According to the theory of cognitive reserve, cognitively enriching aspects of life experience (e.g., education, occupation, and leisure activity) foster the development of more efficient neural networks and cognitive strategies, enabling individuals to cope more effectively with the pathology of dementia. Using extant data from a population-based study, we examined: (1) the effect of reserve accrued through middle life on course of neuropsychological decline; and (2) the role of ongoing engagement in mentally stimulating leisure activities in rate of general cognitive and functional deterioration. In linear mixed models, level of occupational attainment did not affect rate of cognitive or functional decline, although women were found to undergo more rapid deterioration in cognitive ability. Occupational skill area was associated with trajectory of decline in several neuropsychological domains. Specifically, vocations emphasizing practical, hands-on skills were associated with slower deterioration in auditory-verbal and visual memory, as well as visuospatial and constructional abilities. Teaching and helping professions, in contrast, were associated with more rapid decline in memory and executive functioning. Increased engagement in cognitive leisure activities through late life was associated with slower deterioration in general cognitive ability in mild dementia, but its effects were no longer evident in more severe AD. An understanding of how rate of decline intersects with patients' past histories and efforts to maintain and enhance cognitive capacity will enable clinicians to target areas for cognitive training and rehabilitative therapy.

Alzheimer’s disease is a growing public health concern with the current number afflicted of 5 million in the US expected to triple by 2050. Since there is currently no cure or preventive pharmacological treatment, AD prevention research is now recognized as an important enterprise, with a goal to identify modifiable lifestyle factors that can reduce AD risk or delay its onset. Among these, increased physical activity, healthier food choices, more cognitive stimulation, better sleep quality, stress management, and social engagement have been identified as reasonable targets for behavioral intervention. A smartphone application-based behavioral intervention targeting these six behavioral domains was recently developed and a six-month randomized controlled trial was conducted, both to determine feasibility and compliance with technology usage and to test its efficacy. This study, titled the Gray Matters Study, was conducted in Cache County, Utah, enrolling a sample of 146 middle-aged participants (aged 40 to 64 years) randomized to treatment or control condition. Under the Health Belief Model, individuals who perceive a greater susceptibility to a particular health condition are hypothesized to be more likely to engage in more positive behaviors to reduce disease risk. Following this model, perceived threat of AD (operationalized by fear of AD, family history of AD, and metacognitive concerns) was examined for prediction of behavioral change over the six-month Gray Matters intervention period in these same six behavioral domains. Persons with a moderate level of fear of AD made significantly greater improvements in physical activity than those with low or high levels of fear. Family history was not a significant predictor of health-related behavioral change. However, persons with a moderate level of metacognitive concerns made significantly greater improvements in both physical activity and food quality than those with low or high levels of concerns. This is the first study to examine these psychological constructs related to AD risk and the extent to which they predict health-related behavior change. Future studies should extend the length of follow-up to at least one full year, include a more diverse sample of participants to expand generalizability, and build upon these findings to personalize supportive behavioral change interventions in order to be sensitive to these psychological factors.

Dementia is the top global public health threat of the twenty first century. Within the dementia spectrum, Alzheimer’s disease (AD) is the most common type of dementia that occurs with aging and accounts for about 60% - 80% of diagnosed cases. But currently available discoveries failed to develop disease-modifying therapies for all patients living with AD. Recent discoveries can only partially slow down cognitive decline in a small subset of patients with limited effectiveness. The heterogeneity and complexity of the pathophysiology of AD indicate that a single drug approach may not be sufficient to prevent disease onset and progression. Human umbilical cord blood cells (HUCBC) and lithium treatment have shown promise against numerous neurological conditions, including AD. Yet, they also show significant unwanted, adverse effects. To address this barrier to yield successful treatments, we employed two key modifications to these two treatment strategy. We used human umbilical cord blood derived serum (HUCBS, also labeled as CBS) rather than HUCBC. We also utilized ionic cocrystal of lithium salicylate l-proline (LISPRO, also labeled as LP) instead of usual lithium salt. Both HUCBS and LISPRO have been shown to have strong neuroprotective, anti-inflammatory properties in separate studies conducted in transgenic AD mouse models. The studies detailed herein independently investigated the effectiveness of biological (HUCBS) and pharmacological (LISPRO) approaches in modulating the pathology and cognitive impairments in AD mouse models (e.g., 5XFAD, 3XTg-AD, APPswe/PS1dE9, and Tg2576). While administration of HUCBC stimulate anti-inflammatory pathways shown in previous studies, we found that HUCBS markedly promoted neurotrophic soluble amyloid precursor protein alpha (sAPPα) through non-amyloidogenic amyloid precursor protein (APP) processing pathway compared to adult (ABS) and aged blood serum (AgBS) in Chinese hamster ovary cells expressing wild type APP (CHO/APPwt). Using chromatographic fractionation, mass-spectrometry, and targeting complement proteins in cord blood serum fraction (αCBSF), we discovered the source of sAPPα in HUCBS as C1 complement protein. Further, intraperitoneal administration of αCBSF via osmotic minipump for 6 weeks showed prevention of cognitive impairment in 5XFAD mice assessed by novel object recognition, and Y-maze test. A series of recent studies have shown that lithium can prevent both AD- and age-associated cognitive decline. But, current United States Food and Drug Administration-approved lithium pharmaceutics (carbonate and citrate forms) have a narrow therapeutic window and unstable pharmaceutics that can cause toxicity without monitoring. Here we investigated the safety, pharmacokinetics, and therapeutic efficacy of LISPRO (LP), lithium salicylate (LS), and lithium carbonate (LC) in cell culture and mouse (B6129SF2/J, Tg2576, and 3xTg-AD) models. Cytokine profiles from the brain, plasma and splenocytes demonstrated that 8-week oral treatment with LISPRO downregulates pro-inflammatory cytokines, upregulates anti-inflammatory cytokines and suppress renal cyclooxygenase 2 (COX2) expression in Tg2576 mice. Pharmacokinetic studies indicated that LISPRO provides significantly higher brain and more steady plasma lithium levels in both B6129SF2/J and transgenic Tg2576 mice compared with lithium carbonate. Oral administration of LISPRO for 28 weeks significantly reduced β-amyloid plaques and tau phosphorylation. In addition, LISPRO significantly elevated pre-synaptic (synaptophysin) and post-synaptic protein (post synaptic density protein 95) expression in brains from transgenic 3XTg-AD mice. Moreover, female APPswe/PS1dE9 mice at 4 months of age were orally treated with LP, LS, or LC for 8- to 9- months at 2.25 mmol lithium/kg/day followed by measuring body weight, internal organs’ growth, and cognitive and non-cognitive function. LISPRO treatment prevented cognitive decline compared with transgenic APPswe/PS1dE9 cohort, as shown by shorter escape latency during training and probe trials in the Morris water maze and longer contextual freezing time during fear conditioning. As expected, LISPRO treatment also reduced depression assayed by tail suspension test and irritability assessed with the touch escape test. But, lithium treatment did not alter anxiety or locomotor activity as assessed by open field, elevated plus maze or accelerated rotarod tests. Taken together, these data indicate that both biological HUCBS and pharmacological LISPRO treatment may prove to be viable effective strategy for ameliorating Alzheimer’s like pathology and cognitive impairment in preclinical models.

Objective: The purpose of this study was to assess the influence of three single nucleotide polymorphisms (SNP) previously associated with Alzheimer's disease on specific domains of cognition, when controlling for Apolipoprotein E gene (APOE), in a sample of individuals with Alzheimer's disease. Methods: The data were drawn from the Alzheimer's Disease Neuroimaging Initiative database, a comprehensive, longitudinal database of controls, persons with mild cognitive impairment, and persons with mild Alzheimer's disease. Each subject has a full neuropsychological assessment, neuroimaging, genetic sequencing, and physical evaluation. For the purposes of this study, individuals were selected based on the presence of the three SNPs of interest: CR1 (rs3818361_T), CLU (rs11136000_T), and PICALM (rs3851179_A). Each SNP was then measured against the available tests of the ADNI neuropsychological battery that measured immediate and long delay memory, semantic fluency, and confrontation naming. Results: Only the CR1 SNP (rs3818361_T) had significant findings. The presence of the CR1 SNP associated with lower performance on logical memory recall total score, AVLT immediate recall trials 2 and 4, AVLT delayed recall, and confrontation naming in the 12-month control group. Logical memory and AVLT delayed recall were also negatively associated with CR1 in the 12-month AD case group. Discussion: These results support previous findings that the CR1 SNP rs3818361_T is a risk factor for cognitive impairment in individuals with and without AD. Such findings can aid in the earlier detection of Alzheimer's disease, risk for domain specific cognitive impairment, and novel targets for personalized pharmacotherapy.

La maladie d'Alzheimer (MA) est une pathologie neurodégénérative principalement caractérisée par la présence de dépôts amyloïdes et d'enchevêtrements neurofibrillaires composés de protéines tau hyperphosphorylées. Tau est une protéine associée aux microtubules qui possède de nombreux sites de phosphorylation pouvant être phosphorylés par différentes kinases. En plus de la pathologie tau, on observe également dans le cerveau des patients atteints de la MA, une apparition précoce d’altérations métaboliques ainsi qu’une perte synaptique qui est à l’origine du développement des troubles cognitifs. En effet, les synapses sont des connexions neuronales essentielles pour la formation de la mémoire qui nécessitent une importante quantité d’énergie pour maintenir leurs fonctions. Depuis plusieurs années, des études suggèrent que l’AMPK – senseur métabolique essentiel des cellules – pourrait être impliquée dans le développement de la MA. En effet, des travaux réalisés in vitro ont permis de montrer que l’AMPK est une kinase de tau. Par ailleurs, il a été mis en évidence que chez les patients atteints de la MA, l’AMPK est dérégulée dans les neurones en dégénérescence où elle co-localise avec les protéines tau hyperphosphorylées. Enfin, des études menées dans notre équipe ont également permis de mettre en évidence que suite à une activation synaptique, l'AMPK restaure les niveaux d'énergie des neurones laissant ainsi supposer qu'une dérégulation de son activité pourrait avoir un impact néfaste sur le métabolisme neuronal. Au vu de ces données, les objectifs de mon projet de thèse ont donc été de déterminer l'impact d'une dérégulation de l’AMPK neuronale sur la pathologie tau, la perte synaptique et le métabolisme énergétique neuronal dans un modèle de culture primaire de neurones et in vivo chez la souris. La réalisation de ces objectifs nous a permis de démontrer (1) que l'AMPK régule la phosphorylation et la pathologie tau, (2) que la dérégulation de l’AMPK induit une diminution du nombre des synapses ainsi qu'une perte de la fonctionnalité du réseau neuronal, via une voie de signalisation impliquant l’autophagie et (3) que la dérégulation de l’AMPK entraine des perturbations du métabolisme énergétique neuronal. En conclusion, ce travail de thèse a permis d’apporter une meilleure compréhension sur le rôle de la dérégulation de l’AMPK dans le développement des différentes caractéristiques de la MA. Dans l’ensemble, ces données laissent fortement suggérer que l’AMPK pourrait faire le lien entre les dysfonctionnements métaboliques et l’ensemble des altérations qui se mettent en place au cours de la MA. / Alzheimer's disease (AD) is a neurodegenerative disorder mainly characterized by the presence of amyloid deposits and neurofibrillary tangles composed of hyperphosphorylated tau proteins. Tau is a microtubule-associated protein that bears many phosphorylation sites which can be phosphorylated by different kinases. Beside tau pathology, AD is also characterized by cerebral metabolic alterations and synaptic loss, the latter being responsible for the development of cognitive disorders. Indeed, synapses are essential for memory formation and require a large amount of energy to maintain their functions. Interestingly, studies have suggested that AMP-activated protein kinase (AMPK) – a crucial intracellular metabolic sensor – could be involved in the development of AD. Indeed, in vitro studies have shown that AMPK is a tau kinase. In addition, AMPK is deregulated in degenerating neurons of AD patients brain where it co-localizes with hyperphosphorylated tau proteins. Additionally, studies carried out in our team showed that upon synaptic activation, AMPK activity is essential to maintain neuronal energy levels thus suggesting that a deregulation of its activity could have harmful impact on neuronal metabolism. On the basis of these data, the objectives of this thesis were to determine the impact of neuronal AMPK deregulation on tau pathology, synaptic loss and neuronal energy metabolism in primary neurons and in vivo in mice. The achievement of these objectives allowed us to demonstrate (1) that AMPK regulated tau phosphorylation and pathology (2) that AMPK deregulation caused a decrease of synapses number as well as a loss of neuronal networks functionality, through a signaling pathway involving autophagy and (3) that AMPK deregulation impacted on neuronal energy metabolism. In conclusion, this thesis has provided a better understanding of the role of AMPK deregulation in the development of different hallmarks of AD. Altogether, these data strongly suggest that AMPK could be the link between neuronal metabolism dysfunctions and the development of the alteration that occur during AD.

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[Truncated abstract] Background: Dementia, largely due to Alzheimer's disease (AD), is a major public health problem. The early identification of disease is an important challenge for clinicians because treatment of AD is now available. A simple and accurate means of stratifying risk for AD and identifying early disease is needed so that risk factor modification and treatment can occur optimally. To date, despite many attempts, an accurate means of standardising an approach to the assessment of subtle cognitive symptoms has not been developed. A subjective complaint of poor memory has been identified as a possible marker for underlying brain disease. This study examines the utility of neuropsychological scores, homocysteine levels, APOE genotyping and brain imaging as predictors of cognitive decline in individuals with subjective memory complaint (SMC). Method Eighty subjects with SMC were recruited from memory clinics and the community (MC: 1). Forty-two control subjects were also examined (MC: 0). CAMDEX was used to describe baseline clinical features. The CAMCOG was used as a global test of cognition and was administered annually for four years. At baseline, neuropsychological testing was administered. Cranial CT scanning, measurement of plasma homocysteine and APOE genotyping were completed. Categorical variables were analysed using chi-square according to Pearson's method. Continuous data was analysed using Student's t-tests and Mann-Whitney tests. A logistic regression model was used to identify independent contributors to the presence of memory complaint. Participants were then matched for age, gender and time to follow-up (up for three years) to determine longitudinal predictors of cognitive decline. ... Baseline CAMCOG scores were greater in the control group (MC:0 = 98.3 ? 2.8, MC:1 94.2 ? 5.5, Z ?4.46, p 0.000). There were no differences in neuropsychological scores, concentration of total plasma homocysteine, APOE genotype or brain scan measurements. Using the Wald stepwise selection method, logistic regression could not be established due to non-convergence regardless of whether or not the continuous variables were re-coded into dichotomous variables. A matching process that created 32 pairs of controls/subjects allowed follow-up analysis. The controls showed significant improvement with time on the CAMCOG unlike subjects (mean ? SD, controls 1.5 ?-3.0, Z - 2.61, p 0.01, subjects 0.2 ? 3.2, Z ? 0.24, p 0.81). The logistic regression analysis showed that group membership could not be defined by any single independent variable. When group membership was abandoned and those with stable scores were compared to those who declined no clear meaningful independent predictors of decline apart from age were identified. Conclusions: Methodological issues such as small sample size and inadequate follow up duration were identified that may have precluded identification of predictive factors for cognitive decline. The results indicate that complaints of memory problems are not associated with established risk factors for Alzheimer's disease and fail to predict objective cognitive decline over three years. Future studies should continue trying to identify robust predictors of cognitive decline in later life.

Alzheimer�s disease (AD) is a neurodegenerative disorder, charaeterised by progressive loss of memory. It is important to understand what factors initiate the onset of AD so that effective therapeutic treatments can be developed to target the precise mechanisms that initiate this disease. Currently, synaptic dysfunction is widely believed to be the first significant alteration preceding the onset of AD, and is thought to be initiated by an intracellular accumulation of amyloid-β (Aβ), or a free radical-induced increase of oxidative stress. As Aβ levels rise during the onset of AD, a concomitant reduction of secreted amyloid precursor protein-α (sAPPα) is observed, as the two proteins exist in equilibrium. Intriguingly, the neuroprotective and neurotrophic properties of sAPPα indicate that it is intimately involved in the physiological pathways of the major hypotheses for the cause of AD, and may also be involved in the mechanisms that underlie learning and memory. Therefore, it is possible that during the onset of AD, the decrease of sAPPα may contribute to synaptic dysfunction by disrupting the mechanisms of synaptic plasticity. Long-term potentiation (LTP) is the leading experimental model for investigating the neural substrate of memory formation, and describes the molecular mechanisms that underlie an increase in the strength of synaptic transmission. The role sAPPα may play in the induction and maintenance of LTP has not previously been addressed in vivo. Therefore, the aim of this thesis was to investigate whether sAPPα affects the induction of LTP in the hippocampus of the anaesthetised rat. The present findings are the first to suggest that sAPPα may modulate the induction of LTP in vivo. Decreasing the function of endogenous sAPPα (with sAPPα-binding antibodies and a pharmacological inhibition of α-secretase) significantly reduced the magnitude of LTP induced in the dentate gyrus. Therefore, the reduction of sAPPα during AD is likely to have a detrimental impact on the mechanisms of synaptic plasticity, and by extension, learning and memory. The present investigation has also found that the application of recombinant, purified sAPPα to the rat hippocampus has an �inverted U-shaped� dose-response effect on the magnitude of LTP. Low concentrations of sAPPα significantly enhanced LTP, supporting previous findings that exogenous sAPPα can facilitate in vitro LTP and enhance memory performance in animals. On the other hand, comparatively high concentrations of sAPPα significantly decreased the magnitude of LTP. This observation is also consistent with previous findings, in which high concentrations of sAPPα have been shown to be less synaptogenic and memory enhancing than lower doses. These results are the first to suggest that sAPPα modulates in vivo synaptic plasticity, and have important implications for the development of strategies to treat AD.

In spite of impressive recent progress, the aetiopathogenesis of Alzheimer’s disease (AD) remains incompletely understood. The distinctive neuropathological features of AD, in particular the plaques and tangles, have been the particular focus of most aetiological theories. It is well accepted that AD is a multifactorial disease, with alterations to a variety of brain structures and cell types, including neurons, glia and the brain vasculature. Studies of risk factors have revealed a diversity of genetic variables that interact with health, diet and lifestyle-related factors in the causation of AD. These factors influence the structure, aggregation and function of a set of proteins that are increasingly the focus of research. The work in this thesis has focused on the pathophysiological aspects of some of these proteins in a number of cellular compartments and brain. Several assays have been established and techniques utilized in the completion of this work, including; differential detergent fractionation of brain tissue, 1D and 2D PAGE, western blotting with chemiluminescence detection, ELISA assays of Abeta 1-40 and 1-42, quantitative ECNI GCMS of o- and m-tyrosine as well as metabolites of the kynurenine pathway, quantitative MALDI-TOF assay of hemorphins and LCMSMS based proteomics, to identify proteins with altered expression levels in AD relative to control brain tissue. A variety of regional differences have been observed in the biochemistry of the AD cortex which are probably the outcome of local response variations to AD pathology. One of the most consistent threads throughout this work has been an apparent resilience of the occipital lobe relative to the other brain regions, as reflected in lower overall levels of oxidative stress and increased levels of proteins associated with metabolic processes, neuronal remodeling and stress reduction.