Dementia is a devastating disorder that commonly affects people over the age of 65. Alzheimer's disease and vascular dementia are the most common forms of dementias. A number of studies have implicated cardiovascular risks as important factors in the development of dementia. These risks include high-risk behaviors such as smoking and risks related at least partially to health behaviors such as diet and exercise. This study examines a group of cardiovascular risk factors, as defined by the Framingham study, to ascertain if they are predictors of dementia. A retrospective chart review of 481consecutive patients seen in a geriatric medicine clinic produced a sample of 177 individuals diagnosed with dementia and 304 individuals without a dementia diagnosis. Relative risk ratio (RRR) results indicate that a history of hypertension (RRR= 1.80, p = .009) and a history of hypercholesterolemia (RRR = 1.85, p = .016) are significant predictors of Alzheimer's disease. A history of tobacco use (RRR = 2.18, p = .01) is a significant predictor of vascular dementia. Stepwise regression analyses indicate that hypercholesterolemia is an independent predictor of dementia (b = -.113, p = .009) and hypercholesterolemia (b = -.104, p = .018) and hypertension (b = -.094, p = .031) clustered together have an additive risk factor effect. These results are discussed in terms of the importance of specific health behaviors in the development and possible prevention of dementia.

This study examined differences in scoring patterns among those diagnosed with Alzheimer's dementia and vascular dementia on the clock-drawing test. Archival clock drawing data was retrieved on 279 patients presenting at a county hospital-based memory clinic. Analysis of drawings was based on frequency of qualitative errors, as well as an overall quantitative score. Mean comparisons found those patients with Alzheimer's dementia to perform worse on both quantitative and qualitative scoring measures. However, Pearson's chi-squared test revealed a significantly higher rate of spacing errors among subjects with vascular dementia. Such lends support to my hypothesis that impaired executive functioning in vascular dementia patients would lead to poor qualitative performance. Logistic regression found significant predictive ability for the qualitative criteria in diagnosis (χ2 = 25.49, p < .001), particularly the rate of omission (z = 8.96, p = .003) and addition errors (z = 7.58, p = .006). Such findings hold important implications for the use of qualitative criteria in cognitive screening assessments.

Caregivers for individuals diagnosed with Alzheimer's disease (AD) shoulder a remarkably complex burden as compared to other caregivers of elderly individuals. For long distance caregivers, geographical separation further compounds the problems experienced by AD caregivers, as they are isolated from family members and support networks. Both on-site and long-distance AD caregivers experience uncertainty; the findings from this study illustrate how AD caregivers manage the uncertainty of the disease and primary care, as well as how uncertainty differs between on-site and long-distance caregivers. AD caregiver (N = 13) interviews were transcribed and qualitatively analyzed using uncertainty management theory as a thematic lens. The analysis revealed that AD caregivers experience overwhelming feelings of burden, guilt, and doubt; however, these feelings manifest differently depending on caregiver type. The findings of this study demonstrate that sources for obtaining information regarding AD and caregiving were useful for on-site caregivers; however, the sources did not account for the needs of long-distance caregivers or the psychosocial needs of on-site caregivers. Furthermore, AD caregivers did not seek support or information about AD and caregiving from health care professionals. Implications for future research regarding long-distance and on-site AD caregiving are discussed.

A doença de Alzheimer (DA) é complexa e de etiologia desconhecida. Provavelmente componentes multifatoriais influenciam no desencadeamento dessa patologia, sendo que o único fator genético de risco bem estabelecido até o momento para a doença é a variante alélica APOE*E4. Nos últimos anos, descobriu-se uma série de polimorfismos em genes diferentes sugerindo que essas alterações possam ter participação discreta na patologia. O presente estudo avaliou vinte e um polimorfismos distribuídos em treze genes, sendo estes APOE, ACE, APP, BDNF, CALHM1, CST3, GAB2, GAPDH, GSK3B, GSTP1, IL1A, IL1B e SORL1 , em pacientes, controles idosos e indivíduos com comprometimento cognitivo leve, na tentativa de verificar se existe algum tipo de associação entre os polimorfismos investigados como fatores de risco para DA. Nossos resultados mostraram associações positivas entre cinco polimorfismos conferindo risco elevado para o desenvolvimento de DA (rs429358 e rs7412 de APOE, rs2373115 de GAB2, rs6438552 de GSK3B e rs641120 de SORL1). Outro achado consistente de nosso estudo foi que 20/21 polimorfismos estudados apresentaram ao menos um genótipo associado com risco elevado para DA na presença de um alelo APOE*E4. Com nosso trabalho contribuímos para aumentar o conhecimento sobre a etiologia da DA, identificando possíveis marcadores moleculares de suscetibilidadenessa patologia. / Alzheimers disease (AD) is complex, and its ethiology is not completely understood yet. It is likely that multifactorial components do account for this pathology development, being the allelic variant APOE*E4 is the only well-established genetic risk factor so far. Recently, a series of polymorphisms located at different genes were related to AD, suggesting that those variations might have a modest participation in this pathology. The present study evaluated twenty-one polymorphisms distributed in thirteen genes, being them APOE, ACE, APP, BDNF, CALHM1, CST3, GAB2, GAPDH, GSK3B, GSTP1, IL1A, IL1B and SORL1, in elderly controls, AD and mild cognitive impairment patients, attempting to verify if there is any kind of association between the selected polymorphisms as risk factors for AD. Our results show positive associations between five polymorphisms and AD (APOE rs429358 and rs7412, GAB2 rs2373115, GSK3B rs6438552 and SORL1 rs641120). Another consistent finding was that 20/21 polymorphisms analyzed showed at least one genotype associated with increased risk for AD at the presence of at least one APOE*E4 allele. We intend that our research might contribute to increase what is known about AD ethiology, by deciphering possible molecular susceptibility markers evolved with this pathology.

No description available.

L’étude des interactions moléculaires au niveau des membranes biologiques est un enjeu capital pour le développement et le screening de nouvelles molécules médicamenteuses. La MA est la forme de démence sénile la plus répandue dans le monde et représente le principal problème socioéconomique en matière de soins de santé. L'apparition et la progression de cette maladie neurodégénérative sont associées à l'agrégation du peptide Aβ.Une stratégie thérapeutique contre la MA consiste à développer des molécules capables d'interférer à des étapes spécifiques de l’agrégation du peptide. Pour les identifier, des méthodes expérimentales sont nécessaires pour suivre et caractériser le peptide Aβ au cours de son processus de fibrillation. Ces méthodes doivent être suffisamment simples pour rester compatibles avec une démarche de drug discovery. Dans le présent travail de thèse, nous avons proposé de combiner des méthodes expérimentales pour permettre une caractérisation multiparamétrique de modulateurs potentiels de la fibrillation du peptide Aβ1-42, en y intégrant des liposomes de composition définie, comme membranes neuronales biomimétiques. Il est en effet établi que les lipides neuronaux sont un facteur important dans la formation des fibres amyloïdes et leur toxicité. Les liposomes ont été formulés par la méthode de réhydratation de film lipidique, et leurs propriétés physico-chimiques caractérisées par RMN, DLS, potentiel ζ.La détermination expérimentale du coefficient de partage de composés d’intérêt a pu être réalisée par spectrophotométrie, y compris de façon originale, par fluorescence, en utilisant ces liposomes, dans des tests miniaturisés. Des études cinétiques de l’agrégation du peptide Aβ1-42 ont été effectuées en présence de liposomes. La fluorescence de la ThT a été mesurée pour suivre la voie de la fibrillation du peptide Aβ, utilisé dans sa forme sauvage ou celle d’un mutant oligomérique, l’oG37C. Une analyse de fuite d’un fluorophore à partir des liposomes, appuyée par des mesures en DLS, a été réalisée afin d'évaluer l'impact des interactions entre le peptide et les membranes pour prévoir tout effet de déstabilisation. Les fibres toxiques formées par Aβ étant principalement organisées en feuillets β, les données ont été corrélées à l'analyse de la structure secondaire du peptide par spectroscopie ATR-FTIR. Après avoir mis en œuvre cette approche sur différentes molécules modèles et un hit d’intérêt potentiel dans le traitement de la MA, l’ensemble de ce travail a abouti à un test multiparamétrique permettant la caractérisation de l’interactome molécules/Aβ/membranes et la discrimination de modulateurs de l'agrégation du peptide Aβ1-42. Cette approche pourra être avantageusement transposée à d'autres maladies amyloïdes. / The study of molecular interactions at the level of biological membranes is a key issue for the screening and the development of new drugs. Alzheimer's disease (AD) is the most common form of senile dementia in the world and is the leading socio-economic problem in health care. The appearance and progression of this neurodegenerative disease are associated with the aggregation of the amyloid-β peptide (Aβ). A therapeutic strategy against AD consists in the development of molecules able to interfere with specific steps of Aβ aggregation. To identify such compounds, experimental methods are required to monitor and characterize the Aβ peptide during its fibrillation process. These methods must be simple enough to remain compatible with drug discovery. In this PhD project, we have proposed to combine experimental methods to allow a multiparametric characterization of potential Aβ1-42 fibrillation modulators, by integrating liposomes of defined composition as biomimetic neuronal membranes. It is indeed established that neuronal lipids are an important factor in the formation of amyloid fibers and their toxicity. The liposomes were formulated by the lipid film rehydration method, and their physicochemical properties characterized by NMR, DLS, ζ potential. The experimental determination of the compounds partition coefficient could be carried out by spectrophotometry, including in an original way, by fluorescence, these liposomes, in miniaturized tests. Kinetic studies of Aβ1-42 peptide aggregation were performed in the presence of liposomes.The ThT fluorescence was monitored to follow the Aβ peptide fibrillation pathway, used in its wild form or with an oligomeric mutant, oG37C. A fluorophore leakage analysis from liposomes, supported by DLS measurements, was performed to evaluate the impact of peptide/membranes interactions to predict any destabilization effects. The toxic fibers formed by Aβ being mainly organized in β-sheets, the data were correlated with the analysis of the peptide secondary structure by ATR-FTIR spectroscopy. After the implementation of this approach on different model molecules and a hit of potential interest in the AD treatment, all of this work has resulted in a multiparametric test allowing the molecules/Aβ/membranes interactome characterization and the discrimination of Aβ1-42 peptide aggregation modulators. This approach may be advantageously transposed to other amyloid diseases.

Autophagy is the major cellular, conservative, lysosomal catabolic process to eliminate and recycle intracellular waste and organelles through autophagosomes. Enhancing autophagy to promote the clearance of toxic proteins is developing as a promising approach to treat proteinopathy disorders like Alzheimer's disease (AD). AD is the most common aging-associated neurodegenerative disease. It is characterized by the aggregation of aberrantly hyperphosphorylated tau (p-Tau) and excessively produced Amyloid-beta (Aβ) into neurofibrillary tangles (NFTs), and amyloid plaques (AP) respectively. Reprogramming autophagy lysosomal pathway (ALP) through autophagy master controller, transcription factor EB (TFEB), is developing as an attractive strategy to treat AD. It is already proven that TFEB overexpression can promote Aβ and p-Tau lysosomal clearance, attenuate NFT and AP deposition and restore the behavioural deficits in AD mice models. Previously Song et al., 2016 have identified a small molecule curcumin derivative C1. They reported that C1 could bind to recombinant TFEB and enhance ALP both in vitro and in vivo conditions independent of mTOR inhibition. In the current study, C1 is systematically evaluated for its bioavailability, anti-AD efficacy in vitro, and in vivo AD experimental models. To validate TFEB mediated anti-AD efficacy of C1 in vitro, we tested the C1 effect on amyloid precursor protein (APP) and p-Tau degradation in vitro neuronal AD cell culture models. In N2a cells overexpressed with APP (695) and EGFP-P301L tau plasmids, C1 induced APP, CTFβ, and Tau lysosomal degradation. To demonstrate the TFEB dependent autophagic clearance effects of C1, TFEB is silenced in N2a cells with lentiviral shRNA particles. Under TFEB silenced condition, C1 induced reduction of FL-APP, CTFβ, and Tau was compromised. Overall In vitro experiments show that C1 induced lysosomal digestion of FL-APP, CTFβ, and p-Tau in a TFEB dependent manner. To further demonstrate C1 brain bioavailability, C1 and curcumin comparative pharmacokinetic studies (Pk study) in both mice (time course Pk study) and rat (single time point analysis) are conducted. In Pk studies, both C1 and curcumin are dosed at 10 mg/kg to determine their concentration in the whole brain (mice), separate brain regions (rat), CSF (rat), and plasma. The WinNonlin analysis of C1 and curcumin mice Pk study data revealed that C1 is significantly more bioavailable than curcumin in both brain and plasma, which is also corroborated by the single time point analysis in rats. To illustrate C1 anti-AD activity in vivo, C1 is screened in homozygous P301S (Tau), heterozygous 5xFAD (Aβ), and homozygous 3xTg (both Aβ and Tau) AD transgenic mice models. These mice were started to treat with C1 before the onset of AD pathology until the AD pathological phenotype is expressed to cause impairment in mice behaviour. In mice behavioural examination, C1 treatment has significantly improved mice motor function (Rotarod-P301S), restored cognitive impairment related to the cortex (contextual fear conditioning-5xFAD), hippocampus (Morris water maze-3xTg) and improved cholinergic activation (open field-3xTg). In the brain biochemical examination, C1 activated the TFEB mediated ALP pathway to degrade FL-APP, CTFα/β, Aβ, and p-Tau and reduced the amyloid plaque load, extra neuronal-NFT positive cells. Notably, C1 treatment in 5xFAD mice has significantly restored hippocampal synaptic function. In summary, the current study validates C1 as an orally bio-available potent small molecule TFEB activator which restores mice cognitive impairment, altered behaviour, and synaptic plasticity by reducing Aβ and tau levels in AD experimental models. Overall, the TFEB activator C1 can be a promising drug to treat AD.

The prevalence of both Type 2 diabetes mellitus (T2DM) and Alzheimer's disease (AD) is increasing worldwide, and the trends are unfortunately expected to continue. AD has recently been tied with mitochondrial dysfunction and insulin resistance, creating a mechanistic tie between AD and T2DM. Unfortunately, insulin resistance is often increased with aging and therefore, all individuals are at risk of brain mitochondrial dysfunction. Without proper mitochondrial function, the brain will degenerate, causing impaired cognitive function and reduced quality of life. The purpose of this study is two-fold: first, to understand the role of ceramides in insulin-induced brain mitochondrial dysfunction, and; second, to understand how ketones can restore brain mitochondrial function in aged brains. To evaluate the role of insulin resistance and ceramides in brain mitochondrial function, we induced hyperinsulinemia in ApoE4 mice. In addition to insulin, one group received myriocin injections to inhibit ceramide biosynthesis. We observed significant increases in brain ceramides in the insulin-treated group, which correlated with disrupted brain mitochondrial function. However, the group receiving myriocin alone, and, importantly, myriocin with insulin, had normal lipid profiles and normal mitochondrial bioenergetics. Altogether, these findings support the hypothesis of the key role of ceramides in insulin resistance-induced mitochondrial dysfunction within the brain. Next, young adult (5 months old) and old (28 months old) rats were assigned to either standard chow diets or very-low-carbohydrate, high-fat, ketogenic diets for 4 weeks. Following the treatment period, we analyzed brain mitochondrial function and oxidative stress. We found that the old rats fed the ketogenic diet had improved mitochondrial function in comparison to the old rats consuming standard rodent chow. In addition, the old rats fed a standard diet had significantly higher levels of oxidative stress than the aged rats on the very-low-carbohydrate, high-fat diet. These findings revealed that ketones can protect brain mitochondrial function in aging. Collectively, these results suggest that insulin resistance has a role in the development of brain mitochondrial dysfunction due to ceramide accumulation, while ketones can help mitigate some of the negative consequences of aging, perhaps some due to insulin resistance, on brain mitochondrial function.

No description available.

Accumulation of amyloid beta (Aβ) in the brain is a pathological hallmark of Alzheimer's disease (AD) and has been shown to lead to synaptic dysfunction and cognitive decline. Recent studies have indicated synapse dysfunction as an early pathology in AD, but how synaptic function is altered by Aβ remains unclear. We hypothesize that neuronal functional stability may be altered by Aβ via dysregulation of homeostatic synaptic plasticity (HSP), a negative-feedback-based regulation that serves to restrain neuronal activity within a physiological range. Here, I show that Aβ can regulate HSP in response to activity deprivation with an over scaling up of postsynaptic AMPAR expression and excitatory synaptic currents. Aβ treatment during activity deprivation increases the surface expression of both calcium-permeable (Cp), GluA2-lacking (CpAMPARs) and regular, GluA2-containing AMPARs. This in turn may make neurons more vulnerable to neuronal injury after a toxic glutamatergic challenge. Homeostatic synaptic scaling requires the PI3K/Akt signaling pathway and expression of CpAMPARs. Consistent with this, I found that blockade of either PI3K or CpAMPARs occludes over-scaling in the presence of Aβ, suggesting that the enhancement of HSP is mediated through homeostatic mechanisms. Furthermore, challenging neurons with glutamate after Aβ-mediated enhancement of HSP shows increased neuronal death. These findings provide a novel mechanism by which Aβ alters neuronal plasticity and calcium homeostasis in the brain, suggesting that the HSP pathway may be a target in clinical treatment of Alzheimer's disease.