Posts tagged Alzheimer

June 28, 2012

In a genome-wide association (GWA) study, researchers from Boston University Schools of Medicine (BUSM) and Public Health (BUSPH) have identified several genes which influence degeneration of the hippocampus, the part of the brain most associated with Alzheimer disease (AD). The study, which currently appears online as a Rapid Communication in the Annals of Neurology, demonstrates the efficacy of endophenotypes for broadening the understanding of the genetic basis of and pathways leading to AD.

AD is a progressive neurodegenerative disorder for which there are no prevention methods. Available drugs only marginally affect disease severity and progression, making AD effectively untreatable.

GWA studies using very large samples have increased the number of robust associations to 10 genes, including APOE. However, these genes account for no more than 35 percent of the inherited risk of AD and most of the genetic underpinning of the disorder remains unexplained. According to the researchers, magnetic resonance imaging (MRI) of the brain provides in vivo quantitative measures of neurodegenerative and cerebrovascular brain injury that may represent AD-related changes long before clinical symptoms appear. These measures are more powerful than comparisons of individuals with AD with cognitively healthy persons because they avoid misclassification of normal persons who will develop disease in the future.

BUSM researchers conducted a two-stage GWA study for quantitative measures of hippocampal volume (HV), total cerebral volume (TCV) and white matter hyperintensities (WMH). Brain MRI measures of HV, TCV and WMH were obtained from 981 Caucasian and 419 African-American AD cases and their cognitively normal siblings in the MIRAGE (Multi Institutional Research in Alzheimer’s Genetic Epidemiology) Study. In addition, similar MRI measures were obtained from 168 AD cases, 336 individuals with mild cognitive impairment and 188 controls (all Caucasian) in the AD Neuroimaging Initiative (ADNI) Study. The MIRAGE Caucasian families and ADNI subjects were included in the first stage and the MIRAGE African American families were added in stage two. Results from the two Caucasians data sets were combined by meta-analysis.

In stage two, one genetic marker (i.e. single nucleotide polymorphism or SNP) from each of the gene regions that were most significantly associated with AD in the Caucasian data sets was evaluated in the African-American data set.

Novel genome-wide significant associations were observed for HV with SNPs in the APOE, F5/SELP, LHFP, and GCFC2 gene regions. All of these associations were supported by evidence in each data set.

"Our two-stage GWAS identified highly significant associations between a measure of degeneration in the brain region most strongly correlated with AD and several genes in both Caucasian and African American samples containing AD, cognitively impaired and cognitively healthy subjects. One of these associations was with the ε4 variant of APOE which is the most well-established genetic risk factor for AD.

Other associations were demonstrated with markers in F5/SELP, LHFP, and GCFC2, genes not previously implicated in this disease” explained senior author Lindsay Farrer, PhD, chief of biomedical genetics at BUSM. He also noted, “previous studies showed that blood level of P-selectin (the protein encoded by SELP) has been correlated with rate of cognitive decline in AD patients.”

Farrer believes it is very likely that the number and specificity of these associations will increase in future studies using larger samples and focused on additional precise structural and functional MRI measures. “These findings will inform experiments designed to increase our understanding of disease-causing mechanism and may lead to new therapeutics targets,” added Farrer.

Provided by Boston University Medical Center

Source: medicalxpress.com

ScienceDaily (June 27, 2012) — Modern anesthesia is extremely safe. But as risks to heart, lungs and other organs have waned, another problem has emerged in the elderly: post-operative cognitive dysfunction. Mentally, some patients “just aren’t the same” for months or longer after surgery. Other factors play a role, but a small number of patients deteriorate mentally due to anesthesia per se. Those with Alzheimer’s disease suffer exacerbations, and those without the diagnosis may have it unmasked by anesthesia, suggesting some relationship.

Alzheimer’s disease has two types of brain lesions. Beta-amyloid deposits accumulate outside neurons but don’t cause cognitive problems. Neurofibrillary tangles inside neurons, composed of hyper-phosphorylated ‘tau’, a protein normally attached to microtubules, do correlate with dementia. These same tau tangles are found in post-anesthesia dementia.

Microtubules (MTs) polymerize from ‘tubulin’ proteins to grow, shape and regulate neurons. Synaptic components are transported by motor proteins which move like railroad trains along MT tracks. In branching dendrites, motors change MTs repeatedly to reach their destination. Tau is a traffic signal, telling motors where to get on and off, the route encoded in MT binding sites for tau.

That MTs process information stems from Charles Sherrington in the 1950s, with recent controversial suggestions of MT computing, and even quantum computing mediating consciousness and memory. But whether MTs play a primary, or mere supportive role, their stability and function are essential to cognition and consciousness.

Excessive phosphorylation had been thought the culprit in detaching tau and causing tangles. But destabilized MTs now appear to be the primary problem in both Alzheimer’s and post-anesthesia dementia, releasing tau which then becomes hyperphosphorylated. Anesthetics are known to bind to tubulin, in some cases for days after exposure, and in high doses to cause MT disassembly.

Now, in a study in PLoS ONE, a team from Canada, Portugal and the USA report molecular modeling showing 32 anesthetic binding sites per tubulin, with at least 1 percent (10 million) of the billion tubulins per brain neuron binding an anesthetic molecule at clinical concentration (1 ‘MAC’). Two particular anesthetic binding regions may destabilize MTs, one inactivating tubulin C-termini tails (which otherwise knit together neighboring tubulins). The other weakens side-to-side tubulin couplings, the critical link in MT lattices, but only at high anesthetic concentrations, or perhaps with other MT destabilizing factors (low temperature, low zinc, high calcium, acidosis).

Travis Craddock PhD, lead author on the study said: “The good news is that therapies aimed at microtubule stabilization may help in both Alzheimer’s and post-anesthetic dementias. Clinical trials are underway, or planned, for microtubule stabilizers Epothilone D, NAPVSIPQ, and the zinc ionophore PBT2, as well as brain ultrasound, shown in vitro to excite MT resonances and promote polymerization. However it’s done, ‘tightening the tubules’ may best treat dementia.”

Source: Science Daily

ScienceDaily (June 26, 2012) — Rhode Island Hospital researcher Suzanne de la Monte, M.D., has found a link between brain insulin resistance (diabetes) and two other key mediators of neuronal injury that help Alzheimer’s disease (AD) to propagate. The research found that once AD is established, therapeutic efforts must also work to reduce toxin production in the brain.

The study, “Dysfunctional Pro-Ceramide, ER Stress, and Insulin/IGF Signaling Networks with Progression of Alzheimer’s Disease”, is published in the June 22, 2012, supplement of the Journal of Alzheimer’s Disease.

Alzheimer’s disease is one of the most common degenerative dementias, and more than 115 million new cases are projected worldwide in the next 40 years. There is clinical and experimental evidence that treatment with insulin or insulin sensitizer agents can enhance cognitive function and in some circumstances help slow the rate of cognitive decline in AD. Alzheimer’s and other neurodegenerative diseases destroy the brain until the patients finally succumb. In order to effectively halt the process of neurodegeneration, the forces that advance and perpetuate the disease, particularly with regard to the progressive worsening of brain insulin/IGF resistance, must be understood.

"Brain insulin resistance (diabetes) is very much like regular diabetes," de la Monte said. "Since the underlying problems continue to be just about the same, we believe that the development of new therapies would be applicable for all types of diabetes, including Alzheimer’s disease, which we refer to as Type III diabetes."

She continued, “This study points out that once AD is established, therapeutic efforts should target several different pathways — not just one. The reason is that a positive feedback loop gets going, making AD progress. We have to break the vicious cycle. Restoring insulin responsiveness and insulin depletion will help, but we need to reduce brain stress and repair the metabolic problems that cause the brain to produce toxins.”

Ultimately, these findings will help to expand ways to both detect and treat AD.

Growing evidence supports the concept that AD is fundamentally a metabolic syndrome that leads to abnormalities linked to brain insulin and insulin-like growth factor (IGF) resistance. In AD, brain insulin and IGF resistance and deficiencies begin early and worsen with severity of the disease. The rationale behind the progression of the disease is that insulin-resistance dysregulates lipid metabolism and promotes ceramide accumulation, thereby increasing inflammation and lipid metabolism, causing toxic ceramides to accumulate in the brain. The end result is increased stress that threatens the survival and function of neurons in the brain.

The present study was designed to gain a better understanding of how brain insulin resistance becomes progressive and contributes to the neurodegeneration in AD, focusing on the roles of ceramides and stress. The researchers studied the same brain samples used previously to demonstrate progressive impairments in brain insulin/IGF signaling with increasing severity of AD.

Source: Science Daily

June 26, 2012

The inexorable spread of Alzheimer’s disease through the brain leaves dead neurons and forgotten thoughts in its wake. Researchers at Linköping University in Sweden are the first to show how toxic proteins are transferred from neuron to neuron.

Two nerve cells, each about 10 micrometers large, are visible as shadows in this picture. From the beginning only the right one (yellow arrow) contained the toxic, red stained, oligomeric beta-amyloid. When these sick cells make contacts with the healthy, green labeled cells (black arrow), toxic beta-amyloid will spread through the neuronal projections (white arrow). Subsequently, also the green cell will become sick. Credit: Martin Hallbeck

Through experiments on stained neurons, the research team – under the leadership of Martin Hallbeck, associate professor of Pathology – has been able to depict the process of neurons being invaded by diseased proteins that are then passed on to nearby cells.

"The spread of Alzheimer’s, which can be studied in the brains of diseased patients, always follows the same pattern. But until now how and why this happens has not been understood," says Hallbeck, who along with his research group has now published their results in The Journal of Neuroscience.

The illness starts in the entorhinal cortex – a part of the cerebral cortex, and then spreads to the hippocampus. Both of these areas are important for memory. Gradually, pathological changes take place in more and more areas of the brain, while the patient becomes even sicker.

Two proteins have been identified in connection with Alzheimer’s: beta amyloid and tau. Normally tau is found in the axons – the outgrowths that connect between neurons – where it has a stabilising function, while beta amyloid seems to have a role in the synapses where the neurons transfer signal substances to each other. But in Alzheimer’s patients, something happens with these proteins; autopsies reveal abnormal accumulations of both.

Why they become abnormal is still unknown, but what is known is that it’s not the large accumulations, or plaques, that damage the neurons. Instead, smaller groups of beta amyloid – called oligomeres – seem to be the toxic form that gradually destroy the neurons and shrink the brain.

"We wanted to investigate whether these oligomeres can spread from neuron to neuron, something many researchers tried earlier but didn’t succeed," Hallbeck says.

The study was inaugurated with an experiment on neuron cultures, where researchers injected oligomeres stained with a phosphorescent red substance called TMR using a very thin needle. The next day the neighbouring, connected neurons were also red, which showed that the oligomeres had spread.

To test whether a sick neuron can “infect” others, they conducted a round of experiments with mature human neurons stained green and mixed with others that were red after having taken up stained oligomeres. After a day, approximately half of the green cells had been in contact with a few of the red ones. After two more days, the axons had lost their shape and organelles in the cell nucleus had started to leak.

"Gradually more and more of the green cells became sick. Those that hadn’t taken up the oligomeres, on the other hand, weren’t affected," Hallbeck says.

The study is a breakthrough in understanding Alzheimer’s and its progress. If a way of stopping the transfer can be found, it could lead to a more effective inhibitor against the disease.

Provided by Linköping University

Source: medicalxpress.com

June 25, 2012 By Traci Pedersen

Scientists have found improvements on memory tests and an increase in brain volume in Chinese seniors who practice tai chi three times a week, according to an article published in the Journal of Alzheimer’s Disease.

The trial also showed increases in brain volume and smaller cognitive improvements in individuals that participated in lively discussions three times per week over the same time period.

Researchers from the University of South Florida and Fudan University in Shanghai conducted an eight-month randomized controlled trial involving a group of seniors who practiced tai chi as well as a group who participated in lively conversations.  Researchers compared these to a control group who received no intervention.

Previous studies have shown an increase in brain volume in people who participated in aerobic exercise, and in one of these trials, memory was improved as well.

However, this was the first trial to prove that a less aerobic form of exercise, tai chi, as well as stimulating discussion, led to similar increases in brain volume and improvements on psychological tests of memory and thinking.

Volunteers who did not participate in the interventions showed brain shrinkage during this time period, consistent with what generally has been observed for persons in their 60s and 70s.

Several studies have shown that dementia and the gradual cognitive decline that precedes it is linked to increasing shrinkage of the brain as nerve cells and their connections are slowly lost.

“The ability to reverse this trend with physical exercise and increased mental activity implies that it may be possible to delay the onset of dementia in older persons through interventions that have many physical and mental health benefits,” said lead author James Mortimer, Ph.D., professor of epidemiology at the University of South Florida College of Public Health.

Research suggests that aerobic exercise is associated with increased production of brain growth factors. It has been undetermined whether forms of exercise like tai chi that include an important mental exercise component could lead to similar changes in brain development.

“If this is shown, then it would provide strong support to the concept of ‘use it or lose it’ and encourage seniors to stay actively involved both intellectually and physically,” Mortimer said.

One question raised by the research is whether sustained physical and mental exercise can help prevent Alzheimer’s disease.

“Epidemiologic studies have shown repeatedly that individuals who engage in more physical exercise or are more socially active have a lower risk of Alzheimer’s disease,” Mortimer said. “The current findings suggest that this may be a result of growth and preservation of critical regions of the brain affected by this illness.”

Source: PsychCentral

June 18, 2012

Among well-functioning older adults without dementia, diabetes mellitus (DM) and poor glucose control among those with DM are associated with worse cognitive function and greater cognitive decline, according to a report published Online First by Archives of Neurology, a JAMA Network publication.

Findings from previous studies have suggested an association between diabetes mellitus and an increased risk of cognitive impairment and dementia, including Alzheimer disease, but this association continues to be debated and less is known regarding incident DM in late life and cognitive function over time, the authors write as background in the study.

Kristine Yaffe, M.D., of the University of California, San Francisco and the San Francisco VA Medical Center, and colleagues evaluated 3,069 patients (mean age, 74.2 years; 42 percent black; 52 percent female) who completed the Modified Mini-Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST) at baseline and selected intervals over 10 years.

At study baseline, 717 patients (23.4 percent) had prevalent DM and 2,352 (76.6 percent) were without DM, 159 of whom developed DM during follow-up. Patients who had prevalent DM at baseline had lower 3MS and DSST test scores than patients without DM, and results from analysis show similar patterns for 9-year decline with participants with prevalent DM showing significant decline on both the 3MS and DSST compared with those without DM.

Also, among participants with prevalent DM at baseline, higher levels of hemoglobin A1c (HbA1c) were associated with lower 3MS and DSST scores. However, after adjusting for age, sex, race and education, scores remained significantly lower for those with mid (7 percent to 8 percent) and high (greater than or equal to 8 percent) HbA1c levels on the 3MS but were no longer significant for the DSST.

"This study supports the hypothesis that older adults with DM have reduced cognitive function and that poor glycemic control may contribute to this association,” the authors conclude. “Future studies should determine if early diagnosis and treatment of DM lessen the risk of developing cognitive impairment and if maintaining optimal glucose control helps mitigate the effect of DM on cognition.”

Provided by JAMA and Archives Journals

Source: medicalxpress.com

ScienceDaily (June 14, 2012) — No effective treatments are currently available for the prevention or cure of Alzheimer’s disease (AD), the most frequent form of dementia in the elderly. The most recognized risk factors, advancing age and having the apolipoprotein E Ɛ4 gene, cannot be modified or treated. Increasingly, scientists are looking toward other risk factors to identify preventive and therapeutic strategies. Much attention recently has focused on the metabolic syndrome (MetS), with a strong and growing body of research suggesting that metabolic disorders and obesity may play a role in the development of dementia.

A new supplement to the Journal of Alzheimer’s Disease provides a state-of-the-art assessment of research into the link between metabolic syndrome and cognitive disorders. The supplement is guest edited by Vincenza Frisardi, of the Department of Neurological and Psychiatric Sciences, University of Bari, and the Geriatric Unit and Gerontology-Geriatrics Research Laboratory, IRCCS, Foggia, Italy, and Bruno P. Imbimbo, Research and Development Department, Chiesi Farmaceutici, Parma, Italy.

The prevalence of MetS and obesity has increased over the past several decades. MetS is a cluster of vascular and metabolic risk factors including obesity, hypertension, an abnormal cholesterol profile, and impaired blood glucose regulation. “Although molecular mechanisms underlying the relationship between MetS and neurological disorders are not fully understood, it is becoming increasingly clear that cellular and biochemical alterations observed in MetS may represent a pathological bridge between MetS and various neurological disorders,” explains Dr. Frisardi.

Type 2 diabetes (T2D) has been linked with cognitive impairment in a number of studies. The risk for developing both T2D and AD increases proportionately with age, and evidence shows that individuals with T2D have a nearly twofold higher risk of AD than nondiabetic individuals.

Paula I. Moreira, Faculty of Medicine and Center for Neuroscience and Cell Biology, University of Coimbra, Portugal, outlines some of the likely mechanisms. Both AD and T2D present similar abnormalities in the mitochondria, which play a pivotal role in cellular processes that impair their ability to regulate oxidation in the cell. Human amylin, a peptide that forms deposits in the pancreatic cells of T2D patients, shares several properties with amyloid-ß plaques in the Alzheimer’s brain. Insulin resistance is another feature shared by both disorders. Impairment of insulin signalling is directly involved in the development of tau tangles and amyloid ß (Aß) plaques. “Understanding the key mechanisms underlying this deleterious interaction may provide opportunities for the design of effective therapeutic strategies,” Dr. Moreira notes.

In another article, author, José A. Luchsinger of the Division of General Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, notes that while there seems to be little dispute that T2D can cause cerebrovascular disease and vascular cognitive impairment, whether T2D can cause late onset AD remains to be determined. “Although the idea is highly speculative, the association between T2D and cognitive impairment may not be causal. Several lines of evidence provide some support to the idea that late onset Alzheimer’s disease could cause T2D, or that both could share causal pathways,” he notes. He reviews epidemiological, imaging, and pathological studies and clinical trials to provide insight. “Given the epidemic of T2D in the world, it’s important to determine whether the association between T2D and cognitive impairment, particularly late onset AD, is causal and if so, what are the mechanisms underlying it.”

Dr. Frisardi notes that most efforts by the pharmaceutical industry have been directed against the production and accumulation of amyloid-ß. “Unfortunately, these efforts have not produced effective therapies yet, since the exact mechanisms of AD are largely unknown. Given that the onset of AD most likely results from the interaction of genetic and environmental factors, the research agenda should consider new platforms of study, going beyond the monolithic outlook of AD, by synthesizing epidemiological, experimental, and biological data under a unique pathophysiological model as a point of reference for further advances in the field.”

Source: Science Daily

June 13, 2012

Researchers from Boston University School of Medicine (BUSM) have identified a novel group of proteins that accumulate in the brains of patients with Alzheimer’s disease. These findings, which appear online in the Journal of Neuroscience, may open up novel approaches to diagnose and stage the progression likelihood of the disease in Alzheimer patients.

Alzheimer’s disease is presumed to be caused by the accumulation of β-amyloid, which then induces aggregation of a neuronal protein, called tau, and neurodegeneration ensues. The diagnosis of Alzheimer’s disease focuses on β-amyloid and tau protein, with much attention focusing on radiolabeled markers that bind to β-amyloid (such as the compound PiB). However, imaging β-amyloid is problematic because many cognitively normal elderly have large amounts of β-amyloid in their brain, and appear as “positives” in the imaging tests.

Therapeutic approaches for Alzheimer’s disease generally have focused on β-amyloid because the process of producing a neurofibrillary tangle composed on tau protein has been poorly understood. Hence, few tau therapies have been developed. According to the researchers, this study makes important advances on both of these fronts.

The BUSM researchers identified a new group of proteins, termed RNA-binding proteins, which accumulate in the brains of patients with Alzheimer’s disease, and are present at much lower levels in subjects who are cognitively intact. The group found two different proteins, both of which show striking patterns of accumulation. “Proteins such as TIA-1 and TTP, accumulate in neurons that accumulate tau protein, and co-localize with neurofibrillary tangles. These proteins also bind to tau, and so might participate in the disease process,” explained senior author Benjamin Wolozin, MD, PhD, a professor in the departments of pharmacology and neurology at BUSM. “A different RNA binding protein, G3BP, accumulates primarily in neurons that do not accumulate pathological tau protein. This observation is striking because it shows that neurons lacking tau aggregates (and neurofibrillary tangles) are also affected by the disease process,” he added.

The researchers believe this work opens up novel approaches to diagnose and stage the likelihood of progression by quantifying the levels of these RNA-binding protein biomarkers that accumulate in the brains of Alzheimer patients.

Wolozin’s group also pursued the observation that some of the RNA binding proteins bind to tau protein, and tested whether one of these proteins, TIA-1, might contribute to the disease process. Previously, scientists have demonstrated that TIA-1 spontaneously aggregates in response to stress as a normal part of the stress response. Wolozin and his colleagues hypothesize that since TIA-1 binds tau, it might stimulate tau aggregation during the stress response. They introduced TIA-1 into neurons with tau protein, and subjected the neurons to stress. Consistent with their hypothesis, tau spontaneously aggregated in the presence of TIA-1, but not in the absence. Thus, the group has potentially identified an entirely novel mechanism to induce tau aggregates de novo. In future work, the group hopes to use this novel finding to understand how neurofibrillary tangles for in Alzheimer’s disease and to screen for novel compounds that might inhibit the progression of Alzheimer’s disease.

Provided by Boston University Medical Center

Source: medicalxpress.com

ScienceDaily (June 12, 2012) — A team led by investigators at the Stanford University School of Medicine has found that the most common genetic risk factor for Alzheimer’s disease disrupts brain function in healthy, older women but has little impact on brain function in healthy, older men. Women harboring the gene variant, known to be a potent risk factor for Alzheimer’s disease, show brain changes characteristic of the neurodegenerative disorder that can be observed before any outward symptoms manifest.

Both men and women who inherit two copies (one from each parent) of this gene variant, known as ApoE4, are at extremely high risk for Alzheimer’s. But the double-barreled ApoE4 combination is uncommon, affecting only about 2 percent of the population, whereas about 15 percent of people carry a single copy of this version of the gene.

The Stanford researchers demonstrated for the first time the existence of a gender distinction among outwardly healthy, older people who carry the ApoE4 variant. In this group, women but not men exhibit two telltale characteristics that have been linked to Alzheimer’s disease: a signature change in their brain activity, and elevated levels of a protein called tau in their cerebrospinal fluid.

One implication of the study, published June 13 in the Journal of Neuroscience, is that men revealed by genetic tests to carry a single copy of ApoE4 shouldn’t be assumed to be at elevated risk for Alzheimer’s, a syndrome afflicting about 5 million people in the United States and nearly 30 million worldwide. The new findings also may help explain why more women than men develop this disease, said Michael Greicius, MD, assistant professor of neurology and neurological sciences and medical director of the Stanford Center for Memory Disorders. Most critically, identifying the prominent interaction between ApoE4 and gender opens a host of new experimental avenues that will allow Greicius’ team and the field generally to better understandhow ApoE4 increases risk for Alzheimer’s disease.

For every three women with Alzheimer’s disease, only about two men have the neurodegenerative disorder, said Greicius, the study’s senior author. (The first author is Jessica Damoiseaux, PhD, a postdoctoral scholar in Greicius’ laboratory. They collaborated with colleagues at the University of California-San Francisco and UCLA.) True, women live longer than men do, on average, and old age is by far the greatest risk factor for Alzheimer’s, Greicius said. “But the disparity in Alzheimer’s risk persists even if you correct for the difference in longevity,” he said. “This disparate impact of ApoE4 status on women versus men might account for a big part of the skewed gender ratio.”

Besides age, another well-studied major risk factor is genetic: possession of a particular version of the gene known as ApoE. This gene is a recipe for a protein involved in transporting cholesterol into cells — an important job, as cholesterol is a crucial constituent of all cell membranes including those of nerve cells. And nerve cells are constantly responding to experience by developing or enhancing small, bulblike electrochemical contacts to other nerve cells, or diminishing or abolishing them. For all these processes, efficient cholesterol transport is critical.

The ApoE protein comes in three versions, each the product of a slightly differing version of the ApoE gene: E2, E3 or E4. Most people have two copies of the E3 version of ApoE. A small percentage carries one copy of E3 and one of E2, and even fewer two copies of E2. The protein specified by the E4 gene version seems to be somewhat defective in comparison to the one encoded by either E2 or the much more common E3. Thus, while only about 10-15 percent of the population carries one copy of E4 (or, much less commonly, two), more than 50 percent of people who develop Alzheimer’s are E4 carriers.

But, as it turns out, the heightened risk E4 imposes may be largely restricted to women.

To demonstrate this, the scientists first obtained functional MRI scans of 131 healthy people, with a median age of 70, to examine connections in the brain’s memory network. They used sophisticated brain-imaging analysis to show that in older women carrying the E4 variant, this network of interconnected brain regions, which normally share a synchronized pattern of activity, exhibit a loss of that synchrony — a pattern typically seen in Alzheimer’s patients. In healthy, older women (but not men) with at least one E4 allele, activity in a brain area called the precuneus appeared be out of synch with other regions whose firing patterns generally are closely coordinated.

The brain-imaging technique Greicius and his colleagues used is known as functional-connectivity magnetic resonance imaging, or fcMRI. Performed on “resting” subjects, who remain in the scanner awake but not focusing on any particular task, fcMRI can discern on the order of 20 different brain networks, each consisting of a set of dispersed brain regions that are physically connected by nerve tracts and whose pulses of activity are synchronized, or in phase. Greicius, Damoiseaux and their associates have previously shown that the synchronous firing pattern of one network in particular, critical to memory function and known as the “default mode network,” is specifically targeted by Alzheimer’s and deteriorates as the disease progresses.

To independently confirm their imaging-based observations, the scientists assessed records from a large public database compiled from the Alzheimer’s Disease Neuroimaging Initiative, a multi-site study of healthy aging and Alzheimer’s disease. The Stanford study focused on the healthy 55- to 90-year-old volunteers who had agreed to undergo a spinal tap and have their cerebrospinal fluid analyzed.

From this database the Greicius team extracted the records of 91 subjects, with an average age of 75, and divided them into four groups representing women with or without a copy of the E4 variant, and men with or without a copy. For each group, they checked recorded concentrations of a protein named tau in these subjects’ cerebrospinal fluid. Elevated tau levels in cerebrospinal fluid are a key biomarker of Alzheimer’s disease. The results — the CSF of women, but not men, who carried at least one E4 allele was substantially enriched in tau — confirmed the brain-imaging findings.

The tau findings constitute another first. “It was only possible to see these differences in tau levels when we separated the patients by gender,” Greicius said.

Notably, all the men and women participating in the Journal of Neuroscience study were screened for cognitive status. Only those whose ability to think and remember appeared normal for their age were admitted. Thus, the observed changes in brain activity and CSF composition were occurring well before the onset of classic Alzheimer’s symptoms such as memory loss, disorientation and dementia. It may someday be practical to substitute fcMRI, which is noninvasive, for a spinal tap as a diagnostic tool, Greicius said.

Source: Science Daily

ScienceDaily (June 11, 2012) — An arsenal of Alzheimer’s research revealed at the Society of Nuclear Medicine’s 59th Annual Meeting indicates that beta-amyloid plaque in the brain not only is involved in the pathology of Alzheimer’s disease but may also precede even mild cognitive decline. These and other studies advance molecular imaging for the early detection of beta-amyloid, for which one product is now approved in the United States , as a major push forward in the race for better treatments.

"Diagnosis of Alzheimer’s disease can now be made when the patient first presents symptoms and still has largely preserved mental function," says Christopher Rowe, M.D., a lead investigator for the Australian Imaging, Biomarkers and Lifestyle study of aging (AIBL) and professor of nuclear medicine at Austin Hospital in Melbourne, Australia. "Previously there was an average delay of three years between consulting a doctor over memory concerns and the diagnosis of Alzheimer’s, as the diagnosis required the presence of dementia. When used as an adjunct to other diagnostic measures, molecular imaging can help lead to earlier diagnosis. This may give the patient several years to prepare for dementia while they still have control over their destiny."

According to the World Health Organization, Alzheimer’s disease affects an estimated 18 million people worldwide, and incidence of the disease is expected to double by the year 2025 to 34 million. The National Institute on Aging estimates that as many as 50 percent of Americans aged 85 or older are affected.

Alzheimer’s disease is a chronic and currently incurable neurodegenerative disease. Beta-amyloid burden can begin to build in the brain several years, if not more than a decade, before an individual shows any sign of dementia. Those who go on to develop Alzheimer’s disease not only lose their ability to remember their loved ones but also have difficulty with essential bodily functions such as breathing and swallowing in the late stages of disease.

In one study, researchers used a molecular imaging technique called positron emission tomography (PET), which images physiological patterns in the body. PET was combined with an imaging agent called F-18 florbetaben, which binds to amyloid in the brain. This and other PET agents are drawn to targets in the body and emit a positron signal that is picked up by a scanner. Here molecular imaging was performed in conjunction with clinical and neuropsychological testing in order to better understand the long-term effects of beta amyloid plaques in the brains of older individuals with mild cognitive impairment. Those of the 45 subjects in the study who showed high levels of imaging agent binding during imaging and atrophy of the hippocampus, the memory center, had an 80 percent chance of developing Alzheimer’s disease within two years, researchers said.

"Molecular imaging is proving to be an essential part of Alzheimer’s disease detection," says Rowe. "This and other amyloid imaging techniques will have an increasing role in the earlier and more accurate diagnosis of neurodegenerative conditions such as Alzheimer’s disease due to their ability to measure the actual underlying disease process."

Another AIBL study included 194 healthy participants, 92 people with mild cognitive impairment and 70 subjects with Alzheimer’s disease, and used another imaging agent called C-11 PiB (Pittsburgh compound B) with PET to gauge amyloid burden in the brain. Researchers showed that, in this study group, widespread amyloid plaque build-up preceded cognitive impairment, and those with extensive amyloid burden were at higher risk of cognitive decline.

This and another study mark two of the first studies of their kind focusing on beta amyloid in healthy subjects. In the other study, 137 adults with normal cognitive function aged 30 to 89 years were imaged using PET with F-18 florbetapir, now FDA-approved for the detection of beta amyloid plaques, as well as functional magnetic resonance imaging in order to explore how amyloid build-up affects connections in specific areas of the brain involved in cognition, namely the default mode and salience networks, which are responsible for different states of wakeful rest and alertness. Those with increased amyloid burden in these neural networks were prone to impaired cognitive performance.

"The effect of beta amyloid in healthy aging is of great interest since this protein is strongly associated with Alzheimer’s disease and may be predictive of the transition from mild cognitive impairment to Alzheimer’s disease," says Michael Devous, Sr., Ph.D., director of neuroimaging at the Alzheimer’s Disease Center at UT Southwestern Medical Center in Dallas, Texas. "Less is known about its impact on cognition in otherwise healthy aging individuals. In addition, brain connectivity in these areas is thought to be sensitive to early changes in brain function caused both by aging itself and by disease processes such as Alzheimer’s disease."

Another study assessed the PET imaging agent C-11 PiB for its ability to detect amyloid plaque in comparison to another imaging agent, 18-F fluorodeoxyglucose (F-18 FDG). The latter acts like glucose, the brain’s primary energy source, to map out the metabolic functioning of the brain. Results of the study showed C-11 PiB amyloid imaging to be a better means of evaluating amyloid patterns in the brain than F-18 FDG imaging. In addition, of the 100 healthy participants, 15 percent were shown to have some amyloid build-up when molecular imaging was performed.

"We are using state-of-the-art, noninvasive PET and MRI technologies to look at some of the earliest developments of Alzheimer’s disease onset in the brains of normal middle-aged people," says Guofan Xu, M.D., Ph.D., lead author of the study and research scientist at the department of nuclear medicine and radiology at the University of Wisconsin located in Madison. "With this we can evaluate whether pathological changes associated with Alzheimer’s disease are happening many years before onset of significant clinical symptoms."

No treatments are currently available to cure or prevent Alzheimer’s disease. With advances in molecular imaging to detect beta amyloid plaques, researchers have an important new tool that may bring the medical community one step closer to making therapies and vaccines a reality for the disease.

Source: Science Daily