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A Multimodal Approach to Stratification of Patients with Dementia: Selection of Mixed Dementia Patients Prior to Autopsy

Alzheimer’s disease (AD) and vascular cognitive impairment and dementia (VCID) are major causes of dementia, and when combined lead to accelerated cognitive loss. We hypothesized that biomarkers of neurodegeneration and neuroinflammation could be used to stratify patients into diagnostic groups. Dia...

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Autores principales: Rosenberg, Gary A., Prestopnik, Jillian, Knoefel, Janice, Adair, John C., Thompson, Jeffrey, Raja, Rajikha, Caprihan, Arvind
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721392/
https://www.ncbi.nlm.nih.gov/pubmed/31374883
http://dx.doi.org/10.3390/brainsci9080187
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author Rosenberg, Gary A.
Prestopnik, Jillian
Knoefel, Janice
Adair, John C.
Thompson, Jeffrey
Raja, Rajikha
Caprihan, Arvind
author_facet Rosenberg, Gary A.
Prestopnik, Jillian
Knoefel, Janice
Adair, John C.
Thompson, Jeffrey
Raja, Rajikha
Caprihan, Arvind
author_sort Rosenberg, Gary A.
collection PubMed
description Alzheimer’s disease (AD) and vascular cognitive impairment and dementia (VCID) are major causes of dementia, and when combined lead to accelerated cognitive loss. We hypothesized that biomarkers of neurodegeneration and neuroinflammation could be used to stratify patients into diagnostic groups. Diagnosis of AD can be made biologically with detection of amyloid and tau proteins in the cerebrospinal fluid (CSF) and vascular disease can be identified with diffusion tensor imaging (DTI). We recruited patients with cognitive complaints and made an initial clinical diagnosis. After one year of follow-up we made a biological diagnosis based on the use of biomarkers obtained from DTI, CSF AD, and inflammatory proteins, and neuropsychological testing. Patients with AD had primarily findings of neurodegeneration (CSF showing increased tau and reduced amyloid), while patients with neuroinflammation had abnormal DTI mean diffusion (MD) in the white matter. Using the biological biomarkers resulted in many of the clinically diagnosed AD patients moving into mixed dementia (MX). Biomarkers of inflammation tended to be higher in the MX than in either the AD or VCID, suggesting dual pathology leads to increased inflammation, which could explain accelerated cognitive decline in that group.
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spelling pubmed-67213922019-09-10 A Multimodal Approach to Stratification of Patients with Dementia: Selection of Mixed Dementia Patients Prior to Autopsy Rosenberg, Gary A. Prestopnik, Jillian Knoefel, Janice Adair, John C. Thompson, Jeffrey Raja, Rajikha Caprihan, Arvind Brain Sci Article Alzheimer’s disease (AD) and vascular cognitive impairment and dementia (VCID) are major causes of dementia, and when combined lead to accelerated cognitive loss. We hypothesized that biomarkers of neurodegeneration and neuroinflammation could be used to stratify patients into diagnostic groups. Diagnosis of AD can be made biologically with detection of amyloid and tau proteins in the cerebrospinal fluid (CSF) and vascular disease can be identified with diffusion tensor imaging (DTI). We recruited patients with cognitive complaints and made an initial clinical diagnosis. After one year of follow-up we made a biological diagnosis based on the use of biomarkers obtained from DTI, CSF AD, and inflammatory proteins, and neuropsychological testing. Patients with AD had primarily findings of neurodegeneration (CSF showing increased tau and reduced amyloid), while patients with neuroinflammation had abnormal DTI mean diffusion (MD) in the white matter. Using the biological biomarkers resulted in many of the clinically diagnosed AD patients moving into mixed dementia (MX). Biomarkers of inflammation tended to be higher in the MX than in either the AD or VCID, suggesting dual pathology leads to increased inflammation, which could explain accelerated cognitive decline in that group. MDPI 2019-08-01 /pmc/articles/PMC6721392/ /pubmed/31374883 http://dx.doi.org/10.3390/brainsci9080187 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Rosenberg, Gary A.
Prestopnik, Jillian
Knoefel, Janice
Adair, John C.
Thompson, Jeffrey
Raja, Rajikha
Caprihan, Arvind
A Multimodal Approach to Stratification of Patients with Dementia: Selection of Mixed Dementia Patients Prior to Autopsy
title A Multimodal Approach to Stratification of Patients with Dementia: Selection of Mixed Dementia Patients Prior to Autopsy
title_full A Multimodal Approach to Stratification of Patients with Dementia: Selection of Mixed Dementia Patients Prior to Autopsy
title_fullStr A Multimodal Approach to Stratification of Patients with Dementia: Selection of Mixed Dementia Patients Prior to Autopsy
title_full_unstemmed A Multimodal Approach to Stratification of Patients with Dementia: Selection of Mixed Dementia Patients Prior to Autopsy
title_short A Multimodal Approach to Stratification of Patients with Dementia: Selection of Mixed Dementia Patients Prior to Autopsy
title_sort multimodal approach to stratification of patients with dementia: selection of mixed dementia patients prior to autopsy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721392/
https://www.ncbi.nlm.nih.gov/pubmed/31374883
http://dx.doi.org/10.3390/brainsci9080187
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