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Ballarini T, Albrecht F, Mueller K, Jech R, Diehl-Schmid J, Fliessbach K, Kassubek J, Lauer M, Fassbender K, Schneider A, Synofzik M, Wiltfang J, Otto M, Schroeter ML. Disentangling brain functional network remodeling in corticobasal syndrome - A multimodal MRI study. NEUROIMAGE-CLINICAL 2019; 25:102112. [PMID: 31821953 PMCID: PMC6906725 DOI: 10.1016/j.nicl.2019.102112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The clinical diagnosis of corticobasal syndrome (CBS) represents a challenge for physicians and reliable diagnostic imaging biomarkers would support the diagnostic work-up. We aimed to investigate the neural signatures of CBS using multimodal T1-weighted and resting-state functional magnetic resonance imaging (MRI). METHODS Nineteen patients with CBS (age 67.0 ± 6.0 years; mean±SD) and 19 matched controls (66.5 ± 6.0) were enrolled from the German Frontotemporal Lobar Degeneration Consortium. Changes in functional connectivity and structure were respectively assessed with eigenvector centrality mapping complemented by seed-based analysis and with voxel-based morphometry. In addition to mass-univariate statistics, multivariate support vector machine (SVM) classification tested the potential of multimodal MRI to differentiate patients and controls. External validity of SVM was assessed on independent CBS data from the 4RTNI database. RESULTS A decrease in brain interconnectedness was observed in the right central operculum, middle temporal gyrus and posterior insula, while widespread connectivity increases were found in the anterior cingulum, medial superior-frontal gyrus and in the bilateral caudate nuclei. Severe and diffuse gray matter volume reduction, especially in the bilateral insula, putamen and thalamus, characterized CBS. SVM classification revealed that both connectivity (area under the curve 0.81) and structural abnormalities (0.80) distinguished CBS from controls, while their combination led to statistically non-significant improvement in discrimination power, questioning the additional value of functional connectivity over atrophy. SVM analyses based on structural MRI generalized moderately well to new data, which was decisively improved when guided by meta-analytically derived disease-specific regions-of-interest. CONCLUSIONS Our data-driven results show impairment of functional connectivity and brain structure in CBS and explore their potential as imaging biomarkers.
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Affiliation(s)
- Tommaso Ballarini
- Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany.
| | - Franziska Albrecht
- Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Karsten Mueller
- Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Robert Jech
- Department of Neurology, Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Germany
| | - Klaus Fliessbach
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Bonn, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Germany
| | - Martin Lauer
- Clinic for Psychiatry, Psychosomatic medicine and Psychotherapy, University Würzburg, Germany
| | | | - Anja Schneider
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Bonn, Germany
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Centre for Neurology & Hertie-Institute for Clinical Brain Research, University of Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | | | | | | | - Markus Otto
- Department of Neurology, University of Ulm, Germany
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany; Clinic for Cognitive Neurology, University Clinic, Leipzig, Germany
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Tanaka KF, Hamaguchi T. Translational approach to apathy-like behavior in mice: From the practical point of view. Psychiatry Clin Neurosci 2019; 73:685-689. [PMID: 31304614 DOI: 10.1111/pcn.12915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 12/23/2022]
Abstract
Apathy is a pervasive clinical phenomenon that deserves more attention at the translational and pre-clinical levels. To study apathy-like behavior in mice, we relied on an operational definition of apathy: the quantitative reduction of voluntary, goal-directed behaviors. We recently found that the chronic loss of function of a specific cell type (striatal dopamine receptor type 2-expressing medium spiny neurons, D2-MSN) in a restricted region (the ventrolateral striatum, VLS) was sufficient to induce apathy-like behavior in a food-seeking operant task. We further showed that VLS D2-MSN are activated at the preparatory period, and that optogenetic inhibition of VLS D2-MSN during that period resulted in transient decreases in instrumental motivation, strengthening the hypothesis that VLS D2-MSN mediate apathy-like behavior in mice. Mice bearing VLS D2-MSN dysfunction can thus be regarded as an apathy model for future translational studies.
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Affiliation(s)
- Kenji F Tanaka
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takuya Hamaguchi
- Center for Kampo Medicine, Keio University School of Medicine, Tokyo, Japan
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Forrest SL, Kril JJ, Halliday GM. Cellular and regional vulnerability in frontotemporal tauopathies. Acta Neuropathol 2019; 138:705-727. [PMID: 31203391 DOI: 10.1007/s00401-019-02035-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022]
Abstract
The frontotemporal tauopathies all deposit abnormal tau protein aggregates, but often of only certain isoforms and in distinguishing pathologies of five main types (neuronal Pick bodies, neurofibrillary tangles, astrocytic plaques, tufted astrocytes, globular glial inclusions and argyrophilic grains). In those with isoform specific tau aggregates glial pathologies are substantial, even though there is limited evidence that these cells normally produce tau protein. This review will assess the differentiating features and clinicopathological correlations of the frontotemporal tauopathies, the genetic predisposition for these different pathologies, their neuroanatomical selectivity, current observations on how they spread through the brain, and any potential contributing cellular and molecular changes. The findings show that diverse clinical phenotypes relate most to the brain region degenerating rather than the type of pathology involved, that different regions on the MAPT gene and novel risk genes are associated with specific tau pathologies, that the 4-repeat glial tauopathies do not follow individual patterns of spreading as identified for neuronal pathologies, and that genetic and pathological data indicate that neuroinflammatory mechanisms are involved. Each pathological frontotemporal tauopathy subtype with their distinct pathological features differ substantially in the cell type affected, morphology, biochemical and anatomical distribution of inclusions, a fundamental concept central to future success in understanding the disease mechanisms required for developing therapeutic interventions. Tau directed therapies targeting genetic mechanisms, tau aggregation and pathological spread are being trialled, although biomarkers that differentiate these diseases are required. Suggested areas of future research to address the regional and cellular vulnerabilities in frontotemporal tauopathies are discussed.
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54
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Dodich A, Cerami C, Inguscio E, Iannaccone S, Magnani G, Marcone A, Guglielmo P, Vanoli G, Cappa SF, Perani D. The clinico-metabolic correlates of language impairment in corticobasal syndrome and progressive supranuclear palsy. NEUROIMAGE-CLINICAL 2019; 24:102009. [PMID: 31795064 PMCID: PMC6978212 DOI: 10.1016/j.nicl.2019.102009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/06/2019] [Accepted: 09/17/2019] [Indexed: 01/14/2023]
Abstract
CBS and PSP patients show heterogeneous language profiles. Patients with nfvPPA profile show the typical nfvPPA hypometabolic pattern. Parietal hypometabolism characterizes CBS cases with undefined language deficits. Frontal hypometabolism characterizes PSP cases with undefined language deficits. Patients without language deficit show a predominant right hemisphere involvement.
Purpose To assess the clinical-metabolic correlates of language impairment in a large sample of patients clinically diagnosed as corticobasal syndrome (CBS) and progressive supranuclear palsy syndrome (PSPs). Methods We included 70 patients fulfilling current criteria for CBS (n = 33) or PSPs (n = 37). All subjects underwent clinical-neuropsychological and FDG-PET assessments at the time of diagnosis. The whole patient's cohort was grouped into three subgroups according to the language characteristics, i.e., (a) nfv-PPA; (b) subtle language impairments, LANG-; (c) no language deficits, NOL-. FDG-PET data were analysed using an optimized voxel-based SPM method at the single-subject and group levels in order to evaluate specific hypometabolic patterns and regional dysfunctional FDG-PET commonalities in subgroups. Results 21 patients had a nfvPPA diagnosis (i.e., nfv-PPA/CBS = 12 and nfv-PPA/PSPs = 9), while 20 patients had a subtle language impairment LANG- (i.e., CBS = 12 and PSPs = 8), not fulfilling the criteria for a nfv-PPA diagnosis. The remaining sample (i.e., 9/33 CBS and 20/37 PSPs patients) did not show any language deficit. FDG-PET results in individuals with a nfv-PPA diagnosis were consistent with the typical nfv-PPA pattern of hypometabolism (i.e., left fronto-insular and superior medial frontal cortex involvement), both in CBS and PSPs. The LANG-CBS and LANG-PSPs subjects had different FDG-PET hypometabolic patterns involving, respectively, parietal and frontal regions. As expected, NOL-CBS and NOL-PSPs showed a predominant right hemisphere involvement, with selective functional metabolic signatures typical of the two syndromes. Conclusions Language impairments, fulfilling the nfv-PPA criteria, are associated with both CBS and PSPs clinical presentations early in the disease course. Subtle language deficits may be present in an additional proportion of patients not fulfilling the nfv-PPA criteria. The topography of brain hypometabolism is a major dysfunctional signature of language deficits in CBS and PSPs clinical phenotypes.
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Affiliation(s)
- Alessandra Dodich
- NIMTlab, Neuroimaging and Innovative Molecular Tracers Laboratory, University of Geneva, Geneva, Switzerland
| | - Chiara Cerami
- Neurorehabilitation Unit and Cognitive Neuroscience Laboratory, Istituti Clinici Scientifici Maugeri IRCCS di Pavia, Pavia, Italy
| | | | - Sandro Iannaccone
- Clinical Neuroscience Department, San Raffaele Hospital, Milan, Italy
| | | | | | | | | | - Stefano F Cappa
- Istituto Universitario di Studi Superiori, Pavia, Italy; IRCCS Ospedale Mondino, Pavia, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy; Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy; Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy.
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55
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Fiorenzato E, Antonini A, Camparini V, Weis L, Semenza C, Biundo R. Characteristics and progression of cognitive deficits in progressive supranuclear palsy vs. multiple system atrophy and Parkinson's disease. J Neural Transm (Vienna) 2019; 126:1437-1445. [PMID: 31432258 DOI: 10.1007/s00702-019-02065-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/13/2019] [Indexed: 01/03/2023]
Abstract
Cognitive impairment is frequent in progressive supranuclear palsy (PSP) and less common in multiple system atrophy (MSA), but characteristics and progression compared with Parkinson's disease (PD) need to be properly defined. We evaluated 35 PSP with Richardson's syndrome (PSP-RS), 30 MSA as well as 65 age-, sex-, and education-matched PD with an extensive clinical and neuropsychological assessment, allowing Level II cognitive diagnosis. Eighteen PSP, 12 MSA and 30 PD had a second evaluation between 12 and 18 months (mean 15 months) after the first assessment. PSP performance at Montreal Cognitive Assessment (MoCA), verbal fluencies (phonemic and semantic tasks), Stroop test (Error and Time), Digit Span Sequencing (DSS), incomplete letters of Visual Object and Space Perception (VOSP) and Benton's Judgment of Line Orientation (JLO) performance were significantly poorer at baseline compared to PD and MSA. Executive, language and visuospatial abilities declined longitudinally in PSP, but not in PD and MSA. After 1.5 year, 16% of PSP converted to dementia. Our study provides evidence that cognitive progression is more severe and rapid in PSP-RS than PD and MSA. Further, we observed that MoCA, verbal fluency (particularly semantic), DSS and Benton's JLO are valuable tests to detect cognitive progression in PSP-RS and may be proposed as possible biomarker to assess efficacy of disease modification strategies.
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Affiliation(s)
| | - Angelo Antonini
- Department of Neurosciences, Padova Neuroscience Center, University of Padua, Via Giustiniani, 5, 35128, Padua, Italy
| | | | - Luca Weis
- IRCCS San Camillo Hospital, Via Alberoni, 70, 30126, Venice, Italy
| | - Carlo Semenza
- IRCCS San Camillo Hospital, Via Alberoni, 70, 30126, Venice, Italy.,Department of Neurosciences, Padova Neuroscience Center, University of Padua, Via Giustiniani, 5, 35128, Padua, Italy
| | - Roberta Biundo
- IRCCS San Camillo Hospital, Via Alberoni, 70, 30126, Venice, Italy
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Gut NK, Mena-Segovia J. Dichotomy between motor and cognitive functions of midbrain cholinergic neurons. Neurobiol Dis 2019; 128:59-66. [PMID: 30213733 PMCID: PMC7176324 DOI: 10.1016/j.nbd.2018.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/18/2018] [Accepted: 09/09/2018] [Indexed: 12/15/2022] Open
Abstract
Cholinergic neurons of the pedunculopontine nucleus (PPN) are interconnected with all the basal ganglia structures, as well as with motor centers in the brainstem and medulla. Recent theories put into question whether PPN cholinergic neurons form part of a locomotor region that directly regulates the motor output, and rather suggest a modulatory role in adaptive behavior involving both motor and cognitive functions. In support of this, experimental studies in animals suggest that cholinergic neurons reinforce actions by signaling reward prediction and shape adaptations in behavior during changes of environmental contingencies. This is further supported by clinical studies proposing that decreased cholinergic transmission originated in the PPN is associated with impaired sensorimotor integration and perseverant behavior, giving rise to some of the symptoms observed in Parkinson's disease and progressive supranuclear palsy. Altogether, the evidence suggests that cholinergic neurons of the PPN, mainly through their interactions with the basal ganglia, have a leading role in action control.
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Affiliation(s)
- Nadine K Gut
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, USA
| | - Juan Mena-Segovia
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, USA.
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57
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Coundouris SP, Adams AG, Grainger SA, Henry JD. Social perceptual function in parkinson's disease: A meta-analysis. Neurosci Biobehav Rev 2019; 104:255-267. [PMID: 31336113 DOI: 10.1016/j.neubiorev.2019.07.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/20/2022]
Abstract
Social perceptual impairment is a common presenting feature of Parkinson's disease (PD) that has the potential to contribute considerably to disease burden. The current study reports a meta-analytic integration of 79 studies which shows that, relative to controls, PD is associated with a moderate emotion recognition deficit (g = -0.57, K = 73), and that this deficit is robust and almost identical across facial and prosodic modalities. However, the magnitude of this impairment does appear to vary as a function of task and emotion type, with deficits generally greatest for identification tasks (g = -0.65, K = 54), and for negative relative to other basic emotions. With respect to clinical variables, dopaminergic medication, deep brain stimulation, and a predominant left side onset of motor symptoms are each associated with greater social perceptual difficulties. However, the magnitude of social perceptual impairment seen for the four atypical parkinsonian conditions is broadly comparable to that associated with PD. The theoretical and practical implications of these findings are discussed.
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Affiliation(s)
| | | | - Sarah A Grainger
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Julie D Henry
- School of Psychology, University of Queensland, Brisbane, Australia
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58
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Test Your Memory (TYM test): diagnostic evaluation of patients with non-Alzheimer dementias. J Neurol 2019; 266:2546-2553. [PMID: 31267204 PMCID: PMC6765477 DOI: 10.1007/s00415-019-09447-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 01/15/2023]
Abstract
Background/aims To validate the use of the Test Your Memory (TYM) test in dementias other than Alzheimer’s disease, and to compare the TYM test to two other short cognitive tests. Methods One hundred and fifty-seven patients with dementia other than typical Alzheimer’s disease were recruited from a specialist memory clinic. Patients completed the TYM test, the revised Addenbrooke’s Cognitive Examination (ACE-R) and Mini-Mental State Examination (MMSE), plus neurological examination, clinical diagnostics and multi-disciplinary team review. Their TYM scores were compared to age-matched controls and an Alzheimer’s disease cohort. Results Patients scored an average of 34.4/50 on the TYM test compared to 46.0/50 in age-matched controls. Using the threshold of 42/50, the TYM test detected 80% of non-Alzheimer dementias. The area under the ROC curve was 0.89 with a PPV of 0.80 and a NPV of 0.84. The TYM test performed better than the ACE-R (using the threshold of 83) which detected 69% of cases and the MMSE (using a threshold of 24) which detected only 27%. Conclusions The TYM test is a useful test in the detection of non-Alzheimer dementia. The TYM test performs much better than the MMSE at detecting non-Alzheimer dementias.
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59
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Ramanan S, Strikwerda-Brown C, Mothakunnel A, Hodges JR, Piguet O, Irish M. Fronto-parietal contributions to episodic retrieval-evidence from neurodegenerative disorders. Learn Mem 2019; 26:262-271. [PMID: 31209121 PMCID: PMC6581008 DOI: 10.1101/lm.048454.118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/10/2019] [Indexed: 02/04/2023]
Abstract
Converging evidence suggests a critical role for the parietal cortices in episodic memory retrieval. Here, we examined episodic memory performance in Corticobasal Syndrome (CBS), a rare neurodegenerative disorder presenting with early parietal atrophy in the context of variable medial temporal lobe damage. Forty-four CBS patients were contrasted with 29 typical Alzheimer's disease (AD), 29 healthy Controls, and 20 progressive supranuclear palsy patients presenting with brainstem atrophy as a disease control group. Participants completed standardized assessments of verbal episodic memory (learning, delayed recall, and recognition), and underwent structural and diffusion-weighted MRI. Selective delayed recall deficits were evident in the CBS group relative to Controls, at an intermediate level to the stark amnesia displayed by AD, and Control-level performance noted in progressive supranuclear palsy. Considerable variability within the CBS group on delayed recall performance led to the identification of memory-spared (N = 19) and memory-impaired (N = 25) subgroups. Whereas CBS-Spared showed no significant memory deficits, the CBS-Impaired subgroup were indistinguishable from typical AD across all episodic memory measures. Whole-brain voxel-based morphometry analyses implicated fronto-parietal and medial temporal regions in delayed recall performance in both the CBS-Impaired and AD groups. Furthermore, diffusion tensor imaging analyses revealed correlations between delayed recall performance and altered structural connectivity between fronto-parietal and frontotemporal regions in the CBS-Impaired group. Our findings underscore the importance of a distributed brain network including frontal, medial temporal, and parietal brain regions in supporting the capacity for successful episodic memory retrieval.
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Affiliation(s)
- Siddharth Ramanan
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales 2050, Australia
- The University of Sydney, School of Psychology, Sydney, New South Wales 2006, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales 2109, Australia
| | - Cherie Strikwerda-Brown
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales 2050, Australia
- The University of Sydney, School of Psychology, Sydney, New South Wales 2006, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales 2109, Australia
| | - Annu Mothakunnel
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales 2050, Australia
| | - John R Hodges
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales 2050, Australia
- The University of Sydney, School of Psychology, Sydney, New South Wales 2006, Australia
- The University of Sydney, School of Medical Sciences, Sydney, New South Wales 2006, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales 2050, Australia
- The University of Sydney, School of Psychology, Sydney, New South Wales 2006, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales 2109, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales 2050, Australia
- The University of Sydney, School of Psychology, Sydney, New South Wales 2006, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales 2109, Australia
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60
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Dai XJ, Liu BX, Ai S, Nie X, Xu Q, Hu J, Zhang Q, Xu Y, Zhang Z, Lu G. Altered inter-hemispheric communication of default-mode and visual networks underlie etiology of primary insomnia. Brain Imaging Behav 2019; 14:1430-1444. [DOI: 10.1007/s11682-019-00064-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Di Stasio F, Suppa A, Marsili L, Upadhyay N, Asci F, Bologna M, Colosimo C, Fabbrini G, Pantano P, Berardelli A. Corticobasal syndrome: neuroimaging and neurophysiological advances. Eur J Neurol 2019; 26:701-e52. [PMID: 30720235 DOI: 10.1111/ene.13928] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/30/2019] [Indexed: 01/14/2023]
Abstract
Corticobasal degeneration (CBD) is a neurodegenerative condition characterized by 4R tau protein deposition in several brain regions that clinically manifests itself as a heterogeneous atypical parkinsonism typically expressed in adulthood. The prototypical clinical phenotype of CBD is corticobasal syndrome (CBS). Important insights into the pathophysiological mechanisms underlying motor and higher cortical symptoms in CBS have been gained by using advanced neuroimaging and neurophysiological techniques. Structural and functional neuroimaging studies often show asymmetric cortical and subcortical abnormalities, mainly involving perirolandic and parietal regions and basal ganglia structures. Neurophysiological investigations including electroencephalography and somatosensory evoked potentials provide useful information on the origin of myoclonus and on cortical sensory loss. Transcranial magnetic stimulation demonstrates heterogeneous and asymmetric changes in the excitability and plasticity of primary motor cortex and abnormal hemispheric connectivity. Neuroimaging and neurophysiological abnormalities in multiple brain areas reflect asymmetric neurodegeneration, leading to asymmetric motor and higher cortical symptoms in CBS.
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Affiliation(s)
- F Di Stasio
- IRCCS Neuromed Institute, 'Sapienza' University of Rome, Pozzilli (Isernia), Italy
| | - A Suppa
- IRCCS Neuromed Institute, 'Sapienza' University of Rome, Pozzilli (Isernia), Italy.,Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - L Marsili
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - N Upadhyay
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - F Asci
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - M Bologna
- IRCCS Neuromed Institute, 'Sapienza' University of Rome, Pozzilli (Isernia), Italy.,Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - C Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
| | - G Fabbrini
- IRCCS Neuromed Institute, 'Sapienza' University of Rome, Pozzilli (Isernia), Italy.,Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - P Pantano
- IRCCS Neuromed Institute, 'Sapienza' University of Rome, Pozzilli (Isernia), Italy.,Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - A Berardelli
- IRCCS Neuromed Institute, 'Sapienza' University of Rome, Pozzilli (Isernia), Italy.,Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
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Madden DL, Sale MV, O'Sullivan J, Robinson GA. Improved language production with transcranial direct current stimulation in progressive supranuclear palsy. Neuropsychologia 2019; 127:148-157. [PMID: 30836131 DOI: 10.1016/j.neuropsychologia.2019.02.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 12/19/2018] [Accepted: 02/28/2019] [Indexed: 01/05/2023]
Abstract
Progressive supranuclear palsy (PSP) is an atypical parkinsonian disorder that can present with language production deficits in addition to the characteristic progressive parkinsonian motor symptoms. Although typical parkinsonism treatments such as pharmacotherapy are not effective in PSP, non-invasive brain stimulation techniques such as transcranial direct current stimulation (tDCS) have shown promise for treating cognitive deficits relating to this disorder. We report the case of KN, who presented with reduced verbal fluency and connected speech production in the context of PSP. KN completed a set of language tasks, followed by an alternate version of the tasks in conjunction with either sham or active tDCS over the left dorsolateral prefrontal cortex (DLPFC) across four sessions. Results showed improved performance with active stimulation compared to sham stimulation for phonemic fluency and action naming, as well as mixed results suggesting possible benefits for connected speech production. There were no benefits of active stimulation for control tasks, indicating that tDCS can produce specific benefits for phonemic fluency, action naming, and connected speech production in PSP. These promising, preliminary findings warrant further investigation into whether these benefits of tDCS can be a useful therapeutic tool for PSP patients to maintain language.
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Affiliation(s)
- Daniel L Madden
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia
| | - Martin V Sale
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia; Queensland Brain Institute, The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia
| | - John O'Sullivan
- Neurology Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia; Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane, Australia
| | - Gail A Robinson
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia; Queensland Brain Institute, The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia; Neurology Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia.
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63
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Southi N, Honan CA, Hodges JR, Piguet O, Kumfor F. Reduced capacity for empathy in corticobasal syndrome and its impact on carer burden. Int J Geriatr Psychiatry 2019; 34:497-503. [PMID: 30520157 DOI: 10.1002/gps.5045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 11/14/2018] [Indexed: 01/10/2023]
Abstract
Corticobasal syndrome (CBS) is clinically characterised by a wide range of motor, cognitive, and behavioural features but remains challenging to diagnose accurately. Despite recent evidence supporting the presence of social cognition and emotion processing disturbances, few studies have explored the nature of empathic ability in CBS. This study aimed to (a) investigate the extent to which cognitive and affective dimensions of empathy are affected in CBS and (b) to determine the impact of such changes on carer burden. Empathic capacity was assessed in 29 CBS patients and 28 matched healthy controls. We employed the Interpersonal Reactivity Index (IRI), an instrument measuring: (a) perspective taking, (b) fantasy, (c) empathic concern, and (d) personal distress. A significant change in both perspective taking and empathic concern was observed in CBS following disease onset. Furthermore, affective empathy deficits in CBS patients predicted higher levels of carer burden. Disturbances in both cognitive and affective empathy are present in CBS and lead to increased levels of carer burden.
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Affiliation(s)
- Natalie Southi
- School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - Cynthia A Honan
- School of Psychology, The University of Tasmania, Hobart, Australia
| | - John R Hodges
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Australia.,Clinical Medical School, The University of Sydney, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia
| | - Olivier Piguet
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Australia.,School of Psychology, The University of Sydney, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia
| | - Fiona Kumfor
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Australia.,School of Psychology, The University of Sydney, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia
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64
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Catricalà E, Boschi V, Cuoco S, Galiano F, Picillo M, Gobbi E, Miozzo A, Chesi C, Esposito V, Santangelo G, Pellecchia MT, Borsa VM, Barone P, Garrard P, Iannaccone S, Cappa SF. The language profile of progressive supranuclear palsy. Cortex 2019; 115:294-308. [PMID: 30884283 DOI: 10.1016/j.cortex.2019.02.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 12/12/2018] [Accepted: 02/14/2019] [Indexed: 11/17/2022]
Abstract
A progressive speech/language disorder, such as the non fluent/agrammatic variant of primary progressive aphasia and progressive apraxia of speech, can be due to neuropathologically verified Progressive Supranuclear Palsy (PSP). The prevalence of linguistic deficits and the linguistic profile in PSP patients who present primarily with a movement disorder is unknown. In the present study, we investigated speech and language performance in a sample of clinically diagnosed PSP patients using a comprehensive language battery, including, besides traditional language tests, a detailed analysis of connected speech (picture description task assessing 26 linguistic features). The aim was to identify the most affected linguistic levels in seventeen PSP with a movement disorder presentation, compared to 21 patients with Parkinson's disease and 27 healthy controls. Machine learning methods were used to detect the most relevant language tests and linguistic features characterizing the language profile of PSP patients. Our results indicate that even non-clinically aphasic PSP patients have subtle language deficits, in particular involving the lexical-semantic and discourse levels. Patients with the Richardson's syndrome showed a lower performance in the word comprehension task with respect to the other PSP phenotypes with predominant frontal presentation, parkinsonism and progressive gait freezing. The present findings support the usefulness of a detailed language assessment in all patients in the PSP spectrum.
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Affiliation(s)
| | | | - Sofia Cuoco
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Italy
| | | | - Marina Picillo
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Italy
| | - Elena Gobbi
- IRCCS San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonio Miozzo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cristiano Chesi
- NEtS Center, School of Advanced Studies IUSS Pavia, Pavia, Italy
| | - Valentina Esposito
- Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriella Santangelo
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Italy; Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Italy
| | - Virginia M Borsa
- NEtS Center, School of Advanced Studies IUSS Pavia, Pavia, Italy; NEUROFARBA - Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Florence, Italy
| | - Paolo Barone
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Italy
| | - Peter Garrard
- Neuroscience Research Centre, St George's-University of London, London, UK
| | - Sandro Iannaccone
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano F Cappa
- NEtS Center, School of Advanced Studies IUSS Pavia, Pavia, Italy; IRCCS San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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65
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18F-THK5351 PET Imaging in the Behavioral Variant of Frontotemporal Dementia. Dement Neurocogn Disord 2019; 17:163-173. [PMID: 30906406 PMCID: PMC6425882 DOI: 10.12779/dnd.2018.17.4.163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 12/25/2018] [Accepted: 12/31/2018] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose Behavioral variant frontotemporal dementia (bvFTD) is a subtype of frontotemporal dementia, which has clinical symptoms of progressive personality and behavioral changes with deterioration of social cognition and executive functions. The pathology of bvFTD is known to be tauopathy or TDP-43 equally. We analyzed the 18F-THK5351 positron emission tomography (PET) scans, which were recently developed tau PET, in patients with clinically-diagnosed bvFTD. Methods Forty-eight participants, including participants with behavioral variant frontotemporal dementia (bvFTD, n=3), Alzheimer's disease (AD, n=21) and normal cognition (NC, n=24) who completed 3T magnetic resonance images, 18F-THK5351 PET scans, and detailed neuropsychological tests were included in the study. Voxel-wise statistical analysis and region of interest (ROI)-based analyses were performed to evaluate the retention of THK in bvFTD patients. Results In the voxel-based and ROI-based analyses, patients with bvFTD showed greater THK retention in the prefrontal, medial frontal, orbitofrontal, anterior cingulate, insula, anterior inferior temporal and striatum regions compared to NC participants. Left-right asymmetry was noted in the bvFTD patients. A patient with extrapyramidal symptoms showed much greater THK retention in the brainstem. Conclusions The distribution of THK retention in the bvFTD patients was mainly in the frontal, insula, anterior temporal, and striatum regions which are known to be the brain regions corresponding to the clinical symptoms of bvFTD. Our study suggests that 18F-THK5351 PET imaging could be a supportive tool for diagnosis of bvFTD.
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66
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Burrell JR, Ballard KJ, Halliday GM, Hodges JR. Aphasia in Progressive Supranuclear Palsy: As Severe as Progressive Non-Fluent Aphasia. J Alzheimers Dis 2019; 61:705-715. [PMID: 29254097 DOI: 10.3233/jad-170743] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adynamic speech is characteristic of progressive supranuclear palsy (PSP), but higher language deficits have been reported inconsistently, in the context of clinical and pathological overlaps with progressive non-fluent aphasia (PNFA). OBJECTIVE The present study tested two hypotheses: 1) PSP and PNFA display impaired single word repetition, object naming, semantic knowledge, and syntactic comprehension; and 2) PSP have reduced speed on timed cognitive tasks. METHODS Structured clinical and neuropsychological assessments of language were performed on patients with clinically defined PSP and PNFA. Language was tested using the Sydney Language Battery (SYDBAT) and the Test of Reception of Grammar (TROG). RESULTS In total, 144 participants were studied (PSP 22, PNFA 29, and Control 93). PSP patients had prominent eye movement abnormalities, parkinsonism, and falls. All 4 PSP patients who underwent postmortem examination had 4-Repeat tauopathy, with PSP pathology in 3. The frequency and severity of impairment on the SYDBAT (naming, word comprehension, semantic association), and TROG (syntactic comprehension) did not differ between PSP and PNFA, but PSP were significantly slower on timed non-language cognitive tests. CONCLUSION Tested formally, aphasia may be seen in PSP, with a severity similar to that seen in PNFA.
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Affiliation(s)
- James R Burrell
- Concord General Hospital, Sydney, Australia.,Brain and Mind Centre, University of Sydney Medical School, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Kirrie J Ballard
- Neuroscience Research Australia, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Glenda M Halliday
- Brain and Mind Centre, University of Sydney Medical School, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - John R Hodges
- Brain and Mind Centre, University of Sydney Medical School, Sydney, Australia.,The University of Sydney, Sydney, Australia
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67
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Fabbrini G, Fabbrini A, Suppa A. Progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration. ACTA ACUST UNITED AC 2019; 165:155-177. [DOI: 10.1016/b978-0-444-64012-3.00009-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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68
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Abbate C, Trimarchi PD, Manzoni L, Quarenghi AM, Salvi GP, Inglese S, Giunco F, Bagarolo R, Mari D, Arosio B. A posterior variant of corticobasal syndrome: Evidence from a longitudinal study of cognitive and functional status in a single case. COGENT PSYCHOLOGY 2018. [DOI: 10.1080/23311908.2018.1452868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Carlo Abbate
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122 Milan, Italy
| | - Pietro Davide Trimarchi
- Alzheimer’s Assessment Unit, S. Maria Nascente, Fondazione IRCCS Don Carlo Gnocchi, via Alfonso Capecelatro 66, 20148 Milan, Italy
| | - Laura Manzoni
- Istituto Clinico Quarenghi, via San Carlo 70, 24016 San Pellegrino Terme, Italy
| | | | - Gian Pietro Salvi
- Istituto Clinico Quarenghi, via San Carlo 70, 24016 San Pellegrino Terme, Italy
| | - Silvia Inglese
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122 Milan, Italy
| | - Fabrizio Giunco
- Alzheimer’s Assessment Unit, S. Maria Nascente, Fondazione IRCCS Don Carlo Gnocchi, via Alfonso Capecelatro 66, 20148 Milan, Italy
| | - Renzo Bagarolo
- Alzheimer’s Assessment Unit, S. Maria Nascente, Fondazione IRCCS Don Carlo Gnocchi, via Alfonso Capecelatro 66, 20148 Milan, Italy
| | - Daniela Mari
- Department of Medical Sciences and Community Health, University of Milan, via Francesco Sforza 35, 20122 Milan, Italy
| | - Beatrice Arosio
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122 Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, via Francesco Sforza 35, 20122 Milan, Italy
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69
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Bhidayasiri R, Sringean J, Reich SG, Colosimo C. Red flags phenotyping: A systematic review on clinical features in atypical parkinsonian disorders. Parkinsonism Relat Disord 2018; 59:82-92. [PMID: 30409560 DOI: 10.1016/j.parkreldis.2018.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/28/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022]
Abstract
To establish a clinical diagnosis of a parkinsonian disorder, physicians rely on their ability to identify relevant red flags, in addition to cardinal features, to support or refute their working diagnosis in an individual patient. The term 'red flag', was originally coined in 1989 to define the presence of non-cardinal features that may raise a suspicion of multiple system atrophy (MSA), or at least suggest alternative diagnosis to Parkinson's disease (PD). Since then, the term 'red flag', has been consistently used in the literature to denote the clinical history or signs that may signal to physicians the possibility of an atypical parkinsonian disorder (APD). While most red flags were originally based on expert opinion, many have gained acceptance and are now included in validated clinical diagnostic criteria of PD and APDs. The clinical appreciation of red flags, in conjunction with standard criteria, may result in a more accurate and earlier diagnosis compared to standard criteria alone. However, red flags can be clinical signs that are non-neurological, making the systematic assessment for them a real challenge in clinical practice. Here, we have conducted a systematic review to identify red flags and their clinical evidence in the differential diagnosis of common degenerative parkinsonism, including PD, MSA, progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and dementia with Lewy body (DLB). Increasing awareness and appropriate use of red flags in clinical practice may benefit physicians in the diagnosis and management of their patients with parkinsonism.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand; Department of Neurology, Juntendo University, Tokyo, Japan.
| | - Jirada Sringean
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Stephen G Reich
- Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
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70
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Social Cognition through the Lens of Cognitive and Clinical Neuroscience. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4283427. [PMID: 30302338 PMCID: PMC6158937 DOI: 10.1155/2018/4283427] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/13/2018] [Indexed: 12/13/2022]
Abstract
Social cognition refers to a set of processes, ranging from perception to decision-making, underlying the ability to decode others' intentions and behaviors to plan actions fitting with social and moral, besides individual and economic considerations. Its centrality in everyday life reflects the neural complexity of social processing and the ubiquity of social cognitive deficits in different pathological conditions. Social cognitive processes can be clustered in three domains associated with (a) perceptual processing of social information such as faces and emotional expressions (social perception), (b) grasping others' cognitive or affective states (social understanding), and (c) planning behaviors taking into consideration others', in addition to one's own, goals (social decision-making). We review these domains from the lens of cognitive neuroscience, i.e., in terms of the brain areas mediating the role of such processes in the ability to make sense of others' behavior and plan socially appropriate actions. The increasing evidence on the “social brain” obtained from healthy young individuals nowadays constitutes the baseline for detecting changes in social cognitive skills associated with physiological aging or pathological conditions. In the latter case, impairments in one or more of the abovementioned domains represent a prominent concern, or even a core facet, of neurological (e.g., acquired brain injury or neurodegenerative diseases), psychiatric (e.g., schizophrenia), and developmental (e.g., autism) disorders. To pave the way for the other papers of this issue, addressing the social cognitive deficits associated with severe acquired brain injury, we will briefly discuss the available evidence on the status of social cognition in normal aging and its breakdown in neurodegenerative disorders. Although the assessment and treatment of such impairments is a relatively novel sector in neurorehabilitation, the evidence summarized here strongly suggests that the development of remediation procedures for social cognitive skills will represent a future field of translational research in clinical neuroscience.
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71
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Sami S, Williams N, Hughes LE, Cope TE, Rittman T, Coyle-Gilchrist ITS, Henson RN, Rowe JB. Neurophysiological signatures of Alzheimer's disease and frontotemporal lobar degeneration: pathology versus phenotype. Brain 2018; 141:2500-2510. [PMID: 30060017 PMCID: PMC6061803 DOI: 10.1093/brain/awy180] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/27/2018] [Accepted: 05/17/2018] [Indexed: 01/21/2023] Open
Abstract
The disruption of brain networks is characteristic of neurodegenerative dementias. However, it is controversial whether changes in connectivity reflect only the functional anatomy of disease, with selective vulnerability of brain networks, or the specific neurophysiological consequences of different neuropathologies within brain networks. We proposed that the oscillatory dynamics of cortical circuits reflect the tuning of local neural interactions, such that different pathologies are selective in their impact on the frequency spectrum of oscillations, whereas clinical syndromes reflect the anatomical distribution of pathology and physiological change. To test this hypothesis, we used magnetoencephalography from five patient groups, representing dissociated pathological subtypes and distributions across frontal, parietal and temporal lobes: amnestic Alzheimer's disease, posterior cortical atrophy, and three syndromes associated with frontotemporal lobar degeneration. We measured effective connectivity with graph theory-based measures of local efficiency, using partial directed coherence between sensors. As expected, each disease caused large-scale changes of neurophysiological brain networks, with reductions in local efficiency compared to controls. Critically however, the frequency range of altered connectivity was consistent across clinical syndromes that shared a likely underlying pathology, whilst the localization of changes differed between clinical syndromes. Multivariate pattern analysis of the frequency-specific topographies of local efficiency separated the disorders from each other and from controls (accuracy 62% to 100%, according to the groups' differences in likely pathology and clinical syndrome). The data indicate that magnetoencephalography has the potential to reveal specific changes in neurophysiology resulting from neurodegenerative disease. Our findings confirm that while clinical syndromes have characteristic anatomical patterns of abnormal connectivity that may be identified with other methods like structural brain imaging, the different mechanisms of neurodegeneration also cause characteristic spectral signatures of physiological coupling that are not accessible with structural imaging nor confounded by the neurovascular signalling of functional MRI. We suggest that these spectral characteristics of altered connectivity are the result of differential disruption of neuronal microstructure and synaptic physiology by Alzheimer's disease versus frontotemporal lobar degeneration.
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Affiliation(s)
- Saber Sami
- Department of Clinical Neurosciences, University of Cambridge, UK
| | | | - Laura E Hughes
- Department of Clinical Neurosciences, University of Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Thomas E Cope
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, UK
| | | | - Richard N Henson
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
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72
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Alster P, Krzyżanowska E, Koziorowski D, Szlufik S, Różański D, Noskowska J, Mianowicz J, Michno A, Królicki L, Friedman A. Difficulties in the diagnosis of four repeats (4R) tauopathic parkinsonian syndromes. Neurol Neurochir Pol 2018; 52:459-464. [PMID: 30025721 DOI: 10.1016/j.pjnns.2018.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/03/2018] [Accepted: 06/19/2018] [Indexed: 11/28/2022]
Abstract
Corticobasal Degeneration Degeneration (CBD) and Progressive Supranuclear Palsy (PSP) are types of four repeats (4R) tauopathies, which are associated to parkinsonian syndromes. The aim of the work is to analyze cases of patients of the Department of Neurology, overlapping of syndromes related to both pathologies and to show that most likely CBS and PSP are not lineary related to their commonly associated syndromes i.e. adequately corticobasal syndromes and progressive supranuclear palsy syndromes. In the context of each patient factors in favor of most likely CBS, PSP or both diseases are discussed and analyzed using contemporary criteria. This work discusses multidimensional aspect of the examination of five patient aged 64 to 83 - 4 females and 1 male with 4R tauopathies and difficulties in distinguishing both diseases. The duration of the disease varied from 1 to 5 years. Each patient after neurological examination was assessed using magnetic resonance imaging (MRI) and psychological test. Examination of all patients was extended using single photon emission computer tomography (SPECT) to reveal the usefulness of this tool in differentiation of diseases was done. The outcome of this examination was verified with prior clinical manifestation of patients and morphological abnormalities in magnetic resonance imaging. Autopsies were not conducted.
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Affiliation(s)
- Piotr Alster
- Department of Neurology, Medical University of Warsaw, Poland.
| | | | | | | | - Dorota Różański
- Department of Neurology, Medical University of Warsaw, Poland
| | | | | | | | - Leszek Królicki
- Department of Nuclear Medicine, Medical University of Warsaw, Poland
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73
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Liu X, Zheng J, Liu BX, Dai XJ. Altered connection properties of important network hubs may be neural risk factors for individuals with primary insomnia. Sci Rep 2018; 8:5891. [PMID: 29651014 PMCID: PMC5897381 DOI: 10.1038/s41598-018-23699-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/14/2018] [Indexed: 12/18/2022] Open
Abstract
Primary insomnia (PIs) is highly prevalent and can lead to adverse socioeconomic impacts, but the underlying mechanism of its complex brain network impairment remains largely unknown. Functional studies are too few and diverse in methodology, which makes it difficult to glean general conclusions. To answer this question, we first used graph theory-based network analyse, together with seed-based functional connectivity approach, to characterize the topology architecture of whole-brain functional networks associated with PIs. Forty-eight subjects with PIs and 48 age/sex/education-matched good sleepers were recruited. We found PIs is associated with altered connection properties of intra-networks within the executive control network, default mode network and salience network, and inter-network between auditory language comprehension center and executive control network. These complex networks were correlated with negative emotions and insomnia severity in the PIs group. Altered connection properties of these network hubs appeared to be neural risk factors for neuropsychological changes of PIs, and might be used as potential neuroimaging markers to distinguish the PIs from the good sleepers. These findings highlight the role of functional connectivity in the pathophysiology of PIs, and may underlie the neural mechanisms of etiology of PIs.
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Affiliation(s)
- Xuming Liu
- Department of Radiology, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Jiyong Zheng
- Department of Medical Imaging, The affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, 223300, Jiangsu, People's Republic of China
| | - Bi-Xia Liu
- Department of Respiration, the First Hospital Affiliated to Soochow University, Suzhou, 215006, People's Republic of China.,Department of ICU, Jiangxi Provincial Cancer Hospital, Nanchang, 330029, Jiangxi, People's Republic of China
| | - Xi-Jian Dai
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, People's Republic of China. .,Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China.
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74
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Lansdall CJ, Coyle-Gilchrist ITS, Jones PS, Vázquez Rodríguez P, Wilcox A, Wehmann E, Dick KM, Robbins TW, Rowe JB. White matter change with apathy and impulsivity in frontotemporal lobar degeneration syndromes. Neurology 2018; 90:e1066-e1076. [PMID: 29453244 PMCID: PMC5874447 DOI: 10.1212/wnl.0000000000005175] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/21/2017] [Indexed: 12/11/2022] Open
Abstract
Objective To identify the white matter correlates of apathy and impulsivity in the major syndromes associated with frontotemporal lobar degeneration, using diffusion-weighted imaging and data from the PiPPIN (Pick's Disease and Progressive Supranuclear Palsy: Prevalence and Incidence) study. We included behavioral and language variants of frontotemporal dementia, corticobasal syndrome, and progressive supranuclear palsy. Methods Seventy patients and 30 controls underwent diffusion tensor imaging at 3-tesla after detailed assessment of apathy and impulsivity. We used tract-based spatial statistics of fractional anisotropy and mean diffusivity, correlating with 8 orthogonal dimensions of apathy and impulsivity derived from a principal component analysis of neuropsychological, behavioral, and questionnaire measures. Results Three components were associated with significant white matter tract abnormalities. Carer-rated change in everyday skills, self-care, and motivation correlated with widespread changes in dorsal frontoparietal and corticospinal tracts, while carer observations of impulsive–apathetic and challenging behaviors revealed disruption in ventral frontotemporal tracts. Objective neuropsychological tests of cognitive control, reflection impulsivity, and reward responsiveness were associated with focal changes in the right frontal lobe and presupplementary motor area. These changes were observed across clinical diagnostic groups, and were not restricted to the disorders for which diagnostic criteria include apathy and impulsivity. Conclusion The current study provides evidence of distinct structural network changes in white matter associated with different neurobehavioral components of apathy and impulsivity across the diverse spectrum of syndromes and pathologies associated with frontotemporal lobar degeneration.
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Affiliation(s)
- Claire J Lansdall
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.S.J., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; The Dementia Research Centre (K.M.D.), Institute of Neurology, University College London; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK.
| | - Ian T S Coyle-Gilchrist
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.S.J., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; The Dementia Research Centre (K.M.D.), Institute of Neurology, University College London; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
| | - P Simon Jones
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.S.J., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; The Dementia Research Centre (K.M.D.), Institute of Neurology, University College London; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
| | - Patricia Vázquez Rodríguez
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.S.J., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; The Dementia Research Centre (K.M.D.), Institute of Neurology, University College London; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
| | - Alicia Wilcox
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.S.J., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; The Dementia Research Centre (K.M.D.), Institute of Neurology, University College London; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
| | - Eileen Wehmann
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.S.J., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; The Dementia Research Centre (K.M.D.), Institute of Neurology, University College London; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
| | - Katrina M Dick
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.S.J., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; The Dementia Research Centre (K.M.D.), Institute of Neurology, University College London; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
| | - Trevor W Robbins
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.S.J., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; The Dementia Research Centre (K.M.D.), Institute of Neurology, University College London; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
| | - James B Rowe
- From the Departments of Clinical Neurosciences (C.J.L., I.T.S.C.-G., P.S.J., P.V.R., A.W., E.W., J.B.R.) and Psychology (T.W.R.), and Behavioral and Clinical Neuroscience Institute (T.W.R., J.B.R.), University of Cambridge, UK; University Medical Centre Hamburg-Eppendorf (E.W.), University of Hamburg, Germany; The Dementia Research Centre (K.M.D.), Institute of Neurology, University College London; and MRC Cognition and Brain Sciences Unit (J.B.R.), Cambridge, UK
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75
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Nishida H, Hayashi Y, Harada N, Sakurai T, Wakida K. Diagnosing Corticobasal Syndrome Based on the Presence of Visual Hallucinations and Imaging with Amyloid Positron Emission Tomography. Intern Med 2018; 57:605-611. [PMID: 29269636 PMCID: PMC5849562 DOI: 10.2169/internalmedicine.8534-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 61-year-old woman was admitted to our hospital due to memory difficulties, visual hallucinations, and slowly progressing motor difficulties in the limbs. A clinical examination revealed bradykinesia, gait disturbance, left-side-dominant rigidity, ideomotor apraxia, dressing apraxia, left-sided spatial agnosia, impaired visuospatial ability, and executive dysfunction. Her symptoms were unresponsive to levodopa, and corticobasal syndrome (CBS) was diagnosed. One year later, amyloid positron emission tomography revealed amyloid beta accumulation in the bilateral cerebral cortices; at this point, CBS with underlying Alzheimer's disease pathology (CBS-AD) was diagnosed. Visual hallucinations may help differentiate CBS with corticobasal degeneration (CBS-CBD) from other pathologies, including CBS-AD.
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Affiliation(s)
- Hiroshi Nishida
- Department of Neurology, Gifu Prefectural General Medical Center, Japan
| | - Yuichi Hayashi
- Departments of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Japan
| | - Naoko Harada
- Department of Neurology, Gifu Prefectural General Medical Center, Japan
| | - Takeo Sakurai
- Department of Neurology, Gifu Prefectural General Medical Center, Japan
| | - Kenji Wakida
- Department of Neurology, Gifu Prefectural General Medical Center, Japan
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76
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Caine D, Nihat A, Crabb P, Rudge P, Cipolotti L, Collinge J, Mead S. The language disorder of prion disease is characteristic of a dynamic aphasia and is rarely an isolated clinical feature. PLoS One 2018; 13:e0190818. [PMID: 29304167 PMCID: PMC5755885 DOI: 10.1371/journal.pone.0190818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/20/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Akinetic mutism is a key diagnostic feature of prion diseases, however, their rapidly progressive nature makes detailed investigation of the language disorder in a large cohort extremely challenging. This study aims to position prion diseases in the nosology of language disorders and improve early clinical recognition. METHODS A systematic, prospective investigation of language disorders in a large cohort of patients diagnosed with prion diseases. 568 patients were included as a sub-study of the National Prion Monitoring Cohort. All patients had at least one assessment with the MRC Scale, a milestone-based functional scale with language and non-language components. Forty patients, with early symptoms and able to travel to the study site, were also administered a comprehensive battery of language tests (spontaneous speech, semantics, syntax, repetition, naming, comprehension and lexical retrieval under different conditions). RESULTS 5/568 (0.9%) patients presented with leading language symptoms. Those with repeated measurements deteriorated at a slower rate in language compared to non-language milestones. Amongst the subgroup of 40 patients who underwent detailed language testing, only three tasks-semantic and phonemic fluency and sentence comprehension-were particularly vulnerable early in the disease. These tasks were highly correlated with performance on non-verbal executive tests. Patients were also impaired on a test of dynamic aphasia. CONCLUSION These results provide evidence that the language disorder in prion disease is rarely an isolated clinical or cognitive feature. The language abnormality is indicative of a dynamic aphasia in the context of a prominent dysexecutive syndrome, similar to that seen in patients with the degenerative movement disorder progressive supranuclear palsy (PSP).
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Affiliation(s)
- Diana Caine
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, United Kingdom
| | - Akin Nihat
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, United Kingdom
| | - Philippa Crabb
- Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Peter Rudge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, United Kingdom
| | - Lisa Cipolotti
- Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - John Collinge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, United Kingdom
| | - Simon Mead
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, United Kingdom
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77
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Burrell JR, Hodges JR. Falls in frontotemporal dementia and related syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2018; 159:195-203. [PMID: 30482314 DOI: 10.1016/b978-0-444-63916-5.00012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Frontotemporal dementia (FTD) and related diseases are important causes of younger-onset dementia. Falls may be a source of morbidity and mortality in FTD, but remain underreported, and very few high-quality studies have been performed. In this chapter, we briefly review the clinical features of FTD and related syndromes such as motor neuron disease (MND) and atypical parkinsonian syndromes, such as progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). Falls are frequently encountered in patients who present with FTD syndromes. Although cognitive impairment is associated with falls generally, motor symptoms and signs, as seen in FTD cases that overlap with atypical parkinsonian disorders such as PSP or CBS, or MND, appear to pose the greatest risk. At present, very few systematic studies have been performed to determine the precise frequency, timing, diagnostic implications, and complications of falls in FTD. Further studies are required to understand the scope of this problem, and to develop effective treatments and management strategies.
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Affiliation(s)
- James R Burrell
- Concord Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Brain and Mind Centre, University of Sydney Medical School, Sydney, NSW, Australia.
| | - John R Hodges
- Brain and Mind Centre, University of Sydney Medical School, Sydney, NSW, Australia
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78
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Oliveira LMD, Barcellos I, Teive HAG, Munhoz RP. Cognitive dysfunction in corticobasal degeneration. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:570-579. [PMID: 28813088 DOI: 10.1590/0004-282x20170077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/30/2017] [Indexed: 01/30/2023]
Abstract
Corticobasal degeneration (CBD) was originally described as a distinct clinicopathological entity in 1967. Since then, different phenotypic presentations have emerged as possible manifestations of CBD histopathological findings. In addition, pathophysiological findings and the molecular basis have been delineated and several aspects of its cognitive manifestations have been clarified. Thus, not only the spectrum of what is currently designated as CBD has expanded, but overlap with other degenerative and even secondary disorders has made clinical diagnostic certainty even more challenging in the absence of specific and readily-available markers. Cognitive deficits in CBD are now recognized as a frequent initial presentation and may appear up to eight years before the motor symptoms, depending on the phenotypic variant. Characteristic cognitive features of CBD involve language deficits, visuospatial and executive dysfunctions, apraxia, and behavioral disorders. Semantic and episodic memories are usually preserved, while language is often impaired in the early stages.
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Affiliation(s)
- Laís Machado de Oliveira
- University Health Network, Toronto Western Hospital, Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto, ON, M5T 2S8, Canada
| | - Igor Barcellos
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Serviço de Neurologia, Curitiba PR, Brasil
| | - Hélio A G Teive
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Setor de Distúrbios do Movimento, Curitiba, PR, Brasil
| | - Renato Puppi Munhoz
- University Health Network, Toronto Western Hospital, Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto, ON, M5T 2S8, Canada
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79
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Canesi M, Rusconi ML, Cereda E, Ranghetti A, Cereda V, Moroni F, Pezzoli G. Divergent Thinking in Parkinsonism: A Case-Control Study. Front Neurol 2017; 8:534. [PMID: 29118735 PMCID: PMC5661018 DOI: 10.3389/fneur.2017.00534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/25/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Creativity is a multidimensional phenomenon and an important component of human capacities. This ability is characterized by the involvement of several cognitive functions particularly linked to the prefrontal cortex. We compared divergent thinking, a measure of creativity, in patients affected by progressive supranuclear palsy (PSP), other parkinsonian syndromes, and healthy controls (HCs). METHODS Creativity features were evaluated using the Abbreviated Torrance Test for Adults (ATTA). Consecutive PSP outpatients were screened for inclusion. Then, patients with multiple system atrophy (MSA) and Parkinson's disease (PD) and a group of HC were studied. All groups have preserved cognitive functions and were matched for gender, education, disease duration, and age at onset with exception of PD patients who were matched by disease severity rather than disease duration. RESULTS PSP patients were characterized by lower values in total ATTA and all subscales than HC and both MSA and PD patients. No differences were found comparing HC versus both MSA and PD patients. PSP patients were characterized by more impaired frontal functioning [assessed by means of Frontal Assessment Battery (FAB)] than HC and both PD and MSA patients. CONCLUSION In the present study, ATTA was significantly lower in PSP patients than in the other study groups. The worst performance in ATTA-total score and the lower score in FAB in PSP patients support the role of frontal function in creative processes.
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Affiliation(s)
- Margherita Canesi
- Parkinson Institute, Azienda Socio Sanitaria Territoriale Pini-CTO, Milano, Italy
| | - Maria Luisa Rusconi
- Department of Human and Social Sciences, Università degli Studi di Bergamo, Bergamo, Italy
| | - Emanuele Cereda
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Ranghetti
- Parkinson Institute, Azienda Socio Sanitaria Territoriale Pini-CTO, Milano, Italy
| | - Viviana Cereda
- Parkinson Institute, Azienda Socio Sanitaria Territoriale Pini-CTO, Milano, Italy
| | - Federica Moroni
- Department of Human and Social Sciences, Università degli Studi di Bergamo, Bergamo, Italy
| | - Gianni Pezzoli
- Parkinson Institute, Azienda Socio Sanitaria Territoriale Pini-CTO, Milano, Italy
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80
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Brown JA, Hua AY, Trujillo A, Attygalle S, Binney RJ, Spina S, Lee SE, Kramer JH, Miller BL, Rosen HJ, Boxer AL, Seeley WW. Advancing functional dysconnectivity and atrophy in progressive supranuclear palsy. Neuroimage Clin 2017; 16:564-574. [PMID: 28951832 PMCID: PMC5605489 DOI: 10.1016/j.nicl.2017.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/01/2017] [Accepted: 09/06/2017] [Indexed: 02/07/2023]
Abstract
Progressive supranuclear palsy syndrome (PSP-S) results from neurodegeneration within a network of brainstem, subcortical, frontal and parietal cortical brain regions. It is unclear how network dysfunction progresses and relates to longitudinal atrophy and clinical decline. In this study, we evaluated patients with PSP-S (n = 12) and healthy control subjects (n = 20) at baseline and 6 months later. Subjects underwent structural MRI and task-free functional MRI (tf-fMRI) scans and clinical evaluations at both time points. At baseline, voxel based morphometry (VBM) revealed that patients with mild-to-moderate clinical symptoms showed structural atrophy in subcortex and brainstem, prefrontal cortex (PFC; supplementary motor area, paracingulate, dorsal and ventral medial PFC), and parietal cortex (precuneus). Tf-fMRI functional connectivity (FC) was examined in a rostral midbrain tegmentum (rMT)-anchored intrinsic connectivity network that is compromised in PSP-S. In healthy controls, this network contained a medial parietal module, a prefrontal-paralimbic module, and a subcortical-brainstem module. Baseline FC deficits in PSP-S were most severe in rMT network integrative hubs in the prefrontal-paralimbic and subcortical-brainstem modules. Longitudinally, patients with PSP-S had declining intermodular FC between the subcortical-brainstem and parietal modules, while progressive atrophy was observed in subcortical-brainstem regions (midbrain, pallidum) and posterior frontal (perirolandic) cortex. This suggested that later-stage subcortical-posterior cortical change may follow an earlier-stage subcortical-anterior cortical disease process. Clinically, patients with more severe baseline impairment showed greater subsequent prefrontal-parietal cortical FC declines and posterior frontal atrophy rates, while patients with more rapid longitudinal clinical decline showed coupled prefrontal-paralimbic FC decline. VBM and FC can augment disease monitoring in PSP-S by tracking the disease through stages while detecting changes that accompany heterogeneous clinical progression.
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Affiliation(s)
- Jesse A. Brown
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Alice Y. Hua
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Andrew Trujillo
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Suneth Attygalle
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Richard J. Binney
- Temple University, Eleanor M. Saffran Center for Cognitive Neuroscience, Department of Communication Sciences and Disorders, Philadelphia, PA, USA
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Suzee E. Lee
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Joel H. Kramer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - William W. Seeley
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, USA
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81
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Bharti K, Bologna M, Upadhyay N, Piattella MC, Suppa A, Petsas N, Giannì C, Tona F, Berardelli A, Pantano P. Abnormal Resting-State Functional Connectivity in Progressive Supranuclear Palsy and Corticobasal Syndrome. Front Neurol 2017. [PMID: 28634465 PMCID: PMC5459910 DOI: 10.3389/fneur.2017.00248] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Pathological and MRI-based evidence suggests that multiple brain structures are likely to be involved in functional disconnection between brain areas. Few studies have investigated resting-state functional connectivity (rsFC) in progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). In this study, we investigated within- and between-network rsFC abnormalities in these two conditions. Methods Twenty patients with PSP, 11 patients with CBS, and 16 healthy subjects (HS) underwent a resting-state fMRI study. Resting-state networks (RSNs) were extracted to evaluate within- and between-network rsFC using the Melodic and FSLNets software packages. Results Increased within-network rsFC was observed in both PSP and CBS patients, with a larger number of RSNs being involved in CBS. Within-network cerebellar rsFC positively correlated with mini-mental state examination scores in patients with PSP. Compared to healthy volunteers, PSP and CBS patients exhibit reduced functional connectivity between the lateral visual and auditory RSNs, with PSP patients additionally showing lower functional connectivity between the cerebellar and insular RSNs. Moreover, rsFC between the salience and executive-control RSNs was increased in patients with CBS compared to HS. Conclusion This study provides evidence of functional brain reorganization in both PSP and CBS. Increased within-network rsFC could represent a higher degree of synchronization in damaged brain areas, while between-network rsFC abnormalities may mainly reflect degeneration of long-range white matter fibers.
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Affiliation(s)
- Komal Bharti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Matteo Bologna
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Neuromed Institute IRCCS, Pozzilli, Isernia, Italy
| | - Neeraj Upadhyay
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Antonio Suppa
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Neuromed Institute IRCCS, Pozzilli, Isernia, Italy
| | - Nikolaos Petsas
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Costanza Giannì
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Francesca Tona
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Neuromed Institute IRCCS, Pozzilli, Isernia, Italy
| | - Patrizia Pantano
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Neuromed Institute IRCCS, Pozzilli, Isernia, Italy
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82
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Lansdall CJ, Coyle-Gilchrist ITS, Jones PS, Vázquez Rodríguez P, Wilcox A, Wehmann E, Dick KM, Robbins TW, Rowe JB. Apathy and impulsivity in frontotemporal lobar degeneration syndromes. Brain 2017; 140:1792-1807. [PMID: 28486594 PMCID: PMC5868210 DOI: 10.1093/brain/awx101] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/16/2017] [Accepted: 03/06/2017] [Indexed: 01/30/2023] Open
Abstract
Apathy and impulsivity are common and disabling consequences of frontotemporal lobar degeneration. They cause substantial carer distress, but their aetiology remains elusive. There are critical limitations to previous studies in this area including (i) the assessment of either apathy or impulsivity alone, despite their frequent co-existence; (ii) the assessment of behavioural changes within single diagnostic groups; and (iii) the use of limited sets of tasks or questions that relate to just one aspect of these multifactorial constructs. We proposed an alternative, dimensional approach that spans behavioural and language variants of frontotemporal dementia, progressive supranuclear palsy and corticobasal syndrome. This accommodates the commonalities of apathy and impulsivity across disorders and reveals their cognitive and anatomical bases. The ability to measure the components of apathy and impulsivity and their associated neural correlates across diagnostic groups would provide better novel targets for pharmacological manipulations, and facilitate new treatment strategies and strengthen translational models. We therefore sought to determine the neurocognitive components of apathy and impulsivity in frontotemporal lobar degeneration syndromes. The frequency and characteristics of apathy and impulsivity were determined by neuropsychological and behavioural assessments in 149 patients and 50 controls from the PIck's disease and Progressive supranuclear palsy Prevalence and INcidence study (PiPPIN). We derived dimensions of apathy and impulsivity using principal component analysis and employed these in volumetric analyses of grey and white matter in a subset of 70 patients (progressive supranuclear palsy, n = 22; corticobasal syndrome, n = 13; behavioural variant, n = 14; primary progressive aphasias, n = 21) and 27 control subjects. Apathy and impulsivity were present across diagnostic groups, despite being criteria for behavioural variant frontotemporal dementia alone. Measures of apathy and impulsivity frequently loaded onto the same components reflecting their overlapping relationship. However, measures from objective tasks, patient-rated questionnaires and carer-rated questionnaires loaded onto separate components and revealed distinct neurobiology. Corticospinal tracts correlated with patients' self-ratings. In contrast, carer ratings correlated with atrophy in established networks for goal-directed behaviour, social cognition, motor control and vegetative functions, including frontostriatal circuits, orbital and temporal polar cortex, and the brainstem. Components reflecting response inhibition deficits correlated with focal frontal cortical atrophy. The dimensional approach to complex behavioural changes arising from frontotemporal lobar degeneration provides new insights into apathy and impulsivity, and the need for a joint therapeutic strategy against them. The separation of objective tests from subjective questionnaires, and patient from carer ratings, has important implications for clinical trial design.awx101media15448041163001.
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Affiliation(s)
| | | | - P. Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, UK
| | | | - Alicia Wilcox
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Eileen Wehmann
- Department of Clinical Neurosciences, University of Cambridge, UK
- University Medical Centre Hamburg-Eppendorf, University of Hamburg, Germany
| | - Katrina M. Dick
- The Dementia Research Centre, Institute of Neurology, University College London, UK
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
- Department of Psychology, University of Cambridge, UK
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
- MRC Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, UK
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83
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Abstract
Previous studies of patients with brain damage have suggested a close relationship between aphasia and movement disorders. Neurodegenerative extrapyramidal syndromes associated with cognitive impairment provide an interesting model for studying the neural substrates of cognitive and motor symptoms. In this review, we focused on studies investigating language production abilities in patients with Parkinson's disease (PD), Corticobasal Syndrome (CBS) and Progressive Supranuclear Palsy (PSP). According to some reports, these patients exhibit a reduction in performance in both action and object naming or verb production compared to healthy individuals. Furthermore, a disproportional impairment of action naming compared to object naming was systematically observed in patients with these disorders. The study of these clinical conditions offers the unique opportunity to examine the close link between linguistic features and motor characteristics of action. This particular pattern of language impairment may contribute to the debate on embodiment theory and on the involvement of the basal ganglia in language and in integrating language and movement. From a translational perspective, we suggest that language ability assessments are useful in the clinical work-up, along with neuropsychological and motor evaluations. Specific protocols should be developed in the near future to better characterize language deficits and to permit an early cognitive diagnosis. Moreover, the link between language deficits and motor impairment opens a new issue for treatment approaches. Treatment of one of these two symptoms may ameliorate the other, and treating both may produce a greater improvement in patients' global clinical conditions.
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84
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Silsby M, Tweedie-Cullen RY, Murray CR, Halliday GM, Hodges JR, Burrell JR. The midbrain-to-pons ratio distinguishes progressive supranuclear palsy from non-fluent primary progressive aphasias. Eur J Neurol 2017; 24:956-965. [PMID: 28510312 DOI: 10.1111/ene.13314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE To determine the clinical utility of the midbrain-to-pons (M/P) ratio as a clinical biomarker of progressive supranuclear palsy (PSP) in patients with non-fluent primary progressive aphasia syndromes. METHODS Patients with PSP, progressive non-fluent aphasia (PNFA) and logopenic progressive aphasia (LPA) were recruited. Patients were diagnosed clinically, but pathological confirmation was available in a proportion of patients. Midbrain and pons areas were measured using Osirix Lite, a free DICOM viewer. The M/P ratio and Magnetic Resonance Parkinsonism Index were calculated and their diagnostic utility compared. RESULTS A total of 72 participants were included (16 PSP, 18 PNFA, 16 LPA and 22 controls). Patients with PSP had motor features typical of the syndrome. Both the M/P ratio and Magnetic Resonance Parkinsonism Index differed significantly in PSP compared with controls. The M/P ratio was disproportionately reduced in PSP compared with PNFA and LPA (PSP, 0.182 ± 0.043; PNFA, 0.255 ± 0.034; LPA, 0.258 ± 0.033; controls, 0.292 ± 0.031; P < 0.001). An M/P ratio of ≤0.215 produced a positive predictive value of 77.8% for the diagnosis of PSP syndrome. Pathological examination revealed Alzheimer's disease in three cases (all LPA), pathological PSP in two cases (one clinical PSP and one PNFA) and corticobasal degeneration in one case (PNFA). The M/P ratio was ≤0.215 in both pathological cases of PSP. CONCLUSIONS The M/P ratio was disproportionately reduced in PSP, suggesting its potential as a clinical marker of the PSP syndrome. Larger studies of pathologically confirmed cases are needed to establish the M/P ratio as a biomarker of PSP pathology.
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Affiliation(s)
- M Silsby
- Concord Hospital, Sydney, NSW, Australia
| | | | - C R Murray
- Brain and Mind Centre, University of Sydney Medical School, Sydney, NSW, Australia
| | - G M Halliday
- Brain and Mind Centre, University of Sydney Medical School, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| | - J R Hodges
- Brain and Mind Centre, University of Sydney Medical School, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - J R Burrell
- Concord Hospital, Sydney, NSW, Australia.,Brain and Mind Centre, University of Sydney Medical School, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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85
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Upadhyay N, Suppa A, Piattella MC, Giannì C, Bologna M, Di Stasio F, Petsas N, Tona F, Fabbrini G, Berardelli A, Pantano P. Functional disconnection of thalamic and cerebellar dentate nucleus networks in progressive supranuclear palsy and corticobasal syndrome. Parkinsonism Relat Disord 2017; 39:52-57. [PMID: 28318985 DOI: 10.1016/j.parkreldis.2017.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/10/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
Abstract
AIM To assess functional rearrangement following neurodegeneration in the thalamus and dentate nucleus in patients with progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). METHODS We recruited 19 patients with PSP, 11 with CBS and 14 healthy subjects. All the subjects underwent resting-state (rs) fMRI using a 3T system. Whole brain functional connectivity of the thalamus and dentate nucleus were calculated by means of a seed-based approach with FEAT script in FSL toolbox. Thalamic volume was calculated by means of FIRST, and the dentate area by means of Jim software. RESULTS Both thalamic volume and dentate area were significantly smaller in PSP and CBS patients than in healthy subjects. No significant difference emerged in thalamic volume between PSP and CBS patients, whereas dentate area was significantly smaller in PSP than in CBS. Thalamic functional connectivity was significantly reduced in both patient groups in various cortical, subcortical and cerebellar areas. By contrast, changes in dentate nucleus functional connectivity differed in PSP and CBS: it decreased in subcortical and prefrontal cortical areas in PSP, but increased asymmetrically in the frontal cortex in CBS. CONCLUSIONS Evaluating the dentate nucleus size and its functional connectivity may help to differentiate patients with PSP from those with CBS.
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Affiliation(s)
- Neeraj Upadhyay
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Antonio Suppa
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed Institute, Pozzilli (IS), Italy
| | | | - Costanza Giannì
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Matteo Bologna
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed Institute, Pozzilli (IS), Italy
| | | | - Nikolaos Petsas
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Francesca Tona
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Giovanni Fabbrini
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed Institute, Pozzilli (IS), Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed Institute, Pozzilli (IS), Italy
| | - Patrizia Pantano
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed Institute, Pozzilli (IS), Italy.
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86
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Boschi V, Catricalà E, Consonni M, Chesi C, Moro A, Cappa SF. Connected Speech in Neurodegenerative Language Disorders: A Review. Front Psychol 2017; 8:269. [PMID: 28321196 PMCID: PMC5337522 DOI: 10.3389/fpsyg.2017.00269] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 02/10/2017] [Indexed: 12/12/2022] Open
Abstract
Language assessment has a crucial role in the clinical diagnosis of several neurodegenerative diseases. The analysis of extended speech production is a precious source of information encompassing the phonetic, phonological, lexico-semantic, morpho-syntactic, and pragmatic levels of language organization. The knowledge about the distinctive linguistic variables identifying language deficits associated to different neurodegenerative diseases has progressively improved in the last years. However, the heterogeneity of such variables and of the way they are measured and classified limits any generalization and makes the comparison among studies difficult. Here we present an exhaustive review of the studies focusing on the linguistic variables derived from the analysis of connected speech samples, with the aim of characterizing the language disorders of the most prevalent neurodegenerative diseases, including primary progressive aphasia, Alzheimer's disease, movement disorders, and amyotrophic lateral sclerosis. A total of 61 studies have been included, considering only those reporting group analysis and comparisons with a group of healthy persons. This review first analyzes the differences in the tasks used to elicit connected speech, namely picture description, story narration, and interview, considering the possible different contributions to the assessment of different linguistic domains. This is followed by an analysis of the terminologies and of the methods of measurements of the variables, indicating the need for harmonization and standardization. The final section reviews the linguistic domains affected by each different neurodegenerative disease, indicating the variables most consistently impaired at each level and suggesting the key variables helping in the differential diagnosis among diseases. While a large amount of valuable information is already available, the review highlights the need of further work, including the development of automated methods, to take advantage of the richness of connected speech analysis for both research and clinical purposes.
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Affiliation(s)
- Veronica Boschi
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Eleonora Catricalà
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Monica Consonni
- Third Neurology Unit and Motor Neuron Diseases Center, IRCCS Foundation "Carlo Besta" Neurological Institute Milan, Italy
| | - Cristiano Chesi
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Andrea Moro
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Stefano F Cappa
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-PaviaPavia, Italy; IRCCS S. Giovanni di Dio FatebenefratelliBrescia, Italy
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87
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Höglinger GU, Kassubek J, Csoti I, Ehret R, Herbst H, Wellach I, Winkler J, Jost WH. Differentiation of atypical Parkinson syndromes. J Neural Transm (Vienna) 2017; 124:997-1004. [DOI: 10.1007/s00702-017-1700-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/20/2017] [Indexed: 01/31/2023]
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88
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Tsutsui-Kimura I, Takiue H, Yoshida K, Xu M, Yano R, Ohta H, Nishida H, Bouchekioua Y, Okano H, Uchigashima M, Watanabe M, Takata N, Drew MR, Sano H, Mimura M, Tanaka KF. Dysfunction of ventrolateral striatal dopamine receptor type 2-expressing medium spiny neurons impairs instrumental motivation. Nat Commun 2017; 8:14304. [PMID: 28145402 PMCID: PMC5296642 DOI: 10.1038/ncomms14304] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 12/16/2016] [Indexed: 11/25/2022] Open
Abstract
Impaired motivation is present in a variety of neurological disorders, suggesting that decreased motivation is caused by broad dysfunction of the nervous system across a variety of circuits. Based on evidence that impaired motivation is a major symptom in the early stages of Huntington's disease, when dopamine receptor type 2-expressing striatal medium spiny neurons (D2-MSNs) are particularly affected, we hypothesize that degeneration of these neurons would be a key node regulating motivational status. Using a progressive, time-controllable, diphtheria toxin-mediated cell ablation/dysfunction technique, we find that loss-of-function of D2-MSNs within ventrolateral striatum (VLS) is sufficient to reduce goal-directed behaviours without impairing reward preference or spontaneous behaviour. Moreover, optogenetic inhibition and ablation of VLS D2-MSNs causes, respectively, transient and chronic reductions of goal-directed behaviours. Our data demonstrate that the circuitry containing VLS D2-MSNs control motivated behaviours and that VLS D2-MSN loss-of-function is a possible cause of motivation deficits in neurodegenerative diseases. D2 receptor-expressing medium spiny neurons (D2-MSNs) are thought to suppress goal-directed behaviours. Here authors ablate D2-MSNs specifically in the ventrolateral striatum, and find that surprisingly, it leads to a reduction in goal-directed motivation in mice.
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Affiliation(s)
- Iku Tsutsui-Kimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan.,Research Fellow of Japan Society for the Promotion of Science (RPD), Tokyo 102-0083, Japan
| | - Hiroyuki Takiue
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan.,Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Keitaro Yoshida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Ming Xu
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Ryutaro Yano
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan.,Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hiroyuki Ohta
- Department of Physiology, National Defense Medical College, Saitama 359-8513, Japan
| | - Hiroshi Nishida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Youcef Bouchekioua
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Motokazu Uchigashima
- Department of Anatomy and Embryology, University of Hokkaido, Hokkaido 060-8638, Japan
| | - Masahiko Watanabe
- Department of Anatomy and Embryology, University of Hokkaido, Hokkaido 060-8638, Japan
| | - Norio Takata
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Michael R Drew
- Center for Learning and Memory, Department of Neuroscience, The University of Texas at Austin, Austin, Texas 78712, USA
| | - Hiromi Sano
- Division of System Neurophysiology, National Institute for Physiological Sciences, Okazaki 444-8585, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kenji F Tanaka
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
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89
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van Meerkerk-Aanen PJ, de Vroege L, Khasho D, Foruz A, van Asseldonk JT, van der Feltz-Cornelis CM. La belle indifférence revisited: a case report on progressive supranuclear palsy misdiagnosed as conversion disorder. Neuropsychiatr Dis Treat 2017; 13:2057-2067. [PMID: 28814874 PMCID: PMC5546807 DOI: 10.2147/ndt.s130475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Since the advent of computed tomography and magnetic resonance imaging scans, neurological disorders have less often been falsely labeled as conversion disorder (CD). However, misdiagnosis of a neurological disorder as CD still occurs, especially in cases with insidious onset. Misinterpretation of la belle indifférence may contribute to such misdiagnosis. Here, we describe a case of progressive supranuclear palsy/Richardson's syndrome (PSPS) misdiagnosed as a case of CD. CASE A 62-year-old woman consulted two different neurologists in 2012 because of falling spells since 2009 and was diagnosed with CD. She was referred to the Clinical Center of Excellence for Body, Mind, and Health for treatment of CD. After neurological examination, blood tests, and psychiatric examination, in which la belle indifférence and a history of incest were found, CD was confirmed. However, despite treatment for CD, the patient's physical symptoms deteriorated over a year. After repeated physical and psychiatric examinations, neurocognitive assessment, and consultation with a third neurologist because of suspicion of neurological disease, the patient was diagnosed with PSPS. CONCLUSION La belle indifférence may be a psychological sign in the context of CD, but it may also be an expression of lack of mimic due to Parkinsonism or of eye movement disorder in the context of neurological illness. A diagnosis of CD should not be considered definitive if no improvement occurs in terms of physical, mental, and cognitive symptoms despite appropriate therapy. In case of deterioration, neurological reexamination and reinterpretation of la belle indifférence should be considered.
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Affiliation(s)
| | - Lars de Vroege
- Clinical Center of Excellence for Body, Mind, and Health, GGz Breburg.,Department Tranzo, Tilburg School of Behavioral and Social Sciences, Tilburg University
| | - David Khasho
- Clinical Center of Excellence for Body, Mind, and Health, GGz Breburg
| | - Aziza Foruz
- Clinical Center of Excellence for Body, Mind, and Health, GGz Breburg
| | | | - Christina M van der Feltz-Cornelis
- Clinical Center of Excellence for Body, Mind, and Health, GGz Breburg.,Department Tranzo, Tilburg School of Behavioral and Social Sciences, Tilburg University
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90
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Rittman T, Rubinov M, Vértes PE, Patel AX, Ginestet CE, Ghosh BCP, Barker RA, Spillantini MG, Bullmore ET, Rowe JB. Regional expression of the MAPT gene is associated with loss of hubs in brain networks and cognitive impairment in Parkinson disease and progressive supranuclear palsy. Neurobiol Aging 2016; 48:153-160. [PMID: 27697694 PMCID: PMC5096886 DOI: 10.1016/j.neurobiolaging.2016.09.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/12/2016] [Accepted: 09/02/2016] [Indexed: 01/08/2023]
Abstract
Abnormalities of tau protein are central to the pathogenesis of progressive supranuclear palsy, whereas haplotype variation of the tau gene MAPT influences the risk of Parkinson disease and Parkinson's disease dementia. We assessed whether regional MAPT expression might be associated with selective vulnerability of global brain networks to neurodegenerative pathology. Using task-free functional magnetic resonance imaging in progressive supranuclear palsy, Parkinson disease, and healthy subjects (n = 128), we examined functional brain networks and measured the connection strength between 471 gray matter regions. We obtained MAPT and SNCA microarray expression data in healthy subjects from the Allen brain atlas. Regional connectivity varied according to the normal expression of MAPT. The regional expression of MAPT correlated with the proportionate loss of regional connectivity in Parkinson's disease. Executive cognition was impaired in proportion to the loss of hub connectivity. These effects were not seen with SNCA, suggesting that alpha-synuclein pathology is not mediated through global network properties. The results establish a link between regional MAPT expression and selective vulnerability of functional brain networks to neurodegeneration.
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Affiliation(s)
- Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Cambridge, UK; Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.
| | - Mikail Rubinov
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, Cambridge, UK; Churchill College, University of Cambridge, Cambridge, UK
| | - Petra E Vértes
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, Cambridge, UK
| | - Ameera X Patel
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, Cambridge, UK
| | - Cedric E Ginestet
- Department of Biostatistics, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Boyd C P Ghosh
- Wessex Neurological Centre, University Hospital Southampton, Southampton, UK
| | - Roger A Barker
- Department of Clinical Neurosciences, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Cambridge, UK; Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Maria Grazia Spillantini
- Department of Clinical Neurosciences, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Cambridge, UK; John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Edward T Bullmore
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Cambridge, UK; Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
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91
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Rittman T, Coyle-Gilchrist IT, Rowe JB. Managing cognition in progressive supranuclear palsy. Neurodegener Dis Manag 2016; 6:499-508. [PMID: 27879155 PMCID: PMC5134756 DOI: 10.2217/nmt-2016-0027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cognitive impairment is integral to the syndrome of progressive supranuclear palsy. It is most commonly described as a frontal dysexecutive syndrome but other impairments include apathy, impulsivity, visuospatial and memory functions. Cognitive dysfunction may be exacerbated by mood disturbance, medication and communication problems. In this review we advocate an individualized approach to managing cognitive impairment in progressive supranuclear palsy with the education of caregivers as a central component. Specific cognitive and behavioral treatments are complemented by treatment of mood disturbances, rationalizing medications and a patient-centered approach to communication. This aims to improve patients’ quality of life, reduce carer burden and assist people with progressive supranuclear palsy in decisions about their life and health, including discussions of feeding and end-of-life issues.
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Affiliation(s)
- Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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92
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Clinical characteristics of parkinsonism in frontotemporal dementia according to subtypes. J Neurol Sci 2016; 372:51-56. [PMID: 28017247 DOI: 10.1016/j.jns.2016.11.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 10/31/2016] [Accepted: 11/14/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND We investigated the prevalence of parkinsonism in frontotemporal dementia (FTD) subtypes and the cognitive and behavioral differences between FTD with and without parkinsonism in a well-structured, prospective cohort. METHODS One hundred and ninety-one FTD patients were enrolled and all patients underwent comprehensive neurological evaluations, neuropsychological tests, and the Unified Parkinson's Disease Rating Scale. RESULTS The prevalence of parkinsonism was 38.7% (74 patients), and included 33 (46.5%) behavioral variant FTD (bvFTD), 16 (24.2%) semantic dementia (SD), 19 (45.2%) progressive nonfluent aphasia (PNFA), and 6 (50%) FTD associated with motor neuron disease (FTD-MND). SD patients with parkinsonism had higher CDR sum of boxes scores (9.7±4.5 vs 6.2±4.5, p=0.024), frontal behavioral inventory total score (33.7±20.5 vs 24.3±14.5, p=0.045), and executive function score of frontal executive dysfunction, disinhibition, and apathy (28.9±13.7 vs 19.2±12.9, p=0.021) than those without parkinsonism. Seoul Instrumental Activities of Daily Living score (bvFTD: 23.5±11.7 vs 17.3±11.3, p=0.031, SD: 23.1±11.1 vs 11.3±9.3, p=0.005) was higher for bvFTD and SD with parkinsonism than for those without parkinsonism. CONCLUSIONS Parkinsonism is found to be more common in patients with bvFTD, PNFA, and FTD-MND patients than those with SD. Behavioral disturbances were more prominent in SD with parkinsonism than without. Additional studies are needed to determine the pathomechanism and optimal treatment of parkinsonism in different FTD subtypes.
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93
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Parmera JB, Rodriguez RD, Studart Neto A, Nitrini R, Brucki SMD. Corticobasal syndrome: A diagnostic conundrum. Dement Neuropsychol 2016; 10:267-275. [PMID: 29213468 PMCID: PMC5619264 DOI: 10.1590/s1980-5764-2016dn1004003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/20/2016] [Indexed: 11/21/2022] Open
Abstract
Corticobasal syndrome (CBS) is an atypical parkinsonian syndrome of great interest to movement disorder specialists and behavioral neurologists. Although originally considered a primary motor disorder, it is now also recognized as a cognitive disorder, usually presenting cognitive deficits before the onset of motor symptoms. The term CBS denotes the clinical phenotype and is associated with a heterogeneous spectrum of pathologies. Given that disease-modifying agents are targeting the pathologic process, new diagnostic methods and biomarkers are being developed to predict the underlying pathology. The heterogeneity of this syndrome in terms of clinical, radiological, neuropsychological and pathological aspects poses the main challenge for evaluation.
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Affiliation(s)
- Jacy Bezerra Parmera
- Behavioral and Cognitive Neurology Unit, Department of
Neurology, University of São Paulo, Brazil
| | - Roberta Dieh Rodriguez
- Behavioral and Cognitive Neurology Unit, Department of
Neurology, University of São Paulo, Brazil
| | - Adalberto Studart Neto
- Behavioral and Cognitive Neurology Unit, Department of
Neurology, University of São Paulo, Brazil
| | - Ricardo Nitrini
- Behavioral and Cognitive Neurology Unit, Department of
Neurology, University of São Paulo, Brazil
| | - Sonia Maria Dozzi Brucki
- Behavioral and Cognitive Neurology Unit, Department of
Neurology, University of São Paulo, Brazil
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94
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Armstrong RA. Visual signs and symptoms of corticobasal degeneration. Clin Exp Optom 2016; 99:498-506. [PMID: 27553583 DOI: 10.1111/cxo.12429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/23/2016] [Accepted: 04/28/2016] [Indexed: 11/28/2022] Open
Abstract
Corticobasal degeneration is a rare, progressive neurodegenerative disease and a member of the 'parkinsonian' group of disorders, which also includes Parkinson's disease, progressive supranuclear palsy, dementia with Lewy bodies and multiple system atrophy. The most common initial symptom is limb clumsiness, usually affecting one side of the body, with or without accompanying rigidity or tremor. Subsequently, the disease affects gait and there is a slow progression to influence ipsilateral arms and legs. Apraxia and dementia are the most common cortical signs. Corticobasal degeneration can be difficult to distinguish from other parkinsonian syndromes but if ocular signs and symptoms are present, they may aid clinical diagnosis. Typical ocular features include increased latency of saccadic eye movements ipsilateral to the side exhibiting apraxia, impaired smooth pursuit movements and visuo-spatial dysfunction, especially involving spatial rather than object-based tasks. Less typical features include reduction in saccadic velocity, vertical gaze palsy, visual hallucinations, sleep disturbance and an impaired electroretinogram. Aspects of primary vision such as visual acuity and colour vision are usually unaffected. Management of the condition to deal with problems of walking, movement, daily tasks and speech problems is an important aspect of the disease.
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95
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Upadhyay N, Suppa A, Piattella MC, Bologna M, Di Stasio F, Formica A, Tona F, Colosimo C, Berardelli A, Pantano P. MRI gray and white matter measures in progressive supranuclear palsy and corticobasal syndrome. J Neurol 2016; 263:2022-31. [PMID: 27411806 DOI: 10.1007/s00415-016-8224-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 02/02/2023]
Abstract
We evaluated MRI measures of gray and white matter damages in 19 patients with progressive supranuclear palsy (PSP), 11 with corticobasal syndrome (CBS), and 14 healthy subjects (HS) to differentiate patients with PSP from those with CBS. We calculated surface-based maps of the cortical volume, cortical thickness, surface area, and voxel level maps of sub-cortical volume, and diffusion tensor imaging parameters using automated scripts implemented in FreeSurfer and FSL toolboxes. No significant differences in cortical volume loss were observed between PSP and CBS. When cortical volume was divided into cortical thickness and surface area, cortical thickness in peri-rolandic brain regions was significantly smaller in CBS than in PSP patients, whereas surface area was significantly smaller in PSP than HS. We also found widespread volume loss in sub-cortical structures in patients with PSP and CBS in comparison to HS. Both patient groups displayed diffusion tensor imaging abnormalities: compared to HS, widespread fractional anisotropy and radial diffusivity changes were observed in PSP, whereas axial and radial diffusivity changes were prominent in CBS. Mini-mental state examination positively correlated with diffusion changes in patients with PSP. In conclusion, cortical thickness, surface area, and diffusion tensor imaging parameters may be sensitive enough to help differentiate patients with PSP from those with CBS.
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Affiliation(s)
- Neeraj Upadhyay
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Antonio Suppa
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- IRCCS INM Neuromed, Pozzilli, IS, Italy
| | - Maria Cristina Piattella
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Matteo Bologna
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- IRCCS INM Neuromed, Pozzilli, IS, Italy
| | | | - Alessandra Formica
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Francesca Tona
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- IRCCS INM Neuromed, Pozzilli, IS, Italy
| | - Patrizia Pantano
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
- IRCCS INM Neuromed, Pozzilli, IS, Italy.
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96
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Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) performance in progressive supranuclear palsy and multiple system atrophy. J Neural Transm (Vienna) 2016; 123:1435-1442. [PMID: 27334897 DOI: 10.1007/s00702-016-1589-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
To determine if Montreal Cognitive Assessment (MoCA) is more sensitive than the commonly used Mini-Mental State Examination (MMSE) in detecting cognitive abnormalities in patients with probable progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) compared with Parkinson's disease (PD). In this multicenter observational study, MMSE and MoCA were administered in a random order to 130 patients: 35 MSA, 30 PSP and 65 age, and education and gender matched-PD. We assessed between-group differences for MMSE, MoCA, and their subitems. Receiver-operating characteristic (ROC) curves were calculated. The mean MMSE was higher than the mean MoCA score in each MSA (27.7 ± 2.4 vs. 22.9 ± 3.0, p < 0.0001), PSP (26.0 ± 2.9 vs. 18.2 ± 3.9, p < 0.0001), and PD (27.3 ± 2.0 vs. 22.3 ± 3.5, p < 0.0001). MoCA total score as well as its letter fluency subitem differentiated PSP from MSA and PD with high specificity and moderate sensitivity. More specifically, a cut-off score of 7 F-words or less per minute would support a diagnosis of PSP (PSP vs. PD: 86 % specificity, 70 % sensitivity; PSP vs. MSA: 71 % specificity, 70 % sensitivity). By contrast, MMSE presented an overall ceiling effect for most subitems, except for the pentagon scores, where PSP did less well than MSA or PD patients. These preliminary results suggest that PSP and MSA, similar to PD patients, may present normal MMSE and reduced MoCA performance. Overall, MoCA is more sensitive than MMSE in detecting cognitive impairment in atypical parkinsonism and together with verbal fluency would be a useful test to support PSP diagnosis.
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Bondulich MK, Guo T, Meehan C, Manion J, Rodriguez Martin T, Mitchell JC, Hortobagyi T, Yankova N, Stygelbout V, Brion JP, Noble W, Hanger DP. Tauopathy induced by low level expression of a human brain-derived tau fragment in mice is rescued by phenylbutyrate. Brain 2016; 139:2290-306. [PMID: 27297240 PMCID: PMC4958900 DOI: 10.1093/brain/aww137] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/01/2016] [Indexed: 12/11/2022] Open
Abstract
Human neurodegenerative tauopathies exhibit pathological tau aggregates in the brain along with diverse clinical features including cognitive and motor dysfunction. Post-translational modifications including phosphorylation, ubiquitination and truncation, are characteristic features of tau present in the brain in human tauopathy. We have previously reported an N-terminally truncated form of tau in human brain that is associated with the development of tauopathy and is highly phosphorylated. We have generated a new mouse model of tauopathy in which this human brain-derived, 35 kDa tau fragment (Tau35) is expressed in the absence of any mutation and under the control of the human tau promoter. Most existing mouse models of tauopathy overexpress mutant tau at levels that do not occur in human neurodegenerative disease, whereas Tau35 transgene expression is equivalent to less than 10% of that of endogenous mouse tau. Tau35 mice recapitulate key features of human tauopathies, including aggregated and abnormally phosphorylated tau, progressive cognitive and motor deficits, autophagic/lysosomal dysfunction, loss of synaptic protein, and reduced life-span. Importantly, we found that sodium 4-phenylbutyrate (Buphenyl®), a drug used to treat urea cycle disorders and currently in clinical trials for a range of neurodegenerative diseases, reverses the observed abnormalities in tau and autophagy, behavioural deficits, and loss of synapsin 1 in Tau35 mice. Our results show for the first time that, unlike other tau transgenic mouse models, minimal expression of a human disease-associated tau fragment in Tau35 mice causes a profound and progressive tauopathy and cognitive changes, which are rescued by pharmacological intervention using a clinically approved drug. These novel Tau35 mice therefore represent a highly disease-relevant animal model in which to investigate molecular mechanisms and to develop novel treatments for human tauopathies.
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Affiliation(s)
- Marie K Bondulich
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Tong Guo
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Christopher Meehan
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - John Manion
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Teresa Rodriguez Martin
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Jacqueline C Mitchell
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Tibor Hortobagyi
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Natalia Yankova
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Virginie Stygelbout
- 2 Laboratory of Histology, Neuroanatomy and Neuropathology (CP 620), ULB Neuroscience Institute, Université Libre de Bruxelles, Faculty of Medicine 808, route de Lennik, 1070 Brussels, Belgium
| | - Jean-Pierre Brion
- 2 Laboratory of Histology, Neuroanatomy and Neuropathology (CP 620), ULB Neuroscience Institute, Université Libre de Bruxelles, Faculty of Medicine 808, route de Lennik, 1070 Brussels, Belgium
| | - Wendy Noble
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Diane P Hanger
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
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Finding a new therapeutic approach for no-option Parkinsonisms: mesenchymal stromal cells for progressive supranuclear palsy. J Transl Med 2016; 14:127. [PMID: 27160012 PMCID: PMC4862050 DOI: 10.1186/s12967-016-0880-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/27/2016] [Indexed: 12/30/2022] Open
Abstract
Background The trophic, anti-apoptotic and regenerative effects of bone marrow mesenchymal stromal cells (MSC) may reduce neuronal cell loss in neurodegenerative disorders. Methods We used MSC as a novel candidate therapeutic tool in a pilot phase-I study for patients affected by progressive supranuclear palsy (PSP), a rare, severe and no-option form of Parkinsonism. Five patients received the cells by infusion into the cerebral arteries. Effects were assessed using the best available motor function rating scales (UPDRS, Hoehn and Yahr, PSP rating scale), as well as neuropsychological assessments, gait analysis and brain imaging before and after cell administration. Results One year after cell infusion, all treated patients were alive, except one, who died 9 months after the infusion for reasons not related to cell administration or to disease progression (accidental fall). In all treated patients motor function rating scales remained stable for at least six-months during the one-year follow-up. Conclusions We have demonstrated for the first time that MSC administration is feasible in subjects with PSP. In these patients, in whom deterioration of motor function is invariably rapid, we recorded clinical stabilization for at least 6 months. These encouraging results pave the way to the next randomized, placebo-controlled phase-II study that will definitively provide information on the efficacy of this innovative approach. Trial registration ClinicalTrials.gov NCT01824121
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Coyle-Gilchrist ITS, Dick KM, Patterson K, Vázquez Rodríquez P, Wehmann E, Wilcox A, Lansdall CJ, Dawson KE, Wiggins J, Mead S, Brayne C, Rowe JB. Prevalence, characteristics, and survival of frontotemporal lobar degeneration syndromes. Neurology 2016; 86:1736-43. [PMID: 27037234 PMCID: PMC4854589 DOI: 10.1212/wnl.0000000000002638] [Citation(s) in RCA: 317] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/21/2016] [Indexed: 12/13/2022] Open
Abstract
Objectives: To estimate the lifetime risk, prevalence, incidence, and mortality of the principal clinical syndromes associated with frontotemporal lobar degeneration (FTLD) using revised diagnostic criteria and including intermediate clinical phenotypes. Methods: Multisource referral over 2 years to identify all diagnosed or suspected cases of frontotemporal dementia (FTD), progressive supranuclear palsy (PSP), or corticobasal syndrome (CBS) in 2 UK counties (population 1.69 million). Diagnostic confirmation used current consensus diagnostic criteria after interview and reexamination. Results were adjusted to the 2013 European standard population. Results: The prevalence of FTD, PSP, and CBS was 10.8/100,000. The incidence and mortality were very similar, at 1.61/100,000 and 1.56/100,000 person-years, respectively. The estimated lifetime risk is 1 in 742. Survival following diagnosis varied widely: from PSP 2.9 years to semantic variant FTD 9.1 years. Age-adjusted prevalence peaked between 65 and 69 years at 42.6/100,000: the age-adjusted prevalence for persons older than 65 years is double the prevalence for those between 40 and 64 years. Fifteen percent of those screened had a relevant genetic mutation. Conclusions: Key features of this study include the revised diagnostic criteria with improved specificity and sensitivity, an unrestricted age range, and simultaneous assessment of multiple FTLD syndromes. The prevalence of FTD, PSP, and CBS increases beyond 65 years, with frequent genetic causes. The time from onset to diagnosis and from diagnosis to death varies widely among syndromes, emphasizing the challenge and importance of accurate and timely diagnosis. A high index of suspicion for FTLD syndromes is required by clinicians, even for older patients.
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Affiliation(s)
- Ian T S Coyle-Gilchrist
- From the Department of Clinical Neurosciences (I.T.S.C.-G., K.P., P.V.R., A.W., C.J.L., K.E.D., J.W., J.B.R.) and Cambridge Institute of Public Health (C.B.), University of Cambridge; Dementia Research Centre (K.M.D.) and MRC Prion Unit and Department of Neurodegenerative Disease (S.M.), University College London, UK; and University Medical Center Eppendorf (E.W.), University Hamburg, Germany.
| | - Katrina M Dick
- From the Department of Clinical Neurosciences (I.T.S.C.-G., K.P., P.V.R., A.W., C.J.L., K.E.D., J.W., J.B.R.) and Cambridge Institute of Public Health (C.B.), University of Cambridge; Dementia Research Centre (K.M.D.) and MRC Prion Unit and Department of Neurodegenerative Disease (S.M.), University College London, UK; and University Medical Center Eppendorf (E.W.), University Hamburg, Germany
| | - Karalyn Patterson
- From the Department of Clinical Neurosciences (I.T.S.C.-G., K.P., P.V.R., A.W., C.J.L., K.E.D., J.W., J.B.R.) and Cambridge Institute of Public Health (C.B.), University of Cambridge; Dementia Research Centre (K.M.D.) and MRC Prion Unit and Department of Neurodegenerative Disease (S.M.), University College London, UK; and University Medical Center Eppendorf (E.W.), University Hamburg, Germany
| | - Patricia Vázquez Rodríquez
- From the Department of Clinical Neurosciences (I.T.S.C.-G., K.P., P.V.R., A.W., C.J.L., K.E.D., J.W., J.B.R.) and Cambridge Institute of Public Health (C.B.), University of Cambridge; Dementia Research Centre (K.M.D.) and MRC Prion Unit and Department of Neurodegenerative Disease (S.M.), University College London, UK; and University Medical Center Eppendorf (E.W.), University Hamburg, Germany
| | - Eileen Wehmann
- From the Department of Clinical Neurosciences (I.T.S.C.-G., K.P., P.V.R., A.W., C.J.L., K.E.D., J.W., J.B.R.) and Cambridge Institute of Public Health (C.B.), University of Cambridge; Dementia Research Centre (K.M.D.) and MRC Prion Unit and Department of Neurodegenerative Disease (S.M.), University College London, UK; and University Medical Center Eppendorf (E.W.), University Hamburg, Germany
| | - Alicia Wilcox
- From the Department of Clinical Neurosciences (I.T.S.C.-G., K.P., P.V.R., A.W., C.J.L., K.E.D., J.W., J.B.R.) and Cambridge Institute of Public Health (C.B.), University of Cambridge; Dementia Research Centre (K.M.D.) and MRC Prion Unit and Department of Neurodegenerative Disease (S.M.), University College London, UK; and University Medical Center Eppendorf (E.W.), University Hamburg, Germany
| | - Claire J Lansdall
- From the Department of Clinical Neurosciences (I.T.S.C.-G., K.P., P.V.R., A.W., C.J.L., K.E.D., J.W., J.B.R.) and Cambridge Institute of Public Health (C.B.), University of Cambridge; Dementia Research Centre (K.M.D.) and MRC Prion Unit and Department of Neurodegenerative Disease (S.M.), University College London, UK; and University Medical Center Eppendorf (E.W.), University Hamburg, Germany
| | - Kate E Dawson
- From the Department of Clinical Neurosciences (I.T.S.C.-G., K.P., P.V.R., A.W., C.J.L., K.E.D., J.W., J.B.R.) and Cambridge Institute of Public Health (C.B.), University of Cambridge; Dementia Research Centre (K.M.D.) and MRC Prion Unit and Department of Neurodegenerative Disease (S.M.), University College London, UK; and University Medical Center Eppendorf (E.W.), University Hamburg, Germany
| | - Julie Wiggins
- From the Department of Clinical Neurosciences (I.T.S.C.-G., K.P., P.V.R., A.W., C.J.L., K.E.D., J.W., J.B.R.) and Cambridge Institute of Public Health (C.B.), University of Cambridge; Dementia Research Centre (K.M.D.) and MRC Prion Unit and Department of Neurodegenerative Disease (S.M.), University College London, UK; and University Medical Center Eppendorf (E.W.), University Hamburg, Germany
| | - Simon Mead
- From the Department of Clinical Neurosciences (I.T.S.C.-G., K.P., P.V.R., A.W., C.J.L., K.E.D., J.W., J.B.R.) and Cambridge Institute of Public Health (C.B.), University of Cambridge; Dementia Research Centre (K.M.D.) and MRC Prion Unit and Department of Neurodegenerative Disease (S.M.), University College London, UK; and University Medical Center Eppendorf (E.W.), University Hamburg, Germany
| | - Carol Brayne
- From the Department of Clinical Neurosciences (I.T.S.C.-G., K.P., P.V.R., A.W., C.J.L., K.E.D., J.W., J.B.R.) and Cambridge Institute of Public Health (C.B.), University of Cambridge; Dementia Research Centre (K.M.D.) and MRC Prion Unit and Department of Neurodegenerative Disease (S.M.), University College London, UK; and University Medical Center Eppendorf (E.W.), University Hamburg, Germany
| | - James B Rowe
- From the Department of Clinical Neurosciences (I.T.S.C.-G., K.P., P.V.R., A.W., C.J.L., K.E.D., J.W., J.B.R.) and Cambridge Institute of Public Health (C.B.), University of Cambridge; Dementia Research Centre (K.M.D.) and MRC Prion Unit and Department of Neurodegenerative Disease (S.M.), University College London, UK; and University Medical Center Eppendorf (E.W.), University Hamburg, Germany
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Zweig RM, Disbrow EA, Javalkar V. Cognitive and Psychiatric Disturbances in Parkinsonian Syndromes. Neurol Clin 2016; 34:235-46. [DOI: 10.1016/j.ncl.2015.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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