Independent validation and outlier analysis of EuroPOND Alzheimer’s disease staging model using ADNI and real-world clinical data
Year: 2025
Type: article
Abstract: Event-based modeling (EBM) traces sequential progression of events in complex processes like neurodegenerative diseases, adept at handling uncertainties. This study validated an EBM for Alzheimer’s disease (AD) staging designed by EuroPOND, an EU-funded Horizon 2020 project, using research and real-world datasets, a crucial step towards application in multi-center trials. The training dataset comprised 1737 subjects from ADNI-1/GO/2, using the EuroPOND EBM toolbox. Testing datasets included a research cohort from University of Antwerp (controls, CN (n = 46), subjective cognitive decline, SCD (n = 10), mild cognitive impairment, MCI (n = 47), AD dementia, ADD (n = 16)) and a real-world cohort from 9 Belgian Dementia Council memory clinics (CN (n = 91), SCD (n = 66), (non-amnestic) naMCI (n = 54), aMCI (n = 255), and ADD (n = 220). Biomarkers included: 2 clinical scores (Mini Mental State Examination (MMSE), Rey Auditory Verbal Learning Test (RAVLT)); 3 CSF-biomarkers (Aβ1−42, P-tau181, total-Tau); and 4 magnetic resonance imaging (MRI) biomarkers (volumes of the hippocampi, temporal, parietal, and frontal cortices) computed with icobrain dm. The naMCI and aMCI groups were compared by EBM stage proportions, and the model’s effectiveness at patient level was evaluated. The research cohort’s maximum likelihood event sequence comprised CSF Aβ1-42, P-tau181, T-tau, RAVLT, MMSE, and cortical volumes. The clinical cohort’s order was frontal cortex volume, MMSE, and remaining cortical regions. aMCI subjects showed higher staging than naMCI, with 54% in the two most advanced stages compared to 38% in naMCI. In the research cohort, 10 outliers were identified with potential mismatches between assigned stages and clinical or biomarker profiles, with CN (n = 4) and SCD (n = 2) subjects assigned in stage 4, one control in stage 9 with abnormal imaging, and three aMCI cases in stage 0 despite clinical or volumetric signs of impairment. This study highlights the generalizability of EuroPOND’s AD EBM model across research and real-world clinical datasets, supporting its use in multi-center trials. aMCI subjects generally reside in more advanced stages than naMCI, who may not necessarily have AD, demonstrating utility for precision recruitment/screening. EBM for AD staging is generalizable and reliable across research and real-world clinical datasets. Amnestic MCI subjects exhibited higher EBM scores than non-amnestic subjects, indicating utility for precision recruitment and screening in clinical trials. Tailored EBM models for distinct AD subtypes and diverse neurodegenerative diseases are imperative for accurate staging and understanding varied disease trajectories.
Source: Alzheimer s Research & Therapy
Authors: Mandy M. J. Wittens, Diana M. Sima, Arne Brys, Hanne Struyfs, Ellis Niemantsverdriet, Ellen De Roeck, Christine Bastin, Florence Benoit, Bruno Bergmans, Jean-Christophe Bier, Peter Paul de Deyn, Olivier Deryck, Bernard Hanseeuw, Adrian Ivanoiu, Gaëtane Picard, Eric Salmon, Kurt Segers, Anne Sieben, Evert Thiery, Jos Tournoy, Anne-Marie van Binst, Jan Versijpt, Dirk Smeets, Maria Bjerke, Maura Bellio, Neil P. Oxtoby, Daniel C. Alexander, Annemie Ribbens, Sebastiaan Engelborghs
Institutions: Vrije Universiteit Brussel, University of Antwerp, Universitair Ziekenhuis Brussel, Icometrix (Belgium), Ziekenhuis aan de Stroom, University of Liège, Fund for Scientific Research, Université Libre de Bruxelles, Centre Hospitalier Universitaire Brugmann, Ghent University Hospital, Ghent University, AZ Sint-Jan, Erasmus Hospital, University Medical Center Groningen, University of Groningen, AZ Sint-Lucas, Cliniques Universitaires Saint-Luc, Walloon Excellence in Lifesciences and Biotechnology, UCLouvain, Clinique Saint Pierre, Antwerp University Hospital, Institute Born-Bunge, Universitair Ziekenhuis Leuven, KU Leuven, University College London
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,290
OpenAlex ID: W4411345784