Ε4 Allele Research Articles

Are Digital Markers of Everyday Driving Comparable to Fluid Biomarkers in Identifying Preclinical Alzheimer Disease?

AbstractBackgroundPreclinical Alzheimer’s disease (AD) may have a subtle functional signature reflected in changes in everyday driving behaviour. Driving has the potential to serve as a digital marker for AD when captured continuously and characterized accurately. This study directly compares the diagnostic performance of digital markers of everyday driving, cerebrospinal fluid (CSF), and blood biomarkers in detecting amyloid deposition in AD, using amyloid positron emission tomography (PET) as the “gold standard”.MethodParticipants were enrolled in a longitudinal study on driving and preclinical AD biomarkers at Washington University School of Medicine. The Driving Real‐World In‐Vehicle Evaluation System (DRIVES) Project uses in‐vehicle GPS dataloggers to collect daily driving among cognitive normal drivers. This study included 121 drivers (aged 65+) with complete blood, CSF, and PET biomarker data. We employed three artificial neural network (ANN) to examine the relationship between everyday driving and PET‐amyloid status. The first model solely included driving features. The second ANN model (i.e., “non‐intrusive” model) added age and education level as additional features. The third model included all of the previous features plus APOE e4 status. Plasma Aß42/Aß40<0.1013 and CSF Aß42/Aß40<0.0673 were used to detect PET‐amyloid positivity. To compare the performance of the ANN models and the CSF and plasma biomarkers, area under the receiver operating curve (AUC) from 5‐fold cross‐validation were calculated.ResultIndividuals who were PET‐amyloid positive (n = 46) were more likely to be older (p<.05) and carry an APOE e4 allele (p<.0001). The two groups did not differ in sex or education. In predicting PET‐amyloid positivity, the five most important driving features were the number of left turns per mile, 80th percentile of jerk, minimum vehicle speed, speed variability, and the number of speeding incidents. The CSF biomarker achieved the highest performance (AUC = 0.96±0.04), followed by the model with driving, age, education and APOE e4 status (AUC = 0.88±0.05). The model with only driving features achieved lower performance (AUC = 0.74±0.07), while the non‐intrusive ANN model achieved comparable performance to the plasma biomarker (AUC: 0.82±0.11vs.0.83±0.12).ConclusionDigital markers of everyday driving along with age and education level offer a non‐intrusive and scalable diagnostic tool for preclinical AD that provides ongoing assessments.

Investigation of neighborhood disadvantage in the context of APOE‐associated amyloid onset age risk

AbstractBackgroundExposome social determinants of health (SDoH), such as neighborhood disadvantage, have shown associations with accelerated cognitive decline, brain volume loss, and postmortem AD pathology. However, associations between neighborhood disadvantage and amyloid biomarker positivity (A+) onset remain understudied. This study uses estimated A+ onset age (EAOA) and the Area Deprivation Index (ADI; an exposome SDoH) to investigate associations between neighborhood disadvantage and A+ risk.MethodsParticipants (n = 599, Table 1) from the Wisconsin Registry for Alzheimer’s Prevention (WRAP) and the Wisconsin Alzheimer’s Disease Research Center (WADRC) with available amyloid PET, address, and APOE genotype were included. EAOA was estimated using sampled iterative local approximation. Neighborhood disadvantage was categorized by national‐rank 2020 ADI (most disadvantaged ≥80th percentile; least disadvantaged <80th percentile). APOE groups were established based on the number of e4 alleles. Cox proportional hazard models assessed A+ risk associated with APOE, ADI, and their interaction. Secondary Cox models used continuous ADI and a lower 70th ADI percentile for neighborhood groups. Kaplan‐Meier curves were generated to depict A‐ probability vs. age for combinations of APOE and ADI groups. A‐ were right censored.ResultsA significant interaction (p = 0.015) between ADI and APOE groups was observed such that APOE‐e4 homozygotes who resided within a highly disadvantaged neighborhood had higher risk of becoming A+, but this group was limited to two participants. Secondary analyses indicated no significant effect of ADI or interaction with APOE on A+ risk (p>0.49). Plots of A+/‐ and EAOA by ADI and APOE group (Figure 1) and Kaplan‐Meier EAOA curves indicated EAOA overlap of ADI groups within APOE strata. A+ risk was significantly higher for APOE‐e4 homozygotes, followed by APOE‐e4 heterozygotes, and then APOE‐e4 non‐carriers.ConclusionsIn this mostly unimpaired, highly educated sample, higher number of APOE‐e4 alleles was associated with higher A+ risk and earlier A+ onset. APOE‐associated A+ risk was similar for all ADI groups, but representation across APOE genotypes for individuals residing within highly disadvantaged neighborhoods was limited. Further work is needed in more diverse samples to investigate the possible influence of ADI and other exposome SDoH factors on AD biomarker timing and trajectories.

The Effects of Hypertension on White Matter Microstructural and Vascular Imaging Metrics

AbstractBackgroundHypertension is one of the key vascular risk factors of AD and related dementia. Cerebral blood flow (CBF) and white matter (WM) integrity may play an essential role in understanding the vascular contributions to dementia (VCID). We investigated if hypertension is related to WM microstructural and vascular imaging metrics in WM.MethodFour‐hundred‐seven subjects (age: 69.7±8.1 years) enrolled in the Wake Forest Alzheimer’s Disease Research Center (ADRC) Clinical Core underwent MRI, including neurite orientation dispersion and density imaging (NODDI) and eight‐phase pseudo‐continuous ASL (PCASL). The subjects included 158 MCI, 111 APOE e4 allele carriers, 224 with hypertension, and 249 with impaired glycemic status which includes type 2 diabetes and prediabetics. Hypertension status was defined as SBP≥130mmHG and DBP≥80mmHG. The microstructural imaging metrics including intracellular volume fraction (ICVF), isotropic volume fraction (ISOVF), and orientation dispersion index (ODI) were obtained from NODDI. The vascular imaging metric included CBF. CBF was obtained from PCASL sequence. Voxel‐wise linear regression analyses were performed to examine if CBF, ICVF, ISOVF, or ODI were related to hypertension adjusting for cognitive status, glycemic status, APOE e4 allele, age, sex, and years of education. All images were normalized into standard space. Tract‐based spatial statistics (TBSS) were used to normalize NODDI images. The false positive cluster thresholding was applied.ResultHypertensive subjects showed impairments in both microstructural and vascular imaging metrics. Based on Figures 1‐(A), 2‐(A) and 3‐(A), there are overlapping brain image voxels between the microstructural and vascular imaging metrics. Additionally, the hypertensive subjects showed significantly lower CBF, higher ISOVF, and higher ODI than normal subjects within the voxel clusters (Figures 1‐(B), 2‐(B), and 3‐(B)). Note that APOE e4 allele, glycemic status, and cognitive status also showed statistical significance in the NODDI parameters, but there was no association in CBF.ConclusionHypertension showed the potential association between the microstructural and vascular impairments in the WM. Each risk factor and cognitive status differently affected WM microstructural and vascular dynamic imaging parameters. These findings warrant further investigations of contributions of hypertension to the microstructural and vascular abnormalities in dementia.

Alzheimer’s disease plasma markers and depressive symptoms: an IPD meta‐analysis

AbstractBackgroundDepression has been associated with an increased risk of Alzheimer’s disease (AD), but the biological mechanisms are still not fully understood. Plasma biomarkers, such as amyloid‐beta, tau, glial fibrillary acidic protein (GFAP), and neurofilament light (NfL), have been associated with AD pathophysiology. However, the relationship with depression is unclear. Assessing these biomarkers in the blood allows for the opportunity to assess if AD pathology is related to depressive symptoms on a large‐scale. We hypothesized if depression is part of the AD process, then these markers will be associated with depressive symptoms.MethodA two‐stage IPD meta‐analysis was performed based on eight cohorts of individuals without dementia as part of the Netherlands Consortium of Dementia Cohorts (NCDC). We examined the cross‐sectional association between each plasma marker for AD (amyloid‐beta42/40 ratio, p‐tau181, NfL, and GFAP) with depressive symptoms (the GDS‐15, PHQ‐9, CES‐D, and SF‐36). Plasma markers were assessed using Single Molecular Array (Simoa; Quanterix) assays. Both plasma markers and depressive symptoms were standardized. We estimated the effect per plasma marker with depressive symptoms using linear regressions, correcting for age, sex, education, and APOE e4 allele presence, in each cohort. The effect estimates were entered into a random‐effects meta‐analysis. We also performed subgroup analyses assessing sex differences and between those with and without an APOE e4 allele.ResultThis study involved 7210 participants with an age range of 38 to 102 years. Based on clinical cut‐offs per questionnaire, high depressive symptomology ranged from one to 22% per cohort. None of the plasma markers were associated with depressive symptoms in the meta‐analysis. However, subgroup analyses found an association with NfL and depressive symptoms in women (beta 0.07; 95% CI: 0.03‐0.10, p < 0.001) and in those with an APOE e4 allele (beta 0.11; 95% CI: 0.05‐0.17, p = 0.001).ConclusionAD pathology did not show an overall relationship with depressive symptoms. However, in women and in those with a genetic risk for AD, NfL showed an association. As NfL is a marker of overall neurodegeneration, this pathology in plasma may be specific to depressive symptoms in certain subgroups.

Generation of microglia‐containing APOE4 cerebral organoids as a model of Down syndrome associated Alzheimer’s disease

AbstractBackgroundDown syndrome (DS) is among the most common forms of familial Alzheimer’s disease (AD), resulting from triplication of the amyloid precursor protein (APP) gene on chromosome 21 which leads to increased amyloid beta (Aβ) peptide accumulation in the brain. As a result, all people with DS will develop Aβ plaques and tau tangles by the age of 40, and the majority will eventually develop AD‐related cognitive decline. Carrying the e4 allele of the apolipoprotein E gene (APOE), APOE4, because it catalyzes the formation of neurotoxic Aβ oligimers. The combination of APOE4 and trisomy 21 results in a very high risk for DS associated AD. APOE4 has also been shown to drive altered microglial activity in the AD brain, leading to increased neuroinflammation, neurodegeneration and cognitive decline. Studying mechanisms underlying APOE4‐microglial interactions could lead to identification of new therapeutic targets for DS‐AD treatments. Microglia‐containing cerebral organoids (MCOs) derived from human induced pluripotent stem cells (hiPSCs) with both trisomy 21 and APOE4 would offer a distinct advantage over prior models.MethodIsogenic hiPSC disomic or trisomic for chromosome 21 from an individual mosaic for trisomy 21 and carrying the APOE3/3 genotype and CRISPR‐Cas9 gene editing was then used to generate hiPSCs with the APOE4/4 genotype. hiPSCs were then differentiated into hematopoetic progenitor cells (HPCs) and neural progenitor cells (NPCs) and co‐cultured at a 7:3 ratio (NPCs:HPCs) to form MCOs.ResultControl cerebral organoids (COs) lacking HPCs were reduced in size compared to age‐matched MCOs, suggesting the successful integration of HPCs with NPCs during co‐culture. Immunohistochemical analysis showed neural rosettes characteristic of COs and shows that neurons, astrocytes and microglia were all present in MCOs throughout development.ConclusionWe have developed a novel model for DS‐AD that will be critical for identifying APOE4‐microglial interactions as a therapeutic target in DS‐AD. These MCOs may be used in pre‐clinical testing of potential therapies, which may lead to treatment for the highly vulnerable population of APOE4 carriers with DS‐AD.

Sex Moderates the Association Between Age and Myelin Water Fraction in the Cingulum and Fornix among Older Adults Without Dementia:A Preliminary Study

AbstractBackgroundCognitive decline in normal aging and Alzheimer’s disease (AD) has been associated with changes in cerebral white matter tracts. Although women are at higher risk of developing AD, studies investigating the effect of sex on white matter integrity have been mixed. Decreased white matter integrity in limbic pathways including the fornix and cingulum have been reported in AD although underlying mechanisms and potential sex differences remain understudied. We explored sex as a moderator of the effect of age on myelin water fraction (MWF), a measure of myelin content, in older adults.MethodFifty‐two older adults without dementia (mean age = 72; 61% female) underwent neuropsychological evaluation and 3T MRI at two research sites. Multicomponent driven equilibrium single pulse observation of T1 and T2 (mcDESPOT) quantified MWF in three a priori regions of interest including the fornix, cingulum in the hippocampal formation (CGH), and cingulum in the cingulate gyrus (CGC). The California Verbal Learning Test‐Second Edition assessed learning and long‐delay free recall. Separate multiple linear regressions assessed for (1) interactions between age and sex on regional MWF and (2) associations of regional MWF and memory. All models adjusted for APOE e4 allele frequency, vascular risk, and site; the second analysis additionally adjusted for age and sex.Result(1) There was a significant ageXsex interaction for CGC MWF (p = 0.006) and fornix MWF (p = 0.016) (see Figure) but not CGH MWF (p = 0.443). Specifically, for both interactions, in women but not men, as age increased, MWF decreased. (2) Fornix MWF was associated with memory (p = 0.002), but MWF of the two cingulum regions were not (p>0.05). Results did not change when adjusting for hippocampal volume.ConclusionResults suggest that the relationship between age and myelin content of limbic fiber pathways depends on sex, with women but not men showing age‐related decreases. Additionally, and consistent with previous studies, we observed an association between fornix MWF and learning and memory. Understanding sex differences in MWF may facilitate earlier detection of AD risk for women. Longitudinal study with larger samples is needed to further clarify the role sex plays in limbic system myelin integrity and potentially inform interventions.

The Effects of Hypertension on White Matter Microstructural and Vascular Imaging Metrics

AbstractBackgroundHypertension is one of the key vascular risk factors of AD and related dementia. Cerebral blood flow (CBF) and white matter (WM) integrity may play an essential role in understanding the vascular contributions to dementia (VCID). We investigated if hypertension is related to WM microstructural and vascular imaging metrics in WM.MethodFour‐hundred‐seven subjects (age: 69.7±8.1 years) enrolled in the Wake Forest Alzheimer’s Disease Research Center (ADRC) Clinical Core underwent MRI, including neurite orientation dispersion and density imaging (NODDI) and eight‐phase pseudo‐continuous ASL (PCASL). The subjects included 158 MCI, 111 APOE e4 allele carriers, 224 with hypertension, and 249 with impaired glycemic status which includes type 2 diabetes and prediabetics. Hypertension status was defined as SBP = 130mmHG and DBP = 80mmHG. The microstructural imaging metrics including intracellular volume fraction (ICVF), isotropic volume fraction (ISOVF), and orientation dispersion index (ODI) were obtained from NODDI. The vascular imaging metric included CBF. CBF was obtained from PCASL sequence. Voxel‐wise linear regression analyses were performed to examine if CBF, ICVF, ISOVF, or ODI were related to hypertension adjusting for cognitive status, glycemic status, APOE e4 allele, age, sex, and years of education. All images were normalized into standard space. Tract‐based spatial statistics (TBSS) were used to normalize NODDI images. The false positive cluster thresholding was applied.ResultHypertensive subjects showed impairments in both microstructural and vascular imaging metrics. Based on Figures 1‐(A), 2‐(A) and 3‐(A), there are overlapping brain image voxels between the microstructural and vascular imaging metrics. Additionally, the hypertensive subjects showed significantly lower CBF, higher ISOVF, and higher ODI than normal subjects within the voxel clusters (Figures 1‐(B), 2‐(B), and 3‐(B)). Note that APOE e4 allele, glycemic status, and cognitive status also showed statistical significance in the NODDI parameters, but there was no association in CBF.ConclusionHypertension showed the potential association between the microstructural and vascular impairments in the WM. Each risk factor and cognitive status differently affected WM microstructural and vascular dynamic imaging parameters. These findings warrant further investigations of contributions of hypertension to the microstructural and vascular abnormalities in dementia.

Glia‐Selective Replacement of APOE4 with APOE2: Implications for AD‐Associated Pathologies

AbstractBackgroundCompared to the ‘neutral’ E3, the E4 allele of Apolipoprotein E (APOE) confers up to a 15‐fold increase in Alzheimer’s Disease (AD) risk. Conversely, the neuroprotective E2 allele decreases AD risk by a similar degree. APOE’s strong risk profile and multitude of effects make it a promising therapeutic target. Here, we aimed to assess the therapeutic potential of allelic ‘switching’ by investigating the physiological changes associated with an inducible, in vivo APOE4 to APOE2 transition in a novel transgenic mouse model.MethodsThe APOE “switch mouse” (APOE4s2) uses the Cre‐loxP system to allow for inducible APOE allele switching from APOE4 to APOE2. These mice express a floxed human APOE4 coding region followed by the human APOE2 coding region. To study the effects of full body APOE switching, APOE4s2 mice were crossed to ubiquitous ROSA26‐CreERT1 mice. Gene expression and proteomic analyses were used to validate that the model worked as expected. Lipidomics and single‐cell RNAseq were used to measure physiological changes following the APOE4 to APOE2 allele switch.ResultmRNA and protein analyses confirm that APOE4s2 mice synthesize full‐length human APOE4/ApoE4 pre‐switch and that the inducible switch results in successful and efficient recombination and expression of human APOE2/ApoE2. Single‐cell RNAseq shows that global, genetic replacement of APOE4 with APOE2 results in distinct alterations to glial cell transcriptomes affecting pathways involved with lipid and mitochondrial metabolism, inflammation, blood‐brain barrier integrity, and amyloid beta. Excitingly, differentially expressed genes associated with an E4 to E2 ‘switch’ included several AD GWAS, and both aging‐ and AD‐associated pathways. Additionally, untargeted lipidomics reveals changes to several lipid classes in the brain, in particular glycerophospholipids.ConclusionTogether, these data suggest that a successful transition from APOE4 to APOE2 has broad impact on the cerebral transcriptome as well as peripheral and cerebral metabolism. Ongoing studies aim to determine whether cell‐specific replacement of APOE4 with APOE2 will rescue E4‐associated metabolic dysfunction, disease‐associated gene signatures, and AD pathology.

The moderating effect of APOE E4 on the association of plasma biomarkers with markers of cognition and brain health in Alzheimer’s disease

AbstractBackgroundDue to low success rates in clinical trials for Alzheimer’s disease (AD), there is a need to apply precision medicine approaches, such as stratifying based on APOE genotype, in order to assess its effects on outcome measures. Herein, we aim to better understand how plasma biomarkers of AD and neurodegenerative pathology are associated with cognition and neurodegeneration in APOE E4 carriers compared to non‐carriers.MethodPatients from the Ontario Neurodegenerative Disease Research Initiative (ONDRI) diagnosed with AD were included (n = 126, age = 71.0±8.2, 55%M). Plasma concentrations of Aβ40 and Aβ42 (Aβ42/40 ratio), glial fibrillary acidic protein (GFAP), neurofilament light (NfL) and phosphorylated‐tau181 (p‐tau181) were measured using Simoa assays. Composite cognitive domain scores (attention & working memory, executive function, language, memory, and visuospatial function) were computed from a comprehensive neuropsychological assessment. Volumes of regional grey matter, ventricular cerebrospinal fluid, white matter hyperintensities, perivascular spaces, lacunes and strokes were extracted from 3T structural MRI sequences using the SABRE pipeline. Linear regression models with an interaction term, controlling for age, sex and education were used to test the moderating effect of the APOE E4 allele on the association of plasma biomarkers with cognitive and MRI variables. When interaction effects were significant, post‐hoc models stratified by APOE E4 carrier status and controlling for age, sex and education were assessed.ResultThe APOE E4 allele moderated the association of GFAP, NfL and p‐tau181 with memory. Further stratification revealed that higher levels of GFAP, NfL and p‐tau181 were all associated with worse memory only in APOE E4 carriers. APOE E4 was also found to moderate the association of GFAP and p‐tau181 with many imaging markers. Further stratification revealed that higher levels of GFAP were associated with increased white matter hyperintensities, ventricular expansion and grey matter atrophy (temporal lobe, occipital lobe, hippocampus, basal ganglia and thalamus) only in APOE E4 carriers. Higher levels of p‐tau181 were also associated with increased temporal, parietal, and hippocampal atrophy only in APOE E4 carriers.ConclusionPlasma biomarkers, especially GFAP and p‐tau181, appear to be significantly more predictive of memory deficits and brain neurodegeneration in APOE E4 carriers compared to non‐carriers in AD.

Vitamin D deficiency may increase the risk of developing cognitive impairment especially for APOE e4 non‐carriers

AbstractBackgroundVitamin D has been reported to play a role for neural protection and anti‐inflammation. However, its effects on the risk of cognitive decline has been inconsistent. Apolipoprotein E (APOE) could be a possible modulator of such influences as it takes part in the transport of cholesterol sharing a synthetic pathway with vitamin D and APOE e4 isoform is a well‐known significant risk factor of cognitive impairment. This study aimed to demonstrate the effects of vitamin D on incident cognitive impairment including mild cognitive impairment (MCI) and dementia and to explore its associations according to APOE e4 allele presence.MethodWe enrolled 1,271 cognitively normal community‐dwelling adults aged 60 years or older from the participants in the Korean Longitudinal Study on Cognitive Aging and Dementia. They were evaluated every two years from 2010 to 2018. We measured serum 25‐hydroxyvitamin D [25(OH)D] level and administered diagnostic assessment on MCI and dementia at every evaluation. We grouped the serum 25(OH)D into three levels as sufficient (> 30 ng/mL), insufficient (20 – 29.9 ng/mL), and deficient (< 20 ng/mL). We examined the associations of serum 25(OH)D level with the risks of incident MCI and dementia using Cox proportional hazard models adjusting for potential confounders. Then we also analyzed these effects in the APOE e4 non‐carriers and carriers separately.Result221 subjects showed a progression to MCI or dementia while 1,050 remained unchanged or improved cognitive function during follow‐up period. Participants who had deficient vitamin D concentration showed significant associations with a higher risk of cognitive decline (HR = 2.945, 95% CI = 1.088 – 7.970, p = 0.033) compared to sufficient 25(OH)D level group. APOE e4 non‐carriers who were vitamin D deficiency at baseline were 3.3‐fold more likely to suffer progression of cognitive impairment (HR = 3.308, 95% CI = 1.050 – 10.426, p = 0.041), whereas APOE e4 carriers did not show significant correlations of 25(OH)D levels with such progression (p > 0.05).ConclusionThese results indicate that vitamin D deficiency may increase the risk of developing cognitive impairment and the effects would be greater for APOE e4 non‐carriers compared to APOE e4 carriers.

Visit‐to‐visit blood pressure variability and medial temporal perfusion in APOE e4 homozygotes

AbstractBackgroundBlood pressure variability (BPV), independent of traditionally studied/targeted average blood pressure levels, is an emerging risk factor for cognitive impairment and Alzheimer’s dementia, possibly through links with cerebrovascular disease. Recent studies suggest vulnerability of the medial temporal lobes to tau accumulation and atrophy among individuals with elevated BPV, especially older APOE e4 carriers. Increased BPV has also been linked with lower cerebral blood flow (CBF) and perfusion decline in medial temporal regions, but it remains unclear how BPV and APOE e4 may interact to influence CBF. The aim of the current study was to determine whether the relationship between BPV and medial temporal lobe CBF varies by APOE e4 dose in older adults without dementia.Method105 older adults without dementia from the Alzheimer’s Disease Neuroimaging Initiative underwent 3‐4 blood pressure measurements between study baseline and 12‐months follow‐up and arterial spin labeling (ASL)‐MRI at 12‐months follow‐up or later (range: 0 – 84 months). Visit‐to‐visit BPV was calculated as variability independent of mean. CBF was determined for medial temporal regions (residualized by precentral [reference region] CBF), including hippocampus, parahippocampal gyrus, and entorhinal cortex. Venipuncture determined APOE e4 allele count (0 alleles: n = 71; 1 allele: n = 28; 2 alleles: n = 6). Multiple linear regression examined the interaction of BPV x APOE e4 dose on medial temporal CBF, controlling for age, sex, race/ethnicity, antihypertensive use, mean blood pressure, and cerebral metabolism (FDG‐PET).ResultElevated BPV was associated with lower CBF in entorhinal cortex (ß = ‐.96 [‐1.62, ‐.31]; p = .005) and parahippocampal gyrus (ß = ‐.63 [‐1.26, ‐.0002]; p = .049) in individuals with 2 APOE e4 alleles, whereas BPV was not significantly associated with CBF in these regions in individuals with 0 or 1 APOE e4 alleles (p’s > = .08). There was no significant interaction of BPV x APOE e4 dose on hippocampal CBF.ConclusionHigher BPV is associated with lower medial temporal CBF in APOE e4/e4 carriers, suggesting BPV may be an understudied vascular risk factor for those at greatest genetic risk for Alzheimer’s disease, with potential therapeutic implications.

Association of plasma biomarkers with cognitive domains across three neurodegenerative diseases and cerebrovascular disease

AbstractBackgroundIt is critical to better understand the value of plasma biomarkers in predicting cognitive deficits before widespread use as diagnostic and prognostic tools in specialized clinics and as markers of neurodegenerative disease progression in trials. Herein, we investigate their association with five cognitive domains across three common neurodegenerative diseases and cerebrovascular disease.MethodPatients from the curated multi‐site Ontario Neurodegenerative Disease Research Initiative (ONDRI) were included in this study, classified by diagnostic group: Alzheimer’s disease/Mild cognitive impairment (AD/MCI, n = 126, age = 71.0±8.2, 55%M), frontotemporal dementia spectrum disorders (FTD, n = 53, age = 67.8±7.1, 64%M), Parkinson’s disease (PD, n = 140, age = 67.9±6.3, 78%M) and cerebrovascular disease (CVD, n = 161, age = 69.2±7.4, 68%M). Plasma concentrations of Aβ40 and Aβ42 (Aβ42/40 ratio), glial fibrillary acidic protein (GFAP), neurofilament light (NfL) and phosphorylated‐tau181 (p‐tau181) were measured using high‐sensitivity Simoa assays. Scores from a 26‐test comprehensive neuropsychological assessment were used to compute composite z‐scores for five cognitive domains: attention & working memory, executive function, language, memory, and visuospatial function. Linear regression models controlling for age, sex, education and APOE E4 allele were used to test the association between plasma biomarkers and cognitive domains in each group separately.ResultIn AD/MCI, higher levels of GFAP, NfL and p‐tau181 were all associated with worse attention & working memory, executive function, and memory. In PD, higher levels of NfL were associated with worse attention & working memory, executive function, and visuospatial function; higher levels of GFAP were also associated with worse executive function. In CVD, higher levels of GFAP were associated with worse executive function, memory and visuospatial function; higher levels of p‐tau181 were also associated with worse memory. In FTD, no associations were found.ConclusionPlasma biomarkers indicative of neuronal and glial pathology are useful to predict the severity of widespread cognitive deficits in AD/MCI, PD, and CVD. Interestingly, p‐tau181 predicted memory deficits in both AD/MCI and CVD, suggesting potential mixed disease or pathological overlap. Plasma Aβ42/40 does not appear to predict any cognitive deficits in any of the neurodegenerative diseases studied. As FTD is highly heterogeneous and had the least number of patients, we are possibly lacking power to detect effects in this group.

Lifestyle for Brain Health Score, Genetic Risk and Incidence of Dementia

AbstractBackgroundAssessing whether modifiable factors are associated with dementia risk regardless of genetic risk for the disease is primordial for precision prevention. So far, studies on gene‐by‐environment interactions (GxE) in dementia have been controversial. We leveraged a large cohort of older persons to investigate the association between numerous modifiable factors, reflected by the lifestyle for brain‐health (LIBRA) score (defined in figure 1), and the incidence of dementia, evaluating effect modification by genetic risk.MethodWe included participants from the Three‐City (3C) study, free of dementia at baseline and followed for up to 17 years. The LIBRA score and a genetic risk score (GRS) based on the latest Alzheimer’s disease GWAS (excluding the apolipoprotein E {APOE} locus) were constructed. Illness‐death models for interval‐censored data were used to assess the relation of LIBRA, GRS and carriership of the e4 allele of the APOE gene (and their interactions) to the incidence of dementia, accounting for potential competing risk by death.ResultThe population included 5170 3C participants aged on average 73.8 years at baseline. Both genetic factors and LIBRA were significantly associated with dementia risk. In multivariable‐adjusted models, each one‐point increase in LIBRA was associated with a 10% higher risk of dementia (95% CI 1.07‐1.13). We found no evidence of GxE interaction (p≥0.2 for two‐order [LIBRA by each genetic variable] and three‐order interaction terms [LIBRA‐by‐GRS‐by‐APOE4]); a higher LIBRA was significantly associated with increased dementia risk in both APOE4 carriers and non‐carriers (figure 1) and in low, medium or high GRS level (figure 2), with similar magnitude of associations in all strata. Although power was limited to examine APOE4 carriers by GRS strata, the trend of association of LIBRA (continuous) to dementia risk was not meaningfully different from what found in other groups (figure 3).ConclusionIn this large cohort of older persons, increasing number of health and lifestyle risk factors for dementia was associated with higher dementia risk in all levels of genetic risk. These findings suggest prevention programs with targeted lifestyle modifications and health management may be efficient even in those with highest risk for dementia based on their genetic susceptibility.

Investigation of neighborhood disadvantage in the context of APOE‐associated amyloid onset age risk

AbstractBackgroundExposome social determinants of health (SDoH), such as neighborhood disadvantage, have shown associations with accelerated cognitive decline, brain volume loss, and postmortem AD pathology. However, associations between neighborhood disadvantage and amyloid biomarker positivity (A+) onset remain understudied. This study uses estimated A+ onset age (EAOA) and the Area Deprivation Index (ADI; an exposome SDoH) to investigate associations between neighborhood disadvantage and A+ risk.MethodParticipants (n = 599, Table 1) from the Wisconsin Registry for Alzheimer’s Prevention (WRAP) and the Wisconsin Alzheimer’s Disease Research Center (WADRC) with available amyloid PET, address, and APOE genotype were included. EAOA was estimated using sampled iterative local approximation. Neighborhood disadvantage was categorized by national‐rank 2020 ADI (most disadvantaged = 80th percentile; least disadvantaged <80th percentile). APOE groups were established based on the number of e4 alleles. Cox proportional hazard models assessed A+ risk associated with APOE, ADI, and their interaction. Secondary Cox models used continuous ADI and a lower 70th ADI percentile for neighborhood groups. Kaplan‐Meier curves were generated to depict A‐ probability vs. age for combinations of APOE and ADI groups. A‐ were right censored.ResultA significant interaction (p = 0.015) between ADI and APOE groups was observed such that APOE‐e4 homozygotes who resided within a highly disadvantaged neighborhood had higher risk of becoming A+, but this group was limited to two participants. Secondary analyses indicated no significant effect of ADI or interaction with APOE on A+ risk (p>0.49). Plots of A+/‐ and EAOA by ADI and APOE group (Figure 1) and Kaplan‐Meier EAOA curves indicated EAOA overlap of ADI groups within APOE strata. A+ risk was significantly higher for APOE‐e4 homozygotes, followed by APOE‐e4 heterozygotes, and then APOE‐e4 non‐carriers.ConclusionIn this mostly unimpaired, highly educated sample, higher number of APOE‐e4 alleles was associated with higher A+ risk and earlier A+ onset. APOE‐associated A+ risk was similar for all ADI groups, but representation across APOE genotypes for individuals residing within highly disadvantaged neighborhoods was limited. Further work is needed in more diverse samples to investigate the possible influence of ADI and other exposome SDoH factors on AD biomarker timing and trajectories.

White Matter Lesion Asymmetry: A Potential Indicator of Amyloid Positivity in Patients with Mild Cognitive Impairment

AbstractBackgroundAssessing amyloid‐positivity in patients with mild cognitive impairment (MCI) is crucial as amyloid‐positive individuals have a higher risk of dementia conversion than amyloid‐negative patients. This study aimed to investigate whether the asymmetry of white matter lesions (WML) on T2‐fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI), measured by artificial intelligence (AI) hyperintensity segmentation, could be a potential indicator for amyloid positron emission tomography (PET) positivity in patients with MCI.MethodThis retrospective cohort study included MCI patients who visited the memory clinic of Yeouido St. Mary’s Hospital. All participants underwent a set of clinical and neuropsychological assessments, brain MRI, and amyloid PET using [18F]‐Flutemetamol. Our in‐house AI software was utilized on paired T1 and T2‐FLAIR MRIs to process to segment and separate WML into left and right hemispheres. From the processed segmentation, we measured the subjects' individual WML differences through a volumetric assessment.ResultsTotal 122 subjects were enrolled in this study. By the amyloid‐PET positivity, 53 and 69 patients were in the amyloid‐negative and amyloid‐positive groups, respectively. The two groups were comparable with no significant differences of age (p = 0.189), sex (p = 0.057), education years (p = 0.411) and MMSE scores (p = 0.861). However, the amyloid‐positive group had a significantly higher frequency of having an e4 allele of APOE genotype (p = 0.033) and Clinical Dementia Rating scale (p = 0.024). The average volume between hemispheres significantly differed in the amyloid‐negative group (p = 0.020) but not in the amyloid‐positive group (p = 0.220). Both groups had a larger WML volume in the left hemisphere, which did not differ significantly between groups.ConclusionOur findings suggest that evaluating the asymmetry of WML rather than the total hyperintensity lesion load is necessary in MCI patients, particularly in those without amyloid pathology. In conclusion, WML asymmetry may serve as a potential indicator of amyloid positivity in MCI patients.

Vascular contribution to the relationship between cerebrovascular reactivity and cognition

AbstractBackgroundBrain vascular health is closely related to cognitive performance, and cerebrovascular reactivity (CVR), an indicator of cerebral blood flow (CBF) compensatory capacity in response to vasoactive stimuli, may help elucidate this relationship. Arterial spin labeling (ASL) and blood‐oxygen‐level‐dependent (BOLD) are two representative methods for measuring CVR, although BOLD is a complex combination of CBF, cerebral volume, and cerebral metabolic rate of oxygen. This study aimed to investigate the relationship between cognition and two different CVR methods.MethodSeventy‐nine subjects (age: 68.7±7.2 years) enrolled in the Wake Forest Alzheimer’s Disease Research Center (ADRC) Clinical Core underwent MRI, including both dynamic pseudo‐continuous ASL (PCASL) under a hypercapnic respiratory challenge and multi‐TI PCASL for resting CBF and ATT mapping. The dynamic PCASL with a longer TE (20ms) provided simultaneous acquisition of ASL and BOLD. CVR was obtained by calculating CBF or BOLD signal changes during a hypercapnic period. Voxel‐wise multiple linear regression analyses were performed to examine the relationship between CVR and mild cognitive impairment (MCI), adjusting for age, sex, glycemic status, APOE e4 allele, hypertensive status, and years of education. False positive cluster thresholding was applied for each modality. Additional statistical analyses were conducted to investigate differences in baseline CBF and ATT between cognitively healthy and MCI groups within the voxel clusters that showed significantly different CVR values.ResultIn the BOLD‐based CVR analysis, two voxel clusters in the white matter (WM) of superior temporal and parietal lobes showed lower CVR in the MCI group compared to the cognitively healthy group (Figure 1). Additionally, reduced CBF and prolonged ATT were observed within the clusters (Figure 2 and 3).ConclusionSubjects with MCI exhibited lower BOLD‐based CVR in WM, while no association was found between ASL‐based CVR and MCI. BOLD‐based CVR may be a more sensitive measure than ASL‐based CVR in association with cognition, particularly in WM where optimization of ASL acquisition is challenging. The impaired CVR in the MCI group may be due to cerebrovascular impairments, such as reduced CBF and prolonged ATT.

APOE genotype modifies microglial immunometabolism

AbstractBackgroundMetabolic dysfunction and neuroinflammation characterize Alzheimer’s disease (AD), but it is unclear if these two facets of the disease are linked. The E4 allele of Apolipoprotein E (APOE) is the strongest genetic risk factor for late‐onset AD and is associated with increased neuroinflammation. Recent data from our lab and others show that E4 is also associated with increased aerobic glycolysis. These two findings may be intrinsically linked through the concept of ‘immunometabolism’ ‐ an emerging paradigm that implicates increased glycolysis as a core requirement during pro‐inflammatory activation, whereas increased oxidative phosphorylation is required for anti‐inflammatory responses.MethodPrimary microglia from mice expressing human APOE isoforms were stimulated with a combination of interferon‐γ and tumor necrosis factor‐α, two pro‐inflammatory cytokines implicated in AD. Metabolic responses were measured using the Agilent Seahorse platform and targeted metabolomics. In addition, we performed single‐cell RNA sequencing on brains from APOE targeted replacement mice at 3‐, 10‐, and 18 months of age. APOE targeted replacement mice were also crossed to the 5x Familial Alzheimer’s Disease model and brains were analyzed by spatial transcriptomics.ResultSeahorse revealed increased glycolysis and decreased mitochondrial respiration in E4 microglia. Targeted metabolomics revealed increased lactate and succinate in E4 microglia, metabolites known to accumulate in pro‐inflammatory macrophages. Aged E4 brains were found to harbor a metabolically distinct cluster of microglia that expressed a signature similar to the established ‘disease associated microglia’ (DAM) phenotype, even in the absence of neuropathology. SCENIC regulon analysis linked this cluster to the transcription network of HIF1a. Ongoing experiments targeting the HIF1a pathway seek to correct the E4‐associated increased aerobic glycolysis and excess pro‐inflammatory cytokine secretion.ConclusionOur findings reveal that inflammatory stimulation, age, and amyloid each induce a distinct metabolic response in E4 microglia. The accumulation of lactate and succinate and increased glycolysis in E4 microglia indicate altered metabolic preference conducive to pro‐inflammatory activation, whereas the decreased mitochondrial respiration may preclude effective anti‐inflammatory responses. We propose that this altered metabolism skews E4 microglia towards a phenotype that favors chronic neuroinflammation and neurodegeneration. Thus, reprogramming metabolism in E4 microglia may provide a novel therapeutic avenue for the treatment of AD.

Motor Sequence Learning in Mild Cognitive Impairment and Alzheimer’s Disease and its Relationship to Biomarkers

AbstractBackgroundWhile mild cognitive impairment (MCI) and Alzheimer’s disease (AD) are primarily associated with cognitive impairments, studies have also demonstrated that individuals may experience motor impairments that can precede cognitive symptoms by several years. Here, we examine potential differences in motor sequence learning abilities in individuals with MCI and AD compared to cognitively normal individuals (CNI). Moreover, we investigate whether motor sequence learning impairments could be an early behavioral biomarker. To that end, we evaluated associations between motor learning ability and existing AD biomarkers.MethodTo date, 26 individuals with AD, 27 with MCI, and 47 CNI performed a serial reaction time task that allowed us to assess the amount of sequence‐specific learning at the end of the task and the rate of such learning across the task. Additionally, participants underwent APOE genotyping to determine the presence of e4 alleles, amyloid PET imaging to quantify amyloid deposition, and structural MRI scanning to obtain hippocampal volume.ResultWhile motor responses of individuals with AD and MCI were generally slower than those of CNI, motor sequence learning occurred regardless of cognitive status and did not significantly differ among the three groups. Results of correlational analyses showed no significant associations between motor learning scores and AD biomarkers.ConclusionOur findings suggest that motor sequence learning abilities are relatively preserved in MCI and AD, which could have implications for the design of rehabilitation programs. However, its observed independence of existing biomarkers indicates that sequence learning may not be suitable as an early disease maker. Our ongoing work focuses on measuring general motor proficiency via a broad assessment spanning multiple motor domains, and evaluating whether such proficiency can serve as a predictor of disease status and progression.

The effects of ApoE e4 genotype on plasma p‐tau181 concentrations on clinically diagnosed Alzheimer’s disease (AD) compared to controls

AbstractBackgroundThe association between ApoE e4, a powerful genetic risk factor for AD, and beta‐amyloid (Aβ) pathology has been reported, but the evidence for the correlation with tau pathology is not as clear. The current study examined the relationship between ApoE e4 allele and plasma concentrations of p‐tau181 in patients with clinically diagnosed AD compared with an age‐matched controls with normal cognitive function.MethodWe examined 302 EDTA plasma samples of patients assessed at the UBC Hospital Clinic for Alzheimer’s disease. The cohort was clinically characterized as controls (n = 59) if no significant cognitive impairment was found, and AD (n = 243) if they fulfilled the NIA‐AA criteria (McKhann 2011). The plasma ptau‐181 levels were measured using an ADx‐developed p‐tau181‐specific Simoa assay. ApoE genotyping was performed on extracted DNA from blood samples. We examined the association of presence of ApoE e4 allele and plasma p‐tau181 concentrations using two‐by‐two ANOVA using SPSS 29.ResultThe plasma concentrations of p‐tau181 in AD who are ApoE e4 carriers (75.4 pg/ml) were slightly higher than but not significantly different from in AD non‐ ApoE4 carriers (70.1 pg/ml) (p = 0.64). The plasma levels of ptau‐181 in control cases with and without the ApoE allele were 24.8 and 24 pg/ml respectively (p = 1.000). There was no statistical significant interaction between the effects of AD and ApoE e4 carrier status on plasma p‐tau181 (F (1, 298) = 0.21, p = 0.65, ηp2 = 0.001).ConclusionWhile the plasma p‐tau181 concentrations were significantly higher in AD groups compared to controls (p<0.001) it was no significant effect of ApoE e4 genotype on the levels of plasma p‐tau181 in the control or AD groups (p = 0.94, p = 0.21). This suggests that the ApoE e4 carrier status does not affect plasma p‐tau181 concentrations significantly, independent of the AD clinical status.

Distinct effects of cholesterol profile components on amyloid and vascular burdens

AbstractBackgroundCholesterol plays important roles in β‐amyloid (Aβ) metabolism and atherosclerosis. However, the relationships of plasma cholesterol levels with Aβ and cerebral small vessel disease (CSVD) burdens are not fully understood in Asians. Herein, we investigated the relationships between plasma cholesterol profile components and Aβ and CSVD burdens in a large, non‐demented Korean cohort.MethodWe enrolled 1,175 non‐demented participants (456 with unimpaired cognition [CU] and 719 with mild cognitive impairment [MCI]) aged ≥ 45 years who underwent Aβ PET at the Samsung Medical Center in Korea. We performed linear regression analyses with each cholesterol (low‐density lipoprotein cholesterol [LDL‐c], high‐density lipoprotein cholesterol [HDL‐c], and triglyceride) level as a predictor and each image marker (Aβ uptake on PET, white matter hyperintensity [WMH] volume, and hippocampal volume) as an outcome after controlling for potential confounders.ResultIncreased LDL‐c levels (β = 0.014 to 0.115, p = 0.013) were associated with greater Aβ uptake, independent of the APOE e4 allele genotype and lipid‐lowering medication. Decreased HDL‐c levels (β = −0.133 to −0.006, p = 0.032) were predictive of higher WMH volumes. Increased LDL‐c levels were also associated with decreased hippocampal volume (direct effect β = −0.053, p = 0.040), which was partially mediated by Aβ uptake (indirect effect β = −0.018, p = 0.006).ConclusionOur findings highlight that increased LDL‐c and decreased HDL‐c levels are important risk factors for Aβ and CSVD burdens, respectively. Furthermore, considering that plasma cholesterol profile components are potentially modified by diet, exercise, and pharmacological agents, our results provide evidence that regulating LDL‐c and HDL‐c levels is a potential strategy to prevent dementia.