Neuroinflammation Exacerbates Irritability and Agitation in Alzheimer’s Disease
Authors: Aguzzoli Cristiano Schaffer , Ferreira Pamela C.L. , Povala Guilherme , Soares Carolina , Ferrari‐Souza João Pedro , Bellaver Bruna , Zalzale Hussein , Lussier Firoza Z , Rohden Francieli , Abbas Sarah , Lemaire Peter Charles , Leffa Douglas Teixeira , Cabrera Arlec , Therriault Joseph , Benedet Andrea Lessa , Tissot Cécile , Wang Yi‐Ting , Chamoun Mira , Servaes Stijn , Macedo Arthur C. , Vermeiren Marie , Bezgin Gleb , Kang Min Su , Stevenson Jenna , Rahmouni Nesrine , Pallen Vanessa , Poltronetti Nina Margherita , Cohen Annie , Lopez Oscar L. , Tudorascu Dana , Klunk William E , Villemagne Victor L , Soucy Jean‐Paul , Gauthier Serge , Souza Diogo O. , Schilling Lucas Porcello , Karikari Thomas K , Ashton Nicholas J. , Zetterberg Henrik , Blennow Kaj , Zimmer Eduardo R , Rosa‐Neto Pedro , Pascoal Tharick A. 
Published: December 2023

Background

Previous studies have shown that microglial activation (MA) plays a key role in the physiopathology and progression of Alzheimer’s disease (AD). Unpublished data suggest that MA is highly associated with the development of neuropsychiatric symptoms (NPS) in patients with AD. Thus, we aim to investigate here the contribution of each NPS domain to this association across individuals in the AD continuum.

Method

We assessed 132 individuals (86 cognitively unimpaired (CU), 28 MCI, and 18 AD dementia) from the TRIAD cohort who underwent clinical assessments with the Neuropsychiatry Inventory Questionnaire (NPI‐Q), and had positron emission tomography (PET) for amyloid‐β (Aβ) ([18F]AZD4694), tau tangles ([18F]MK6240) and MA ([11C]PBR28) at the same visit. Regions were tailored using Desikan‐Killiany (DK) atlas. SUVRs were calculated using the cerebellum gray matter as a reference. Linear regression tested the association between biomarkers accounting for age, sex, and cognitive status.

Result

NPI‐Q total score was significantly associated with [11C]PBR28 in the cingulate, inferior temporal, and precuneus accounting for age, sex, and after false discovery rate (FDR) correction for multiple comparisons (Figure 1A). This association was independent of Aβ and tau levels (Table 1). When we stratify NPI‐Q domains (agitation, irritability, motor disturbance, disinhibition, elation, delusion, hallucinations, nighttime disturbance, depression, anxiety, apathy, and appetite disturbance) severity score, we found that the hyperactivity subdomain (agitation, irritability, motor disturbance, disinhibition, and elation) showed the larger contribution to the results (Figure 1B). Bootstrapping each NPI‐Q domain from the NPI‐Q total score, linear regression analysis reveals that irritability, nighttime disturbance, and agitation are the main contributors to the association between NPS and MA (Figure 1C). Removing these domains, but no other combination of two or three NPI‐Q domains, from the NPI‐Q total score, abolishes this association (Figure 1D).

Conclusion

Our results suggest that MA is associated with neuropsychiatric dysfunction in AD. Notably, we found that irritability, nighttime disturbance, and agitation drive the association between NPS and MA.