang, Minmin | Xu, Hua | Liu, Yuanyuan | Hong, Bo | Yan, Feng | Yue, Ling | Wang, Jinghua | Xiao, Shifu | Xie, Zuoquan | Wang, Tao

Article Type: Research Article

Abstract: Background: Amnestic mild cognitive impairment (aMCI) is a prodromal stage of Alzheimer’s disease (AD) involving imbalanced beta-site amyloid precursor protein cleaving enzyme 1 (BACE1). MicroRNAs (miRNAs) are associated with AD. Objective: This study aimed to investigated whether plasma miRNAs can predict prodromal AD or are associated with AD pathology. Methods: Participants in the discovery set (n  = 10), analysis set (n  = 30), and validation set (n  = 80) were screened from the China Longitudinal Aging Study. RNA was extracted from the participants’ plasma. Microarray sequencing provided miRNA profiles and differentially expressed miRNAs (DEmiRNAs) in the discovery set included …patients with 18 F-Flutemetamol positron emission tomography scan-confirmed aMCI. Potential biomarkers were screened in the analysis set. The predict capability of candidate miRNAs was assessed in the validation set. Candidate miRNAs modulation of BACE1 expression was explored in rat and human hippocampal neurons in vitro . Results: We verified 46 significant DEmiRNAs between the aMCI and NC groups (p  < 0.05), among which 33 were downregulated. In the analysis set, miR-1185-2-3p, miR-1909-3p, miR-22-5p, and miR-134-3p levels decreased significantly in the aMCI group. These miRNAs and previously identified miR-107 were selected as potential biomarkers. A prediction model comprising these five miRNAs showed outstanding accuracy (81.25%) to discriminate aMCI at cut-off value of 0.174. Except for miR-134-3p, the other four miRNAs significantly suppressed Bace1 expression in rat hippocampal neurons in vitro . BACE1 modulation of miR-1185-2-3p, miR-1909-3p, and miR-134-3p was confirmed in human hippocampal neurons in vitro . Conclusion: A predictive model consisting of five BACE1-related plasma miRNAs could be a novel biomarker for aMCI. Show more

Keywords: Alzheimer’s disease, biomarkers, microRNAs, mild cognitive impairment

DOI: 10.3233/JAD-210307

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 779-790, 2021

Authors: Wammes, Joost D. | Nakanishi, Miharu | van der Steen, Jenny T. | MacNeil Vroomen, Janet L.

Article Type: Research Article

Abstract: Background: Japan has one of the highest percentages of persons with dementia and hospital deaths in the world. Hospitals are often not equipped to handle the care complexity required for persons with dementia at the end of life. The National Dementia Orange plan aimed to decrease hospital deaths by expanding time in the community. Objective: The aim of this study is to evaluate whether the National Dementia Orange Plan is associated with a decrease in hospitals deaths for persons with dementia. Methods: We used quarterly, cross-sectional, national death certificate data consisting of the total Japanese dementia …population 65 years and older, spanning a period from 2009 to 2016. The primary outcome was quarterly adjusted relative risk rates (aRRR) of dying in hospital, nursing home, home, or elsewhere. An interrupted time series analysis was performed to study the slope change over time. Analyses were adjusted for sex and seasonality. Results: 149,638 died with dementia. With the implementation of the Orange Plan, death in nursing home (aRRR 1.08, [1.07–1.08], p  < 0.001) and elsewhere (aRRR 1.05, [1.05–1.06], p  < 0.001) increased over time compared to hospital death. No changes were found in death at home. Conclusion: This study provides evidence that the National Dementia Orange plan was associated with a small increase in death in nursing home and elsewhere. Hospital death remained the primary location of death. End-of-life strategies should be expanded in national dementia policies to increase aging in the community until death. Show more

Keywords: Dementia, end-of-life, health policy, interrupted time series, Japan, place of death

DOI: 10.3233/JAD-210521

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 791-797, 2021

Authors: Cai, Hong-Yan | Yang, Dan | Qiao, Jing | Yang, Jun-Ting | Wang, Zhao-Jun | Wu, Mei-Na | Qi, Jin-Shun | Hölscher, Christian

Article Type: Research Article

Abstract: Background: Alzheimer’s disease (AD) is a degenerative disorder, accompanied by progressive cognitive decline, for which there is no cure. Recently, the close correlation between AD and type 2 diabetes mellitus (T2DM) has been noted, and a promising anti-AD strategy is the use of anti-T2DM drugs. Objective: To investigate if the novel glucagon-like peptide-1 (GLP-1)/glucose-dependent insulinotropic polypeptide (GIP) receptor agonist DA4-JC shows protective effects in the triple APP/PS1/tau mouse model of AD. Methods: A battery of behavioral tests were followed by in vivo recording of long-term potentiation (LTP) in the hippocampus, quantified synapses using the …Golgi method, and biochemical analysis of biomarkers. Results: DA4-JC improved cognitive impairment in a range of tests and relieved pathological features of APP/PS1/tau mice, enhanced LTP in the hippocampus, increased numbers of synapses and dendritic spines, upregulating levels of post-synaptic density protein 95 (PSD95) and synaptophysin (SYP), normalized volume and numbers of mitochondria and improving the phosphatase and tensin homologue induced putative kinase 1 (PINK1) - Parkin mitophagy signaling pathway, while downregulating amyloid, p-tau, and autophagy marker P62 levels. Conclusion: DA4-JC is a promising drug for the treatment of AD. Show more

Keywords: Alzheimer’s disease, cognitive impairment, glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, type 2 diabetes mellitus

DOI: 10.3233/JAD-210256

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 799-818, 2021

Authors: Zhou, Jie | Ma, Luping | Zhao, Lulei | Sheng, Jiamin | Xu, Yuhua | Chen, Jie | Yu, Liangjun | Sun, Quan | Zhou, Hangyang | Zhu, Shaofeng | Lu, Zefeng | Wei, Bo

Article Type: Research Article

Abstract: Background: Nutritional status has been recognized as an important factor influencing cognitive function-related diseases, but few comprehensive nutrition indicators are available to assess the risk of cognitive decline. Objective: This study aimed to investigate the relationship between the prognostic nutritional index (PNI) and cognitive function in an elderly population, and the differences in nutrient intake between different levels of nutritional risk. Methods: Based on cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014, we included 2,564 older participants. The lower quartile of each of the four cognitive tests was considered to have cognitive …function impairment (CFI). Binary and multivariate logistic regression models were used to estimate the relationship between the PNI and the odds ratio of CFI. Results: After adjustment for confounding variables, we found that the odds of CFI were significantly lower for participants with normal PNI levels than for those with low PNI levels. In a comparison of global cognitive impairment scores, participants with a normal PNI had lower ratios of poor cognitive performance than those with a low PNI. By comparing the nutrient intake at different PNI levels, we found a reduction in the intake of protein, dietary fiber, total saturated fatty acids, and multiple micronutrients in the low PNI group. Conclusion: Our study shows that the PNI can be a good predictor of the odds of CFI in the elderly population and that it is a convenient indicator of reduced intake of nutrients which may be important to brain health. Show more

Keywords: Cognitive function impairment, malnutrition, national health and nutrition examination survey (NHANES), older adults, prognostic nutritional index

DOI: 10.3233/JAD-210141

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 819-831, 2021

Authors: Yu, Yang | Gao, Yang | Winblad, Bengt | Tjernberg, Lars O. | Schedin-Weiss, Sophia

Article Type: Research Article

Abstract: Background: Processing of the amyloid-β protein precursor (AβPP) is neurophysiologically important due to the resulting fragments that regulate synapse biology, as well as potentially harmful due to generation of the 42 amino acid long amyloid β-peptide (Aβ42 ), which is a key player in Alzheimer’s disease. Objective: Our aim was to clarify the subcellular locations of the fragments involved in the amyloidogenic pathway in primary neurons with a focus on Aβ42 and its immediate substrate AβPP C-terminal fragment (APP-CTF). To overcome the difficulties of resolving these compartments due to their small size, we used super-resolution microscopy. …Methods: Mouse primary hippocampal neurons were immunolabelled and imaged by stimulated emission depletion (STED) microscopy, including three-dimensional three-channel imaging, and quantitative image analyses. Results: The first (β-secretase) and second (γ-secretase) cleavages of AβPP were localized to functionally and distally distinct compartments. The β-secretase cleavage was observed in early endosomes in soma, where we were able to show that the liberated N- and C-terminal fragments were sorted into distinct vesicles budding from the early endosomes. Lack of colocalization of Aβ42 and APP-CTF in soma suggested that γ-secretase cleavage occurs in neurites. Indeed, APP-CTF was, in line with Aβ42 in our previous study, enriched in the presynapse but absent from the postsynapse. In contrast, full-length AβPP was not detected in either the pre- or the postsynaptic side of the synapse. Furthermore, we observed that endogenously produced and endocytosed Aβ42 were localized in different compartments. Conclusion: These findings provide critical super-resolved insight into amyloidogenic AβPP processing in primary neurons. Show more

Keywords: Aβ42, Alzheimer’s disease, amyloid-β protein precursor, stimulated emission depletion microscopy, synapse

DOI: 10.3233/JAD-215008

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 833-852, 2021

Authors: Sweigart, Benjamin | Andersen, Stacy L. | Gurinovich, Anastasia | Cosentino, Stephanie | Schupf, Nicole | Perls, Thomas T. | Sebastiani, Paola

Article Type: Research Article

Abstract: Background: The E4 allele of the APOE gene is known to be associated with cognitive impairment. However, a limited number of studies have examined the association between the E2 allele and longitudinal changes of cognitive function. Objective: To determine whether rates of cognitive change differ in carriers of the APOE E2 allele compared to other genotypes. Methods: We conducted a secondary analysis of data from two ongoing longitudinal cohort studies, the Long Life Family Study (LLFS) and New England Centenarian Study (NECS). We included participants who had APOE genotyping data, data from longitudinal …administrations of the Telephone Interview for Cognitive Status (TICS), and age, sex, and education available. We assessed whether cognitive change as measured by rate of decline in TICS score differed among people with different APOE genotypes. We used a hierarchical mixed effect model with APOE genotypes, their interactions with age, and potential confounders. Results: After adjusting for sex and education, in carriers of the common E3/E3 genotype, TICS score decreased by 0.15 points per year of age. In those with the E2/E2 genotype, TICS score decreased by 0.05 points per year of age, a significantly slower rate of decline (p  = 0.017). We observed no protective effect of the E2/E3 genotype on cognitive decline. Conclusion: These results suggest a protective effect of the E2/E2 genotype on a measure of global cognitive function. Show more

Keywords: Apolipoproteins E, cognitive aging, cognitive dysfunction, genetics

DOI: 10.3233/JAD-201205

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 853-860, 2021

Authors: Pudumjee, Shehroo B. | Lundt, Emily S. | Albertson, Sabrina M. | Machulda, Mary M. | Kremers, Walter K. | Jack Jr., Clifford R. | Knopman, David S. | Petersen, Ronald C. | Mielke, Michelle M. | Stricker, Nikki H.

Article Type: Research Article

Abstract: Background: Longitudinal, but not cross-sectional, cognitive testing is one option proposed to define transitional cognitive decline for individuals on the Alzheimer’s disease continuum. Objective: Compare diagnostic accuracy of cross-sectional subtle objective cognitive impairment (sOBJ) and longitudinal objective decline (Δ OBJ) over 30 months for identifying 1) cognitively unimpaired participants with preclinical Alzheimer’s disease defined by elevated brain amyloid and tau (A+T+) and 2) incident mild cognitive impairment (MCI) based on Cogstate One Card Learning (OCL) accuracy performance. Methods: Mayo Clinic Study of Aging cognitively unimpaired participants aged 50 + with amyloid and tau PET scans (n  = 311) comprised …the biomarker-defined sample. A case-control sample of participants aged 65 + remaining cognitively unimpaired for at least 30 months included 64 who subsequently developed MCI (incident MCI cases) and 184 controls, risk-set matched by age, sex, education, and visit number. sOBJ was assessed by OCL z-scores. Δ OBJ was assessed using within subjects’ standard deviation and annualized change from linear regression or linear mixed effects (LME) models. Concordance measures Area Under the ROC Curve (AUC) or C-statistic and odds ratios (OR) from conditional logistic regression models were derived. sOBJ and Δ OBJ were modeled jointly to compare methods. Results: sOBJ and Δ OBJ-LME methods differentiated A+T+ from A-T- (AUC = 0.64, 0.69) and controls from incident MCI (C-statistic = 0.59, 0.69) better than chance; other Δ OBJ methods did not. Δ OBJ-LME improved prediction of future MCI over baseline sOBJ (p  = 0.003) but not over 30-month sOBJ (p  = 0.09). Conclusion: Longitudinal decline did not offer substantial benefit over cross-sectional assessment in detecting preclinical Alzheimer’s disease or incident MCI. Show more

Keywords: Amyloid, biomarker, cognigram, memory, neuropsychology, reliable change index, sensitivity and specificity, tau, transitional cognitive decline, validity

DOI: 10.3233/JAD-210251

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 861-877, 2021

Authors: Kapasi, Alifiya | Yu, Lei | Stewart, Christopher | Schneider, Julie A. | Bennett, David A. | Boyle, Patricia A.

Article Type: Research Article

Abstract: Background: Recent findings suggest that poor decision making and increased scam susceptibility are harbingers of Alzheimer’s disease (AD) dementia and may be among the earliest behavioral manifestations of pathologic cognitive aging. However, the degree to which poor decision making and scam susceptibility reflect accumulating Alzheimer’s disease (AD) pathology remains unclear. Objective: To investigate the associations of AD pathology with decision making and scam susceptibility in older adults without dementia. Methods: Data came from 198 deceased participants without clinical dementia (mean age at death = 90 years; 69%women) from two ongoing studies of aging. All underwent annual clinical evaluations, …completed assessments of healthcare and financial decision making and scam susceptibility, and brain donation. Neuropathologic evaluations quantified pathologic hallmarks of AD, amyloid-β and tau-tangles, Lewy body pathology, and TDP-43 proteinopathy. Results: In linear regression models adjusted for demographics, amyloid-β pathology was associated with lower decision making (estimate = –0.35; SE = 0.16, p  = 0.03), particularly healthcare decision making (estimate = –0.20; SE = 0.09, p  = 0.03), as well as greater scam susceptibility (estimate = 0.12; SE = 0.04, p  = 0.003); tau-tangle pathology was not related. Further, TDP-43 pathology was associated with greater scam susceptibility (estimate = 0.10; SE = 0.04; p  = 0.02). Conclusion: Accumulating AD pathology, particularly amyloid-β, is associated with poor decision making and increased scam susceptibility among older persons without overt cognitive impairment. These findings provide compelling evidence that decision making and scam susceptibility are sensitive to the earliest pathological changes of AD. Show more

Keywords: Aging, Alzheimer’s disease pathology, amyloid-beta, decision making, scam

DOI: 10.3233/JAD-210356

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 879-887, 2021

Authors: Liu, Xiao | Abudukeremu, Ayiguli | Jiang, Yuan | Cao, Zhengyu | Wu, Maoxiong | Sun, Runlu | Chen, Zhiteng | Chen, Yangxin | Zhang, Yuling | Wang, Jingfeng

Article Type: Research Article

Abstract: Background: Several kinds of motor dysfunction can predict future cognitive impairment in elderly individuals. However, the ability of the fine motor index (FINEA) and gross motor index (GROSSA) to predict the risk of cognitive impairment has not been assessed. Objective: We investigated the associations between FINEA/GROSSA and cognitive impairment. Methods: The data of 4,745 participants from The Irish Longitudinal Study on Ageing (TILDA) were analyzed. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). We first assessed the correlation between the FINEA/GROSSA and MMSE in a cross-sectional study. Then, we further investigated the predictive role …of the incidence of cognitive impairment in a prospective cohort study. Results: We found that both FINEA and GROSSA were negatively correlated with MMSE in both the unadjusted (FINEA: B  = –1.00, 95%confidence intervals (CI): –1.17, –0.83, t  = –11.53, p  < 0.001; GROSSA: B  = –0.85, 95%CI: –0.94, –0.76, t  = –18.29, p  < 0.001) and adjusted (FINEA: B  = –0.63, 95%CI: –0.79, –0.47, t  = –7.77, p  < 0.001; GROSSA: B  = –0.57, 95%CI: –0.66, –0.48, t  = –12.61, p  < 0.001) analyses in a cross-sectional study. In a prospective cohort study, both high FINEA and high GROSSA were associated with an increased incidence of cognitive function impairment (FINEA: adjusted odds ratios (OR) = 2.35, 95%CI: 1.05, 5.23, p  = 0.036; GROSSA adjusted OR = 3.00, 95%CI: 1.49, 6.03, p  = 0.002) after 2 years of follow-up. Conclusion: Higher FINEA and GROSSA scores were both associated with an increased incidence of cognitive impairment. FINEA or GROSSA might be a simple tool for identifying patients with cognitive impairment. Show more

Keywords: Cognitive impairment, fine motor index, gross motor index, the Irish longitudinal study on ageing

DOI: 10.3233/JAD-210704

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 889-896, 2021

Authors: Qin, Wei | Li, Wenwen | Wang, Qi | Gong, Min | Li, Tingting | Shi, Yuqing | Song, Yang | Li, Ying | Li, Fangyu | Jia, Jianping

Article Type: Research Article

Abstract: Background: The global race-dependent association of Alzheimer’s disease (AD) and apolipoprotein E (APOE ) genotype is not well understood. Transethnic analysis of APOE could clarify the role of genetics in AD risk across populations. Objective: This study aims to determine how race and APOE genotype affect the risks for AD. Methods: We performed a systematic search of PubMed, Embase, Web of Science, and the Cochrane Library since 1993 to Aug 25, 2020. A total of 10,395 reports were identified, and 133 were eligible for analysis with data on 77,402 participants. Studies contained AD clinical …diagnostic and APOE genotype data. Homogeneous data sets were pooled in case-control analyses. Odds ratios and 95% confidence intervals for developing AD were calculated for populations of different races and APOE genotypes. Results: The proportion of APOE genotypes and alleles differed between populations of different races. Results showed that APOE ɛ 4 was a risk factor for AD, whereas APOE ɛ 2 protected against it. The effects of APOE ɛ 4 and ɛ 2 on AD risk were distinct in various races, and they were substantially attenuated among Black people. Sub-group analysis found a higher frequency of APOE ɛ 4/ɛ 4 and lower frequency of APOE ɛ 3/ɛ 3 among early-onset AD than late-onset AD in a combined group and different races. Conclusion: Our meta-analysis suggests that the association of APOE genotypes and AD differ among races. These results enhance our understanding of APOE -related risk for AD across race backgrounds and provide new insights into precision medicine for AD. Show more

Keywords: Alzheimer’s disease, APOE genotype, race, risk

DOI: 10.3233/JAD-210549

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 897-906, 2021

Authors: Tsapanou, Angeliki | Zoi, Panagiota | Kalligerou, Faidra | Blekou, Patra | Sakka, Paraskevi

Article Type: Research Article

Abstract: Background: The impact of the new coronavirus disease (COVID-19) is deteriorating as time passes and the virus keeps spreading, with people with dementia and their caregivers being affected significantly. Objective: The aim of this study was to examine the effect of prolonged isolation because of the COVID-19 pandemic on people with dementia and their caregivers. Methods: Caregivers answered online questions regarding their own physical and psychological burden, and of the person they take care of. Participants were mostly members of online seminars of the Athens Alzheimer’s Association. Questions referred to their own burden, the overall decline …of the persons they take care of, and changes in specific domains as well. Further, participants were asked about any changes between the two major lockdown periods. Analysis was performed including the total sample and then, by three different stages of dementia. Results: A total of 339 caregivers took part in the study. Results indicated significant decline, both in an overall aspect of the people with dementia, and in specific domains (mostly communication and mood). Regarding the caregivers, they reported having significantly increased physical and psychological burden, and also, noticing an overall change between the two lockdown periods in their own burden. Analysis by dementia-stage group indicated that significant decline occurred both in the middle-stage and the late-stage group. Conclusion: An urgency for further support of both the people with neurodegenerative disorders and their caregivers is needed. Collaboration among care workers, online programs, governmental support, and day-care centers should be planned to ensure continuity of care for those in need during the pandemic. Show more

Keywords: Caregivers, COVID-19, dementia

DOI: 10.3233/JAD-210702

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 907-913, 2021

Authors: Edgar, Chris J. | Siemers, Eric | Maruff, Paul | Petersen, Ronald C. | Aisen, Paul S. | Weiner, Michael W. | Albala, Bruce | for the Alzheimer’s Disease Neuroimaging Initiative

Article Type: Research Article

Abstract: Background: There is a need for feasible, scalable assessments to detect cognitive impairment and decline. The Cogstate Brief Battery (CBB) is validated for Alzheimer’s disease (AD) and in unsupervised and bring your own device contexts. The CBB has shown usability for self-completion in the home but has not been employed in this way in a multisite clinical trial in AD. Objective: The objective of the pilot was to evaluate feasibility of at-home, self-completion of the CBB in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) over 24 months. Methods: The CBB was included as a pilot for cognitively …normal (CN) and mild cognitive impairment (MCI) participants in ADNI-2, invited to take the assessment in-clinic, then at at-home over a period of 24 months follow-up. Data were analyzed to explore acceptability/usability, concordance of in-clinic and at-home assessment, and validity. Results: Data were collected for 104 participants (46 CN, 51 MCI, and 7 AD) who consented to provide CBB data. Subsequent analyses were performed for the CN and MCI groups only. Test completion rates were 100%for both the first in-clinic supervised and first at-home unsupervised assessments, with few repeat performances required. However, available follow-up data declined sharply over time. Good concordance was seen between in-clinic and at-home assessments, with non-significant and small effect size differences (Cohen’s d between -0.04 and 0.28) and generally moderate correlations (r  = 0.42 to 0.73). Known groups validity was also supported (11/16 comparisons with Cohen’s d ≥0.3). Conclusion: These data demonstrate the feasibility of use for the CBB for unsupervised at-home, testing, including MCI groups. Optimal approaches to the application of assessments to support compliance over time remain to be determined. Show more

Keywords: Alzheimer’s disease, clinical trials as a topic, cognition, digital technology, healthcare research

DOI: 10.3233/JAD-210201

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 915-925, 2021

Authors: Tadokoro, Koh | Yamashita, Toru | Kimura, Shuhei | Nomura, Emi | Ohta, Yasuyuki | Omote, Yoshio | Takemoto, Mami | Hishikawa, Nozomi | Morihara, Ryuta | Morizane, Yuki | Abe, Koji

Article Type: Research Article

Abstract: Background: Cost-effective and noninvasive methods for in vivo imaging of amyloid deposition are needed to screen Alzheimer’s disease (AD). Although retinal amyloid is a possible diagnostic marker of AD, there are very few studies on in vivo retinal amyloid imaging. Objective: To examine the usefulness of in vivo imaging of retinal amyloid in AD patients. Methods: To examine amyloid deposition, 30 Japanese subjects (10 normal control (NC), 7 with mild cognitive impairment (MCI), and 13 with AD) underwent a complete ophthalmic examination, including fundus imaging by scanning laser ophthalmoscopy before and after oral …curcumin intake. Results: Retinal amyloid deposition was greater in AD than in NC subjects (* p  < 0.05) while MCI showed a slight but insignificant increase of retinal amyloid deposition relative to NC subjects. Retinal amyloid deposition was correlated with whole gray matter atrophy (r  = 0.51, * p  < 0.05) but not with the cognitive score of the Mini-Mental State Examination, nor with medial temporal lobe atrophy. Conclusion: The present noninvasive in vivo detection of retinal amyloid deposition is useful for screening AD patients. Show more

Keywords: Alzheimer’s disease, amyloid, mild cognitive impairment, retina

DOI: 10.3233/JAD-210327

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 927-934, 2021

Authors: Perry, George

Article Type: Book Review

DOI: 10.3233/JAD-210744

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 935-935, 2021

Article Type: Correction

DOI: 10.3233/JAD-219009

Citation: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 937-937, 2021