The anticipation of progression of Alzheimer’s disease (AD) is crucial for evaluations of secondary prevention measures thought to modify the disease trajectory. However, it is difficult to forecast the natural progression of AD, notably because several functions decline at different ages and different rates in different patients. We evaluate here AD Course Map, a statistical model predicting the progression of neuropsychological assessments and imaging biomarkers for a patient from current medical and radiological data at early disease stages. We tested the method on more than 96,000 cases, with a pool of more than 4,600 patients from four continents. We measured the accuracy of the method for selecting participants displaying a progression of clinical endpoints during a hypothetical trial. We show that enriching the population with the predicted progressors decreases the required sample size by 38% to 50%, depending on trial duration, outcome, and targeted disease stage, from asymptomatic individuals at risk of AD to subjects with early and mild AD. We show that the method introduces no biases regarding sex or geographic locations and is robust to missing data. It performs best at the earliest stages of disease and is therefore highly suitable for use in prevention trials.

Alzheimer's disease Clinical trial design Individual forecast Digital twin Longitudinal data Prognostic enrichment

Variability in neurodegenerative disease progression poses great challenges for the evaluation of potential treatments. Identifying the persons who will experience significant progression in the short term is key for the implementation of trials with smaller sample sizes. We apply here disease course mapping to forecast biomarker progression for individual carriers of the pathological CAG repeat expansions responsible for Huntington disease. We used data from two longitudinal studies (TRACK-HD and TRACK-ON) to synchronize temporal progression of 15 clinical and imaging biomarkers from 290 participants with Huntington disease. We used then the resulting HD COURSE MAP to forecast clinical endpoints from the baseline data of 11,510 participants from ENROLL-HD, an external validation cohort. We used such forecasts to select participants at risk for progression and compute the power of trials for such an enriched population. HD COURSE MAP forecasts biomarkers 5 years after the baseline measures with a maximum mean absolute error of 10 points for the total motor score and 2.15 for the total functional capacity. This allowed reducing sample sizes in trial up to 50% including participants with a higher risk for progression ensuring a more homogeneous group of participants.

Huntington disease Clinical trial design Individual forecast Digital twin Longitudinal data

Alzheimer’s disease (AD) is characterized by the progressive alterations seen in brain images which give rise to the onset of various sets of symptoms. The variability in the dynamics of changes in both brain images and cognitive impairments remains poorly understood. This paper introduces AD Course Map a spatiotemporal atlas of Alzheimer’s disease progression. It summarizes the variability in the progression of a series of neuropsychological assessments, the propagation of hypometabolism and cortical thinning across brain regions and the deformation of the shape of the hippocampus. The analysis of these variations highlights strong genetic determinants for the progression, like possible compensatory mechanisms at play during disease progression. AD Course Map also predicts the patient’s cognitive decline with a better accuracy than the 56 methods benchmarked in the open challenge TADPOLE. Finally, AD Course Map is used to simulate cohorts of virtual patients developing Alzheimer’s disease. AD Course Map offers therefore new tools for exploring the progression of AD and personalizing patients care.

Alzheimer disease Individual forecast Longitudinal data Virtual cohort Digital twin

The analysis of longitudinal trajectories is a longstanding problem in medical imaging which is often tackled in the context of Riemannian geometry: the set of observations is assumed to lie on an a priori known Riemannian manifold. When dealing with high-dimensional or complex data, it is in general not possible to design a Riemannian geometry of relevance. In this paper, we perform Riemannian manifold learning in association with the statistical task of longitudinal trajectory analysis. After inference, we obtain both a submanifold of observations and a Riemannian metric so that the observed progressions are geodesics. This is achieved using a deep generative network, which maps trajectories in a low-dimensional Euclidean space to the observation space.

Riemannian geometry Longitudinal progression Medical Imaging Alzheimer's Disease Recurrent Neural Networks

Repeated failures in clinical trials for Alzheimer’s disease (AD) have raised a strong interest for the prodromal phase of the disease. A better understanding of the brain alterations during this early phase is crucial to diagnose patients sooner, to estimate an accurate disease stage, and to give a reliable prognosis. According to recent evidence, structural alterations in the brain are likely to be sensitive markers of the disease progression. Neuronal loss translates in specific spatiotemporal patterns of cortical atrophy, starting in the enthorinal cortex and spreading over other cortical regions according to specific propagation pathways. We developed a digital model of the cortical atrophy in the left hemisphere from prodromal to diseased phases, which is built on the temporal alignment and combination of several short-term observation data to reconstruct the long-term history of the disease. The model not only provides a description of the spatiotemporal patterns of cortical atrophy at the group level but also shows the variability of these patterns at the individual level in terms of difference in propagation pathways, speed of propagation, and age at propagation onset. Longitudinal MRI datasets of patients with mild cognitive impairments who converted to AD are used to reconstruct the cortical atrophy propagation across all disease stages. Each observation is considered as a signal spatially distributed on a network, such as the cortical mesh, each cortex location being associated to a node. We consider how the temporal profile of the signal varies across the network nodes. We introduce a statistical mixed-effect model to describe the evolution of the cortex alterations. To ensure a spatiotemporal smooth propagation of the alterations, we introduce a constrain on the propagation signal in the model such that neighboring nodes have similar profiles of the signal changes. Our generative model enables the reconstruction of personalized patterns of the neurodegenerative spread, providing a way to estimate disease progression stages and predict the age at which the disease will be diagnosed. The model shows that, for instance, APOE carriers have a significantly higher pace of cortical atrophy but not earlier atrophy onset.

Disease progression Brain networks Spatiotemporal propagation patterns Alzheimer's Disease Individual variability

We introduce a mixed-effects model to learn spatiotempo- ral patterns on a network by considering longitudinal measures dis- tributed on a fixed graph. The data come from repeated observations of subjects at different time points which take the form of measure- ment maps distributed on a graph such as an image or a mesh. The model learns a typical group-average trajectory characterizing the prop- agation of measurement changes across the graph nodes. The subject- specific trajectories are defined via spatial and temporal transforma- tions of the group-average scenario, thus estimating the variability of spatiotemporal patterns within the group. To estimate population and individual model parameters, we adapted a stochastic version of the Expectation-Maximization algorithm, the MCMC-SAEM. The model is used to describe the propagation of cortical atrophy during the course of Alzheimer’s Disease. Model parameters show the variability of this aver- age pattern of atrophy in terms of trajectories across brain regions, age at disease onset and pace of propagation. We show that the personaliza- tion of this model yields accurate prediction of maps of cortical thickness in patients.

Spatiotemporal propagation Spatially distributed data MCMC methods Stochastic EM algorithm Riemannian Geometry