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Adams-Carr KL, Bestwick JP, Shribman S, Lees A, Schrag A, Noyce AJ. Constipation preceding Parkinson's disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2016; 87:710-6. [PMID: 26345189 DOI: 10.1136/jnnp-2015-311680] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 08/10/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review published literature to estimate the magnitude of association between premorbid constipation and later diagnosis of Parkinson's disease. BACKGROUND Constipation is a recognised non-motor feature of Parkinson's and has been reported to predate diagnosis in a number of observational studies. METHODS A systematic review and meta-analysis was carried out following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) criteria. A literature search was undertaken in December 2014 using PubMed and the search terms 'Parkinson's disease' and 'constipation'. Articles were screened for suitability and reviewed against inclusion and exclusion criteria. Studies were included if they assessed constipation by means of a structured questionnaire or if constipation/drugs used to treat constipation were coded in patient medical records. Data were extracted using a standardised template and effect size estimates combined using a fixed-effects model. Heterogeneity was explored with the I(2) statistic. RESULTS 9 studies were included in the meta-analysis, with a combined sample size of 741 593 participants. Those with constipation had a pooled OR of 2.27 (95% CI 2.09 to 2.46) for developing subsequent Parkinson's disease compared with those without constipation. Weak evidence for heterogeneity was found (I(2)=18.9%, p=0.282). Restricting analysis to studies assessing constipation more than 10 years prior to Parkinson's disease gave a pooled OR of 2.13 (95% CI 1.78 to 2.56; I(2)=0.0%). CONCLUSIONS This systematic review and meta-analysis demonstrates that people with constipation are at a higher risk of developing Parkinson's disease compared with those without and that constipation can predate Parkinson's diagnosis by over a decade.
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Affiliation(s)
| | - Jonathan P Bestwick
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, London, UK
| | - Samuel Shribman
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrew Lees
- Institute of Neurology, University College London, London, UK
| | - Anette Schrag
- Institute of Neurology, University College London, London, UK
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Mahlknecht P, Gasperi A, Willeit P, Kiechl S, Stockner H, Willeit J, Rungger G, Sawires M, Nocker M, Rastner V, Mair KJ, Hotter A, Poewe W, Seppi K. Prodromal Parkinson's disease as defined per MDS research criteria in the general elderly community. Mov Disord 2016; 31:1405-8. [PMID: 27273736 DOI: 10.1002/mds.26674] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/08/2016] [Accepted: 04/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, the International Parkinson and Movement Disorder Society has defined research criteria for prodromal Parkinson's disease (PD), but to date their predictive value has not yet been tested in population-based cohorts. METHODS We retrospectively applied these criteria to the longitudinal Bruneck Study cohort aged 55-94 years using recorded data on all included risk and prodromal markers that are quick and easily assessable. RESULTS After excluding participants with idiopathic PD or secondary parkinsonism, prevalence of probable prodromal PD in the remaining 539 participants was 2.2% (95% confidence interval, 1.2%-3.9%). Of 488 participants followed up over 5 years, 11 developed incident PD. Sensitivity of "probable prodromal PD" status for incident PD was 54.6% (95% confidence interval, 28.0%-78.8%), specificity was 99.2% (97.8%-99.8%), positive predictive value was 60.0% (31.2%-83.3%), and negative predictive value was 99.0% (97.5%-99.6%). CONCLUSIONS Our findings suggest that the new research criteria for prodromal PD are a promising tool to identify cases of incident PD over 5 years, arguing for their usefulness in defining target populations for disease-prevention trials. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.,Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Arno Gasperi
- Department of Neurology, Hospital of Bruneck, Bruneck, Italy
| | - Peter Willeit
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.,King's British Heart Foundation Centre, King's College London, London, United Kingdom.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Stefan Kiechl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Heike Stockner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Martin Sawires
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Michael Nocker
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Verena Rastner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Katherina J Mair
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Anna Hotter
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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Bergareche A, Rodríguez-Oroz MC, Estanga A, Gorostidi A, López de Munain A, Castillo-Triviño T, Ruiz-Martínez J, Mondragón E, Gaig C, Lomeña F, Sarasqueta C, Tolosa E, Martí-Massó JF. DAT imaging and clinical biomarkers in relatives at genetic risk for LRRK2 R1441G Parkinson's disease. Mov Disord 2015; 31:335-43. [DOI: 10.1002/mds.26478] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/08/2015] [Accepted: 10/11/2015] [Indexed: 12/25/2022] Open
Affiliation(s)
- Alberto Bergareche
- Neurology Service; Hospital Universitario Donostia; San Sebastian Spain
- Ilundain Fundazioa; San Sebastian Spain
- Neuroscience Area. Biodonostia Research Institute; Spain
- Centro de Investigación Biomédicas en Red Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Ministry of Economy and Competitiveness; Spain
| | - Maria Cruz Rodríguez-Oroz
- Neurology Service; Hospital Universitario Donostia; San Sebastian Spain
- Neuroscience Area. Biodonostia Research Institute; Spain
- Centro de Investigación Biomédicas en Red Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Ministry of Economy and Competitiveness; Spain
- Ikerbasque. Basque Foundation for Science; Bilbao Spain
| | - Ainara Estanga
- Ilundain Fundazioa; San Sebastian Spain
- Neuroscience Area. Biodonostia Research Institute; Spain
- Department of Neuroscience; University of the Basque Country UPV/EHU; Spain
| | - Ana Gorostidi
- Neuroscience Area. Biodonostia Research Institute; Spain
- Centro de Investigación Biomédicas en Red Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Ministry of Economy and Competitiveness; Spain
| | - Adolfo López de Munain
- Neurology Service; Hospital Universitario Donostia; San Sebastian Spain
- Ilundain Fundazioa; San Sebastian Spain
- Neuroscience Area. Biodonostia Research Institute; Spain
- Centro de Investigación Biomédicas en Red Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Ministry of Economy and Competitiveness; Spain
- Department of Neuroscience; University of the Basque Country UPV/EHU; Spain
| | - Tamara Castillo-Triviño
- Neurology Service; Hospital Universitario Donostia; San Sebastian Spain
- Neuroscience Area. Biodonostia Research Institute; Spain
| | - Javier Ruiz-Martínez
- Neurology Service; Hospital Universitario Donostia; San Sebastian Spain
- Neuroscience Area. Biodonostia Research Institute; Spain
- Centro de Investigación Biomédicas en Red Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Ministry of Economy and Competitiveness; Spain
| | - Elisabet Mondragón
- Neurology Service; Hospital Universitario Donostia; San Sebastian Spain
- Neuroscience Area. Biodonostia Research Institute; Spain
| | - Carles Gaig
- Centro de Investigación Biomédicas en Red Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Ministry of Economy and Competitiveness; Spain
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clínic and Institut d'Investigació Biomèdiques August Pi i Sunyer; Spain
| | - Francisco Lomeña
- Nuclear Medicine Service, Hospital Clinic de Barcelona, Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Hospital Clinic de Barcelona; Spain
| | - Cristina Sarasqueta
- Unidad de Apoyo Metodológico. Hospital Universitario Donostia. Biodonostia Research Institute, REDISSEC; Spain
| | - Eduardo Tolosa
- Centro de Investigación Biomédicas en Red Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Ministry of Economy and Competitiveness; Spain
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS; Spain
| | - José Félix Martí-Massó
- Neurology Service; Hospital Universitario Donostia; San Sebastian Spain
- Ilundain Fundazioa; San Sebastian Spain
- Neuroscience Area. Biodonostia Research Institute; Spain
- Centro de Investigación Biomédicas en Red Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Ministry of Economy and Competitiveness; Spain
- Department of Neuroscience; University of the Basque Country UPV/EHU; Spain
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Rolinski M, Zokaei N, Baig F, Giehl K, Quinnell T, Zaiwalla Z, Mackay CE, Husain M, Hu MTM. Visual short-term memory deficits in REM sleep behaviour disorder mirror those in Parkinson's disease. Brain 2015; 139:47-53. [PMID: 26582557 PMCID: PMC4949392 DOI: 10.1093/brain/awv334] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/05/2015] [Indexed: 11/13/2022] Open
Abstract
Individuals with REM sleep behaviour disorder are at significantly higher risk of developing Parkinson’s disease. Here we examined visual short-term memory deficits—long associated with Parkinson’s disease—in patients with REM sleep behaviour disorder without Parkinson’s disease using a novel task that measures recall precision. Visual short-term memory for sequentially presented coloured bars of different orientation was assessed in 21 patients with polysomnography-proven idiopathic REM sleep behaviour disorder, 26 cases with early Parkinson’s disease and 26 healthy controls. Three tasks using the same stimuli controlled for attentional filtering ability, sensorimotor and temporal decay factors. Both patients with REM sleep behaviour disorder and Parkinson’s disease demonstrated a deficit in visual short-term memory, with recall precision significantly worse than in healthy controls with no deficit observed in any of the control tasks. Importantly, the pattern of memory deficit in both patient groups was specifically explained by an increase in random responses. These results demonstrate that it is possible to detect the signature of memory impairment associated with Parkinson’s disease in individuals with REM sleep behaviour disorder, a condition associated with a high risk of developing Parkinson’s disease. The pattern of visual short-term memory deficit potentially provides a cognitive marker of ‘prodromal’ Parkinson’s disease that might be useful in tracking disease progression and for disease-modifying intervention trials.
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Affiliation(s)
- Michal Rolinski
- 1 Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Nahid Zokaei
- 3 Department of Psychiatry, University of Oxford, Oxford, UK 4 Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Fahd Baig
- 1 Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kathrin Giehl
- 5 Department of Nuclear Medicine, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Timothy Quinnell
- 6 Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, UK
| | - Zenobia Zaiwalla
- 7 Department of Clinical Neurophysiology, John Radcliffe Hospital, Oxford, UK
| | - Clare E Mackay
- 1 Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK 3 Department of Psychiatry, University of Oxford, Oxford, UK
| | - Masud Husain
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK 4 Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Michele T M Hu
- 1 Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Autonomic dysfunction in subjects at high risk for Parkinson's disease. J Neurol 2015; 262:2643-52. [PMID: 26530505 DOI: 10.1007/s00415-015-7888-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 12/15/2022]
Abstract
Aim of this project was to evaluate autonomic dysfunction in subjects proposed to be at high risk to develop Parkinson's disease (PD) compared to control subjects and PD patients at different disease stages. Combinations of substantia nigra hyperechogenicity (SN+) assessed by transcranial ultrasound (TCS), hyposmia, lifetime prevalence of depression and mild PD-specific motor signs were used to identify subjects at high risk for motor Parkinson's disease (HR-PD). Supine and standing blood pressure (BP), hearth rate (HR), orthostatic, urinary, sexual and bowel symptoms were evaluated in HR-PD, healthy control subjects and PD patients, divided into mild and advanced stages. The study group consisted of 113 PD patients (mild PD n = 71, advanced PD, n = 42), 40 HR-PD individuals and 50 controls. Compared to controls, HR-PD subjects complained more often about urinary (p = 0.002) and bowel dysfunction (p = 0.001) and had a higher diastolic BP drop after standing (p = 0.01). The cumulative number of autonomic symptoms differentiated PD as well as HR-PD significantly from controls (p < 0.001). Advanced PD patients presented often and severe orthostatic symptoms, not significantly different from mild PD after concomitant medication correction. Our results support the presence of urinary and bowel dysfunction in subjects at high risk for motor PD. Presence and severity of orthostatic symptoms was higher during stages and increase in advanced stages, at least partly due to increase in dopaminergic and conflicting medication. Understanding the progression of non-motor aspects in PD might offer the possibility to use them as targets for disease-modifying therapies.
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56
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An algorithmic approach to the evaluation and treatment of olfactory disorders. Curr Opin Otolaryngol Head Neck Surg 2015; 23:8-14. [PMID: 25569294 DOI: 10.1097/moo.0000000000000118] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW To review the current evidence in diagnosing olfactory disorders and suggest an algorithmic approach to patients with relevant complaints. RECENT FINDINGS New literature suggests that the incidence of olfactory loss increases with age. Age-associated olfactory loss is often multifactorial and requires careful history and physical exam. Psychophysical tests have a role in screening patients at risk for Parkinson's and Alzheimer's disease, but there is lack of evidence regarding timing and patient selection. Prediction of olfactory improvement in patients with chronic rhinosinusitis (CRS) is difficult with variable results from different studies. Olfactory training is suggested to be an emerging modality in patients with postinfectious olfactory loss. SUMMARY There is no standard treatment for olfactory loss. Each patient must be approached individually based on the suspected cause. Patients with CRS may require medical management and surgical treatment for alleviation of their olfactory dysfunction.
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Fedotova EY, Chechetkin AO, Abramycheva NY, Chigaleychik LA, Baziyan BK, Ponomareva ТА, Alexeeva NS, Fedin PA, Kravchenko MA, Varakin YY, Ivanova-Smolenskaya IA, Illarioshkin SN. [Identification of people at the latent stage of Parkinson's disease (the PARKINLAR study): first results and an optimization of the algorithm]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:4-11. [PMID: 26356391 DOI: 10.17116/jnevro2015115614-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To work out an optimal algorithm to identify people at the latent stage of neurodegenerative process of «parkinsonian» type in the Russian population. MATERIAL AND METHODS Authors launched a two-step study aimed at identifying people at the latent stage of Parkinson's disease (PD) in the Russian population - the PARKINLAR (PARKINsonism, LAtent stage, Russia). As the first step, we formed a group of «primary risk» by the identification in neurologically healthy people of at least one of the following confirmed PD risk factors: a) the substantia nigra hyperechogenicity (ultrasound screening was performed in 193 people); b) mutations in «parkinsonian» genes (genetic screening was performed in 29 relatives of PD patients from families with LRRK2, PARK2 and GBA mutations). Thereby, 37 people comprised the «primary risk» group, of whom 23 agreed to continue further examination (44±10.2 years). A matched group of people without the aforementioned primary biomarkers of PD served as control. As the second step, we undertook in the prescreened groups a complex of investigations assessing the presence of secondary («minor») biomarkers of PD: Sniffin' Sticks olfactory testing; color visual evoked potentials; analysis of goal-directed eye-head-hand movements with the use of a special neuro-cybernetic system; assessment of motor and non-motor symptoms with the use of UPDRS and NMSS scales. RESULTS When comparing the «primary risk» group with controls, maximal differences in the occurrence of symptoms were seen for goal-directed eye movements (43.5% vs. 20.0%) and color vision (39.1% vs. 26.7%). Among these individuals, we found two people with 4 secondary biomarkers and one with 3, and no such observations in controls. People with the combination of a primary biomarker with several secondary biomarkers of PD comprised a group of «high risk» in our study. CONCLUSION Optimization of this algorithm of population screening of people predisposed to the development of PD may be done by expanding the spectrum of biomarkers and assessing their validity in a long-term prospective observational study.
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Affiliation(s)
- E Yu Fedotova
- Research Center of Neurology, Russian Academy of Sciences, Moscow
| | - A O Chechetkin
- Research Center of Neurology, Russian Academy of Sciences, Moscow
| | - N Yu Abramycheva
- Research Center of Neurology, Russian Academy of Sciences, Moscow
| | - L A Chigaleychik
- Research Center of Neurology, Russian Academy of Sciences, Moscow
| | - B Kh Baziyan
- Research Center of Neurology, Russian Academy of Sciences, Moscow
| | - Т А Ponomareva
- Research Center of Neurology, Russian Academy of Sciences, Moscow
| | - N S Alexeeva
- Research Center of Neurology, Russian Academy of Sciences, Moscow
| | - P A Fedin
- Research Center of Neurology, Russian Academy of Sciences, Moscow
| | - M A Kravchenko
- Research Center of Neurology, Russian Academy of Sciences, Moscow
| | - Yu Ya Varakin
- Research Center of Neurology, Russian Academy of Sciences, Moscow
| | | | - S N Illarioshkin
- Research Center of Neurology, Russian Academy of Sciences, Moscow
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Hauser RA. α-Synuclein in Parkinson's disease: getting to the core of the matter. Lancet Neurol 2015; 14:785-786. [DOI: 10.1016/s1474-4422(15)00136-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
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Liu R, Umbach DM, Peddada SD, Xu Z, Tröster AI, Huang X, Chen H. Potential sex differences in nonmotor symptoms in early drug-naive Parkinson disease. Neurology 2015; 84:2107-15. [PMID: 25925983 DOI: 10.1212/wnl.0000000000001609] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/06/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine potential sex differences in nonmotor symptoms (NMS) among drug-naive patients with Parkinson disease (PD), and to identify NMS that can best differentiate patients with early PD from controls. METHODS Our cross-sectional analysis included 414 newly diagnosed, untreated patients with PD (269 men and 145 women) and 188 healthy controls (121 men and 67 women) in the Parkinson's Progression Markers Initiative Study. NMS were measured using well-validated instruments covering sleep, olfactory, neurobehavioral, autonomic, and neuropsychological domains. RESULTS Male and female patients with PD were fairly comparable on motor presentations but differed on several nonmotor features. Male patients with PD had significantly more pronounced deficits in olfaction (p = 0.02) and in certain cognitive measurements (all p < 0.01) than female patients, whereas female cases experienced higher trait anxiety (p = 0.02). Multiple stepwise logistic regression analysis showed that the combination of NMS measures-University of Pennsylvania Smell Identification Test (UPSIT), Montreal Cognitive Assessment (MoCA), Scales for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT), and state anxiety from the State-Trait Anxiety Inventory-effectively differentiated patients with PD from controls with an area under the receiver operating characteristic curve (AUC) of 0.913 (95% confidence interval [CI]: 0.89-0.94). UPSIT, MoCA, and SCOPA-AUT were the most predictive NMS measurements in men (AUC = 0.919; 95% CI: 0.89-0.95) as compared to UPSIT, MoCA, and REM Sleep Behavior Disorder Screening Questionnaire in women (AUC = 0.903; 95% CI: 0.86-0.95). CONCLUSIONS Our analysis revealed notable sex differences in several nonmotor features of patients with de novo PD. Furthermore, we found a parsimonious NMS combination that could effectively differentiate de novo cases from healthy controls.
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Affiliation(s)
- Rui Liu
- From the Epidemiology Branch (R.L., Z.X., H.C.) and Biostatistics and Computational Biology Branch (D.M.U., S.D.P.) of the National Institute of Environmental Health Sciences, Research Triangle Park, NC; Barrow Neurological Institute (A.I.T.), Phoenix, AZ; Department of Neurology (X.H.), Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA.
| | - David M Umbach
- From the Epidemiology Branch (R.L., Z.X., H.C.) and Biostatistics and Computational Biology Branch (D.M.U., S.D.P.) of the National Institute of Environmental Health Sciences, Research Triangle Park, NC; Barrow Neurological Institute (A.I.T.), Phoenix, AZ; Department of Neurology (X.H.), Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA
| | - Shyamal D Peddada
- From the Epidemiology Branch (R.L., Z.X., H.C.) and Biostatistics and Computational Biology Branch (D.M.U., S.D.P.) of the National Institute of Environmental Health Sciences, Research Triangle Park, NC; Barrow Neurological Institute (A.I.T.), Phoenix, AZ; Department of Neurology (X.H.), Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA
| | - Zongli Xu
- From the Epidemiology Branch (R.L., Z.X., H.C.) and Biostatistics and Computational Biology Branch (D.M.U., S.D.P.) of the National Institute of Environmental Health Sciences, Research Triangle Park, NC; Barrow Neurological Institute (A.I.T.), Phoenix, AZ; Department of Neurology (X.H.), Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA
| | - Alexander I Tröster
- From the Epidemiology Branch (R.L., Z.X., H.C.) and Biostatistics and Computational Biology Branch (D.M.U., S.D.P.) of the National Institute of Environmental Health Sciences, Research Triangle Park, NC; Barrow Neurological Institute (A.I.T.), Phoenix, AZ; Department of Neurology (X.H.), Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA
| | - Xuemei Huang
- From the Epidemiology Branch (R.L., Z.X., H.C.) and Biostatistics and Computational Biology Branch (D.M.U., S.D.P.) of the National Institute of Environmental Health Sciences, Research Triangle Park, NC; Barrow Neurological Institute (A.I.T.), Phoenix, AZ; Department of Neurology (X.H.), Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA
| | - Honglei Chen
- From the Epidemiology Branch (R.L., Z.X., H.C.) and Biostatistics and Computational Biology Branch (D.M.U., S.D.P.) of the National Institute of Environmental Health Sciences, Research Triangle Park, NC; Barrow Neurological Institute (A.I.T.), Phoenix, AZ; Department of Neurology (X.H.), Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA
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Feinberg JI, Bakulski KM, Jaffe AE, Tryggvadottir R, Brown SC, Goldman LR, Croen LA, Hertz-Picciotto I, Newschaffer CJ, Fallin MD, Feinberg AP. Paternal sperm DNA methylation associated with early signs of autism risk in an autism-enriched cohort. Int J Epidemiol 2015; 44:1199-210. [PMID: 25878217 DOI: 10.1093/ije/dyv028] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Epigenetic mechanisms such as altered DNA methylation have been suggested to play a role in autism, beginning with the classical association of Prader-Willi syndrome, an imprinting disorder, with autistic features. OBJECTIVES Here we tested for the relationship of paternal sperm DNA methylation with autism risk in offspring, examining an enriched-risk cohort of fathers of autistic children. METHODS We examined genome-wide DNA methylation (DNAm) in paternal semen biosamples obtained from an autism spectrum disorder (ASD) enriched-risk pregnancy cohort, the Early Autism Risk Longitudinal Investigation (EARLI) cohort, to estimate associations between sperm DNAm and prospective ASD development, using a 12-month ASD symptoms assessment, the Autism Observation Scale for Infants (AOSI). We analysed methylation data from 44 sperm samples run on the CHARM 3.0 array, which contains over 4 million probes (over 7 million CpG sites), including 30 samples also run on the Illumina Infinium HumanMethylation450 (450K) BeadChip platform (∼485 000 CpG sites). We also examined associated regions in an independent sample of post-mortem human brain ASD and control samples for which Illumina 450K DNA methylation data were available. RESULTS Using region-based statistical approaches, we identified 193 differentially methylated regions (DMRs) in paternal sperm with a family-wise empirical P-value [family-wise error rate (FWER)] <0.05 associated with performance on the Autism Observational Scale for Infants (AOSI) at 12 months of age in offspring. The DMRs clustered near genes involved in developmental processes, including many genes in the SNORD family, within the Prader-Willi syndrome gene cluster. These results were consistent among the 75 probes on the Illumina 450K array that cover AOSI-associated DMRs from CHARM. Further, 18 of 75 (24%) 450K array probes showed consistent differences in the cerebellums of autistic individuals compared with controls. CONCLUSIONS These data suggest that epigenetic differences in paternal sperm may contribute to autism risk in offspring, and provide evidence that directionally consistent, potentially related epigenetic mechanisms may be operating in the cerebellum of individuals with autism.
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Affiliation(s)
- Jason I Feinberg
- Johns Hopkins Bloomberg School of Public Health, Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins University, Center for Epigenetics
| | - Kelly M Bakulski
- Johns Hopkins Bloomberg School of Public Health, Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins University, Center for Epigenetics, Johns Hopkins Bloomberg School of Public Health, Epidemiology
| | - Andrew E Jaffe
- Lieber Institute for Brain Development, Johns Hopkins Bloomberg School of Public Health, Mental Health and
| | | | - Shannon C Brown
- Johns Hopkins Bloomberg School of Public Health, Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Epidemiology
| | - Lynn R Goldman
- George Washington University, Milken Institute School of Public Health, Johns Hopkins Bloomberg School of Public Health
| | - Lisa A Croen
- Kaiser Permanente, Division of Research, Autism Research Program
| | | | - Craig J Newschaffer
- Drexel University, A.J. Drexel Autism Institute, Drexel University School of Public Health, Epidemiology and Biostatistics
| | - M Daniele Fallin
- Johns Hopkins Bloomberg School of Public Health, Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Mental Health and
| | - Andrew P Feinberg
- Johns Hopkins University, Center for Epigenetics, Johns Hopkins University School of Medicine, Medicine
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Abstract
Sporadic or idiopathic Parkinson's disease (PD) is an age-related neurodegenerative disorder of unknown origin that ranks only second behind Alzheimer's disease (AD) in prevalence and its consequent social and economic burden. PD neuropathology is characterized by a selective loss of dopaminergic neurons in the substantia nigra pars compacta; however, more widespread involvement of other CNS structures and peripheral tissues now is widely documented. The onset of molecular and cellular neuropathology of PD likely occurs decades before the onset of the motor symptoms characteristic of PD. The hallmark symptoms of PD, resting tremors, rigidity and postural disabilities, are related to dopamine (DA) deficiency. Current therapies treat these symptoms by replacing or boosting existing DA. All current interventions have limited therapeutic benefit for disease progression because damage likely has progressed over an estimated period of ~5 to 15years to a loss of 60%-80% of the nigral DA neurons, before symptoms emerge. There is no accepted definitive biomarker of PD. An urgent need exists to develop early diagnostic biomarkers for two reasons: (1) to intervene at the onset of disease and (2) to monitor the progress of therapeutic interventions that may slow or stop the course of the disease. In the context of disease development, one of the promises of personalized medicine is the ability to predict, on an individual basis, factors contributing to the susceptibility for the development of a given disease. Recent advances in our understanding of genetic factors underlying or contributing to PD offer the potential for monitoring susceptibility biomarkers that can be used to identify at-risk individuals and possibly prevent the onset of disease through treatment. Finally, the exposome concept is new in the biomarker discovery arena and it is suggested as a way to move forward in identifying biomarkers of neurological diseases. It is a two-stage scheme involving a first stage of exposome-wide association studies (EWAS) to profile omic features in serum to discover molecular biomarkers. The second stage involves application of this knowledge base in follow-up studies. This strategy is unique in that it promotes the use of data-driven (omic) strategies in interrogating diseased and healthy populations and encourages a movement away from using only reductionist strategies to discover biomarkers of exposure and disease. In this short review we will examine 1) advances in our understanding of the molecular mechanisms underlying PD that have led to candidate biomarkers for diagnosis and treatment efficacy and 2) new technologies on the horizon that will lead to novel approaches in biomarker development.
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Affiliation(s)
- Diane B Miller
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV 26505.
| | - James P O'Callaghan
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV 26505.
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Abstract
PURPOSE OF REVIEW This review highlights recent advances in premotor and nonmotor features in Parkinson's disease, focusing on these issues in the context of prodromal and early-stage Parkinson's disease. RECENT FINDINGS Although Parkinson's disease patients experience a wide range of nonmotor symptoms throughout the disease course, studies demonstrate that nonmotor features are not solely a late manifestation. Indeed, disturbances of smell, sleep, mood, and gastrointestinal function may herald Parkinson's disease or related synucleinopathies and precede these neurodegenerative conditions by 5 or more years. In addition, other nonmotor symptoms such as cognitive impairment are now recognized in incident or de-novo Parkinson's disease cohorts. Many of these nonmotor features reflect disturbances in nondopaminergic systems and early involvement of peripheral and central nervous systems, including olfactory, enteric, and brainstem neurons as in Braak's proposed pathological staging of Parkinson's disease. Current research focuses on identifying potential biomarkers that may detect persons at risk for Parkinson's disease and permit early intervention with neuroprotective or disease-modifying therapeutics. SUMMARY Recent studies provide new insights into the frequency, pathophysiology, and importance of nonmotor features in Parkinson's disease as well as the recognition that these nonmotor symptoms occur in premotor, early, and later phases of Parkinson's disease.
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Chen H, Zhao EJ, Zhang W, Lu Y, Liu R, Huang X, Ciesielski-Jones AJ, Justice MA, Cousins DS, Peddada S. Meta-analyses on prevalence of selected Parkinson's nonmotor symptoms before and after diagnosis. Transl Neurodegener 2015; 4:1. [PMID: 25671103 PMCID: PMC4322463 DOI: 10.1186/2047-9158-4-1] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/05/2015] [Indexed: 12/11/2022] Open
Abstract
Background Nonmotor symptoms are common among patients with Parkinson’s disease (PD) and some may precede disease diagnosis. Methods We conducted a meta-analysis on the prevalence of selected nonmotor symptoms before and after PD diagnosis, using random-effect models. We searched PubMed (1965 through October/November 2012) for the following symptoms: hyposmia, constipation, rapid eye movement sleep behavior disorder, excessive daytime sleepiness, depression, and anxiety. Eligible studies were publications in English with original data on one or more of these symptoms. Results The search generated 2,373 non-duplicated publications and 332 met the inclusion criteria, mostly (n = 320) on symptoms after PD diagnosis. For all symptoms, the prevalence was substantially higher in PD cases than in controls, each affecting over a third of the patients. Hyposmia was the most prevalent (75.5% in cases vs. 19.1% in controls), followed by constipation (50% vs. 17.7%), anxiety (39.9% vs. 19.1%), rapid eye movement sleep behavior disorder (37.0% vs. 7.0%), depression (36.6% vs. 14.9%), and excessive daytime sleepiness (33.9% vs. 10.5%). We observed substantial heterogeneities across studies and meta-regression analyses suggested that several factors might have contributed to this. However, the prevalence estimates were fairly robust in several sensitivity analyses. Only 20 studies had data on any symptoms prior to PD diagnosis, but still the analyses revealed higher prevalence in future PD cases than in controls. Conclusion These symptoms are common among PD patients both before and after diagnosis. Further studies are needed to understand the natural history of nonmotor symptoms in PD and their etiological and clinical implications. Electronic supplementary material The online version of this article (doi:10.1186/2047-9158-4-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Honglei Chen
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Dr, P.O. Box 12233, Mail drop A3-05, Research Triangle Park, NC 27709 USA
| | - Edward J Zhao
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Dr, P.O. Box 12233, Mail drop A3-05, Research Triangle Park, NC 27709 USA
| | - Wen Zhang
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Dr, P.O. Box 12233, Mail drop A3-05, Research Triangle Park, NC 27709 USA
| | - Yi Lu
- Social & Scientific Systems, Inc, Durham, North Carolina USA
| | - Rui Liu
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Dr, P.O. Box 12233, Mail drop A3-05, Research Triangle Park, NC 27709 USA
| | - Xuemei Huang
- Departments of Neurology, Radiology, Neurosurgery, Pharmacology, & Kinesiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania USA
| | | | | | | | - Shyamal Peddada
- Biostatistics Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC USA
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Schrag A, Horsfall L, Walters K, Noyce A, Petersen I. Prediagnostic presentations of Parkinson's disease in primary care: a case-control study. Lancet Neurol 2015; 14:57-64. [PMID: 25435387 DOI: 10.1016/s1474-4422(14)70287-x] [Citation(s) in RCA: 399] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Parkinson's disease has an insidious onset and is diagnosed when typical motor features occur. Several motor and non-motor features can occur before diagnosis, early in the disease process. We aimed to assess the association between first presentation of several prediagnostic features in primary care and a subsequent diagnosis of Parkinson's disease, and to chart the timeline of these first presentations before diagnosis. METHODS We identified individuals with a first diagnosis of Parkinson's disease and those without Parkinson's disease from Jan 1, 1996, to Dec 31, 2012, from The Health Improvement Network UK primary care database. Codes were extracted for a range of possible prediagnostic or early symptoms, comprising motor features (tremor, rigidity, balance impairments, neck pain or stiffness, and shoulder pain or stiffness), autonomic features (constipation, hypotension, erectile dysfunction, urinary dysfunction, and dizziness), neuropsychiatric disturbances (memory problems, late-onset anxiety or depression, cognitive decline, and apathy), and additional features (fatigue, insomnia, anosmia, hypersalivation and rapid-eye-movement sleep behaviour disorder) in the years before diagnosis. We report the incidence of symptoms recorded in more than 1% of cases per 1000 person-years and incidence risk ratios (RRs) for individuals with and without Parkinson's disease at 2, 5, and 10 years before diagnosis. FINDINGS 8166 individuals with and 46,755 individuals without Parkinson's disease were included in the study. Apathy, REM sleep behaviour disorder, anosmia, hypersalivation, and cognitive decline were all reported in less than 1% of people per 1000 person-years and were excluded from further analyses. At 2 years before Parkinson's disease diagnosis, the incidence of all studied prediagnostic features except neck pain or stiffness was higher in patients who went on to develop Parkinson's disease (n=7232) than in controls (n=40,541). At 5 years before diagnosis, compared with controls (n=25,544), patients who went on to develop Parkinson's disease (n=4769) had a higher incidence of tremor (RR 13·70, 95% CI 7·82-24·31), balance impairments (2·19, 1·09-4·16), constipation (2·24, 2·04-2·46), hypotension (3·23, 1·85-5·52), erectile dysfunction (1·30, 1·11-1·51), urinary dysfunction (1·96, 1·34-2·80), dizziness (1·99, 1·67-2·37), fatigue (1·56, 1·27-1·91), depression (1·76, 1·41-2·17), and anxiety (1·41, 1·09-1·79). At 10 years before diagnosis of Parkinson's disease, the incidence of tremor (RR 7·59, 95% CI 1·11-44·83) and constipation (2·01, 1·62-2·49) was higher in those who went on to develop Parkinson's disease (n=1680) than in controls (n=8305). INTERPRETATION A range of prediagnostic features can be detected several years before diagnosis of Parkinson's disease in primary care. These data can be incorporated into ongoing efforts to identify individuals at the earliest stages of the disease for inclusion in future trials and to help understand progression in the earliest phase of Parkinson's disease. FUNDING Parkinson's UK.
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Affiliation(s)
- Anette Schrag
- UCL Institute of Neurology, University College London, London, UK.
| | - Laura Horsfall
- UCL Department of Primary Care and Population Sciences, University College London, London, UK
| | - Kate Walters
- UCL Department of Primary Care and Population Sciences, University College London, London, UK
| | - Alastair Noyce
- UCL Institute of Neurology, University College London, London, UK
| | - Irene Petersen
- UCL Department of Primary Care and Population Sciences, University College London, London, UK
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J. White V, C. Nayak R. Re-circulating Phagocytes Loaded with CNS Debris: A Potential Marker of Neurodegeneration in Parkinsons Disease? AIMS MEDICAL SCIENCE 2015. [DOI: 10.3934/medsci.2015.1.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Louter M, Maetzler W, Prinzen J, van Lummel RC, Hobert M, Arends JBAM, Bloem BR, Streffer J, Berg D, Overeem S, Liepelt-Scarfone I. Accelerometer-based quantitative analysis of axial nocturnal movements differentiates patients with Parkinson's disease, but not high-risk individuals, from controls. J Neurol Neurosurg Psychiatry 2015; 86:32-7. [PMID: 24777169 DOI: 10.1136/jnnp-2013-306851] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION There is a need for prodromal markers to diagnose Parkinson's disease (PD) as early as possible. Knowing that most patients with overt PD have abnormal nocturnal movement patterns, we hypothesised that such changes might occur already in non-PD individuals with a potentially high risk for future development of the disease. METHODS Eleven patients with early PD (Hoehn & Yahr stage ≤2.5), 13 healthy controls and 33 subjects with a high risk of developing PD (HR-PD) were investigated. HR-PD was defined by the occurrence of hyperechogenicity of the substantia nigra in combination with prodromal markers (eg, slight motor signs, olfactory dysfunction). A triaxial accelerometer was used to quantify nocturnal movements during two nights per study participant. Outcome measurements included mean acceleration, and qualitative axial movement parameters, such as duration and speed. RESULTS Mean acceleration of nocturnal movements was lower in patients with PD compared to controls. Frequency and speed of axial movements did not differ between patients with PD and controls, but mean size and duration were lower in PD. The HR-PD group did not significantly differ from the control group in any of the parameters analysed. CONCLUSIONS Compared with controls, patients with PD had an overall decreased mean acceleration, as well as smaller and shorter nocturnal axial movements. These changes did not occur in our potential HR-PD individuals, suggesting that relevant axial movement alterations during sleep have either not developed or cannot be detected by the means applied in this at-risk cohort.
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Affiliation(s)
- Maartje Louter
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical centre, Nijmegen, The Netherlands Sleep Medicine Centre Kempenhaeghe, Heeze, The Netherlands
| | - Walter Maetzler
- Department for Neurodegenerative Diseases, Centre of Neurology, German Center of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | | | - Markus Hobert
- Department for Neurodegenerative Diseases, Centre of Neurology, German Center of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Johan B A M Arends
- Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical centre, Nijmegen, The Netherlands
| | - Johannes Streffer
- Janssen Research and Development, Janssen-Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium
| | - Daniela Berg
- Department for Neurodegenerative Diseases, Centre of Neurology, German Center of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Sebastiaan Overeem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical centre, Nijmegen, The Netherlands Sleep Medicine Centre Kempenhaeghe, Heeze, The Netherlands
| | - Inga Liepelt-Scarfone
- Department for Neurodegenerative Diseases, Centre of Neurology, German Center of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Tunc S, Graf J, Tadic V, Brüggemann N, Schmidt A, Al-Khaled M, Wolff S, Vollstedt EJ, Lorwin A, Hampf J, Piskol L, Klein C, Hagenah J, Kasten M. A population-based study on combined markers for early Parkinson's disease. Mov Disord 2014; 30:531-7. [DOI: 10.1002/mds.26100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 10/07/2014] [Accepted: 10/26/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sinem Tunc
- Department of Psychiatry and Psychotherapy; University of Luebeck; Germany
- Institute of Neurogenetics; University of Luebeck; Germany
| | - Julia Graf
- Institute of Neurogenetics; University of Luebeck; Germany
| | - Vera Tadic
- Institute of Neurogenetics; University of Luebeck; Germany
| | | | | | | | - Simone Wolff
- Institute of Neurogenetics; University of Luebeck; Germany
| | - Eva-Juliane Vollstedt
- Department of Psychiatry and Psychotherapy; University of Luebeck; Germany
- Institute of Neurogenetics; University of Luebeck; Germany
| | - Anne Lorwin
- Department of Psychiatry and Psychotherapy; University of Luebeck; Germany
- Institute of Neurogenetics; University of Luebeck; Germany
| | - Jennie Hampf
- Department of Psychiatry and Psychotherapy; University of Luebeck; Germany
- Institute of Neurogenetics; University of Luebeck; Germany
| | - Linda Piskol
- Institute of Neurogenetics; University of Luebeck; Germany
| | | | - Johann Hagenah
- Department of Neurology; Westkuestenklinikum Heide Heide Germany
| | - Meike Kasten
- Department of Psychiatry and Psychotherapy; University of Luebeck; Germany
- Institute of Neurogenetics; University of Luebeck; Germany
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The relation of SMI and the VSEP in a risk sample for neurodegenerative disorders. J Neural Transm (Vienna) 2014; 122:1167-74. [DOI: 10.1007/s00702-014-1351-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
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Silveira-Moriyama L, Lees AJ. How reliable are prodromal indicators of Parkinson disease? Nat Rev Neurol 2014; 11:5-6. [DOI: 10.1038/nrneurol.2014.235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Liepelt-Scarfone I, Lerche S, Behnke S, Godau J, Gaenslen A, Pausch C, Fassbender K, Brockmann K, Srulijes K, Huber H, Wurster I, Berg D. Clinical characteristics related to worsening of motor function assessed by the Unified Parkinson's Disease Rating Scale in the elderly population. J Neurol 2014; 262:451-8. [PMID: 25451854 DOI: 10.1007/s00415-014-7584-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Abstract
There is evidence that nigrostriatal pathology may at least partly underlie mild Parkinsonian signs. We evaluated whether an increase in the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) could be predicted by the presence of risk and prodromal markers for neurodegenerative diseases in elderly individuals without those diseases. Therefore, we analyzed the UPDRS-III score and various risk and prodromal markers known to antecede neurodegenerative diseases in a population-based cohort comprising 807 individuals free of neurodegenerative diseases at baseline. After 5 years, eight persons (1.0 %) were diagnosed with Parkinson's Disease (PD). Of those, seven (87.5 %) had motor worsening ≥3 points on the UPDRS-III from baseline to follow-up, one had two points increase. Of the 788 people without PD, 568 (72.1 %) showed no increase in the UPDRS-III scale, 220 (27.9 %) had ≥1 point increase and out of these 104 (13.2 %) had an increase of ≥3 points in the UPDRS-III score after 5 years. We identified an age >60 years (relative risk, RR = 1.7; confidence interval, CI 1.3-2.1) and the occurrence of ≥2 risk factors (RR = 1.5; CI 1.2-1.9) as possible predictors of motor progression. After 5 years, individuals with an increase in the UPDRS-III score had more often a one-sided reduced arm swing (p < 0.001) and identified less odors in the Sniffin' sticks test (p < 0.041) than persons with stable motor performance. Our data support the assumption that progression of Parkinsonian signs assessed by the UPDRS-III parallels the development of prodromal markers for neurodegenerative diseases in the elderly population.
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Affiliation(s)
- Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany,
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Santiago JA, Potashkin JA. Current Challenges Towards the Development of a Blood Test for Parkinson's Disease. Diagnostics (Basel) 2014; 4:153-64. [PMID: 26852683 PMCID: PMC4665557 DOI: 10.3390/diagnostics4040153] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/08/2014] [Accepted: 10/11/2014] [Indexed: 12/25/2022] Open
Abstract
Parkinson’ disease (PD) is the second most prevalent neurodegenerative disease worldwide. To date, there is no disease-modifying agent, and current medical treatment only provides symptomatic benefits. Early diagnosis of PD would be useful in clinical practice to identify patients for clinical trials, test potential drugs and neuroprotective agents and track their therapeutic effect. Considerable progress has been made in the discovery and validation of diagnostic biomarkers for PD. In particular, blood-based biomarkers have shown promise in identifying PD patients in samples from independent clinical trials. Evaluation of these biomarkers in de novo patients and individuals at risk for PD remains a top priority. Here, we review the current advances and challenges toward the clinical translation of these biomarkers into a blood-based test for PD.
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Affiliation(s)
- Jose A Santiago
- The Cellular and Molecular Pharmacology Department, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064-3037, USA.
| | - Judith A Potashkin
- The Cellular and Molecular Pharmacology Department, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064-3037, USA.
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Walter U, Heilmann R, Kaulitz L, Just T, Krause BJ, Benecke R, Höppner J. Prediction of Parkinson's disease subsequent to severe depression: a ten-year follow-up study. J Neural Transm (Vienna) 2014; 122:789-97. [PMID: 25217967 DOI: 10.1007/s00702-014-1313-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
Abstract
Major depressive disorder (MDD) has been associated with an increased risk of subsequent Parkinson's disease (PD) in case-control and cohort studies. However, depression alone is unlikely to be a useful marker of prodromal PD due to its low specificity. In this longitudinal observational study, we assessed whether the presence of other potential markers of prodromal PD predicts the subsequent development of PD in MDD patients. Of 57 patients with severe MDD but no diagnosis of PD who underwent a structured interview, olfactory and motor investigation and transcranial sonography at baseline, 46 (36 women; mean age 54.9 ± 11.7 years) could be followed for up to 11 (median, 10) years. Three patients (2 women; age 64, 65 and 70 years) developed definite PD after 1, 7, and 9 years, respectively. The combined finding of mild asymmetric motor slowing, idiopathic hyposmia, and substantia nigra hyperechogenicity predicted subsequent PD in all patients who could be followed for longer than 1 year. Out of the whole study cohort, only the subjects with subsequent PD presented with the triad of asymmetric motor slowing, idiopathic hyposmia, and substantia nigra hyperechogenicity in combination with at least two out of four reportable risk factors (family history of PD, current non-smoker, non-coffee drinker, constipation) at baseline investigation. Post-hoc analysis revealed that additional rating of eye and eye-lid motor abnormalities might further improve the prediction of PD in larger cohorts. Findings of this pilot-study suggest that MDD patients at risk of subsequent PD can be identified using an inexpensive non-invasive diagnostic battery.
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Affiliation(s)
- Uwe Walter
- Department of Neurology, University of Rostock, Rostock, Germany,
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Chen H, Huang X, Guo X, Peddada S. Individual and joint prevalence of three nonmotor symptoms of PD in the US general population. Mov Disord 2014; 29:1316-9. [PMID: 24985078 PMCID: PMC4183355 DOI: 10.1002/mds.25950] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 05/28/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Some nonmotor symptoms may precede the clinical diagnosis of Parkinson's disease (PD) by years. METHODS We examined the individual and joint prevalence of depression, daytime sleepiness, and infrequent bowel movement among 10,477 participants of the US National Health and Nutrition Examination Surveys 2005-2008. RESULTS For all symptoms, the prevalence was higher in women than in men. Importantly, few participants had two or more symptoms: 1.3% at ages 20 to 29, 1.0% at 30 to 39, 1.2% at 40 to 49, 3.5% at 50 to 59, 1.7% at 60 to 69, 1.1% at 70 to 79, and 1.2% at ages 80 years or older in men; the corresponding prevalence in women was 3.1%, 5.2%, 5.7%, 4.1%, 3.1%, 2.3%, and 1.2%, respectively. In both men and women, depression was correlated with infrequent bowel movement and daytime sleepiness, but the latter two were mutually independent. CONCLUSION The presence of multiple nonmotor symptoms was uncommon in the general population and the prevalence was higher in women than in men.
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Affiliation(s)
- Honglei Chen
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Xuemei Huang
- Penn State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Shyamal Peddada
- Biostatistics Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
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Driver-Dunckley E, Adler CH, Hentz JG, Dugger BN, Shill HA, Caviness JN, Sabbagh MN, Beach TG. Olfactory dysfunction in incidental Lewy body disease and Parkinson's disease. Parkinsonism Relat Disord 2014; 20:1260-2. [PMID: 25172126 DOI: 10.1016/j.parkreldis.2014.08.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/18/2014] [Accepted: 08/11/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Olfactory dysfunction in Parkinson's disease (PD) is well-established and may represent one of the earliest signs of the disease. OBJECTIVE & METHODS The objective of this study was to evaluate the relationship of olfactory dysfunction, using the University of Pennsylvania Smell Identification Test (UPSIT), to clinical and pathological parameters of clinicopathologically diagnosed PD (n = 10), incidental Lewy body disease (ILBD) (n = 13), and identically assessed controls who lacked a neurodegenerative disease (n = 69). RESULTS Mean UPSIT scores were significantly lower in PD (16.3, p < 0.001) and ILBD (22.2, p = 0.004) compared to controls (27.7). Using an UPSIT cutoff score of <22 (the 15th percentile) the sensitivity for detecting PD was 9/10 (90%) and ILBD 6/13 (46%), while the specificity was 86% (Controls with score of <22 = 10/69). CONCLUSIONS These results add to the growing body of evidence suggesting that olfactory testing could be useful as a screening tool for identifying early, pre-motor PD.
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Affiliation(s)
- Erika Driver-Dunckley
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA.
| | - Charles H Adler
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | - Holly A Shill
- Banner Sun Health Research Institute, Sun City, AZ, USA
| | - John N Caviness
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
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Shah M, Seibyl J, Cartier A, Bhatt R, Catafau AM. Molecular Imaging Insights into Neurodegeneration: Focus on α-Synuclein Radiotracers. J Nucl Med 2014; 55:1397-400. [DOI: 10.2967/jnumed.113.136515] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Abstract
It is now well recognized that there is a premotor phase of Parkinson's disease (PD) with hyposmia and REM sleep behavior disorder caused by degeneration of specific CNS neurons. Most patients with PD describe autonomic symptoms at the time of diagnosis suggesting that these features may have potential sensitivity as clinical biomarkers of the premotor phase. The recognition that damage to peripheral autonomic neurons is present in the early stages of PD has led to a search for specific abnormalities in autonomic function that could serve as predictive biomarkers. There is evidence that constipation, urinary and sexual dysfunction and more recently decreased cardiac chronotropic response during exercise, are part of the premotor parkinsonian phenotype. The sensitivity and specificity of these features has yet to be accurately assessed. We briefly review the evidence for autonomic dysfunction as biomarker of premotor PD.
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Chahine LM, Stern MB. Characterizing Premotor Parkinson's Disease: Clinical Features and Objective Markers. Mov Disord Clin Pract 2014; 1:299-306. [PMID: 30363867 DOI: 10.1002/mdc3.12062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/25/2014] [Accepted: 05/29/2014] [Indexed: 11/07/2022] Open
Abstract
Increasingly, it has been recognized that in order to affect underlying neurodegeneration in Parkinson's disease (PD), individuals must be identified before onset of the classic motor symptoms. Thus, for research purposes, a redefinition of PD has been proposed into preclinical, premotor, and motor phases. In the preclinical phase, no clinical signs or symptoms of PD are present. In the premotor phase, nonmotor manifestations are detectable. These include olfactory, neuropsychiatric, sleep, gastrointestinal, and autonomic changes. A multi-modal approach is needed to maximize both sensitivity and specificity of any assessment of the premotor phase. To that end, several objective markers, such as dopaminergic imaging and electrophysiologic techniques, exist and are of potential utility. This review discusses the candidate nonmotor features and potential objective measures that may be used to define the premotor phase of PD.
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Affiliation(s)
- Lama M Chahine
- Penn Parkinson's Disease and Movement Disorders Center Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Matthew B Stern
- Penn Parkinson's Disease and Movement Disorders Center Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
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Adler CH, Beach TG, Hentz JG, Shill HA, Caviness JN, Driver-Dunckley E, Sabbagh MN, Sue LI, Jacobson SA, Belden CM, Dugger BN. Low clinical diagnostic accuracy of early vs advanced Parkinson disease: clinicopathologic study. Neurology 2014; 83:406-12. [PMID: 24975862 DOI: 10.1212/wnl.0000000000000641] [Citation(s) in RCA: 336] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Determine diagnostic accuracy of a clinical diagnosis of Parkinson disease (PD) using neuropathologic diagnosis as the gold standard. METHODS Data from the Arizona Study of Aging and Neurodegenerative Disorders were used to determine the predictive value of a clinical PD diagnosis, using 2 clinical diagnostic confidence levels, PossPD (never treated or not clearly responsive) and ProbPD (responsive to medications). Neuropathologic diagnosis was the gold standard. RESULTS Based on first visit, 9 of 34 (26%) PossPD cases had neuropathologically confirmed PD while 80 of 97 (82%) ProbPD cases had confirmed PD. PD was confirmed in 8 of 15 (53%) ProbPD cases with <5 years of disease duration and 72 of 82 (88%) with ≥5 years of disease duration. Using final diagnosis at time of death, 91 of 107 (85%) ProbPD cases had confirmed PD. Clinical variables that improved diagnostic accuracy were medication response, motor fluctuations, dyskinesias, and hyposmia. CONCLUSIONS Using neuropathologic findings of PD as the gold standard, this study establishes the novel findings of only 26% accuracy for a clinical diagnosis of PD in untreated or not clearly responsive subjects, 53% accuracy in early PD responsive to medication (<5 years' duration), and >85% diagnostic accuracy of longer duration, medication-responsive PD. Caution is needed when interpreting clinical studies of PD, especially studies of early disease that do not have autopsy confirmation. The need for a tissue or other diagnostic biomarker is reinforced. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that a clinical diagnosis of PD identifies patients who will have pathologically confirmed PD with a sensitivity of 88% and specificity of 68%.
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Affiliation(s)
- Charles H Adler
- From the Parkinson's Disease and Movement Disorders Center, Department of Neurology (C.H.A., J.N.C., E.D.-D.), and Department of Biostatistics (J.G.H.), Mayo Clinic, Scottsdale; Civin Laboratory for Neuropathology (T.G.B., L.I.S., B.N.D.) and Cleo Roberts Center (H.A.S., M.N.S., S.A.J., C.M.B.), Banner Sun Health Research Institute, Sun City, AZ; and University of Arizona College of Medicine (H.A.S., M.N.S., S.A.J.), Phoenix.
| | - Thomas G Beach
- From the Parkinson's Disease and Movement Disorders Center, Department of Neurology (C.H.A., J.N.C., E.D.-D.), and Department of Biostatistics (J.G.H.), Mayo Clinic, Scottsdale; Civin Laboratory for Neuropathology (T.G.B., L.I.S., B.N.D.) and Cleo Roberts Center (H.A.S., M.N.S., S.A.J., C.M.B.), Banner Sun Health Research Institute, Sun City, AZ; and University of Arizona College of Medicine (H.A.S., M.N.S., S.A.J.), Phoenix
| | - Joseph G Hentz
- From the Parkinson's Disease and Movement Disorders Center, Department of Neurology (C.H.A., J.N.C., E.D.-D.), and Department of Biostatistics (J.G.H.), Mayo Clinic, Scottsdale; Civin Laboratory for Neuropathology (T.G.B., L.I.S., B.N.D.) and Cleo Roberts Center (H.A.S., M.N.S., S.A.J., C.M.B.), Banner Sun Health Research Institute, Sun City, AZ; and University of Arizona College of Medicine (H.A.S., M.N.S., S.A.J.), Phoenix
| | - Holly A Shill
- From the Parkinson's Disease and Movement Disorders Center, Department of Neurology (C.H.A., J.N.C., E.D.-D.), and Department of Biostatistics (J.G.H.), Mayo Clinic, Scottsdale; Civin Laboratory for Neuropathology (T.G.B., L.I.S., B.N.D.) and Cleo Roberts Center (H.A.S., M.N.S., S.A.J., C.M.B.), Banner Sun Health Research Institute, Sun City, AZ; and University of Arizona College of Medicine (H.A.S., M.N.S., S.A.J.), Phoenix
| | - John N Caviness
- From the Parkinson's Disease and Movement Disorders Center, Department of Neurology (C.H.A., J.N.C., E.D.-D.), and Department of Biostatistics (J.G.H.), Mayo Clinic, Scottsdale; Civin Laboratory for Neuropathology (T.G.B., L.I.S., B.N.D.) and Cleo Roberts Center (H.A.S., M.N.S., S.A.J., C.M.B.), Banner Sun Health Research Institute, Sun City, AZ; and University of Arizona College of Medicine (H.A.S., M.N.S., S.A.J.), Phoenix
| | - Erika Driver-Dunckley
- From the Parkinson's Disease and Movement Disorders Center, Department of Neurology (C.H.A., J.N.C., E.D.-D.), and Department of Biostatistics (J.G.H.), Mayo Clinic, Scottsdale; Civin Laboratory for Neuropathology (T.G.B., L.I.S., B.N.D.) and Cleo Roberts Center (H.A.S., M.N.S., S.A.J., C.M.B.), Banner Sun Health Research Institute, Sun City, AZ; and University of Arizona College of Medicine (H.A.S., M.N.S., S.A.J.), Phoenix
| | - Marwan N Sabbagh
- From the Parkinson's Disease and Movement Disorders Center, Department of Neurology (C.H.A., J.N.C., E.D.-D.), and Department of Biostatistics (J.G.H.), Mayo Clinic, Scottsdale; Civin Laboratory for Neuropathology (T.G.B., L.I.S., B.N.D.) and Cleo Roberts Center (H.A.S., M.N.S., S.A.J., C.M.B.), Banner Sun Health Research Institute, Sun City, AZ; and University of Arizona College of Medicine (H.A.S., M.N.S., S.A.J.), Phoenix
| | - Lucia I Sue
- From the Parkinson's Disease and Movement Disorders Center, Department of Neurology (C.H.A., J.N.C., E.D.-D.), and Department of Biostatistics (J.G.H.), Mayo Clinic, Scottsdale; Civin Laboratory for Neuropathology (T.G.B., L.I.S., B.N.D.) and Cleo Roberts Center (H.A.S., M.N.S., S.A.J., C.M.B.), Banner Sun Health Research Institute, Sun City, AZ; and University of Arizona College of Medicine (H.A.S., M.N.S., S.A.J.), Phoenix
| | - Sandra A Jacobson
- From the Parkinson's Disease and Movement Disorders Center, Department of Neurology (C.H.A., J.N.C., E.D.-D.), and Department of Biostatistics (J.G.H.), Mayo Clinic, Scottsdale; Civin Laboratory for Neuropathology (T.G.B., L.I.S., B.N.D.) and Cleo Roberts Center (H.A.S., M.N.S., S.A.J., C.M.B.), Banner Sun Health Research Institute, Sun City, AZ; and University of Arizona College of Medicine (H.A.S., M.N.S., S.A.J.), Phoenix
| | - Christine M Belden
- From the Parkinson's Disease and Movement Disorders Center, Department of Neurology (C.H.A., J.N.C., E.D.-D.), and Department of Biostatistics (J.G.H.), Mayo Clinic, Scottsdale; Civin Laboratory for Neuropathology (T.G.B., L.I.S., B.N.D.) and Cleo Roberts Center (H.A.S., M.N.S., S.A.J., C.M.B.), Banner Sun Health Research Institute, Sun City, AZ; and University of Arizona College of Medicine (H.A.S., M.N.S., S.A.J.), Phoenix
| | - Brittany N Dugger
- From the Parkinson's Disease and Movement Disorders Center, Department of Neurology (C.H.A., J.N.C., E.D.-D.), and Department of Biostatistics (J.G.H.), Mayo Clinic, Scottsdale; Civin Laboratory for Neuropathology (T.G.B., L.I.S., B.N.D.) and Cleo Roberts Center (H.A.S., M.N.S., S.A.J., C.M.B.), Banner Sun Health Research Institute, Sun City, AZ; and University of Arizona College of Medicine (H.A.S., M.N.S., S.A.J.), Phoenix
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Zokaei N, McNeill A, Proukakis C, Beavan M, Jarman P, Korlipara P, Hughes D, Mehta A, Hu MTM, Schapira AHV, Husain M. Visual short-term memory deficits associated with GBA mutation and Parkinson's disease. ACTA ACUST UNITED AC 2014; 137:2303-11. [PMID: 24919969 PMCID: PMC4107740 DOI: 10.1093/brain/awu143] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Individuals with mutation in the lysosomal enzyme glucocerebrosidase (GBA) gene are at significantly high risk of developing Parkinson’s disease with cognitive deficit. We examined whether visual short-term memory impairments, long associated with patients with Parkinson’s disease, are also present in GBA-positive individuals—both with and without Parkinson’s disease. Precision of visual working memory was measured using a serial order task in which participants observed four bars, each of a different colour and orientation, presented sequentially at screen centre. Afterwards, they were asked to adjust a coloured probe bar’s orientation to match the orientation of the bar of the same colour in the sequence. An additional attentional ‘filtering’ condition tested patients’ ability to selectively encode one of the four bars while ignoring the others. A sensorimotor task using the same stimuli controlled for perceptual and motor factors. There was a significant deficit in memory precision in GBA-positive individuals—with or without Parkinson’s disease—as well as GBA-negative patients with Parkinson’s disease, compared to healthy controls. Worst recall was observed in GBA-positive cases with Parkinson’s disease. Although all groups were impaired in visual short-term memory, there was a double dissociation between sources of error associated with GBA mutation and Parkinson’s disease. The deficit observed in GBA-positive individuals, regardless of whether they had Parkinson’s disease, was explained by a systematic increase in interference from features of other items in memory: misbinding errors. In contrast, impairments in patients with Parkinson’s disease, regardless of GBA status, was explained by increased random responses. Individuals who were GBA-positive and also had Parkinson’s disease suffered from both types of error, demonstrating the worst performance. These findings provide evidence for dissociable signature deficits within the domain of visual short-term memory associated with GBA mutation and with Parkinson’s disease. Identification of the specific pattern of cognitive impairment in GBA mutation versus Parkinson’s disease is potentially important as it might help to identify individuals at risk of developing Parkinson’s disease.
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Affiliation(s)
- Nahid Zokaei
- 1 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK2 Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK
| | - Alisdair McNeill
- 3 Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Christos Proukakis
- 3 Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Michelle Beavan
- 3 Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Paul Jarman
- 3 Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Prasad Korlipara
- 3 Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Derralynn Hughes
- 4 Department of Haematology, University College London, Royal Free Hospital, London, UK
| | - Atul Mehta
- 3 Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Michele T M Hu
- 1 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | | | - Masud Husain
- 1 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK2 Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK
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Pfeiffer HCV, Løkkegaard A, Zoetmulder M, Friberg L, Werdelin L. Cognitive impairment in early-stage non-demented Parkinson's disease patients. Acta Neurol Scand 2014; 129:307-18. [PMID: 24117192 DOI: 10.1111/ane.12189] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In Parkinson's disease (PD), Parkinson's disease dementia (PDD) and Parkinson's disease-mild cognitive impairment (PD-MCI) are common. PD-MCI is a risk factor for developing PDD. Knowledge of cognition in early-stages PD is essential in understanding and predicting the dementia process. MATERIALS AND METHODS We describe the cognitive profile in early-stage PD patients with no prior clinical suspicion of cognitive impairment, depression or psychiatric disturbances, and investigate possible features distinguishing patients with cognitive deficits, defining a PD-MCI risk-profile. Single Photon Emission Computerized Tomography (SPECT) DaT-scan and neurological examination confirmed the diagnosis. Mini-mental state examination-, Addenbrooke's Cognitive Examination, Unified Parkinson's Disease Rating Scale scoring, Hoehn &Yahr/Activity of Daily Living staging and a neuropsychological test battery were applied. Mild cognitive impairment patients were identified according to modified criteria by Troster necessarily omitting subjective cognitive complaints. 80 patients, mean age 61.0 years (SD 6.6), mean duration of disease 3.4 years (SD 1.2) were included. 76 patients were neuropsychologically tested. RESULTS 26 (34%) patients fulfilled modified PD-MCI criteria, 18 (69%) of these showed episodic memory deficits, 14 (54%) executive dysfunction, 13 (50%) language/praxis deficits, 12 (46%) visuospatial/constructional deficits and 9 (35%) attention/working memory deficits. Cognitive impairment was associated with higher Unified Parkinson's Disease Rating scale (UPDRS)-, bradykinesia- and rigidity scores and more symmetric distribution of symptoms, but not tremor scores. Patients with cognitive impairment were less educated. Other demographic and clinical variables were comparable. CONCLUSIONS 34% of early-stage PD patients without prior clinical suspicion of cognitive impairment exhibit cognitive impairment, which is associated to disease severity, especially bradykinesia, rigidity, axial symptoms and less asymmetry of motor symptoms, even at early disease stages and when cognitive symptoms are mild.
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Affiliation(s)
- H. C. V. Pfeiffer
- Department of Neurology; Bispebjerg University Hospital; Copenhagen Denmark
- Department of Clinical Physiology and Nuclear Medicine; Bispebjerg University Hospital; Copenhagen Denmark
| | - A. Løkkegaard
- Department of Neurology; Bispebjerg University Hospital; Copenhagen Denmark
| | - M. Zoetmulder
- Department of Neurology; Bispebjerg University Hospital; Copenhagen Denmark
| | - L. Friberg
- Department of Clinical Physiology and Nuclear Medicine; Bispebjerg University Hospital; Copenhagen Denmark
| | - L. Werdelin
- Department of Neurology; Bispebjerg University Hospital; Copenhagen Denmark
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81
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Bradykinesia-akinesia incoordination test: validating an online keyboard test of upper limb function. PLoS One 2014; 9:e96260. [PMID: 24781810 PMCID: PMC4004565 DOI: 10.1371/journal.pone.0096260] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/04/2014] [Indexed: 11/19/2022] Open
Abstract
Background The Bradykinesia Akinesia Incoordination (BRAIN) test is a computer keyboard-tapping task that was developed for use in assessing the effect of symptomatic treatment on motor function in Parkinson's disease (PD). An online version has now been designed for use in a wider clinical context and the research setting. Methods Validation of the online BRAIN test was undertaken in 58 patients with Parkinson's disease (PD) and 93 age-matched, non-neurological controls. Kinesia scores (KS30, number of key taps in 30 seconds), akinesia times (AT30, mean dwell time on each key in milliseconds), incoordination scores (IS30, variance of travelling time between key presses) and dysmetria scores (DS30, accuracy of key presses) were compared between groups. These parameters were correlated against total motor scores and sub-scores from the Unified Parkinson's Disease Rating Scale (UPDRS). Results Mean KS30, AT30 and IS30 were significantly different between PD patients and controls (p≤0.0001). Sensitivity for 85% specificity was 50% for KS30, 40% for AT30 and 29% for IS30. KS30, AT30 and IS30 correlated significantly with UPDRS total motor scores (r = −0.53, r = 0.27 and r = 0.28 respectively) and motor UPDRS sub-scores. The reliability of KS30, AT30 and DS30 was good on repeated testing. Conclusions The BRAIN test is a reliable, convenient test of upper limb motor function that can be used routinely in the outpatient clinic, at home and in clinical trials. In addition, it can be used as an objective longitudinal measurement of emerging motor dysfunction for the prediction of PD in at-risk cohorts.
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Iranzo A. Parkinson disease and sleep: sleep-wake changes in the premotor stage of Parkinson disease; impaired olfaction and other prodromal features. Curr Neurol Neurosci Rep 2014; 13:373. [PMID: 23881622 DOI: 10.1007/s11910-013-0373-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Parkinson disease (PD) has a premotor stage where neurodegeneration occurs before parkinsonism becomes apparent. Identification of individuals at this stage provides an opportunity to study early disease progression and test disease-modifying interventions. Hyposmia, constipation, depression and hypersomnia are part of this premotor phase and predictive of future development of PD. However, these features are common in the general population, and they are most often the result of causes other than incipient PD. In contrast, most individuals with idiopathic REM sleep behavior disorder (IRBD) eventually develop PD and other synucleinopathies. IRBD individuals with hyposmia, substantia nigra hyperechogenicity, and abnormal striatal dopamine transporter imaging findings have increased short-term risk of developing a synucleinopathy. IRBD is an optimal target to test disease-modifying agents in the PD prodromal phase. Serial dopamine transporter imaging, but not olfactory tests, may serve to monitor the disease process in future disease-modifying trials in IRBD.
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Affiliation(s)
- Alex Iranzo
- Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED, C/Villarroel 170, 08036, Barcelona, Spain.
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83
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Xiao Q, Chen S, Le W. Hyposmia: a possible biomarker of Parkinson's disease. Neurosci Bull 2014; 30:134-40. [PMID: 24136244 PMCID: PMC5562575 DOI: 10.1007/s12264-013-1390-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/05/2013] [Indexed: 01/23/2023] Open
Abstract
Hyposmia, identified as reduced sensitivity to odor, is a common non-motor symptom of Parkinson's disease (PD) that antedates the typical motor symptoms by several years. It occurs in ∼90% of early-stage cases of PD. In addition to the high prevalence, the occurrence of hyposmia may also predict a higher risk of PD. Investigations into hyposmia and its relationship with PD may help elucidate the underlying pathogenic mechanisms. This review provides an update of olfactory dysfunction in PD and its potential as a biomarker for this devastating disease.
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Affiliation(s)
- Qian Xiao
- Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Sheng Chen
- Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Weidong Le
- Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
- Institutes of Translational Medicine, 1st Affiliated Hospital of Dalian Medical Universtiy, Dalian, 116011 China
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Noyce AJ, Bestwick JP, Silveira-Moriyama L, Hawkes CH, Knowles CH, Hardy J, Giovannoni G, Nageshwaran S, Osborne C, Lees AJ, Schrag A. PREDICT-PD: identifying risk of Parkinson's disease in the community: methods and baseline results. J Neurol Neurosurg Psychiatry 2014; 85:31-7. [PMID: 23828833 PMCID: PMC3888633 DOI: 10.1136/jnnp-2013-305420] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To present methods and baseline results for an online screening tool to identify increased risk for Parkinson's disease (PD) in the UK population. METHODS Risk estimates for future PD were derived from the results of a systematic review of risk factors and early features of PD. Participants aged 60-80 years without PD were recruited by self-referral. They completed an online survey (including family history, non-motor symptoms and lifestyle factors), a keyboard-tapping task and the University of Pennsylvania Smell Identification Test. Risk scores were calculated based on survey answers. Preliminary support for the validity of this algorithm was assessed by comparing those estimated to be higher risk for PD with those at lower risk using proxies, including smell loss, REM-sleep behaviour disorder and reduced tapping speed, and by assessing associations in the whole group. RESULTS 1324 eligible participants completed the survey and 1146 undertook the keyboard-tapping task. Smell tests were sent to 1065 participants. Comparing the 100 highest-risk participants and 100 lowest-risk participants, median University of Pennsylvania Smell Identification Test scores were 30/40 versus 33/40 (p<0.001), mean number of key taps in 30 s were 55 versus 58 (p=0.045), and 24% versus 10% scored above cut-off for REM-sleep behaviour disorder (p=0.008). Regression analyses showed increasing risk scores were associated with worse scores in the three proxies across the whole group (p≤0.001). CONCLUSIONS PREDICT-PD is the first study to systematically combine risk factors for PD in the general population. Validity to predict risk of PD will be tested through longitudinal follow-up of incident PD diagnosis.
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Affiliation(s)
- Alastair J Noyce
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, , London, UK
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85
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Risk factors and prodromal markers and the development of Parkinson’s disease. J Neurol 2013; 261:180-7. [DOI: 10.1007/s00415-013-7171-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/16/2013] [Accepted: 10/18/2013] [Indexed: 10/26/2022]
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Chen H, Burton EA, Ross GW, Huang X, Savica R, Abbott RD, Ascherio A, Caviness JN, Gao X, Gray KA, Hong JS, Kamel F, Jennings D, Kirshner A, Lawler C, Liu R, Miller GW, Nussbaum R, Peddada SD, Rick AC, Ritz B, Siderowf AD, Tanner CM, Tröster AI, Zhang J. Research on the premotor symptoms of Parkinson's disease: clinical and etiological implications. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:1245-52. [PMID: 23933572 PMCID: PMC3855519 DOI: 10.1289/ehp.1306967] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/07/2013] [Indexed: 05/20/2023]
Abstract
BACKGROUND The etiology and natural history of Parkinson's disease (PD) are not well understood. Some non-motor symptoms such as hyposmia, rapid eye movement sleep behavior disorder, and constipation may develop during the prodromal stage of PD and precede PD diagnosis by years. OBJECTIVES We examined the promise and pitfalls of research on premotor symptoms of PD and developed priorities and strategies to understand their clinical and etiological implications. METHODS This review was based on a workshop, Parkinson's Disease Premotor Symptom Symposium, held 7-8 June 2012 at the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina. DISCUSSION Research on premotor symptoms of PD may offer an excellent opportunity to characterize high-risk populations and to better understand PD etiology. Such research may lead to evaluation of novel etiological hypotheses such as the possibility that environmental toxicants or viruses may initiate PD pathogenesis in the gastrointestinal tract or olfactory bulb. At present, our understanding of premotor symptoms of PD is in its infancy and faces many obstacles. These symptoms are often not specific to PD and have low positive predictive value for early PD diagnosis. Further, the pathological bases and biological mechanisms of these premotor symptoms and their relevance to PD pathogenesis are poorly understood. CONCLUSION This is an emerging research area with important data gaps to be filled. Future research is needed to understand the prevalence of multiple premotor symptoms and their etiological relevance to PD. Animal experiments and mechanistic studies will further understanding of the biology of these premotor symptoms and test novel etiological hypothesis.
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Affiliation(s)
- Honglei Chen
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
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87
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Potential impact of self-perceived prodromal symptoms on the early diagnosis of Parkinson’s disease. J Neurol 2013; 260:3077-85. [DOI: 10.1007/s00415-013-7125-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
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88
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Amara AW, Standaert DG. Metabolomics and the search for biomarkers in Parkinson's disease. Mov Disord 2013; 28:1620-1. [PMID: 24105981 DOI: 10.1002/mds.25644] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 07/15/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Amy W Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Liepelt-Scarfone I, Gauss K, Maetzler W, Müller K, Bormann C, Fruhmann Berger M, Timmers M, Streffer J, Berg D. Evaluation of progression markers in the premotor phase of Parkinson's disease: the progression markers in the premotor phase study. Neuroepidemiology 2013; 41:174-82. [PMID: 24051361 DOI: 10.1159/000353560] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 06/06/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical diagnosis of Parkinson's disease (PD) is proposed to be too late for the application of beneficial neuroprotective treatment. Thus, it is important to identify and follow individuals at risk for PD in order to gain knowledge about the prodromal course of the disease. Substantia nigra hyperechogenicity (SN+) has been confirmed as a risk factor for PD and appears promising as a predictor of PD, particularly in combination with other putative PD markers. We present the design and initial data of a 2-year longitudinal investigation of subjects proposed to be at high risk of developing PD (HRPD), compared to early PD patients and control subjects. The aim of the presented study is to monitor progression of the neurodegenerative process to motor PD. METHODS In total, 40 HRPD, 16 PD and 41 control individuals were recruited. The HRPD subjects had SN+ and additionally either 1 cardinal PD motor sign or 2 further risk (e.g. positive family history) or prodromal markers (e.g. hyposmia). In this cohort, motor function, olfaction, mood and blood markers will be evaluated every 6 months, complemented by a comprehensive clinical, imaging and electrophysiological assessment. RESULTS PD, HRPD and control subjects did not differ significantly regarding age, but the HRPD group consisted mainly of males (72.5% of HRPD subjects vs. 43.9% of controls; p = 0.013). Mean disease duration in PD patients was 31 months (range 15-56). HRPD subjects were predominantly recruited according to the occurrence of slight motor signs (HRPD 77.5%, PD 100%, p = 0.05; controls 0%, HRPD vs. controls, p < 0.017). The Unified Parkinson's Disease Rating Scale motor score (mean, range) indicated that the HRPD group (4, 0-12) had values between those of controls (0, 0-2; p < 0.017) and PD subjects (26, 9-55; p < 0.017). Among nonmotor symptoms, hyposmia was more common in both HRPD (47.5%) and PD subjects (75%) than in controls (5.1%; p < 0.017 for both comparisons). CONCLUSIONS Here, we describe the recruitment of a highly enriched-risk cohort and a promising study design to assess progression to motor PD. Whether the HRPD group indeed suffers from early, PD-specific neurodegeneration remains to be verified in the ongoing follow-up examinations.
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Affiliation(s)
- Inga Liepelt-Scarfone
- Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany
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90
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Dexter DT, Jenner P. Parkinson disease: from pathology to molecular disease mechanisms. Free Radic Biol Med 2013; 62:132-144. [PMID: 23380027 DOI: 10.1016/j.freeradbiomed.2013.01.018] [Citation(s) in RCA: 442] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 01/17/2013] [Accepted: 01/18/2013] [Indexed: 12/21/2022]
Abstract
Parkinson disease (PD) is a complex neurodegenerative disorder with both motor and nonmotor symptoms owing to a spreading process of neuronal loss in the brain. At present, only symptomatic treatment exists and nothing can be done to halt the degenerative process, as its cause remains unclear. Risk factors such as aging, genetic susceptibility, and environmental factors all play a role in the onset of the pathogenic process but how these interlink to cause neuronal loss is not known. There have been major advances in the understanding of mechanisms that contribute to nigral dopaminergic cell death, including mitochondrial dysfunction, oxidative stress, altered protein handling, and inflammation. However, it is not known if the same processes are responsible for neuronal loss in nondopaminergic brain regions. Many of the known mechanisms of cell death are mirrored in toxin-based models of PD, but neuronal loss is rapid and not progressive and limited to dopaminergic cells, and drugs that protect against toxin-induced cell death have not translated into neuroprotective therapies in humans. Gene mutations identified in rare familial forms of PD encode proteins whose functions overlap widely with the known molecular pathways in sporadic disease and these have again expanded our knowledge of the neurodegenerative process but again have so far failed to yield effective models of sporadic disease when translated into animals. We seem to be missing some key parts of the jigsaw, the trigger event starting many years earlier in the disease process, and what we are looking at now is merely part of a downstream process that is the end stage of neuronal death.
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Affiliation(s)
- David T Dexter
- Parkinson's Disease Research Group, Centre for Neuroinflammation & Neurodegeneration, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Peter Jenner
- Neurodegenerative Diseases Research Group, Institute of Pharmaceutical Science, School of Biomedical Sciences, King's College London, London SE1 9NH, UK.
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91
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Clark AJ, Ritz B, Prescott E, Rod NH. Psychosocial risk factors, pre-motor symptoms and first-time hospitalization with Parkinson's disease: a prospective cohort study. Eur J Neurol 2013; 20:1113-20. [PMID: 23433314 PMCID: PMC3664243 DOI: 10.1111/ene.12117] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Experimental studies support a link between stress and development of parkinsonian symptoms, but prospective population studies are lacking. The aim of the current study is to determine the effects of several psychosocial factors on the risk of Parkinson's disease (PD), as well as to identify potential pre-motor symptoms for PD in a large prospective cohort study. METHODS In 1991-1993, a total of 9955 women and men free of PD from the Copenhagen City Heart Study were asked about major life events, economic hardship, social network, impaired sleep and vital exhaustion. The participants were followed for first-time hospitalization with PD in nationwide registers until 2011. RESULTS Vital exhaustion was associated with a higher risk of PD hospitalization in an exposure-dependent manner (P(trend) = 0.001), with high vs. low vital exhaustion being associated with a hazard ratio of 2.50 [95% confidence interval (CI): 1.28-4.89]. A slightly higher risk of PD hospitalization (hazard ratio = 1.49; 95% CI: 0.87-2.56) was suggested in participants with impaired sleep at baseline. No more than weak associations were observed for economic hardship, major life events or inadequate social network in the current study. CONCLUSIONS Overall, the hypothesis that psychosocial risk factors affect the risk of PD is not supported. The results, however, suggest that vital exhaustion may be a pre-motor marker of the neurodegenerative process eventually leading to motor symptoms and clinical PD. Vital exhaustion may be useful for screening aimed at early detection and when considering disease-modifying therapies in people at high risk of clinical PD.
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Affiliation(s)
- A J Clark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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92
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Mahlknecht P, Poewe W. Is there a need to redefine Parkinson’s disease? J Neural Transm (Vienna) 2013; 120 Suppl 1:S9-17. [DOI: 10.1007/s00702-013-1038-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/14/2013] [Indexed: 01/22/2023]
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93
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Mahlknecht P, Seppi K, Stockner H, Nocker M, Scherfler C, Kiechl S, Willeit J, Schmidauer C, Gasperi A, Rungger G, Poewe W. Substantia nigra hyperechogenicity as a marker for Parkinson's disease: a population-based study. NEURODEGENER DIS 2013; 12:212-8. [PMID: 23689066 DOI: 10.1159/000348595] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/31/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical diagnosis of Parkinson's disease (PD) is currently anchored in its cardinal motor symptoms. According to hospital-based studies, an enlarged echogenicity in the area of the substantia nigra (SN) assessed with transcranial sonography (TCS) may represent a useful biomarker in the diagnosis of PD. OBJECTIVE To evaluate SN hyperechogenicity as a marker for PD in the Bruneck Study cohort, which is representative of the general elderly community. METHODS The diagnostic accuracy of TCS in distinguishing clinically diagnosed PD from nonparkinsonian subjects was assessed in 574 subjects from this cohort. RESULTS There was a good diagnostic accuracy of TCS in distinguishing PD subjects from nonparkinsonian subjects with an area under the curve value of 0.82. At a receiver-operating characteristic curve analysis-based cutoff value for SN hyperechogenicity of 0.18 cm(2), TCS had a sensitivity of 88.2% (95% confidence interval, CI, 64.4-98.0), a specificity of 77.0% (95% CI 72.8-80.6), a positive predictive value of 12.7% (95% CI 7.8-20.0) and a negative predictive value of 99.4% (95% CI 97.8-100.0) for subjects with clinically definite PD at baseline. When analyzing the same population after 5 years with regard to the presence of known and newly diagnosed PD cases, baseline TCS yielded very similar diagnostic accuracy values. CONCLUSION SN hyperechogenicity may represent a useful biomarker for PD not only in a hospital-based setting but also in the general community.
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Iranzo A, Tolosa E, Gelpi E, Molinuevo JL, Valldeoriola F, Serradell M, Sanchez-Valle R, Vilaseca I, Lomeña F, Vilas D, Lladó A, Gaig C, Santamaria J. Neurodegenerative disease status and post-mortem pathology in idiopathic rapid-eye-movement sleep behaviour disorder: an observational cohort study. Lancet Neurol 2013; 12:443-53. [PMID: 23562390 DOI: 10.1016/s1474-4422(13)70056-5] [Citation(s) in RCA: 492] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND We postulated that idiopathic rapid-eye-movement (REM) sleep behaviour disorder (IRBD) represents the prodromal phase of a Lewy body disorder and that, with sufficient follow-up, most cases would eventually be diagnosed with a clinical defined Lewy body disorder, such as Parkinson's disease (PD) or dementia with Lewy bodies (DLB). METHODS Patients from an IRBD cohort recruited between 1991 and 2003, and previously assessed in 2005, were followed up during an additional period of 7 years. In this original cohort, we sought to identify the nature and frequency of emerging defined neurodegenerative syndromes diagnosed by standard clinical criteria. We estimated rates of survival free from defined neurodegenerative disease by means of the Kaplan-Meier method. We further characterised individuals who remained diagnosed as having only IRBD, through dopamine transporter (DAT) imaging, transcranial sonography (TCS), and olfactory testing. We did a neuropathological assessment in three patients who died during follow-up and who had the antemortem diagnosis of PD or DLB. FINDINGS Of the 44 participants from the original cohort, 36 (82%) had developed a defined neurodegenerative syndrome by the 2012 assessment (16 patients were diagnosed with PD, 14 with DLB, one with multiple system atrophy, and five with mild cognitive impairment). The rates of neurological-disease-free survival from time of IRBD diagnosis were 65·2% (95% CI 50·9 to 79·5) at 5 years, 26·6% (12·7 to 40·5) at 10 years, and 7·5% (-1·9 to 16·9) at 14 years. Of the four remaining neurological-disease-free individuals who underwent neuroimaging and olfactory tests, all four had decreased striatal DAT uptake, one had substantia nigra hyperechogenicity on TCS, and two had impaired olfaction. In three patients, the antemortem diagnoses of PD and DLB were confirmed by neuropathological examination showing widespread Lewy bodies in the brain, and α-synuclein aggregates in the peripheral autonomic nervous system in one case. In these three patients, neuronal loss and Lewy pathology (α-synuclein-containing Lewy bodies and Lewy neurites) were found in the brainstem nuclei that regulate REM sleep atonia. INTERPRETATION Most IRBD individuals from our cohort developed a Lewy body disorder with time. Patients who remained disease-free at follow-up showed markers of increased short-term risk for developing PD and DLB in IRBD, such as decreased striatal DAT binding. Our findings indicate that in most patients diagnosed with IRBD this parasomnia represents the prodromal phase of a Lewy body disorder. IRBD is a candidate for the study of early events and progression of this prodromal phase, and to test disease-modifying strategies to slow or stop the neurodegenerative process. FUNDING None.
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Affiliation(s)
- Alex Iranzo
- Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas CIBERNED, Barcelona 08036, Spain.
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Mahlknecht P, Poewe W. Defining premotor Parkinson’s disease: a window of opportunity for neuroprotection? Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.12.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY The diagnosis of Parkinson’s disease (PD) is based on clinical grounds alone and requires the presence of bradykinesia and at least one further motor symptom out of tremor, rigidity or postural instability. Nevertheless, a variety of non-motor symptoms are an integral part of the clinical spectrum of the disease and may even be present before the first appearance of classical motor signs. The ultimate goal of any neuroprotective therapy will be to delay or prevent the onset of clinical disease. The current challenge is, therefore, to identify markers that would allow earlier diagnosis during the premotor stages of PD. The present review discusses potential markers of premotor PD including non-motor symptoms, neuroimaging, genetic susceptibility factors and molecular biomarkers. With the aid of such biomarkers, PD risk cohorts may eventually become sufficiently well defined to allow for ‘neuroprevention’ trials using rates of conversion to motor PD as a primary end point.
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, University of Innsbruck, A-6020 Innsbruck, Anichstraße 35, Austria
| | - Werner Poewe
- Department of Neurology, University of Innsbruck, A-6020 Innsbruck, Anichstraße 35, Austria
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96
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The Completed Self: An Immunological View of the Human-Microbiome Superorganism and Risk of Chronic Diseases. ENTROPY 2012. [DOI: 10.3390/e14112036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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97
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Maetzler W, Hausdorff JM. Reply: Presyndromic phase: Proposal for a new term for an emerging concept. Mov Disord 2012. [DOI: 10.1002/mds.25212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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98
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Streffer JR, Grachev ID, Fitzer-Attas C, Gomez-Mancilla B, Boroojerdi B, Bronzova J, Ostrowitzki S, Victor SJ, Fontoura P, Alexander R. Prerequisites to launch neuroprotective trials in Parkinson's disease: an industry perspective. Mov Disord 2012; 27:651-5. [PMID: 22508283 DOI: 10.1002/mds.25017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Realizing that 60% to 80% of dopaminergic nigrostriatal neurons are nonfunctional at the time of clinical diagnosis, there is an emerging consensus that disease-modifying treatments should be initiated in the earliest stages of Parkinson's disease (PD). To date, clinical trial designs and metrics in PD have been focused on motor symptoms as the core feature of the clinical disease. To identify earlier or "pre-motor" populations in PD, new markers have been proposed. We address the prerequisites needed to use these pre-motor markers in clinical trials for the selection of subjects, definition of populations, and monitoring of disease progression. This may require the development of new diagnostic criteria potentially based on non-motor clinical signs, imaging techniques, or biological features, all requiring discussion in a regulatory framework. Questions addressed include: Which steps must be taken to gain a broad consensus in the field from academic opinion leaders, patient advocacy groups, regulatory bodies, and industry? How do we prevent the selection of subgroups, which may not be representative of the full disease spectrum? Is there a way forward in personalized medicine? How do we balance risk and benefit in an at-risk population? While many tools are available, a concerted effort is required to develop integrated data sets, as well as to achieve the necessary standardization for multicenter clinical trials. To this end, public-private consortia (including academic centers, patient advocacy groups, and industry) will be of crucial importance to prospectively investigate and define the best tools and treatment paradigms.
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Affiliation(s)
- Johannes R Streffer
- Janssen Research & Development, Janssen-Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium.
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