Book Reviews

Principles of Cardiac Arrhythmias. 3rd ed. By Edward K. Chung. Pp. xiii 809. Illustrated. Baltimore: Williams &Wilkins. 1983.Ethical Issues in Reproductive Medicine. Ed. by M. Reidy. Pp. 176. Illustrated. RI9,60. Dublin: Gill & Macmillan. 1982.From Parasitic Infection to Parasitic Disease (Contribution to Microbiology and Immunology, vol. 7). Ed. by P. L. Gigase and E. A. C. van Marck. Pp. ix + 269. Illustrated. DM 216,-. Basle: S. Karger. 1983.Prolonged Arrest of Cancer (New Horizons in Oncology, vol. I). Ed. by B. A. Stoll. Pp. xiv + 454. Illustrated. £25,75. London: John Wiley. 1982.Pediatric Angiography. Ed. by P. Stanley. Pp. xv + 425. Illustrated. Baltimore: Williams & Wilkins. 1982.Thin-needle Aspiration Biopsy (Major Problems in Pathology, vol. 14). By W. J. Frable. Pp. X\'iii + 358. Illustrated. £42,25. Philadelphia: \'(t B. Saunders. 1983.Essentials of Pulmonary Medicine. By M. H. Williams. Pp. xi + 190. Illustrated. Philadelphia: W. B. Saunders. 1982.Noninvasive Assessment of the Cardiovascular System: Diagnostic Principles and Techniques. Ed. by E. B. Diethrich. Pp. xxiii + 319. Illustrated. £25,75. London: Wright PSG. 1982.Periodic Abstinence for Family Planning. Ed. by R. L. Kleinman. Pp. 60. Illustrated. £1,75 (in K only). London: IPPF Medical Publications. 1983

Increasing the accessibility and impact of justice-related student and practitioner research

Much good quality research by pre-doctoral students and case-work focused practitioners remains unpublished. However, their findings could contribute to the evidence base underpinning science and practice within international justice system contexts. There are two main challenges to making findings accessible: reaching all criminal justice stakeholders, and encouraging collaborative efforts in research addressing ‘real world’ problems. This article presents the rationale for a new, open access repository. The aim is to share good quality pre-doctoral and practitioner criminal justice research across traditional disciplinary and international borders. Such a repository should be easy to use, well maintained and sustainable. Its reach, value and impact also need to be measurable. We present the major considerations relating to the operation and workflow of such a repository, and outline the potential value, benefits and limitations. Our research suggests that the proposed repository could foster interdisciplinary and collaborative work to benefit global justice systems and societies

A conformational variant of p53 (U-p53AZ) as blood-based biomarker for the prediction of the onset of symptomatic Alzheimer\u27s disease

BACKGROUND: Ongoing research seeks to identify blood-based biomarkers able to predict onset and progression of Alzheimer\u27s disease (AD). OBJECTIVE: The unfolded conformational variant of p53 (U-p53AZ), previously observed in AD individuals, was evaluated in plasma samples from individuals participating in the Australian Imaging, Biomarkers and Lifestyle (AIBL) cohort for diagnostic and prognostic assessment, validated on a neuropsychological-based diagnosis, over the course of six years. DESIGN: Retrospective Longitudinal Prognostic biomarker study. SETTING: Single-center study based on the AIBL cohort. PARTICIPANTS: 482 participants of the AIBL cohort, aged 60-85 years, without uncontrolled diabetes, vascular disease, severe depression or psychiatric illnesses. MEASUREMENTS: The AlzoSure® Predict test, consisting of immunoprecipitation (IP) followed by liquid chromatography (LC) tandem mass spectrometry (MS/MS), was performed to quantify the AZ 284® peptide as readout of U-p53AZ and compared with an independent neuropsychological diagnosis. The amyloid load via amyloid β-positron emission tomography (Aβ-PET) and supporting clinical information were included where possible. RESULTS: U-p53AZ diagnostic and prognostic performance was assessed in both time-independent and time-dependent (36, 72 and 90 months following initial sampling) analyses. Prognostic performance of Aβ-PET and survival analyses with different risk factors (gender, Aβ-PET and APOE ε4 allele status) were also performed. U-p53AZ differentiated neuropsychologically graded AD from non-AD samples, and its detection at intermediate/high levels precisely identified present and future symptomatic AD. In both time-independent and time-dependent prognostic analyses U-p53AZ achieved area under the curve (AUC) \u3e98%, significantly higher than Aβ-PET AUCs (between 84% and 93%, P respectively \u3c0.0001 and \u3c0.001). As single factor, U-p53AZ could clearly determine the risk of AD neuropsychological diagnosis over time (low versus intermediate/high U-p53AZ hazard ratio=2.99). Proportional hazards regression analysis identified U-p53AZ levels as a major independent predictor of AD onset. CONCLUSIONS: These findings support use of U-p53AZ as blood-based biomarker predicting whether individuals would reach neuropsychologically-defined AD within six years prior to AD diagnosis. Integration of U-p53AZ in screening processes could support refined participant stratification for interventional studies

Book Reviews

ImmunoparasitologyImmunoparasitology: Principles and Methods in Malaria and Schistosomiasis Research. Ed. by G. T. Strickland and K. W. Hunter. Pp. 294. Illustrated. £29,75. London: Praeger. 1982.Walsh and Hoyt's Clinical Neuro-Ophthalmology, vol. 1. By Neil R. Miller. Pp. xii +381. Illustrated. R66,-. Baltimore: Williams & Wilkins. 1982Urinary tract infectionUrinary Tract Infection (Currenr Topics in Infection, No. 3). By R. Maskell. Pp. viii + 144. Illustrated. R37,-. London: Edward Amold. 1982.Common Health Problems in Medical Practice. By E. Scott Medley. Pp. xvi +343. Illustrated. Baltimore: Williams & Wilkins. 1982.Endocrine pathologyEndocrine Pathology: General and Surgical. 2nd ed. Ed. by J. M. B. Bloodworth jun. Pp. xii + 895. Illustrated. Baltimore: Williams & Wilkins. 1982.Experimental Hematology Today, 1982. Ed. by S. J. Baum, D. D. Ledney and S. Thierfelder. Pp. xx +266. Illusuated. DM 237,-. Basle: S. Karger. 1982.Medical Disorders of Alcoholism: Pathogenesis and Treatment (Major Problems in International Medicine, vol. XXII). By C. S. Lieber. Pp. xvii + 589. Illusuated. ± RI08,-. Philadelphia: W. B. Saunders. 19.82.Breast Cancer (Clinics in Oncology, No. I, vol. 3). Guest ed. M. Baum. Pp. vii +647 + 955. Illustrated. Rll,75. Philadelphia: W. B. Saunders. 1982.Handbook of Medical Parasitology. By Viqar Zaman and Loh Ah Keong. Pp. viii + 218. Illustrated. £17,-. New York: ADIS Health Science Press. 1982

Assessment of a polygenic hazard score for the onset of pre-clinical Alzheimer’s disease

Background: With a growing number of loci associated with late-onset (sporadic) Alzheimer’s disease (AD), the polygenic contribution to AD is now well established. The development of polygenic risk score approaches have shown promising results for identifying individuals at higher risk of developing AD, thereby facilitating the development of preventative and therapeutic strategies. A polygenic hazard score (PHS) has been proposed to quantify age-specific genetic risk for AD. In this study, we assessed the predictive power and transferability of this PHS in an independent cohort, to support its clinical utility. Results: Using genotype and imaging data from 780 individuals enrolled in the Australian Imaging, Biomarkers and Lifestyle (AIBL) study, we investigated associations between the PHS and several AD-related traits, including 1) cross-sectional Aβ-amyloid (Aβ) deposition, 2) longitudinal brain atrophy, 3) longitudinal cognitive decline, 4) age of onset. Except in the cognitive domain, we obtained results that were consistent with previously published findings. The PHS was associated with increased Aβ burden, faster regional brain atrophy and an earlier age of onset. Conclusion: Overall, the results support the predictive power of a PHS, however, with only marginal improvement compared to apolipoprotein E alone

Plasma p-tau181/Aβ1-42 ratio predicts Aβ-PET status and correlates with CSF-p-tau181/Aβ1-42 and future cognitive decline

Background: In Alzheimer\u27s disease (AD), plasma amyloid beta (Aβ)1-42 and phosphorylated tau (p-tau) predict high amyloid status from Aβ positron emission tomography (PET); however, the extent to which combination of these plasma assays can predict remains unknown. Methods: Prototype Simoa assays were used to measure plasma samples from participants who were either cognitively normal (CN) or had mild cognitive impairment (MCI)/AD in the Australian Imaging, Biomarkers and Lifestyle (AIBL) study. Results: The p-tau181/Aβ1-42 ratio showed the best prediction of Aβ-PET across all participants (area under the curve [AUC] = 0.905, 95% confidence interval [CI]: 0.86–0.95) and in CN (AUC = 0.873; 0.80–0.94), and symptomatic (AUC = 0.908; 0.82–1.00) adults. Plasma p-tau181/Aβ1-42 ratio correlated with cerebrospinal fluid (CSF) p-tau181 (Elecsys, Spearman\u27s ρ = 0.74, P \u3c 0.0001) and predicted abnormal CSF Aβ (AUC = 0.816; 0.74–0.89). The p-tau181/Aβ1-42 ratio also predicted future rates of cognitive decline assessed by AIBL Preclinical Alzheimer Cognitive Composite or Clinical Dementia Rating Sum of Boxes (P \u3c 0.0001). Discussion: Plasma p-tau181/Aβ1-42 ratio predicted both Aβ-PET status and cognitive decline, demonstrating potential as both a diagnostic aid and as a screening and prognostic assay for preclinical AD trials

Rates of age- and amyloid β-associated cortical atrophy in older adults with superior memory performance

Introduction: Superior cognitive performance in older adults may reflect underlying resistance to age-associated neurodegeneration. While elevated amyloid b (Ab) deposition (Ab1) has been associated with increased cortical atrophy, it remains unknown whether “SuperAgers” may be protected from Ab-associated neurodegeneration. Methods: Neuropsychologically defined SuperAgers (n 5 172) and cognitively normal for age (n 5 172) older adults from the Australian Imaging, Biomarkers and Lifestyle study were case matched. Rates of cortical atrophy over 8 years were examined by SuperAger classification and Ab status. Results: Of the case-matched SuperAgers and cognitively normal for age older adults, 40.7% and 40.1%, respectively, were Ab1. Rates of age- and Ab-associated atrophy did not differ between the groups on any measure. Ab2 individuals displayed the slowest rates of atrophy. Discussion: Maintenance of superior memory in late life does not reflect resistance to age- or Abassociated atrophy. However, those individuals who reached old age without cognitive impairment nor elevated Ab deposition (i.e. Ab2) displayed reduced rates of cortical atrophy

Plasma glial fibrillary acidic protein is associated with 18F-SMBT-1 PET: Two putative astrocyte reactivity biomarkers for Alzheimer\u27s disease

Background: Astrocyte reactivity is an early event along the Alzheimer\u27s disease (AD) continuum. Plasma glial fibrillary acidic protein (GFAP), posited to reflect astrocyte reactivity, is elevated across the AD continuum from preclinical to dementia stages. Monoamine oxidase-B (MAO-B) is also elevated in reactive astrocytes observed using 18F-SMBT-1 PET in AD. Objective: The objective of this study was to evaluate the association between the abovementioned astrocyte reactivity biomarkers. Methods: Plasma GFAP and Aβ were measured using the Simoa® platform in participants who underwent brain 18F-SMBT-1 and Aβ-PET imaging, comprising 54 healthy control (13 Aβ-PET+ and 41 Aβ-PET-), 11 mild cognitively impaired (3 Aβ-PET+ and 8 Aβ-PET-) and 6 probable AD (5 Aβ-PET+ and 1 Aβ-PET-) individuals. Linear regressions were used to assess associations of interest. Results: Plasma GFAP was associated with 18F-SMBT-1 signal in brain regions prone to early Aβ deposition in AD, such as the supramarginal gyrus (SG), posterior cingulate (PC), lateral temporal (LT) and lateral occipital cortex (LO). After adjusting for age, sex, APOE ɛ4 genotype, and soluble Aβ (plasma Aβ42/40 ratio), plasma GFAP was associated with 18F-SMBT-1 signal in the SG, PC, LT, LO, and superior parietal cortex (SP). On adjusting for age, sex, APOE ɛ4 genotype and insoluble Aβ (Aβ-PET), plasma GFAP was associated with 18F-SMBT-1 signal in the SG. Conclusion: There is an association between plasma GFAP and regional 18F-SMBT-1 PET, and this association appears to be dependent on brain Aβ load

Two-year prognostic utility of plasma p217+tau across the Alzheimer’s continuum

Background: Plasma p217+tau has shown high concordance with cerebrospinal fluid (CSF) and positron emission tomography (PET) measures of amyloid- (A ) and tau in Alzheimer’s Disease (AD). However, its association with longitudinal cognition and comparative performance to PET A and tau in predicting cognitive decline are unknown. Objectives: To evaluate whether p217+tau can predict the rate of cognitive decline observed over two-year average follow-up and compare this to prediction based on A (18F-NAV4694) and tau (18F-MK6240) PET. We also explored the sample size required to detect a 30% slowing in cognitive decline in a 2-year trial and selection test cost using p217+tau (pT+) as compared to PET A (A+) and tau (T+) with and without p217+tau pre-screening. Design: A prospective observational cohort study. Setting: Participants of the Australian Imaging, Biomarker & Lifestyle Flagship Study of Ageing (AIBL) and Australian Dementia Network (ADNeT). Participants: 153 cognitively unimpaired (CU) and 50 cognitively impaired (CI) individuals. Measurements: Baseline p217+tau Simoa assay 18F-MK6240 tau-PET and 18F-NAV4694 A -PET with neuropsychological follow-up (MMSE, CDR-SB, AIBL-PACC) over 2.4 ± 0.8 years. Results: In CI, p217+tau was a significant predictor of change in MMSE ( = −0.55, p \u3c 0.001) and CDR-SB ( =0.61, p \u3c 0.001) with an effect size similar to A Centiloid (MMSE = −0.48, p = 0.002; CDR-SB = 0.43, p = 0.004) and meta-temporal (MetaT) tau SUVR (MMSE: = −0.62, p \u3c 0.001; CDR-SB: = 0.65, p \u3c 0.001). In CU, only MetaT tau SUVR was significantly associated with change in AIBL-PACC ( = −0.22, p = 0.008). Screening pT+ CI participants into a trial could lead to 24% reduction in sample size compared to screening with PET for A+ and 6–13% compared to screening with PET for T+ (different regions). This would translate to an 81–83% biomarker test cost-saving assuming the p217+tau test cost one-fifth of a PET scan. In a trial requiring PET A+ or T+, p217+tau pre-screening followed by PET in those who were pT+ would cost more in the CI group, compared to 26–38% biomarker test cost-saving in the CU. Conclusions: Substantial cost reduction can be achieved using p217+tau alone to select participants with MCI or mild dementia for a clinical trial designed to slow cognitive decline over two years, compared to participant selection by PET. In pre-clinical AD trials, p217+tau provides significant cost-saving if used as a pre-screening measure for PET A+ or T+ but in MCI/mild dementia trials this may add to cost both in testing and in the increased number of participants needed for testing

Plasma p217+tau versus NAV4694 amyloid and MK6240 tau PET across the Alzheimer\u27s continuum

Introduction: We evaluated a new Simoa plasma assay for phosphorylated tau (P-tau) at aa217 enhanced by additional p-tau sites (p217+tau). Methods: Plasma p217+tau levels were compared to 18F-NAV4694 amyloid beta (Aβ) positron emission tomography (PET) and 18F-MK6240 tau PET in 174 cognitively impaired (CI) and 223 cognitively unimpaired (CU) participants. Results: Compared to Aβ− CU, the plasma levels of p217+tau increased 2-fold in Aβ+ CU and 3.5-fold in Aβ+ CI. In Aβ− the p217+tau levels did not differ significantly between CU and CI. P217+tau correlated with Aβ centiloids P =.67 (CI, P =.64; CU, P =.45) and tau SUVRMT P =.63 (CI, P =.69; CU, P =.34). Area under curve (AUC) for Alzheimer\u27s disease (AD) dementia versus Aβ− CU was 0.94, for AD dementia versus other dementia was 0.93, for Aβ+ versus Aβ− PET was 0.89, and for tau+ versus tau− PET was 0.89. Discussion: Plasma p217+tau levels elevate early in the AD continuum and correlate well with Aβ and tau PET