Evaluation and implementation of functional cerebral biomarkers in Alzheimer’s disease

The aim of this thesis was to evaluate and implement functional cerebral biomarkers in Alzheimer’s disease (AD) with respect to pathophysiology, disease severity, prognosis and treatment effect in medical trials. We focused on functional cerebral biomarkers that assess synaptic activity and functional connectivity using electroencephalography (EEG), magnetoencephalography (MEG) and 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET). In the different chapters a broad range of challenges associated with this topic was covered. We started by using FDG- PET to observe the effects of the experimental treatment of AD patients with the medical food Souvenaid, followed by EEG as treatment outcome measure in a trial with the drug PQ912. Next to the primary outcomes, the results of these studies revealed that more research was needed to observe which markers could observe reliable, reproducible and valid results and what the factors were that could influence their ability to do this. The EEG markers, rather than the FDG- PET markers, showed promising results. Therefore, we aimed to investigate the effects of sensitivity, reproducibility, heterogeneity of the population and treatment efficacy, while maintaining a well-defined study population and study design, on EEG biomarkers. We first investigated the reproducibility of AD related changes in functional connectivity captured by different measures in electroencephalography (EEG) and magnetoencephalography (MEG). Second, we evaluated the influence of subtypes of AD on various EEG measures and, on the other hand, we used EEG to find heterogeneity and to predict clinical progression

Differentiation of Alzheimer's disease dementia, mild cognitive impairment and normal condition using PET-FDG and AV-45 imaging : a machine-learning approach

Nous avons utilisé l'imagerie TEP avec les traceurs F18-FDG et AV45 en conjonction avec les méthodes de classification du domaine du "Machine Learning". Les images ont été acquises en mode dynamique, une image toutes les 5 minutes. Les données ont été transformées par Analyse en Composantes Principales et Analyse en Composantes Indépendantes. Les images proviennent de trois sources différentes: la base de données ADNI (Alzheimer's Disease Neuroimaging Initiative) et deux protocoles réalisés au sein du centre TEP de l'hôpital Purpan. Pour évaluer la performance de la classification nous avons eu recours à la méthode de validation croisée LOOCV (Leave One Out Cross Validation). Nous donnons une comparaison entre les deux méthodes de classification les plus utilisées, SVM (Support Vector Machine) et les réseaux de neurones artificiels (ANN). La combinaison donnant le meilleur taux de classification semble être SVM et le traceur AV45. Cependant les confusions les plus importantes sont entre les patients MCI et les sujets normaux. Les patients Alzheimer se distinguent relativement mieux puisqu'ils sont retrouvés souvent à plus de 90%. Nous avons évalué la généralisation de telles méthodes de classification en réalisant l'apprentissage sur un ensemble de données et la classification sur un autre ensemble. Nous avons pu atteindre une spécificité de 100% et une sensibilité supérieure à 81%. La méthode SVM semble avoir une meilleure sensibilité que les réseaux de neurones. L'intérêt d'un tel travail est de pouvoir aider à terme au diagnostic de la maladie d'Alzheimer.We used PET imaging with tracers F18-FDG and AV45 in conjunction with the classification methods in the field of "Machine Learning". PET images were acquired in dynamic mode, an image every 5 minutes.The images used come from three different sources: the database ADNI (Alzheimer's Disease Neuro-Imaging Initiative, University of California Los Angeles) and two protocols performed in the PET center of the Purpan Hospital. The classification was applied after processing dynamic images by Principal Component Analysis and Independent Component Analysis. The data were separated into training set and test set. To evaluate the performance of the classification we used the method of cross-validation LOOCV (Leave One Out Cross Validation). We give a comparison between the two most widely used classification methods, SVM (Support Vector Machine) and artificial neural networks (ANN) for both tracers. The combination giving the best classification rate seems to be SVM and AV45 tracer. However the most important confusion is found between MCI patients and normal subjects. Alzheimer's patients differ somewhat better since they are often found in more than 90%. We evaluated the generalization of our methods by making learning from set of data and classification on another set . We reached the specifity score of 100% and sensitivity score of more than 81%. SVM method showed a bettrer sensitivity than Artificial Neural Network method. The value of such work is to help the clinicians in diagnosing Alzheimer's disease

Alzheimer PEThology

Scheltens, P. [Promotor]Lammertsma, A.A. [Promotor]Berckel, B.N.M. van [Copromotor]Flier, W.M. van der [Copromotor

Doctor of Philosophy

dissertationAn important aspect of medical research is the understanding of anatomy and its relation to function in the human body. For instance, identifying changes in the brain associated with cognitive decline helps in understanding the process of aging and age-related neurological disorders. The field of computational anatomy provides a rich mathematical setting for statistical analysis of complex geometrical structures seen in 3D medical images. At its core, computational anatomy is based on the representation of anatomical shape and its variability as elements of nonflat manifold of diffeomorphisms with an associated Riemannian structure. Although such manifolds effectively represent natural biological variability, intrinsic methods of statistical analysis within these spaces remain deficient at large. This dissertation contributes two critical missing pieces for statistics in diffeomorphisms: (1) multivariate regression models for cross-sectional study of shapes, and (2) generalization of classical Euclidean, mixed-effects models to manifolds for longitudinal studies. These models are based on the principle that statistics on manifold-valued information must respect the intrinsic geometry of that space. The multivariate regression methods provide statistical descriptors of the relationships of anatomy with clinical indicators. The novel theory of hierarchical geodesic models (HGMs) is developed as a natural generalization of hierarchical linear models (HLMs) to describe longitudinal data on curved manifolds. Using a hierarchy of geodesics, the HGMs address the challenge of modeling the shape-data with unbalanced designs typically arising as a result of follow-up medical studies. More generally, this research establishes a mathematical foundation to study dynamics of changes in anatomy and the associated clinical progression with time. This dissertation also provides efficient algorithms that utilize state-of-the-art high performance computing architectures to solve models on large-scale, longitudinal imaging data. These manifold-based methods are applied to predictive modeling of neurological disorders such as Alzheimer's disease. Overall, this dissertation enables clinicians and researchers to better utilize the structural information available in medical images

Recent publications from the Alzheimer's Disease Neuroimaging Initiative: Reviewing progress toward improved AD clinical trials

INTRODUCTION: The Alzheimer's Disease Neuroimaging Initiative (ADNI) has continued development and standardization of methodologies for biomarkers and has provided an increased depth and breadth of data available to qualified researchers. This review summarizes the over 400 publications using ADNI data during 2014 and 2015. METHODS: We used standard searches to find publications using ADNI data. RESULTS: (1) Structural and functional changes, including subtle changes to hippocampal shape and texture, atrophy in areas outside of hippocampus, and disruption to functional networks, are detectable in presymptomatic subjects before hippocampal atrophy; (2) In subjects with abnormal β-amyloid deposition (Aβ+), biomarkers become abnormal in the order predicted by the amyloid cascade hypothesis; (3) Cognitive decline is more closely linked to tau than Aβ deposition; (4) Cerebrovascular risk factors may interact with Aβ to increase white-matter (WM) abnormalities which may accelerate Alzheimer's disease (AD) progression in conjunction with tau abnormalities; (5) Different patterns of atrophy are associated with impairment of memory and executive function and may underlie psychiatric symptoms; (6) Structural, functional, and metabolic network connectivities are disrupted as AD progresses. Models of prion-like spreading of Aβ pathology along WM tracts predict known patterns of cortical Aβ deposition and declines in glucose metabolism; (7) New AD risk and protective gene loci have been identified using biologically informed approaches; (8) Cognitively normal and mild cognitive impairment (MCI) subjects are heterogeneous and include groups typified not only by "classic" AD pathology but also by normal biomarkers, accelerated decline, and suspected non-Alzheimer's pathology; (9) Selection of subjects at risk of imminent decline on the basis of one or more pathologies improves the power of clinical trials; (10) Sensitivity of cognitive outcome measures to early changes in cognition has been improved and surrogate outcome measures using longitudinal structural magnetic resonance imaging may further reduce clinical trial cost and duration; (11) Advances in machine learning techniques such as neural networks have improved diagnostic and prognostic accuracy especially in challenges involving MCI subjects; and (12) Network connectivity measures and genetic variants show promise in multimodal classification and some classifiers using single modalities are rivaling multimodal classifiers. DISCUSSION: Taken together, these studies fundamentally deepen our understanding of AD progression and its underlying genetic basis, which in turn informs and improves clinical trial desig

Computerized tools : a substitute or a supplement when diagnosing Alzheimer's disease?

Alzheimer’s disease (AD) is the most common form of dementia in the elderly characterized by difficulties in memory, disturbances in language, changes in behavior, and impairments in daily life activities. By the time cognitive impairment manifests, substantial synaptic and neuronal degeneration has already occurred. Therefore, patients need to be diagnosed as early as possible at a preclinical or presymptomatic stage. This will be important when disease-modifying treatments exist in the future. The main focus of this thesis is on the study of structural neuroimaging in AD and in prodromal stages of the disease. We emphasize the use of statistical learning for the analysis of structural neuroimaging data to achieve individual prediction of disease status and conversion from prodromal stages. The main aims of the thesis were to develop and validate computerized tools to identify patterns of atrophy with the potential of becoming markers of AD pathology using structural magnetic resonance imaging (sMRI) data and to develop a segmentation tool for Computed Tomography (CT). Using automated neuroanatomical software we measured multiple brain structures that were given to statistical learning techniques to create discriminative models for prediction of presence of disease and conversion from prodromal stages. Building statistical models based on sMRI data we investigated optimal normalization strategies for the combination of structural measures such as cortical thickness, cortical and subcortical volumes (Study I). A baseline model was created based on the optimal normalization strategy and combination of structural measures. This model was used to compare the discrimination ability of different statistical learning algorithms (decision trees, artificial neural networks, support vector machines and orthogonal partial least squares (OPLS)). Additionally, the addition of age, years of education and APOE phenotype was added to the baseline model to assess the impact on discrimination ability (Study II). The OPLS classification algorithm was trained on the baseline model to produce a structural index reflecting information about AD-like patterns of atrophy from each individual’s sMRI data. Additional longitudinal information at one-year follow-up was used to characterize the temporal evolution of the derived index (Study III). Since total intracranial volume (ICV) remains a morphological measure of interest and CT is today widely used in routine clinical investigations, we developed and validated an automated segmentation algorithm to estimate ICV from CT scans (Study IV). We believe computerized tools (automated neuroimaging software and statistical discriminative algorithms) have significantly enriched our knowledge and understanding of associated neurodegenerative pathology, its effects on cognition and interaction with age. These tools were mainly developed for research purposes but we believe all accumulated knowledge and insights could be translated into clinical settings, however, that is a challenge that remains open for future studies

Modelling prognostic trajectories in Alzheimer’s disease

Progression to dementia due to Alzheimer’s Disease (AD) is a long and protracted process that involves multiple pathways of disease pathophysiology. Predicting these dynamic changes has major implications for timely and effective clinical management in AD. There are two reasons why at present we lack appropriate tools to make such predictions. First, a key feature of AD is the interactive nature of the relationships between biomarkers, such as accumulation of β-amyloid -a peptide that builds plaques between nerve cells-, tau -a protein found in the axons of nerve cells- and widespread neurodegeneration. Current models fail to capture these relationships because they are unable to successfully reduce the high dimensionality of biomarkers while exploiting informative multivariate relationships. Second, current models focus on simply predicting in a binary manner whether an individual will develop dementia due to AD or not, without informing clinicians about their predicted disease trajectory. This can result in administering inefficient treatment plans and hindering appropriate stratification for clinical trials. In this thesis, we overcome these challenges by using applied machine learning to build predictive models of patient disease trajectories in the earliest stages of AD. Specifically, to exploit the multi-dimensionality of biomarker data, we used a novel feature generation methodology Partial Least Squares regression with recursive feature elimination (PLSr-RFE). This method applies a hybrid-feature selection and feature construction method that captures co-morbidities in cognition and pathophysiology, resulting in an index of Alzheimer’s disease atrophy from structural MRI. We validated our choice of biomarker and the efficacy of our methodology by showing that the learnt pattern of grey matter atrophy is highly predictive of tau accumulation in an independent sample. Next, to go beyond predicting binary outcomes to deriving individualised prognostic scores of cognitive decline due to AD, we used a novel trajectory modelling approach (Generalised Metric Learning Vector Quantization – Scalar projection) that mines multimodal data from large AD research cohorts. Using this approach, we derive individualised prognostic scores of cognitive decline due to AD, revealing interactive cognitive, and biological factors that improve prediction accuracy. Next, we extended our machine learning framework to classify and stage early AD individuals based on future pathological tau accumulation. Our results show that the characteristic spreading pattern of tau in early AD can be predicted by baseline biomarkers, particularly when stratifying groups using multimodal data. Further, we showed that our prognostic index predicts individualised rates of future tau accumulation with high accuracy and regional specificity in an independent sample of cognitively unimpaired individuals. Overall, our work used machine learning to combine continuous information from AD biomarkers predicting pathophysiological changes at different stages in the AD cascade. The approaches presented in this thesis provide an excellent framework to support personalised clinical interventions and guide effective drug discovery trials