Spectroscopic detection of pathological severity in Alzheimer's disease
Herpy, James Philip
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Alzheimer’s disease (AD) has emerged as one of the most widespread and devastating forms of dementia. Over the past few decades, AD has consistently increased in prevalence worldwide due to the rising proportion of elderly individuals and lack of effective screening and treatment modalities. To date, few economically viable and widely applicable tools exist to make definitive, early diagnoses of the disease. Therefore, there is a clear need for interventions that facilitate accurate diagnoses, monitoring, and therapeutic treatment of AD. In the course of AD, cognitive impairment is preceded by physiological changes to the central nervous system (CNS). This includes neuronal atrophy, synaptic dysfunction, and the abnormal post-translational modification of the proteins tau and beta-amyloid (A), which contributes to the deposition of intracellular neurofibrillary tangles (NFTs) and extracellular neuritic plaques (NPs). The pathological cellular changes in AD occur long before the clinical course of the disease, and biomarkers for these changes can be detected prior to measurable cognitive decline. Because the biochemical changes associated with AD are irreversible, effective tools for diagnosis must detect the presence and severity of molecular pathology during the preliminary stages of the disease’s insidious onset. Biomarkers of AD can be detected by neuroimaging technologies, including magnetic resonance imaging (MRI), positron emission tomography (PET), and blood or cerebrospinal fluid (CSF) analyses. However, these methods are not currently suited to diagnose and monitor the unique pathogenesis of AD prior to cognitive decline. An ideal instrument for widespread AD screening, diagnosis, and monitoring must be noninvasive, inexpensive, portable, and accommodating to the cognitive sensitivities of patients on a spectrum from mild cognitive impairment (MCI) to full-blown dementia. Recently, several spectroscopic methods of assessing AD pathology have met these criteria and may be better suited for widespread clinical application. The objective of this thesis is to evaluate the use of near-infrared optical spectroscopy (NIRS) to detect pathological severity in human AD. Near-infrared (NIR) light is poorly absorbed by biological tissue, and can safely penetrate bone, skin, vasculature, and neuronal tissue. NIRS has traditionally been used in biomedical contexts to evaluate cerebral oxygenation changes, however the dense protein aggregates NFTs and NPs in AD tissue have recently been shown to characteristically affect several optical parameters of a NIR signal, including fluorescence and particle path (scattering). To date, applications of NIRS have been used to differentiate AD brains from non-AD controls in vitro, and further identify MCI patients in vivo, suggesting the NIR signal can identify molecular changes in AD. Severe AD cases are characterized by increased involvement of NFTs and NPs in the cerebral cortex, which would be expected to further affect the extent of NIR scatter. The current study aims to quantify AD-related pathology for investigation into whether the extent of optical scattering is correlated with the severity of amyloid plaque load and NFT density in the temporal cortex. Quantification of these lesions was accomplished using immunohistochemistry (IHC) and stereological analyses. Preliminary results show that the severity of AD pathology detected via IHC can be correlated with measured parameters of an in vitro near-infrared signal. Future studies aim to further characterize the relationship between scattering intensity and pathological severity, as well as evaluate the in vivo potential of this technology in predicting the clinical outcome and cognitive status of individuals in different stages of AD.