Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
Department of Radiology, University of California at San Francisco, San Francisco, CA, USA.
Brain. 2022 Oct 21;145(10):3594-3607. doi: 10.1093/brain/awac181.
The extent to which the pathophysiology of autosomal dominant Alzheimer's disease corresponds to the pathophysiology of 'sporadic' late onset Alzheimer's disease is unknown, thus limiting the extrapolation of study findings and clinical trial results in autosomal dominant Alzheimer's disease to late onset Alzheimer's disease. We compared brain MRI and amyloid PET data, as well as CSF concentrations of amyloid-β42, amyloid-β40, tau and tau phosphorylated at position 181, in 292 carriers of pathogenic variants for Alzheimer's disease from the Dominantly Inherited Alzheimer Network, with corresponding data from 559 participants from the Alzheimer's Disease Neuroimaging Initiative. Imaging data and CSF samples were reprocessed as appropriate to guarantee uniform pipelines and assays. Data analyses yielded rates of change before and after symptomatic onset of Alzheimer's disease, allowing the alignment of the ∼30-year age difference between the cohorts on a clinically meaningful anchor point, namely the participant age at symptomatic onset. Biomarker profiles were similar for both autosomal dominant Alzheimer's disease and late onset Alzheimer's disease. Both groups demonstrated accelerated rates of decline in cognitive performance and in regional brain volume loss after symptomatic onset. Although amyloid burden accumulation as determined by PET was greater after symptomatic onset in autosomal dominant Alzheimer's disease than in late onset Alzheimer's disease participants, CSF assays of amyloid-β42, amyloid-β40, tau and p-tau181 were largely overlapping in both groups. Rates of change in cognitive performance and hippocampal volume loss after symptomatic onset were more aggressive for autosomal dominant Alzheimer's disease participants. These findings suggest a similar pathophysiology of autosomal dominant Alzheimer's disease and late onset Alzheimer's disease, supporting a shared pathobiological construct.
尚不清楚常染色体显性阿尔茨海默病的病理生理学与“散发性”晚发性阿尔茨海默病的病理生理学有多大程度的对应,因此限制了将常染色体显性阿尔茨海默病的研究发现和临床试验结果外推到晚发性阿尔茨海默病。我们比较了 292 名来自常染色体显性阿尔茨海默病网络的致病性变异携带者的脑 MRI 和淀粉样蛋白 PET 数据,以及脑脊液中淀粉样蛋白β42、淀粉样蛋白β40、tau 和磷酸化 tau 位置 181 的浓度,与来自阿尔茨海默病神经影像学倡议的 559 名参与者的相应数据。对成像数据和 CSF 样本进行了适当的重新处理,以保证统一的管道和检测。数据分析得出了阿尔茨海默病症状发作前后的变化率,从而在一个有临床意义的基准上,即参与者的症状发作年龄,使两个队列之间约 30 年的年龄差异对齐。生物标志物谱在常染色体显性阿尔茨海默病和晚发性阿尔茨海默病中相似。两组在症状发作后认知表现和区域性脑容量损失的下降速度都加快。尽管常染色体显性阿尔茨海默病患者 PET 确定的淀粉样蛋白负荷积累在症状发作后比晚发性阿尔茨海默病患者更大,但两组的脑脊液淀粉样蛋白β42、淀粉样蛋白β40、tau 和 p-tau181 检测结果基本重叠。症状发作后认知表现和海马体积丧失的变化率在常染色体显性阿尔茨海默病患者中更为激进。这些发现表明常染色体显性阿尔茨海默病和晚发性阿尔茨海默病具有相似的病理生理学,支持共同的病理生物学结构。