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NACC

National Alzheimer’s Coordinating Center (NACC)

UW-based center featured in Neurology Today’s list of top advances of 2013

Neurology Today has released a list, chosen by its expert editorial advisory board, of the year’s 17 most important advances in a range of subject areas, from health policy to neurogenetics to Parkinson’s disease. Of the three advances that related to Alzheimer’s disease, two relied on the work of a data center based at the University of Washington.

The National Alzheimer’s Coordinating Center (NACC) — Walter A. Kukull, PhD, director , is an internationally known data center housed in the UW Department of Epidemiology and funded by the National Institute on Aging (cooperative grant U01 AG016976). NACC maintains a large database of clinical data, collected annually, on subjects at 30 Alzheimer’s Disease Centers, also funded by NIA, around the U.S. At this writing, nearly 30,000 subjects make up NACC’s Uniform Data Set. NACC cleans and curates the data and makes them available to researchers around the world.

Because NACC’s Uniform Data Set is longitudinal, with data collected during annual clinic visits, it allows researchers to observe change over time across a range of some 800 data elements. In Alzheimer’s disease, a variable of special interest is a subject’s cognitive status.

Also of great value to research is the fact that nearly 3,000 subjects who had been evaluated annually for the Uniform Data Set are now part of the Neuropathology Data Set, having died and consented to autopsy. With focus in the field of Alzheimer’s disease turning to the very earliest stages of the disease, the NACC data allow researchers to link subtle changes in cognition seen earlier in life to brain pathology after death.

Two projects singled out by Neurology Today make use of NACC’s neuropathology data. One study, published in the journal Neurology and led by NACC Research Scientist Sarah Monsell, with contributions by NACC faculty member Charles Mock and others, looked at the autopsies of subjects with and without symptoms of Alzheimer’s disease who proved to have varying degrees of AD neuropathologic change. Among the findings, expression of AD symptoms was affected more by neurofibrillary tangle scores than neuritic plaque burden, and symptomatic patients tended to be older, have a history of recent depression, and have higher Hachinski Ischemic Scores, suggestive of vascular dementia (although cerebrovascular pathology was not associated with symptoms). There was also an effect of apolipoprotein E (APOE) allelic status even after the amount of amyloid-beta neuropathology was taken into account.

According to Neurology Today, this finding is noteworthy because it not only provides an explanation for the pathophysiology of this gene mutation (APOE), but also suggests that there may be a new mechanism of disease at work in patients with the gene mutation.

Another study, led by J.B. Toledo of the University of Pennsylvania Alzheimer’s Disease Center and published in the journal Brain, examined the contribution of cerebrovascular disease in confirmed neurodegenerative disease cases in the NACC database. In a series of 6205 autopsy cases of dementia, all types of dementias were found to have a vascular component, ranging from 60 percent in frontotemporal dementias to 80 percent in AD. In every case, the presence of vascular disease decreased the threshold of the presentation of dementia.

This study made the publication’s list because vascular disease is highly treatable, and identifying the vascular component could prevent, delay, or mitigate dementia. Even a small delay in the onset would make a huge difference. For instance, delaying the onset of AD by one year would cut the prevalence by 20 percent; delaying it by five years would cut the prevalence of dementia in half.

 

Possted December 26, 2013