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Firth, N. C.

Publications and source records attributed to Firth, N. C..

3 recordsLinked to original sources

Non-Parametric Mixture Modelling and its Application to Disease Progression Modelling

Dementia is characterised by its progressive degeneration of cognitive abilities. In research cohorts, detailed neuropsychological test batteries are often administered to better understand how cognition changes over time. Understanding cognitive changes in dementia is of great importance, particularly in determining how structural changes in the brain may affect cognition and in facilitating earlier detection of symptomatic changes. Disease progression models are often applied to these data to understand how a disease changes over time from cross-sectional data or to disease trajectories from large numbers of individuals. Previous disease progression models used to build longitudinal models from cross-sectional data have focused on brain imaging data; however, these models are not directly applicable to cognitive data. Here we use the novel, non-parametric, Kernel Density Estimation Mixture Modelling (KDEMM) approach and demonstrate accurate modelling of the progression of cognitive test data. We found that using KDEMM resulted in more accurate models of disease progression in simulated data compared to Gaussian Mixture Models (GMMs) for the majority of parameters used to simulate the data. When comparing KDEMM and GMM to cognitive data collected in different Alzheimers Disease subtypes, we found the KDEMM resulted in a model much more in line with clinical phenotype. We anticipate that the KDEMM will be used to integrate cognitive test data, and other non-normally distributed datasets into complex disease progression models.

neuroscience

Sequence of cognitive changes associated with development of Alzheimer’s disease in Down syndrome – data driven analysis

ObjectiveIndividuals with Down syndrome (DS) have an extremely high genetic risk for Alzheimers disease (AD) however the course of cognitive decline associated with progression to dementia is ill-defined. Data-driven methods can estimate long-term trends from cross-sectional data while adjusting for variability in baseline ability, which complicates dementia assessment in those with DS.\n\nMethodsWe applied an event-based model to cognitive test data and informant-rated questionnaire data from 283 adults with DS (the largest study of cognitive functioning in DS to date) to estimate the sequence of cognitive decline and individuals disease stage.\n\nResultsDecline in tests of memory, sustained attention / motor coordination, and verbal fluency occurred early, demonstrating that AD in DS follows a similar pattern of change to other forms of AD. Later decline was found for informant measures. Using the resulting staging model, we showed that adults with a clinical diagnosis of dementia and those with APOE 3:4 or 4:4 genotype were significantly more likely to be staged later, suggesting the model is valid.\n\nInterpretationOur results identify tests of memory and sustained attention may be particularly useful measures to track decline in the preclinical/prodromal stages of AD in DS whereas informant-measures may be useful in later stages (i.e. during conversion to dementia, or post-diagnosis). These results have implications for the selection of outcome measures of treatment trials to delay or prevent cognitive decline due to AD in DS. As clinical diagnoses are generally made late into AD progression, early assessment is essential.

neuroscience

Progression of regional grey matter atrophy in multiple sclerosis

Grey matter atrophy is present from the earliest clinical stages of multiple sclerosis (MS), but the temporal ordering is poorly understood. We aimed to determine the sequence in which grey matter regions become atrophic in MS, and its association with disability accumulation.\n\nIn this longitudinal study, we included 1,417 subjects: 253 with clinically-isolated syndrome (CIS), 708 relapsing-remitting MS (RRMS), 128 secondary-progressive MS (SPMS), 125 primary-progressive MS (PPMS), and 203 healthy controls from 7 European centres. Subjects underwent repeated MRI scanning (total number of scans 3,604); the mean follow-up for patients was 2.41yrs (SD{+/-}1.97). Disability was scored using the Expanded Disability Status Scale (EDSS). We calculated the volume of brain grey matter regions and brainstem using an unbiased within-subject template. We used an established data-driven event-based model (EBM) to determine the sequence of occurrence of atrophy and its uncertainty. We assigned each subject to a specific EBM stage, based on the number of their atrophic regions. We used nested linear mixed-effects regression models to explore the associations between the rate of increase in the EBM stages over time, disease duration and annual rate of EDSS gain.\n\nThe first regions to become atrophic in CIS and relapse-onset MS patients (RRMS and SPMS) were the posterior cingulate cortex and precuneus, followed by the middle cingulate cortex, brainstem and thalamus. The sequence of atrophy in PPMS showed a similar involvement of the thalamus, cuneus, precuneus, and pallidum, followed by the brainstem and posterior cingulate cortex. The cerebellum, caudate and putamen showed early atrophy in relapse-onset MS and late atrophy in PPMS. Patients with SPMS showed the highest EBM stages (highest number of atrophic regions, all p<0.001) at study entry. Rates of increase in EBM stages were significantly different from healthy controls in all MS phenotypes, except for CIS. The increase in the number of atrophic regions (EBM stage) was associated with disease duration in all patients. EBM stage was associated with disability accumulation in RRMS independent of disease duration (p<0.0001).\n\nThis data-driven staging of atrophy progression in a large MS sample demonstrates that grey matter atrophy spreads to involve more regions over time. The sequence in which regions become atrophic is reasonably consistent across MS phenotypes. The spread of atrophy was associated with disease duration, and disability accumulation in RRMS.\n\nAbbreviations

neuroscience