Locus coeruleus metabolic changes as a predictor of tau accumulation and cognitive decline

Abstract

AbstractBackgroundThe locus coeruleus (LC), the primary noradrenergic nucleus in the brainstem, is among the earliest brain structures to accumulate tau pathology, one of the neuropathologic hallmarks of Alzheimer’s disease (AD). Tau pathology in the earlier stages and significant cell loss in the disease’s later stages can affect the metabolic turnover of the LC. In addition, alterations in the LC’s metabolic turnover have been associated with tau formation and propagation. We investigated differences in LC glucose metabolism across AD clinical diagnostic and biomarker groups and its association with longitudinal tau, beta‐amyloid, and cognitive measurements.MethodWe investigated LC FDG‐PET signal of 295 participants from the ADNI‐1 and ADNI‐2/GO cohorts, who were equally distributed across the CSF beta‐amyloid (A) and phosphorylated‐tau (T) biomarker groups (Table 1). An in‐house developed joint‐entropy‐penalized image deblurring algorithm was used to quantify Positron Emission Tomography (PET) signal within small brain regions (Figure 2A). ANCOVA was used to investigate diagnostic and biomarker‐based group differences in LC metabolism. Post‐hoc Tukey contrasts corrected for multiple comparisons in subsequent pairwise analyses. Linear mixed‐effects models investigated the predictive value of LC metabolism on the rate of change in CSF‐based p‐tau, beta‐amyloid and cognitive scores.ResultLow LC FDG‐PET signal was observed in the amyloid and tau‐positive group compared to the other groups (p<0.0001). Pair‐wise differences between the diagnostic groups did not survive correction for multiple comparisons. Combining biomarker and diagnostic status, we observed lower LC metabolism in A+T+ MCI and AD groups compared to CN and MCI A+T‐ and A‐T‐ groups (p<0.001; Figure 1B). Lower LC metabolism predicted accumulation of p‐tau (t(127) = ‐2.65, p = 0.009) and PACC decline (t(128) = 2.2, p = 0.029; Figure 2). LC metabolism did not significantly predict changes in beta‐amyloid levels or MMSE scores.ConclusionThis is the first study relating in‐vivo spatially specific measures of LC metabolism to AD‐related biomarker status. Low LC metabolism was most pronounced in those with evidence of underlying AD pathologic change and cognitive impairment. Furthermore, lower LC metabolism predicted greater CSF‐based p‐tau accumulation and declining cognition over time, providing an early marker of AD progression.