Presymptomatic Mutation Carriers Research Articles

Plasma metabolomics of presymptomatic PSEN1-H163Y mutation carriers: a pilot study.

Background and Objective PSEN1‐H163Y carriers, at the presymptomatic stage, have reduced 18FDG‐PET binding in the cerebrum of the brain (Scholl et al., Neurobiol Aging 32:1388–1399, 2011). This could imply dysfunctional energy metabolism in the brain. In this study, plasma of presymptomatic PSEN1 mutation carriers was analyzed to understand associated metabolic changes.MethodsWe analyzed plasma from noncarriers (NC, n = 8) and presymptomatic PSEN1‐H163Y mutation carriers (MC, n = 6) via untargeted metabolomics using gas and liquid chromatography coupled with mass spectrometry, which identified 1199 metabolites. All the metabolites were compared between MC and NC using univariate analysis, as well as correlated with the ratio of Aβ 1–42/A β 1–40, using Spearman’s correlation. Altered metabolites were subjected to Ingenuity Pathway Analysis (IPA).ResultsBased on principal component analysis the plasma metabolite profiles were divided into dataset A and dataset B. In dataset A, when comparing between presymptomatic MC and NC, the levels of 79 different metabolites were altered. Out of 79, only 14 were annotated metabolites. In dataset B, 37 metabolites were significantly altered between presymptomatic MC and NC and nine metabolites were annotated. In both datasets, annotated metabolites represent amino acids, fatty acyls, bile acids, hexoses, purine nucleosides, carboxylic acids, and glycerophosphatidylcholine species. 1‐docosapentaenoyl‐GPC was positively correlated, uric acid and glucose were negatively correlated with the ratio of plasma Aβ 1–42/Aβ 1–40 (P < 0.05).InterpretationThis study finds dysregulated metabolite classes, which are changed before the disease symptom onset. Also, it provides an opportunity to compare with sporadic Alzheimer’s Disease. Observed findings in this study need to be validated in a larger and independent Familial Alzheimer’s Disease (FAD) cohort.

Visuomotor integration deficits are common to familial and sporadic preclinical Alzheimer's disease.

We investigated whether subtle visuomotor deficits were detectable in familial and sporadic preclinical Alzheimer’s disease. A circle-tracing task—with direct and indirect visual feedback, and dual-task subtraction—was completed by 31 individuals at 50% risk of familial Alzheimer’s disease (19 presymptomatic mutation carriers; 12 non-carriers) and 390 cognitively normal older adults (members of the British 1946 Birth Cohort, all born during the same week; age range at assessment = 69–71 years), who also underwent β-amyloid-PET/MRI to derive amyloid status (positive/negative), whole-brain volume and white matter hyperintensity volume. We compared preclinical Alzheimer’s groups against controls cross-sectionally (mutation carriers versus non-carriers; amyloid-positive versus amyloid-negative) on speed and accuracy of circle-tracing and subtraction. Mutation carriers (mean 7 years before expected onset) and amyloid-positive older adults traced disproportionately less accurately than controls when visual feedback was indirect, and were slower at dual-task subtraction. In the older adults, the same pattern of associations was found when considering amyloid burden as a continuous variable (Standardized Uptake Value Ratio). The effect of amyloid was independent of white matter hyperintensity and brain volumes, which themselves were associated with different aspects of performance: greater white matter hyperintensity volume was also associated with disproportionately poorer tracing accuracy when visual feedback was indirect, whereas larger brain volume was associated with faster tracing and faster subtraction. Mutation carriers also showed evidence of poorer tracing accuracy when visual feedback was direct. This study provides the first evidence of visuomotor integration deficits common to familial and sporadic preclinical Alzheimer’s disease, which may precede the onset of clinical symptoms by several years.

Modelling the cascade of biomarker changes in GRN-related frontotemporal dementia

ObjectiveProgranulin-related frontotemporal dementia (FTD-GRN) is a fast progressive disease. Modelling the cascade of multimodal biomarker changes aids in understanding the aetiology of this disease and enables monitoring of individual mutation...

Impairment of episodic memory in genetic frontotemporal dementia: A GENFI study.

IntroductionWe aimed to assess episodic memory in genetic frontotemporal dementia (FTD) with the Free and Cued Selective Reminding Test (FCSRT).MethodsThe FCSRT was administered in 417 presymptomatic and symptomatic mutation carriers (181 chromosome 9 open reading frame 72 [C9orf72], 163 progranulin [GRN], and 73 microtubule‐associated protein tau [MAPT]) and 290 controls. Group differences and correlations with other neuropsychological tests were examined. We performed voxel‐based morphometry to investigate the underlying neural substrates of the FCSRT.ResultsAll symptomatic mutation carrier groups and presymptomatic MAPT mutation carriers performed significantly worse on all FCSRT scores compared to controls. In the presymptomatic C9orf72 group, deficits were found on all scores except for the delayed total recall task, while no deficits were found in presymptomatic GRN mutation carriers. Performance on the FCSRT correlated with executive function, particularly in C9orf72 mutation carriers, but also with memory and naming tasks in the MAPT group. FCSRT performance also correlated with gray matter volumes of frontal, temporal, and subcortical regions in C9orf72 and GRN, but mainly temporal areas in MAPT mutation carriers.DiscussionThe FCSRT detects presymptomatic deficits in C9orf72‐ and MAPT‐associated FTD and provides important insight into the underlying cause of memory impairment in different forms of FTD.

FDG-PET in presymptomatic C9orf72 mutation carriers

ObjectiveOur aim is to investigate patterns of brain glucose metabolism using fluorodeoxyglucose positron emission tomography (FDG-PET) in presymptomatic carriers of the C9orf72 repeat expansion to better understand the early preclinical stages of frontotemporal dementia (FTD). MethodsStructural MRI and FDG-PET were performed on clinically asymptomatic members of families with FTD caused by the C9orf72 repeat expansion (15 presymptomatic mutation carriers, C9orf72+; 20 non-carriers, C9orf72-). Regional glucose metabolism in cerebral and cerebellar gray matter was compared between groups. ResultsThe mean age of the C9orf72+ and C9orf72- groups were 45.3 ± 10.6 and 56.0 ± 11.0 years respectively, and the mean age of FTD onset in their families was 56 ± 7 years. Compared to non-carrier controls, the C9orf72+ group exhibited regional hypometabolism, primarily involving the cingulate gyrus, frontal and temporal neocortices (left > right) and bilateral thalami. ConclusionsThe C9orf72 repeat expansion is associated with changes in brain glucose metabolism that are demonstrable up to 10 years prior to symptom onset and before changes in gray matter volume become significant. These findings indicate that FDG-PET may be a particularly sensitive and useful method for investigating and monitoring the earliest stages of FTD in individuals with this underlying genetic basis.

Disease-related cortical thinning in presymptomatic granulin mutation carriers

Mutations in the granulin gene (GRN) cause familial frontotemporal dementia. Understanding the structural brain changes in presymptomatic GRN carriers would enforce the use of neuroimaging biomarkers for early diagnosis and monitoring. We studied 100 presymptomatic GRN mutation carriers and 94 noncarriers from the Genetic Frontotemporal dementia initiative (GENFI), with MRI structural images. We analyzed 3T MRI structural images using the FreeSurfer pipeline to calculate the whole brain cortical thickness (CTh) for each subject. We also perform a vertex-wise general linear model to assess differences between groups in the relationship between CTh and diverse covariables as gender, age, the estimated years to onset and education. We also explored differences according to TMEM106B genotype, a possible disease modifier. Whole brain CTh did not differ between carriers and noncarriers. Both groups showed age-related cortical thinning. The group-by-age interaction analysis showed that this age-related cortical thinning was significantly greater in GRN carriers in the left superior frontal cortex. TMEM106B did not significantly influence the age-related cortical thinning. Our results validate and expand previous findings suggesting an increased CTh loss associated with age and estimated proximity to symptoms onset in GRN carriers, even before the disease onset.

Emotion recognition of morphed facial expressions in presymptomatic and symptomatic frontotemporal dementia, and Alzheimer’s disease

AbstractBackgroundAn increasing amount of studies are emphasizing the importance of social cognitive assessments to improve early diagnosis between frontotemporal dementia (FTD) and Alzheimer’s Disease (AD). Traditional measures of social cognition, including emotion recognition paradigms, however seem insensitive to the subtle deficits in the earliest dementia stages. The Emotion Recognition Task (ERT) was developed to identify early deficits in the recognition of facial expressions across different levels of intensity.MethodUsing the ERT, we assessed the recognition of morphed facial expressions of six emotions (anger, disgust, fear, happiness, sadness and surprise) across four intensities (40, 60, 80 and 100%) in patients with behavioural variant FTD (bvFTD; n=32), patients with AD (n=32), FTD mutation carriers (presymptomatic n=47, mildly/questionably symptomatic n=5) and controls (n=49). We examined group differences using multilevel linear regression modelling, and performed post hoc analyses on presymptomatic (MAPT, GRN and C9orf72) and mildly/questionably symptomatic mutation carriers. Classification abilities were investigated with logistic regression analyses; we determined sensitivity/specificity with ROC analyses.ResultThe lowest ERT total scores were found in bvFTD and AD patients, whereas equally highest scores were found in mutation carriers and controls. bvFTD patients scored significantly lower than AD patients on anger (p=0.023) and happiness (p&lt;0.001), where subjects with mild/questionable FTD had an intermediate position between patients with dementia and those without (p=0.051) (Figure). Discriminative ability was better at the lowest (40%) than at the highest intensity (100%). Presymptomatic C9orf72 mutation carriers were worse at recognizing anger at the lowest (40%) emotional intensity than controls (p=0.038) and presymptomatic GRN mutation carriers (p=0.047). The ERT classified between patients with bvFTD and controls, patients with AD and controls (both p&lt;0.001), but not between patients with bvFTD and AD, nor the total group of mutation carriers and controls (p&gt;0.05).ConclusionOur results demonstrate clear emotion recognition deficits in bvFTD and AD, and suggest the presence of subtle changes in facial emotion recognition in early‐stage FTD. This provides us more insight into the discrete neural substrates involved in behavioural and emotional changes in developing FTD, but also highlights the importance of incorporating emotion recognition paradigms into standard neuropsychological assessment for early differential diagnosis.

The Free Cued Selective Reminding Test detects episodic memory impairment in the presymptomatic period of familial frontotemporal dementia within the GENFI cohort

AbstractBackgroundEpisodic memory is increasingly reported in frontotemporal dementia (FTD) and it has been suggested to differ between genetic forms of FTD. However, systematic investigations of episodic memory in familial FTD, and specifically the presymptomatic stage, are scarce. This cross‐sectional study investigates performance on the Free Cued and Selective Reminding Test (FCSRT) in the Genetic Frontotemporal Dementia Initiative (GENFI), a large familial FTD cohort.Method685 participants were tested with the FCSRT (52 presymptomatic and 21 symptomatic MAPT, 135 presymptomatic and 42 symptomatic GRN, 109 presymptomatic and 63 symptomatic C9orf72 mutation carriers and 263 non‐carriers). The presymptomatic mutation carriers were split into an early and late presymptomatic period (more than or within ten years of expected symptom onset). Groups were compared using linear regression models, adjusted for age and education, with bootstrapping.ResultPerformance on all FCSRT test scores had a negative correlation with age (0.18 &gt; r &lt; 0.38) and immediate free recall (r = 0.21), immediate total recall (r = 0.14) and delayed free recall (r = 0.24) had a positive correlation with education. All symptomatic mutation carrier groups scored significantly lower than controls on immediate free recall (MAPT: −2.54 ± 1.52; GRN: −3.15 ± 2.13; C9orf72: −2.67 ± 1.32), immediate total recall (MAPT: −4.83 ± 4.42; GRN: −6.65 ± 5.69; C9orf72: −3.63 ± 3.99), delayed free recall (MAPT: −2.66 ± 1.98; GRN: −3.08 ± 2.17; C9orf72: −2.64 ± 1.41) and delayed total recall (MAPT: −4.32 ± 4.49; GRN: −6.48 ± 6.63; C9orf72: −4.32 ± 4.49). In the presymptomatic group, C9orf72 participants performed significantly lower on immediate (late: −0.75 ± 0.93) and delayed free recall (early: −0.11 ± 1.12; late: −0.57 ± 1.14) measures.ConclusionEpisodic memory is impaired in genetic FTD, with decline already starting in the presymptomatic period in C9orf72 mutation carriers. The differences between mutation carriers groups in free versus cued recall formats corroborates the notion that the clinical presentation of episodic memory deficits (i.e. as a result of executive impairment versus “true” consolidation problems) in FTD depend on the underlying mutation, and thus atrophy pattern. Our next step is to replicate results in a larger dataset and correlate performance on the FCSRT to grey matter density in each genetic group using voxel‐based morphometry.

Sex differences in body composition in non‐demented individuals with autosomal dominant Alzheimer’s disease

AbstractBackgroundBody mass index (BMI) is a known risk factor for Alzheimer’s disease (AD). Research with autosomal dominant Alzheimer’s disease (ADAD) has shown a relationship between lower BMI, greater amyloid burden and worse memory performance in presymptomatic mutation carriers. Women have a higher incidence of AD, and may be more susceptible to AD‐ related pathology. However, little is known about the effects of sex/gender on BMI in individuals at increased risk for AD. As carriers of ADAD mutations are destined to develop early‐onset dementia, they allow us to investigate sex differences without aging confounds known to vary by sex (i.e., life expectancy, menopause). We sought to examine sex differences in BMI in non‐demented mutation carriers and non‐carriers from a Colombian kindred with ADAD.Method191 carriers of the Presenilin‐1 E280A mutation (104 females; age range: 18‐55 years) and 261 age‐matched non‐carriers (165 females) were included. All participants completed clinical and cognitive assessments, including BMI (kg/m2) measures, MMSE and CERAD Word List tests. Mann‐Whitney‐U test was used to examine sex differences on BMI. General linear models were used to examine the associations between BMI, MMSE and memory, controlling for age and education.ResultCompared to non‐carriers, carriers had lower BMI (carriers: 23.05 +/‐ 3.65; non‐carriers: 24.26 +/‐ 3.92, p=0.002). In carriers, lower BMI was associated with worse performance on MMSE (r=0.49, p=0.001). Compared to male carriers, female carriers had greater BMI (males: 22.4 +/‐ 3.3, females: 23.5 +/‐ 3.7, p=0.04), and performed worse on the MMSE (males: 28.19 +/‐1.8, females: 27.91 +/‐1.91, p=0.04). There was a trend for female carriers to also have worse memory performance (p=0.06). Sex differences were not observed in non‐carriers. There were no associations between BMI and memory.ConclusionThere are sex differences in body composition in carriers of ADAD without dementia. These findings suggest that changes in BMI may reflect early signs of abnormal systemic responses to AD‐related pathology. Future studies should examine longitudinal changes in BMI, from preclinical to clinical stages, and other contributing factors (e.g. vascular risk factors and sex hormones) to determine the potential role of BMI as a risk factor for dementia.

Plasma phospho‐tau in familial Alzheimer’s disease

AbstractBackgroundBlood biomarkers have the potential to advance clinical care and accelerate the development of disease‐modifying treatments. P‐tau181 is a promising blood biomarker, with levels increasing in Alzheimer’s disease (AD) dementia (doi:10.1016/j.jalz.2018.02.013). However, a better understanding of the timing and trajectory of plasma p‐tau181 changes is needed. Therefore, we conducted a longitudinal study in familial AD (FAD).MethodsUsing an in house Single molecule array method, P‐tau181 was measured in 153 plasma samples from 70 individuals from families with PSEN1 or APP mutations (mean ± SD = 2.2 ±1.3 samples/participant;median [IQR] duration of follow up =1.0 (0, 3.7) years). We compared plasma p‐tau181 between symptomatic mutation carriers, presymptomatic carriers, and noncarriers, adjusting for age and sex. We also examined the relationship between plasma p‐tau181 and estimated years to/from symptom onset (EYO), as well as years to/from actual symptom onset (AAO) in a symptomatic subgroup. In addition, we studied associations between plasma p‐tau181 and clinical severity, as well testing for differences in concentration between genetic subgroups (PSEN1 vs APP carriers, PSEN1 pre‐codon 200 vs PSEN1 post‐codon 200 carriers).Results24 of the asymptomatic participants were mutation carriers (mean baseline EYO ‐9.6 years); 27 were noncarriers. Compared with noncarriers, plasma p‐tau181 concentration was higher in symptomatic (p&lt;0.001) and presymptomatic mutation carriers (p&lt;0.001) (Figure 1). Plasma p‐tau181 discriminated symptomatic (AUC 0·93[95% CI 0·84−0·98]) and presymptomatic (AUC 0.86 [95% CI 0·73−0·95]) carriers from noncarriers. Plasma p‐tau181 concentration increased in mutation carriers from 16 years prior to estimated symptom onset (p=0.049) (Figure 2). Plasma p‐tau181 in symptomatic mutation carriers, modelled using AAO, appeared eventually to plateau. Longitudinal p‐tau181 measures demonstrated significant inter‐ and intra‐individual variability, with some participants exhibiting large changes over relatively short time intervals. We did not find a difference in plasma p‐tau181 concentration between APP and PSEN1 carriers, but there was weak evidence (p=0.053) that symptomatic PSEN1 post‐codon 200 carriers had a 54% higher p‐tau181 concentration (95% CI:1% lower, 138% higher) than pre‐codon 200 carriers.ConclusionOur finding that plasma p‐tau181 concentration is increased in presymptomatic and symptomatic FAD suggests its potential utility as an easily accessible biomarker of AD pathology.

Brain volumetric deficits in MAPT mutation carriers: a multisite study.

Objective MAPT mutations typically cause behavioral variant frontotemporal dementia with or without parkinsonism. Previous studies have shown that symptomatic MAPT mutation carriers have frontotemporal atrophy, yet studies have shown mixed results as to whether presymptomatic carriers have low gray matter volumes. To elucidate whether presymptomatic carriers have lower structural brain volumes within regions atrophied during the symptomatic phase, we studied a large cohort of MAPT mutation carriers using a voxelwise approach.MethodsWe studied 22 symptomatic carriers (age 54.7 ± 9.1, 13 female) and 43 presymptomatic carriers (age 39.2 ± 10.4, 21 female). Symptomatic carriers’ clinical syndromes included: behavioral variant frontotemporal dementia (18), an amnestic dementia syndrome (2), Parkinson’s disease (1), and mild cognitive impairment (1). We performed voxel‐based morphometry on T1 images and assessed brain volumetrics by clinical subgroup, age, and mutation subtype.ResultsSymptomatic carriers showed gray matter atrophy in bilateral frontotemporal cortex, insula, and striatum, and white matter atrophy in bilateral corpus callosum and uncinate fasciculus. Approximately 20% of presymptomatic carriers had low gray matter volumes in bilateral hippocampus, amygdala, and lateral temporal cortex. Within these regions, low gray matter volumes emerged in a subset of presymptomatic carriers as early as their thirties. Low white matter volumes arose infrequently among presymptomatic carriers.InterpretationA subset of presymptomatic MAPT mutation carriers showed low volumes in mesial temporal lobe, the region ubiquitously atrophied in all symptomatic carriers. With each decade of age, an increasing percentage of presymptomatic carriers showed low mesial temporal volume, suggestive of early neurodegeneration.

Plasma microRNA signature in presymptomatic and symptomatic subjects with C9orf72-associated frontotemporal dementia and amyotrophic lateral sclerosis

ObjectiveTo identify potential biomarkers of preclinical and clinical progression in chromosome 9 open reading frame 72 gene (C9orf72)-associated disease by assessing the expression levels of plasma microRNAs (miRNAs) in C9orf72...

Brain functional network integrity sustains cognitive function despite atrophy in presymptomatic genetic frontotemporal dementia.

The presymptomatic phase of neurodegenerative disease can last many years, with sustained cognitive function despite progressive atrophy. We investigate this phenomenon in familial frontotemporal dementia (FTD). We studied 121 presymptomatic FTD mutation carriers and 134 family members without mutations, using multivariate data-driven approach to link cognitive performance with both structural and functional magnetic resonance imaging. Atrophy and brain network connectivity were compared between groups, in relation to the time from expected symptom onset. There were group differences in brain structure and function, in the absence of differences in cognitive performance. Specifically, we identified behaviorally relevant structural and functional network differences. Structure-function relationships were similar in both groups, but coupling between functional connectivity and cognition was stronger for carriers than for non-carriers, and increased with proximity to the expected onset of disease. Our findings suggest that the maintenance of functional network connectivity enables carriers to maintain cognitive performance.

Early Mechanical Alterations in Phospholamban Mutation Carriers: Identifying Subclinical Disease Before Onset of Symptoms

ObjectivesThis study aimed to explore echocardiographic characteristics of phospholamban (PLN) p.Arg14del mutation carriers to investigate whether structural and/or functional abnormalities could be identified before onset of symptoms. BackgroundCarriers of the genetic PLN p.Arg14del mutation may develop arrhythmogenic and/or dilated cardiomyopathy. Overt disease is preceded by a pre-symptomatic phase of variable length in which disease expression seems to be absent. MethodsPLN p.Arg14del mutation carriers with an available echocardiogram were included. Mutation carriers were classified as pre-symptomatic if they had no history of ventricular arrhythmias (VAs), a premature ventricular complex count of <500/24 h, and a left ventricular (LV) ejection fraction of ≥45%. In addition, we included 70 control subjects with similar age and sex distribution as the pre-symptomatic mutation carriers. Comprehensive echocardiographic analysis (including deformation imaging) was performed. ResultsThe final study population consisted of 281 PLN p.Arg14del mutation carriers, 139 of whom were classified as pre-symptomatic. In comparison to control subjects, pre-symptomatic mutation carriers had lower global longitudinal strain and higher LV mechanical dispersion (both p < 0.001). In addition, post-systolic shortening (PSS) in the LV apex was observed in 43 pre-symptomatic mutation carriers (31%) and in none of the control subjects. During a median follow-up of 3.2 years (interquartile range: 2.1 to 5.6 years) in 104 pre-symptomatic mutation carriers, nonsustained VA occurred in 13 (13%). Presence of apical PSS was the strongest echocardiographic predictor of VA (multivariable hazards ratio: 5.11; 95% confidence interval [CI]: 1.37 to 19.08; p = 0.015), which resulted in a negative predictive value of 96% (95% CI: 89% to 98%) and a positive predictive value of 29% (95% CI: 21% to 40%). ConclusionsGlobal and regional LV mechanical alterations in PLN p.Arg14del mutation carriers precede arrhythmic symptoms and overt structural disease. Pre-symptomatic mutation carriers with normal deformation patterns in the apex are at low risk of developing VA within 3 years, whereas mutation carriers with apical PSS appear to be at higher risk.

Optical coherence tomography detects retinal changes in hereditary cerebral amyloid angiopathy.

Investigating mutation carriers with Dutch-type hereditary (D-) cerebral amyloid angiopathy (CAA), offers the possibility to identify markers in pre- and symptomatic stages of CAA. Optical coherence tomography (OCT) has shown potential to detect retinal changes in several neurodegenerative diseases. The aim of the present exploratory study was to investigate thinning of retinal layers as a possible (early) biomarker in D-CAA mutation carriers. Twenty-one D-CAA mutation carriers (n=8 presymptomatic, n=13 symptomatic, median age 50years) and nine controls (median age 53years) were scanned using spectral-domain OCT. Symptomatic mutation carriers were defined as having a history of ≥1 symptomatic intracerebral hemorrhage. D-CAA mutation carriers and controls were recruited from our D-CAA cohort and a healthy control cohort. Total peripapillary retinal nerve fiber layer (pRNFL) thickness, six regions of pRNFL, total macular volume (TMV), and individual macular region thickness were measured and analysed, adjusted for age. The overall median (interquartile range) thickness of pRNFL was lower in symptomatic, but not presymptomatic D-CAA mutation carriers compared with controls [91(86-95) µm vs. 99(87-108) µm; P=0.006]. Both presymptomatic [111 (93-122) µm vs. 131 (123-143) µm; P<0.001] and symptomatic carriers [119(95-128) µm vs. 131(123-143) µm; P=0.034] had a thinner temporal-superior quadrant of the pRNFL versus controls. TMV or individual macular layer thickness did not differ between carriers and controls. Thinning of the retinal nerve fiber layer may be a candidate marker of disease in hereditary CAA. Further studies are needed to determine whether retinal thinning is present in sporadic CAA and estimate its value as a marker for disease progression.

Social cognition impairment in genetic frontotemporal dementia within the GENFI cohort

A key symptom of frontotemporal dementia (FTD) is difficulty interacting socially with others. Social cognition problems in FTD include impaired emotion processing and theory of mind difficulties, and whilst these have been studied extensively in sporadic FTD, few studies have investigated them in familial FTD. Facial Emotion Recognition (FER) and Faux Pas (FP) recognition tests were used to study social cognition within the Genetic Frontotemporal Dementia Initiative (GENFI), a large familial FTD cohort of C9orf72, GRN, and MAPT mutation carriers. 627 participants undertook at least one of the tasks, and were separated into mutation-negative healthy controls, presymptomatic mutation carriers (split into early and late groups) and symptomatic mutation carriers. Groups were compared using a linear regression model with bootstrapping, adjusting for age, sex, education, and for the FP recognition test, language. Neural correlates of social cognition deficits were explored using a voxel-based morphometry (VBM) study. All three of the symptomatic genetic groups were impaired on both tasks with no significant difference between them. However, prior to onset, only the late presymptomatic C9orf72 mutation carriers on the FER test were impaired compared to the control group, with a subanalysis showing differences particularly in fear and sadness. The VBM analysis revealed that impaired social cognition was mainly associated with a left hemisphere predominant network of regions involving particularly the striatum, orbitofrontal cortex and insula, and to a lesser extent the inferomedial temporal lobe and other areas of the frontal lobe. In conclusion, theory of mind and emotion processing abilities are impaired in familial FTD, with early changes occurring prior to symptom onset in C9orf72 presymptomatic mutation carriers. Future work should investigate how performance changes over time, in order to gain a clearer insight into social cognitive impairment over the course of the disease.

Different Clinical Contexts of Use of Blood Neurofilament Light Chain Protein in the Spectrum of Neurodegenerative Diseases.

One of the most pressing challenges in the clinical research of neurodegenerative diseases (NDDs) is the validation and standardization of pathophysiological biomarkers for different contexts of use (CoUs), such as early detection, diagnosis, prognosis, and prediction of treatment response. Neurofilament light chain (NFL) concentration is a particularly promising candidate, an indicator of axonal degeneration, which can be analyzed in peripheral blood with advanced ultrasensitive methods. Serum/plasma NFL concentration is closely correlated with cerebrospinal fluid NFL and directly reflects neurodegeneration within the central nervous system. Here, we provide an update on the feasible CoU of blood NFL in NDDs and translate recent findings to potentially valuable clinical practice applications. As NFL is not a disease-specific biomarker, however, blood NFL is an easily accessible biomarker with promising different clinical applications for several NDDs: (1) early detection and diagnosis (i.e., amyotrophic lateral sclerosis, Creutzfeldt-Jakob disease, atypical parkinsonisms, sporadic late-onset ataxias), (2) prognosis (Huntington's disease and Parkinson's disease), and (3) prediction of time to symptom onset (presymptomatic mutation carriers in genetic Alzheimer's disease and spinocerebellar ataxia type 3).

Association of education with Aβ burden in preclinical familial and sporadic Alzheimer disease.

To determine whether years of education and the ε4 risk allele at APOE influence β-amyloid (Aβ) pathology similarly in asymptomatic individuals with a family history of sporadic Alzheimer disease (AD) and presymptomatic autosomal dominant AD mutation carriers. We analyzed cross-sectional data from 106 asymptomatic individuals with a parental history of sporadic AD (PREVENT-AD cohort; age 67.28 ± 4.72 years) and 117 presymptomatic autosomal dominant AD mutation carriers (DIAN cohort; age 35.04 ± 9.43 years). All participants underwent structural MRI and Aβ-PET imaging. In each cohort we investigated the influence of years of education, APOE ε4 status, and their interaction on Aβ-PET. Asymptomatic individuals with a parental history of sporadic AD showed increased Aβ burden associated with APOE ε4 carriage and lower level of education, but no interaction between these. Presymptomatic mutation carriers of autosomal dominant AD showed no relation between APOE ε4 and Aβ burden, but increasing level of education was associated with reduced Aβ burden. The association between educational attainment and Aβ burden was similar in the 2 cohorts. While the APOE ε4 allele confers increased tendency toward Aβ accumulation in sporadic AD only, protective environmental factors, like increased education, may promote brain resistance against Aβ pathology in both sporadic and autosomal dominant AD.

Emotion recognition of morphed facial expressions in presymptomatic and symptomatic frontotemporal dementia, and Alzheimer\u2019s dementia

BackgroundThe emotion recognition task (ERT) was developed to overcome shortcomings of static emotion recognition paradigms, by identifying more subtle deficits in emotion recognition across different intensity levels. In this study, we used the ERT to investigate emotion recognition deficits across the frontotemporal (FTD) and Alzheimer’s Dementia (AD) spectrum.MethodsWith the ERT, we assessed the recognition of facial emotional expressions (anger-disgust-fear-happiness-sadness-surprise) across four intensities (40–60–80–100%) in patients with behavioural variant FTD (bvFTD; n = 32), and AD (n = 32), presymptomatic FTD mutation carriers (n = 47) and controls (n = 49). We examined group differences using multilevel linear regression with age, sex and education level as covariates, and performed post hoc analyses on presymptomatic (MAPT, GRN and C9orf72) mutation carriers. Classification abilities were investigated by means of logistic regression.ResultsLowest ERT total scores were found in patients with bvFTD and AD, whereas equal highest performance was found in presymptomatic mutation carriers and controls. For all emotions, significantly lower subscores were found in patients with bvFTD than in presymptomatic mutation carriers and in controls (highest p value = 0.025). Patients with bvFTD performed lower than patients with AD on anger (p = 0.005) and a trend towards significance was found for a lower performance on happiness (p = 0.065). Task performance increased with higher emotional intensity, and classification was better at the lowest than at the highest intensity. C9orf72 mutation carriers performed worse on recognizing anger at the lowest intensity than GRN mutation carriers (p = 0.047) and controls (p = 0.038). The ERT differentiated between patients with bvFTD and controls, and between patients with AD and controls (both p < 0.001).DiscussionOur results demonstrate emotion recognition deficits in both bvFTD and AD, and suggest the presence of subtle emotion recognition changes in presymptomatic C9orf72-FTD. This highlights the importance of incorporating emotion recognition paradigms into standard neuropsychological assessment for early differential diagnosis, and as clinical endpoints in upcoming therapeutic trials.

Plasma phospho-tau181 in presymptomatic and symptomatic familial Alzheimer's disease: a longitudinal cohort study.

Blood biomarkers have great potential to advance clinical care and accelerate trials in Alzheimer's disease (AD). Plasma phospho-tau181 (p-tau181) is a promising blood biomarker however, it is unknown if levels increase in presymptomatic AD. Therefore, we investigated the timing of p-tau181 changes using 153 blood samples from 70 individuals in a longitudinal study of familial AD (FAD). Plasma p-tau181 was measured, using an in-house single molecule array assay. We compared p-tau181 between symptomatic carriers, presymptomatic carriers, and non-carriers, adjusting for age and sex. We examined the relationship between p-tau181 and neurofilament light and estimated years to/from symptom onset (EYO), as well as years to/from actual onset in a symptomatic subgroup. In addition, we studied associations between p-tau181 and clinical severity, as well testing for differences between genetic subgroups. Twenty-four were presymptomatic carriers (mean baseline EYO -9.6 years) while 27 were non-carriers. Compared with non-carriers, plasma p-tau181 concentration was higher in both symptomatic (p < 0.001) and presymptomatic mutation carriers (p < 0.001). Plasma p-tau181 showed considerable intra-individual variability but individual values discriminated symptomatic (AUC 0.93 [95% CI 0.85-0.98]) and presymptomatic (EYO ≥ -7 years) (AUC 0.86 [95% CI 0.72-0.94]) carriers from non-carriers of the same age and sex. From a fitted model there was evidence (p = 0.050) that p-tau181 concentrations were higher in mutation carriers than non-carriers from 16 years prior to estimated symptom onset. Our finding that plasma p-tau181 concentration is increased in symptomatic and presymptomatic FAD suggests potential utility as an easily accessible biomarker of AD pathology.