Are concussions related to Alzheimer’s disease?

A new study suggests that a history of concussion involving at least a momentary loss of consciousness may be related to the buildup of Alzheimer’s-associated plaques in the brain. The research is published in the December 26, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"Interestingly, in people with a history of concussion, a difference in the amount of brain plaques was found only in those with memory and thinking problems, not in those who were cognitively normal," said study author Michelle Mielke, PhD, with Mayo Clinic in Rochester, Minn.

For the study, people from Olmsted County in Minnesota were given brain scans; these included 448 people without any signs of memory problems and 141 people with memory and thinking problems called mild cognitive impairment. Participants, who were all age 70 or older, were also asked about whether they had ever experienced a brain injury that involved any loss of consciousness or memory.

Of the 448 people without any thinking or memory problems, 17 percent reported a brain injury and 18 percent of the 141 with memory and thinking difficulties reported a concussion or head trauma.

The study found no difference in any brain scan measures among the people without memory and thinking impairments, whether or not they had head trauma. However, people with memory and thinking impairments and a history of head trauma had levels of amyloid plaques an average of 18 percent higher than those with no head trauma history.

"Our results add merit to the idea that concussion and Alzheimer’s disease brain pathology may be related," said Mielke. "However, the fact that we did not find a relationship in those without memory and thinking problems suggests that any association between head trauma and amyloid is complex."

Study Shows Where Alzheimer’s Starts and How It Spreads

Using high-resolution functional MRI (fMRI) imaging in patients with Alzheimer’s disease and in mouse models of the disease, Columbia University Medical Center (CUMC) researchers have clarified three fundamental issues about Alzheimer’s: where it starts, why it starts there, and how it spreads. In addition to advancing understanding of Alzheimer’s, the findings could improve early detection of the disease, when drugs may be most effective. The study was published today in the online edition of the journal Nature Neuroscience.

“It has been known for years that Alzheimer’s starts in a brain region known as the entorhinal cortex,” said co-senior author Scott A. Small, MD, Boris and Rose Katz Professor of Neurology, professor of radiology, and director of the Alzheimer’s Disease Research Center. “But this study is the first to show in living patients that it begins specifically in the lateral entorhinal cortex, or LEC. The LEC is considered to be a gateway to the hippocampus, which plays a key role in the consolidation of long-term memory, among other functions. If the LEC is affected, other aspects of the hippocampus will also be affected.”

The study also shows that, over time, Alzheimer’s spreads from the LEC directly to other areas of the cerebral cortex, in particular, the parietal cortex, a brain region involved in various functions, including spatial orientation and navigation. The researchers suspect that Alzheimer’s spreads “functionally,” that is, by compromising the function of neurons in the LEC, which then compromises the integrity of neurons in adjoining areas.

A third major finding of the study is that LEC dysfunction occurs when changes in tau and amyloid precursor protein (APP) co-exist. “The LEC is especially vulnerable to Alzheimer’s because it normally accumulates tau, which sensitizes the LEC to the accumulation of APP. Together, these two proteins damage neurons in the LEC, setting the stage for Alzheimer’s,” said co-senior author Karen E. Duff, PhD, professor of pathology and cell biology (in psychiatry and in the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain) at CUMC and at the New York State Psychiatric Institute.

In the study, the researchers used a high-resolution variant of fMRI to map metabolic defects in the brains of 96 adults enrolled in the Washington Heights-Inwood Columbia Aging Project (WHICAP). All of the adults were free of dementia at the time of enrollment.

“Dr. Richard Mayeux’s WHICAP study enables us to follow a large group of healthy elderly individuals, some of whom have gone on to develop Alzheimer’s disease,” said Dr. Small. “This study has given us a unique opportunity to image and characterize patients with Alzheimer’s in its earliest, preclinical stage.”

The 96 adults were followed for an average of 3.5 years, at which time 12 individuals were found to have progressed to mild Alzheimer’s disease. An analysis of the baseline fMRI images of those 12 individuals found significant decreases in cerebral blood volume (CBV) — a measure of metabolic activity — in the LEC compared with that of the 84 adults who were free of dementia.

A second part of the study addressed the role of tau and APP in LEC dysfunction. While previous studies have suggested that entorhinal cortex dysfunction is associated with both tau and APP abnormalities, it was not known how these proteins interact to drive this dysfunction, particularly in preclinical Alzheimer’s.

To answer this question, explained first author Usman Khan, an MD-PhD student based in Dr. Small’s lab, the team created three mouse models, one with elevated levels of tau in the LEC, one with elevated levels of APP, and one with elevated levels of both proteins. The researchers found that the LEC dysfunction occurred only in the mice with both tau and APP.

The study has implications for both research and treatment. “Now that we’ve pinpointed where Alzheimer’s starts, and shown that those changes are observable using fMRI, we may be able to detect Alzheimer’s at its earliest preclinical stage, when the disease might be more treatable and before it spreads to other brain regions,” said Dr. Small. In addition, say the researchers, the new imaging method could be used to assess the efficacy of promising Alzheimer’s drugs during the disease’s early stages.

Brain repair after injury and Alzheimer’s disease

Researchers at Penn State University have developed an innovative technology to regenerate functional neurons after brain injury, and also in model systems used for research on Alzheimer’s disease. The scientists have used supporting cells of the central nervous system, glial cells, to regenerate healthy, functional neurons, which are critical for transmitting signals in the brain.

Gong Chen, a professor of biology, the Verne M. Willaman Chair in Life Sciences at Penn State, and the leader of the research team, calls the method a breakthrough in the long journey toward brain repair. “This technology may be developed into a new therapeutic treatment for traumatic brain and spinal cord injuries, stroke, Alzheimer’s disease, Parkinson’s disease, and other neurological disorders,” Chen said. The research will be posted online by the journal Cell Stem Cell on 19 December 2013.

When the brain is harmed by injury or disease, neurons often die or degenerate, but glial cells become more branched and numerous. These “reactive glial cells” initially build a defense system to prevent bacteria and toxins from invading healthy tissues, but this process eventually forms glial scars that limit the growth of healthy neurons. “A brain-injury site is like a car-crash site,” Chen explained. “Reactive glial cells are like police vehicles, ambulances, and fire trucks immediately rushing in to help — but these rescue vehicles can cause problems if too many of them get stuck at the scene. The problem with reactive glial cells is that they often stay at the injury site, forming a glial scar and preventing neurons from growing back into the injured areas,” he explained.

So several years ago, Chen’s lab tested new ways to transform glial scar tissue back to normal neural tissue. “There are more reactive glial cells and fewer functional neurons in the injury site,” Chen said, “so we hypothesized that we might be able to convert glial cells in the scar into functional neurons at the site of injury in the brain. This research was inspired by the Nobel prize-winning technology of induced pluripotent stem cells (iPSCs) developed in Shinya Yamanaka’s group, which showed how to reprogram skin cells into stem cells,” Chen recalled.

Chen and his team began by studying how reactive glial cells respond to a specific protein, NeuroD1, which is known to be important in the formation of nerve cells in the hippocampus area of adult brains. They hypothesized that expressing NeuroD1 protein into the reactive glial cells at the injury site might help to generate new neurons — just as it does in the hippocampus. To test this hypothesis, his team infected reactive glial cells with a retrovirus that specifies the genetic code for the NeuroD1 protein. “The retrovirus we used is replication-deficient and thus cannot kill infected cells like other viruses found in the wild,” Chen said. “More importantly, a retrovirus can infect only dividing cells such as reactive glial cells, but it does not affect neurons, which makes it ideal for therapeutic use with minimal side effect on normal brain functions.”

In a first test, Chen and his team investigated whether reactive glial cells can be converted into functional neurons after injecting NeuroD1 retrovirus into the cortex area of adult mice. The scientists found that two types of reactive glial cells — star-shaped astroglial cells and NG2 glial cells — were reprogrammed into neurons within one week after being infected with the NeuroD1 retrovirus. “Interestingly, the reactive astroglial cells were reprogrammed into excitatory neurons, whereas the NG2 cells were reprogrammed into both excitatory and inhibitory neurons, making it possible to achieve an excitation-inhibition balance in the brain after reprogramming,” Chen said. His lab also performed electrophysiological tests, which demonstrated that the new neurons converted by the NeuroD1 retrovirus could receive neurotransmitter signals from other nerve cells, suggesting that the newly converted neurons had successfully integrated into local neural circuits.

In a second test, Chen and his team used a transgenic-mouse model for Alzheimer’s disease, and demonstrated that reactive glial cells in the mouse’s diseased brain also can be converted into functional neurons. Furthermore, the team demonstrated that even in 14-month-old mice with Alzheimer’s disease — an age roughly equivalent to 60 years old for humans — injection of the NeuroD1 retrovirus into a mouse cortex can still induce a large number of newborn neurons reprogrammed from reactive glial cells. “Therefore, the conversion technology that we have demonstrated in the brains of mice potentially may be used to regenerate functional neurons in people with Alzheimer’s disease,” Chen said.

To ensure that the glial cell-to-neuron conversion method is not limited to rodent animals, Chen and his team further tested the method on cultured human glial cells. “Within 3 weeks after expression of the NeuroD1 protein, we saw in the microscope that human glial cells were reinventing themselves: they changed their shape from flat sheet-like glial cells into normal-looking neurons with axon and dendritic branches,” Chen said. The scientists further tested the function of these newly converted human neurons and found that, indeed, they were capable of both releasing and responding to neurotransmitters.

"Our dream is to develop this in vivo conversion method into a useful therapy to treat people suffering from neural injury or neurological disorders," Chen said. "Our passionate motivation for this research is the idea that an Alzheimer’s patient, who for a long time was not able to remember things, could start to have new memories after regenerating new neurons as a result of our in vivo conversion method, and that a stroke victim who could not even move his legs might start to walk again."

Brain Area Attacked by Alzheimer’s Links Learning and Rewards

One of the first areas of the brain to be attacked by Alzheimer’s disease is more active when the brain isn’t working very hard, and quiets down during the brain’s peak performance.

The question that Duke University graduate student Sarah Heilbronner wanted to resolve was whether this brain region, called the posterior cingulate cortex, or PCC, actively dampens cognitive performance, say by allowing the mind to wander, or is instead monitoring performance and trying to improve it when needed.

If the PCC were monitoring and improving performance, increased activity there would be the result of poor performance, not the cause of it.

The PCC connects to both learning and reward systems, Heilbronner said, and is a part of the “default mode network.” It lies along a mid-line between the ears, where many structures related to rewards can be found. “It’s kind of a nexus for multiple systems,” said Heilbronner, who is currently a postdoctoral researcher in neuroanatomy at the University of Rochester.

"As this area begins to deteriorate, people begin to show the early signs of cognitive decline — problems learning and remembering things, getting lost, trouble planning — that ultimately manifest as outright dementia," said Michael Platt, director of the Duke Institute for Brain Sciences, who supervised Heilbronner’s 2012 dissertation. Their findings appear Dec. 18 in the journal Neuron.

Heilbronner’s experiment to better understand the PCC’s role in learning and remembering relied on two rhesus macaque monkeys fitted with electrodes to read out the activity of individual neurons in their brains. Their task was akin to playing video games with their eyes. The monkeys were shown a series of photographs each day marked with dots at the upper left and lower right corners. To get a rewarding squirt of juice, they had to move their gaze to the correct target dot on a photo, and they learned by trial and error which dot would yield the reward for each photo.

Each day, they were shown up to 12 photos from an assortment of Heilbronner’s vacation snaps  at Yellowstone National Park and the Grand Canyon. Some of each day’s images were familiar with a known reward target, and others were new. As the monkeys responded with their gaze, the researchers watched the activity of dozens of neurons in each monkey’s brain immediately following correct and incorrect responses. They also altered the amount of juice dispensed in some cases, creating a sense of high-reward and low-reward answers.

If the PCC actively dampened performance, the researchers would expect to see it active before a choice is made or the feedback is received. Instead, they saw it working after the feedback, lasting sometimes until the next image was presented. Neurons in the PCC responded strongly when the monkeys needed to learn something new, especially when they made errors or didn’t earn enough reward to keep motivated.

The researchers also ran the task after administering a drug, muscimol, that impaired the function of the PCC temporarily during testing. With the center inactivated by the drug, the monkeys could recall earlier learning regardless of the size of the reward. Learning a new item was still possible when the reward was large, but the monkeys couldn’t learn anything new when rewards were small. “Maybe it didn’t seem worth it,” Heilbronner said.

The dampening experiment also reinforced what the researchers had seen in the timing of the PCC’s response. If this center’s role is to let the mind wander, performance should have improved when the muscimol was administered, but the opposite was true.

Heilbronner concludes that the PCC summons more resources for a challenging cognitive task. So rather than being the cause of poor performance on a task, PCC actually steps in during a challenge to improve the situation.

"This study tells us that a healthy PCC is required for monitoring performance and keeping motivated during learning, particularly when problems are challenging," Platt said.

Heilbronner  is now interested in finding out whether the PCC is more important to learning than it is to recall, and how motivation interacts with PCC abnormalities seen in Alzheimer’s disease.

Alzheimer-substance may be the nanomaterial of tomorrow

It causes brain diseases like Alzheimer’s, Parkinson’s and Creutzfeldt-Jakob’s disease. It is also hard and rigid as steel. Now research at Chalmers University of Technology shows that the amyloid protein carries unique characteristics that may lead to the development of new composite materials for nano processors and data storage of tomorrow and even make objects invisible.

Piotr Hanczyc, PhD student at the department of Chemical and Biological Engineering, shows in an article in Nature Photonics, that the amyloid, a very dense aggregate of protein that causes brain diseases like Alzheimer’s and Parkinson’s, carries unique characteristics. Unlike well-functioning protein the amyloid reacts upon multi photon laser irradiation. This laser may in the future possibly be used for detection of amyloids inside a human brain. This discovery is in itself a breakthrough.

- But you can also create these aggregates in an artificial way in a laboratory and in combination with other materials create unique characteristics, Piotr Hanczyc says.

The amyloid aggregates are as hard and rigid as steel. The difference is that steel is much heavier and has defined material properties whereas amyloids can be tuned for desired purpose. By attaching a material’s molecules to the dense amyloid its characteristics change. This has been known for more than ten years and is already used by scientists.

- What hasn’t been known is that the amyloids react to multi-photon irradiation and this opens up new possibilities to also change the nature of the material attached to the amyloids, Piotr Hanczyc says.

The amyloids are shaped like discs densely piled upon each other.  When a material gets merged with these discs its molecules end up so densely and regularly that they can communicate and exchange information. This means totally new possibilities to change a material’s characteristics.

Multi-photon tests on materials tied to amyloids are yet to be performed, but Piotr sees an opportunity for cooperation with Chalmers material science researchers interested for example in solar cell technology.

And though it may still be science fiction, he also considers that one day scientists may use the material properties of amyloid fibrils in the research of invisible metamaterials.

- An object’s ability to reflect light could be altered so that what’s behind it gets reflected instead of the object itself, in principle changing the index of light refraction, kind of like when light hits the surface of water, Piotr Hanczyc says.

Sleep-Deprived Mice Show Connections Among Lack of Shut-eye, Diabetes, Age

Sleep, or the lack of it, seems to affect just about every aspect of human physiology. Yet, the molecular pathways through which sleep deprivation wreaks its detrimental effects on the body remain poorly understood. Although numerous studies have looked at the consequences of sleep deprivation on the brain, comparatively few have directly tested its effects on peripheral organs.

During sleep deprivation cells upregulate the UPR – the unfolded protein response – a process where misfolded proteins get refolded or degraded.

Five years ago, researchers at the Perelman School of Medicine, University of Pennsylvania, showed that the UPR is an adaptive response to stress induced by sleep deprivation and is impaired in the brains of old mice. Those findings suggested that inadequate sleep in the elderly, who normally experience sleep disturbances, could exacerbate an already-impaired protective response to protein misfolding that happens in aging cells. Protein misfolding and clumping is associated with many diseases such as Alzheimer’s and Parkinson’s, noted Nirinjini Naidoo, Ph.D., research associate professor in the Division of Sleep Medicine in that study.

Naidoo is also senior author of a follow-up study in Aging Cell this month that shows, for the first time, an effect of sleep deprivation on the UPR in peripheral tissue, in this case, the pancreas. They showed that stress in pancreatic cells due to sleep deprivation may contribute to the loss or dysfunction of these cells important to maintaining proper blood sugar levels, and that these functions may be exacerbated by normal aging.

“The combined effect of aging and sleep deprivation resulted in a loss of control of blood sugar reminiscent of pre-diabetes in mice,” says Naidoo. “We hypothesize that older humans might be especially susceptible to the effects of sleep deprivation on the disruption of glucose homeostasis via cell stress.”

Working with Penn colleague Joe Baur, Ph.D., assistant professor of Physiology, Naidoo started a collaboration to look at the relationship of sleep deprivation, the UPR, and metabolic response with age. Other researchers had suggested that the death of beta cells associated with type 2 diabetes may be due to stress in a cell compartment called the endoplasmic reticulum (ER). The UPR is one part of the quality control system in the ER, where some proteins are made.

Knowing this, Naidoo and Baur asked if sleep deprivation (SD) causes ER stress in the pancreas, via an increase in protein misfolding, and in turn, how this relates to aging.

The team examined tissues in mice for cellular stress following acute SD, and they also looked for cellular stress in aging mice. Their results show that both age and SD combine to induce cellular stress in the pancreas.

Older mice fared markedly worse when subjected to sleep deprivation. Pancreas tissue from older mice or from young animals subjected to sleep deprivation exhibited signs of protein misfolding, yet both were able to maintain insulin secretion and control blood sugar levels. Pancreas tissue from acutely sleep-deprived aged animals exhibited a marked increase in CHOP, a protein associated with cell death, suggesting a maladaptive response to cellular stress with age that was amplified by sleep deprivation.

Acute sleep deprivation caused increased plasma glucose levels in both young and old animals. However, this change was not overtly related to stress in beta cells, since plasma insulin levels were not lower following acute lack of sleep.

Accordingly, young animals subjected to acute sleep deprivation remained tolerant to a glucose challenge. In a chronic sleep deprivation experiment, young mice were sensitized to insulin and had improved control of their blood sugar, whereas aged animals became hyperglycemic and failed to maintain appropriate plasma insulin concentrations.

While changes in insulin secretion are unlikely to play a major role in the acute effects of SD, cellular stress in pancreatic tissue suggests that chronic SD may contribute to the loss or dysfunction of endocrine cells, and that these effects may be exacerbated by normal aging, say the researchers.

Music brings memories back to the brain injured

In the first study of its kind, two researchers have used popular music to help severely brain-injured patients recall personal memories. Amee Baird and Séverine Samson outline the results and conclusions of their pioneering research in the recent issue of the journal Neuropsychological Rehabilitation.

Although their study covered a small number of cases, it’s the very first to examine ‘music-evoked autobiographical memories’ (MEAMs) in patients with acquired brain injuries (ABIs), rather than those who are healthy or suffer from Alzheimer’s Disease.

In their study, Baird and Samson played extracts from ‘Billboard Hot 100’ number-one songs in random order to five patients. The songs, taken from the whole of the patient’s lifespan from age five, were also played to five control subjects with no brain injury. All were asked to record how familiar they were with a given song, whether they liked it, and what memories it invoked.

Doctors Baird and Samson found that the frequency of recorded MEAMs was similar for patients (38%–71%) and controls (48%–71%). Only one of the four ABI patients recorded no MEAMs. In fact, the highest number of MEAMs in the whole group was recorded by one of the ABI patients. In all those studied, the majority of MEAMs were of a person, people or a life period and were typically positive. Songs that evoked a memory were noted as more familiar and more liked than those that did not.

As a potential tool for helping patients regain their memories, Baird and Samson conclude that: “Music was more efficient at evoking autobiographical memories than verbal prompts of the Autobiographical Memory Interview (AMI) across each life period, with a higher percentage of MEAMs for each life period compared with AMI scores.”

“The findings suggest that music is an effective stimulus for eliciting autobiographical memories and may be beneficial in the rehabilitation of autobiographical amnesia, but only in patients without a fundamental deficit in autobiographical recall memory and intact pitch perception.”

The authors hope that their ground-breaking work will encourage others to carry out further studies on MEAMs in larger ABI populations. They also call for further studies of both healthy people and those with other neurological conditions to learn more about the clear relationship between memory, music and emotion; they hope that one day we might truly “understand the mechanisms underlying the unique memory enhancing effect of music”.