Longitudinal neurodegeneration in relation to amyloid pathology among cognitively unimpaired individuals

IF 13 1区 医学 Q1 CLINICAL NEUROLOGY Alzheimer's & Dementia Pub Date : 2025-01-09 DOI:10.1002/alz.092448
Henry Gilreath Stephenson, Tobey J. Betthauser, Carol A. Van Hulle, Lianlian Du, Rebecca E. Langhough, Erin M. Jonaitis, Gwendlyn Kollmorgen, Clara Quijano-Rubio, Nathaniel A. Chin, Ozioma C Okonkwo, Cynthia M. Carlsson, Sanjay Asthana, Bradley T. Christian, Sterling C. Johnson, Kaj Blennow, Henrik Zetterberg, Barbara B. Bendlin
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Abstract

Background

The timing of neurodegeneration in relation to the onset of Alzheimer’s disease pathology is not fully known. This study examined the association of longitudinal atrophy derived from T1-weighted MRI with 1) cerebrospinal fluid (CSF) amyloid-tau (AT) groupings and 2) Pittsburgh compound B (PiB) PET-derived estimates of amyloid duration among cognitively unimpaired (CU) individuals.

Method

CU participants in the Wisconsin Registry for Alzheimer’s Prevention and Wisconsin Alzheimer’s Disease Research Center (N = 297) underwent longitudinal MRI, APOE genotyping, and lumbar puncture to determine CSF Aβ42/40 (A) and pTau181 (T) concentration at baseline using in-house cutoffs. CSF measurements were performed using the NeuroToolKit, a panel of robust prototype biomarker assays (Roche Diagnostics International Ltd). Image segmentation was performed using a longitudinal pipeline in SPM12. Grey matter volumes from AD-associated regions (adjusted for intracranial volume) were z-scored according to age-associated predictions from a robust longitudinal A-T-/APOE4-/CU control group. Differences in longitudinal atrophy relative to controls were tested in linear mixed-effects models using contrasts between A+T- and A+T+ groups and A-T- controls and interactions with time (years from baseline). In the PiB PET subset, sampled iterative local approximation was used to estimate time-to-positivity at baseline relative to a PiB DVR threshold of 1.16. CSF A+ individuals were grouped as CSF A+ only, early PiB+ (PiB+ <= 5 years), and established PiB+ (PiB+ > 5 years). Differences in longitudinal atrophy were tested with A+ group/A-T- contrasts and interactions with time. All analyses were FDR-corrected. See Table 1 and Figure 1 for participant characteristics and model details.

Result

Based on CSF assays, both A+ groups showed longitudinal atrophy relative to controls in a majority of ROIs, suggesting that A+, regardless of pTau+, is associated with neurodegeneration. Further analysis incorporating PET showed that CSF A+ in the absence of PiB+ was not associated with atrophy, but early PiB+ was associated with atrophy in medial temporal ROIs and precuneus. The largest and most widespread atrophy was observed in the established PiB+ group (Figure 2).

Conclusion

Neurodegeneration appears to begin soon after the onset of PET-measurable amyloid-positivity. Clinical intervention at the earliest signs of amyloid deposition may be needed to delay neurodegeneration.

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纵向神经变性与淀粉样蛋白病理在认知未受损个体中的关系
背景神经退行性变与阿尔茨海默病发病病理的关系尚不完全清楚。本研究检查了T1加权MRI得出的纵向萎缩与1)脑脊液(CSF)淀粉样蛋白- tau (AT)分组和2)匹兹堡化合物B (PiB) PET得出的认知未受损(CU)个体中淀粉样蛋白持续时间的相关性。方法来自威斯康辛州阿尔茨海默病预防登记中心和威斯康辛州阿尔茨海默病研究中心的cu参与者(N = 297)通过纵向MRI、APOE基因分型和腰椎穿刺来测定基线时脑脊液A - β42/40 (A)和pTau181 (T)的浓度。脑脊液测量使用NeuroToolKit进行,NeuroToolKit是一组强大的原型生物标志物测定试剂盒(罗氏诊断国际有限公司)。在SPM12中使用纵向管道进行图像分割。根据纵向a‐T‐/APOE4‐/CU对照组的年龄相关预测,对AD相关区域的灰质体积(根据颅内体积调整)进行z‐评分。在线性混合效应模型中,使用A+T -组和A+T -组以及A - T -对照组之间的对比以及与时间(距基线年)的相互作用来测试相对于对照组的纵向萎缩差异。在PiB PET子集中,使用采样迭代局部近似来估计相对于PiB DVR阈值1.16的基线时间对正性。CSF A+个体分为单纯CSF A+、早期PiB+ (PiB+ <= 5年)和已建立PiB+ (PiB+ >;5年)。纵向萎缩的差异通过A+组/A‐T‐对比和与时间的相互作用来检验。所有分析均经过FDR校正。参与者特征和模型细节见表1和图1。结果根据脑脊液分析,在大多数roi中,A+组相对于对照组显示纵向萎缩,这表明A+与pTau+无关,与神经退行性变有关。结合PET的进一步分析显示,在没有PiB+的情况下,脑脊液A+与萎缩无关,但早期PiB+与内侧颞叶roi和楔前叶萎缩有关。在已建立的PiB+组中观察到最大和最广泛的萎缩(图2)。结论:神经退行性变似乎在PET可测量的淀粉样蛋白阳性发作后不久开始。在淀粉样蛋白沉积的早期迹象进行临床干预可能需要延迟神经变性。
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来源期刊
Alzheimer's & Dementia
Alzheimer's & Dementia 医学-临床神经学
CiteScore
14.50
自引率
5.00%
发文量
299
审稿时长
3 months
期刊介绍: Alzheimer's & Dementia is a peer-reviewed journal that aims to bridge knowledge gaps in dementia research by covering the entire spectrum, from basic science to clinical trials to social and behavioral investigations. It provides a platform for rapid communication of new findings and ideas, optimal translation of research into practical applications, increasing knowledge across diverse disciplines for early detection, diagnosis, and intervention, and identifying promising new research directions. In July 2008, Alzheimer's & Dementia was accepted for indexing by MEDLINE, recognizing its scientific merit and contribution to Alzheimer's research.
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