1. Neuropathology of Parkinson’s Disease with Dementia (CN)
11/21/ :57 PM
CSF biomarkers in neurodegeneration: Preliminary findings and cut-offs recommendations of the Croatian project on early detection of Alzheimer’s disease Likvorski biološki biljezi u neurodegeneraciji: Preliminarni rezultati i preporučene isključne vrijednosti hrvatskog projekta ranog otkrivanja Alzheimerove bolesti
Goran Šimić, MD, PhD
Full Professor of Neuroscience and Anatomy Redoviti profesor neuroznanosti i anatomije
Department of Neuroscience, Croatian Institute for Brain Research
Zavod za neuroznanost, Hrvatski institut za istraživanje mozga
Medical School Zagreb
Medicinski fakultet Zagreb
6th Croatian Congress on Alzheimer’s disease
6. hrvatski kongres o Alzheimerovoj bolesti
Primošten, 15 Oct 2012
Hrvatska zaklada za znanost
Projekt br. 09/16 ( )
Croatian Science Foundation

2. Croatian Science Foundation project Projekt Hrvatske zaklade za znanost

3. Collaborators / Suradnici na projektu
Neuropathology of Parkinson’s Disease with Dementia (CN)
11/21/ :57 PM
Collaborators / Suradnici na projektu
Hrvatska zaklada za znanost
Projekt br. 09/16 ( )
Matea Nikolac, Nela Pivac, Dorotea Mück Šeler, Gordana Nedić, Maja Mustapić, Mirjana Babić, Fran Borovečki, Dubravka Švob Štrac, Maja Jazvinšćak Jembrek, Sanja Hajnšek, Ratimir Petrović,
Svjetlana Kalanj Bognar, Željka Vukelić, Patrick R. Hof,
Milan Radoš, Ninoslav Mimica, Paola Presečki, Danira Bažadona, Nataša Jovanov Milošević, Gabrijela Stanić, Neven Henigsberg
Croatian Science Foundation

4. Major issues in dementia syndrome Ključni problemi sindroma demencije
1. Similar clinical picture of dementia – many histologies /
Slična klinička slika
– različiti neuropatološki supstrati
2. Late th intervention is less efficient / kasna th intervencija nije učinkovita

5. Main goals of the project Glavni ciljevi projekta
1. To use/identify biomarkers suitable for better differentiation of the primary causes of dementia / pospješiti razlikovanje primarnih uzroka demencije pomoću za tu svrhu prikladnih bioloških biljega
2. To establish reliable early diagnosis (in the preclinical stage) of the disease by „pattern recognition” i.e. by using a combination of clinical/genetical/imaging/biomarker data uspostaviti pouzdanu ranu dijagnozu (po mogućnosti u predkliničkom stadiju bolesti) uz pomoć kombinacije kliničkih/genetskih/slikovnih/bioloških podataka

6. Autosomal dominant AD Autosomno dominantna AB
Schellenberg et al., 2012

7. Autosomal dominant AD Autosomno dominantna AB
Schellenberg et al., 2012

8. Autosomal dominant AD Autosomno dominantna AB
Bielschowsky
H-E, 200x
Schellenberg et al., 2012

9. Sporadic late-onset AD Sporadična AB s kasnim početkom
Schellenberg et al., 2012

10. Sporadic late-onset AD Sporadična AB s kasnim početkom
Bielschowsky

11. Hypothetical time line for the onset and progression of sporadic AD
Trojanowski et al., 2011

12. Nagao prijelaz zbog
superponiranog
age-associated gubitka
sinapsi i neurona.

13. Early concern (ADI 10 warning signs) www.alzheimer.hr
Current approaches to early assessment of MCI to AD conversion Današnje mogućnosti u ranoj dijagnostici konverzije MCI u AD
Early concern (ADI 10 warning signs)
Dementia severity psychological assessment tools (lack early power as well as MMSE)
Positive diagnostic tests (still too invasive and expensive for screening):
1. Structural MRI (hipp. & entorh. cx lower
volumes, whole cx lower volume)
2. F-nal PET brain scan (FDGlucose, NFT: DDNP,
BA: Thioflavin-S & Congo-red derivatives - radioisotopes)
3. CSF – elevated total tau and phospho-tau levels, low -amyloid levels

14. Fox et al. Lancet ‘04
Fox et al. Lancet ‘04

16. AD – parijeto-temporalni hipometabolizam
(perfuzijski SPECT KBC Zagreb, Dr. Ratimir Petrović )

17. + Nordberg A. et al.
Lancet Neurology
2004

19. Major pitfalls (1) Glavne poteškoće (1)
The first major pitfall when studying CSF biomarkers to predict AD in MCI cohorts is the fact that conversion from MCI to AD in specialist clinical setting is only about 9.6% per year (in contrast, only 1-2% of healthy older population convert to AD per year), whereas the rest of MCI patients have a less progressive form of memory impairment (Mitchell et al., 2009);
Therefore, only an extensive follow-up time (5 – 10 years) of patients with stable MCI might further increase the specificity of CSF/other biomarkers
Only then (after 5-10 years) we will be able to conclude which cut-off levels are best to distinguish MCI that will progress to AD from those who will not

20. Major pitfalls (2) Glavne poteškoće (2)
The second major pitfall when studying CSF biomarkers to predict AD in MCI cohorts is the fact that use of clinical diagnosis instead of neuropathological diagnosis lead to a 14-17% underestimation of the CSF biomarker accuracy (Toledo et al., 2012);
Therefore, to increase the accuracy for the early diagnosis of AD (and neurodegenerative disease in general) CSF diagnostic panels much be standardized and established based on neuropathological rather than clinical diagnoses!

21. Preliminary data /Preliminarni podatci N=126: 54 AD, 30 MCI, 9 VaD, 4 LBD, 11 FTD, 18HC

22. Preliminary data according to clinical dg Preliminarni podatci prema kliničkim dg

23. ROC analysis of preliminary data
AD vs CON
(Number of patients)
Cut off
Sensitivity (%)
Specificity (%)
AUC
P-value
Specificity (if sensitivity ≥ 85%)
T-tau (102)
226,5 pg/ml
75,9
72,2
0,744
0,002*
55,6
Aβ (102)
309,75 pg/ml
90,7
44,4
0,661
0,042*
P-tau231 (36)
7,61 U/ml
76,5 80
0,824
0,031* 61
AD vs MCI
249,2 pg/ml
70,4
73,3
0,754
<0,001*
43,3
245,8 pg/ml
79,6
46,7
0,595
0,151
3,76 U/ml
88,2
64,3
0,811
0,003*

24. MCI to AD p-tau199
Urakami, Psychogeriatrics ‘06

25. p-tau231
Vrijednosti p-tau231 markera iz likvora bile su statistički značajno više u skupini bolesnika s AB u odnosu na skupinu bolesnika s MCI (U=45; Z=-2,938; p=0,003), odnosno kontrolnu skupinu (U=15; Z=-2,155; p=0,031).
No, nije nađena statistički značajna razlika za p-tau231 između skupine bolesnika s MCI i kontrolne skupine (U=30; Z=-0,463; p=0,687).

26. Toxicity of soluble tau Toksičnost topljivih tau proteina

27. Toxicity of soluble tau Toksičnost topljivih tau proteina
Kopeikina et al., 2012

28. Thank you for your attention! Zahvaljujem na pažnji!