Hyperactivation cérébrale et réseaux fonctionnels associés chez les individus à risque de développer la maladie d'Alzheimer
Alzheimer's disease (AD) is the most common cause of dementia in older adults. Its early diagnosis is essential to better understand the brain mechanisms underlying the phenotypical manifestation of the disease and develop consequent interventions. The study of individuals at risk of AD, for example those presenting with subjective cognitive decline (SCD) or mild cognitive impairment (MCI), offers the opportunity to examine the neuropathophysiological processes preceding the dementia stage. This would allow, among other things, to identify early biomarkers of the disease. The general aim of this thesis was to determine the presence of cerebral hyperactivation and to assess functional brain networks associated with hyperactivation. Hyperactivation is defined by the presence of higher levels of brain activation in individuals at risk of AD (i.e. SCD, MCI) in comparison to cognitively healthy controls. Hyperactivation is most often measured with functional magnetic resonance imaging (fMRI) while participants perform a cognitive task. In this thesis, the reader will first be exposed to the studies which used fMRI to examine patterns of brain activation and connectivity in individuals with a clinical diagnosis of AD, MCI or presenting with SCD. Theoretical models resulting from these studies will then be presented. The scientific issues remaining to be addressed to better understand the phenomenon of hyperactivation and its relation to functional brain networks will then be described (Chapter 1). Three empirical studies forming the core of this thesis will be presented. The first study aimed to assess the presence, localization and longitudinal evolution of hyperactivation associated with an episodic memory task in individuals meeting criteria for MCI and having subsequently progressed towards dementia (Chapter 2). The second study aimed to determine the trajectory of brain activation associated with an associative memory task as a function of disease severity in a group of individuals at risk of AD. It also aimed to determine if hyperactivation is present in viii participants meeting criteria for SCD plus (or SCD+), who are individuals presenting with memory complaint in addition to genetic and/or neurodegeneresence markers of AD (Chapter 3). The third and last study aimed to examine patterns of functional connectivity related to regions of hyperactivation, and to assess how hyperactivation and its associated functional networks relate to memory performance in individuals at risk of AD (Chapter 4). Results from the first study highlighted the presence of hyperactivation in individuals with MCI who subsequently progressed to the dementia stage. Findings from the second study revealed a quadratic function describing the relationship between proxies of disease severity (neurodegeneration, memory performance) and left superior parietal activation in a group of individuals at risk of AD (SCD+ and MCI). Moreover, higher levels of activation, i.e. hyperactivation, were found in hippocampal and temporo-parietal regions in the SCD+ group. Hypoactivation was rather found in the left superior parietal area in the MCI group. Finally, results from the third study revealed that hyperactivation of predetermined regions was associated with dysfunction of functional brain networks underlying associative memory in SCD+ and MCI. Moreover, these hyperactivation-network interactions were associated with increasing symptomatology. The implications of this thesis and its limits are addressed in the discussion section (Chapter 5).
Neuroimagerie Cognition Alzheimer’s disease Mild cognitive impairment Subjective cognitive decline Neuroimaging Functional magnetic resonance imaging Functional connectivity Episodic memory