Interface originated modification of electron-vibration coupling in resonant photoelectron spectroscopy

We present a comprehensive study of the photon energy ($h \nu$) dependent line-shape evolution of molecular orbital signals of large $\pi$-conjugated molecules by resonant photoelectron spectroscopy (RPES). A comparison to RPES data of small molecules suggests that the excitation into different vibrational levels on the intermediate state potential energy surface of the electronic excitation is responsible for the observed effect. In this simplified picture of electron-vibration couping the character of the potential energy surfaces involved in the RPES process determines the line-shape of the molecular orbital signal for a particular $h \nu$. We use the sensitivity of this effect to probe the influence of different interfaces on the electron-vibration coupling in the investigated systems. The magnitude of the variation in line-shape throughout the particular $h \nu$ region allows to reveal significant differences within the physisorptive regime

A Multi-tracer PET approach to study early-onset familial and sporadic Alzheimer's disease

Cumulated scientific evidence suggests that the pathology causing Alzheimer's disease (AD) occurs many years or even decades before memory impairment and other clinical symptoms arise. Tangible and detailed knowledge about different pathological processes, their interactions, and time course is therefore of the essence both for the development of potentially successful treatments and a reliable early diagnosis of this relentless disorder. The past decade has thus seen an explosion in research on biomarkers that could provide in vivo evidence for these pathological processes, involving β-amyloid (Aβ) production and aggregation into plaques, neurofibrillary tangle formation, neuroinflammation, and eventually neurodegeneration. The rare form of dominantly-inherited early-onset familial AD (eoFAD), with almost complete mutation penetrance and defined age of disease onset, has been proposed as a model to study the very early disease mechanisms that are also supposed to underlie the common sporadic form (sAD). However, more than 200 mutations in three different genes (PSEN1 and 2, APP) have been identified as causing eoFAD, some of which have been shown to differ substantially from others. This work employed multi-tracer positron emission tomography (PET), using the tracers 2-[18F]‐fluoro-2‐deoxy‐D‐glucose (FDG), N-methyl-[11C] 2-(4'- methylaminophenyl)-6-hydroxy-benzothiazole (PIB), and [11C]-L-deuterium-deprenyl (DED) to explore the characteristics, time course and interrelationship of cerebral glucose metabolism, fibrillar Aβ burden, and astrocyte activation (astrocytosis) at different presymptomatic and symptomatic disease stages of eoFAD and sAD, in relationship to cognition, other AD biomarkers, and/or post-mortem pathology. Thalamic hypometabolism in PSEN1 eoFAD mutation carriers was demonstrated in this thesis nearly 20 years before they were expected to develop clinical symptoms. The pattern of hypometabolism studied in several mutation carriers spread subsequently to regions that are also typically affected in sAD, correlating well with cognitive decline at symptomatic disease stages. Regional hypometabolism was furthermore found to correlate with typical AD pathology, namely neuritic Aβ plaques at post-mortem examination, suggesting that FDG PET is an excellent marker of disease progression from early presymptomatic stages to terminal disease. One particular eoFAD mutation, the Arctic APP mutation, has been reported to modify amyloid processing in a way that obviates the formation of fibrillar Aβ, the form of Aβ most prone to aggregate into neuritic plaques. In contrast to carriers of other eoFAD mutations and sAD patients, we found that carriers of the Arctic APP mutation showed no cortical PIB PET retention as a measure of fibrillar Aβ load, while Aβ and tau in cerebral spinal fluid and glucose metabolism, and in advanced disease also medial temporal lobe atrophy as measured by magnetic resonance imaging and cognition were clearly pathological and typical of AD. The findings imply that clinical AD can be caused by forms of Aβ, supposedly oligomeric or protofibrillar, which cannot be detected by PIB PET. Very little is still known from in vivo studies about when and where in the brain neuroinflammation occurs in AD. Here, it could be shown that DED binding as a measure of astrocytosis was elevated in prodromal AD patients, whereas binding levels in AD were comparable to those in controls. PIB PET retention was increased and glucose metabolism decreased in both groups and there was no regional relationship between the three tracers, indicating that astrocytosis is an early phenomenon in AD that follows a different spatial and temporal pattern than Aβ plaque deposition and impaired synaptic activity as measured by glucose metabolism. Multi-tracer PET is in this work proven to provide novel insights in eoFAD and sAD pathogenesis with processes such as astrocytosis and the potential role of different Aβ species. This knowledge is of significance for the understanding of disease mechanisms as well as the comparability of the purely genetic and the sporadic form of AD

Current advances in digital cognitive assessment for preclinical Alzheimer\u27s disease

There is a pressing need to capture and track subtle cognitive change at the preclinical stage of Alzheimer\u27s disease (AD) rapidly, cost-effectively, and with high sensitivity. Concurrently, the landscape of digital cognitive assessment is rapidly evolving as technology advances, older adult tech-adoption increases, and external events (i.e., COVID-19) necessitate remote digital assessment. Here, we provide a snapshot review of the current state of digital cognitive assessment for preclinical AD including different device platforms/assessment approaches, levels of validation, and implementation challenges. We focus on articles, grants, and recent conference proceedings specifically querying the relationship between digital cognitive assessments and established biomarkers for preclinical AD (e.g., amyloid beta and tau) in clinically normal (CN) individuals. Several digital assessments were identified across platforms (e.g., digital pens, smartphones). Digital assessments varied by intended setting (e.g., remote vs. in-clinic), level of supervision (e.g., self vs. supervised), and device origin (personal vs. study-provided). At least 11 publications characterize digital cognitive assessment against AD biomarkers among CN. First available data demonstrate promising validity of this approach against both conventional assessment methods (moderate to large effect sizes) and relevant biomarkers (predominantly weak to moderate effect sizes). We discuss levels of validation and issues relating to usability, data quality, data protection, and attrition. While still in its infancy, digital cognitive assessment, especially when administered remotely, will undoubtedly play a major future role in screening for and tracking preclinical AD

Biomarkers for Microglial Activation in Alzheimer's Disease

Intensive research over the last decades has provided increasing evidence for neuroinflammation as an integral part in the pathogenesis of neurodegenerative diseases such as Alzheimer's disease (AD). Inflammatory responses in the central nervous system (CNS) are initiated by activated microglia, representing the first line of the innate immune defence of the brain. Therefore, biochemical markers of microglial activation may help us understand the underlying mechanisms of neuroinflammation in AD as well as the double-sided qualities of microglia, namely, neuroprotection and neurotoxicity. In this paper we summarize candidate biomarkers of microglial activation in AD along with a survey of recent neuroimaging techniques

18F-AV-1451 tau PET imaging correlates strongly with tau neuropathology in MAPT mutation carriers

Tau positron emission tomography ligands provide the novel possibility to image tau pathology in vivo. However, little is known about how in vivo brain uptake of tau positron emission tomography ligands relates to tau aggregates observed post-mortem. We performed tau positron emission tomography imaging with 18F-AV-1451 in three patients harbouring a p.R406W mutation in the MAPT gene, encoding tau. This mutation results in 3- and 4-repeat tau aggregates similar to those in Alzheimer's disease, and many of the mutation carriers initially suffer from memory impairment and temporal lobe atrophy. Two patients with short disease duration and isolated memory impairment exhibited 18F-AV-1451 uptake mainly in the hippocampus and adjacent temporal lobe regions, correlating with glucose hypometabolism in corresponding regions. One patient died after 26 years of disease duration with dementia and behavioural deficits. Pre-mortem, there was 18F-AV-1451 uptake in the temporal and frontal lobes, as well as in the basal ganglia, which strongly correlated with the regional extent and amount of tau pathology in post-mortem brain sections. Amyloid-β (18F-flutemetamol) positron emission tomography scans were negative in all cases, as were stainings of brain sections for amyloid. This provides strong evidence that 18F-AV-1451 positron emission tomography can be used to accurately quantify in vivo the regional distribution of hyperphosphorylated tau protein

Imaging tau pathology in Alzheimer's disease with positron emission tomography: lessons learned from imaging-neuropathology validation studies

Though the presence of both amyloid-β (Aβ) plaques and tau neurofibrillary tangles is necessary for neuropathologic diagnosis of Alzheimer’s disease (AD), it is now widely recognized that tau burden correlates more strongly with neurodegeneration and cognitive impairment in life than the development of Aβ plaques [1]. Recent developments of tau-sensitive radiotracers for imaging with positron emission tomography (PET) have, for the first time, enabled visualisation, mapping, and quantification of inclusions of aggregated, paired helical filament (PHF) tau associated with AD in the living brain [2]. In-depth characterisation of tau PET tracers, and in particular comparison of antemortem PET readings with postmortem neuropathologic findings, were of paramount importance to understand the clinical potential and limitations of the new imaging tools. In the case of [18F]flortaucipir, the most widely used tau PET ligand, these cross-validation studies, together with autoradiography evaluations, provided information about the specificity of this tracer to PHF-tau in AD but also revealed substantial undesired (off-target) binding and limited ability to detect PHF-tau at the earliest Braak stages [3,4,5,6,7]. The combined data subsequently underpinned the implementation of an effective method for the clinical interpretation of [18F]flortaucipir PET scans [3]. Ultimately, these efforts have led to the approval of [(18)^F]flortaucipir by the US Food and Drug Administration (FDA) as the first PET radiopharmaceutical indicated to ‘estimate the density and distribution of aggregated neurofibrillary tangles in patients with cognitive impairment who are being evaluated for AD (Tauvid prescribing information, https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/212123s000lbl.pdf)

Increased Medial Temporal Tau Positron Emission Tomography Uptake in the Absence of Amyloid-β Positivity

IMPORTANCE: An increased tau positron emission tomography (PET) signal in the medial temporal lobe (MTL) has been observed in older individuals in the absence of amyloid-β (Aβ) pathology. Little is known about the longitudinal course of this condition, and its association with Alzheimer disease (AD) remains unclear. OBJECTIVE: To study the pathologic and clinical course of older individuals with PET-evidenced MTL tau deposition (TMTL+) in the absence of Aβ pathology (A-), and the association of this condition with the AD continuum. DESIGN, SETTING, AND PARTICIPANTS: A multicentric, observational, longitudinal cohort study was conducted using pooled data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), Harvard Aging Brain Study (HABS), and the AVID-A05 study, collected between July 2, 2015, and August 23, 2021. Participants in the ADNI, HABS, and AVID-A05 studies (N = 1093) with varying degrees of cognitive performance were deemed eligible if they had available tau PET, Aβ PET, and magnetic resonance imaging scans at baseline. Of these, 128 participants did not meet inclusion criteria based on Aβ PET and tau PET biomarker profiles (A+ TMTL-). EXPOSURES: Tau and Aβ PET, magnetic resonance imaging, cerebrospinal fluid biomarkers, and cognitive assessments. MAIN OUTCOMES AND MEASURES: Cross-sectional and longitudinal measures for tau and Aβ PET, cortical atrophy, cognitive scores, and core AD cerebrospinal fluid biomarkers (Aβ42/40 and tau phosphorylated at threonine 181 p-tau181 available in a subset). RESULTS: Among the 965 individuals included in the study, 503 were women (52.1%) and the mean (SD) age was 73.9 (8.1) years. A total of 51% of A- individuals and 78% of A+ participants had increased tau PET signal in the entorhinal cortex (TMTL+) compared with healthy younger (aged <39 years) controls. Compared with A- TMTL-, A- TMTL+ participants showed statistically significant, albeit moderate, longitudinal (mean [SD], 1.83 [0.84] years) tau PET increases that were largely limited to the temporal lobe, whereas those with A+ TMTL+ showed faster and more cortically widespread tau PET increases. In contrast to participants with A+ TMTL+, those with A- TMTL+ did not show any noticeable Aβ accumulation over follow-up (mean [SD], 2.36 [0.76] years). Complementary cerebrospinal fluid analysis confirmed longitudinal p-tau181 increases in A- TMTL+ in the absence of increased Aβ accumulation. Participants with A- TMTL+ had accelerated MTL atrophy, whereas those with A+ TMTL+ showed accelerated atrophy in widespread temporoparietal brain regions. Increased MTL tau PET uptake in A- individuals was associated with cognitive decline, but at a significantly slower rate compared with A+ TMTL+. CONCLUSIONS AND RELEVANCE: In this study, individuals with A- TMTL+ exhibited progressive tau accumulation and neurodegeneration, but these processes were comparably slow, remained largely restricted to the MTL, were associated with only subtle changes in global cognitive performance, and were not accompanied by detectable accumulation of Aβ biomarkers. These data suggest that individuals with A- TMTL+ are not on a pathologic trajectory toward AD

Characteristics of amnestic patients with hypometabolism patterns suggestive of Lewy body pathology

A clinical diagnosis of Alzheimer's disease dementia encompasses considerable pathological and clinical heterogeneity. While Alzheimer's disease patients typically show a characteristic temporo-parietal pattern of glucose hypometabolism on FDG-PET imaging, previous studies identified a subset of patients showing a distinct posterior-occipital hypometabolism pattern associated with Lewy body pathology. Here, we aimed to improve the understanding of the clinical relevance of these posterior-occipital FDG-PET patterns suggestive of Lewy body pathology in patients with Alzheimer's disease-like amnestic presentations. Our study included 1214 patients with clinical diagnoses of Alzheimer's disease dementia (ADD; N=305) or amnestic mild cognitive impairment (aMCI, N=909) from the Alzheimer's Disease Neuroimaging Initiative, who had FDG-PET scans available. Individual FDG-PET scans were classified as suggestive of Alzheimer's (AD-like) or Lewy body (LB-like) pathology by using a logistic regression classifier previously trained on a separate set of patients with autopsy-confirmed Alzheimer's disease or Lewy body pathology. AD- and LB-like subgroups were compared on Aβ- and tau-PET, domain-specific cognitive profiles (memory vs executive function performance), as well as the presence of hallucinations and their evolution over follow-up (≈6y for aMCI, ≈3y for ADD). 13.7% of the aMCI patients and 12.5% of the ADD patients were classified as LB-like. For both aMCI and ADD patients, the LB-like group showed significantly lower regional tau-PET burden than AD-like, but Aβ load was only significantly lower in the aMCI LB-like subgroup. LB- and AD-like subgroups did not significantly differ in global cognition (aMCI: d=0.15, p=0.16; ADD: d=0.02, p=0.90), but LB-like patients exhibited a more dysexecutive cognitive profile relative to the memory deficit (aMCI: d=0.35, p=0.01; ADD: d=0.85 p<0.001), and had a significantly higher risk of developing hallucinations over follow-up (aMCI: HR=1.8, 95% CI = [1.29, 3.04], p=0.02; ADD: HR=2.2, 95% CI = [1.53, 4.06] p=0.01). In summary, a sizeable group of clinically diagnosed ADD and aMCI patients exhibit posterior-occipital FDG-PET patterns typically associated with Lewy body pathology, and these also show less abnormal Alzheimer's disease biomarkers as well as specific clinical features typically associated with dementia with Lewy bodies

Association of Chronic Kidney Disease With Plasma NfL and Other Biomarkers of Neurodegeneration: The H70 Birth Cohort Study in Gothenburg

BACKGROUND AND OBJECTIVES: Studies associate chronic kidney disease (CKD) with neurodegeneration. This study investigated the relation between kidney function, blood, cerebrospinal fluid (CSF), and structural brain MRI markers of neurodegeneration, in a sample including individuals with and without CKD. METHODS: Participants from the Gothenburg H70 Birth Cohort Study, with data on plasma-neurofilament light (P-NfL), estimated glomerular filtration rate (eGFR) and structural brain MRI were included. Participants were invited to also have CSF collected. The primary endpoint of the present study was to determine any association between CKD and P-NfL. Secondary endpoints included cross-sectional associations between CKD, eGFR and cerebrospinal fluid (CSF)- and MRI-derived markers of neurodegeneration and Alzheimer's disease (AD) pathology (MRI: cortical thickness, hippocampal volume, lateral ventricle volume, white matter lesion volume; CSF: β-amyloid (Aβ) 42, Aβ42/40, Aβ42/p-tau, t-tau, p-tau, NfL). Participants with P-NfL and eGFR at baseline were re-examined on eGFR, 5.5 (5.3; 6.1) years (median; IQR) after the first visit, and the predictive value of P-NfL levels on incident CKD was estimated longitudinally, using a Cox proportional hazards model. RESULTS: We included 744 participants, 668 without CKD (Age 71 (70; 71) years, 50% males) and 76 with CKD (age 71 (70;71) years, 39% males). Biomarkers from cerebrospinal fluid (CSF) were analysed in 313 participants. 558 individuals returned for a re-examination of eGFR (75% response rate, age 76 (76; 77), 48% males, 76 new cases of CKD). Participants with CKD had higher P-NfL levels than those with normal kidney function (median; 18.8 versus 14.0 pg/mL, p<0.001), while MRI and CSF markers were similar between the groups. P-NfL was independently associated with CKD after adjustment for confounding variables, including hypertension and diabetes (OR; 3.231, p<0.001), in a logistic regression model. eGFR, and CSF Aβ 42/40: R=0.23, p=0.004 correlated in participants with Aβ42 pathology. P-NfL levels in the highest quartile were associated with incident CKD at follow-up (HR; 2.08 (1.14: 4.50)). DISCUSSION: In a community-based cohort of 70-year olds, P-NfL was associated with both prevalent and incident CKD, while CSF and/or imaging measures did not differ by CKD status. Participants with CKD and dementia presented similar levels of P-NfL