Douglas Teixeira Leffa

Douglas Teixeira Leffa
University of Pittsburgh | Pitt · Department of Psychiatry

MD PhD

About

116
Publications
11,554
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1,701
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Introduction
Psychiatry Resident at the University of Pittsburgh Medical Center, interested in ADHD, neuromodulation, and Alzheimer's disease.
Additional affiliations
September 2015 - December 2018
Universidade Federal do Rio Grande do Sul
Position
  • PhD Student
Education
March 2011 - July 2018

Publications

Publications (116)
Preprint
Full-text available
Experimental evidence suggests that activated microglia induce astrocyte reactivity in neurodegenerative disorders, such as Alzheimer’s disease (AD). Here, we investigated the association between microglial activation and amyloid-β (Aβ) with reactive astrogliosis in the living AD human brain. We studied 101 individuals across the AD spectrum with p...
Preprint
Full-text available
Previous studies have shown that glial and neuronal changes may trigger synaptic dysfunction in Alzheimer’s disease(AD). However, the link between glial and neuronal markers and synaptic abnormalities in the living brain is poorly understood. Here, we investigated the association between biomarkers of astrocyte and microglial reactivity and synapti...
Article
Full-text available
The progression of PET-based Braak stages correlates with cognitive deterioration in aging and Alzheimer’s disease. Here, we investigate the association between PET-based Braak stages and functional impairment and assess whether PET-based Braak staging predicts a longitudinal decline in the performance of activities of daily living. In this cohort...
Article
Background Healthy synapses are the key to proper brain function, ensuring communication between neurons. Recent studies have associated synaptic dysfunction with Alzheimer’s disease (AD) proteins, however, little is known about the role of glial reactivity, another pathology closely linked to AD, in brain synaptic dysfunction (Figure 1). Method W...
Article
Background Neuroinflammation typically involves the activation of microglial cells in the brain and has been linked to Alzheimer’s disease (AD) pathology. However, how microglial activation influences brain neurodegeneration in individuals across the AD continuum is still poorly understood. Here, we aimed to investigate the influence of microglial...
Article
Background Glial contributions to Alzheimer’s disease (AD) etiology and progression have been increasingly recognized. Experimental and clinical evidence suggests that both microglial activation and astrocyte reactivity have pivotal roles in the progression of tau pathology. However, it remains to be elucidated how microglia and astrocytes compleme...
Article
Background It has been suggested that phosphorylated tau(p‐tau) at threonine 231 and 217 are markers of amyloid‐β(Aβ) rather than tau pathology. However, most of the studies were conducted in cohorts composed mainly of preclinical Alzheimer Disease(AD) individuals. It remains to be elucidated if p‐tau is still more associated with Aβ than tau patho...
Article
Background A significant percentage of Aβ‐positive cognitively unimpaired (CU) individuals do not develop detectable downstream tau pathology and, consequently, cognitive decline.Experimental literature suggest that reactive astrocytes are necessary to unleashing Aβ effects in pathological tau phosphorylation.Here we aimed to investigate whether as...
Article
Background Recent studies have suggested that plasma p‐tau biomarkers are associated with cross‐sectional brain amyloid(Aβ) rather than tau tangle pathology. However, it is still unclear if plasma tau biomarkers are closely related to changes in AD pathophysiology over time. In this work, we aimed to determine if cross‐sectional measures of plasma...
Article
Background Tau plays a prominent role in the synapse and has been shown to be closely related to neurodegeneration. Recent evidence show that cerebrospinal fluid (CSF) synaptic markers are related to CSF tau and degeneration. However, it is not clear whether synaptic dysfunction in combination with tau tangles is associated with neurodegeneration i...
Article
Background Aβ accumulation precedes tau pathology in cognitively unimpaired (CU) individuals, which is an event closely related to the development of cognitive symptoms. However, Aβ leads to tau pathology in some individuals, but not in others, suggesting the presence of other processes triggering the deleterious effects of Aβ in the early Alzheime...
Article
Background The ATN classification system assumes a sequential model of disease progression. However, there are groups of individuals in the same ATN category that exhibit a predominance of abnormality (higher burden) of one of the biomarkers, creating heterogeneous ATN groups regarding pathological predominance. Thus, we tested the hypothesis that...
Article
Background Astrocyte reactivity is a common finding in individuals across the Alzheimer’s disease (AD) continuum. Recently, we demonstrated that individuals with higher levels of plasma glial fibrillary acidic protein (GFAP), a marker of astrocyte reactivity, present a stronger association between amyloid‐β (Aβ) and tau pathologies in preclinical A...
Article
Background Recent epidemiological studies showed that patients with attention‐deficit/hyperactivity disorder (ADHD) are more likely to be diagnosed with Alzheimer’s Disease (AD). Additionally, increased genetic risk for ADHD, measured with ADHD polygenic risk scores (ADHD‐PRS), was associated with amyloid‐dependent cognitive decline in older adults...
Article
Full-text available
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 d...
Article
Background The mechanisms by which the apolipoprotein E ε4 ( APOE ε4) allele influences Alzheimer’s disease (AD) pathophysiological progression are poorly understood. Here, we tested the association of APOE ε4 carriership and amyloid‐β (Aβ) burden with longitudinal tau pathology progression. Method We studied 104 individuals across the aging and A...
Article
Background Biomarkers of astrocyte reactivity have the potential to improve diagnostic precision, disease monitoring, and treatment efficacy. Glial fibrillary acidic protein (GFAP) protein is expressed in astrocytes, which is important to synaptic plasticity, cell communication, and reactive gliosis. Method Cerebrospinal fluid (CSF) biomarkers wer...
Article
Background Activation of microglial cells in the brain, more commonly known as neuroinflammation, has often been linked to the pathophysiology of Alzheimer’s disease (AD). However, how microglial activation is associated with longitudinal tau tangle accumulation and consequent cognitive decline is poorly understood. Here, we aimed to investigate wh...
Article
Background Previous studies have shown that microglial activation (MA) plays a key role in the pathophysiological and clinical progressions of Alzheimer’s disease (AD). However, little is known whether MA is also associated with the development of neuropsychiatric symptoms typically found in patients with AD. Thus, we aim to investigate here the as...
Article
Background The use of enrichment strategies is crucial for selecting individuals with the highest probability of Alzheimer’s disease (AD)‐related progression in typical clinical trial time frames. Although both amyloid‐β (Aβ) pathology and the apolipoprotein E ε4 ( APOE ε4) genotype have been shown to accelerate tau accumulation, it is still not cl...
Article
Background Deep learning models, particularly convolutional neural networks (CNNs), have shown promise in Alzheimer’s disease (AD) classification using tau PET data. However, limited sample sizes and unharmonized tau tracers present challenges to developing an agnostic tau tracer tool to predict AD using machine learning. Transfer learning, which l...
Article
Background Growing evidence suggests an increased prevalence of Alzheimer’s disease (AD) in females compared to males. Elucidating how disease biomarkers correlate in females and males is critical to understanding the basis of sex differences in AD. Our aim was to evaluate sex‐related differences in the association of plasma Glial fibrillary acidic...
Article
Background The preclinical stage of Alzheimer’s disease (AD) is one of the main focuses of clinical trials. Plasma and positron emission tomography (PET) biomarkers have already been proposed to monitor participants’ disease progression in clinical trials targeting cognitively unimpaired (CU) individuals. Although longitudinal changes in plasma pho...
Article
Background CSF total tau (t‐tau) is postulated as a marker of neuronal degeneration in the ATN criteria. Here, we hypothesize that CSF t‐tau is more closely related to synaptic loss than over neurodegeneration. Method We evaluated 128 older individuals (75 CU,33 MCI,20 AD) in the TRIAD cohort (McGill, Canada) with CSF t‐tau, SNAP25long and Neurofi...
Article
Background A significant percentage of Aß‐positive cognitively unimpaired (CU) individuals do not develop detectable downstream tau pathology and, consequently, cognitive decline.Experimental literature suggest that reactive astrocytes are necessary to unleashing Aß effects in pathological tau phosphorylation.Here we aimed to investigate whether as...
Article
Background Tau plays a prominent role in the synapse and has been shown to be closely related to neurodegeneration. Recent evidence show that cerebrospinal fluid (CSF) synaptic markers are related to CSF tau and degeneration. However, it is not clear whether synaptic dysfunction in combination with tau tangles is associated with neurodegeneration i...
Article
Background The ATN classification system assumes a sequential model of disease progression. However, there are groups of individuals in the same ATN category that exhibit a predominance of abnormality (higher burden) of one of the biomarkers, creating heterogeneous ATN groups regarding pathological predominance. Thus, we tested the hypothesis that...
Article
Background Healthy synapses are the key to proper brain function, ensuring communication between neurons. Recent studies have associated synaptic dysfunction with Alzheimer’s disease (AD) proteins, however, little is known about the role of glial reactivity, another pathology closely linked to AD, in brain synaptic dysfunction (Figure 1). Method W...
Article
Background Astrocyte reactivity is a common finding in individuals across the Alzheimer’s disease (AD) continuum. Recently, we demonstrated that individuals with higher levels of plasma glial fibrillary acidic protein (GFAP), a marker of astrocyte reactivity, present a stronger association between amyloid‐ß (Aß) and tau pathologies in preclinical A...
Article
Background Previous studies have shown that microglial activation (MA) plays a key role in the pathophysiological and clinical progressions of Alzheimer’s disease (AD). However, little is known whether MA is also associated with the development of neuropsychiatric symptoms typically found in patients with AD. Thus, we aim to investigate here the as...
Article
Background Glial contributions to Alzheimer’s disease (AD) etiology and progression have been increasingly recognized. Experimental and clinical evidence suggests that both microglial activation and astrocyte reactivity have pivotal roles in the progression of tau pathology. However, it remains to be elucidated how microglia and astrocytes compleme...
Article
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 d...
Article
Background The mechanisms by which the apolipoprotein E e4 (APOEe4) allele influences Alzheimer’s disease (AD) pathophysiological progression are poorly understood. Here, we tested the association of APOEe4 carriership and amyloid‐ß (Aß) burden with longitudinal tau pathology progression. Method We studied 104 individuals across the aging and AD c...
Article
Background Activation of microglial cells in the brain, more commonly known as neuroinflammation, has often been linked to the pathophysiology of Alzheimer’s disease (AD). However, how microglial activation is associated with longitudinal tau tangle accumulation and consequent cognitive decline is poorly understood. Here, we aimed to investigate wh...
Article
Background The use of enrichment strategies is crucial for selecting individuals with the highest probability of Alzheimer’s disease (AD)‐related progression in typical clinical trial time frames. Although both amyloid‐ß (Aß) pathology and the apolipoprotein E e4 (APOEe4) genotype have been shown to accelerate tau accumulation, it is still not clea...
Article
Background The preclinical stage of Alzheimer’s disease (AD) is one of the main focuses of clinical trials. Plasma and positron emission tomography (PET) biomarkers have already been proposed to monitor participants’ disease progression in clinical trials targeting cognitively unimpaired (CU) individuals. Although longitudinal changes in plasma pho...
Article
Background Biomarkers of astrocyte reactivity have the potential to improve diagnostic precision, disease monitoring, and treatment efficacy. Glial fibrillary acidic protein (GFAP) protein is expressed in astrocytes, which is important to synaptic plasticity, cell communication, and reactive gliosis. Method Cerebrospinal fluid (CSF) biomarkers wer...
Article
Background It has been suggested that phosphorylated tau(p‐tau) at threonine 231 and 217 are markers of amyloid‐ß(Aß) rather than tau pathology. However, most of the studies were conducted in cohorts composed mainly of preclinical Alzheimer Disease(AD) individuals. It remains to be elucidated if p‐tau is still more associated with Aß than tau patho...
Article
Background CSF total tau (t‐tau) is postulated as a marker of neuronal degeneration in the ATN criteria. Here, we hypothesize that CSF t‐tau is more closely related to synaptic loss than over neurodegeneration. Method We evaluated 128 older individuals (75 CU,33 MCI,20 AD) in the TRIAD cohort (McGill, Canada) with CSF t‐tau, SNAP25long and Neurofi...
Article
Background Neuroinflammation typically involves the activation of microglial cells in the brain and has been linked to Alzheimer’s disease (AD) pathology. However, how microglial activation influences brain neurodegeneration in individuals across the AD continuum is still poorly understood. Here, we aimed to investigate the influence of microglial...
Article
Full-text available
Importance Neuropsychiatric symptoms are commonly encountered and are highly debilitating in patients with Alzheimer disease. Understanding their underpinnings has implications for identifying biomarkers and treatment for these symptoms. Objective To evaluate whether glial markers are associated with neuropsychiatric symptoms in individuals across...
Article
Full-text available
The mechanisms by which the apolipoprotein E ε4 (APOEε4) allele influences the pathophysiological progression of Alzheimer’s disease (AD) are poorly understood. Here we tested the association of APOEε4 carriership and amyloid-β (Aβ) burden with longitudinal tau pathology. We longitudinally assessed 94 individuals across the aging and AD spectrum wh...
Article
INTRODUCTION Phosphorylated tau (p‐tau) biomarkers have been recently proposed to represent brain amyloid‐β (Aβ) pathology. Here, we evaluated the plasma biomarkers' contribution beyond the information provided by demographics (age and sex) to identify Aβ and tau pathologies in individuals segregated as cognitively unimpaired (CU) and impaired (CI)...
Article
Full-text available
An unresolved question for the understanding of Alzheimer’s disease (AD) pathophysiology is why a significant percentage of amyloid-β (Aβ)-positive cognitively unimpaired (CU) individuals do not develop detectable downstream tau pathology and, consequently, clinical deterioration. In vitro evidence suggests that reactive astrocytes unleash Aβ effec...
Article
Gene-environment interactions (GxE) have been increasingly explored in psychiatry but with low replication rates. Attention-deficit/hyperactivity disorder (ADHD) is a suitable candidate for studying GxE due to its high heritability and well-defined environmental risk factors. Here, we explored GxE using polygenic risk score (PRS) to represent the g...
Article
Full-text available
Animal studies suggest that the apolipoprotein E ε4 (APOEε4) allele is a culprit of early microglial activation in Alzheimer's disease (AD). Here, we tested the association between APOEε4 status and microglial activation in living individuals across the aging and AD spectrum. We studied 118 individuals with positron emission tomography for amyloid-...
Article
Introduction: Amyloid-β (Aβ) and tau can be quantified in blood. However, biological factors can influence the levels of brain-derived proteins in the blood. The blood-brain barrier (BBB) regulates protein transport between cerebrospinal fluid (CSF) and blood. BBB altered permeability might affect the relationship between brain and blood biomarker...
Article
Objective: To test the utility of longitudinal changes in plasma phosphorylated tau 181 (p-tau181) and neurofilament light chain (NfL) as surrogate markers for clinical trials targeting cognitively unimpaired (CU) populations. Methods: We estimated the sample size needed to test a 25% drug effect with 80% of power at a 0.05 level on reducing cha...
Preprint
Full-text available
An unresolved question for the understanding of Alzheimer’s disease (AD) pathophysiology is why a significant percentage of amyloid β (Aβ)-positive cognitively unimpaired (CU) individuals do not develop detectable downstream tau pathology and, consequently, clinical deterioration. In vitro evidence suggests that reactive astrocytes are key to unlea...
Article
Full-text available
Neurodevelopmental disorders – including attention‐deficit/hyperactivity disorder (ADHD), autism spectrum disorder, communication disorders, intellectual disability, motor disorders, specific learning disorders, and tic disorders – manifest themselves early in development. Valid, reliable and broadly usable biomarkers supporting a timely diagnosis...
Article
Background Although it has been already demonstrated that plasma amyloid‐β (Aβ), phosphorylated tau (p‐tau), and glial fibrillar protein (GFAP) can predict with high accuracy Alzheimer's disease (AD) pathophysiology, no previous study has compared their performance in the same set of individuals. Here, we compare the performance of plasma Aβ42/40,...
Article
Inflammation has long been pointed out as a key feature in Alzheimer’s disease (AD). However, the heterogeneity of AD pathology might trigger different aspects of the immune response. Here, we aimed to study the association of the newly proposed concept of inflammatory composite indexes with Aβ and tau pathologies across the aging and AD spectra. W...
Article
[18F]MK6240 tau‐PET can detect changes in the early and late stages of tau tangles accumulation. However, off‐target binding, often observed in the meninges and neuromelanin‐containing cells, can interfere with longitudinal tracer quantification. Here, we investigated the association of longitudinal changes in off‐target and target signals using [1...
Article
It has already been shown that longitudinal changes in plasma phosphorylated tau 181 (p‐tau181) correlate with longitudinal Alzheimer’s disease (AD) progression. However, it is unclear whether longitudinal plasma p‐tau181 is a suitable measure to be used as a surrogate variable in clinical trials. This study aims to evaluate the utility of using lo...
Article
Vascular risk factors (VRFs) have an important role in the etiology and progression of Alzheimer´s Disease (AD). We recently described that VRF burden interacts with AD pathophysiology increasing plasma neurofilament light (NfL) levels, a biomarker of neuroaxonal damage. However, whether individual VRFs interact with AD pathophysiology to promote l...
Article
Mid‐life hypertension (HTN) is considered a risk factor for the development of clinical Alzheimer´s Disease (AD). Yet, it is not known whether late‐life hypertension relates to AD´s pathophysiology, with current literature being contradictory. We recently demonstrated that a vascular risk factor composite, which includes HTN, interact with the AD p...
Preprint
Full-text available
The mechanisms by which the apolipoprotein E ε4 ( APOE ε4) allele influences Alzheimer’s disease (AD) pathophysiological progression are poorly understood. Here, we tested the association of APOE ε4 carriership and amyloid-β (Aβ) burden with longitudinal tau pathology progression. We studied 104 individuals across the aging and AD spectrum who unde...
Article
Full-text available
Importance The recent proliferation of phosphorylated tau (p-tau) biomarkers has raised questions about their preferential association with the hallmark pathologies of Alzheimer disease (AD): amyloid-β plaques and tau neurofibrillary tangles. Objective To determine whether cerebrospinal fluid (CSF) and plasma p-tau biomarkers preferentially reflec...
Article
Full-text available
Attention-deficit/hyperactivity disorder (ADHD) persists in older age and is postulated as a risk factor for cognitive impairment and Alzheimer’s Disease (AD). However, these findings rely primarily on electronic health records and can present biased estimates of disease prevalence. An obstacle to investigating age-related cognitive decline in ADHD...
Article
[18F]MK6240 tau‐PET can detect changes in the early and late stages of tau tangles accumulation. However, off‐target binding, often observed in the meninges and neuromelanin‐containing cells, can interfere with longitudinal tracer quantification. Here, we investigated the association of longitudinal changes in off‐target and target signals using [1...
Article
Recent evidence suggests that microglial activation sets the stage for tau spread in Alzheimer’s disease (AD). However, the underpinnings of microglial activation in early regions of tau accumulation are poorly understood. The apolipoprotein E (APOE) ε4 allele is the strongest genetic risk factor for sporadic AD and influences microglial response i...
Article
Although it has been alredy demonstrated that plasma amyloid‐β (Aβ), phosphorylated tau (p‐tau), and glial fibrillar protein (GFAP) can predict with high accuracy Alzheimer's disease (AD) pathophysiology, no previous study has compared their performance in the same set of individuals. Here, we compare the performance of plasma Aβ42/40, p‐tau, GFAP,...
Article
Background Recent epidemiological studies using population‐based registers showed that patients with Attention‐Deficit/Hyperactivity Disorder (ADHD) are more likely to be diagnosed with mild cognitive impairment (MCI) and Alzheimer’s disease (AD), suggesting a higher risk for cognitive impairment in older age. Here, we aimed to assess whether genet...
Article
Full-text available
[18F]MK6240 tau-PET tracer quantifies brain tau neurofibrillary tangles (NFT) load in Alzheimer's disease (AD). The aims of our study are to test the stability of common reference region estimates in the cerebellum over time and across diagnoses and evaluate the effects of age-related and off-target retention on the longitudinal quantification of [...
Preprint
Background: Although longitudinal changes in plasma phosphorylated tau 181 (p-tau181) and neurofilament light (NfL) correlate with Alzheimers disease (AD) progression, it is unknown whether these changes can be used to monitor drug effects in preventive clinical trials. Here, we tested the utility of changes in plasma p-tau181 and NfL as surrogate...
Article
Full-text available
Background Very few predictive models in Psychiatry had their performance validated in independent external samples. A previously developed multivariable demographic model for attention‐deficit/hyperactivity disorder (ADHD) accurately predicted young adulthood ADHD using clinical and demographical information collected in childhood in three samples...
Article
Full-text available
Astrocytes can adopt multiple molecular phenotypes in the brain of Alzheimer’s disease (AD) patients. Here, we studied the associations of cerebrospinal fluid (CSF) glial fibrillary acidic protein (GFAP) and chitinase-3-like protein 1 (YKL-40) levels with brain amyloid-β (Aβ) and tau pathologies. We assessed 121 individuals across the aging and AD...
Article
Importance: Transcranial direct current stimulation (tDCS) may improve symptoms of inattention in adults with attention-deficit/hyperactivity disorder (ADHD). However, previous trials are characterized by small sample sizes, heterogeneous methodologies, and short treatment periods using clinic-based tDCS. Objective: To determine the efficacy and...
Preprint
Microglial activation is an early phenomenon in Alzheimer′s disease (AD) that may occur prior to and independently of amyloid-β (Aβ) aggregation. Recent studies in transgenic animal models suggest that the apolipoprotein E ϵ4 ( APOE ϵ4) allele may be a culprit of early microglial activation in AD. However, it is unclear whether the APOE ϵ4 genotype...
Article
Full-text available
Attention-Deficit Hyperactivity Disorder (ADHD) is a complex and heterogeneous neurodevelopmental condition for which curative treatments are lacking. Whilst pharmacological treatments are generally effective and safe, there is considerable inter-individual variability among patients regarding treatment response, required dose, and tolerability. Ma...
Preprint
Full-text available
Introduction [ ¹⁸ F]MK6240 is a tau-PET tracer that quantifies brain tau neurofibrillary tangles (NFT) load in Alzheimer’s disease (AD). The aims of our study are to test the stability of common reference regions estimates in the cerebellum over time and across diagnoses and evaluate the effects of age-related and off-target retention in the longit...
Chapter
Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neuropsychiatric disorder associated with significant impairment and distress throughout the lifespan. Recent investigations have shed light on different aspects regarding the trajectory of ADHD, including reports on risk factors in childhood, that are associated with remission or persi...
Preprint
Full-text available
Background Attention-Deficit/Hyperactivity Disorder (ADHD) persists in older age and is postulated to be a risk factor for cognitive impairment and Alzheimer’s Disease (AD). However, this notion relies exclusively on epidemiological associations, and no previous study has linked ADHD with a decline in cognitive performance in older adults or with A...
Article
Full-text available
The objective of this study is to examine the association between preterm infants’ size at 1 year and attention-deficit/hyperactivity disorder (ADHD) assessed categorically and dimensionally in childhood and adolescence. We studied infants born < 37 weeks’ gestation from two Brazilian birth cohorts (n = 653). ADHD was evaluated using the Developmen...
Preprint
Full-text available
Introduction Plasma amyloid-β (Aβ), phosphorylated tau (p-tau), and glial fibrillar acid protein (GFAP) can identify Alzheimer’s disease (AD) pathophysiology with high accuracy. However, comparing their performance in the same individuals remains under-explored. Methods We compared the predictive performance of plasma Aβ42/40, p-tau(at threonine 1...
Preprint
Full-text available
Astrocytes can adopt multiple molecular phenotypes in the brain of Alzheimer's disease (AD) patients. Here, we studied the associations of cerebrospinal fluid (CSF) glial fibrillary acidic protein (GFAP) and chitinase-3-like protein 1 (YKL-40) levels with brain amyloid-β (Aβ) and tau pathologies. We assessed 121 individuals across the aging and AD...
Preprint
Full-text available
Understanding whether vascular risk factors synergistically potentiate Alzheimer's disease progression is important in the context of emerging treatments for preclinical Alzheimer's disease. The existence of a synergistic relationship could suggest that the combination of therapies targeting Alzheimer's disease pathophysiology and vascular risk fac...