CSF Aβ42 Research Articles

COVID-19 vaccination may prevent postoperative delirium in elderly patients undergoing elective non-cardiac surgery: The PNDRFAP and PNDABLE studies

BackgroundPostoperative delirium (POD) often occurs in elderly patients after surgery. We conducted two clinical studies to determine whether COVID-19 vaccination has a protective effect on POD and to explore the role of CSF biomarkers in this process. MethodsWe conducted two clinical studies, Perioperative Neurocognitive Disorder Risk Factor and Prognosis (PNDRFAP) and Perioperative Neurocognitive Disorder and Biomarker Lifestyle (PNDABLE), in which patients more than or equal to 65 years old who have had elective non-cardiac surgery were enrolled. The preoperative cognitive status of patients were evaluated by Mini-Mental State Examination (MMSE) one day preoperatively. Confusion Assessment Method (CAM) was used to diagnose POD. We used the mediation model to analyze the relationship between CSF biomarkers, COVID-19 vaccination and POD, as well as Dynamic Nomogram to calculate the incidence of Non-Postoperative Delirium (NPOD). The main outcome of these studies was the incidence of POD during seven days postoperatively or before discharge, which was assessed by CAM. ResultsIn the final, 705 participants were enrolled in the PNDRFAP study, and 638 patients in the PNDABLE. In both studies, we found that the occurrence of POD was lower in patients who had injected COVID-19 vaccination before surgery compared with those without vaccination (PNDRFAP: 10.20 % [21/205] vs 25.80 % [129/500], P < 0.001; PNDABLE: 2.40 % [4/164] vs 34.60 % [164/474], P < 0.001). Mediation analysis showed that the protective effect of preoperative COVID-19 vaccine on POD was significantly mediated by CSF Aβ42 (proportion = 17.56 %), T-tau (proportion = 19.64 %), Aβ42/T-tau (proportion = 29.67 %), and Aβ42/P-tau (proportion = 12.26 %). ConclusionsCOVID-19 vaccine is a protective factor for POD in old patients, which is associated with CSF biomarkers.

CSF β-Amyloid and Tau Biomarker Changes in Veterans With Mild Traumatic Brain Injury.

Moderate-to-severe traumatic brain injuries (TBI) have been reported to increase the risk of Alzheimer disease (AD). Whether mild TBI (mTBI) in veterans confers a similar increased risk of AD is less known. This study investigated early AD changes using CSF biomarkers in veterans with blast mTBI. This was a cross-sectional case-control study of veterans with mTBI and non-mTBI veterans and civilians from 2 study sources. Blast-mTBI veterans had at least 1 war zone blast or combined blast/impact mTBI meeting Veterans Affairs (VA) and Department of Defense (DoD) criteria for mTBI. Non-mTBI participants had no lifetime history of TBI. All participants underwent standardized clinical and neuropsychological assessments and lumbar puncture for collection of the CSF. CSF biomarkers were measured using MesoScale Discovery assays for Aβ40 and Aβ42 and INNOTEST ELISAs for phosphorylated tau181 (p-tau181) and total tau (t-tau). Our sample comprised 51 participants with mTBI and 85 non-mTBI participants with mean (SD) ages 34.0 (10.1) and 33.5 years (8.9), respectively. All participants but 1 (99%) were male. Differences in CSF AD biomarkers between mTBI and non-mTBI groups were age dependent and most pronounced at older ages (omnibus test p ≤ 0.08). At age 50 years, the mTBI group had lower mean [95% CI] CSF Aβ42 and Aβ40 than the non-mTBI group by 154 [-12 to 319] and 1864 [610-3,118] pg/mL, respectively. By contrast, CSF p-tau181 and t-tau mean levels remained relatively constant with age in participants with mTBI, while tending to be higher at older ages for the non-mTBI group. The mTBI group also demonstrated poorer cognitive performance at older ages (omnibus p < 0.08): at age 50 years, the mean TMT-B time was higher by 34 seconds [10-58] and the mean CVLT-II short-delay recall was lower by 4.2 points [1.9-6.6]. Poorer verbal memory and verbal fluency performance were associated with lower CSF Aβ42 (p ≤ 0.05) in older participants. CSF Aβ levels decreased in middle-aged veterans with blast-related mTBI. These data suggest that chronic neuropathologic processes associated with blast mTBI share properties in common with pathogenic processes known to portend AD onset, thus raising concern that veterans with blast-related mTBI may develop a dementing disorder later in life.

Longitudinal Relationship Between Brain Atrophy Patterns, Cognitive Decline, and Cerebrospinal Fluid Biomarkers in Alzheimer's Disease Explored by Orthonormal Projective Non-Negative Matrix Factorization.

Longitudinal magnetic resonance imaging (MRI) has been proposed for tracking the progression of Alzheimer's disease (AD) through the assessment of brain atrophy. Detection of brain atrophy patterns in patients with AD as the longitudinal disease tracker. We used a refined version of orthonormal projective non-negative matrix factorization (OPNMF) to identify six distinct spatial components of voxel-wise volume loss in the brains of 83 subjects with AD from the ADNI3 cohort relative to healthy young controls from the ABIDE study. We extracted non-negative coefficients representing subject-specific quantitative measures of regional atrophy. Coefficients of brain atrophy were compared to subjects with mild cognitive impairment and controls, to investigate the cross-sectional and longitudinal associations between AD biomarkers and regional atrophy severity in different groups. We further validated our results in an independent dataset from ADNI2. The six non-overlapping atrophy components represent symmetric gray matter volume loss primarily in frontal, temporal, parietal and cerebellar regions. Atrophy in these regions was highly correlated with cognition both cross-sectionally and longitudinally, with medial temporal atrophy showing the strongest correlations. Subjects with elevated CSF levels of TAU and PTAU and lower baseline CSF Aβ42 values, demonstrated a tendency toward a more rapid increase of atrophy. The present study has applied a transferable method to characterize the imaging changes associated with AD through six spatially distinct atrophy components and correlated these atrophy patterns with cognitive changes and CSF biomarkers cross-sectionally and longitudinally, which may help us better understand the underlying pathology of AD.

BDNF Val66Met moderates episodic memory decline and tau biomarker increases in early sporadic Alzheimer's disease.

Allelic variation in the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism has been shown to moderate rates of cognitive decline in preclinical sporadic Alzheimer's disease (AD; i.e., Aβ + older adults), and pre-symptomatic autosomal dominant Alzheimer's disease (ADAD). In ADAD, Met66 was also associated with greater increases in CSF levels of total-tau (t-tau) and phosphorylated tau (p-tau181). This study sought to determine the extent to which BDNF Val66Met is associated with changes in episodic memory and CSF t-tau and p-tau181 in Aβ + older adults in early-stage sporadic AD. Aβ + Met66 carriers (n = 94) and Val66 homozygotes (n = 192) enrolled in the Alzheimer's Disease Neuroimaging Initiative who did not meet criteria for AD dementia, and with at least one follow-up neuropsychological and CSF assessment, were included. A series of linear mixed models were conducted to investigate changes in each outcome over an average of 2.8years, covarying for CSF Aβ42, APOE ε4 status, sex, age, baseline diagnosis, and years of education. Aβ + Met66 carriers demonstrated significantly faster memory decline (d = 0.33) and significantly greater increases in CSF t-tau (d = 0.30) and p-tau181 (d = 0.29) compared to Val66 homozygotes, despite showing equivalent changes in CSF Aβ42. These findings suggest that reduced neurotrophic support, which is associated with Met66 carriage, may increase vulnerability to Aβ-related tau hyperphosphorylation, neuronal dysfunction, and cognitive decline even prior to the emergence of dementia. Additionally, these findings highlight the need for neuropsychological and clinicopathological models of AD to account for neurotrophic factors and the genes which moderate their expression.

Bile acid profile associated with CSF and PET biomarkers in Alzheimer’s disease

BackgroundRecent studies have shown that gut microbiota can affect the development of Alzheimer’s disease (AD) through various mechanisms. Bile acids (BAs), which are the final byproducts of cholesterol metabolism created through both the human body and gut microbiome, appear to be influenced by gut microbiota and may impact AD pathological characteristics such as the accumulation of tau and amyloid-β. We aimed to investigate the associations between various serum BAs and CSF biomarkers (including Aβ, total tau, and p-tau). Additionally, we sought to examine the longitudinal changes in brain Aβ and tau through PET imaging in relation to BAs profile.MethodsThe data of 828 subjects including 491 diagnosed with mild cognitive impairment (MCI), 119 patients diagnosed with AD, and 267 cognitively normal (CN) participants were obtained from ADNI. The baseline and longitudinal [18F] florbetapir and [18F] flortaucipir PET standard uptake value ratios (SUVR) measures were obtained to assess the accumulation of tau and Aβ. Moreover, baseline levels of serum BAs and CSF Aβ1–42, tau, and p-tau were used.ResultsAfter FDR correction we observed that five BAs level and relevant calculated ratios were associated with CSF p-tau and tau, three with CSF Aβ1–42. Furthermore, three BAs level and relevant calculated ratios were associated with the tau-PET rate of change, and two with the Aβ rate of change.ConclusionThe findings from our study suggest a correlation between altered profiles of BAs and CSF and imaging biomarkers associated with AD. These results provide supporting evidence for the link between the gut microbiome and the pathological features of AD.

Evaluation of ATNPD Framework and Biofluid Markers to Predict Cognitive Decline in Early Parkinson Disease.

In Parkinson disease (PD), Alzheimer disease (AD) copathology is common and clinically relevant. However, the longitudinal progression of AD CSF biomarkers-β-amyloid 1-42 (Aβ42), phosphorylated tau 181 (p-tau181), and total tau (t-tau)-in PD is poorly understood and may be distinct from clinical AD. Moreover, it is unclear whether CSF p-tau181 and serum neurofilament light (NfL) have added prognostic utility in PD, when combined with CSF Aβ42. First, we describe longitudinal trajectories of biofluid markers in PD. Second, we modified the AD β-amyloid/tau/neurodegeneration (ATN) framework for application in PD (ATNPD) using CSF Aβ42 (A), p-tau181 (T), and serum NfL (N) and tested ATNPD prediction of longitudinal cognitive decline in PD. Participants were selected from the Parkinson's Progression Markers Initiative cohort, clinically diagnosed with sporadic PD or as controls, and followed up annually for 5 years. Linear mixed-effects models (LMEMs) tested the interaction of diagnosis with longitudinal trajectories of analytes (log transformed, false discovery rate [FDR] corrected). In patients with PD, LMEMs tested how baseline ATNPD status (AD [A+T+N±] vs not) predicted clinical outcomes, including Montreal Cognitive Assessment (MoCA; rank transformed, FDR corrected). Participants were 364 patients with PD and 168 controls, with comparable baseline mean (±SD) age (patients with PD = 62 ± 10 years; controls = 61 ± 11 years]; Mann-Whitney Wilcoxon: p = 0.4) and sex distribution (patients with PD = 231 male individuals [63%]; controls = 107 male individuals [64%]; χ2: p = 1). Patients with PD had overall lower CSF p-tau181 (β = -0.16, 95% CI -0.23 to -0.092, p = 2.2e-05) and t-tau than controls (β = -0.13, 95% CI -0.19 to -0.065, p = 4e-04), but not Aβ42 (p = 0.061) or NfL (p = 0.32). Over time, patients with PD had greater increases in serum NfL than controls (β = 0.035, 95% CI 0.022 to 0.048, p = 9.8e-07); slopes of patients with PD did not differ from those of controls for CSF Aβ42 (p = 0.18), p-tau181 (p = 1), or t-tau (p = 0.96). Using ATNPD, PD classified as A+T+N± (n = 32; 9%) had worse cognitive decline on global MoCA (β = -73, 95% CI -110 to -37, p = 0.00077) than all other ATNPD statuses including A+ alone (A+T-N-; n = 75; 21%). In patients with early PD, CSF p-tau181 and t-tau were low compared with those in controls and did not increase over 5 years of follow-up. Our study shows that classification using modified ATNPD (incorporating CSF Aβ42, CSF p-tau181, and serum NfL) can identify biologically relevant subgroups of PD to improve prediction of cognitive decline in early PD.

Predicting amyloid positivity from FDG-PET images using radiomics: A parsimonious model

Background and ObjectiveAmyloid plaques are one of the physical hallmarks of Alzheimer's disease. The objective of this study is to predict amyloid positivity non-invasively from FDG-PET images using a radiomics approach. MethodsWe obtained FDG-PET images of 301 individuals from various groups, including control normal (CN), mild cognitive impairment (MCI), and Alzheimer's Disease (AD), from the ADNI database. Following the utilization of the CSF Aβ1–42 (192) and Standardized Uptake Value Ratio (SUVR) (1.11) thresholds derived from Florbetapir scans, the subjects were categorized into two categories: those with a positive amyloid status (n = 185) and those with a negative amyloid status (n = 116). The process of segmenting the entire brain into 95 classes using the DKT-atlas was utilized. Following that, we obtained 120 characteristics for each of the 95 regions of interest (ROIs). We employed eight feature selection methods to analyze the features. Additionally, we utilized eight different classifiers on the 20 most significant features extracted from each feature selection method. Finally, in order to improve interpretability, we selected the most important features and ROIs. ResultWe found that the GNB classifier and the LASSO feature selection method had the best performance with an average accuracy of (AUC=0.924) while using 18 features on 15 ROIs. We were then able to reduce the model to three regions (Hippocampus, inferior parietal, and isthmus cingulate) and three gray-level based features (AUC=0.853). ConclusionThe FDG-PET images which serve to study metabolic activity can be used to predict amyloid positivity without the use of invasive methods or another PET tracer and study. The proposed method has superior prediction accuracy with respect to similar studies reported in the literature using other imaging modalities. Only three brain regions had a high impact on amyloid positivity results.

Differential diagnosis of mild cognitive impairment of Alzheimer's disease by Simoa p-tau181 measurements with matching plasma and CSF.

Alzheimer's disease (AD) is characterized by a long preclinical phase. Although late-stage AD/dementia may be robustly differentiated from cognitively normal individuals by means of a clinical evaluation, PET imaging, and established biofluid biomarkers, disease differentiation between cognitively normal and various subtypes of mild cognitive impairment (MCI) remains a challenging task. Differential biomarkers for early-stage AD diagnosis with accessible biofluid samples are urgently needed. Misfolded phosphorylated tau aggregates (p-tau) are present in multiple neurodegenerative diseases known as "tauopathies", with the most common being AD. P-tau181 is a well-established p-tau biomarker to differentiate AD dementia from non-AD pathology. However, it is unclear if p-tau181 is capable of diagnosing MCI, an early AD stage, from cognitively normal subjects, or if it can discriminate MCI subtypes amnestic MCI (aMCI) from non-amnestic MCI (naMCI). Here we evaluated the capability of p-tau181 in diagnosing MCI from cognitively normal subjects and discriminating aMCI from naMCI subtypes. We collected matching plasma and CSF samples of a clinically diagnosed cohort of 35 cognitively normal, 34 aMCI, 17 naMCI, and 31 AD dementia cases (total 117 participants) with supplemental CSF Aβ42 and total tau AD biomarker levels and performed Simoa p-tau181 assays. The diagnostic capabilities of Simoa p-tau181 assays to differentiate these cohorts were evaluated. We found (i) p-tau181 can robustly differentiate MCI or aMCI from cognitively normal cohorts with matching plasma and CSF samples, but such differentiation is weaker in diagnosing naMCI from cognitively normal groups, (ii) p-tau181 is not capable of differentiating aMCI from naMCI cohorts, and (iii) either factor of Aβ or total tau burden markedly improved differentiation power to diagnose aMCI from cognitively normal group. Plasma and CSF p-tau181 levels may serve as a promising biomarker for diagnosing aMCI from normal controls in the preclinical phase. But more robust new biomarkers are needed to differentiate naMCI from cognitively normal cases or to discriminate between MCI subtypes, aMCI from naMCI.

CSF Extracellular Vesicle Aβ42 and Tau/Aβ42 Ratio Are Associated with Cognitive Impairment in Older People with HIV.

HIV-associated neurocognitive disorders (HAND) remain prevalent despite viral suppression on antiretroviral therapy (ART). Older people with HIV (PWH) are also at risk for amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD). β-amyloid (Aβ) and Tau biomarkers are associated with aMCI/AD, but their relationship to HAND is unclear. Given the role of extracellular vesicles (EVs) in age-related neurological disorders, we investigated soluble and EV-associated Aβ42, total Tau, NFL, GFAP, ICAM-1, VCAM-1, and CRP in relation to cognitive impairment in PWH. Plasma and CSF EVs were isolated from 184 participants (98 PWH on ART and 86 HIV- controls). Biomarkers were measured using Meso Scale Discovery assays. The median age of PWH was 53 years, and 52% were diagnosed with mild forms of HAND. PWH had increased plasma NFL (p = 0.04) and CSF Aβ42 (p = 0.0003) compared with HIV- controls but no significant difference in Tau or EV-associated forms of these markers. CSF EV Aβ42 was decreased (p = 0.0002) and CSF EV Tau/Aβ42 ratio was increased (p = 0.001) in PWH with HAND vs. no HAND, while soluble forms of these markers showed no significant differences. Decreased CSF EV Aβ42 (p < 0.0001) and an increased CSF EV Tau/Aβ42 ratio (p = 0.0003) were associated with lower neurocognitive T scores in age-adjusted models; an optimal model included both CSF EV Aβ42 and plasma NFL. Levels of soluble, but not EV-associated, ICAM-1, VCAM-1, and CRP were increased in PWH with HAND vs. no HAND (p < 0.05). These findings suggest that decreased Aβ42 and an increased Tau/Aβ42 ratio in CSF EVs are associated with cognitive impairment in older PWH, and these EV-associated biomarkers may help to distinguish aMCI/AD from HIV-related cognitive disorders in future studies.

Cortical microstructural associations with CSF amyloid and pTau

Diffusion MRI (dMRI) can be used to probe microstructural properties of brain tissue and holds great promise as a means to non-invasively map Alzheimer’s disease (AD) pathology. Few studies have evaluated multi-shell dMRI models such as neurite orientation dispersion and density imaging (NODDI) and mean apparent propagator (MAP)-MRI in cortical gray matter where many of the earliest histopathological changes occur in AD. Here, we investigated the relationship between CSF pTau181 and Aβ1–42 burden and regional cortical NODDI and MAP-MRI indices in 46 cognitively unimpaired individuals, 18 with mild cognitive impairment, and two with dementia (mean age: 71.8 ± 6.2 years) from the Alzheimer’s Disease Neuroimaging Initiative. We compared findings to more conventional cortical thickness measures. Lower CSF Aβ1–42 and higher pTau181 were associated with cortical dMRI measures reflecting less hindered or restricted diffusion and greater diffusivity. Cortical dMRI measures, but not cortical thickness measures, were more widely associated with Aβ1–42 than pTau181 and better distinguished Aβ+ from Aβ- participants than pTau+ from pTau- participants. dMRI associations mediated the relationship between CSF markers and delayed logical memory performance, commonly impaired in early AD. dMRI metrics sensitive to early AD pathogenesis and microstructural damage may be better measures of subtle neurodegeneration in comparison to standard cortical thickness and help to elucidate mechanisms underlying cognitive decline.

The effect of BDNF Val66Met on memory, CSF total‐tau, CSF ptau181 and CSF Aβ42 in early sporadic Alzheimer’s disease

AbstractBackgroundAllelic variation in the brain‐derived neurotrophic factor (BDNF) Val66Met polymorphism has been shown to moderate rates of cognitive decline in preclinical sporadic Alzheimer’s disease (i.e., Aβ+ older adults), and pre‐symptomatic dominantly inherited Alzheimer’s disease (DIAD). In DIAD, Met66 was also associated with greater increases in CSF levels of total‐tau and phosphorylated tau (p‐tau181). This study sought to determine the extent to which BDNF Val66Met is also associated with changes in episodic memory and CSF total‐tau and p‐tau181 in Aβ+ older adults in early‐stage sporadic AD.MethodAβ+ Met66 carriers (n = 94) and Val66 homozygotes (n = 192) enrolled in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) who did not meet criteria for AD dementia were included. Only participants with at least one follow‐up neuropsychological and CSF assessment were included. Episodic memory was measured by the ADNI Memory Composite and CSF samples were collected via lumbar puncture to determine levels of total‐tau, p‐tau181 and Aβ42. A series of linear mixed models were conducted to investigate changes in each outcome variable over 10 years, covarying for CSF Aβ42 (except when examining changes in CSF Aβ42), APOE ε4 status, sex, age, baseline diagnosis and years of education.ResultWhen followed over 10 years, Aβ+ Met66 carriers demonstrated significantly faster memory decline (d = 0.33) and significantly greater increases in CSF total‐tau (d = 0.30) and p‐tau181 (d = 0.29) compared to Val66 homozygotes, despite showing equivalent rates of change in CSF Aβ42 (Table 1; Figure 1).ConclusionIn non‐demented Aβ+ older adults, Met66 carriers showed greater memory decline and greater increases in both CSF total‐tau and CSF p‐tau181 over 10 years compared to Val66 homozygotes, despite showing equivalent changes in CSF Aβ42. This suggests that Met66 carriage, which is associated with lower BDNF availability and lower neurotrophic support, may confer greater vulnerability to Aβ‐related increases in tau compared to Val66 homozygosity in the early stages of sporadic AD.

Digital and plasma biomarkers for an early diagnosis of Mild Cognitive Impairment and prodromal Alzheimer’s disease

AbstractBackgroundThe application of blood‐based biomarkers for the identification of Alzheimer’s disease (AD) and the development of novel digital technologies as cognitive screening tests are critical to moving toward a reliable, more accessible early diagnosis. Our aim was to evaluate the diagnostic performance of a machine learning‐based cognitive assessment known as Altoida’s digital neuro‐signature (DNS) in patients with non‐degenerative mild cognitive impairment (ndMCI) and MCI due to AD (prodromal AD) and its association with CSF and plasma biomarkers.MethodAltoida’s MCI‐DNS is a 10‐minute cognitive test battery evaluating activities of daily living via motoric and augmented reality tasks. The test consists of placing and finding virtual objects in a real environment and its final score is obtained by weighting multi‐modal digital data features, such as hands’ micro‐movements, speed, reaction times, or navigation trajectories. We included 81 participants, classified according to their clinical status and CSF AD biomarker profile as: cognitively unimpaired controls, CTR (n = 10; age = 68.5±5.9; MMSE = 29.4±1.1), ndMCI (n = 25; age = 67.6±7.2; MMSE = 26.9±1.9) and prodromal AD (n = 46; age = 70.8±4.9; MMSE = 24.3±3.3). We further investigated a subsample of participants classified according to their plasma pTau181 levels as measured by SiMoA [cutoff = 1.37 pg/mL (Sarto et al., 2022)]: pTau181 negative (n = 27; age = 68.5±5.9; MMSE = 26.9±2.7) or pTau181 positive (n = 30; age = 70.3±5.5; MMSE = 24.1±3.7).ResultSignificant differences were found in MCI‐DNS scores between CTR group and ndMCI (F = 23.5; p&lt;0.001) and prodromal AD (F = 114.4; p&lt;0.001) groups. Also, ndMCI showed higher MCI‐DNS scores than the prodromal AD group (F = 4.53; p&lt;0.05, Fig. 1). ROC curves showed an excellent diagnostic accuracy of the MCI‐DNS in the discrimination between CTR vs. ndMCI (AUC = 0.879) and CTR vs. prodromal AD (AUC = 0.975) (Fig. 1). Further analyses showed differences in MCI‐DNS scores between CSF Aβ42 negative and CSF Aβ42 positive (F = 18.9; p&lt;0.001; Fig. 2), as well as between plasma pTau181 negative and plasma pTau181 positive (F = 6.16; p&lt;0.01; Fig. 2). Finally, MCI DNS scores significantly correlated with CSF Aβ42, CSF Aβ42/pTau ratio, CSF neurofilament‐light chain (NfL) and plasma pTau181 concentrations (Fig. 3).ConclusionAltoida’s MCI‐DNS test allows excellent discrimination between CTR and patients with MCI. MCI‐DNS scores significantly correlate with CSF AD core biomarkers, biomarkers of neurodegeneration and blood‐based biomarkers (i.e., plasma pTau181).

Associations of Antemortem Cerebrospinal Fluid Biomarkers with Alzheimer’s Disease Neuropathologic changes at Autopsy

AbstractBackgroundCerebrospinal fluid (CSF) amyloid‐beta 42 (Aβ42) and tau phosphorylated at threonine 181 (p‐tau181) have been widely used as biomarkers for Alzheimer’s disease (AD). AT(N) classification even proposes each substance as a direct biomarker of amyloid (A) and tau (T) pathologies, respectively. However, recent studies suggest that increased CSF p‐tau181 may rather be associated with amyloid pathology. Although neuropathological evaluation at autopsy is the gold standard for assessing these changes, studies evaluating the association between CSF biomarkers and AD neuropathologic changes are limited.MethodWe retrospectively studied patients who underwent antemortem CSF AD biomarker measurement and neuropathological evaluation at autopsy at our institution from 1995 to 2021. CSF biomarkers were measured by ELISA (Fujirebio, Belgium). Neuropathological evaluation of AD was performed routinely regardless of diagnosis and Thal phase, Braak neurofibrillary tangle (NFT) stage, and CERAD score were assessed according to current guidelines.ResultThe mean age of the 119 patients was 76.2 ± 8.9 years; 49 were women. The duration from lumbar puncture to autopsy was median 2 years (0‐13 years). AD pathology was observed in 29 patients (24%). Other common pathologies were Lewy body disease and frontotemporal lobar degeneration. Antemortem CSF Aβ42 and p‐tau181 results were obtained in 119 and 68 patients, respectively. As expected, CSF Aβ42 decreased with increasing Thal phase and CERAD score. CSF p‐tau181 increased with increasing Thal phase, Braak NFT stage, and CERAD score. Even when the analysis was restricted to patients with Braak NFT stage 3 or less (n = 48), CSF p‐tau181 increased mildly with increasing Thal phase and CERAD score. In patients with moderate or severe amyloid pathology by Thal phase or CERAD score (n = 34), CSF p‐tau181 increased more highly at Braak NFT stage 5 or more.ConclusionThe results of this study, which directly compared antemortem CSF biomarkers with AD neuropathologic changes at autopsy, support the current theories that increased CSF p‐tau181 is caused by both amyloid and tau pathology related to AD while decreased CSF Aβ42 is associated with amyloid pathology.

Distinct CSF biomarker‐associated DNA methylation in Alzheimer’s disease and cognitively normal subjects

AbstractBackgroundGrowing evidence has demonstrated that DNA methylation (DNAm) plays an important role in Alzheimer’s disease and that DNAm differences can be detected in the blood of AD subjects. Because access to human brain tissues is primarily limited to postmortem samples, most studies have correlated blood DNAm with clinical diagnosis of AD in living individuals. However, as the pathophysiological process of AD can begin many years before the onset of clinical symptoms, there is often disagreement between neuropathology in the brain and clinical phenotypes. Thus, the association of blood DNAm with changes in AD neuropathology, rather than with clinical data, would provide more relevant information on AD pathogenesis.MethodCSF biomarkers are well‐established AD endophenotypes and correlate significantly with neuropathology scores measured on postmortem brain samples. In this study, we performed a comprehensive analysis to identify blood DNA methylation associated with CSF pathological biomarkers for AD in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. Our study included matched samples of whole blood DNA methylation, CSF Aβ42, phosphorylated tau181 (pTau181), and total tau (tTau) biomarkers data, measured on the same subjects and at the same clinical visits from a total of 202 subjects (123 cognitively normal, 79 AD cases).ResultWe identified a number of novel associations between blood DNAm and CSF Aβ42, pTau181, and total tau biomarkers, demonstrating that changes in various pathological processes in the CSF are also reflected in the blood epigenome. Overall, the CSF biomarker‐associated DNAm is relatively distinct in cognitively normal (CN) and AD subjects, highlighting the importance of analyzing omics data measured on cognitively normal subjects (which includes preclinical AD subjects) to identify diagnostic biomarkers, and considering disease stages in the development and testing of AD treatment strategies. Moreover, our pathway analysis of CSF biomarker associated‐DNAm from CN subjects revealed that biological processes associated with early brain impairment relevant to AD are marked by DNAm in the blood.ConclusionOur study provides a valuable resource for future mechanistic and biomarker studies of DNAm in AD.

Blood‐derived mitochondrial DNA copy number is associated with Alzheimer’s Disease through the regulation of plasma lipid and amino acid metabolism

AbstractBackgroundBlood‐derived mitochondrial DNA copy number (mtDNA‐CN) is the proxy measurement of mitochondrial function in the peripheral and central systems. Abnormal mtDNA‐CN not only indicates impaired mtDNA replication and transcription machinery but also dysregulated biological processes such as energy and lipid metabolism. However, the relationship between mtDNA‐CN and Alzheimer’s Disease (AD) and the underlying mechanisms of mitochondrial dysfunction in the pathogenesis of AD are still unclear.MethodTo investigate the causal relationship between mtDNA‐CN and AD, we performed two‐sample Mendelian randomization (MR) using publicly available summary statistics from GWAS for mtDNA‐CN and AD. Further, we estimated mtDNA‐CN using whole‐genome sequence data from blood samples of 1,521 ADNI participants and used a Cox proportional hazard model, adjusted for age, sex, and study phase, to assess the association between mtDNA‐CN and AD risk. The association of AD biomarkers measured in brain and plasma metabolites with mtDNA‐CN was evaluated using linear regression. We conducted causal mediation analysis to test the natural indirect effects of mtDNA‐CN change on AD risk through the significantly associated biomarkers and metabolites.ResultMR analysis using a profile likelihood approach suggested a causal relationship between decreased blood‐derived mtDNA‐CN and increased risk of AD (OR = 0.71; P = 0.023). Survival analysis showed that decreased mtDNA‐CN was significantly associated with increased risk of conversion from mild cognitive impairment to AD (HR = 0.80; P = 0.0017). We also identified significant associations between mtDNA‐CN and brain glucose metabolism (β = 0.050; P = 0.047) and amyloid‐β (Aβ) (β = 0.069; P = 0.015) and CSF Aβ (β = ‐0.051; P = 0.048). Plasma Aβ was, however, not associated. Several lipid species, amino acids, biogenic amines, and inflammatory proteins in plasma were also significantly associated with mtDNA‐CN. Finally, causal mediation analyses showed that the effect of change in mtDNA‐CN on AD risk is mediated by plasma neurofilament light (β = ‐0.055; P = 0.010), glycine (β = 0.016; P = 0.044), and hexadecenoylcarnitine (β = ‐0.017; P = 0.049).ConclusionOur study indicates that mtDNA‐CN measured in blood is predictive of AD risk. Associations of mtDNA‐CN with Aβ in CSF and brain, but not plasma, suggest cross‐tissue regulation of mitochondria. Decreased mtDNA‐CN might increase AD risk through lipid and amino acid metabolism. These results also suggest potential development of mtDNA‐CN as a blood‐based biomarker.

Sex differences of cerebrospinal fluid biomarkers in Alzheimer’s disease

AbstractBackgroundAlzheimer’s disease (AD) is more common in women than in men. Thus, to investigate the sex‐specific mechanism is important to understand the pathogenesis of AD. We examined the sex differences in levels of CSF biomarkers (tau, ptau‐181, Aβ42, HVA and 5HIAA) in AD.MethodThe subjects of this study consisted of clinically diagnosed 386 patients with AD (age 75.9±8.4 years, 237 women and 149 men). The clinical diagnosis was made based on the AD diagnostic criteria (NIA/AA, McKhann GM, et al., Alzheimers Dement 2011; 7: 263‐269). The CSF samples were obtained by lumbar puncture after informed consent was obtained. The levels of CSF tau, ptau‐181 and Aβ42 were measured by ELISA (Fujirebio, Belgium) according to the manufacturer’s protocol. The levels of CSF HVA and 5HIAA were measured by HPLC. We compared the levels of CSF biomarkers between women and men.ResultAge, the levels of CSF tau, ptau‐181 and Aβ42 showed no sex differences. The levels of CSF HVA (ng/ml) were 32.6±19.3 in women and 25.9±14.4 in men. The levels of 5HIAA were 19.1±11.7 in women and 14.8±7.7 in men. The levels of CSF HVA and 5HIAA were significantly higher in women than those in men (t‐test, HVA: p&lt;0.001, 5HIAA: p&lt;0.001).It has been reported that women have higher values of HVA and 5HIAA among normal subjects, due to higher monoamine oxidase (MAO) activity in women. The MAO‐A and MAO‐B genes are located on the X chromosome, and are controlled by XCI (X‐chromosome inactivation). However, the MAO genes may escape XCL MAO‐B has also been reported to be γ‐secretase associated protein and regulate neuronal amyloid β‐peptide levels. Thus, increased MAO‐B activity may be one of the reasons why AD is more common in women.ConclusionBoth CSF levels of HVA and 5HIAA were significantly higher in women in AD, presumably due to increased MAO activity.

Diagnostic performance and clinical applicability of plasma pTau181 to predict dementia risk in a large real‐world cohort of a memory clinic

AbstractBackgroundThe Alzheimer Association has recently remarked the diagnostic and prognostic revolution that plasma biomarkers will mean for AD diagnosis, and highlighting the need of further research to translate them as a realistic option in the clinical practice. However, many studies to date have assessed them in research cohorts. Here we evaluated the diagnostic performance and clinical applicability of plasma pTau181 as a predictive marker of dementia risk in a real‐world memory clinic cohort.MethodThe ACE cohort encompass 1649 patients with subjective cognitive decline (SCD), mild cognitive impairment (MCI), AD dementia and other dementias, with a complete battery of neurological tests, biochemistry data, and paired CSF and plasma samples of the Ace Alzheimer Center Barcelona memory clinic. CSF AB42, AB40, pTau181 and tTau, and plasma pTau181 were measured using the Lumipulse G1200 automatic platform (Fujirebio Inc.). Complete cohort were divided in the Testing cohort (n = 1000) and Validation cohort (n = 649).ResultPlasma pTau181 significantly correlated (P&lt;0.0001) with CSF pTau181 in MCI, AD dementia and other dementias, but not in SCD. Sex appeared not significant in plasma pTau181 levels, whereas age significantly influenced in the biomarker’s performance. ROC curve of A+T+ patients vs rest showed an AUC = 0.8250 and P&lt;0.0001. Specifically for MCI patients, ROC curve of MCI A+T+ vs MCI A‐T‐ showed and AUC = 0.8874 and P&lt;0.0001. A cut off value of 1.300 pg/ml of plasma pTau181 exhibited a 93.6% sensibility, 72.4% specificity, 77.8% precision and only 8.3% of false negatives in MCI patients. Hazard ratio of survival of conversion analysis showed that MCI patients above this cut off value exhibited a 4.570 higher risk to convert to dementia than MCI under the cut off value. Validation cohort confirmed these findings.ConclusionPlasma pTau181 could be useful as a pre‐screening biomarker of MCI patients with high risk to progress to dementia. However, positive patients will also require a CSF/PET confirmatory test. Plasma pTau181 by itself does not present a suitable performance in SCD patients. Another biomarker or a combination of biomarkers would be needed to this population. Further studies are need to obtain more clinical data and improve the biomarker performance to finally substitute CSF/PET biomarkers.

Adjusting for CSF Reference Proteins Improves Biomarker Accuracy

AbstractBackgroundCSF biomarkers are key AD descriptors, but the CSF volume as well as the production and clearance rates of proteins varies in individuals. Adjusting for reference proteins, which reflect these factors, might improve the accuracy of CSF biomarkers, similar to when normalizing CSF Aβ42 levels to Aβ40 levels. For other biomarkers, individual CSF dynamics are seldom adjusted for, which may result in disagreement with other techniques (e.g., PET). Additionally, this may contribute to inaccurate conclusions about CSF protein correlations that mainly exist due to high or low CSF dilution levels. The aim of this work is therefore to establish the use of CSF reference proteins to improve CSF AD biomarker accuracy.MethodWe used measurements of 2944 CSF proteins in the Swedish BioFINDER‐2 cohort (n = 982, 80% train and 20% test). Reference protein candidates (reflecting CSF dilution levels without being related to any disease) were searched for in a data‐driven manner, using t‐distributed stochastic neighbor embedding (t‐SNE) and a semi‐supervised K‐means clustering algorithm. The final candidate proteins were evaluated in logistic regression models, using CSF P‐tau181 and CSF Aβ42 as main predictors of tau‐PET and amyloid‐PET, respectively.ResultMost proteins were associated with an individual dilution level, although at different strengths (Fig 1 and Fig 2e). From the different colorings of the t‐SNE space, proteins of similar expressions were placed nearby, creating areas of extra interest (yellow areas in subfigures 2c‐2h). The semi‐supervised K‐means algorithm highlighted an area (cluster 11) containing proteins with superior reference protein characteristics, from which single reference protein candidates were identified. All examined references (e.g., Aβ40, NTRK3, NTRK2, BLMH,CBLN4, PTPRN2 or PTPRS) outperformed using no reference for both the P‐tau181 and Aβ42 model (Figure 3). For P‐tau181, highest performance was achieved using CBLN4 (AUC = 0.944). For Aβ42, Aβ40 performed best as reference (AUC = 0.992).ConclusionThe individual CSF dilution level affects many CSF proteins. We describe several novel and previously suggested CSF reference proteins, which can significantly improve the accuracy of CSF biomarkers as key AD descriptors.

CSF Aβ42/40 is associated with neurodegeneration independently of CSF p‐tau in the earliest AD continuum

AbstractBackgroundSoluble Aβ dyshomeostasis is thought to be the earliest detectable alteration in AD, but is believed to have little impact on neurodegeneration. Conversely, the onset of tau pathology in the presence of Aβ drives subsequent neurodegeneration. Here, we aimed to assess the independent contribution of soluble Aβ and tau dyshomeostasis to neurodegeneration, in the earliest stages of the AD continuum.MethodThe first 330 consecutive participants of the ALFA+ study with available longitudinal (3.45±0.24 y) MRI, CSF Aβ42, Aβ40, p‐tau181, and NfL at baseline were included. CSF biomarkers were assessed with the Roche NeuroToolKit robust prototype immunoassays and p‐tau181 with the Elecsys® Phospho‐Tau (181P) CSF immunoassay (Roche Diagnostics International Ltd). Gray matter volume (GMv) changes were computed voxelwise using SPM12 on T1w scans. Hippocampal subfields were segmented using ASHS on high‐resolution acquisitions. To detect regions showing early neurodegeneration, correlations between CSF NfL and GMv changes were sought. Then, GMv and hippocampal subfields changes were sought in association with CSF Aβ42/40 and CSF p‐tau181, both alone and after controlling for the other biomarkers. The interactive effect of CSF p‐tau181 and Aβ status (CSF Aβ42/40 &lt; 0.071) on brain structure was determined.ResultTable 1 shows sample’s characteristics. CSF NfL concentrations were associated with longitudinal GMv atrophy in the medial and inferior temporal areas (Fig. 1A). CSF Aβ42/40 significantly predicted GMv atrophy in the hippocampus bilaterally, alone and when controlling for CSF p‐tau181 and NfL (Fig. 1B‐C). CSF p‐tau181 interacted with Aβ status to predict GMv atrophy in the posterior hippocampus bilaterally (Fig. 1D). Longitudinal GMv atrophy in the hippocampal subfields were confirmed in association with CSF Aβ42/40 in the bilateral CA1, dentate gyrus and BA35 (Table 2).ConclusionIndependently of p‐tau, early Aβ dyshomeostasis is associated with longitudinal GMv atrophy in AD‐sensitive brain areas in the early AD continuum. As expected, tau levels were associated with additional atrophy in these regions in Aβ+ individuals. Pathophysiological alterations other than Aβ, but correlated with CSF Aβ levels, might contribute to the observed atrophy patterns. Control of the earliest pathophysiological alterations in AD may have a relevant impact on neurodegeneration, even at the earliest preclinical stages.

Plasma biomarkers of Alzheimer’s disease in dementia with Lewy bodies

AbstractBackgroundAlzheimer’s disease (AD) co‐pathology is a common feature in dementia with Lewy bodies (DLB) and associated with a more rapid decline. Here, we aimed to evaluate plasma biomarkers as alternatives for CSF biomarkers for the detection of amyloid pathology, and for their diagnostic and prognostic value in DLB.MethodPlasma Aβ42/40, GFAP, NfL, pTau181 and pTau231, were measured by SIMOA in patients with DLB (n = 342), AD (n = 131), and healthy controls (n = 89) from the E‐DLB consortium cohort. Associations of biomarkers with CSF Aβ42 status were assessed with ANCOVA corrected for age and sex. ROC analyses were performed to assess biomarker’s performance for amyloid detection and differential diagnosis. Associations of biomarkers with cognitive impairment and decline were determined by linear regression and mixed effects models.ResultAltered Aβ42/40 (β = ‐0.0076, 95%CI:‐0.0137 to ‐0.0016, p&lt;.05), pTau181 (β = 0.2503, 95%CI: 0.0555 to 0.4451, p&lt;.05) and pTau231 levels (β = 0.2269, 95%CI:0.0347 to 0.4191, p&lt;.05) were associated with amyloid pathology in DLB, as assessed by CSF Aβ42. The combination of these biomarkers differentiated amyloid normal from abnormal DLB patients with an AUC of 0.728 (sensitivity = 64.6%, specificity = 75.0%). pTau181 best differentiated these groups as a single marker (AUC = 0.700, sensitivity = 62.5%, specificity = 73.1%). The combination of Aβ42/40, NfL and pTau231 differentiated DLB from AD with an AUC of 0.726 (sensitivity = 73.3%, specificity = 68.8%). In DLB, increased GFAP (β = ‐8.9, 95%CI:‐11.7 to ‐6.1, p&lt;.001), NfL (β = ‐7.2, 95%CI:‐10.0 to ‐4.4, p&lt;.001), pTau181 (β = ‐2.6, 95%CI:‐4.0 to ‐1.2, p&lt;.001) and pTau231 (β = ‐2.4, 95%CI:‐3.7 to ‐1.2, p&lt;.001) were associated with lower baseline MMSE scores and increased GFAP (annual change of ‐2.1 MMSE points (95%CI:‐2.9 to ‐1.3, p&lt;.001) and NfL (annual change of ‐2.1 MMSE points (95%CI:‐3.0 to ‐1.3, p&lt;.001) predicted faster cognitive decline.ConclusionPlasma Aβ42/40, pTau181 and pTau231 were associated with amyloid abnormality in DLB. Their utility for differential diagnosis and identifying amyloid pathology in DLB was modest. Our findings suggest a prognostic value of GFAP and NfL for cognitive decline in DLB.