The Australian Imaging Biomarkers and Lifestyle Flagship Study of Ageing

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1 The Australian Imaging Biomarkers and Lifestyle Flagship Study of Ageing. (AUSTRALIAN ADNI) July 2013 UPDATE Imaging Christopher Rowe MD Neuroimaging stream leader

2 June 2013 The Australian Imaging Biomarkers and Lifestyle Flagship Study of Ageing. October 2006 Replacement MCI and smc Women s Healthy Aging Program 58 new participants AV-45 Funded anon 102 new participants Flutemetamol Funded by GE 105 new participants Florbetaben Funded by Bayer/Piramal 823 not imaged 738 not imaged Original Cohort 632 not imaged 83 participants Flutemetamol Funded by GE 92 participants AV-45 Funded anon 390 not imaged 288 imaged MRI + 11C-PiB Funded by CSIRO 230 imaged MRI + 11C-PiB Funded by CSIRO 172 imaged MRI and 11C-PiB Funded by SIEF 141 participants MRI and 11C-PiB Funded by SIEF 0 yrs 1.5 yrs 3 yrs 1112 recruited 968 remain 824 remain 4.5 yrs 718 remain plus 268 new

3 The Australian Imaging Biomarkers and Lifestyle Flagship Study of Ageing. 3 year Data Release 221 subjects (, MCI, AD) with baseline PiB PET and MRI now with 3 year clinical data and 3 year PiB PET in 173 with MRI in Data and Samples - Access Data

4 Canada USA Colombia Mexico Cuba Argentina 540 research groups granted access to through ADNI website Denmark UK Ireland Germany France Spain Italy Belgium Netherlands Switzerland Poland Algeria Egypt Bulgaria Israel Turkey Finland Sweden India Pakistan Saudi Arabia Iran China Taiwan Japan Hong Kong Korea Australia New Zealand Includes access granted to the following companies: Abbott Labs, Abiant, ADM diagnostics, Astra Zeneca, Avid, BioClinica, Biogen Idec, Bristol-Myers Squibb, Cogstate Cytokinetics, Eisai, Elan, Eli Lilly, GE Health Care, General Resonance, Genetech, Imorphics, Iris Biotechnologies, Janssen, Johnson Johnson, M and M Scientific, Merck & Co, Mimvista, Pentara Corp, Pfizer, Philips, Predixion software, Rancho Biosciences, Servier, Siemens, Soft team solutions, UCB, United Biosource Corp.

5 Neocortical SUVR PiB neocortical SUVR % 99% % (n = 366) 1.40±0.4 (n = 195) MCI 1.91±0.6 (n = 92) AD 2.30±0.4 (n = 79)

6 Neocortical SUVR Longitudinal PiB PET 6-year follow-up yo male (e3/e3) 74 yo female (e3/e3) MMSE 29 MMSE 29 MMSE 29 MMSE 29 MMSE 28 MMSE 29 MCI MMSE 25 MCI MMSE 30 MMSE 26 MCI MMSE yo female (e3/e3) MMSE 29 MMSE 30 MMSE 29 MMSE 30 MMSE Time (months)

7

8 Rate of Ab deposition Relation between baseline Ab burden and rates of Ab deposition 3-5 year follow-up R 2 = 0.23 (p<0.0001) Baseline Ab burden

9 Rate of Ab deposition Rate of Ab deposition vs MMSE 3-5 year follow-up 0.10 MCI AD R 2 = 0.08 (p=0.0006) Baseline MMSE

10 MCI + AD The natural history of Ab deposition in sporadic AD 3.0 Neocortical SUVR cb + * SUVR/yr (95%CI SUVR/yr) 12.0 yr 19.2 yr (95%CI yrs) Mean SUVR AD+ (2.33) Mean SUVR - (1.17) - MCI- 1.0 (95%CI yrs) Time (years)

11 Biomarker magnitude Relationship between abnormality and CDR of 1.0 abnormal CDR 1.0 Ab deposition Hippocampal volume Episodic memory Grey matter volume Non-memory cut-off normal Time (years) non-demented demented

12 Risk of decline over 3 years: Positive vs negative amyloid scan (n=183) MCI (n=87) NEGATIVE (n=130) 25% to MCI/AD POSITIVE (n=53) 29% (8/27) to dementia NEGATIVE (n=27) 77% (46/60) to AD POSITIVE (n=60) Odds Ratio 4.8 (p = 0.001) Odds Ratio 7 ( p< 0.001) (OR increases to 14 if non-ad dementia removed)

13 MCI to AD over 3 years (n=87; 59% progressed) MCI positive for marker Odds Ratio PPV NPV HV ApoE-e CVLT< PiB PiB+e PiB+HV PiB+CVLT 43 na

14 Neocortical SUVR Predictive value of low (<1.4) vs intermediate vs high (>1.9) PiB binding PPV 82% 2.00 PPV 35% 1.50 PPV 17% PPV 44% 1.00 (n = 183) RASAD March 2012 MCI (n = 87) AD (n = 79)

15 CVLT-II Delayed Recall CVLT-II Delayed Recall over 36 mths PiB -ve n =122, SUVR = Mild Cognitive Impairment 8 PiB +ve n = 55, SUVR = PiB -ve n = 16, SUVR = Healthy Older Persons PiB +ve n = 32, SUVR = Baseline 18 months 36 months 2 Baseline 18 months 36 months

16 Rates of Ab deposition Ab burden Initial Ab burden is a better predictor of progression from MCI to AD than the rate of Ab accumulation p = p < non-converters converters non-converters converters OR = 5.4 OR = 15

17 Biomarker magnitude 17-23yrs Preclinical Stage CDR 1 Abnormal yrs 5-8yrs 1-3yrs Cut-points 1-2yrs Ab Amyloid Neuronal Injury Cognitive Symptoms Normal Cognitively Normal MCI Dementia Clinical disease stage

18 to MCI or AD over 3 years (n=183; 13% progressed) positive for marker OR PPV NPV HV e EM< PiB PiB+e PiB+HV PiB+EM AIBL composite EM Z-score <-1 (n=49), OR 11, PPV 35%, NPV 96% without correction for age or education.

19 Future Directions for AIBL Imaging Further refine prognostic value and comparative effectiveness of imaging biomarkers Replace 11 C-PiB with 18 F-NAV4694 Add Tau imaging Create a new pool of amyloid scan positive and MCI for early intervention trials Use AIBL infrastructure to support the A4 and DIAN therapy trials

20 Tau, Aβ and glucose metabolism in Alzheimer's disease patient [ 18 F]THK [ 11 C] PiB [ 18 F]FDG SUVR SUVR SUVR

21 Acknowledgements and thanks AIBL is a large collaborative study and a complete list of contributors and the management committee can be found at This research is funded in part by the Science and Industry Endowment Fund. We thank all who took part in the study.