Regional-based static and dynamic alterations in Alzheimer disease: a longitudinal study.

White matter (WM) has traditionally been considered structurally important but functionally inert in fMRI research. However, growing evidence indicates that WM exhibits meaningful BOLD fluctuations and participates in functional connectivity. Here, we investigate alterations in WM functional network connectivity (FNC) across the Alzheimer's disease (AD) spectrum using resting-state fMRI data from the Alzheimer's Disease Neuroimaging Initiative (ADNI; 415 cognitively normal (CN), 283 mild cognitive impairment (MCI), 91 AD). We applied a guided independent component analysis (ICA) approach based on a combined multiscale template including 202 intrinsic connectivity networks [ICNs; 97 WM, 105 gray matter (GM)] to estimate subject-specific timecourses and compute FNC. Group differences in WM-WM, GM-GM, and WM-GM functional network connectivity (AD-CN, AD-MCI, MCI-CN) were evaluated using two-sample t-tests on residual FNC values for age, sex, and mean framewise displacement. Multiple comparisons across edges were controlled using false discovery rate correction (q < 0.05), and effect sizes were quantified using Hedges' g. Results showed robust alterations in WM-WM and WM-GM connectivity in AD, particularly involving WM subcortical, frontal, sensorimotor, and occipitotemporal networks. Several WM-GM interactions with cerebellar and hippocampal GM networks were also disrupted, including reduced GM-cerebellar: WM-frontal coupling and increased GM-hippocampal: WM-frontal connectivity. Notably, MCI already showed WM-GM dysconnectivity relative to CN, suggesting that functional disruption of WM circuits emerges prior to overt dementia. These findings provide converging evidence that WM functional connectivity is both measurable and selectively altered across the AD continuum. Our findings support WM FNC as a candidate biomarker to GM-based measures for staging and monitoring AD. Together, these results position WM-GM dysconnectivity as an important systems-level signature of the AD continuum and support WM functional network connectivity as a promising complement to established GM-based measures for understanding disease progression.

Alterations in functional connectivity have been demonstrated in Alzheimer's disease (AD), an age-progressive neurodegenerative disorder that affects cognitive function; however, directional information flow has never been analyzed. This study aimed to determine changes in resting-state directional functional connectivity measured using a novel approach, granger causality density (GCD), in patients with AD, and mild cognitive impairment (MCI) and explore novel neuroimaging biomarkers for cognitive decline detection. In this study, structural MRI, resting-state functional magnetic resonance imaging, and neuropsychological data of 48 Alzheimer's Disease Neuroimaging Initiative participants were analyzed, comprising 16 patients with AD, 16 with MCI, and 16 normal controls. Volume-based morphometry (VBM) and GCD were used to calculate the voxel-based gray matter (GM) volumes and directed functional connectivity of the brain. We made full use of voxel-based between-group comparisons of VBM and GCD values to identify specific regions with significant alterations. In addition, Pearson's correlation analysis was conducted between directed functional connectivity and several clinical variables. Furthermore, receiver operating characteristic (ROC) analysis related to classification was performed in combination with VBM and GCD. In patients with cognitive decline, abnormal VBM and GCD (involving inflow and outflow of GCD) were noted in default mode network (DMN)-related areas and the cerebellum. GCD in the DMN midline core system, hippocampus, and cerebellum was closely correlated with the Mini- Mental State Examination and Functional Activities Questionnaire scores. In the ROC analysis combining VBM with GCD, the neuroimaging biomarker in the cerebellum was optimal for the early detection of MCI, whereas the precuneus was the best in predicting cognitive decline progression and AD diagnosis. Changes in GM volume and directed functional connectivity may reflect the mechanism of cognitive decline. This discovery could improve our understanding of the pathology of AD and MCI and provide available neuroimaging markers for the early detection, progression, and diagnosis of AD and MCI.

Disruptions in the inter-regional connective correlation within the brain are believed to contribute to memory impairment. To detect these corresponding correlation networks in Alzheimer's disease (AD), we conducted three types of inter-regional correlation analysis, including structural covariance, functional connectivity and group-level independent component analysis (group-ICA). The analyzed data were obtained from the Alzheimer's Disease Neuroimaging Initiative, comprising 52 cognitively normal (CN) participants without subjective memory concerns, 52 individuals with late mild cognitive impairment (LMCI) and 52 patients with AD. We firstly performed vertex-wise cortical thickness analysis to identify brain regions with cortical thinning in AD and LMCI patients using structural MRI data. These regions served as seeds to construct both structural covariance networks and functional connectivity networks for each subject. Additionally, group-ICA was performed on the functional data to identify intrinsic brain networks at the cohort level. Through a comparison of the structural covariance and functional connectivity networks with ICA networks, we identified several inter-regional correlation networks that consistently exhibited abnormal connectivity patterns among AD and LMCI patients. Our findings suggest that reduced inter-regional connectivity is predominantly observed within a subnetwork of the default mode network, which includes the posterior cingulate and precuneus regions, in both AD and LMCI patients. This disruption of connectivity between key nodes within the default mode network provides evidence supporting the hypothesis that impairments in brain networks may contribute to memory deficits in AD and LMCI.

Alzheimer's disease may be conceptualized as a 'disconnection syndrome', characterized by the breakdown of neural connectivity within the brain as a result of amyloid-beta plaques, tau neurofibrillary tangles and other factors leading to progressive degeneration and shrinkage of neurons, along with synaptic dysfunction. It has been suggested that misfolded tau proteins spread through functional connections (known as 'prion-like' properties of tau). However, the local effect of tau spreading on the synaptic function and communication between regions is not well understood. I aimed to investigate how the spreading of tau aggregates through connections can locally influence functional connectivity. In total, the imaging data of 211 participants including 117 amyloid-beta-negative non-demented and 94 amyloid-beta-positive non-demented participants were recruited from the Alzheimer's Disease Neuroimaging Initiative. Furthermore, normative resting-state functional MRI connectomes were used to model tau spreading through functional connections, and functional MRI of the included participants was used to determine the effect of tau spreading on functional connectivity. I found that lower functional connectivity to tau epicentres is associated with tau spreading through functional connections in both amyloid-beta-negative and amyloid-beta-positive participants. Also, amyloid-beta-PET in tau epicentres mediated the association of tau spreading and functional connectivity to epicentres suggesting a partial mediating effect of amyloid-beta deposition in tau epicentres on the local effect of tau spreading on functional connectivity. My findings provide strong support for the notion that tau spreading through connection is locally associated with disrupted functional connectivity between tau epicentre and non-epicentre regions independent of amyloid-beta pathology. Also, I defined several groups based on the relationship between tau spreading and functional disconnection, which provides quantitative assessment to investigate susceptibility or resilience to functional disconnection related to tau spreading. I showed that amyloid-beta, other copathologies and the apolipoprotein E epsilon 4 allele can be a leading factor towards vulnerability to tau relative functional disconnection.

The pathogenesis of Alzheimer's disease (AD) remains unclear, but revealing individual differences in functional connectivity (FC) may provide insights and improve diagnostic precision. A hierarchical clustering-based autoencoder with functional connectivity was proposed to categorize 82 AD patients from the Alzheimer's Disease Neuroimaging Initiative. Compared to directly performing clustering, using an autoencoder to reduce the dimensionality of the matrix can effectively eliminate noise and redundant information in the data, extract key features, and optimize clustering performance. Subsequently, subtype differences in clinical and graph theoretical metrics were assessed. Results indicate a significant inter-subject heterogeneity in the degree of FC disruption among AD patients. We have identified two neurophysiological subtypes: subtype I exhibits widespread functional impairment across the entire brain, while subtype II shows mild impairment in the Limbic System region. What is worth noting is that we also observed significant differences between subtypes in terms of neurocognitive assessment scores associations with network functionality, and graph theory metrics. Our method can accurately identify different functional disruptions in subtypes of AD, facilitating personalized treatment and early diagnosis, ultimately improving patient outcomes.

The Alzheimer’s disease Neuroimaging Initiative (ADNI) Private Partners Scientific Board (PPSB) encompasses members from industry, biotechnology, diagnostic, and non-profit organizations that have until recently been managed by the Foundation for the National Institute of Health (FNIH) and provided financial and scientific support to ADNI programs. In this article, we review some of the major activities undertaken by the PPSB, focusing on those supporting the most recently completed National Institute on Aging grant, ADNI3, and the impact it has had on streamlining biomarker discovery and validation in Alzheimer’s disease. We also provide a perspective on the gaps that may be filled with future PPSB activities as part of ADNI4 and beyond.

Develop a cerebrospinal fluid biomarker signature for mild Alzheimer's disease (AD) in Alzheimer's Disease Neuroimaging Initiative (ADNI) subjects. Amyloid-beta 1 to 42 peptide (A beta(1-42)), total tau (t-tau), and tau phosphorylated at the threonine 181 were measured in (1) cerebrospinal fluid (CSF) samples obtained during baseline evaluation of 100 mild AD, 196 mild cognitive impairment, and 114 elderly cognitively normal (NC) subjects in ADNI; and (2) independent 56 autopsy-confirmed AD cases and 52 age-matched elderly NCs using a multiplex immunoassay. Detection of an AD CSF profile for t-tau and A beta(1-42) in ADNI subjects was achieved using receiver operating characteristic cut points and logistic regression models derived from the autopsy-confirmed CSF data. CSF A beta(1-42) was the most sensitive biomarker for AD in the autopsy cohort of CSF samples: receiver operating characteristic area under the curve of 0.913 and sensitivity for AD detection of 96.4%. In the ADNI cohort, a logistic regression model for A beta(1-42), t-tau, and APO epsilon 4 allele count provided the best assessment delineation of mild AD. An AD-like baseline CSF profile for t-tau/A beta(1-42) was detected in 33 of 37 ADNI mild cognitive impairment subjects who converted to probable AD during the first year of the study. The CSF biomarker signature of AD defined by A beta(1-42) and t-tau in the autopsy-confirmed AD cohort and confirmed in the cohort followed in ADNI for 12 months detects mild AD in a large, multisite, prospective clinical investigation, and this signature appears to predict conversion from mild cognitive impairment to AD.

Alzheimer's disease (AD) is an incurable neurodegenerative disorder accounting for 70%-80% dementia cases worldwide. Although, research on AD has increased in recent years, however, the complexity associated with brain structure and functions makes the early diagnosis of this disease a challenging task. Resting-state functional magnetic resonance imaging (rs-fMRI) is a neuroimaging technology that has been widely used to study the pathogenesis of neurodegenerative diseases. In literature, the computer-aided diagnosis of AD is limited to binary classification or diagnosis of AD and MCI stages. However, its applicability to diagnose multiple progressive stages of AD is relatively under-studied. This study explores the effectiveness of rs-fMRI for multi-class classification of AD and its associated stages including CN, SMC, EMCI, MCI, LMCI, and AD. A longitudinal cohort of resting-state fMRI of 138 subjects (25 CN, 25 SMC, 25 EMCI, 25 LMCI, 13 MCI, and 25AD) from Alzheimer's Disease Neuroimaging Initiative (ADNI) is studied. To provide a better insight into deep learning approaches and their applications to AD classification, we investigate ResNet-18 architecture in detail. We consider the training of the network from scratch by using single-channel input as well as performed transfer learning with and without fine-tuning using an extended network architecture. We experimented with residual neural networks to perform AD classification task and compared it with former research in this domain. The performance of the models is evaluated using precision, recall, f1-measure, AUC and ROC curves. We found that our networks were able to significantly classify the subjects. We achieved improved results with our fine-tuned model for all the AD stages with an accuracy of 100%, 96.85%, 97.38%, 97.43%, 97.40% and 98.01% for CN, SMC, EMCI, LMCI, MCI, and AD respectively. However, in terms of overall performance, we achieved state-of-the-art results with an average accuracy of 97.92% and 97.88% for off-the-shelf and fine-tuned models respectively. The Analysis of results indicate that classification and prediction of neurodegenerative brain disorders such as AD using functional magnetic resonance imaging and advanced deep learning methods is promising for clinical decision making and have the potential to assist in early diagnosis of AD and its associated stages.

The Alzheimer's Disease Neuroimaging Initiative (ADNI) is an ongoing, longitudinal, multicenter study designed to develop clinical, imaging, genetic, and biochemical biomarkers for the early detection and tracking of Alzheimer's disease (AD). The study aimed to enroll 400 subjects with early mild cognitive impairment (MCI), 200 subjects with early AD, and 200 normal control subjects; $67 million funding was provided by both the public and private sectors, including the National Institute on Aging, 13 pharmaceutical companies, and 2 foundations that provided support through the Foundation for the National Institutes of Health. This article reviews all papers published since the inception of the initiative and summarizes the results as of February 2011. The major accomplishments of ADNI have been as follows: (1) the development of standardized methods for clinical tests, magnetic resonance imaging (MRI), positron emission tomography (PET), and cerebrospinal fluid (CSF) biomarkers in a multicenter setting; (2) elucidation of the patterns and rates of change of imaging and CSF biomarker measurements in control subjects, MCI patients, and AD patients. CSF biomarkers are consistent with disease trajectories predicted by β-amyloid cascade (Hardy, J Alzheimers Dis 2006;9(Suppl 3):151-3) and tau-mediated neurodegeneration hypotheses for AD, whereas brain atrophy and hypometabolism levels show predicted patterns but exhibit differing rates of change depending on region and disease severity; (3) the assessment of alternative methods of diagnostic categorization. Currently, the best classifiers combine optimum features from multiple modalities, including MRI, [(18)F]-fluorodeoxyglucose-PET, CSF biomarkers, and clinical tests; (4) the development of methods for the early detection of AD. CSF biomarkers, β-amyloid 42 and tau, as well as amyloid PET may reflect the earliest steps in AD pathology in mildly symptomatic or even nonsymptomatic subjects, and are leading candidates for the detection of AD in its preclinical stages; (5) the improvement of clinical trial efficiency through the identification of subjects most likely to undergo imminent future clinical decline and the use of more sensitive outcome measures to reduce sample sizes. Baseline cognitive and/or MRI measures generally predicted future decline better than other modalities, whereas MRI measures of change were shown to be the most efficient outcome measures; (6) the confirmation of the AD risk loci CLU, CR1, and PICALM and the identification of novel candidate risk loci; (7) worldwide impact through the establishment of ADNI-like programs in Europe, Asia, and Australia; (8) understanding the biology and pathobiology of normal aging, MCI, and AD through integration of ADNI biomarker data with clinical data from ADNI to stimulate research that will resolve controversies about competing hypotheses on the etiopathogenesis of AD, thereby advancing efforts to find disease-modifying drugs for AD; and (9) the establishment of infrastructure to allow sharing of all raw and processed data without embargo to interested scientific investigators throughout the world. The ADNI study was extended by a 2-year Grand Opportunities grant in 2009 and a renewal of ADNI (ADNI-2) in October 2010 through to 2016, with enrollment of an additional 550 participants.

Changes in regional cerebral blood flow and functional connectivity in the cholinergic pathway associated with cognitive performance in subjects with mild Alzheimer's disease after 12-week donepezil treatment

Alzheimer's Disease Neuroimaging Initiative biomarkers as quantitative phenotypes: Genetics core aims, progress, and plans

INTRODUCTIONBiomarkers for Alzheimer's disease neuropathologic change (ADNC) have been instrumental in developing effective disease‐modifying therapeutics. However, to prevent/treat dementia effectively, we require biomarkers for non‐AD neuropathologies; for this, neuropathologic examinations and annotated tissue samples are essential.METHODSWe conducted clinicopathologic correlation for the first 100 Alzheimer's Disease Neuroimaging Initiative (ADNI) Neuropathology Core (NPC) cases.RESULTSClinical syndromes in this cohort showed 95% sensitivity and 79% specificity for predicting high/intermediate ADNC, a 21% false positive rate, and a ∼44% false negative rate. In addition, 60% with high/intermediate ADNC harbored additional potentially dementing co‐pathologies.DISCUSSIONThese results suggest that clinical presentation imperfectly predicts ADNC and that accurate prediction of high/intermediate ADNC does not exclude co‐pathology that may modify presentation, biomarkers, and therapeutic responses. Therefore, new biomarkers are needed for non‐AD neuropathologies. The ADNI NPC supports this mission with well‐characterized tissue samples (available through ADNI and the National Institute on Aging) and “gold‐standard” diagnostic information (soon to include digital histology).HighlightsThe Alzheimer's Disease Neuroimaging Initiative (ADNI) Neuropathology Core (NPC) brain donation cohort now exceeds 200 cases.ADNI NPC data in National Alzheimer's Coordinating Center format are available through the Laboratory of Neuro Imaging.Digitized slide files from the ADNI NPC will be available in 2025.Requests for ADNI brain tissue samples can be submitted online for ADNI/National Institute on Aging evaluation.Clinical diagnoses of Alzheimer's disease (AD)/AD and related dementias (ADRD) do not always predict post mortem neuropathology.Neuropathology is essential for the development of novel AD/ADRD biomarkers.

PURPOSEChronic neuro‐inflammation is an important mechanism underlying normal aging and Alzheimer's disease (AD) that is thought to potentiate medial temporal lobe (MTL) atrophy and memory decline. Currently, there are not enough prognostic biomarkers that can track the development and progression of normal aging versus AD, as well as differing effects on the brain. Our study examined which pro‐ or anti‐inflammatory cerebrospinal fluid (CSF) biomarkers best predicted AD neuropathology over 24 months.METHODSBaseline mass spectrometry data from two hundred and eighty‐five adults was obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Our focus was on examining biomarkers directly associated with inflammatory processes. For our study, we utilized T1‐weighted medial temporal gray matter volumes at baseline and months 6, 12, and 24 after baseline. Statistical analyses were conducted using SPSS 23.0 software. We used linear mixed models as well as least significant differences (LSD) post‐hoc tests to analyze how variables differed by baseline diagnosis (normal aging, pre‐AD, AD) or pre‐AD patients that did or did not convert to AD. We used stepwise regression analyses to analyze which inflammatory biomarkers best predicted atrophy and memory decline over 24 months. We specifically focused on CSF levels of Neuronal Pentraxin 2 (NPTX2) and Chitinase‐3‐like‐protein‐1 (C3LP1), as they are the inflammatory biomarkers that significantly predicted MTL atrophy and memory decline. NPTX2 is a biomarker of synaptic plasticity. C3LP1 is a biomarker of microglial activation and chronic neuro‐inflammation. We also analyzed relative risk ratios for diagnosis with NPTX2 and C3LP1 with multinomial logistic regression analyses. Preliminary results for memory indicate that, regardless of baseline diagnosis, higher NPTX2 levels strongly predict higher memory scores by month 24 (Figure 1).RESULTSNPTX2 and C3LP1, respectively beneficial and adverse biomarkers of synaptic plasticity and microglial activation, loaded significantly. By month 24, higher baseline NPTX2 corresponded to less MTL atrophy [R2= .287] and less memory decline [R2= .560]. Conversely, higher C3LP1 modestly predicted more MTL atrophy [R2=.083].CONCLUSIONSOur study suggests that NPTX2 is a promising biomarker for predicting longitudinal changes in medial temporal volume, especially memory performance across the AD spectrum. Baseline NPTX2 performs better than C3LP1 in predicting MTL atrophy and memory decline over time. C3LP1 was a comparatively modest predictor of medial temporal atrophy and memory decline. For future directions, studies should investigate if clinical trials using anti‐inflammatory drugs/nutritional therapy increase or inhibit NPTX2 and/or C3LP1.Support or Funding InformationThis study was funded by Iowa State University and NIH K99 AG047282. Data collection and sharing for this project were funded by the ADNI (National Institutes of Health Grant U01‐AG‐024904) and Department of Defense ADNI (award number W81XWH‐12‐2‐0012). ADNI is funded by the National Institute on Aging, the National Institute of Biomedical Imaging and Bioengineering, and through generous contributions from the Alzheimer's Association and the Alzheimer's Drug Discovery Foundation. The Canadian Institutes of Health Research is providing funds to support ADNI clinical sites in Canada. Private‐sector contributions are facilitated by the Foundation for the National Institutes of Health (www.fnih.org). The grantee organization is the Northern California Institute for Research and Education, and the study is coordinated by the Alzheimer's Disease Cooperative Study at the University of California, San Diego. ADNI data are disseminated by the Laboratory for Neuro Imaging at the University of Southern California. The data used in the preparation of this article were obtained from the ADNI database (adni.loni.usc.edu). As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report.

Neurophysiological changes associated with Alzheimer's disease (AD) begin decades before clinical symptoms emerge, during preclinical AD. Functional abnormalities in white matter (WM) at this preclinical stage remain largely unexplored. We obtained resting-state functional magnetic resonance imaging (rs-fMRI) data of 295 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and evaluated bundle-wise functional connectivity density (FCD) and fractional amplitude of low-frequency fluctuations (fALFF) across 46 bundles, which reflects the strength of synchronizations of BOLD dynamics between each WM bundle and whole-brain 200 GM parcels, and spontaneous neural activity of each WM bundle, respectively. To mitigate site/scanner effects on the metrics, ComBat harmonization was applied to the data. We then performed permutation tests (n=5,000) on each harmonized metric for each bundle to determine differences in FCD and fALFF in preclinical AD relative to controls, adjusting for sex, age, and education using multiple linear regression. Linear correlations of the metrics with the pathological biomarker beta-amyloid (Aβ) and cognitive scores (mPACC and ADAS11) were assessed using general linear models. Multiple comparisons were corrected via a false discovery rate (FDR). We found that preclinical AD patients had reduced FCD and fALFF in specific WM bundles, such as cingulate and hippocampal cingulum, compared to controls (FDR corrected p < 0.05), some of which were associated with poorer cognitive performance and greater Aβ accumulation (FDR corrected p < 0.05). This study, to the best of our knowledge, is the first to examine bundle-wise FCD and fALFF of WM in preclinical AD using a large-scale, multi-site, cross-sectional dataset, suggesting potential applications of these metrics for assessing preclinical AD with rs-fMRI.

Cross-sectional studies suggest self-reported cancer history is associated with decreased risk of Alzheimer's disease (AD). However, little is known about how self-reported cancer affects longitudinal AD progression, the primary outcome in clinical trials and observational studies. To determine self-reported cancer history's effect on longitudinal AD progression in an observational study. We utilized data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) to evaluate progression to AD by self-reported all-cancer, breast, prostate, colorectal, or non-melanoma skin cancer history. Linear mixed effects models were used to examine baseline differences and rates of progression on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) by self-reported cancer history. Age at AD onset was examined using consensus clinical diagnoses with Cox proportional hazards regression. Among 1,271 participants, models revealed no significant differences in progression over time but did reveal significantly lower baseline ADAS-Cog score, indicating better cognition at a given age in those with self-reported cancer history. Cox models indicated those with self-reported cancer history had significantly later age of AD onset (HR: 0.67, 95% CI: 0.53-0.85) after adjustment for covariates. Participants with self-reported cancer history entered ADNI with better cognition and later age of AD onset, but progressed similarly to participants without such history, indicating differences in AD between those with and without self-reported cancer history emerge early in the disease course. Such differences in longitudinal progression by self-reported cancer history could affect AD trials and observational studies, given the current focus on early disease course. Further investigation is warranted with detailed longitudinal assessment of cancer and AD.