Advances in Stability of NiFe-Based Anodes toward Oxygen Evolution Reaction for Alkaline Water Electrolysis.

Alkaline electrolysis plays a crucial role in sustainable energy solutions by utilizing electrolytic cells to produce hydrogen gas, providing a clean and efficient method for energy storage and conversion. Efficient, stable, and low-cost electrocatalysts for the oxygen evolution reaction (OER) are essential to facilitate alkaline water electrolysis on a commercial scale. Nickel-iron-based (NiFe-based) transition metal electrocatalysts are considered the most promising non-precious metal catalysts for alkaline OER due to their low cost, abundance, and tunable catalytic properties. Nevertheless, the majority of existing NiFe-based catalysts suffer from limited activity and poor stability, posing a significant challenge in meeting industrial applications. This also highlights a common situation where the emphasis on material activity receives significant attention, while the equally critical stability aspect is often underemphasized. Initiating with a comprehensive exploration of the stability of NiFe-based OER materials, this article first summarizes the debate surrounding the determination of active sites in NiFe-based OER electrocatalysts. Subsequently, the degradation mechanisms of recently reported NiFe-based electrocatalysts are outlined, encompassing assessments of both chemical and mechanical endurance, along with essential approaches for enhancing their stability. Finally, suggestions are put forth regarding the essential considerations for the design of NiFe-based OER electrocatalysts, with a focus on heightened stability.

Boosted Oxygen Kinetics of Hierarchically Mesoporous Mo2C/C for High-current-density Zn-air Battery.

The high-current-density Zn-air battery shows big prospects in next-generation energy technologies, while sluggish O2 reaction and diffusion kinetics barricade the applications. Herein, the sequential assembly is innovatively demonstrated for hierarchically mesoporous molybdenum carbides/carbon microspheres with a tunable thickness of mesoporous carbon layers (Meso-Mo2C/C-x, where x represents the thickness). The optimum Meso-Mo2C/C-14 composites (≈2 µm in diameter) are composed of mesoporous nanosheets (≈38 nm in thickness), which possess bilateral mesoporous carbon layers (≈14 nm in thickness), inner Mo2C/C layers (≈8 nm in thickness) with orthorhombic Mo2C nanoparticles (≈2 nm in diameter), a high surface area of ≈426 m2 g-1, and open mesopores (≈6.9 nm in size). Experiments and calculations corroborate the hierarchically mesoporous Mo2C/C can enhance hydrophilicity for supplying sufficient O2, accelerate oxygen reduction kinetics by highly-active Mo2C and N-doped carbon sites, and facilitate O2 diffusion kinetics over hierarchically mesopores. Therefore, Meso-Mo2C/C-14 outputs a high half-wave potential (0.88 V vs RHE) with a low Tafel slope (51 mV dec-1) for oxygen reduction. More significantly, the Zn-air battery delivers an ultrahigh power density (272 mW cm-2), and an unprecedented 100 h stability at a high-current-density condition (100 mA cm-2), which is one of the best performances.

Fundamental aspects of the molecular topology of fuchsine acid dye with connection numbers.

Fuchsine acid serves as a supramolecular dye in Masson's trichrome stain, finding extensive applications in histology. It is also utilized with picric acid in Van Gieson's method to reveal red collagen fibers and in Masson's trichrome to highlight smooth muscle in contrast to collagen. Beyond these applications, it plays a crucial role in electronic fields and photonic devices as an organic semiconductor. Therefore, investigating and predicting the complex molecular structure of fuchsine acid becomes essential, serving as the foundation for understanding its physicochemical features. This article employs topological modeling, specifically a connection number edge partition, to explore the supramolecular nature of fuchsine acid. Closed formulae for key degree-based molecular descriptors are derived, aiming to illuminate the effectiveness of these descriptors for QSAR and QSPR analyses.

AT(N) biomarker profiles and Alzheimer's disease symptomology in Down syndrome.

INTRODUCTION: Down syndrome (DS) is a genetic cause of early-onset Alzheimer's disease (AD). The National Institute on Aging-Alzheimer's Association AT(N) Research Framework is a staging model for AD biomarkers but has not been assessed in DS. METHOD: Data are from the Alzheimer's Biomarker Consortium-Down Syndrome. Positron emission tomography (PET) amyloid beta (Aß; 15 mCi of [11 C]Pittsburgh compound B) and tau (10 mCi of [18 F]AV-1451) were used to classify amyloid (A) -/+ and tau (T) +/-. Hippocampal volume classified neurodegeneration (N) -/+. The modified Cued Recall Test assessed episodic memory. RESULTS: Analyses included 162 adults with DS (aged M = 38.84 years, standard deviation = 8.41). Overall, 69.8% of participants were classified as A-/T-/(N)-, 11.1% were A+/T-/(N)-, 5.6% were A+/T+/(N)-, and 9.3% were A+/T+/(N)+. Participants deemed cognitively stable were most likely to be A-T-(N)- and A+T-(N)-. Tau PET (T+) most closely aligning with memory impairment and AD clinical status. DISCUSSION: Findings add to understanding of AT(N) biomarker profiles in DS. HIGHLIGHTS: Overall, 69.8% of adults with Down syndrome (DS) aged 25 to 61 years were classified as amyloid (A)-/tau (T)-/neurodegeneration (N)-, 11.1% were A+/T-/(N)-, 5.6% were A+/T+/(N)-, and 9.3% were A+/T+/(N)+. The AT(N) profiles were associated with clinical Alzheimer's disease (AD) status and with memory performance, with the presence of T+ aligned with AD clinical symptomology. Findings inform models for predicting the transition to the prodromal stage of AD in DS.

Alzheimer's polygenic risk scores are associated with cognitive phenotypes in Down syndrome.

INTRODUCTION: This study aimed to investigate the influence of the overall Alzheimer's disease (AD) genetic architecture on Down syndrome (DS) status, cognitive measures, and cerebrospinal fluid (CSF) biomarkers. METHODS: AD polygenic risk scores (PRS) were tested for association with DS-related traits. RESULTS: The AD risk PRS was associated with disease status in several cohorts of sporadic late- and early-onset and familial late-onset AD, but not in familial early-onset AD or DS. On the other hand, lower DS Mental Status Examination memory scores were associated with higher PRS, independent of intellectual disability and APOE (PRS including APOE, PRSAPOE , p = 2.84 × 10-4 ; PRS excluding APOE, PRSnonAPOE , p = 1.60 × 10-2 ). PRSAPOE exhibited significant associations with Aß42, tTau, pTau, and Aß42/40 ratio in DS. DISCUSSION: These data indicate that the AD genetic architecture influences cognitive and CSF phenotypes in DS adults, supporting common pathways that influence memory decline in both traits. HIGHLIGHTS: Examination of the polygenic risk of AD in DS presented here is the first of its kind. AD PRS influences memory aspects in DS individuals, independently of APOE genotype. These results point to an overlap between the genes and pathways that leads to AD and those that influence dementia and memory decline in the DS population. APOE ε4 is linked to DS cognitive decline, expanding cognitive insights in adults.

Characterizing the emergence of amyloid and tau burden in Down syndrome.

INTRODUCTION: Almost all individuals with Down syndrome (DS) will develop neuropathological features of Alzheimer's disease (AD). Understanding AD biomarker trajectories is necessary for DS-specific clinical interventions and interpretation of drug-related changes in the disease trajectory. METHODS: A total of 177 adults with DS from the Alzheimer's Biomarker Consortium-Down Syndrome (ABC-DS) underwent positron emission tomography (PET) and MR imaging. Amyloid-beta (Aß) trajectories were modeled to provide individual-level estimates of Aß-positive (A+) chronicity, which were compared against longitudinal tau change. RESULTS: Elevated tau was observed in all NFT regions following A+ and longitudinal tau increased with respect to A+ chronicity. Tau increases in NFT regions I-III was observed 0-2.5 years following A+. Nearly all A+ individuals had tau increases in the medial temporal lobe. DISCUSSION: These findings highlight the rapid accumulation of amyloid and early onset of tau relative to amyloid in DS and provide a strategy for temporally characterizing AD neuropathology progression that is specific to the DS population and independent of chronological age. HIGHLIGHTS: Longitudinal amyloid trajectories reveal rapid Aß accumulation in Down syndrome NFT stage tau was strongly associated with A+ chronicity Early longitudinal tau increases were observed 2.5-5 years after reaching A.

Down Syndrome Biobank Consortium: A perspective.

Individuals with Down syndrome (DS) have a partial or complete trisomy of chromosome 21, resulting in an increased risk for early-onset Alzheimer's disease (AD)-type dementia by early midlife. Despite ongoing clinical trials to treat late-onset AD, individuals with DS are often excluded. Furthermore, timely diagnosis or management is often not available. Of the genetic causes of AD, people with DS represent the largest cohort. Currently, there is a knowledge gap regarding the underlying neurobiological mechanisms of DS-related AD (DS-AD), partly due to limited access to well-characterized brain tissue and biomaterials for research. To address this challenge, we created an international consortium of brain banks focused on collecting and disseminating brain tissue from persons with DS throughout their lifespan, named the Down Syndrome Biobank Consortium (DSBC) consisting of 11 biobanking sites located in Europe, India, and the USA. This perspective describes the DSBC harmonized protocols and tissue dissemination goals.

Adapting prescribing criteria for amyloid-targeted antibodies for adults with Down syndrome.

Prior authorization criteria for Federal Drug Administration (FDA) approved immunotherapeutics, among the class of anti-amyloid monoclonal antibodies (mAbs), established by state drug formulary committees, are tailored for adults with late-onset Alzheimer's disease. This overlooks adults with Down syndrome (DS), who often experience dementia at a younger age and with different diagnostic assessment outcomes. This exclusion may deny DS adults access to potential disease-modifying treatments. To address this issue, an international expert panel convened to establish adaptations of prescribing criteria suitable for DS patients and parameters for access to Centers for Medicare & Medicaid Services (CMS) registries. The panel proposed mitigating disparities by modifying CMS and payer criteria to account for younger onset age, using alternative language and assessment instruments validated for cognitive decline in the DS population. The panel also recommended enhancing prescribing clinicians' diagnostic capabilities for DS and initiated awareness-raising activities within healthcare organizations. These efforts facilitated discussions with federal officials, aimed at achieving equity in access to anti-amyloid immunotherapeutics, with implications for national authorities worldwide evaluating these and other new disease-modifying therapeutics for Alzheimer's disease.

Age of Alzheimer's disease diagnosis in people with Down syndrome and associated factors: Results from the Horizon 21 European Down syndrome consortium.

INTRODUCTION: People with Down syndrome (DS) have high risk of developing Alzheimer's disease (AD). This study examined mean ages of AD diagnosis and associations with co-occurring conditions among adults with DS from five European countries. METHODS: Data from 1335 people with DS from the Horizon 21 European DS Consortium were used for the analysis. RESULTS: Mean ages of AD diagnosis ranged between 51.4 (SD 7.0) years (United Kingdom) and 55.6 (SD 6.8) years (France). Sleep-related and mental health problems were associated with earlier age of AD diagnosis. The higher number of co-occurring conditions the more likely the person with DS is diagnosed with AD at an earlier age. DISCUSSION: Mean age of AD diagnosis in DS was relatively consistent across countries. However, co-occurring conditions varied and impacted on age of diagnosis, suggesting that improvements can be made in diagnosing and managing these conditions to delay onset of AD in DS. HIGHLIGHTS: Mean age of AD diagnosis was relatively consistent between countries Sleep problems and mental health problems were associated with earlier age of AD diagnosis APOE ε4 carriers were diagnosed with AD at an earlier age compared to non-carriers Number of co-occurring conditions was associated with earlier age of AD diagnosis No differences between level of intellectual disability and mean age of AD diagnosis.

Structural modeling and topological characterization of three kinds of dendrimer networks.

Dendrimers, also known as dendritic polymers, have various applications due to their unique properties, such as their monodisperse structure and their ability to be synthesized with precise control over their size, shape, and surface functionality. Dendrimers are used in drug delivery systems to improve drug solubility, bioavailability, and targeting. They can carry drugs to specific sites, such as cancer cells, and release them in a controlled manner, reducing side effects. Dendrimers can be used as gene delivery vehicles to deliver genetic material to cells in a controlled and targeted manner. Mathematical chemistry is useful to model chemical reactions and predict the behavior of chemical systems. It provides a quantitative understanding of chemical phenomena, which can aid in the design of new molecules and materials. It is used to develop molecular descriptors, which are mathematical representations of molecular structures that can be used to quantify the properties of molecules. These descriptors can be useful in structure-activity relationship studies to predict the biological activity of compounds. The topological descriptors are parameters of any molecular structure that gives a mathematical formula to model such molecular structures. In the current study, our concern is to calculate some useful topological indices for three kinds of dendrimer networks and derive closed mathematical formulas for them. The comparisons of these calculated topological indices are also investigated. Our obtained results will be helpful in investigating QSPRs/QSARs of such molecules in many fields of science, such as chemistry, physics and biochemistry. The dendrimer structure (left). From first (G0) to third (G3) generation, the dendrimer's increasing generations are shown schematically (right).

On the construction of some bioconjugate networks and their structural modeling via irregularity topological indices.

Bioconjugate networks refer to networks that are formed by connecting different molecules or particles (such as proteins, enzymes, or nanoparticles) through covalent or non-covalent interactions. These networks are often used in various biological and biomedical applications, such as drug delivery, biosensors, and tissue engineering. The specific properties and behavior of these networks depend on the types of molecules used and the nature of their interactions, which can be studied using various computational and experimental techniques. Farnesyl and geranyl groups are types of isoprenoid chains that are commonly found in various biological molecules such as proteins, lipids, and pigments. The addition of these groups to penicillin molecules may alter their physical and chemical properties, such as solubility, stability, and bioavailability. To gain a better understanding of the structure-property relationships of these antibiotics, this study computes various irregularity indices such as the Albertson index, irregularity index, total irregularity index, Randic irregularity index, and other degree-based indices for two types of sensitive bonds of bioconjugate networks. Numerical results and graphical representations are used to illustrate these findings. The obtained results provide valuable insights into the structure-property relationships of penicillins, which will aid in a better understanding of their behavior and developing more effective antibiotics.

Selective CO2 Reduction to Ethylene Mediated by Adaptive Small-molecule Engineering of Copper-based Electrocatalysts.

Electrochemical CO2 reduction reaction (CO2 RR) over Cu catalysts exhibits enormous potential for efficiently converting CO2 to ethylene (C2 H4 ). However, achieving high C2 H4 selectivity remains a considerable challenge due to the propensity of Cu catalysts to undergo structural reconstruction during CO2 RR. Herein, we report an in situ molecule modification strategy that involves tannic acid (TA) molecules adaptive regulating the reconstruction of a Cu-based material to a pathway that facilitates CO2 reduction to C2 H4 products. An excellent Faraday efficiency (FE) of 63.6 % on C2 H4 with a current density of 497.2 mA cm-2 in flow cell was achieved, about 6.5 times higher than the pristine Cu catalyst which mainly produce CH4 . The in situ X-ray absorption spectroscopy and Raman studies reveal that the hydroxyl group in TA stabilizes Cuδ+ during the CO2 RR. Furthermore, theoretical calculations demonstrate that the Cuδ+ /Cu0 interfaces lower the activation energy barrier for *CO dimerization, and hydroxyl species stabilize the *COH intermediate via hydrogen bonding, thereby promoting C2 H4 production. Such molecule engineering modulated electronic structure provides a promising strategy to achieve highly selective CO2 reduction to value-added chemicals.

Engineering Water Molecules Activation Center on Multisite Electrocatalysts for Enhanced CO2 Methanation.

The renewable energy-powered electrolytic reduction of carbon dioxide (CO2) to methane (CH4) using water as a reaction medium is one of the most promising paths to store intermittent renewable energy and address global energy and sustainability problems. However, the role of water in the electrolyte is often overlooked. In particular, the slow water dissociation kinetics limits the proton-feeding rate, which severely damages the selectivity and activity of the methanation process involving multiple electrons and protons transfer. Here, we present a novel tandem catalyst comprising Ir single-atom (Ir1)-doped hybrid Cu3N/Cu2O multisite that operates efficiently in converting CO2 to CH4. Experimental and theoretical calculation results reveal that the Ir1 facilitates water dissociation into proton and feeds to the hybrid Cu3N/Cu2O sites for the *CO protonation pathway toward *CHO. The catalyst displays a high Faradaic efficiency of 75% for CH4 with a current density of 320 mA cm-2 in the flow cell. This work provides a promising strategy for the rational design of high-efficiency multisite catalytic systems.

Exploring electrophysiological markers of auditory predictive processes and pathological ageing in adults with Down's syndrome.

Down's syndrome is associated with pathological ageing and a propensity for early-onset Alzheimer's disease. The early symptoms of dementia in people with Down's syndrome may reflect frontal lobe vulnerability to amyloid deposition. Auditory predictive processes rely on the bilateral auditory cortices with the recruitment of frontal cortices and appear to be impaired in pathologies characterized by compromised frontal lobe. Hence, auditory predictive processes were investigated to assess Down's syndrome pathology and its relationship with pathological ageing. An auditory electroencephalography (EEG) global-local paradigm was presented to the participants, in which oddball stimuli could either violate local or higher level global rules. We characterised predictive processes in individuals with Down's syndrome and their relationship with pathological ageing, with a focus on the EEG event-related potential called Mismatch Negativity (MMN) and the P300. In Down's syndrome, we also evaluated the EEG components as predictor of cognitive decline 1 year later. We found that predictive processes of detection of auditory violations are overall preserved in Down's syndrome but also that the amplitude of the MMN to local deviancies decreases with age. However, the 1-year follow-up of Down's syndrome found that none of the ERPs measures predicted subsequent cognitive decline. The present study provides a novel characterization of electrophysiological markers of local and global predictive processes in Down's syndrome.

Advanced Platinum-Based Oxygen Reduction Electrocatalysts for Fuel Cells.

ConspectusFuel cells are among the cutting-edge energy technologies. Their commercial development is still hindered by noble platinum (Pt) catalysts for the oxygen reduction reaction (ORR) at the cathode, which not only determine the energy conversion efficiency and service life but also are closely related to the cost and broad application of fuel cells. Given the bright and enormous future of fuel cells, ORR catalysts should possess highly efficient performance yet meet the acceptable Pt costs for large-scale application. Extensive efforts are concentrated on the optimization of Pt-based nanostructures and upgradation of functional carriers to achieve the low-cost and high-activity Pt-based catalysts. By improving the Pt utilization and accessible surface, reducing Pt consumption and catalyst costs, accelerating mass exchange and electron transfer, alleviating the corrosion and agglomeration of carriers and Pt, accompanying with the assistance of robust yet effective functional supports, the service level and life of Pt-based electrocatalysts would be significantly improved and fuel cells could get into commercial market covering broader applications.In this Account, we focus on the recent development of Pt-based catalysts to figure out the problems associated with ORR catalysts in fuel cells. Recent development of Pt-based catalysts is discussed in different stages: (1) multiscale development of Pt-based nanostructures; (2) multielement regulation over Pt-based alloy composition; (3) upgradation of carbon and noncarbon support architectures; (4) development of integrated Pt-based catalysts for fuel cells. Finally, we propose some future issues (such as reaction mechanism, dynamic evolutions, and structure-activity relationship) for Pt-based catalysts, which mainly involve the preparation strategy of Pt-integrated catalysts (combination of Pt nanostructures with nanocarbons), performance evaluation (standard measurement protocols, laboratory-level rotating disk electrode (RDE) measurements, application-level membrane electrode assembly (MEA) service test), advanced interpretation techniques (spectroscopy, electron microscopy, and in situ monitoring), and cutting-edge simulation/calculations and artificial intelligence (simulation, calculations, machine learning, big data screening). This Account calls for the comprehensive development of multiscale, multicomponent, and high-entropy Pt-based alloy nanostructures, and novel and stable carriers, which provide more available options for rational design of low-cost and high-performance Pt-integrated ORR catalysts. More importantly, it will give an in-depth understanding of the reaction mechanism, dynamic development, and structure-performance relationship for Pt-based catalysts in fuel cells and related energy technologies.

Impact of Probiotic Geotrichum candidum QAUGC01 on Health, Productivity, and Gut Microbial Diversity of Dairy Cattle.

Gut microbial diversity is a determinant of animal productivity and health. Probiotic supplementation in feed has been known to modulate the gut microbial diversity resulting in better feed utilization and resistance against diseases. The current study was designed to determine the probiotic potential of Geotrichum candidum QAUGC01 (VHDP00000000) in Sahiwal-Friesian crossbred dairy cows and its impact on gut microbial diversity, health, and productivity. To evaluate health and productivity, growth performance, determination of blood parameters, serum biochemistry, feed efficiency, milk yield & composition, and nutrients digestibility was determined and compared between control and experimental groups. Moreover, at the end of the experiment, the gut microbial diversity was evaluated through MiSeq (Illumina) sequencing of bacterial and fungal/yeast DNA in dung samples of both control and experimental cows. Inspite of a significant reduction in dry matter intake the increase in feed efficiency and milk yield was observed in experimental cows with normal hematological and serum biochemical profile. The increase in anaerobic bacterial count and decrease in the shredding of pathogenic flora was observed in experimental cows. Metagenomic analysis revealed Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes to be the four dominating phyla among bacteria and, Ascomycota followed by Basidiomycota and Neocallimastigomycota among the fungal population in both groups. The diversity of the core microbiome revealed high bacterial and Fungal Alpha diversity in the experimental group than in control via the Shannon index. This study provided insights into the safe use of G. candidum as a probiotic, to improve growth performance, health, productivity and gut microbial diversity of dairy cattle.

Interplay of Ferritin Accumulation and Ferroportin Loss in Ageing Brain: Implication for Protein Aggregation in Down Syndrome Dementia, Alzheimer's, and Parkinson's Diseases.

Iron accumulates in the ageing brain and in brains with neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), and Down syndrome (DS) dementia. However, the mechanisms of iron deposition and regional selectivity in the brain are ill-understood. The identification of several proteins that are involved in iron homeostasis, transport, and regulation suggests avenues to explore their function in neurodegenerative diseases. To uncover the molecular mechanisms underlying this association, we investigated the distribution and expression of these key iron proteins in brain tissues of patients with AD, DS, PD, and compared them with age-matched controls. Ferritin is an iron storage protein that is deposited in senile plaques in the AD and DS brain, as well as in neuromelanin-containing neurons in the Lewy bodies in PD brain. The transporter of ferrous iron, Divalent metal protein 1 (DMT1), was observed solely in the capillary endothelium and in astrocytes close to the ventricles with unchanged expression in PD. The principal iron transporter, ferroportin, is strikingly reduced in the AD brain compared to age-matched controls. Extensive blood vessel damage in the basal ganglia and deposition of punctate ferritin heavy chain (FTH) and hepcidin were found in the caudate and putamen within striosomes/matrix in both PD and DS brains. We suggest that downregulation of ferroportin could be a key reason for iron mismanagement through disruption of cellular entry and exit pathways of the endothelium. Membrane damage and subsequent impairment of ferroportin and hepcidin causes oxidative stress that contributes to neurodegeneration seen in DS, AD, and in PD subjects. We further propose that a lack of ferritin contributes to neurodegeneration as a consequence of failure to export toxic metals from the cortex in AD/DS and from the substantia nigra and caudate/putamen in PD brain.

Scalable Molten Salt Synthesis of Platinum Alloys Planted in Metal-Nitrogen-Graphene for Efficient Oxygen Reduction.

Fuel cells are considered as a promising alternative to the existing traditional energy systems towards a sustainable future. Nevertheless, the synthesis of efficient and robust platinum (Pt) based catalysts remains a challenge for practical applications. In this work, we present a simple and scalable molten-salt synthesis method for producing a low-platinum (Pt) nanoalloy implanted in metal-nitrogen-graphene. The as-prepared low-Pt alloyed graphene exhibits a high oxygen reduction activity of 1.29 A mgPt -1 and excellent durability over 30 000 potential cycles. The catalyst nanoarchitecture of graphene encased Pt nanoalloy provides a robust capability against nanoparticle migration and corrosion due to a strong metal-support interaction. Similarly, advanced characterization and theoretical calculations show that the multiple active sites in platinum alloyed graphene synergistically account for the improved oxygen reduction. This work not only provides an efficient and robust low-Pt catalyst but also a facile design idea and scalable preparation technique for integrated catalysts to achieve more profound applications in fuel cells and beyond.

PET measurement of longitudinal amyloid load identifies the earliest stages of amyloid-beta accumulation during Alzheimer's disease progression in Down syndrome.

INTRODUCTION: Adults with Down syndrome (DS) are predisposed to Alzheimer's disease (AD) and reveal early amyloid beta (Aß) pathology in the brain. Positron emission tomography (PET) provides an in vivo measure of Aß throughout the AD continuum. Due to the high prevalence of AD in DS, there is need for longitudinal imaging studies of Aß to better characterize the natural history of Aß accumulation, which will aid in the staging of this population for clinical trials aimed at AD treatment and prevention. METHODS: Adults with DS (N = 79; Mean age (SD) = 42.7 (7.28) years) underwent longitudinal [C-11]Pittsburgh compound B (PiB) PET. Global Aß burden was quantified using the amyloid load metric (AßL). Modeled PiB images were generated from the longitudinal AßL data to visualize which regions are most susceptible to Aß accumulation in DS. AßL change was evaluated across Aß(-), Aß-converter, and Aß(+) groups to assess longitudinal Aß trajectories during different stages of AD-pathology progression. AßL change values were used to identify Aß-accumulators within the Aß(-) group prior to reaching the Aß(+) threshold (previously reported as 20 AßL) which would have resulted in an Aß-converter classification. With knowledge of trajectories of Aß(-) accumulators, a new cutoff of Aß(+) was derived to better identify subthreshold Aß accumulation in DS. Estimated sample sizes necessary to detect a 25% reduction in annual Aß change with 80% power (alpha 0.01) were determined for different groups of Aß-status. RESULTS: Modeled PiB images revealed the striatum, parietal cortex and precuneus as the regions with earliest detected Aß accumulation in DS. The Aß(-) group had a mean AßL change of 0.38 (0.58) AßL/year, while the Aß-converter and Aß(+) groups had change of 2.26 (0.66) and 3.16 (1.34) AßL/year, respectively. Within the Aß(-) group, Aß-accumulators showed no significant difference in AßL change values when compared to Aß-converter and Aß(+) groups. An Aß(+) cutoff for subthreshold Aß accumulation was derived as 13.3 AßL. The estimated sample size necessary to detect a 25% reduction in Aß was 79 for Aß(-) accumulators and 59 for the Aß-converter/Aß(+) group in DS. CONCLUSION: Longitudinal AßL changes were capable of distinguishing Aß accumulators from non-accumulators in DS. Longitudinal imaging allowed for identification of subthreshold Aß accumulation in DS during the earliest stages of AD-pathology progression. Detection of active Aß deposition evidenced by subthreshold accumulation with longitudinal imaging can identify DS individuals at risk for AD development at an earlier stage.

Clinical and biomarker changes of Alzheimer's disease in adults with Down syndrome: a cross-sectional study.

BACKGROUND: Alzheimer's disease and its complications are the leading cause of death in adults with Down syndrome. Studies have assessed Alzheimer's disease in individuals with Down syndrome, but the natural history of biomarker changes in Down syndrome has not been established. We characterised the order and timing of changes in biomarkers of Alzheimer's disease in a population of adults with Down syndrome. METHODS: We did a dual-centre cross-sectional study of adults with Down syndrome recruited through a population-based health plan in Barcelona (Spain) and through services for people with intellectual disabilities in Cambridge (UK). Cognitive impairment in participants with Down syndrome was classified with the Cambridge Cognitive Examination for Older Adults with Down Syndrome (CAMCOG-DS). Only participants with mild or moderate disability were included who had at least one of the following Alzheimer's disease measures: apolipoprotein E allele carrier status; plasma concentrations of amyloid ß peptides 1-42 and 1-40 and their ratio (Aß1-42/1-40), total tau protein, and neurofilament light chain (NFL); tau phosphorylated at threonine 181 (p-tau), and NFL in cerebrospinal fluid (CSF); and one or more of PET with 18F-fluorodeoxyglucose, PET with amyloid tracers, and MRI. Cognitively healthy euploid controls aged up to 75 years who had no biomarker abnormalities were recruited from the Sant Pau Initiative on Neurodegeneration. We used a first-order locally estimated scatterplot smoothing curve to determine the order and age at onset of the biomarker changes, and the lowest ages at the divergence with 95% CIs are also reported where appropriate. FINDINGS: Between Feb 1, 2013, and June 28, 2019 (Barcelona), and between June 1, 2009, and Dec 31, 2014 (Cambridge), we included 388 participants with Down syndrome (257 [66%] asymptomatic, 48 [12%] with prodromal Alzheimer's disease, and 83 [21%] with Alzheimer's disease dementia) and 242 euploid controls. CSF Aß1-42/1-40 and plasma NFL values changed in individuals with Down syndrome as early as the third decade of life, and amyloid PET uptake changed in the fourth decade. 18F-fluorodeoxyglucose PET and CSF p-tau changes occurred later in the fourth decade of life, followed by hippocampal atrophy and changes in cognition in the fifth decade of life. Prodromal Alzheimer's disease was diagnosed at a median age of 50·2 years (IQR 47·5-54·1), and Alzheimer's disease dementia at 53·7 years (49·5-57·2). Symptomatic Alzheimer's disease prevalence increased with age in individuals with Down syndrome, reaching 90-100% in the seventh decade of life. INTERPRETATION: Alzheimer's disease in individuals with Down syndrome has a long preclinical phase in which biomarkers follow a predictable order of changes over more than two decades. The similarities with sporadic and autosomal dominant Alzheimer's disease and the prevalence of Down syndrome make this population a suitable target for Alzheimer's disease preventive treatments. FUNDING: Instituto de Salud Carlos III, Fundació Bancaria La Caixa, Fundació La Marató de TV3, Medical Research Council, and National Institutes of Health.