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Alzheimer’s Disease: Can a Simple Test Identify Those at Risk?

Innovation Story

Alzheimer’s Disease: Can a Simple Test Identify Those at Risk?

Yakeel Quiroz, PhD, and her research team at Mass General’s Multicultural Alzheimer’s Prevention Program (MAPP) are exploring the connection between verbal fluency and the development of Alzheimer’s disease.

Ruta Nonacs, MD, PhD
October 16, 2023

In 2014, Massachusetts General Hospital brain imaging researcher Yakeel Quiroz, PhD, Paul B. and Sandra M. Edgerley MGH Research Scholar 2020-2025, launched COLBOS (Colombia-Boston), a longitudinal, collaborative study between the Universidad de Antioquia, Colombia and Mass General allowing investigators to use various techniques, including neuroimaging, to study the largest cohort of individuals with autosomal dominant Alzheimer’s disease (AD). In this kindred, those who develop AD carry a gene mutation known as PSEN-1 E280A and experience early onset of AD, typically in their mid-40s.

Carriers of the PSEN-1 E280A mutation provide a unique opportunity for researchers to study the pathogenesis of AD. The hope is that, by studying carriers of the PSEN-1 mutation with preclinical AD, before cognitive changes occur, it may be possible to identify the earliest signs of this disease in the brain and to find biomarkers that could be used to identify individuals at risk for AD. Ideally these biomarkers would also help to identify early signs of AD in those with non-familial forms of AD.

Verbal Fluency as an Early Sign of Alzheimer’s

In a recent study, Dr. Quiroz and her research team at Mass General’s Multicultural Alzheimer’s Prevention Program (MAPP) investigated whether performance on a test of verbal fluency — basically, the ability to access information from memory and produce words — is associated with markers of AD brain pathology in the preclinical and early stages of AD.

In individuals with Alzheimer’s disease, previous studies have demonstrated that changes in verbal fluency, particularly category fluency, occur relatively early in the course of illness. The category fluency test (animal naming) has been widely used and studied; in this test, subjects are asked to name as many animals as they can in one minute. Total scores on this test — the number of animals named — are lower in those with AD; however, recent research indicates that certain elements of category fluency, such as clustering (naming animals sequentially that belong to a subcategory, such as domestic animals) may be more sensitive in terms of detecting early cognitive changes associated with AD.

Yakeel Quiroz, PhD

In this study, a total of 29 carriers of the PSEN-1 E280A mutation without dementia and 32 non-carrier family members completed the category fluency test (Animals) and the Mini-Mental State Examination (MMSE) — a short screening tool for measuring cognitive impairment. The participants also underwent positron emission tomography (PET) scans to evaluate accumulation of amyloid-beta in the neocortex and tau in the medial temporal lobe regions; levels of accumulation in both amyloid-beta and tau can drive the development of AD.

Total scores on the category fluency test did not differ between carriers and non-carriers. However, carriers showed a stronger association between animal fluency clustering and AD brain pathology visualized with PET (neocortical amyloid and entorhinal tau) compared to non-carriers.

What’s Next?

The relationship between amyloid and tau accumulation in the brain and category fluency clustering in this sample suggests that changes in the brain AD pathophysiology have subtle effects on word retrieval and semantic access early on in the course of the illness, even before other measures of cognitive functioning are affected.

While PET and other techniques may be used to identify changes in the brain prior to the onset of cognitive changes in individuals with AD, tests of verbal fluency are easier to administer, more accessible, less invasive and less expensive. The COLBOS team will continue to investigate which cognitive tests are the most sensitive in identifying individuals with preclinical AD with the goal of identifying those who may be good candidates for preventative and therapeutic interventions.

Other researchers involved in this project include Defne Yucebas, Joshua Fox-Fuller, PhD, Alex Badillo Cabrera, BA, Ana Baena, BA, MA, Celina Pluim McDowell, Paula Aduen, PhD, Clara Vila-Castelar, PhD, Yamile Bocanegra, PhD, Victoria Tirado, Justin S Sanchez, Alice Cronin-Golomb, PhD, and Francisco Lopera, MD.

This story was first published in Mass General Psychiatry News.

For more information about Multicultural Alzheimer’s Prevention Program (MAPP), please contact us.

Stock image of pipette and test tubes

This story is just one example of the groundbreaking efforts taking place at Mass General, home to the largest hospital-based research enterprise in the U.S. — the Mass General Research Institute. The Research Institute encompasses and provides support to thousands of scientists, hundreds of laboratories, and helps to guide, connect and promote this unrivaled community of investigators as they advance the future of medicine, from the bench to the bedside, to the community and world.