Introdução: segundo a literatura, sais de lítio podem produzir redução da função renal. A magnitude dessa informação é debatível, uma vez que não há estudo clínico randomizado e controlado entre usuários de lítio, em sua maioria pacientes com depressão ou transtorno bipolar. A possibilidade do uso do lítio para o tratamento da demência de Alzheimer prodrômica reforça a necessidade de maior investigação de efeitos adversos atribuídos ao lítio, especialmente com relação à função renal. Objetivos: avaliar a segurança da utilização do lítio em baixa dosagem com relação à função renal de pacientes idosos. Como objetivos secundários serão avaliadas: a segurança clínica através de exame e questionário específico, as funções tireoidiana, imunológica e o metabolismo glicêmico. Métodos: estudo randomizado e placebo controlado de 2 anos, seguido de fase aberta por mais 2 anos. Foram avaliados 59 idosos com comprometimento cognitivo leve com seguimento mínimo de dois anos (fase controlada). A função renal foi estimada através das fórmulas aMDRD e CKD- EPI, a partir de exames laboratoriais e dados clínicos coletados durante o estudo. As funções tireoidiana, imunológica e glicêmica foram avaliadas respectivamente através de TSH, T4 livre, leucócitos total, neutrófilos, linfócitos, glicemia e insulinemia de jejum, e HOMA-IR. A segurança clínica foi avaliada através de entrevista sistemática realizada a cada 3 meses, utilizando exame físico e a escala UKU para efeitos adversos. Resultados: não houve piora da função renal com o uso do lítio (litemia entre 0,25-0,5 mmol/l) tanto pela aMDRD (p=0,453) como pela CKD-EPI (p=0,181). Houve aumento significativo de neutrófilos (p=0,038) e do TSH (p=0,034). O grupo lítio apresentou incidência significativamente maior de diabetes mellitus (p=0,037) e arritmias (p=0,028), maior ganho de peso (p=0,015), mais sintomas na escala UKU (p=0,045), e maior interferência dos efeitos adversos do lítio em atividades diárias (p<0,001). Houve correlação entre a opinião de médico e do paciente nas interferências das atividades diárias atribuídas aos sintomas adversos (p<0,001). Conclusões: o uso de lítio em baixa dose não alterou a função renal, produziu alterações no sistema imunológico e tireoidiano sem impacto clínico, e foi seguro clinicamente. As razões do aumento de incidência de diabetes e arritmias merecem investigação posterior / Introduction: according to the literature, lithium salts may produce a reduction in kidney function. The magnitude of this information is debatable because there is no randomized and controlled clinical trial among lithium users, being mostly patients with depression or bipolar disorder. The possibility of using lithium for the treatment of prodromal Alzheimer\'s disease dementia increases the need for further investigation of adverse effects attributed to lithium, especially regarding to renal function. Objectives: To evaluate the safety of using low-dose lithium with respect to renal function in elderly patients. Secondary objectives were the evaluation of the clinical safety through specific questionnaire and clinical assessment, and to assess thyroid, immunological and glycemic function. Methods: a randomized and placebo controlled study for 2 years, followed by an open label follow-up of 2 years. We evaluated 59 elderly patients with mild cognitive impairment with accomplishment of at least two years of the controlled phase. Renal function was estimated by the aMDRD and CKD-EPI equation, and by laboratory and clinical data collected during the trial. The thyroid, immunological and glycemic functions were respectively evaluated by TSH, free T4, leukocyte count, neutrophil count, lymphocyte count, fasting plasma glucose and insulin, and the HOMA-IR. The clinical safety was evaluated through systematic examination performed every 3 months, with physical examination, clinical interview and UKU scale for adverse effects. Results: There was no decline of renal function with the use of lithium (litemia between 0.25-0.5 mmol/l) both in the aMDRD (p=0.453) and CKD-EPI (p=0.181) equations. A significant increase of neutrophils (p=0.038) and TSH (p=0.034) were observed. The lithium group showed significantly higher incidence of diabetes mellitus (p=0.037), arrhythmias (p=0.028), weight gain (p=0.015), more symptoms of UKU scale (p=0.045), and greater interference from the adverse effects of lithium during daily activities (p<0.001). There was an observed correlation between the opinion of the attending physician and the patient in respect to the interference in daily activities secondary to the adverse symptoms (p<0.001). Conclusions: The use of lithium in low doses did not result in renal function impairment, produced subtle changes in the immunological system and thyroid function, and was clinically safe for adverse effects. The reasons for the increased incidence of arrhythmias and diabetes mellitus deserve further investigation

A inibição do transporte axonal é um evento que ocorre prematuramente no curso das doenças neurodegenerativas, inclusive antes da formação dos agregados proteicos, os quais estariam envolvidos no processo fisiopatológico das doenças neurodegenerativas. No presente estudo avaliou-se a hipótese de que alterações no transporte de mitocôndrias ocorrem antes da formação dos agregados proteicos envolvidos em neurodegeneração, devido a desregulação dos níveis citoplasmáticos de Ca2+ e o envolvimento da modulação do transporte mitocondrial provido pela proteína Miro neste cenário. Utilizaram-se dois modelos experimentais: o primeiro utilizando a exposição à rotenona em culturas primárias de neurônios do locus coeruleus, hipocampo e substância negra de ratos, e o segundo utilizando neurônios derivados de células tronco de pluripotência induzida (iPSC), isogênicas humanas contendo mutações que levam à deleção do exon 9 da (deltaE9) no gene da presenilina 1 (PS1), o qual apresenta aumento da síntese do peptídeo beta-amiloide com 42 aminoácidos (Abeta42), sem a formação de agregados proteicos. Os resultados mostram disfunções nos níveis citoplasmáticos de Ca2+ em ambos modelos. A mobilidade mitocondrial alterou-se no hipocampo, locus coeruleus e substância negra após exposição à rotenona. No entanto, a direção das alterações observadas não se correlacionaram com os níveis de Ca2+, de acordo com o já descrito na literatura. Não houve alteração da mobilidade mitocondrial, nem nos níveis de Miro1, nos neurônios derivados de iPSC. Em conclusão, o presente estudo demonstrou que alterações nos níveis citoplasmáticos de Ca2+ ocorrem antes e durante a formação de agregados proteicos, o que pode ser importante para a etiologia de doenças neurodegenerativas. Foi também demonstrado que mudanças na mobilidade mitocondrial, acompanhadas por alterações nas concentrações intracelulares de Ca2+, em níveis fisiológicos, ocorrem de forma independente dos níveis da proteína Miro1 em culturas de células. Porém são necessários novos estudos a fim de relacionar alterações na mobilidade mitocondrial e a indução da neurodegeneração / The axonal transport impairment occurs early in neurodegenerative diseases, even before the formation of protein aggregates, which are related with the neuropathophysiology mechanism in neurodegenerative diseases. In this study, we evaluate the hypothesis that disruptions in mitochondria transport occurs before the formation of protein aggregate related with neurodegeneration, triggered by dysregulations in cytosolic Ca2+ levels and the involvement of Miro Ca2+ dependent mechanism of mitochondria trafficking modulation. We employed two experimental models, first using rotenone exposure in primary neuronal cell cultures from locus coeruleus, substantia nigra and hippocampus of newborn rats. Second, using isogenic human neurons derived from induced pluripotent stem cells (iPSCs), harboring mutations, those induce exon 9 deletion (deltaE9) in Presenilin 1 (PS1) gene, and showing increased synthesis of amyloid beta peptide with 42 amino acids (betaA42) without the formation of protein aggregates. We found abnormalities in cytosolic Ca2+ levels in both experimental models, mitochondria trafficking were altered in hippocampus, substantia nigra and locus coeruleus. However, the pattern of mitochondria trafficking alterations did not correlate with cytosolic Ca2+ levels, accordingly with the data that was already published. We did not find alterations in mitochondria trafficking or Miro1 levels in neurons derived from iPSC. In conclusion, our finds demonstrated aberrant cytosolic Ca2+ levels before and during protein aggregation, which may be important for the etiology of neurodegenerative diseases. In addition, this dysfunction in mitochondria trafficking happens after changes in cytosolic Ca2+ levels, in physiological range, independent of Miro1 levels in primary neurons cell cultures. Therefore, new studies need to be done, aiming to elucidate the relation between mitochondria trafficking dysfunctions and the induction of neurodegeneration process.

by Wong Kin Kwan Kelvin. / Thesis submitted in: September 2004. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 91-101). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / 摘要 --- p.iv / Abbreviations --- p.x / List of Figures --- p.xiii / List of Tables --- p.xiv / Chapter Chapter 1 --- Intorduction --- p.1 / Chapter 1.1 --- Alzheimer，s disease --- p.1 / Chapter 1.2 --- Histopathological features --- p.1 / Chapter 1.3 --- Tau protein pathology and AD --- p.4 / Chapter 1.4 --- Tau protein kinase I (TPKI)- GSK-3β --- p.6 / Chapter 1.5 --- Tau protein kinase II (TPKII)- Cyclin dependent kinase 5 (Cdk5) --- p.8 / Chapter 1.6 --- Available treatment --- p.9 / Chapter 1.7 --- Objectives of the present study --- p.12 / Chapter Chapter 2 --- Screening for GSK-3p inhibitors from Traditional Chinese Medicine (TCM) --- p.13 / Chapter 2.1 --- Introduction --- p.13 / Chapter 2.1.1 --- Phosphorylation of tau in AD --- p.13 / Chapter 2.1.2 --- Gsk-3p inhibitors --- p.14 / Chapter 2.1.3 --- Screening of GSK-3β inhibitor from TCM --- p.16 / Chapter 2.2 --- Material and Methods --- p.18 / Chapter 2.2.1 --- Preparation of extracts and fractions (AOF1-5) --- p.18 / Chapter 2.2.2 --- General cell culture techniques --- p.21 / Chapter 2.2.3 --- "3-(4,5-dimethyltiazoI-2-yl)-2, 5-diphenyl-tetrazolium (MTT) assay of AOF" --- p.23 / Chapter 2.2.4 --- Recombinant DNA techniques --- p.23 / Chapter 2.2.5 --- Transfection of GSK-3β and tau cDNA into COS7 cells --- p.28 / Chapter 2.2.6 --- Extraction of total proteins from culture cells --- p.28 / Chapter 2.2.7 --- Quantitation of protein by the Bradford method --- p.29 / Chapter 2.2.8 --- Protein separation by sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS-PAGE) --- p.29 / Chapter 2.2.9 --- Western blot analysis --- p.31 / Chapter 2.2.10 --- GSK-3β kinase assay --- p.32 / Chapter 2.2.11 --- Determination of lithium content by atomic adsorption spectrophotometry --- p.34 / Chapter 2.3 --- Results --- p.35 / Chapter 2.3.1 --- Establishment of a co-transfected cell model for GSK-3β induced tau hyperphosphorylation --- p.35 / Chapter 2.3.2 --- Preliminary screening results of aqueous and ethanol extracts (AOF1 and AOF2) --- p.37 / Chapter 2.3.3 --- Ethanol extract of AOF inhibits GSK-3p induced tau phosphorylation in COS-7 cells --- p.40 / Chapter 2.3.5 --- Effect of the essential oils of AOF on GSK-3P induced tau phosphorylation --- p.46 / Chapter 2.3.6 --- The effect of AOF essential oil on GSK-3P activity in COS7 --- p.50 / Chapter 2.3.7 --- Lithium content of AOF extracts --- p.52 / Chapter 2.4 --- Discussion --- p.54 / Chapter Chapter 4 --- Evaluation of the in vivo efficacy of cryptotenshinone (CT) in Morris Water Maze Task (WMT) --- p.59 / Chapter 4.1 --- Introduction --- p.59 / Chapter 4.1.1 --- Involvement of Cholinergic system in cognitive dysfunction in AD --- p.59 / Chapter 4.1.2 --- Animal model for Alzheimer's disease --- p.60 / Chapter 4.1.3 --- Morris Watermaze Task (WMT) --- p.61 / Chapter 4.2 --- MATERIAL AND METHODS --- p.64 / Chapter 4.2.1 --- Morris Water maze setup --- p.64 / Chapter 4.2.2 --- Animal model --- p.66 / Chapter 4.2.3 --- Drug preparation --- p.67 / Chapter 4.2.4 --- Toxicity test of CT --- p.67 / Chapter 4.2.5 --- Water maze task (WMT) --- p.68 / Chapter 4.2.6 --- Visual acuity test --- p.73 / Chapter 4.3 --- RESULTS --- p.74 / Chapter 4.3.1 --- Chronic crytotanshinone treatment does not cause hepatic damages to the mice --- p.74 / Chapter 4.3.2 --- Training Session --- p.76 / Chapter 4.4 --- DISCUSSION --- p.85 / Chapter Chapter 5 --- General Discussion and Future Directions --- p.87 / Chapter 5.1 --- "AOF, the potential GSK-3 inhibitor" --- p.87 / Chapter 5.2 --- CT´ؤthe AChEI --- p.88 / References --- p.91 / Appendix --- p.102 / Chapter A1 --- Reagents for SDS-PAGE --- p.103 / Chapter A3 --- Solution components provided by QIAGEN Plasmid Maxipreps kit --- p.108 / Chapter A4 --- Reagents and medium for cell culture --- p.109 / Chapter A5 --- Reagents for kinase assay --- p.110 / Chapter A6 --- Raw data of figures --- p.112 / Chapter A7 --- Plasmid map of PCI-neo --- p.119

Alzheimer's disease (AD) is the most common form of dementia. As the prevalence of AD increases with age, population aging will inevitably lead to an exponential increase in the proportion of older persons suffering from this disease. According to 2005 WHO estimate, 26.6 million people (approximately 0.55% of the general population) suffered from this disease. AD not only affects intellectual and functional abilities, it is also associated with significant neuropsychiatric disturbances. The pathogenesis of AD is characterized by widespread cerebral atrophy, abnormal deposition of amyloid plaques and tau protein in the central nervous system. While the classical histopathological features of AD are well recognized, exact physiological mechanisms that initiate the cascade of neural degeneration are still under active investigation. / As mentioned, the telomere length studies focused on ethically Chinese subjects recruited from two independent samples. The first clinical sample consisted of 411 older people and the other sample from healthy aging study, 976 community dwelling men were recruited. All subjects were assessed with the Cantonese version of the Mini-mental State Examination (CMMSE) for global cognitive function. Genomic DNA of the subjects was extracted from the peripheral whole blood sample. Lengths of the telomere were measured with Quantitative Real-Time PCR and the Ct ratio of the telomere and a control gene (36B4) of each sample was compared with the standard curve constructed with 4 selected sample's telomere lengths measured previously by Southern blotting. / For the first association study of the cell cycle checkpoint genes and AD, sample was recruited from a prospective study of cognitive function and risk factors for development of AD. 701 elderly were clinically evaluated for diagnosis of AD by psychiatrists. For this sample, genotyping of tagging SNPs of the 10 cell-cycle checkpoint genes were carried out by Restriction Fragment Length Polymorphism (RFLP) analysis. All tagging SNPs were selected from HapMap database and 5000bp upstream and downstream regions of each gene was also included. / For the results, the association study with cell cycle checkpoint genes, there was no SNPs found to be associated with diagnosis of clinical AD. We also found out that telomere length was associated with age in both two healthy aging men and clinical samples. There was no association between education and telomere lengths. For subjects in the healthy aging study, participants with CMMSE scores fell into the lowest 25% were found to have shorter telomere lengths. Similar result was found in the clinical AD sample. / In the study, telomere lengths were negatively associated with age. As the telomere will be shortened for each cell cycle, this finding correlated with physiological function at a cellular level. Statistical analysis also showed that shorter telomere lengths were found in subjects with poorer cognitive function. However, as age is a major determinant for cognitive impairments, further studies are recommended to evaluate the interaction effects of age in this association. Telomere shortening will cause cell senescence, and may be associated with faster neuronal degeneration, thus affecting cognitive function. Further studies should be conducted to examine its usefulness as an adjuvant biomarker for risk stratification of AD intervention trials. / Recent researches begin to unfold the physiological significance of telomere. A telomere is a repetitive region at the end of a chromosome. Basic functions of telomeres are involved with protection of the chromosome during replication and preventing chromosomal rearrangement or fusion. Abnormal telomere lengthening may be related to cancerous conditions. At a cellular level, telomere may also be related to aging and limitation in cell lifespan. In my study, I aimed to evaluate the association between the lengths of telomere and global cognitive function in community dwelling Chinese older persons in Hong Kong. As the length of telomere is also determined by the turnover rates of cells, apart from association study of telomere lengths and cognitive function, I also tried to study the association of genes related to cell cycles and AD. Polymorphisms of ten cell-cycle checkpoint genes, i.e. RB1, CDKN1A, CDK5R1, CDK2AP1, CDKN2A, CDKN2C, MDM2, P53, GSK3B, TPND1 and CDKN1B genes, were chosen in my project. / The thesis comprised of three studies. The first study was an association study of cell cycle checkpoint gene single nucleotide polymorphisms (SNPs) with clinical diagnosis of AD. The second study was an association study of telomere lengths and clinical diagnosis of AD in a clinical sample of patients suffering from the disease. The third study was an association study of the telomere lengths and global cognitive status in a group of active community dwelling older men who participated in a healthy aging study. / Lau, San Shing. / Adviser: Linda C.W. Lam. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 101-124). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

O presente estudo consistiu-se na avaliação clínica e aplicação de testes cognitivos, além da realização de ressonância magnética (RM), de 3 tesla, do cérebro, processada com a técnica de \"Voxel-based Morphometry\" (VBM) e \"Skull Strip\", e 18F-FDG PET -CT processado com \"Statistical Parametric Mapping\" (SPM8) e correção de volume parcial (PVELab), em idosos sem déficits cognitivos (CDR=0), com comprometimento cognitivo leve amnéstico (CCL) (CDR=0,5) e com Doença de Alzheimer leve (DA leve)(CDR de 0,5 a 1). Os objetivos foram comparar os padrões de neuroimagem estrutural e metabólica entre os grupos, assim como correlacionar alterações estruturais volumétricas da RM e alterações metabólicas cerebrais do PET-CT, a um teste funcional, o \"Informant Questionnaire on Cognitive Decline in the Elderly\" (IQCODE), nessa mesma amostra. Cada um dos grupo 3 grupos, pareados por idade, contém 30 indivíduos, totalizando amostra de 90. Os resultados dos exames de Neuroimagens, divididos por comparações entre os grupos, e corrigidos pela escolaridade, foram considerados significativos todos os achados nos quais a significância corrigida for <= 0,05 (p-FWEcorr <= 0,05). No CCL x DA foi observado hipometabolismo Giro do Cíngulo à Direita. No grupo DA x CCL foram observados hipometabolismos no Giro do Cíngulo à Esquerda, no Precuneus Esquerdo, Precuneus Direito e na parte inferior do Lobo Parietal Esquerdo. Na DA x Controle, utilizando-se pesquisa de área a priori e filtros gaussiano de 8mm e 4mm, foi observada redução estatisticamente significante quanto ao volume de substância cinzenta na Amígdala Esquerda e na Amígdala Direita. No PET - CT, da DA, em relação ao grupo controle foram observadas áreas de hipometabolismos no Giro do Cíngulo à Esquerda, no Precuneus Direito e no Giro Temporal Medial Direito. Na correlação direta do IQCODE, na comparação DA x Controle, no PET - CT evidenciou-se hipometabolismo no Giro Fusiforme Direito. Em conclusão, os resultados das comparações entre os grupos foram semelhantes ao encontrado na literatura para fases iniciais (leves) da patologia e mostraram, ainda, uma tendência a um \"continuum\" do controle até a DA. Por outro lado à correlação do IQCODE no DA x Controle carece de comprovação por outros trabalhos e com outros constructos estatísticos / This study consisted in the clinical evaluation and application of cognitive tests, in addition to magnetic resonance imaging (MRI) of 3 Tesla, of brain, processed with the technique of \"Voxel-based Morphometry\" (VBM) and \"Skull Strip\", and 18F-FDG PET-CT processed by \"Statistical Parametric Mapping\" (SPM8) and partial volume correction (PVELab) in subjects without cognitive impairment (CDR = 0), with amnestic mild cognitive impairment (MCI)(CDR = 0.5) and with mild Alzheimer \'s disease (AD mild)(CDRs of 0.5 to 1). The objectives were to compare the patterns of structural and metabolic neuroimaging between groups, as well as correlate MRI\'s volumetric structural changes and PET-CT\'s metabolic brain with a functional test, the \"Informant Questionnaire on Cognitive Decline in the Elderly\" (IQCODE) in this same sample. Each one of three groups, matched by age, contains 30 subjects, totaling 90. The test results of neuroimaging, divided by comparisons between groups, and corrected by education, were considered significant the findings that corrected significance is <= 0.05 (p-FWEcorr <= 0.05). In CCL x DA was observed hypometabolism right cingulate gyrus. In DA x CCL hypometabolism were observed in the left cingulate gyrus, the left precuneus, right precuneus and left inferior parietal lobe. In DA x Control, using the \"a priori\" research area and gaussian filters 8mm and 4mm was observed statistically significant reduction on the volume of gray matter in the left and right amygdala. In PET - CT of DA relative to control group were observed areas of hypometabolisms in left cingulate, right precuneus and in the right medial temporal gyrus. In direct correlation of the IQCODE, compared DA x Control on PET - CT revealed a hypometabolism in the right fusiform gyrus. In conclusion, the results of the comparisons between groups were similar to those found in the literature for early (mild) pathology and showed a \"continuum\" of control to the DA. On the other hand the correlation of the IQCODE in DA x Control lacks confirmation by other studies and other statistical constructs

O presente estudo consistiu-se na avaliação clínica e aplicação de testes cognitivos, além da realização de ressonância magnética (RM), de 3 tesla, do cérebro, processada com a técnica de \"Voxel-based Morphometry\" (VBM) e \"Skull Strip\", e 18F-FDG PET -CT processado com \"Statistical Parametric Mapping\" (SPM8) e correção de volume parcial (PVELab), em idosos sem déficits cognitivos (CDR=0), com comprometimento cognitivo leve amnéstico (CCL) (CDR=0,5) e com Doença de Alzheimer leve (DA leve)(CDR de 0,5 a 1). Os objetivos foram comparar os padrões de neuroimagem estrutural e metabólica entre os grupos, assim como correlacionar alterações estruturais volumétricas da RM e alterações metabólicas cerebrais do PET-CT, a um teste funcional, o \"Informant Questionnaire on Cognitive Decline in the Elderly\" (IQCODE), nessa mesma amostra. Cada um dos grupo 3 grupos, pareados por idade, contém 30 indivíduos, totalizando amostra de 90. Os resultados dos exames de Neuroimagens, divididos por comparações entre os grupos, e corrigidos pela escolaridade, foram considerados significativos todos os achados nos quais a significância corrigida for <= 0,05 (p-FWEcorr <= 0,05). No CCL x DA foi observado hipometabolismo Giro do Cíngulo à Direita. No grupo DA x CCL foram observados hipometabolismos no Giro do Cíngulo à Esquerda, no Precuneus Esquerdo, Precuneus Direito e na parte inferior do Lobo Parietal Esquerdo. Na DA x Controle, utilizando-se pesquisa de área a priori e filtros gaussiano de 8mm e 4mm, foi observada redução estatisticamente significante quanto ao volume de substância cinzenta na Amígdala Esquerda e na Amígdala Direita. No PET - CT, da DA, em relação ao grupo controle foram observadas áreas de hipometabolismos no Giro do Cíngulo à Esquerda, no Precuneus Direito e no Giro Temporal Medial Direito. Na correlação direta do IQCODE, na comparação DA x Controle, no PET - CT evidenciou-se hipometabolismo no Giro Fusiforme Direito. Em conclusão, os resultados das comparações entre os grupos foram semelhantes ao encontrado na literatura para fases iniciais (leves) da patologia e mostraram, ainda, uma tendência a um \"continuum\" do controle até a DA. Por outro lado à correlação do IQCODE no DA x Controle carece de comprovação por outros trabalhos e com outros constructos estatísticos / This study consisted in the clinical evaluation and application of cognitive tests, in addition to magnetic resonance imaging (MRI) of 3 Tesla, of brain, processed with the technique of \"Voxel-based Morphometry\" (VBM) and \"Skull Strip\", and 18F-FDG PET-CT processed by \"Statistical Parametric Mapping\" (SPM8) and partial volume correction (PVELab) in subjects without cognitive impairment (CDR = 0), with amnestic mild cognitive impairment (MCI)(CDR = 0.5) and with mild Alzheimer \'s disease (AD mild)(CDRs of 0.5 to 1). The objectives were to compare the patterns of structural and metabolic neuroimaging between groups, as well as correlate MRI\'s volumetric structural changes and PET-CT\'s metabolic brain with a functional test, the \"Informant Questionnaire on Cognitive Decline in the Elderly\" (IQCODE) in this same sample. Each one of three groups, matched by age, contains 30 subjects, totaling 90. The test results of neuroimaging, divided by comparisons between groups, and corrected by education, were considered significant the findings that corrected significance is <= 0.05 (p-FWEcorr <= 0.05). In CCL x DA was observed hypometabolism right cingulate gyrus. In DA x CCL hypometabolism were observed in the left cingulate gyrus, the left precuneus, right precuneus and left inferior parietal lobe. In DA x Control, using the \"a priori\" research area and gaussian filters 8mm and 4mm was observed statistically significant reduction on the volume of gray matter in the left and right amygdala. In PET - CT of DA relative to control group were observed areas of hypometabolisms in left cingulate, right precuneus and in the right medial temporal gyrus. In direct correlation of the IQCODE, compared DA x Control on PET - CT revealed a hypometabolism in the right fusiform gyrus. In conclusion, the results of the comparisons between groups were similar to those found in the literature for early (mild) pathology and showed a \"continuum\" of control to the DA. On the other hand the correlation of the IQCODE in DA x Control lacks confirmation by other studies and other statistical constructs

The purpose of this thesis is to explore the diverse experiences of accessing health and social services when living with a neurological condition in Manitoba. Using a qualitative research design, I conducted 15 in-depth semi-structured interviews with adults living with a neurological condition in Manitoba. Findings demonstrated how characteristics of patients, and their service providers/systems, either predisposed them to a lack of service coordination or enabled them to successfully navigate health and social services. In the event that those factors contributed to a need or desire for coordination, participants employed strategies to improve their experience accessing services by i. pursuing knowledge to improve access, ii. actively engaging in behaviours to improve services, or iii. mentally coping with inadequate services. To conclude, practical recommendations on possible initiatives to improve the daily experiences of individuals living with neurological conditions are also provided. / October 2015

No description available.

La survenue de modifications cérébrales issues du vieillissement normal ou provoquées par la maladie d’Alzheimer entraîne un certain bouleversement de l’attention visuelle sélective, soit la capacité à centrer volontairement les mécanismes de perception sur un stimulus particulier en négligeant les stimuli non pertinents. A ces modifications viennent s’ajouter des phénomènes de réorganisations cérébrales qui peuvent s’illustrer sur l’axe inter-hémisphérique par une réduction de la latéralisation cérébrale dans le vieillissement normal et sur l’axe intra-hémisphérique par un accroissement de l’engagement des régions frontales et préfrontales dans le vieillissement normal et la maladie d’Alzheimer. Toutefois, les mécanismes sur lesquels reposent ces phénomènes de réorganisations cérébrales dans le vieillissement normal et la maladie d’Alzheimer dans le contexte de l’attention visuelle restent peu compris. Ce travail de thèse s’intéresse à la nature de la réorganisation cérébrale dans le vieillissement normal (inter-hémisphérique vs. intra-hémisphérique) en condition d’attention visuelle sélective et s’inscrit dans le modèle de la réserve cognitive afin de préciser la nature des mécanismes sous-jacents de la réorganisation cérébrale (réserve neurale vs. compensation neurale). Concernant la maladie d’Alzheimer, ce travail met l’emphase sur la dynamique inter-hémisphérique et son principal substrat anatomique, le corps calleux, afin d’étudier l’efficience des mécanismes inter-hémisphériques. Dans l’ensemble de cette thèse, le substrat (fonctionnel et anatomique) de la réorganisation cérébrale est étudié en manipulant la complexité, ce qui permet d’identifier le mode d’adaptation face à l’accroissement de la demande cognitive soit, les mécanismes qui permettent de faire face au vieillissement normal et aux troubles de la cognition mais aussi d’étudier l’efficience de ces mécanismes. Le premier chapitre présente l’attention sélective, ses modifications neuro-fonctionnelles et les divers phénomènes de réorganisations cérébrales connus au cours du vieillissement normal et dans la maladie d’Alzheimer. Le cadre théorique dans lequel s’inscrit cette thèse, celui de la réserve cognitive, et la problématique du travail de recherche sont également décrits en fin de chapitre. La recherche effectuée est ensuite rapportée sous forme de 5 chapitres distincts. Enfin, les concepts théoriques évoqués par la revue de la littérature et les résultats des expérimentations font l’objet d’une discussion générale. Le deuxième chapitre de cette thèse (Article 1), visant à effectuer une revue de la littérature concernant les aspects inter-hémisphériques, permet de préciser, pour la première fois dans le domaine, le rôle du couplage inter-hémisphérique des ressources cérébrales dans la réorganisation au cours du vieillissement normal, mais aussi de considérer l’effet du découplage dans la maladie d’Alzheimer. Le troisième chapitre (Article 2) explore les mécanismes de réorganisation cérébrale dans le vieillissement normal face à l’accroissement de la charge attentionnelle au niveau perceptif de l’attention sélective (i.e., appariement perceptuel, A-A). Les résultats montrent un patron de réorganisation intra-hémisphérique chez les âgés, sous-tendu en situation de faible charge attentionnelle (i.e., 3 lettres) par la compensation neurale mais qui se voit associée à l’implication concomitante de la réserve neurale en situation de charge attentionnelle élevée (i.e., 5 lettres). Ce travail montre, par conséquent, une certaine flexibilité dans le déploiement de ces mécanismes qui apparaît modulé par la demande cognitive de la tâche. Le quatrième chapitre (Article 3) examine ces mêmes mécanismes de réorganisation dans le vieillissement normal, dans le même contexte attentionnel en ayant recours à un niveau de charge attentionnelle faible (i.e., 3 lettres) et à un niveau de charge attentionnelle élevé (i.e., 5 lettres), mais à un niveau plus complexe de l’attention sélective du fait qu’il implique une opération d’appariement basée sur le nom de la lettre (i.e., appariement nominatif, a-A). Les résultats montrent une amplification du renversement postéro-antérieur avec l’âge sur l’axe intra-hémisphérique face à l’accroissement de la charge attentionnelle (i.e., 5 lettres), suggérant ainsi que ce renversement est exclusivement lié à l’âge et qu’il repose principalement sur le mécanisme de compensation neurale. Le cinquième chapitre (Article 4) présente deux études dans lesquelles la présentation d’une tâche d’appariement de lettres en champ visuel divisé et l’IRM morphologique du corps calleux ont été couplées. L’objectif de cette étude était d’examiner la relation entre les variations de volume du corps calleux et la dynamique inter-hémisphérique chez des participants âgés atteints de la Maladie d’Alzheimer, de troubles cognitifs légers ou qui connaissent un vieillissement normal. La première étude se situait au niveau perceptuel et concernait 3 groupes de participants (Maladie d’Alzheimer vs trouble cognitif léger vs vieillissement normal). La deuxième étude concernait les participants atteints de trouble cognitif léger et des participants âgés contrôles sains et comportait deux tâches avec deux conditions de complexité chacune, une tâche dans laquelle la complexité varie selon le type de jugement - appariement perceptuel (e.g., A-A) vs. nominatif (e.g., a-A) - et une dans laquelle la complexité varie selon la charge attentionnelle (i.e., 3 lettres vs. 5 lettres). Les mesures IRM correspondent au volume total du corps calleux et à cinq volumes régionaux : C1-Rostrum, Genou et partie antérieure du tronc, C2-partie médiane, C3-partie caudale, C4-Isthme et C5-Splenium. Ces deux études montrent que le volume du corps calleux semble affecter la mise en jeu de l’effet facilitateur du traitement inter-hémisphérique selon l’état cognitif des participants et la nature de la demande cognitive mise en jeu. Cet impact modulateur semble partiellement déterminé dans la maladie d’Alzheimer par les portions plus antérieures du corps calleux (C2) et, via l’ensemble du corps calleux dans le vieillissement normal (C2, C3, C4). En revanche cette modulation semble déficitaire chez les participants atteints de trouble cognitif léger et reliée à une atrophie du corps calleux chez les participants atteints de trouble cognitif léger. Enfin, le chapitre 6 constitue la discussion générale de la thèse. L’ensemble des résultats est résumé et discuté en rapport aux différents modèles de la réorganisation cérébrale, de la réserve cognitive et de la dynamique hémisphérique. / Normal aging and disrupt selective visual attention – the ability to focus perceptual mechanisms on target stimuli by neglecting irrelevant stimuli. These modifications are accompanied by brain reorganization on both interhemispheric (hemispheric asymmetry reduction) and intrahemispheric (posterior-anterior shift) dimensions. However, the mechanisms underlying this brain reorganization in the context of visual attention in normal aging and Alzheimer’s disease remain largely unknown. The goal of this dissertation is to better understand the nature of brain reorganization for visual selective attention, as well as the functional neural changes and the anatomical modification in normal aging and in cognitive impairment in nthe ederly. In normal aging, this research focuses on the nature of the brain reorganization (interhemispheric vs. intrahemispheric) in the context of visual selective attention and based on the cognitive reserve model to differentiate the underlying mechanisms (neural reserve vs. neural compensation). It also focuses on Alzheimer’s disease in the context of interhemispheric dynamics and its main anatomical substrate, the corpus callosum. Throughout this dissertation, the substrate (functional and anatomical) of brain reorganization is examined by manipulating the cognitive demand associated with the tasks to better understand the mechanisms applied to cope with normal aging and cognitive impairment. The first chapter introduces the concepts of selective attention, neurofunctional changes in normal aging and cognitive impairment, and the cognitive reserve model before introducing the present research topic. The second chapter (Article 1) reviews the contribution of hemispheric coupling to the preservation of cognitive abilities with age and its uncoupling in Alzheimer’s disease. In this review, the variable contribution of the adaptive callosal mechanism is discussed with reference to successful aging and Alzheimer’s disease. The third (Article 2) and fourth chapters (Article 3) report studies conducted with functional magnetic resonance imaging (fMRI). The purpose of these studies was to investigate to what extent and how the neural reserve and neural compensation mechanisms contribute to coping with normal aging in two contexts of visual selective attention: simple perceptual processing and more complex naming processing. In both studies, the complexity of processes was also manipulated by varying the attentional load related to the number of stimuli to be processed (low: 3 letters vs. high: 5 letters). The results for the perceptual matching study, reported in the third chapter, support the neural compensation hypothesis of cognitive reserve, as the activations regions underlying task performance differed in the younger and older groups. The older group recruited bilateral frontal superior gyri more than the younger one, as in the PASA (posterior-anterior shift in aging) phenomenon, from the lowest attentional load level. In addition, the elderly were found to use compensation and neural reserve concurrently to cope with increasing attentional load for perceptual processing. The results for the naming matching study, reported in the fourth chapter, indicate a load-dependant PASA, supporting the hypothesis that an enhancement of compensatory mechanism is required for the most complex processing. The fifth chapter (Article 4) presents studies investigating the interhemispheric dynamic, using variants of the letter matching paradigm, where cognitive demand is parametrically varied, along with 3D callosal total and regional volume measured, in individuals with Alzheimer disease and amnestic-mild cognitive impairment as well as age-matched healthy individuals. The results show that the relationship between the corpus callosum volume and the across-field advantage emerges for the lowest cognitive demand level in participants with Alzheimer disease but exclusively at high cognitive demand levels in normal aging; this suggests the existence of an interhemispheric compensation mechanism in Alzheimer disease based on the integrity of the corpus callosum and similar processes to those that allow the normal aging brain to cope with cognitive demand. These mechanisms are deficient in amnestic-mild cognitive impairment individuals in the high attentional load condition, due to callosal atrophy. In chapter six the nature of mechanisms to cope with aging and cognitive impairment is discussed, addressing the two main dimensions of brain reorganization: intrahemispheric and interhemispheric. In normal aging, cerebral reorganization of visual selective attention implies an intrahemispheric PASA phenomenon based on neural compensation. To cope with increased cognitive demand, neural reserve can also be recruited in basic perceptual processing, while the recruitment of compensation mechanisms increases in more complex processing of visual selective attention. Our study suggests that compensation and reserve are flexible, adaptive and deployed according to the cognitive demand and the type of processing required. In cognitive impairment, our study suggests the existence of an interhemispheric compensation mechanism in Alzheimer’s disease based on integrity of the corpus callosum and similar processes to those that allow the normal aging brain to cope with cognitive demand. This study provides evidence that interhemispheric interactions, supported by the corpus callosum, constitute a flexible mechanism that can improve the brain’s ability to handle processing demands and thus may compensate for the neural decline in Alzheimer’s disease in low cognitive demand situations. / Réalisée en cotutelle avec l'Unité de Formation à la Recherche Lettres Arts et Sciences Humaines - Université Nice-Sophia Antipolis.

De récents travaux ont mis en évidence que des dysfonctionnements dans l’expression de gènes impliqués dans la plasticité synaptique contribuent aux déclins cognitifs qu’on observe chez les gens âgés et à la progression de la maladie d’Alzheimer. Notre étude avait comme objectif d’étudier le profil d’expression d’ARNm spécifiques impliqués dans la plasticité synaptique chez des rats jeunes et âgés et chez des souris transgéniques 3xTg et WT. Des expériences en qRT-PCR ont été effectuées dans des extraits de cortex et d’hippocampe de rats jeunes et âgés et de souris 3xTg et WT, respectivement. Les résultats ont démontré une augmentation significative de l’expression d’ARNm MAP1B, Stau2, BDNF, CREB et AGO2 principalement dans l’hippocampe (régions CA1-CA3) des souris 3xTg comparé aux souris WT. Une diminution significative a également été observée pour l’ARNm αCaMKII dans le cortex des souris 3xTg comparé aux souris WT. Contrairement à ces observations, aucun changement n’a été observé pour l’expression de gènes impliqués dans la plasticité synaptique chez les rats âgés comparé aux rats jeunes. Ces résultats démontrent qu’un dysfonctionnement existe réellement au début de la maladie d’Alzheimer dans l’expression de gènes spécifiques impliqués dans la plasticité synaptique et contribue potentiellement à la progression de la maladie en engendrant un déséquilibre entre la LTP et la LTD. De plus, les différences d’expressions sont particulièrement observées dans l’hippocampe (régions CA1-CA3) ce qui est consistant avec les études sur la progression de la maladie d’Alzheimer puisqu’il est connu que la région CA1 de l’hippocampe est la plus vulnérable à l’apparition de la maladie. Ces résultats permettent une meilleure compréhension des événements moléculaires qui deviennent dérégulés à l’apparition de la maladie d’Alzheimer. / Recent work has demonstrated that dysregulations in the expression profile of plasticity-related genes in specific brain regions contribute to age-related cognitive decline and Alzheimer’s disease. The aim of this study was to determine the expression profile of a subset of plasticity-related mRNAs in different regions of the brain of young and aged rats as well as 3xTg and wild type (WT) mice. qRT-PCR experiments were performed in extracts of cortex and hippocampus of young and aged rats and of 3xTg and WT mice, respectively. Results demonstrated significant increases in the expression of MAP1B, Stau2, CREB, BDNF, and AGO2 mRNAs, especially in the hippocampus (CA1-CA3 fields) of 3xTg mice compared to WT mice. A significant decrease was also observed in the expression of αCaMKII mRNA in the cortex of 3xTg mice compared to WT mice. On the other hand, no significant changes were observed in the expression of plasticity-related genes in the hippocampus of aged rats compared to young rats. These results confirm that alterations in gene expression occur at the onset of AD and possibly contribute to the progression of the disease by causing an imbalance between long-term potentiation and long-term depression. In addition, patterns of significant altered gene expression, especially in the hippocampus (CA1-CA3 fields) of 3xTg mice are consistent with the progression of AD whereby the hippocampus (CA1 region) is most vulnerable at the onset of the disease. These results provide a better understanding of the molecular events that first become disturbed in AD.