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To examine the relationship between cerebrospinal fluid (CSF) biomarkers of Alzheimer’s disease (AD) and tap test response to elucidate the effects of comorbidity of AD in idiopathic normal-pressure hydrocephalus (iNPH).
Osaka University Hospital.
Patients with possible iNPH underwent a CSF tap test.
Concentrations of amyloid beta (Aβ) 1–40, 1–42, and total tau in CSF were measured. The response of tap test was judged using Timed Up and Go test (TUG), 10-m reciprocation walking test (10MWT), Mini-Mental State Examination (MMSE), and iNPH grading scale. The ratio of Aβ1–42 to Aβ1–40 (Aβ42/40 ratio) and total tau concentration was compared between tap test-negative (iNPH-nTT) and -positive (iNPH-pTT) patients.
We identified 27 patients as iNPH-nTT and 81 as iNPH-pTT. Aβ42/40 ratio was significantly lower (mean [SD] = 0.063 [0.026] vs. 0.083 [0.036], p = 0.008), and total tau in CSF was significantly higher (mean [SD] = 385.6 [237.2] vs. 293.6 [165.0], p = 0.028) in iNPH-nTT than in iNPH-pTT. Stepwise logistic regression analysis revealed that low Aβ42/40 ratio was significantly associated with the negativity of the tap test. The response of cognition was significantly related to Aβ42/40 ratio. The association between Aβ42/40 ratio and tap test response, especially in cognition, remained after adjusting for disease duration and severity at baseline.
A low CSF Aβ42/40 ratio is associated with a poorer cognitive response, but not gait and urinary response, to a tap test in iNPH. Even if CSF biomarkers suggest AD comorbidity, treatment with iNPH may be effective for gait and urinary dysfunction.
This paper considers the placement of m sensors at n > m possible locations. Given noisy observations, knowledge of the state correlation matrix, and a mean-square error criterion (equivalently maximizing an efficacy cost criterion), the problem is formulated as an integer programming problem. Computing the solution for large m and n is infeasible, requiring us to look at approximate algorithms and bounding optimal performance. Approximate algorithms include greedy algorithms and variations based on examining the efficacy cost function and projection-based methods that all run in polynomial time of m and n. A sequence of nested bounds are found that upper bound the optimal performance (with analysis based on using matrix pencils and generalized eigenvectors). Finally, we show through simulations that the approximate algorithms perform well and provide tight implementable lower bounds to optimal performance and the nested bounds provide upper bounds to optimal performance with tighter bounds achieved with increasing complexity. The sensor placement problem has many energy applications where we are often confronted with limited resources. Some examples include where to place environmental sensors for an area in which there are many distributed solar photovoltaic generators and where to place grid monitors on an electrical distribution microgrid.
Because the biological pathological process is observed decades years before the clinical onset of Alzheimer's disease (AD), there is a theoretical ad-vantage in using biological markers for the early diagnosis of AD. Neuro-psychological test batteries, brain imaging and biological markers are expected to be used for screening and differential diagnosis of dementia and also for evaluation of the efficacy of early intervention.
No single biological marker can serve all the purposes of screening, differential diagnosis and measurement of severity. Biological markers that reflect molecular stress, such as oxidative, ribotoxic, and nitroso stress, need to be developed, particularly for measuring the clinical outcomes of interventions. As well as providing a better understanding of the molecular pathogenesis of AD, there is a possibility of finding a surrogate marker of AD, which might fulfill the requirement of sufficient sensitivity and specificity for AD diagnosis, as well as indicating the disease-modifying activity of interventions. In this study we examine whether the mechanism of secretase activity will offer a new surrogate marker of AD.
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