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- Brunnström, Hans, et al.
(författare)
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Cerebrospinal fluid biomarker results in relation to neuropathological dementia diagnoses.
- 2010
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Ingår i: Alzheimer's & dementia. - : Wiley. - 1552-5279 .- 1552-5260. ; 6:2, s. 104-109
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Clinical dementia diagnoses are not always consistent with neuropathological findings. As correct diagnosis is important for treatment and care, new diagnostic possibilities for dementia are in demand. Cerebrospinal fluid biomarkers should ideally be able to identify ongoing processes in the brain, but need to be further compared with neuropathological findings for evaluation of their diagnostic validity. METHODS: This study included 43 patients with a clinical dementia disorder. All patients were neuropathologically examined at the University Hospital in Lund, Sweden, during the years 2001-2008, and all had a lumbar puncture carried out as part of the clinical investigation during the time of cognitive impairment. RESULTS: Of eight patients, five with Alzheimer's disease had elevated total tau protein (T-tau) and decreased amyloid beta 1-42 protein (Abeta42), while both values for the other three patients were normal. Slightly elevated T-tau and/or decreased Abeta42 were also seen in several patients with other dementia diagnoses such as Lewy body disease, frontotemporal lobar degeneration and vascular dementia. Furthermore, T-tau levels did not differ markedly between patients with morphologically tau-positive and tau-negative frontotemporal lobar degeneration. Also, seven of nine patients with Creutzfeldt-Jacob disease exhibited pronounced elevation in T-tau concentration. CONCLUSION: From this rather limited study, being the first of its kind in Sweden, we may conclude that there is no perfect concordance between cerebrospinal fluid biomarker levels and pathological findings, which should be taken into account in the clinical diagnostic setting.
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- Chincarini, Andrea, et al.
(författare)
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Automatic temporal lobe atrophy assessment in prodromal AD: Data from the DESCRIPA study
- 2014
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Ingår i: Alzheimer's & Dementia. - : Wiley. - 1552-5279 .- 1552-5260. ; 10:4, s. 456-467
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the framework of the clinical validation of research tools, this investigation presents a validation study of an automatic medial temporal lobe atrophy measure that is applied to a naturalistic population sampled from memory clinic patients across Europe. Methods: The procedure was developed on 1.5-T magnetic resonance images from the Alzheimer's Disease Neuroimaging Initiative database, and it was validated on an independent data set coming from the DESCRIPA study. All images underwent an automatic processing procedure to assess tissue atrophy that was targeted at the hippocampal region. For each subject, the procedure returns a classification index. Once provided with the clinical assessment at baseline and follow-up, subjects were grouped into cohorts to assess classification performance. Each cohort was divided into converters (co) and nonconverters (nc) depending on the clinical outcome at follow-up visit. Results: We found the area under the receiver operating characteristic curve (AUC) was 0.81 for all co versus nc subjects, and AUC was 0.90 for subjective memory complaint (SMCnc) versus all co subjects. Furthermore, when training on mild cognitive impairment (MCI-nc/MCI-co), the classification performance generally exceeds that found when training on controls versus Alzheimer's disease (CTRL/AD). Conclusions: Automatic magnetic resonance imaging analysis may assist clinical classification of subjects in a memory clinic setting even when images are not specifically acquired for automatic analysis. (C) 2014 The Alzheimer's Association. All rights reserved.
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| 5. |
- Duits, Flora H., et al.
(författare)
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The cerebrospinal fluid "Alzheimer profile": Easily said, but what does it mean?
- 2014
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Ingår i: Alzheimer's & Dementia. - : Elsevier. - 1552-5260 .- 1552-5279. ; 10:6, s. 713-723
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Tidskriftsartikel (refereegranskat)abstract
- Background: We aimed to identify the most useful definition of the "cerebrospinal fluid Alzheimer profile," based on amyloid-beta(1-42) (A beta(42)), total tau, and phosphorylated tau (p-tau), for diagnosis and prognosis of Alzheimers disease (AD). Methods: We constructed eight Alzheimer profiles with previously published combinations, including regression formulas and simple ratios. We compared their diagnostic accuracy and ability to predict dementia due to AD in 1385 patients from the Amsterdam Dementia Cohort. Results were validated in an independent cohort (n = 1442). Results: Combinations outperformed individual biomarkers. Based on the sensitivity of the best performing regression formulas, cutoffs were chosen at 0.52 for the tau/A beta(42) ratio and 0.08 for the p-tau/A beta(42) ratio. Ratios performed similar to formulas (sensitivity, 91%-93%; specificity, 81%-84%). The same combinations best predicted cognitive decline in mild cognitive impairment patients. Validation confirmed these results, especially regarding the tau/A beta(42) ratio. Conclusions: A tau/A beta(42) ratio of greater than0.52 constitutes a robust cerebrospinal fluid Alzheimer profile. We recommend using this ratio to combine biomarkers.
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| 8. |
- Zahirovic, Iris, et al.
(författare)
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Prevalence of Lewy body dementia and neuroleptic treatment in nursing homes in Malmö, Sweden.
- 2014
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Ingår i: Alzheimer's & Dementia. - : Wiley. - 1552-5260 .- 1552-5279.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Lewy body Dementia (LBD) is a well-known neurocognitive disorder in the elderly. The hallmarks of LBD are Parkinsonism without tremor, recurrent and persistent visual hallucinations often with insight, fluctuating cognition and alertness, rapid eye movement (REM) sleep behavior disorder with vivid dreams and violent movements, but relatively preserved memory functions. Nevertheless, LBD is often misdiagnosed and under-recognized. A diagnosis of LBD is important because of the risk of hypersensitivity for neuroleptic drugs. Moreover, appropriate treatment of symptoms can improve quality of life considerably for both the individual with LBD and their caregivers. This study aimed to investigate the prevalence of possible LBD and neuroleptic treatment in elderly care recipients in nursing homes. Methods: Information regarding prevalence of symptoms of LBD and concurrent medication in 644 elderly living in nursing homes in Malmö, Sweden during the time period 2012-13 was collected. We used a questionnaire, medical journals and interviewed the nursing staff. In the questionnaire, symptoms representing the 4 LBD main characteristics were noted as present/absent; Parkinsonism, visual hallucinations, excessive daytime sleepiness, acting out dreams. Neuroleptic treatment was also noted as present or not, as well as the type of drug. Results: In total, 27.3% had_2 of 4 LBD symptoms. 7.1% had 3, and 3.0% had 4 of these symptoms. Visual hallucinations were observed in 20% and REM sleep behaviour disorder in 9% of the patients. Neuroleptic treatment increased significantly (p<0.001) with increasing number of LBD symptoms. In individuals with no symptoms 12.8%, 1 symptom 24.7%, 2 symptoms 26.9%, 3 symptoms 28.9%, and 4 symptoms 42.1% were treated with neuroleptics. Nine percent of the neuroleptics prescribed were of acceptable type (klozapin, quetiapin). Conclusions: Symptoms consistent with LBD are common in elderly in nursing homes. Despite the recommendations of avoiding neuroleptic treatment this was a common finding among the studied individuals. To minimize inappropriate medical treatment recognizing symptoms of LBD are important for general practitioners.
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