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Applying the ATN scheme in a memory clinic population : The ABIDE project

Altomare, Daniele ; de Wilde, Arno ; Ossenkoppele, Rik LU ; Pelkmans, Wiesje ; Bouwman, Femke ; Groot, Colin ; van Maurik, Ingrid ; Zwan, Marissa ; Yaqub, Maqsood and Barkhof, Frederik , et al. (2019) In Neurology 93(17). p.1635-1646
Abstract

OBJECTIVE: To apply the ATN scheme to memory clinic patients, to assess whether it discriminates patient populations with specific features. METHODS: We included 305 memory clinic patients (33% subjective cognitive decline [SCD]: 60 ± 9 years, 61% M; 19% mild cognitive impairment [MCI]: 68 ± 9 years, 68% M; 48% dementia: 66 ± 10 years, 58% M) classified for positivity (±) of amyloid (A) ([18F]Florbetaben PET), tau (T) (CSF p-tau), and neurodegeneration (N) (medial temporal lobe atrophy). We assessed ATN profiles' demographic, clinical, and cognitive features at baseline, and cognitive decline over time. RESULTS: The proportion of A+T+N+ patients increased with syndrome severity (from 1% in SCD to 14% in MCI and 35% in dementia), while... (More)

OBJECTIVE: To apply the ATN scheme to memory clinic patients, to assess whether it discriminates patient populations with specific features. METHODS: We included 305 memory clinic patients (33% subjective cognitive decline [SCD]: 60 ± 9 years, 61% M; 19% mild cognitive impairment [MCI]: 68 ± 9 years, 68% M; 48% dementia: 66 ± 10 years, 58% M) classified for positivity (±) of amyloid (A) ([18F]Florbetaben PET), tau (T) (CSF p-tau), and neurodegeneration (N) (medial temporal lobe atrophy). We assessed ATN profiles' demographic, clinical, and cognitive features at baseline, and cognitive decline over time. RESULTS: The proportion of A+T+N+ patients increased with syndrome severity (from 1% in SCD to 14% in MCI and 35% in dementia), while the opposite was true for A-T-N- (from 48% to 19% and 6%). Compared to A-T-N-, patients with the Alzheimer disease profiles (A+T+N- and A+T+N+) were older (both p < 0.05) and had a higher prevalence of APOE ε4 (both p < 0.05) and lower Mini-Mental State Examination (MMSE) (both p < 0.05), memory (both p < 0.05), and visuospatial abilities (both p < 0.05) at baseline. Non-Alzheimer profiles A-T-N+ and A-T+N+ showed more severe white matter hyperintensities (both p < 0.05) and worse language performance (both p < 0.05) than A-T-N-. A linear mixed model showed faster decline on MMSE over time in A+T+N- and A+T+N+ (p = 0.059 and p < 0.001 vs A-T-N-), attributable mainly to patients without dementia. CONCLUSIONS: The ATN scheme identified different biomarker profiles with overlapping baseline features and patterns of cognitive decline. The large number of profiles, which may have different implications in patients with vs without dementia, poses a challenge to the application of the ATN scheme.

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Contribution to journal
publication status
published
subject
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Neurology
volume
93
issue
17
pages
1635 - 1646
publisher
American Academy of Neurology
external identifiers
  • scopus:85073664313
  • pmid:31597710
ISSN
1526-632X
DOI
10.1212/WNL.0000000000008361
language
English
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yes
id
58dc10de-5290-4b3c-ac21-10abcf9e4e21
date added to LUP
2019-10-31 08:33:19
date last changed
2020-01-16 04:06:56
@article{58dc10de-5290-4b3c-ac21-10abcf9e4e21,
  abstract     = {<p>OBJECTIVE: To apply the ATN scheme to memory clinic patients, to assess whether it discriminates patient populations with specific features. METHODS: We included 305 memory clinic patients (33% subjective cognitive decline [SCD]: 60 ± 9 years, 61% M; 19% mild cognitive impairment [MCI]: 68 ± 9 years, 68% M; 48% dementia: 66 ± 10 years, 58% M) classified for positivity (±) of amyloid (A) ([18F]Florbetaben PET), tau (T) (CSF p-tau), and neurodegeneration (N) (medial temporal lobe atrophy). We assessed ATN profiles' demographic, clinical, and cognitive features at baseline, and cognitive decline over time. RESULTS: The proportion of A+T+N+ patients increased with syndrome severity (from 1% in SCD to 14% in MCI and 35% in dementia), while the opposite was true for A-T-N- (from 48% to 19% and 6%). Compared to A-T-N-, patients with the Alzheimer disease profiles (A+T+N- and A+T+N+) were older (both p &lt; 0.05) and had a higher prevalence of APOE ε4 (both p &lt; 0.05) and lower Mini-Mental State Examination (MMSE) (both p &lt; 0.05), memory (both p &lt; 0.05), and visuospatial abilities (both p &lt; 0.05) at baseline. Non-Alzheimer profiles A-T-N+ and A-T+N+ showed more severe white matter hyperintensities (both p &lt; 0.05) and worse language performance (both p &lt; 0.05) than A-T-N-. A linear mixed model showed faster decline on MMSE over time in A+T+N- and A+T+N+ (p = 0.059 and p &lt; 0.001 vs A-T-N-), attributable mainly to patients without dementia. CONCLUSIONS: The ATN scheme identified different biomarker profiles with overlapping baseline features and patterns of cognitive decline. The large number of profiles, which may have different implications in patients with vs without dementia, poses a challenge to the application of the ATN scheme.</p>},
  author       = {Altomare, Daniele and de Wilde, Arno and Ossenkoppele, Rik and Pelkmans, Wiesje and Bouwman, Femke and Groot, Colin and van Maurik, Ingrid and Zwan, Marissa and Yaqub, Maqsood and Barkhof, Frederik and van Berckel, Bart N. and Teunissen, Charlotte E. and Frisoni, Giovanni B. and Scheltens, Philip and van der Flier, Wiesje M.},
  issn         = {1526-632X},
  language     = {eng},
  month        = {10},
  number       = {17},
  pages        = {1635--1646},
  publisher    = {American Academy of Neurology},
  series       = {Neurology},
  title        = {Applying the ATN scheme in a memory clinic population : The ABIDE project},
  url          = {http://dx.doi.org/10.1212/WNL.0000000000008361},
  doi          = {10.1212/WNL.0000000000008361},
  volume       = {93},
  year         = {2019},
}